International Journal of Transgender Health最新文献

Background: Gender euphoria is a concept that arose from within the trans and gender diverse (hereafter trans) community to describe positive feelings associated with gender identity, expression, and affirmation. Despite its importance within the trans population, there is currently no consistent, valid or reliable way of measuring gender euphoria. Accordingly, this article describes the development and validation of a tool to measure gender euphoria in trans individuals.

Method: An initial 121-item pool for the scale was developed based on qualitative research and a review of existing tools measuring related psychological constructs in trans adults. Trans researchers and experts in trans health reviewed and revised the items, enabling development of a preliminary scale which was pilot tested with a trans community advisory group before being further refined and administered to a larger cohort of trans individuals. A subgroup of individuals within the cohort repeated the scale two weeks following the initial completion to assess for test-retest reliability.

Results: The preliminary scale was undertaken by 664 trans participants aged 16-79 years (median = 32 years, IQR = 25, 43). Exploratory factor analysis produced a final 26-item Gender Euphoria Scale (GES) comprising three subscales: social affirmation, self-affirmation, and community connection. The GES was found to have excellent internal consistency (α = .97), strong test-retest reliability (r = .88), and some evidence of discriminant and convergent validity.

Conclusion: The GES is a reliable and consistent tool to measure gender euphoria in trans individuals and is likely to be of value in both research and clinical settings.

Background: Bicalutamide is a potential anti-androgen for transgender individuals with feminizing embodiment goals, but use is limited because of hepatotoxicity in cisgender men with prostate cancer. This study compared transaminase changes in transfeminine adolescents and young adults (AYA) using low dose bicalutamide with individuals using another androgen blockade.

Methods: A retrospective analysis was conducted using electronic health record data for patients starting gender affirming hormone therapy with at least 10 months of follow-up between 2015 and 2023. The primary outcome was change in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) from baseline. Linear mixed models compared change in ALT and AST from baseline and maximum ALT and AST values in bicalutamide and comparison groups. Secondary outcomes included % individuals with ALT and AST elevation more than 1, 2, or 3 times the upper limit of normal (ULN) (Fisher's exact test), standardized mean estradiol dose by group (t test), and Tanner staging of breast tissue by group (Fisher's exact test).

Results: Eighty-four transfeminine AYA (median age 18) taking bicalutamide were compared to 69 transfeminine AYA (median age 19) taking GnRH agonists, spironolactone or no agent in addition to estradiol. In linear mixed models adjusted for baseline age, race, BMI, baseline ALT or AST, and alcohol use, there were no clinically significant differences in delta or maximum ALT or AST in bicalutamide and comparison groups. No individuals had AST or ALT levels > 3x ULN though % with AST > ULN was higher for bicalutamide (10.7 v 1.5%, p = 0.02). Estradiol doses and Tanner stages were similar between groups among individuals receiving pediatric care.

Conclusion: Bicalutamide was not associated with a clinically significant change in transaminases as compared with other anti-androgen regimens over one year. Bicalutamide appears to be a safe anti-androgen for transfeminine individuals at low dose with close monitoring and deserves further study.

Background: Gender diverse (GD) youth face unique stressors that result in disproportionate mental health challenges compared to their peers. Although mental healthcare is a crucial resource for addressing these challenges, GD youth often report negative experiences, leading to avoidance of services and worsening distress. Understanding mental health practitioners (MHPs) perspectives of supporting GD youth is important for improving their capacity to deliver appropriate, supportive care.

Aim: The aim of this review is to scope and consolidate evidence on the perspectives of MHPs in their work with GD youth.

Methods: PsycINFO, Scopus, PubMed, Proquest dissertations and theses, and Google Scholar were searched between March-April 2024 for English language primary research of any study design, including peer-reviewed articles and theses/dissertations. Thematic synthesis was used to consolidate the findings of 23 included studies.

Results: Six interrelated themes were constructed: (i) perceived lack of availability and utility of GD education and training; (ii) limited knowledge and preparedness for practice; (iii) navigating uncertainty and adapting therapeutic approaches; (iv) the need for multilevel care addressing individual, relational, and systemic needs; (v) providing safety and affirmation, and challenging deficit narratives; and (vi) emotional, ethical, and value-based challenges in supporting GD youth.

Conclusions: There is a need for GD training and evidence-based guidelines for MHPs for working with GD youth and their families. Some MHPs provided safety and acceptance to GD youth, while others experienced conflicted personal and professional values. MHPs may benefit from critical reflection and clinical supervision to navigate challenges associated with their role supporting GD youth.

Background: Transgender women commonly experience poor health outcomes. However, little is known about older transgender women's experiences of government healthcare and social welfare programs in low and middle-income countries, in the context of discrimination and neglect.

Aims: This article discusses older transgender women's barriers to accessing government health and social welfare programs in Indonesia, and how intersecting factors like gender, age, and poverty contribute to poor health outcomes.

Method: A transgender community-led participatory study utilized rapid ethnographic assessment (REA), comprising surveys with 48 older transgender women, interviews with a subset of 15 transgender women, and interviews with five government officials.

Results: Applying an intersectional lens, the following themes were identified from the data: 1) document ownership and program enrollment; 2) healthcare needs and challenges; 3) employment and poverty; 4) housing, family, and social network; 5) barriers to accessing government health and social security programs; 6) consequences of exclusion from programs; and 7) enablers of accessing government health and social security programs. Across these themes, cisgender norms embedded in Indonesia's bureaucratic practices exacerbated participants' vulnerability to poor health.

Discussion: A transgender-led research project helped to identify barriers and advocate for the government to adopt a transgender health equity lens. Exclusion from government health and social welfare programs was due to both gender expression and criteria centered on nuclear family structures, which were misaligned with all participants, who were unmarried. These cisgender norms are a form of structural violence that results in poor health, exacerbated by poverty, old age, and housing insecurity.

