Social Media Use and HIV-Related Risk Behaviors in Young Black and Latino Gay and Bi Men and Transgender Individuals in New York City: Implications for Online Interventions.

PubMed

Patel, Viraj V; Masyukova, Mariya; Sutton, Desmond; Horvath, Keith J

2016-04-01

Urban young men who have sex with men (YMSM) and transgender women continue to experience high rates of new HIV infections in the USA, yet most of this population is not reached by current prevention interventions. The rate of Internet and social media use among youth is high. However, continually updated understanding of the associations between social media access and use and HIV risk behaviors is needed to reach and tailor technology-delivered interventions for those most vulnerable to HIV-racially and ethnically diverse urban YMSM and transgender persons. Thus, we conducted an in-person, venue-based cross-sectional survey among young gay, bisexual, and transgender individuals at locations primarily visited by Black and Latino gay and bisexual and transgender individuals in New York City to understand social media use and how it may relate to HIV risk behaviors to inform social media-based interventions. Among 102 primarily Black and Latino gay and bisexual men (75.5 %) and transgender women (19.6 %), over 90 % were under 30 years of age, 18.6 % reported homelessness in the past 6 months, and 10.8 % reported having HIV. All participants used social media, most accessed these platforms most often via a mobile device (67.6 %) and most logged on multiple times per day (87.3 %). Participants used social media to seek sex partners (56.7 %), exchange sex for money or clothes (19.6 %), and exchange sex for drugs (9.8 %). These results confirm prior studies demonstrating the feasibility of using social media platforms to reach at-risk, urban youth. Of particular concern is the association between recent STI and exchanging sex for money/clothes and drugs. Interventions using social media for young, urban minority MSM and transgender populations should incorporate risk reduction modules addressing exchange partners and promote frequent and regular HIV/STI testing.

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.

PubMed Central

Clements-Nolle, K; Marx, R; Guzman, R; Katz, M

2001-01-01

OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services. PMID:11392934

HIV Diagnoses and Care Among Transgender Persons and Comparison With Men Who Have Sex With Men: New York City, 2006-2011.

PubMed

Wiewel, Ellen Weiss; Torian, Lucia V; Merchant, Pooja; Braunstein, Sarah L; Shepard, Colin W

2016-03-01

We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems. New York City's surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM. In 2006 to 2011, 264 of 23 805 persons diagnosed with HIV were transgender (1%): 98% transgender women and 2% transgender men. Compared with MSM, transgender women had similar CD4 counts at diagnosis and rates of concurrent HIV/AIDS and delayed linkage to care but increased odds of not achieving suppression (adjusted odds ratio = 1.56; 95% confidence interval = 1.13, 2.16). Compared with MSM, transgender women in New York City had similar immunological status at diagnosis but lagged in achieving viral suppression. To provide appropriate assistance along the HIV care continuum, HIV care providers should accurately identify transgender persons.

Selection, Inclusion, Evaluation and Defense of Transgender-Inclusive Fiction for Young Adults: A Resource Guide

ERIC Educational Resources Information Center

Rockefeller, Elsworth I.

2009-01-01

An increasingly visible youth transgender population is emerging and the number of transgender-inclusive fiction texts for young adults is growing. Adults serving teens in schools, libraries, and community agencies must begin actively pursuing, utilizing, and incorporating these texts into resource collections. This article provides an overview of…

HIV Diagnoses and Care Among Transgender Persons and Comparison With Men Who Have Sex With Men: New York City, 2006–2011

PubMed Central

Torian, Lucia V.; Merchant, Pooja; Braunstein, Sarah L.; Shepard, Colin W.

2016-01-01

Objectives. We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems. Methods. New York City’s surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM. Results. In 2006 to 2011, 264 of 23 805 persons diagnosed with HIV were transgender (1%): 98% transgender women and 2% transgender men. Compared with MSM, transgender women had similar CD4 counts at diagnosis and rates of concurrent HIV/AIDS and delayed linkage to care but increased odds of not achieving suppression (adjusted odds ratio = 1.56; 95% confidence interval = 1.13, 2.16). Conclusions. Compared with MSM, transgender women in New York City had similar immunological status at diagnosis but lagged in achieving viral suppression. To provide appropriate assistance along the HIV care continuum, HIV care providers should accurately identify transgender persons. PMID:26691124

Sexual Preferences and Partnerships of Transgender Persons Mid- or Post-Transition.

PubMed

Fein, Lydia A; Salgado, Christopher J; Sputova, Klara; Estes, Christopher M; Medina, Carlos A

2018-01-01

The process of gender transition has varying effects on various aspects of sexuality. The purpose of this study was to investigate the effects of transitioning on transgender persons' sexual preferences and partnerships. Data were collected through an anonymous online survey. Questions focused on timing of gender transition in relation to change in sexual preference. Transgender individuals have a variety of sexual partners, predominantly cisgender, and may change sexual preference when they transition. Transitioning can be associated with having no primary sexual partner, despite past sexual partnerships. Length of time between identifying as transgender and starting the transition might be associated with changing sexual partner preference, particularly in transgender women. The emerging trends of sexual partnerships and changing sexual preferences related to the transition in this study warrant further investigation. These data provide more understanding of the relationship between transitioning and sexual preferences and partnerships.

Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City

PubMed Central

Sanchez, John P.; Danoff, Ann

2009-01-01

Objectives. We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. Methods. We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. Results. Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). Conclusions. Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals. PMID:19150911

[Surgery of the breast on transgender persons].

PubMed

Karhunen-Enckell, Ulla; Kolehmainen, Maija; Kääriäinen, Minna; Suominen, Sinikka

2015-01-01

For a female-to-male transgender person, mastectomy is the most important procedure making the social interaction easier. Along with the size of the breasts, the quantity and quality of skin will influence the selection of surgical technique. Although complications are rare, corrective surgery is performed for as many as 40% of the patients. Of male-to-female transsexual persons, 60 to 70% opt for breast enlargement. Breast enlargement can be carried out by using either silicone implants or fat transplantation. Since the surgical procedures on breasts are irreversible, their implementation requires confirmation of the diagnosis of transsexualism by a multidisciplinary team.

Transgender community belongingness as a mediator between strength of transgender identity and well-being.

PubMed

Barr, Sebastian M; Budge, Stephanie L; Adelson, Jill L

2016-01-01

This study examined transgender community belongingness as a mediator between strength of transgender identity and well-being. A total of 571 transgender adults (n = 209 transgender women, n = 217 transgender men, and n = 145 nonbinary-identified individuals) completed an online survey assessing transgender community belongingness, strength of transgender identity (operationalized as the extent to which a person self-categorizes their identity as transgender and the extent to which they believe their gender transition to be important to their self-definition), and well-being (using measures of self-esteem, satisfaction with life, and psychological well-being). Structural equation modeling was used to analyze the data. When controlling for participants' income, age, and stage of gender transition, transgender community belongingness fully mediated the relationship between strength of transgender identity and well-being. Strength of transgender identity was indirectly and positively related to well-being through community belongingness, but was not directly related to well-being. Results suggest that transgender community belongingness is an important construct in the mental health of transgender people. The strength of a person's transgender identity also appears to be a significant construct in transgender people's well-being via its relationship with transgender community belongingness. Implications of the findings are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Complexity of Family Reactions to Identity among Homeless and College Lesbian, Gay, Bisexual, Transgender, and Queer Young Adults.

PubMed

Schmitz, Rachel M; Tyler, Kimberly A

2018-05-01

Familial responses to lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people's identities range on a spectrum from rejection to acceptance and these reactions strongly impact family relationships and young adult well-being. Less is known, however, about how family members' reactions may differ based on young people's contexts of socioeconomic status. Through a qualitative, life course analysis of in-depth interview data from 46 LGBTQ college students and LGBTQ homeless young adults, our study highlights the diverse, contextual nuances of young people's "linked lives" within their families. We find that the context of socioeconomic status influenced how a young person managed family rejection. Conversely, processes of familial acceptance were also connected to life course transitions that worked in some cases to enhance LGBTQ young adults' family relationships. Finally, the intricacy of familial reactions to a young person's LGBTQ identity transcended socioeconomic contexts as many respondents shared similar experiences of rejection and acceptance. These findings have implications for understanding how young people manage family relationships across different contexts of socioeconomic status and how these experiences can shape their life course trajectories. Results from this study can inform LGBTQ youth service providers by tailoring intervention programs that account for contextual social diversity.

Exploring Individual and Structural Factors Associated with Employment Among Young Transgender Women of Color Using a No-Cost Transgender Legal Resource Center.

PubMed

Hill, Brandon J; Rosentel, Kris; Bak, Trevor; Silverman, Michael; Crosby, Richard; Salazar, Laura; Kipke, Michele

2017-01-01

The purpose of this study was to explore individual and structural factors associated with employment among young transgender women (TW) of color. Sixty-five trans women of color were recruited from the Transgender Legal Defense and Education Fund to complete a 30-min interviewer-assisted survey assessing sociodemographics, housing, workplace discrimination, job-seeking self-efficacy, self-esteem, perceived public passability, and transactional sex work. Logistic regression models revealed that stable housing (structural factor) and job-seeking self-efficacy (individual factor) were significantly associated with currently being employed. Our findings underscore the need for multilevel approaches to assist TW of color gain employment.

Perception of Community Tolerance and Prevalence of Depression among Transgender Persons.

