LGBT health最新文献

Purpose: This cross-sectional study investigated self-reassurance as a protective factor in mitigating depression related to internalized gender stigma and enhancing overall well-being among transgender and nonbinary (TNB) individuals during the first step of the gender-affirmation process. Methods: The study included 101 TNB individuals (mean age = 26.42, standard deviation = 8.83) accessing the "Be as You Are" Clinical and Research Center at Sapienza University of Rome, Italy, which offers psychological support for individuals undergoing gender-affirmation processes, from 2021 to 2024. Participants completed the Gender Minority Stress and Resilience Scale to assess internalized gender stigma; the Self-Criticizing/Attacking and Self-Reassuring Scale to evaluate self-criticism (i.e., hated-self and inadequate-self), and self-reassurance; and the Symptom Checklist-90 to measure depressive symptoms. Mediation and moderated mediation models were tested. Results: Mediation models indicated that inadequate-self significantly mediated the relationship between internalized gender stigma and depressive symptoms. The moderated mediation analysis revealed a complex pattern: higher levels of self-reassurance were associated with a more pronounced mediating effect of inadequate-self, suggesting that self-reassurance may facilitate awareness and processing of self-critical thoughts rather than simply buffer their impact. These findings suggest that self-reassurance is a complex psychological resource that may facilitate recognizing self-critical processes and contribute to emotional regulation during the gender-affirming process. Conclusion: These results underscore the dynamic role of self-reassurance in the initial stages of the gender-affirming process. Clinical approaches such as compassion-focused therapy may help foster self-reassurance and alleviate the psychological burden of minority stress, particularly during the vulnerable period of accessing gender-affirming care.

Purpose: This study examined the association between sexual orientation and the impact, diagnosis, and treatment of endometriosis. Methods: An online survey was conducted in 2023 with 150 adults in the United States diagnosed with endometriosis, 119 of whom identified as heterosexual and 31 with a minority sexual orientation. The impact of endometriosis was measured using the Endometriosis Impact Questionnaire (EIQ), consisting of eight subscales. We also assessed factors related to diagnosis and treatment satisfaction. Data were analyzed using independent samples t-tests and multiple linear regression. Results: Participants with a minority sexual orientation had a higher average impact of endometriosis on the EIQ physical, psychological, and social subscales than heterosexual participants but a lower impact on the fertility subscale, all with medium effect sizes. They took an average of 5 years longer to be diagnosed, with 83.9% of sexual minority versus 45.4% of heterosexual participants receiving at least one misdiagnosis. More sexual minority versus heterosexual participants also reported feeling dismissed or disbelieved (96.8% vs. 64.4%), not feeling listened to by providers (96.8% vs. 62.2%), and having difficulty communicating with providers (90.3% vs. 55.5%). The association between sexual orientation and the EIQ physical, psychological, and social subscales could be explained, in particular, by having been misdiagnosed. Conclusions: These results highlight the need for better medical education and inclusive gynecological care to promote timely diagnosis and treatment of endometriosis. They also suggest that provider biases and discrimination may contribute to a greater impact of endometriosis on sexual minority patients.

Purpose: This study assessed and compared the number and types of challenges and expense delays experienced by sexual minority and heterosexual individuals seeking abortion care. Methods: We analyzed cross-sectional survey data from 1953 individuals who sought an abortion at 25 clinics in five US states from April 2020 to February 2023. The survey asked about 12 challenges (e.g., transportation, emotional burden, cost) and 4 expense delays (e.g., rent, food) associated with obtaining an abortion. We examined types and number of challenges and expense delays by sexual identity. We conducted negative binomial regression (number of challenges) and logistic regression (any expense delay) to quantify differences. Results: Most participants in the analytic sample (N = 1833) experienced at least one challenge to obtaining an abortion (90%), with sexual minority participants (n = 349) experiencing a greater median number of challenges than heterosexual participants (n = 1484) (4 [interquartile range = 2-6] vs. 3 [1-4]; p < 0.001). Sexual minority participants were also more likely to delay an expense (40% vs. 28%; p < 0.001). Adjusting for other factors, sexual minority participants experienced significantly increased challenges (adjusted incident risk ratio = 1.2; 95% confidence interval [CI] = 1.1-1.3) and had greater odds of delaying an expense (adjusted odds ratio = 1.6; 95% CI = 1.2-2.1). Conclusions: Sexual minority individuals face more challenges and are more likely to delay expenses to obtain an abortion. Thus, sexual minority individuals may need additional support specific to the challenges they face, including financial assistance, transportation, and psychosocial support. Addressing inequalities that disproportionately impact sexual minority individuals within society and reproductive health care will help ensure that abortion is more accessible.

Purpose: Recent research suggests that the benefits of minimized structural stigma experienced by gay men are not matched in bisexual men. The purpose of this study was to explore how bisexual men perceive structural stigma compared with gay men in hopes of understanding why improvements in structural stigma among sexual minority individuals may not equally benefit bisexual people. Methods: In 2020-2021, we conducted in-depth interviews with 19 bisexual men and 40 gay men recruited from a larger longitudinal cohort study of 502 men. Interviews were conducted by phone or Zoom (camera off). The interview guides for gay and bisexual men were nearly identical, except that bisexual men were asked specifically about structural stigma related to bisexuality. All interviews were recorded digitally, transcribed verbatim, and analyzed using grounded theory as an analytic strategy. Results: Emergent findings show that three interrelated forces complicate the relationship between structural stigma and outcomes for bisexual men: assumed heterosexuality, invisibility and erasure of bisexuality, and the blurring of interpersonal and structural stigma. In particular, bisexual men had trouble identifying structural stigma, reflecting the difficulty of fully pinning down this type of stigma. Conclusion: To understand the disparate effects of structural stigma for bisexual and gay men, we encourage scholars to take these dynamics into account. We suggest new concrete ways to measure structural stigma against bisexual people and better incorporate perspectives from bisexual men into future structural stigma research and interventions.

Purpose: Health disparities by sexual orientation fluidity are relatively unexplored in middle or late adulthood. We assessed differences in self-reported health and health behaviors according to fluidity status. Methods: We analyzed baseline (2002-2010) and follow-up (2015-2023) survey data of Research Program on Genes, Environment, and Health participants. We classified people based on responses to sexual orientation questions: consistently heterosexual, consistently sexual minority, and fluid (changed reported orientation). We then compared health behavior (smoking, binge drinking, and physical activity) and self-rated health (Patient-Reported Outcomes Measurement Information System and EuroQol EQ-5D-3L) across groups using linear or logistic regression with or without weights for attrition using complete case data and after multiple imputation. Results: Of the 32,058 adults (mean age: 56 years, male: 39.6%), 378 (1.2%) were fluid. Compared with consistently heterosexual adults, fluid individuals had significantly worse self-rated health scores after adjustment for demographics and attrition, although most differences were not clinically meaningful. No differences in health behavior were noted in adjusted analyses. Conclusion: Sexual orientation fluidity occurs in older adults, and this group may have worse health than their heterosexual counterparts.

Purpose: Recognizing the necessity of supportive health care systems, we used strengths-based approaches to explore the potential protective nature of social support against health care barriers among sexually and gender diverse (SGD) young adults. Methods: Using data spanning May 2018 to July 2022 from the National Institutes of Health's All of Us Research Program, we created a sample of and produced descriptive estimates for 2417 SGD young adults between 20 and 35 years of age. Using logistic regressions, we calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to measure the association between two outcomes-delaying health care and reported discrimination in medical settings-and instrumental/emotional social support. We adjusted for age, gender identity, race and ethnicity, housing stability, and income. Results: Of our sample, 70.8% endorsed at least one reason for delaying care, and 45.0% reported discrimination in medical settings "rarely" or more frequently, with significant differences by gender identity, sexual orientation, race and ethnicity, housing stability, income, and education for both outcomes. More social support was associated with fewer reasons for delaying health care (instrumental: aOR = 0.78, 95% CI 0.71-0.86; emotional: aOR = 0.71, 95% CI 0.63-0.79) and fewer reports of discrimination in medical settings (instrumental: aOR = 0.72, 95% CI 0.66-0.78; emotional: aOR = 0.64, 95% CI 0.58-0.70). Conclusion: Our results suggest that social support might serve as a protective factor against health care barriers for SGD young adults. More strengths-based research is needed to understand intersectionality in SGD health care.

Purpose: To improve upon measures of sexual orientation and gender identity (SOGI) used in previous studies, we created and tested seven measures for inclusion in cancer research and refined them based on input from study participants. Methods: Between February and March 2024, cognitive interviews were conducted virtually with a purposive sample of 18 adults ≥50 years old. Equal numbers of participants identified as LGBTQ+ (n = 9) and cisgender heterosexual (n = 9). We chose older adults because-for the most part-participants in past studies on SOGI data acceptability have been younger than those typically recruited in cancer-related studies. Participants were selected for maximum diversity in age, race/ethnicity, U.S. geographic region, and political ideology. Descriptive themes and patterns for each measure were organized, evaluated, synthesized, and summarized. Results: Most participants found six of seven tested measures easy to answer. Respondents were satisfied with being able to choose more than one response option for each item. Some terms, (e.g., response options "cisgender" and "non-binary" for gender identity measure) were new to some respondents. Revisions to measures were made based on respondent feedback. The breast/chest tissue item confused most respondents, so it was withdrawn. Conclusions: This study found that most tested SOGI measures were easy to understand, and the response options were appropriate. Refined measures can serve as a resource for investigators and clinicians to employ who wish to improve SOGI data collection.

Purpose: Guidelines recommend serum estradiol concentrations of 100-200 pg/mL for transgender women prescribed oral, subcutaneous, or transdermal estradiol with or without adjunct antiandrogen as gender-affirming feminizing hormone therapy (HT). The purpose of this systematic review was to evaluate if the guideline range of 100-200 pg/mL for estradiol concentration is associated with indicators of adequate gender-affirming feminizing HT, specifically feminizing sufficiency, insufficiency, testosterone suppression, or toxicity in transgender women. Methods: The Populations/Intervention/Comparator/Outcome model was applied to the study question, whereby the target population included transgender, gender-diverse, and nonbinary adults using gender-affirming feminizing HT by any route of administration, with or without adjunct antiandrogen use. The comparator was defined as estradiol concentrations within (100-200 pg/mL or 367-734 pM) versus outside (100-200 pg/mL) the guideline range; evaluated outcomes were listed by the same clinical guidelines that recommend using the 100-200 pg/mL range. Embase, MEDLINE, and Web of Science were queried over a 24-year time frame (January 1, 1999-April 20, 2023); the search was restricted to English. The extracted outcomes were categorized as indicators of therapeutic insufficiency, sufficiency, toxicity, or hormone concentration. Results: There were 49 studies that met the inclusion criteria, of which 9, 42, 25, and 5 studies included indicators of therapeutic insufficiency, sufficiency, toxicity, or hormone concentration, respectively. The search did not identify articles demonstrating that the 100-200 pg/mL guideline range provides optimal feminizing outcomes or reduces adverse events. Conclusions: Evidence does not support using the guideline range of 100-200 pg/mL to indicate sufficient feminization in transgender women using gender-affirming feminizing HT.