[This corrects the article DOI: 10.1080/26895269.2024.2324100.].

Introduction: Transgender individuals considering feminizing genital gender-affirming surgery (gGAS) face multiple options and potential decisional conflict (DC). Shared decision-making (SDM) between patients and healthcare professionals (HCPs) can support personalized care and improve outcomes. To aid trans women during the decision-making process for gGAS, a decision aid, the GenderAid (GA), was developed.

Methods: This study aimed to investigate the effect of the GA on SDM and DC levels during the decision-making process for feminizing gGAS. An observational cross-sectional mixed methods study was conducted at the departments of Psychology and Plastic Surgery at the Center of Expertise on Gender Dysphoria of the Amsterdam UMC between 2020 and 2023. Questionnaires administered before and after implementing the GA included the validated translations of the SDM-Q-doc and SDM-Q-9 and the Decisional Conflict Scale. Qualitative data from interviews explored trans women's perceptions of the concepts of SDM and DC when deciding on feminizing gGAS.

Results: Significantly higher levels of SDM experienced by trans women were observed after the introduction of the GA, while no such difference was observed for HCPs. The GA facilitated more thorough discussions with HCPs, and trans women felt well prepared for consultations by the decision-aid. DC was low before and after introduction of the GA; however, both quantitative as qualitative data revealed trans women experienced uncertainties during the process, due to new information on (non-)surgical options for gGAS.

Discussion: This study suggests that the GA enhanced SDM in individuals seeking feminizing gGAS and had limited impact on DC by offering extensive information on all (non-)surgical options. However, the improved information overview regarding surgical options also resulted in increased decision uncertainty among trans women. Future controlled research should further explore optimizing information provision throughout the care process, managing uncertainties, and implementing the use of decision-aids by HCPs.

Background: Phalloplasty is the surgical (re)construction of a phallus using pedicled and/or free tissue flaps. The pedicled superficial circumflex iliac artery (SCIA) perforator flap is a novel, up-and-coming technique for phalloplasty. Here, we present our surgical technique and surgical outcomes for pedicled SCIA-based phalloplasty without urethral lengthening (i.e. shaft-only) in transgender men.

Methods: All transgender men who underwent shaft-only phalloplasty using SCIA-based perforator flaps between January 2017 and December 2023 were included in the analysis. Participant demographics, surgical characteristics, and postoperative outcomes were assessed, including (partial) flap failure and postoperative complications.

Results: Forty-seven transgender men were included. Median age at surgery was 30 years (range 19-61 years), and mean BMI 23 ± 2kg/m². Average flap dimensions were 13 cm in length (range 12-15cm) and 11 cm in width (range 9-13cm). Successful penile reconstruction with a unilateral pedicled SCIA-based flap, without additional flaps or requirements, was achieved in 45 (96%) participants. One participant had total flap necrosis and one had partial flap necrosis. Primary closure was obtained in all participants (100%). Wound dehiscence was frequent at phallus/scrotum junction (n = 17), and infrequent at the donor-site (n = 3), and could be managed conservatively in all cases.

Conclusion: The SCIA-based perforator flap is a safe and promising pedicled option for shaft-only phalloplasty, with a concealable donor site and without the need for microvascular anastomosis. Therefore, in our center, the SCIA-based perforator flap has become our primary choice for phalloplasty without urethral lengthening in slim patients.

Background: Compared to negative experiences and ill health, little attention has been paid to positive experiences connected to being transgender and gender diverse (TGD).

Aim: The aim of the current study was to explore TGD people's positive experiences in depth.

Methods: In total, 33 TGD people were interviewed. Transcripts were analyzed using reflexive thematic analysis.

Results: Results show that participants had various positive experiences related to their gender identity. While some of these experiences can be conceptualized as "minority joy," capturing experiences evoking happy emotions, others are better understood as "minority growth"-a personal development and sense of authenticity-and "minority peace"-a sense of comfortability and calmness. The emotional valence of experiences was further explored to better understand the themes.

Discussion: In line with earlier research, some of the positive experiences could be seen as buffers between stressors and ill health and some were clearly connected to experiencing stressors. However, some experiences were freestanding from stressors and positive in their own right. The results of this study give an alternative to the prevailing view of TGD experiences necessarily connected to suffering. The results are relevant for professionals meeting TGD people, since a focus on strengths and positive aspects could be an important, but previously under focused tool to improve general health and quality of life. It may give hope to TGD people themselves, who are often presented with the trope of the suffering TGD person. Not the least, results could inform general society and policy makers.

Background: A new primary care model for provision of hormone therapy to transgender individuals has become increasingly popular in recent years. A small number of studies have described the operation of this model of care and transgender people's experiences.

Aims: This analysis aimed to describe the experiences of people accessing hormone therapy in primary care.

Methods: As most research surrounding this model has been qualitative, we undertook a meta-ethnography to synthesize these studies into a new analysis. Five databases were searched systematically, and a total of 11 studies were included for analysis.

Results: We found that primary care provided a familiar setting for participants, and was highly desired due to the accessibility, speed, and shared decision making. A partnership relationship was present in provider-client relationships which lessened medical gatekeeping compared to other models. We also found that negative experiences were focused on navigating the healthcare setting, and individual providers not providing high quality care. These negative experiences cause feelings of isolation and distrust of healthcare as a whole.

Discussion: Primary care is a suitable setting for access to hormone therapy within the context of an informed consent model of care. An increased focus on medical education could help overcome lack of provider familiarity with the new model, and gender affirming care in general. Overall, we found that the informed consent model of primary care provision of hormone therapy is highly desirable and effective for transgender people, but could be improved with better education of providers.