International Journal of Transgender Health最新文献

Background: Transgender and gender diverse (TGD) people face unique challenges and have distinct needs while incarcerated. Gender-affirming healthcare improves mental health outcomes and supports gender transition. While in recent years, correctional institutions have begun to recognize and address the gender-affirming healthcare needs of TGD people, there is a lack of understanding and awareness of TGD people's experiences when accessing gender-affirming healthcare while incarcerated.

Aims/method: We conducted a scoping review on international empirical research published from 2018 to 2024 on TGD people's experiences with gender-affirming healthcare while incarcerated using the Joanna Briggs Institute methodology. A search of the databases Web of Science, PsycInfo, and PubMed was completed on May 6, 2024. The data was analyzed using thematic analysis with an abolition feminist framework and transformative approach.

Results: Our search yielded 15 studies published between 2018 and 2024, across eight countries. The studies included qualitative and quantitative method designs. The main outcomes of interest were hormone replacement therapy (HRT), staff competency and training, institutional policies, gender-affirming surgeries, and mental health.

Conclusions: Findings from this review highlight the need for consistent, adequate, trans-informed gender-affirming healthcare for all TGD people experiencing incarceration. TGD people frequently face institutional and interpersonal barriers when trying to access gender-affirming healthcare. There is a need for culturally-informed training for correctional staff and clear policies in correctional settings to ensure the delivery of adequate and gender-affirming healthcare.

Background: In the Zapotec culture of Oaxaca (southern Mexico), muxe individuals are people assigned male at birth who describe themselves as a third gender sharing some characteristics of both men and women. While some studies find that they encounter discrimination, muxe individuals also report being valued, respected, and supported given their traditionally recognized third gender status and role within their culture, community and family. The city of Juchitán is the center of this indigenous culture and provides an excellent setting to study factors that combat stigma and give space for gender-diverse thriving with implications for transgender health and well-being.

Aim: This study explores how acceptance around gender and sexual identity development and having a valued social role may promote resilience among muxe individuals and why matters for HIV/STIs prevention and overall health.

Method: On three occasions, in 2004, 2013, and 2023, we collected ethnographic data, including survey data from 38 self-identified muxe individuals.

Results: Our findings include information about demographic characteristics, gender identity, family acceptance, social acceptance, sexual experiences, relationships, involvement in sex work, and health status, including HIV/STI risk and status. Findings show that while muxe individuals report some gender-based discrimination, they also report a fair amount of cultural acceptance - including an accepted family, community, and social role - which has positive impacts on them in terms of health and wellbeing.

Conclusion: We envision this research as a baseline exploration upon which to build ongoing scholarly work in the area of gender diversity and transgender health. It is our hope that a deeper understanding of the muxe culture will advance approaches that learn from diverse cultural understandings of gender and underscore strength-based frames.

Background: Trans youth experience gender minority stress, which contributes to poor mental health outcomes. Previous studies have demonstrated that group cognitive behavioral therapy (CBT) interventions are effective in improving mental health and well-being in LGBTQ+ youth experiencing minority stress more broadly. At the same time, there is growing recognition of the importance of co-designing novel mental health interventions to improve their acceptability and relevance. Currently, there is a need for group CBT interventions that have been co-designed with trans youth to ensure such programs are tailored to their needs.

Aim: To develop a novel group CBT intervention for trans young people using co-design.

Methods: We conducted a co-design study with trans youth recruited from the Royal Children's Hospital Gender Service in Victoria, Australia. Applying a participatory research approach, we held three online co-design workshops where participants designed the intervention's structure, format, objectives and content. We recorded and transcribed the workshops and thematically analyzed the transcripts to develop the intervention.

Results: Eight trans young people aged 15-21 years participated in the study. Participants made recommendations for the intervention centering around: (1) trans community connection, positivity, and hope, and (2) accommodating diverse experiences, perspectives, and needs. TAG TEAM (Trans Adolescent Group ThErapy for Alleviating Minority stress) was developed on the basis of these recommendations, consisting of six two-hour sessions conducted weekly and facilitated by a psychologist and trans peer facilitator.

Discussion: The use of co-design to develop the TAG TEAM intervention is likely to improve its applicability to trans young people and their needs, which in turn increases its potential to improve their mental health.

Background: Transgender youth are more likely than cisgender youth to encounter risk, such as a lack of social support from families and offline friends, leading many to turn to online friendships for social support. Feeling supported is crucial for psychological adjustment, measured in positive outcomes such as pride, self-esteem, and belongingness and in negative outcomes such as internalized transphobia, depression, and loneliness.

Aims: Using the risk and resilience framework, this study explores the relationship between social support across social contexts (families, offline friends, and online friends) and psychological adjustment using hierarchical regression modeling in a sample of 335 binary and nonbinary transgender young adults.

Results: Family and offline friend support had stronger associations with adjustment than online friend support, and online friend support moderated the relationship between family support and pride and the relationship between offline friend support and pride. A qualitative analysis of participants' experiences of being transgender online explored additional insights into how transgender young adults use the internet for support. The qualitative analyses contextualized the qualitative findings, showcasing the varied experiences of trans individuals online and the importance of offline support as a cornerstone for psychological adjustment.

Conclusions: Social support from offline social contexts are more foundational and paramount to promoting positive psychological adjustment than online social support. Online engagement in trans young adults is individualized and offers a variety of supportive and unsupportive experiences.

Purpose: An estimated 1.4-2.3 million transgender and gender nonbinary (TGNB) adults live in the United States. Very few studies have explored TGNB healthcare delivery from the perspectives of primary care providers in the Southeast region broadly, and even fewer have focused on the Central Appalachian region in particular. This project explores the perspectives of providers in the area to better understand the needs of this population.

Methods: Healthcare providers in community health organizations within Central Appalachia participated in sixteen in-depth interviews. Researchers performed a qualitative thematic analysis to identify major themes in experiences of providing gender affirming care (GAC) for TGNB in the region.

Results: Data analysis revealed four major themes: 1) practitioners' baseline knowledge of GAC influences their perception of providing care for TGNB patients, 2) practitioners report a lack of certainty in providing care to TGNB patients, 3) practitioners show interest in and recognize the need for educational resources and support in providing GAC, and 4) colleagues and patients are a useful source of knowledge for providing GAC.

Conclusion: Participants held inconsistent definitions for what Gender Affirming Care means, but did not express confusion or uncertainty about the importance of providing GAC as part of primary care. Hesitation to treat was most often associated with a lack of self-confidence in a provider's ability to provide appropriate care to patients. This suggests a misunderstanding or lack of education related to the health needs of this population, and specifically a lack of awareness that providing GAC goes beyond the provision of transition related medicine.

Background: Transgender individuals face significant barriers to accessing sexual and reproductive health (SRH) services globally. These challenges are exacerbated in South Asian countries, where stigma, discrimination, and a lack of specialized healthcare support prevail. Countries such as India, Nepal, Bangladesh, and Pakistan fall behind in ensuring equal healthcare rights and access for the transgender community.

Aim: This scoping review aims to identify and map the existing literature on the barriers faced by transgender adults in South Asia when accessing SRH services.

Methods: A comprehensive search was conducted across six databases, focusing on studies addressing the SRH concerns of transgender adults in South Asia. From an initial pool of 410 studies, 16 full-text articles and relevant grey literature were selected for review. Data were analyzed and categorized into three key themes.

Results: The review revealed three main themes: (a) Barriers to accessing SRH services, including social rejection, stigma, and healthcare provider gaps; (b) Strategies to improve SRH services, such as community-based interventions and healthcare provider training; and (c) Ethical dilemmas, focusing on patient confidentiality and respectful care. Sub-themes explored the intersectionality of gender identity and access to healthcare, highlighting the urgent need for SRH resources and support.

Conclusion: The findings underscore the need for tailored SRH programs and policies to address the disparities faced by transgender adults in South Asia. International support and advocacy are essential to ensure the provision of quality healthcare to this underserved population.

Introduction: The existing literature on gender transition interruptions for transgender/nonbinary (TNB) people (what is frequently termed "detransitioning") lacks conceptual clarity and precision, resulting in conflictual findings, misinterpretations, and the weaponization of the literature to support harmful policies aimed at limiting TNB individuals' access to gender-affirming care.

Aims: We conducted a review of the existing literature on gender transition interruptions and propose a conceptual framework to address the current weaknesses in the extant scholarship, provide better conceptual clarity, and offer suggestions for improving future research.

Methods: The paper uses a conceptual review and critique of the extant research including scholarship on transition-related desistence, regret, and gender transition interruptions (i.e. "detransitions").

Main outcome measures: The lay understanding and, at times, the scholarly understanding of gender transition interruptions from the existing literature is most frequently collapsed under the idea of "detransitioning." This is true even though few studies actually examine the experiences of individuals who transition from TNB to the gender associated with the sex they were assigned at birth. There is significant conflation of findings about different types of transition interruption experiences with transition interruption experiences that encapsulate a true identity shift from transgender to cisgender. This conceptual slippage and misinterpretation is used politically to weaponize the existing scholarship.

Results: The paper proposes a conceptual framework of gender transition interruptions that outlines the conceptual nuances including identification of desistance, (6) subcategories of transition-related regret, (2) subcategories of adaptive gender transition interruptions, gender recalibration, embodiment goal attainment, other transition interruption, and gender identity recission.

Conclusion: The proposed conceptual framework details the nuances in the various types of gender transition interruptions suggested, and utilizes the extant scholarship to justify the proposed framework.

Background: Transgender and gender diverse (TGD) populations are often excluded from research or inappropriately grouped with other gender modalities despite significant disparities in health and health care. According to models of community-engaged research, involving TGD community members in establishing research priorities can improve the relevance and impact of research for this population. The purpose of this study was to clarify community priorities for research relevant to TGD populations.

Methods: Forty-five individuals participated across five asynchronous online focus groups. Participants discussed topics chosen in collaboration with a community research advisory board, including gender-affirming hormone therapy. Rapid qualitative analysis was used to identify salient themes.

Results: Research priorities voiced across all represented gender identities were: (1) Longitudinal, prospective research on long-term effects of gender-affirming hormone therapy, (2) Standardized training for providers and researchers, (3) Implementation research on methods to educate the public and reduce discrimination, and (4) Basic research on the biological, historical, and social underpinnings of gender identity.

Conclusions: This study provides insight into clinical priorities for TGD populations. Findings highlight a need for basic science research to better understand the underpinnings of gender identity, longitudinal studies to investigate long-term effects of hormone therapy, and education for the public on gender diversity to combat discrimination.

Background: Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. Methods: Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (n = 44) and follow-up semi-structured interview data (n = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. Results: One-sixth (n = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. Conclusions: Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.

Purpose: Transgender and gender diverse (TGD) individuals face substantial barriers to health equity, which are magnified for TGD persons of color and those living in medically underserved areas. This article presents the development and pilot of an interdisciplinary health education program for TGD individuals in an underserved U.S./Mexico border community. Feasibility of the initiative and challenges of implementing such a program are discussed.

Method: A health education program was developed and piloted through a collaboration between The University of Texas at El Paso and a community partner, Borderland Rainbow Center. The program trained graduate students from various health sciences to educate TGD community members, along with their friends, families, and allies, on gender-affirming care and resources. The program took place in El Paso, TX and southern NM, USA between March and October, 2023.

Results: Examples of quantitative and qualitative data that were collected from this pilot program are provided. We present descriptive statistics of pre- versus post-survey data as a demonstration of feasibility and as an example of how such data may be structured in future studies that aim to incorporate more robust statistical analysis.

Conclusion: The details of the program's conceptualization and implementation can serve as a model for developing targeted health education interventions for TGD populations in diverse geographic and sociocultural settings. These interventions are critical as they address both community needs and student education to combat health inequities faced by underrepresented or marginalized groups.