PubMed

Owen-Smith, Ashli A; Sineath, Craig; Sanchez, Travis; Dea, Robin; Giammattei, Shawn; Gillespie, Theresa; Helms, Monica F; Hunkeler, Enid M; Quinn, Virginia P; Roblin, Douglas; Slovis, Jennifer; Stephenson, Robert; Sullivan, Patrick S; Tangpricha, Vin; Woodyatt, Cory; Goodman, Michael

2017-01-01

The goal of the study was to examine the association between depression and perceived community tolerance after controlling for various demographic and personal characteristics, treatment receipt, and past experiences with abuse or discrimination. An on-line survey assessed depressive symptoms among transgender and gender non-conforming individuals. Depression was assessed using the 7-item Beck Depression Inventory for Primary Care (BDI-PC) and the 10-item Center for Epidemiologic Studies Depression (CESD-10) scale. The prevalence ratios (95% confidence intervals) comparing depression in persons who did and did not perceive their area as tolerant were 0.33 (0.20-0.54) for BD-PC and 0.66 (0.49-0.89) for CESD-10. Other factors associated with depression were experience with abuse or discrimination, lower education, and unfulfilled desire to receive hormonal therapy. Depression was common in this sample of transgender and gender non-conforming individuals and was strongly and consistently associated with participants' perceptions of community tolerance, even after adjusting for possible confounding. The association between desire to receive hormonal therapy and depression is a finding that warrants further exploration. Future research should also assess depression and changes in perception of community tolerance in transgender individuals before and after initiation of gender confirmation treatment.

Adherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women.

PubMed

Bazzi, Angela Robertson; Whorms, Debra S; King, Dana S; Potter, Jennifer

2015-11-01

We used retrospective (2012-2013) chart review to examine breast cancer screening among transgender persons and sexual minority women (n = 1263) attending an urban community health center in Massachusetts. Transgender were less likely than cisgender patients and bisexuals were less likely than heterosexuals and lesbians to adhere to mammography screening guidelines (respectively, adjusted odds ratios = 0.53 and 0.56; 95% confidence intervals = 0.31, 0.91 and 0.34, 0.92) after adjustment for sociodemographics. Enhanced cancer prevention outreach is needed among gender and sexual minorities.

Exploring Individual and Structural Factors Associated with Employment Among Young Transgender Women of Color Using a No-Cost Transgender Legal Resource Center

PubMed Central

Hill, Brandon J.; Rosentel, Kris; Bak, Trevor; Silverman, Michael; Crosby, Richard; Salazar, Laura; Kipke, Michele

2017-01-01

Abstract Purpose: The purpose of this study was to explore individual and structural factors associated with employment among young transgender women (TW) of color. Methods: Sixty-five trans women of color were recruited from the Transgender Legal Defense and Education Fund to complete a 30-min interviewer-assisted survey assessing sociodemographics, housing, workplace discrimination, job-seeking self-efficacy, self-esteem, perceived public passability, and transactional sex work. Results: Logistic regression models revealed that stable housing (structural factor) and job-seeking self-efficacy (individual factor) were significantly associated with currently being employed. Conclusion: Our findings underscore the need for multilevel approaches to assist TW of color gain employment. PMID:28795154

A comparison of mental health, substance use, and sexual risk behaviors between rural and non-rural transgender persons.

PubMed

Horvath, Keith J; Iantaffi, Alex; Swinburne-Romine, Rebecca; Bockting, Walter

2014-01-01

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.

Career Counseling with Lesbian, Gay, Bisexual, and Transgendered Persons: The Next Decade.

ERIC Educational Resources Information Center

Chung, Y. Barry

2003-01-01

Proposes future directions for career counseling with lesbian, gay male, bisexual male and female, and transgendered persons. Suggestions include efforts for theory development, empirical research, career assessment, counseling practice, and counselor education. (Contains 53 references.) (GCP)

Personality Disorders in Gay, Lesbian, Bisexual and Transgender Chemically Dependent Patients

PubMed Central

Grant, Jon E.; Flynn, Meredith; Odlaug, Brian L.; Schreiber, Liana R.N.

2011-01-01

This study sought to examine personality disorders and their related clinical variables in a sample of gay, lesbian, bisexual and transgender (GLBT) individuals with substance use disorders. Study participants were 145 GLBT patients who were admitted to a residential dual diagnosis chemical dependency treatment program. A total of 136 (93.8%) had at least one personality disorder. The most common personality disorders were borderline (n=93; 64.1%), obsessive-compulsive (n=82; 56.6%), and avoidant (n=71; 49.0%) personality disorders. Preliminary data suggests there is a high prevalence of personality disorders in the GLBT population undergoing chemical dependency treatment. PMID:21838838

Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India.

PubMed

Ganju, Deepika; Saggurti, Niranjan

2017-08-01

Among marginalised groups in India, HIV prevalence is highest among transgender persons; however, little is known about their HIV vulnerability. This study describes transgender sex workers' experiences of stigma and violence, a key driver of the HIV epidemic, and explores their coping responses. In-depth interviews were conducted with 68 respondents in Maharashtra state, India. Findings show that respondents face pervasive stigma and violence due to multiple marginalised social identities (transgender status, sex work, gender non-conformity), which reinforce and intersect with social inequities (economic and housing insecurity, employment discrimination, poverty), fuelling HIV vulnerability at the micro, meso and macro levels. Several factors, such as felt and internalised stigma associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use; clients' power in sexual transactions; establishing trust in regular partnerships through condomless sex; norms condoning violence against gender non-conforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability. In the face of such adversity, respondents adopt coping strategies to shift power relations and mobilise against abuse. Community mobilisation interventions, as discussed in the paper, offer a promising vulnerability reduction strategy to safeguard transgender sex workers' rights and reduce HIV vulnerability.

HIV Prevalence and Risk Behaviors in Male to Female (MTF) Transgender Persons in Tijuana, Mexico.

PubMed

Salas-Espinoza, Kristian Jesús; Menchaca-Diaz, Rufino; Patterson, Thomas L; Urada, Lianne A; Smith, Davey; Strathdee, Steffanie A; Pitpitan, Eileen V

2017-12-01

Compared to HIV research on men who have sex with men, less is known about the risks and vulnerabilities for HIV among Male to Female (MTF) transgender persons, particularly in different geographic regions like Mexico. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, no precedent data exists on the MTF transgender population. Our aims were to estimate HIV prevalence and examine the behaviors and characteristics of the population. We conducted a cross-sectional study of 100 MTF transgender persons recruited through time location sampling in 2012. Participants underwent interviewer-administered (paper and pen) surveys and rapid tests for HIV. Descriptive univariate analyses were conducted on various factors, including sociodemographics, substance use, accessing social services (requested vs. received), stigma, and sex behaviors. A total of 22% tested positive for HIV, a prevalence higher than other key populations at risk for HIV in Tijuana.

A Comparison of Mental Health, Substance Use, and Sexual Risk Behaviors Between Rural and Non-Rural Transgender Persons

PubMed Central

HORVATH, KEITH J.; IANTAFFI, ALEX; SWINBURNE-ROMINE, REBECCA; BOCKTING, WALTER

2014-01-01

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed. PMID:24380580

Nursing Students' Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review.

PubMed

Lim, Fidelindo A; Hsu, Richard

2016-01-01

The aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons. There is paucity of research to assess the attitudes of nursing students toward LGBT persons. An electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice. Less than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes. There are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.

Culturally competent substance abuse treatment with transgender persons.

PubMed

Nuttbrock, Larry A

2012-01-01

Transgender individuals are misunderstood and inadequately treated in many conventional substance abuse treatment programs. This article reviews current concepts regarding the definition and diversity of transgenderism and summarizes the existing literature on the prevalence and correlates of substance use in transgendered populations. Examples of culturally competent and gender-sensitive treatment in specialized settings are cited, with a call to extend these initiatives throughout the gamut of service venues that engage transgender individuals. Cultural competence combined with gender sensitivity should improve the effectiveness of substance abuse treatment for transgender individuals and will contribute to the goal of providing effective services in an increasingly diverse society.

Transgender identity development as represented by a group of female-to-male transgendered adults.

PubMed

Morgan, Sarah W; Stevens, Patricia E

2008-06-01

This article represents work done in the discipline of nursing to raise awareness about the lives and experiences of transgendered persons, who receive little coverage in our nursing textbooks, professional journals, or student clinical experiences. The findings presented here are from a larger qualitative examination of the lives and experiences of a group of 11 transgendered adults that examined four broad areas: transgender identity recognition, acknowledgement, and development; bodily experiences; relationships with others; and health care experiences. The focus of this article is the relevant findings related to four participants in the study who identified as female-to-male (FTM), meaning they were born female-bodied, but identify as male. The highlight here is on the recognition, acknowledgement, and development of transgender identity. Our intention is to expose uninformed people to first-hand accounts by FTM transgendered persons about their life trajectories, particularly during childhood, adolescence, and the early adult years.

Group Work with Transgender Clients

ERIC Educational Resources Information Center

Dickey, Lore M.; Loewy, Michael I.

2010-01-01

Drawing on the existing literature, the authors' research and clinical experiences, and the first author's personal journey as a member and leader of the transgender community, this article offers a brief history of group work with transgender clients followed by suggestions for group work with transgender clients from a social justice…

Sexual Health Information Seeking Online: A Mixed-Methods Study among Lesbian, Gay, Bisexual, and Transgender Young People

ERIC Educational Resources Information Center

Magee, Joshua C.; Bigelow, Louisa; DeHaan, Samantha; Mustanski, Brian S.

2012-01-01

The current study used a mixed-methods approach to investigate the positive and negative aspects of Internet use for sexual health information among lesbian, gay, bisexual, and transgender (LGBT) young people. A diverse community sample of 32 LGBT young people (aged 16-24 years) completed qualitative interviews focusing on how, where, and when…

Homicide Rates of Transgender Individuals in the United States: 2010-2014.

PubMed

Dinno, Alexis

2017-09-01

To estimate homicide rates of transgender US residents and relative risks (RRs) of homicide with respect to cisgender comparators intersected with age, gender, and race/ethnicity. I estimated homicide rates for transgender residents and transfeminine, Black, Latin@, and young (aged 15-34 years) subpopulations during the period 2010 to 2014 using Transgender Day of Remembrance and National Coalition of Anti-Violence Programs transgender homicide data. I used estimated transgender prevalences to estimate RRs using cisgender comparators. I performed a sensitivity analysis to situate all results within assumptions about underreporting of transgender homicides and assumptions about the prevalence of transgender residents. The overall homicide rate of transgender individuals was likely to be less than that of cisgender individuals, with 8 of 12 RR estimates below 1.0. However, the homicide rates of young transfeminine Black and Latina residents were almost certainly higher than were those of cisfeminine comparators, with all RR estimates above 1.0 for Blacks and all above 1.0 for Latinas. Antiviolence public health programs should identify young and Black or Latina transfeminine women as an especially vulnerable population.

The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: experience from ‘HIM’ initiative

PubMed Central

Oyewale, Tajudeen O.; Ahmed, Shale; Ahmed, Farid; Tazreen, Mona; Uddin, Ziya; Rahman, Anisur; Oyediran, Kola A.

2016-01-01

Introduction The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15–24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%. Methods Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services. Results and discussion A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections. Conclusion The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services. PMID:26945145

Anticipated HIV Stigma and Delays in Regular HIV Testing Behaviors Among Sexually-Active Young Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women.

PubMed

Gamarel, Kristi E; Nelson, Kimberly M; Stephenson, Rob; Santiago Rivera, Olga J; Chiaramonte, Danielle; Miller, Robin Lin

2018-02-01

Young gay, bisexual and other men who have sex with men (YGBMSM) and young transgender women are disproportionately affected by HIV/AIDS. The success of biomedical prevention strategies is predicated on regular HIV testing; however, there has been limited uptake of testing among YGBMSM and young transgender women. Anticipated HIV stigma-expecting rejection as a result of seroconversion- may serve as a significant barrier to testing. A cross-sectional sample of YGBMSM (n = 719, 95.5%) and young transgender women (n = 33, 4.4%) ages 15-24 were recruited to participate in a one-time survey. Approximately one-third of youth had not tested within the last 6 months. In a multivariable model, anticipated HIV stigma and reporting a non-gay identity were associated with an increased odds of delaying regular HIV testing. Future research and interventions are warranted to address HIV stigma, in order to increase regular HIV testing among YGBMSM and transgender women.

Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study.

PubMed

Logie, Carmen H; Lacombe-Duncan, Ashley; Brien, Natasha; Jones, Nicolette; Lee-Foon, Nakia; Levermore, Kandasi; Marshall, Annecka; Nyblade, Laura; Newman, Peter A

2017-04-04

Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV-related stigma is a barrier to HIV testing among Jamaica's general population, yet little is known of MSM and transgender women's HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica. We implemented a community-based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18-30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in-depth individual semi-structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community-based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes. Participant narratives revealed social-ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV-related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT-friendly clinics that peers would discover they were getting tested. HIV-related stigma contributed to fear of testing HIV-positive; this intersected with the stigma of HIV as a "gay" disease. Participants also anticipated healthcare provider

“Just Because It's Out There, People Aren't Going to Use It.” HIV Self-Testing Among Young, Black MSM, and Transgender Women

PubMed Central

Wilton, Leo; Hirshfield, Sabina; Chiasson, Mary Ann; Usher, DaShawn; Lucy, Debbie; McCrossin, Jermaine; Greene, Emily; Koblin, Beryl

2015-01-01

Abstract HIV disproportionately affects young black MSM and transgender women in the US. Increasing HIV testing rates among these populations is a critical public health goal. Although HIV self-tests are commercially available, there is a need to better understand access to and uptake of HIV self-testing among this population. Here, we report results of a qualitative study of 30 young black MSM and transgender women residing in the New York City area to understand facilitators of and barriers to a range of HIV testing approaches, including self-testing. Mean age was 23.7 years (SD = 3.4). Over half (54%) had some college or an associate's degree, yet 37% had an annual personal income of less than $10,000 per year. Most (64%) participants had tested in the past 6 months; venues included community health/free clinics, medical offices, mobile testing units, hospitals, emergency departments, and research sites. Just one participant reported ever using a commercially available HIV self-test. Facilitators of self-testing included convenience, control, and privacy, particularly as compared to venue-based testing. Barriers to self-testing included the cost of the test, anxiety regarding accessing the test, concerns around correct test operation, and lack of support if a test result is positive. Participants indicated that instruction in correct test operation and social support in the event of a positive test result may increase the likelihood that they would use the self-test. Alongside developing new approaches to HIV prevention, developing ways to increase HIV self-testing is a public health priority for young, black MSM, and transgender women. PMID:26376029

Is Type 1 Diabetes Mellitus More Prevalent Than Expected in Transgender Persons? A Local Observation.

PubMed

Defreyne, Justine; De Bacquer, Dirk; Shadid, Samyah; Lapauw, Bruno; T'Sjoen, Guy

2017-09-01

The International Diabetes Federation estimates that approximately 0.4% of the Belgian population is diagnosed with type 1 diabetes mellitus, which is similar to other industrialized countries. The prevalence of transgenderism is estimated at 0.6% to 0.7% of all adults in Western populations. In this study, we evaluated whether there was an increased prevalence of type 1 diabetes mellitus in transgender people in the local cohort. Medical records of transgender patients were analyzed retrospectively. From January 1, 2007 until October 10, 2016, 1,081 transgender patients presented at a tertiary reference center to start hormonal treatment. Nine of these 1,081 patients were previously diagnosed with type 1 diabetes mellitus and 1 was diagnosed with latent autoimmune diabetes in adults. A 2.3-fold higher prevalence of type 1 diabetes mellitus was observed in transgender patients. We concluded that type 1 diabetes mellitus was more prevalent in transgender patients than one would expect from population prevalences. This could be a spurious result in a local cohort, because a causal relation seems unlikely, but our finding might encourage other centers to investigate this putative association. Defreyne J, De Bacquer D, Shadid S, et al. Is Type 1 Diabetes Mellitus More Prevalent Than Expected in Transgender Persons? A Local Observation. Sex Med 2017;5:e215-e218. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Lesbian, Gay, Bisexual, and Transgender Adolescent School Victimization: Implications for Young Adult Health and Adjustment

ERIC Educational Resources Information Center

Russell, Stephen T.; Ryan, Caitlin; Toomey, Russell B.; Diaz, Rafael M.; Sanchez, Jorge

2011-01-01

Background: Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school…

Creating Spaces to Support Transgender Youth

ERIC Educational Resources Information Center

McGuire, Jenifer K.; Conover-Williams, Meredith

2010-01-01

This article explores the opportunity to create spaces within the family, school, and community that specifically promote the well-being of transgender adolescents and young adults. When social contexts are supportive, transgender youth report significantly less risk. Supportive home and school environments have been linked to better outcomes…

Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study

PubMed Central

Logie, Carmen H.; Lacombe-Duncan, Ashley; Brien, Natasha; Jones, Nicolette; Lee-Foon, Nakia; Levermore, Kandasi; Marshall, Annecka; Nyblade, Laura; Newman, Peter A.

2017-01-01

Abstract Introduction: Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV-related stigma is a barrier to HIV testing among Jamaica’s general population, yet little is known of MSM and transgender women’s HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica. Methods: We implemented a community-based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18–30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in-depth individual semi-structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community-based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes. Results: Participant narratives revealed social-ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV-related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT-friendly clinics that peers would discover they were getting tested. HIV-related stigma contributed to fear of testing HIV-positive; this intersected with the stigma of HIV as a “gay” disease

Innovative uses of communication technology for HIV programming for men who have sex with men and transgender persons.

PubMed

Allison, Susannah M; Adams, Darrin; Klindera, Kent C; Poteat, Tonia; Wolf, R Cameron

2014-01-01

Globally, overall rates of HIV are on the decline; however, rates among gay men and other men who have sex with men (MSM) and transgender persons are increasing. Meanwhile, there has been exponential growth in access to communication technology over the last decade. More innovative prevention and care technology-based programmes are needed to help address the growing numbers of MSM and transgender persons living with HIV and those at risk for infection. To address this need, a meeting was hosted by the U.S. Agency for International Development (USAID) through the President's Emergency Plan for AIDS Relief (PEPFAR) and co-sponsored by amfAR, The Foundation for AIDS Research and the National Institute of Mental Health (NIMH). The meeting brought together researchers, community implementers, advocates and federal partners to discuss the current landscape of technology-based interventions for MSM and transgender persons and to discuss key considerations. Presentations and discussions focused on the research gaps, facilitators and barriers to programme implementation and public-private partnerships. This article summarizes the meeting proceedings and outlines key considerations for future work in this area.

Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment.

PubMed

Russell, Stephen T; Ryan, Caitlin; Toomey, Russell B; Diaz, Rafael M; Sanchez, Jorge

2011-05-01

Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior. The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non-Latino White respondents. A 10-item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self-esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self-reported HIV risk. Lesbian, gay, bisexual, and transgender-related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. Reducing LGBT-related school victimization will likely result in significant long-term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities. © 2011, American School Health Association.

Wearing My Identity: A Transgender Teacher in the Classroom

ERIC Educational Resources Information Center

McCarthy, Linda

2003-01-01

The term "transgender" is used by people whose gender identity or expression falls outside the boundaries of traditional gender expectations. In educational systems, transgender issues are becoming increasingly relevant as both students and staff "come out" as transgender, and as young people explore non-normative gender expression. In comparison…

Provision of Patient-Centered Transgender Care.

PubMed

Selix, Nancy W; Rowniak, Stefan

2016-11-01

Transgender individuals have unique health care needs and experience health disparities. There is an increased need for transgender health care services and primary care for this underserved population. However, provision of appropriate health care services for transgender persons requires cultural competency and skill on the part of the health care provider, and providers need specific skills to address the needs of this population. A review of the literature was performed by accessing CINAHL, PsycINFO, and PubMed databases. Pertinent research was extracted and reviewed for relevance. References in these publications were reviewed to identify additional publications that address primary prevention, secondary prevention, and tertiary care of transgender individuals. Articles that include prevention, screening, and treatment of health problems of transgender persons were identified. Research on the health needs of the transgender population is limited. Whenever available, research findings that address this unique population should be incorporated into clinical practice. When research evidence is not available to address the unique needs of transgender individuals, research and clinical care guidelines from the general population may be applied for health screening and maintenance. This article provides information about primary care services for transgender individuals and seeks to improve awareness of the health disparities this underserved population experiences. Simple solutions to modify clinical settings to enhance care are provided. © 2016 by the American College of Nurse-Midwives.

Circulating androgens correlate with resting-state MRI in transgender men.

PubMed

Mueller, Sven C; Wierckx, Katrien; Jackson, Kathryn; T'Sjoen, Guy

2016-11-01

Despite mounting evidence regarding the underlying neurobiology in transgender persons, information regarding resting-state activity, particularly after hormonal treatment, is lacking. The present study examined differences between transgender persons on long-term cross-sex hormone therapy and comparisons on two measures of local functional connectivity, intensity of spontaneous resting-state activity (low frequency fluctuations, LFF) and local synchronization of specific brain areas (regional homogeneity, ReHo). Nineteen transgender women (TW, male-to-female), 19 transgender men (TM, female-to-male), 21 non-transgender men (NTM) and 20 non-transgender women (NTW) underwent a resting-state MRI scan. The results showed differences between transgender persons and non-transgender comparisons on both LFF and ReHo measures in the frontal cortex, medial temporal lobe, and cerebellum. More interestingly, circulating androgens correlated for TM in the cerebellum and regions of the frontal cortex, an effect that was associated with treatment duration in the cerebellum. By comparison, no associations were found for TW with estrogens. These data provide first evidence for a potential masculinization of local functional connectivity in hormonally-treated transgender men. Copyright © 2016 Elsevier Ltd. All rights reserved.

Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization.

PubMed

Brennan, Julia; Kuhns, Lisa M; Johnson, Amy K; Belzer, Marvin; Wilson, Erin C; Garofalo, Robert

2012-09-01

We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration. These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.

Syndemic Theory and HIV-Related Risk Among Young Transgender Women: The Role of Multiple, Co-Occurring Health Problems and Social Marginalization

PubMed Central

Brennan, Julia; Kuhns, Lisa M.; Johnson, Amy K.; Belzer, Marvin; Wilson, Erin C.

2012-01-01

Objectives. We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors. Methods. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey. Results. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration. Conclusions. These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization. PMID:22873480

Applying Social Learning Theory of Career Decision Making to Gay, Lesbian, Bisexual, Transgender, and Questioning Young Adults

ERIC Educational Resources Information Center

Datti, Paul A.

2009-01-01

Incorporating J. D. Krumboltz's (1979) social learning theory of career decision making, the author explores career development issues for gay, lesbian, bisexual, transgender, and questioning (GLBTQ) adolescents and young adults. Unique challenges for the GLBTQ population are discussed, specific recommendations for effective career counseling with…

Pathological, Disabled, Transgender: The Ethics, History, Laws, and Contradictions in Models that Best Serve Transgender Rights.

PubMed

Wahlert, Lance; Gill, Sabrina

This article addresses the precarious place of transgender and gender non-cis persons in relation to their discrimination-protections in recent legal, medical, and ethical policies in the United States. At present, there exists a contradiction such that trans persons are considered "pathological" enough that they are included in the latest iteration of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) as "gender dysphoric," but they are not included in the category of "disabled" under the Americans with Disabilities Act (ADA). As such, trans persons in America are subject to the stigma of pathology (albeit with medical treatment) without the full protections of the ADA. By contrast, transgender and non-cis-gender Americans find their queer cohorts who are HIV-positive to be fully protected by the ADA. We ask whether transgender and non-cis-gender persons should embrace their (already pathologized) personhood as a disability. Sometimes "choosing disability" affords more rights than it deploys stigma.

Transgender Discrimination and the Law

ERIC Educational Resources Information Center

Trotter, Richard

2010-01-01

An emerging area of law is developing regarding sex/gender identity discrimination, also referred to as transgender discrimination, as distinguished from discrimination based on sexual orientation. A transgendered individual is defined as "a person who has a gender-identity disorder which is a persistent discomfort about one?s assigned sex or…

Experience of Career-Related Discrimination for Female-to-Male Transgender Persons: A Qualitative Study

ERIC Educational Resources Information Center

Dispenza, Franco; Watson, Laurel B.; Chung, Y. Barry; Brack, Greg

2012-01-01

In this qualitative study, the authors examined the experience of discrimination and its relationship to the career development trajectory of 9 female-to-male transgender persons. Participants were between 21 and 48 years old and had a variety of vocational experiences. Individual semistructured interviews were conducted via telephone and analyzed…

Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens.

PubMed

Rodriguez, Amanda; Agardh, Anette; Asamoah, Benedict Oppong

2018-05-01

Discrimination has long been tied to health inequality. Rejected by families and communities because of their gender identity and gender-role behavior, transgender individuals are often socially marginalized. This study aimed to assess discrimination in health-care settings among persons self-identifying as transgender in the U.S. in relation to their recognizability as transgender, operationalized as how often they experienced that others recognized them as transgender. Data were obtained from the National Transgender Discrimination Survey (n = 6106 participants, assigned sex at birth = 3608 males, 2480 females, respectively). Binary logistic regressions were performed to examine associations between transgender recognizability and discrimination in health-care settings. Being recognized as transgender to any extent had a significant effect on perceived discrimination in health care. Always recognized as transgender showed significant associations with discrimination in a health-care setting (OR 1.48) and the following individualized health-care settings: social service settings (rape crisis and domestic violence centers, OR 5.22) and mental health settings (mental health clinic and drug treatment program, OR 1.87). Sex work and other street economy, which are known experiential factors affected by discrimination, were also significantly associated with discrimination in health-care settings. Discrimination in health-care settings is pervasive for transgender who are recognized as transgender. Public health efforts to improve access to equitable health care for transgender individuals may benefit from consideration of demographic, experiential, and medical risk factors to more fully understand the source of the seemingly excess risk of discrimination among persons recognized by others as being transgender.

Innovative uses of communication technology for HIV programming for men who have sex with men and transgender persons1

PubMed Central

Allison, Susannah M; Adams, Darrin; Klindera, Kent C; Poteat, Tonia; Wolf, R Cameron

2014-01-01

Globally, overall rates of HIV are on the decline; however, rates among gay men and other men who have sex with men (MSM) and transgender persons are increasing. Meanwhile, there has been exponential growth in access to communication technology over the last decade. More innovative prevention and care technology-based programmes are needed to help address the growing numbers of MSM and transgender persons living with HIV and those at risk for infection. To address this need, a meeting was hosted by the U.S. Agency for International Development (USAID) through the President's Emergency Plan for AIDS Relief (PEPFAR) and co-sponsored by amfAR, The Foundation for AIDS Research and the National Institute of Mental Health (NIMH). The meeting brought together researchers, community implementers, advocates and federal partners to discuss the current landscape of technology-based interventions for MSM and transgender persons and to discuss key considerations. Presentations and discussions focused on the research gaps, facilitators and barriers to programme implementation and public–private partnerships. This article summarizes the meeting proceedings and outlines key considerations for future work in this area. PMID:25280864

Project LifeSkills - a randomized controlled efficacy trial of a culturally tailored, empowerment-based, and group-delivered HIV prevention intervention for young transgender women: study protocol.

PubMed

Kuhns, Lisa M; Mimiaga, Matthew J; Reisner, Sari L; Biello, Katie; Garofalo, Robert

2017-09-16

Transgender women in the U.S. have an alarmingly high incidence rate of HIV infection; condomless anal and vaginal sex is the primary risk behavior driving transmission. Young transgender women are the subpopulation at the highest risk for HIV. Despite this, there are no published randomized controlled efficacy trials testing interventions to reduce sexual risk for HIV among this group. This paper describes the design of a group-based intervention trial to reduce sexual risk for HIV acquisition and transmission in young transgender women. This study, funded by the National Institutes of Health, is a randomized controlled trial of a culturally-specific, empowerment-based, and group-delivered six-session HIV prevention intervention, Project LifeSkills, among sexually active young transgender women, ages 16-29 years in Boston and Chicago. Participants are randomized (2:2:1) to either the LifeSkills intervention, standard of care only, or a diet and nutrition time- and attention-matched control. At enrollment, all participants receive standardized HIV pre- and post-test counseling and screening for HIV and urogenital gonorrhea and chlamydia infections. The primary outcome is difference in the rate of change in the number of self-reported condomless anal or vaginal sex acts during the prior 4-months, assessed at baseline, 4-, 8-, and 12-month follow-up visits. Behavioral interventions to reduce sexual risk for HIV acquisition and transmission are sorely needed for young transgender women. This study will provide evidence to determine feasibility and efficacy in one of the first rigorously designed trials for this population. ClinicalTrials.gov number, NCT01575938 , registered March 29, 2012.

Preferences for HIV test characteristics among young, Black Men Who Have Sex With Men (MSM) and transgender women: Implications for consistent HIV testing.

PubMed

Frye, Victoria; Wilton, Leo; Hirshfield, Sabina; Chiasson, Mary Ann; Lucy, Debbie; Usher, DaShawn; McCrossin, Jermaine; Greene, Emily; Koblin, Beryl

2018-01-01

Promoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29. We conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach. We identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the "fit" between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC. These findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and transgender women. Addressing perceptions of

Preferences for HIV test characteristics among young, Black Men Who Have Sex With Men (MSM) and transgender women: Implications for consistent HIV testing

PubMed Central

Frye, Victoria; Hirshfield, Sabina; Chiasson, Mary Ann; Lucy, Debbie; Usher, DaShawn; McCrossin, Jermaine; Greene, Emily; Koblin, Beryl

2018-01-01

Background Promoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29. Methods We conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach. Results We identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the “fit” between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC. Conclusions These findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and

Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents.

PubMed

Klaver, Maartje; de Mutsert, Renée; Wiepjes, Chantal M; Twisk, Jos W R; den Heijer, Martin; Rotteveel, Joost; Klink, Daniël T

2018-02-01

Transgender adolescents aspiring to have the body characteristics of the affirmed sex can receive hormonal treatment. However, it is unknown how body shape and composition develop during treatment and whether transgender persons obtain the desired body phenotype. To examine the change in body shape and composition from the start of treatment with gonadotropin-releasing hormone agonists (GnRHa) until 22 years of age and to compare these measurements at 22 years with those of age-matched peers. 71 transwomen (birth-assigned boys) and 121 transmen (birth-assigned girls) who started treatment from 1998 through 2014 were included in this retrospective study. GnRHa treatment was started and cross-sex hormonal treatment was added at 16 years of age. Anthropometric and whole-body dual-energy x-ray absorptiometry data were retrieved from medical records. Linear mixed model regression was performed to examine changes over time. SD scores (SDS) were calculated to compare body shape and composition with those of age-matched peers. Change in waist-hip ratio (WHR), total body fat (TBF), and total lean body mass (LBM) during hormonal treatment. SDS of measures of body shape and composition compared with age-matched peers at 22 years of age. In transwomen, TBF increased (+10%, 95% CI = 7-11) while total LBM (-10%, 95% CI = -11 to -7) and WHR (-0.04, 95% CI = -0.05 to -0.02) decreased. Compared with ciswomen, SDS at 22 years of age were +0.3 (95% CI = 0.0-0.5) for WHR, and 0.0 (95% CI = -0.2 to 0.3) for TBF. Compared with cismen, SDS were -1.0 (95% CI = -1.3 to -0.7) for WHR, and +2.2 (95% CI = 2.2-2.4) for TBF. In transmen, TBF decreased (-3%, 95% CI = -4 to -1), while LBM (+3%, 95% CI = 1-4) and WHR (+0.03, 95% CI = 0.01-0.04) increased. Compared with ciswomen, SDS at 22 years of age were +0.6 (95% CI = 0.4-0.8) for WHR, and -1.1 (95% CI = -1.4 to -0.9) for TBF. Compared with cismen, SDS were -0.5 (95% CI = -0.8 to -0.3) for WHR, and +1.8 (95% CI = 1.6-1.9) for TBF. Knowing body

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina.

PubMed

Marshall, Brandon D L; Socías, María Eugenia; Kerr, Thomas; Zalazar, Virginia; Sued, Omar; Arístegui, Inés

2016-07-01

This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.

Monitoring the health of transgender and other gender minority populations: validity of natal sex and gender identity survey items in a U.S. national cohort of young adults.

PubMed

Reisner, Sari L; Conron, Kerith J; Tardiff, Laura Anatale; Jarvi, Stephanie; Gordon, Allegra R; Austin, S Bryn

2014-11-26

A barrier to monitoring the health of gender minority (transgender) populations is the lack of brief, validated tools with which to identify participants in surveillance systems. We used the Growing Up Today Study (GUTS), a prospective cohort study of U.S. young adults (mean age = 20.7 years in 2005), to assess the validity of self-report measures and implement a two-step method to measure gender minority status (step 1: assigned sex at birth, step 2: current gender identity). A mixed-methods study was conducted in 2013. Construct validity was evaluated in secondary data analysis of the 2010 wave (n = 7,831). Cognitive testing interviews of close-ended measures were conducted with a subsample of participants (n = 39). Compared to cisgender (non-transgender) participants, transgender participants had higher levels of recalled childhood gender nonconformity age < 11 years and current socially assigned gender nonconformity and were more likely to have ever identified as not completely heterosexual (p < 0.001). No problems with item comprehension were found for cisgender or gender minority participants. Assigned sex at birth was interpreted as sex designated on a birth certificate; transgender was understood to be a difference between a person's natal sex and gender identity. Participants were correctly classified as male, female, or transgender. The survey items performed well in this sample and are recommended for further evaluation in languages other than English and with diverse samples in terms of age, race/ethnicity, and socioeconomic status.

Characteristics of Transgender Women Living with HIV Receiving Medical Care in the United States.

PubMed

Mizuno, Yuko; Frazier, Emma L; Huang, Ping; Skarbinski, Jacek

2015-09-01

Little has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs. We used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests. An estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing. We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.

Reflections of an Emerging Male-to-Female Transgendered Consciousness.

ERIC Educational Resources Information Center

Glenn, Wendell D.

1999-01-01

Provides a first-person account of one individual's experience as a plainclothes, African American, male-to-female transgendered person, describing his life growing up and how he balanced internal and external factors and offering implications for social work practice with both plainclothes and fixed/prepared male-to-female transgendered youth.…

Caring for transgender patients with epilepsy.

PubMed

Johnson, Emily L; Kaplan, Peter W

2017-10-01

Approximately 25 million individuals older than age 15 identify as transgender, representing about 0.3-0.9% of the world's population. The aim of this paper is to identify and describe important medical and social considerations facing transgender persons with epilepsy. We performed literature searches on the following terms: transgender AND epilepsy, transgender AND neurology, gender dysphoria AND epilepsy, gender dysphoria AND neurology. We also performed literature searches for common feminizing or masculinizing treatment regimens, and searched for interactions of those treatment regimens with antiepileptic drugs (AEDs) and with seizures. There are multiple bidirectional interactions between AEDs and the commonly used treatments for aligning external sex characteristics with identified gender. The scope of the transgender population with epilepsy remains to be elucidated. Transgender patients with epilepsy face significant social and medical challenges. Interactions between medical gender-affirming treatments and AEDs are common, and management must depend on knowledge of these interactions to provide appropriate treatment. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Neural correlates of ostracism in transgender persons living according to their gender identity: a potential risk marker for psychopathology?

PubMed

Mueller, Sven C; Wierckx, Katrien; Boccadoro, Sara; T'Sjoen, Guy

2018-01-15

Stigmatization in society carries a high risk for development of psychopathology. Transgender persons are at particularly high risk for such stigmatization and social rejection by others. However, the neural correlates of ostracism in this group have not been captured. Twenty transgender men (TM, female-to-male) and 19 transgender women (TW, male-to-female) already living in their gender identity and 20 cisgender men (CM) and 20 cisgender women (CW) completed a cyberball task assessing both exclusion and re-inclusion during functional magnetic resonance imaging (fMRI). During psychosocial stress between-group differences were found in the dorsal and ventral anterior cingulate cortex (ACC) and the inferior frontal gyrus (IFG). Patterns were consistent with sex assigned at birth, i.e. CW showed greater activation in dorsal ACC and IFG relative to CM and TW. During re-inclusion, transgender persons showed greater ventral ACC activity relative to CW, possibly indicating persistent feelings of exclusion. Functional connectivity analyses supported these findings but showed a particularly altered functional connectivity between ACC and lateral prefrontal cortex in TM, which may suggest reduced emotional regulation to the ostracism experience in this group. Depressive symptoms or hormonal levels were not associated with these findings. The results bear implications for the role of social exclusion in development of mental health problems in socially marginalized groups.

Medical management of transgender children and adolescents.

PubMed

Castilla-Peón, María Fernanda

2018-01-01

Transgender or gender nonconforming (GN) persons identify themselves with a gender which is different from that correspondent to their birth sex. The demand for health services by families with transgender children or adolescents tends to increase. The prevalence of GN in children is unknown; however, it has been estimated to be > 1% in adolescents. Transgender persons are at increased risk of depression, suicide, illicit drug abuse, human immunodeficiency virus infection, and non-accidental injury. The most accepted model for the care of transgender persons assumes that these adverse outcomes are the consequence of social margination rather than the GI condition itself. Social and physical gender transition seem to be effective in increasing the well-being of people with GI and reducing associated health risks. Mental health professionals can support the child in the process of social transition. The pediatric endocrinologist may offer puberty blockade and cross-sex induction of puberty. Surgical sex reassignment interventions are reserved for adults. Gender identity, gender expression and sexual orientation are three relatively independent categories that can take any value, which is not necessarily binary (male/female) or fixed. Health professionals should be familiar with these concepts in order to offer the best resources available to optimize the well-being of each transgender child or adolescent with an individualized approach. Copyright: © 2018 Permanyer.

Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy: A Narrative Review.

PubMed

Streed, Carl G; Harfouch, Omar; Marvel, Francoise; Blumenthal, Roger S; Martin, Seth S; Mukherjee, Monica

2017-08-15

Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT. Currently, systemic hormone replacement for cisgender adults requires a nuanced discussion based on baseline risk factors and age of administration of exogenous hormones because of concern regarding an increased risk for myocardial infarction and stroke. For transgender adults, CSHT has been associated with the potential for worsening CVD risk factors (such as blood pressure elevation, insulin resistance, and lipid derangements), although these changes have not been associated with increases in morbidity or mortality in transgender men receiving CSHT. For transgender women, CSHT has known thromboembolic risk, and lower-dose transdermal estrogen formulations are preferred over high-dose oral formulations. In addition, many studies of transgender adults focus predominantly on younger persons, limiting the generalizability of CSHT in older transgender adults. The lack of randomized controlled trials comparing various routes and formulations of CSHT, as well as the paucity of prospective cohort studies, limits knowledge of any associations between CSHT and CVD.

"It's not my business": Exploring heteronormativity in young people's discourses about lesbian, gay, bisexual, transgender, and queer issues and their implications for youth health and wellbeing.

PubMed

Ng, Cara Ky; Haines-Saah, Rebecca J; Knight, Rodney E; Shoveller, Jean A; Johnson, Joy L

2017-06-01

In Canada, the issue of creating safe and inclusive school environments for lesbian, gay, bisexual, transgender, and queer students has been in the spotlight. Several researchers and advocates have pointed out the positive effects of lesbian, gay, bisexual, transgender, and queer-positive policy frameworks on the health and wellbeing of all young people. In this article, we take a critical approach to analyzing narrative findings from qualitative interviews conducted with youth in three communities in British Columbia, Canada: "the North," Vancouver, and Abbotsford. Using a Foucauldian Discourse Analytic Approach and Butler's concept of Citationality, our analysis suggested that although explicit homophobia was largely absent from youth discussions, young people discursively constructed lesbian, gay, bisexual, transgender, and queer identities and "communities" in ways that reified heteronormativity. Youth made references to sociopolitical discourses of libertarianism and liberalism and to homonormative stereotypes regarding gay masculinity. A few young people also alluded to egalitarian, queer-positive discourses, which appeared to interrogate structures of heteronormativity. Since studies suggest a connection between the existence of institutional supports for lesbian, gay, bisexual, transgender, and queer students in schools and their mental and physical wellbeing, we conclude by considering the limitations and possibilities of these sociopolitical discourses in the struggle for sexual and gender equity, and how they might help frame future health-related, anti-homophobia policy frameworks in educational settings.

Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: a meta-analysis.

PubMed

Klaver, M; Dekker, M J H J; de Mutsert, R; Twisk, J W R; den Heijer, M

2017-06-01

Weight gain and body fat increase the risk of cardiometabolic disease. Cross-sex hormone therapy in transgender persons leads to changes in body weight and body composition, but it is unclear to what extent. We performed a meta-analysis to investigate the changes in body weight, body fat and lean body mass during cross-sex hormone therapy in transgender persons. We searched the PubMed database for eligible studies until November 2015. Ten studies reporting changes in body weight, body fat or lean mass in hormone naive transgender persons were included, examining 171 male-to-female and 354 female-to-male transgender people. Pooled effect estimates in the male-to-female group were +1.8 kg (95% CI: 0.2;3.4) for body weight, +3.0 kg (2.0;3.9) for body fat and -2.4 kg (-2.8; -2.1) for lean body mass. In the female-to-male group, body weight changed with +1.7 kg (0.7;2.7), body fat with -2.6 kg (-3.9; -1.4) and lean body mass with +3.9 kg (3.2;4.5). Cross-sex hormone therapy increases body weight in both sexes. In the male-to-female group, a gain in body fat and a decline in lean body mass are observed, while the opposite effects are seen in the female-to-male group. Possibly, these changes increase the risk of cardiometabolic disease in the male-to-female group. © 2016 Blackwell Verlag GmbH.

Overcoming psychosocial and developmental barriers to blood and marrow transplantation (BMT) in an adolescent/young adult (AYA) transgender patient with chronic myelogenous leukemia.

PubMed

Khazal, Sajad; Abdel-Azim, Hisham; Kapoor, Neena; Mahadeo, Kris M

2014-11-01

Adolescents/young adults (AYAs) afflicted with cancer face unique barriers to potentially standard curative therapies, such as blood and marrow transplantation (BMT). Transgender AYAs face additional barriers and there is a dearth of published literature regarding their oncology-related experience. We present the case of an AYA male-to-female (MTF) transgender patient on cross-sex hormone therapy, with a history of Chronic Myelogenous Leukemia (CML) and significant psychosocial barriers, which initially served as a barrier to BMT at two different centers; we modified our standard consent and education process and was able to successfully proceed with BMT and subsequently cure her CML. Despite unique challenges, AYA and transgender patients with significant psychosocial barriers may achieve successful outcomes with BMT. Research is needed regarding guidelines for cross-sex hormone therapy administration for patients undergoing BMT and other issues, which may be unique to the transgender experience.

Understanding Engagement in HIV Risk and Prevention Research Among Black Young Men Who Have Sex with Men and Transgender Women in the District of Columbia.

PubMed

Glick, Sara Nelson; Houston, Ebony; Peterson, James; Kuo, Irene; Magnus, Manya

2016-08-01

To develop optimal methods to study sexual health among black young men who have sex with men and transgender women (BYMSM/TW). We conducted a mixed-methods prospective study to identify recruitment and retention strategies for BYMSM/TW (age 16-21) in Washington D.C., and describe HIV risk behaviors and context. Incentivized peer referral was highly productive, and 60% of BYMSM/TW were retained for 3 months. Participants reported high levels of sexual risk, homophobia, racism, and maternal support. BYMSM/TW studies should utilize a combination of peer-based, in-person, and technology-based recruiting strategies. Additional research is needed to leverage mobile technology and social media to enhance retention.

HIV infection risk factors among male-to-female transgender persons: a review of the literature.

PubMed

De Santis, Joseph P

2009-01-01

Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identified.

Pitch Elevation in Male-to-female Transgender Persons-the Würzburg Approach.

PubMed

Meister, Jonas; Hagen, Rudolf; Shehata-Dieler, Wafaa; Kühn, Heike; Kraus, Fabian; Kleinsasser, Norbert

2017-03-01

The present study reports objective and subjective voice results of Wendler's glottoplasty modified by Hagen. This is an outcomes research study. A total of 21 patients underwent Wendler's glottoplasty modified by Hagen. Parameters in the follow-up session were laryngoscopy, voice range profile, Voice Handicap Index, Life Satisfaction Questionnaire, and a visual analog scale for individual satisfaction with the voice. The fundamental frequency was elevated into the typical female fundamental frequency range. Furthermore, an elevation of the lower frequency limit was shown without a reduction of the frequency range. About one third of the population feels affected by the restricted dynamic range. This change of the vocal pitch is seen as part of the voice feminization by some of the patients. The Dysphonia Severity Index as a marker for voice quality was unchanged. Subjective satisfaction with the voice showed a strong correlation with the individual elevation of the pitch. Wendler's glottoplasty modified by Hagen is an effective and low-risk method of raising the vocal pitch of male-to-female transgender persons. However, elevated Scores of the Voice Handicap Index indicated that in everyday life, transgender persons continue to feel handicapped because of their voice. Another indicator for the lack of social acceptance and integration is the reduced general life satisfaction in the Life Satisfaction Questionnaire especially in the domain "friends, acquaintances, relatives." Therefore, a better multidisciplinary therapy concept for voice feminization is necessary. Copyright © 2017. Published by Elsevier Inc.

Reported Use of and Satisfaction with Vocational Rehabilitation Services among Lesbian, Gay, Bisexual, and Transgender Persons

ERIC Educational Resources Information Center

Dispenza, Franco; Hunter, Tameeka

2015-01-01

Purpose: Reported use of and satisfaction rates of vocational rehabilitation (VR) services among a small sample of lesbian, gay, bisexual, and transgender (LGBT) persons living with various chronic illness and disability (CID) conditions in the United States were explored. Method: Data were pulled from a larger data set that was collected via the…

Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group

PubMed Central

Deutsch, Madeline B; Green, Jamison; Keatley, JoAnne; Mayer, Gal; Hastings, Jennifer; Hall, Alexandra M

2013-01-01

Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here. PMID:23631835

Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City.

PubMed

Boyce, Sabrina; Barrington, Clare; Bolaños, Herbert; Arandi, Cesar Galindo; Paz-Bailey, Gabriela

2012-01-01

The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual and heterosexual-identifying men who have sex with men and male-to-female transgender persons in Guatemala City, to inform the development of high quality and population-friendly services. In-depth, semi-structured interviews were conducted with 29 purposively sampled individuals, including 8 transgender, 16 gay/bisexual and 5 heterosexual-identifying participants. Topical codes were applied to the data using software Atlas.ti™ to compare data between sub-groups. Analysis revealed that public clinics were most commonly used due to their lower cost and greater accessibility, but many participants experienced discrimination, violation of confidentiality and distrust of these services. Transgender and gay/bisexual-identifying participants preferred clinics where they felt a sense of belonging, while heterosexual-identifying participants preferred clinics unassociated with the men who have sex with men community. The most prominent barriers to sexual health services included fear of discrimination, fear of having HIV, cost and lack of social support. Findings highlight the need to strengthen existing public sexually transmitted infection clinics so that they address the multiple layers of stigma and discrimination that men who have sex with men and transgender persons experience.

A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum.

PubMed

Anand, Tarandeep; Nitpolprasert, Chattiya; Kerr, Stephen J; Muessig, Kathryn E; Promthong, Sangusa; Chomchey, Nitiya; Hightow-Weidman, Lisa B; Chaiyahong, Prachya; Phanuphak, Praphan; Ananworanich, Jintanat; Phanuphak, Nittaya

2017-07-01

In Thailand, young men who have sex with men (YMSM) and transgender women (TG) are disproportionately affected by HIV and have suboptimal care continuum outcomes. Although Thai YMSM and young TG are early adopters of emerging technologies and have high Internet and technology access and utilization, the potential of technology has not been harnessed to optimize the HIV treatment cascade. We interviewed 18 behaviorally HIV-infected YMSM and young TG regarding care challenges, identified how eHealth could address care needs, and elicited preferences for eHealth interventions. Participants reported struggling with individual and societal-level stigma which negatively impacted linkage to and retention in care, and antiretroviral therapy adherence. YMSM and young TG described inadequate in-person support services and heavily relied on random online resources to fill information and support gaps, but sometimes viewed them as untrustworthy or inconsistent. Participants universally endorsed the development of eHealth resources and proposed how they could ameliorate individual-level fears over stigma and improve public perceptions about HIV. Personalized and integrated eHealth interventions with interactive, user-driven structures, credible content, rewards for engagement, real-time counseling and reminder support could help overcome barriers YMSM and young TG face in traditional HIV healthcare systems and have the potential to improve care outcomes.

Understanding Engagement in HIV Risk and Prevention Research Among Black Young Men Who Have Sex with Men and Transgender Women in the District of Columbia

PubMed Central

Houston, Ebony; Peterson, James; Kuo, Irene; Magnus, Manya

2016-01-01

Abstract Purpose: To develop optimal methods to study sexual health among black young men who have sex with men and transgender women (BYMSM/TW). Methods: We conducted a mixed-methods prospective study to identify recruitment and retention strategies for BYMSM/TW (age 16–21) in Washington D.C., and describe HIV risk behaviors and context. Results: Incentivized peer referral was highly productive, and 60% of BYMSM/TW were retained for 3 months. Participants reported high levels of sexual risk, homophobia, racism, and maternal support. Conclusion: BYMSM/TW studies should utilize a combination of peer-based, in-person, and technology-based recruiting strategies. Additional research is needed to leverage mobile technology and social media to enhance retention. PMID:26651365

Female and male transgender quality of life: socioeconomic and medical differences.

PubMed

Motmans, Joz; Meier, Petra; Ponnet, Koen; T'Sjoen, Guy

2012-03-01

Studies show a positive impact of gender reassignment treatment on the quality of life (QOL) of transgender persons, but little is known about the influence of their socioeconomic status. First, to assess health-related QOL of transgender men and women and compare it with a general population sample, second, to investigate the differences between transgender men and transgender women, and third, to analyze how their levels of QOL differ according to socioeconomic and transition data. One hundred forty-eight current and former transgender patients of a gender identity clinic participated in a large QOL study. Health-related QOL was measured using the Short Form 36-Item Questionnaire. The QOL of transgender women did not differ significantly from the general Dutch female population, although transgender men showed reduced mental health-related QOL compared with the general Dutch male sample. Transgender women had a lower QOL than transgender men for the subscales physical functioning and general health, but better QOL for bodily pain. Time since start of hormone use was positively associated for transgender women with subscales bodily pain and general health, and negatively associated for transgender men with the subscale role limitations due to physical health problems. There was no significant difference in QOL between the group who had undergone genital surgery or surgical breast augmentation and the group who did not have these surgeries. Transgender men with an erection prosthesis scored significantly better on the subscales vitality and (at trend level) on role limitations due to emotional problems. A series of univariate analyses revealed significantly lower QOL scores for transgender persons that were older, low educated, unemployed, had a low household income, and were single. Specific social indicators are important in relation to health-related QOL of transgenders in a context of qualitative and adequate medical care. © 2011 International Society for

Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of health among transgender women of color.

PubMed

Hill, Brandon J; Crosby, Richard; Bouris, Alida; Brown, Rayna; Bak, Trevor; Rosentel, Kris; VandeVusse, Alicia; Silverman, Michael; Salazar, Laura

2018-03-01

The purpose of this exploratory study was to examine the effects of legal name change on socioeconomic factors, general and transgender-related healthcare access and utilization, and transgender-related victimization in a sample of young transgender women (transwomen) of color. A cross-sectional group comparison approach was used to assess the potential effects of legal name change. A convenience sample of young transwomen enrolled in a no-cost legal name change clinic were recruited to complete a 30-minute interviewer-guided telephone survey including sociodemographic and socioeconomic factors, health and well-being, health care utilization, transgender transition-related health care, and transgender-related victimization. Sixty-five transgender women of color (37 = pre-name change group; 28 = post-name change group) completed the survey. Results indicated that the transwomen in the post-name change group were significantly older than the pre-name change group. In age-adjusted analyses, the post-name change group was significantly more likely to have a higher monthly income and stable housing than the pre-name change group. No significant differences were observed for general healthcare utilization; however, a significantly greater percentage of transwomen in the pre-name change group reported postponing medical care due to their gender identity. In addition, a significantly larger proportion of transwomen in the pre-name change group reported using non-prescribed hormones injected by friends and experiencing verbal harassment by family and friends compared to transwomen in the post-name change group. Findings suggest that legal name change may be an important structural intervention for low-income transwomen of color, providing increased socioeconomic stability and improved access to primary and transition-related health care.

Transgender identity and health care: implications for psychosocial and physical evaluation.

PubMed

Alegria, Christine Aramburu

2011-04-01

The purpose of this article is to educate nurse practitioners (NPs) regarding: (a) the definition and range of transgenderism, (b) social influences on transgender persons, and (c) health care for transgender persons. Data sources include review of the literature in the areas of gender, gender identity, marginalized populations, and gender transition. Personal communication was also utilized. Transgender persons remain marginalized and may remain closeted and at risk for negative psychosocial consequences. For those that do come out, other issues present, including the navigation of gender transition and psychosocial and physical changes that may be positive and/or negative. Examples of positive effects may include satisfaction of living authentically and decrease in depression. Negative effects may include social discrimination and loss of relationships. To provide holistic care, NPs need to be aware of transgender lives in social context and of their healthcare needs. Suggestions for cultivating a supportive healthcare environment include the usage of sensitive language and an appropriate health history and physical examination. Further, to help rectify the knowledge deficit regarding transgender care among healthcare providers, NP educators and preceptors may utilize this article as a resource in their work with students. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

HIV Testing Among Transgender Women and Men - 27 States and Guam, 2014-2015.

PubMed

Pitasi, Marc A; Oraka, Emeka; Clark, Hollie; Town, Machell; DiNenno, Elizabeth A

2017-08-25

Transgender persons are at high risk for human immunodeficiency virus (HIV) infection; in a recent analysis of the results of over nine million CDC funded HIV tests, transgender women* had the highest percentage of confirmed positive results (2.7%) of any gender category (1). Transgender men, † particularly those who have sex with cisgender § men, are also at high risk for infection (2). HIV testing is critical for detecting and treating persons who are infected and delivering preventive services to those who are uninfected. CDC recommends that persons at high risk for HIV infection be screened for HIV at least annually, although transgender persons are not specified in the current recommendations. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to describe HIV testing among transgender women and men and two cisgender comparison groups in 27 states and Guam. After adjusting for demographic characteristics, transgender women and men had a lower prevalence of ever testing and past year testing for HIV (35.6% and 31.6% ever, and 10.0% and 10.2% past year, respectively) compared with cisgender gay and bisexual men (61.8% ever and 21.6% past year) and instead reported testing at levels comparable to cisgender heterosexual men and women (35.2% ever, and 8.6% past year). This finding suggests that transgender women and men might not be sufficiently reached by current HIV testing measures. Tailoring HIV testing activities to overcome the unique barriers faced by transgender women and men might increase rates of testing among these populations.

'Competent persons who can treat you with competence, as simple as that' - an interview study with transgender people on their experiences of meeting health care professionals.

PubMed

Lindroth, Malin

2016-12-01

With a focus on sexual health and rights, this study describes how transgender people experience meetings with health care professionals. Transgender people face prejudice and discrimination worldwide. Little is known of their experiences in sexual health-promoting settings. Within a descriptive design, 20 persons aged 18-74 and identifying as transgender and nonbinary were interviewed. The results were analysed with constructivist grounded theory. Disrespect among health care professionals is the core category connected to the experiences in the result; transgender people experience estrangement, expectations and eviction in different sexual health-promoting settings. Transgender knowledge needs to be increased in general, in both specialised transgender health care and many other health care settings, to prevent transgender peoples' experiences of estrangement. Moreover, an increased knowledge of, and respect for, sexual health and rights is needed to prevent transgender peoples' exposure to gender binary, cis- and heteronormative expectations. In addition, access to sexual health care is essential following gender-confirmatory care as well to avoid transgender peoples' experiences of eviction from the health care system. Nurses have an important role to play in striving for equity and justice within health care. This study describes how health care professionals appear to be disrespectful and suggestions of how this can be avoided are made. © 2016 John Wiley & Sons Ltd.

Chasing the rainbow: lesbian, gay, bisexual, transgender and queer youth and pride semiotics.

PubMed

Wolowic, Jennifer M; Heston, Laura V; Saewyc, Elizabeth M; Porta, Carolyn; Eisenberg, Marla E

2017-05-01

While the pride rainbow has been part of political and social intervention for decades, few have researched how lesbian, gay, bisexual, transgender and queer young people perceive and use the symbol. How do lesbian, gay, bisexual, transgender and queer youth who experience greater feelings of isolation and discrimination than heterosexual youth recognise and deploy the symbol? As part of a larger study on supportive lesbian, gay, bisexual, transgender and queer youth environments, we conducted 66 go-along interviews with lesbian, gay, bisexual, transgender and queer youth people from Massachusetts, Minnesota and British Columbia. During interviews, young people identified visible symbols of support, including recognition and the use of the pride rainbow. A semiotic analysis reveals that young people use the rainbow to construct meanings related to affiliation and positive feelings about themselves, different communities and their futures. Constructed and shared meanings help make the symbol a useful tool for navigating social and physical surroundings. As part of this process, however, young people also recognize that there are limits to the symbolism; it is useful for navigation but its display does not always guarantee supportive places and people. Thus, the pride rainbow connotes safety and support, but using it as a tool for navigation is a learned activity that requires caution.

Chasing the rainbow: lesbian, gay, bisexual, transgender and queer youth and pride semiotics

PubMed Central

Wolowic, Jennifer M.; Heston, Laura V.; Saewyc, Elizabeth M.; Porta, Carolyn; Eisenberg, Marla E.

2017-01-01

While the pride rainbow has been part of political and social intervention for decades, few have researched how lesbian, gay, bisexual, transgender and queer young people perceive and use the symbol. How do lesbian, gay, bisexual, transgender and queer youth who experience greater feelings of isolation and discrimination than heterosexual youth recognise and deploy the symbol? As part of a larger study on supportive lesbian, gay, bisexual, transgender and queer youth environments, we conducted 66 go-along interviews with lesbian, gay, bisexual, transgender and queer youth people from Massachusetts, Minnesota and British Columbia. During interviews, young people identified visible symbols of support, including recognition and the use of the pride rainbow. A semiotic analysis reveals that young people use the rainbow to construct meanings related to affiliation and positive feelings about themselves, different communities and their futures. Constructed and shared meanings help make the symbol a useful tool for navigating social and physical surroundings. As part of this process, however, young people also recognize that there are limits to the symbolism; it is useful for navigation but its display does not always guarantee supportive places and people. Thus, the pride rainbow connotes safety and support, but using it as a tool for navigation is a learned activity that requires caution. PMID:27829321

Cancer Screening Considerations and Cancer Screening Uptake for Lesbian, Gay, Bisexual, and Transgender Persons.

PubMed

Ceres, Marc; Quinn, Gwendolyn P; Loscalzo, Matthew; Rice, David

2018-02-01

To describe the current state of cancer screening and uptake for lesbian, gay, bisexual, and transgender (LGBT) persons and to propose cancer screening considerations for LGBT persons. Current and historic published literature on cancer screening and LGBT cancer screening; published national guidelines. Despite known cancer risks for members of the LGBT community, cancer screening rates are often low, and there are gaps in screening recommendations for LGBT persons. We propose evidence-based cancer screening considerations derived from the current literature and extant cancer screening recommendations. The oncology nurse plays a key role in supporting patient preventive care and screening uptake through assessment, counseling, education, advocacy, and intervention. As oncology nurses become expert in the culturally competent care of LGBT persons, they can contribute to the improvement of quality of care and overall well-being of this health care disparity population. Copyright © 2017 Elsevier Inc. All rights reserved.

Self-perception of voice in transgender persons during cross-sex hormone therapy.

PubMed

Bultynck, Charlotte; Pas, Charlotte; Defreyne, Justine; Cosyns, Marjan; den Heijer, Martin; T'Sjoen, Guy

2017-12-01

Self-perception of voice has a significant psychosocial impact on transgender persons. Research about the evolution of self-perception of voice during cross-sex hormone therapy (CSHT) is lacking. The aim of this study was to examine if self-perception of voice changes during CSHT, and if a change of serum testosterone levels as a result of CSHT can predict a change of self-perception of voice. Prospective longitudinal study. The Transsexual Voice Questionnaire (TVQ), consisting of three factors-anxiety and avoidance (AA), gender identity (GI), and voice quality (VQ)-was used. Transgender persons completed the TVQ at baseline (80 trans men and 103 trans women), after 3 and 12 months of CSHT follow-up. Trans men: From 0 to 3 months, 0 to 12 months, and 3 to 2 months of CSHT, the AA and GI scores improved. From 0 to 3 months of CSHT, the increasing testosterone level was predictive for the improvements of AA and GI scores. Trans women: From 0 to 3 months, the GI score improved. From 0 to 12 months, the AA, GI, and VQ scores improved. Improvements of self-perception of voice could not be predicted by changing serum testosterone levels. During CSHT, self-perception of voice improves in both trans men and trans women. In trans men only, the improving self-perception of voice during the first 3 months can be attributed to the CSHT. For trans women, this study supports that testosterone has acted irreversibly virializing to the voice before CSHT, if they already went through male puberty. 4. Laryngoscope, 127:2796-2804, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Barriers to healthcare for transgender individuals.

PubMed

Safer, Joshua D; Coleman, Eli; Feldman, Jamie; Garofalo, Robert; Hembree, Wylie; Radix, Asa; Sevelius, Jae

2016-04-01

Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.

Drug use among transgender people in Ontario, Canada: Disparities and associations with social exclusion.

PubMed

Scheim, Ayden I; Bauer, Greta R; Shokoohi, Mostafa

2017-09-01

We identified the prevalence and correlates of past-year illicit drug use among transgender people in Ontario, Canada, and disparities with the age-standardized non-transgender population. Data on transgender persons aged 16+ (n=406) were obtained from Trans PULSE, a respondent-driven sampling (RDS) survey (2009-2010). Overall and sex-specific estimates of past-year drug use (cocaine and amphetamines, based on data availability) in the reference population were obtained from Ontario residents aged 16+ (n=39, 980) in the Canadian Community Health Survey (2009-2010), and standardized to the overall and gender-specific transgender age distributions. For regression analyses with Trans PULSE data, past-year drug use included drug types associated with high risk of physical, psychological, and social harm to the user, and RDS-II weights were applied to frequencies and prevalence ratios (PR) derived from blockwise logistic regression models. An estimated 12.3% (95% CI: 7.7, 17.0) of transgender Ontarians had used at least one of the specified drugs in the past year, with no significant difference by gender identity. Transgender Ontarians were more likely to use both cocaine (standardized prevalence difference; SPD=6.8%; 95% CI=1.6, 10.9) and amphetamines (SPD=SPD=1.3%, 95% CI=0.2, 3.1) as compared to the age-standardized non-transgender population. History of transphobic assault, homelessness or underhousing, and sex work were associated with greater drug use among transgender persons. The prevalence of cocaine and amphetamine use among transgender people in Ontario, Canada was higher than in the age-standardized reference population. Social exclusion predicted within-group variation in drug use among transgender persons. Copyright © 2017 Elsevier Ltd. All rights reserved.

Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective.

PubMed

Mueller, Sven C; De Cuypere, Griet; T'Sjoen, Guy

2017-12-01

Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals.

Understanding Online Resource Use by Transgender Youth and Caregivers: A Qualitative Study.

PubMed

Evans, Yolanda N; Gridley, Samantha J; Crouch, Julia; Wang, Alicia; Moreno, Megan A; Ahrens, Kym; Breland, David J

2017-01-01

Purpose: This study assessed what online resources transgender youth and their caregivers use to acquire information about transgender health. Methods: Through a variety of settings, including subspecialty clinics, support groups, and online solicitation, we recruited caregivers of transgender youth aged 22 years or younger and self-identified transgender youth aged 14-22 years. We used a mixed methods approach of conducting in-person focus groups, interviews in person or through phone, and an online survey that allowed for increased flexibility for participants and to triangulate key themes from multiple data sources. Scripts were semistructured, and prompts were focused on resources accessed by transgender youth and their caregivers. Results: We had a total of 65 participants, including 50 caregivers and 15 youth. Five main themes emerged from participants on why they sought out information on the Internet and what they found in their online searches. These themes include (1) exploring gender identity, (2) filling knowledge gaps, (3) seeking support networks, (4) finding transgender-friendly providers, and (5) encountering misinformation. Conclusion: Our findings demonstrate the need for reliable trustworthy content online, the importance of the virtual community to support both youth and caregivers, and the challenge of navigating misinformation that is often faced by transgender youth as they navigate online resources. We propose partnering with professional organizations, such as the American Academy of Pediatrics or World Professional Association of Transgender Health, to promote evidence-based guidelines, position statements, and online information on healthcare for transgender youth.

Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review.

PubMed

Alencar Albuquerque, Grayce; de Lima Garcia, Cintia; da Silva Quirino, Glauberto; Alves, Maria Juscinaide Henrique; Belém, Jameson Moreira; dos Santos Figueiredo, Francisco Winter; da Silva Paiva, Laércio; do Nascimento, Vânia Barbosa; da Silva Maciel, Érika; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos; Adami, Fernando

2016-01-14

The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population's access to health services and original articles with full text available online. The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

Social Environment and Sexual Risk-Taking among Gay and Transgender African American Youth

PubMed Central

Stevens, Robin; Bernadini, Stephen; Jemmott, John B.

2014-01-01

More prevention effort is required as the HIV epidemic increases among gay and transgender African American youth. Using ecological systems theory and an integrative model of behaviour change, this study examines the sexual behaviour of gay and transgender African American young people as embedded within the unique social and structural environments affecting this population. Also examined is the important role played by mobile technology in the social and sexual lives of individuals. Seven focus groups were conducted with 54 African American young adults in a northeastern U.S. city. The findings provide a rich examination of the social and sexual lives of gay and transgender African American youth, focusing on the social environment and the impact of the environment on sexual risk behaviour. PMID:23889233

Differences in Alcohol Use and Alcohol-Related Problems between Transgender- and Nontransgender-identified Young Adults

PubMed Central

Coulter, Robert W.S.; Blosnich, John R.; Bukowski, Leigh A.; Herrick, A. L.; Siconolfi, Daniel E.; Stall, Ron D.

2015-01-01

Background Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). Methods Cross-sectional surveys were completed by 75,192 students aged 18–29 years attending 120 post-secondary educational institutions in the United States from 2011–2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. Results Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28–0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24–0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization. Conclusions Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and

Legal issues for transgender people: a review of persistent threats.

PubMed

Green, Jamison

2017-10-01

Background The legal status of transgender (trans) people is in constant flux. Over the past 70 years, gradually increasing transgender visibility, national and global advocacy, and, more recently, widespread Internet access, communication, and broadening support from allies, have all contributed to successful campaigns that have improved transgender lives and legitimised transgender. Still, traumatic interactions with the legal system or policing agencies remain plentiful. This is a very general overview of the most common legal issues confronting trans people. It aims to inform medical and mental health providers about the trepidation with which their patients and clients must engage legal systems, and the scope of their concerns, which ultimately affect their health. This review relies upon reports generated by advocacy organisations based on population surveys in several countries, the projects undertaken by legal and human rights advocacy groups, the topics most frequently discussed in academic texts examining transgender legal issues, and draws upon the author's personal advocacy experience. The most complicated and persistent issues are identity recognition, family law and relationship issues, adverse discrimination and anti-transgender violence and its aftermath. Criminal law, almost universally, treats trans people according to the lowest common denominator, their genital status, which supposedly supports expediency and "safety". Global legal and human rights efforts remain desperately needed to lift transgender people from the margins of society and provide them with equal opportunities to lead healthy and fulfilling lives. Access to appropriate and meaningful health care is a crucial element necessary to affirm the humanity of any person.

Understanding Online Resource Use by Transgender Youth and Caregivers: A Qualitative Study

PubMed Central

Evans, Yolanda N.; Gridley, Samantha J.; Crouch, Julia; Wang, