International Journal of Transgender Health最新文献

Background: Research exploring the lived experiences of gender diverse children and youth with disabilities is still in its infancy. Previous research has either focused on adults or has lumped the experiences of trans and nonbinary children and youth with disabilities in with broader findings of 2SLGBTQI + youth with disabilities. This is problematic given that experiences of sexual diversity are different than experiences of gender diversity and the experiences of children and youth are not identical to adults.

Aims: We conducted a scoping review to map and synthesize research that explores the lived experiences of young people with disabilities who also identify as trans, nonbinary, or gender diverse. The question guiding the review was: what are the lived experiences of gender diverse children and youth with disabilities?

Methods: We followed Joanna Briggs Institute (JBI) best practices in scoping review methodology in addition to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, extension for scoping reviews (PRISMA-ScR) checklist. We searched seven databases: Ovid Medline, Healthstar, Embase, PsycINFO, Scopus, Sociological Abstracts, and Web of Science for empirical peer-reviewed research.

Results: We identified 21 articles that met our inclusion criteria, with an additional 2 articles found from other sources, resulting in 23 included articles. We organized the data in the available research into the following three overarching categories: (1) Experiences of discrimination and abuse; (2) Impact of minoritized identities on health; and (3) Coping strategies of, and interventions to support, gender minoritized youth with disabilities.

Conclusions: Our review shows that gender diverse children and youth with disabilities are at increased risk of experiencing discrimination and abuse, which impacts their psychological well-being and quality of life. We conclude that this population requires increased opportunities to socialize in affirming and inclusive environments and greater supports for accessing social and medical transition.

[This corrects the article DOI: 10.1080/26895269.2023.2278064.].

Background: Gender assessments are often required to access gender-affirming medical interventions. These assessments are typically defended as a way of preventing regret, offering a compromise between the interests of trans and detrans people. Whether they do is integral to ongoing debates about models of care in transgender health.

Methods: Building on previous work demonstrating the inefficacy of gender assessments, this article explores the impact of gender assessments and argues that they are detrimental to detrans people.

Results: Assessments appear to be detrimental to detrans people because they disincentivize honesty and authenticity, inhibit gender exploration, increase shame and anger associated with detransition, foster transnormativity, hinder the development of a strong therapeutic alliance, and diminish the quality of informational disclosure.

Conclusion: Given the detrimental consequences of gender assessments, clinicians should reconsider gatekeeping practices in favor of supporting patient decision-making and offering better care to people who detransition.

Background: It is frequently reported that access to gender affirming medical care (GAMC) is burdened with many barriers, such as lack of parental support, geographic distance, absence of social support, and medical professionals' lack of knowledge. While the current knowledge shows that trans and nonbinary youth (TNBY) experience many challenges when accessing GAMC, there is still limited information available regarding how they navigate GAMC decisions as youth approach puberty.

Methods: To fulfill that gap, a team of researchers conducted semi-structured interviews in six countries (Australia, Canada, India, Switzerland, the UK, and the US) with TNBY ages 8-14 years and their families.

Results: Thematic analysis was conducted on baseline interview data from an international longitudinal study, yielding three themes, and subthemes, relevant to making GAMC decisions: (1) Participants' decisions guided by expectations, (2) conditions for reaching an informed decision, and (3) the role of time in GAMC decision-making. Of these themes, several subthemes allowed researchers to understand how families navigate whether to seek GAMC, and if so, deciding on specific care trajectories.

Conclusion: Results indicated that making decisions regarding GAMC is a process that moves beyond medical impacts and side-effects, as many family dynamics, access to information and time also played into TNBY's decisions to seek GAMC.

Background: Many people who have experienced gender incongruence decide to go through the process of transitioning. A small number of people who transition will decide to stop or reverse some or all aspects of their transition process and detransition.

Aims: To bridge the gap in the psychology literature and the emerging yet poorly understood phenomenon of gender detransition, the aim of the current study was to explore the lived experiences of this unique population.

Method: Thirteen adults who detransitioned participated in semi-structured interviews regarding the external and internal stressors that contributed to their decision to detransition. The authors used Meyer's minority stress model as a theoretical framework and consensual qualitative research methods to conceptualize and analyze the data.

Results: Results of the interview data highlighted that the factors contributing to a person's decision to transition and detransition are multifaceted and unique. Participants' decision to transition were influenced by others who suggested or encouraged them to transition, gender dysphoria, body image concerns, and poor mental health. Participants reported several external (e.g. negative experiences with health service providers) and internal (e.g. regret regarding insufficient exploration) stressors with being transgender. Outcomes of detransitioning were explored and included relational change, increased self-acceptance, improved well-being, and loss of trans community.

Conclusions: Study limitations, implications for counseling, and future research are discussed.

Background: Presurgical psychological assessments (PPA) can be helpful in assessing for psychological risk factors and identifying medical risk factors that may impede recovery from surgery. Transgender and gender diverse (TGD) individuals seeking medically-necessary, gender-affirming hysterectomy and orchiectomy are recommended to undergo a PPA, yet individuals undergoing this surgery for other medical reasons are not. The present study sought to investigate comparative risk profiles among TGD individuals who underwent a PPA prior to hysterectomy or orchiectomy for gender affirmation compared to cisgender and TGD individuals who underwent hysterectomy or orchiectomy for other medical reasons without a formal assessment. Methods: Retrospective chart review was conducted on 195 patients at an integrated health care system. Medical, psychological, and overall risk scores were tabulated and mean ranks were compared among TGD patients with PPA (n = 43), TGD patients without PPA (n = 27), and cisgender patients (n = 125), none of whom underwent PPA. Results: Significant mean rank differences were found for overall and psychological risk, yet the mean rank scores for TGD patients with PPA group did not differ significantly from the cisgender group. No differences in medical risk scores among the groups were found. Eighty-six percent of TGD individuals with PPA were classified as having good prognosis for surgery. Conclusions: TGD patients who underwent a PPA tended to have low overall risk for surgical outcome, indicating that PPA may not have been necessary for these patients and instead served as an unwarranted barrier to medically-necessary care. It is recommended that health care systems, providers, and third-party payors align requirements for PPA for gonadectomy with the recommendations of the World Professional Association of Transgender Health Standards of Care 8 to remove barriers to medically-necessary care, particularly for surgeries with low complication rates, like hysterectomy and orchiectomy.

Background and objectives: Although older trans women sex workers have been denied access to the support structures available in the community and although their vulnerability is known to increase as they age, little research has been conducted on this subject. This scoping review aimed to address gaps in the literature by collecting data from the peer-reviewed and grey literature that deal with the experiences and characteristics of older trans women sex workers.

Methods: A scoping review was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR). A search was carried out using EBSCO, PubMed, SciELO, Scopus and Web of Science, as well as sources of unpublished studies and the grey literature. Of the 963 documents initially identified, 26 met the inclusion criteria and were analyzed using a reflexive thematic analysis method (Braun & Clarke).

Findings: Trans women sex workers are considered old prematurely, which contributes to less attractiveness and value in the sex market. This, combined with the challenges of trans aging per se, can increase their vulnerability. According to the data, trans women sex workers may face more risks as they get older because they lose value in the sex market, often their only source of income. In contrast, younger trans women see them as being more experienced, as having witnessed and survived violence, and sometimes as maternal figures ("Trans Mothers"). Some strategies for dealing with aging were identified, such as trying to appear as young as possible and, when this is no longer feasible, resorting to dangerous and painful strategies such as 'passing as' (being mistaken for cisgender women) or "de-transformation" (returning to an identity that is socially consistent with the sex assigned at birth). Finally, these results showed the need for and the importance of implementing protective policies for this population.

Conclusion: Older trans women sex workers face major access barriers to fundamental social rights, which, combined with the challenges of growing older, have disallowed them from surviving aging. Some practical implications and suggestions for future research are provided. This scoping review protocol is registered with the Open Science Framework (OSF).

[This corrects the article DOI: 10.1080/26895269.2024.2445094.].

Purpose: The expanding number of minors questioning their gender identity and seeking care has led to the constitution of pediatric gender clinics in several countries. The activity of the multidisciplinary Pediatric Gender Team at Ghent University Hospital, Belgium started in 2007. We report on the evolution of referrals, psychological intakes, and trends in the start of gender-affirming medical and surgical interventions from 2007 to 2023.

Methods: The whole cohort of minors (age <17 years) having a psychological intake between 2007 and 2023 was included. Subgroups were analyzed based on sex registered at birth (female or male, RFAB and RMAB respectively), year and age at the psychological intake (below or above 10 years).

Results: Referrals have increased in recent years. Between 2007 and 2023, 890 minors (65.5% RFAB) accessed our service. The ratio RFAB/RMAB has progressively increased, and RFAB with age at first intake >10 represented the greatest proportion. After 12 months, 19.5% were no longer in follow-up at our center; 28.1% of RFAB and 47.2% of RMAB did not start any medical treatment; 66.9% of RFAB and 52.8% of RMAB started gonadal hormone suppression (GHS), achieved with gonadotropin-releasing hormone analogues in 17.7% of RFAB and 34.6% of RMAB, with pro-androgenic progestins in 82.3% of RFAB and with anti-androgens in 65.4% of RMAB. 74.6% of RFAB and 86.4% of RMAB on GHS and older than 16 started gender-affirming hormones. Mastectomy was the most common gender-affirming surgery in RFAB, followed by hystero-gonadectomy. Gender-affirming surgery in RMAB was less frequent; vaginoplasty was the most frequent procedure.

Conclusions: The care of minors with gender incongruence requires a multidisciplinary approach due to the complex psychological, social, and physical needs of this group. The timing and therapeutical options must be tailored to each adolescent.

Background: Menopause is socially coded as an experience of hormonal change which threatens the vitality and identity of (cisgender) women in midlife; yet this framing overlooks the diversity in menopause experiences across age, gender and sexuality. The significance of these less visible experiences has led to calls to broaden the scope of menopause narratives and representations across research, policy, and practice. Methods : Using an established scoping review methodology, we identified eleven articles that reported empirical research from the perspectives and/or experiences of menopause among gender diverse people (which we widened to include sexuality diverse people where some analyses were equally relevant for gender diverse people). Results : Three thematic categories were produced through our analysis, each implying a provocative expansion of assumptions about specific elements of the menopause experience, namely: timing of symptomology, gender and hormones, and sexuality and reproduction. Underpinning these findings is a pressing need for an alternative way of approaching menopause beyond its clinical characteristics, which, in turn, is carried over to the research that evidences these characteristics. Conclusions : The centering of accounts of menopause that assume cisgender and heterosexual women's experiences to be both normative and normal constrain other social (re)imaginings. We argue for more expansive understandings of menopause beyond this normative and clinical framing to consider the more fulsome breadth of socially situated experiences and perspectives that better serves the needs of gender diverse people.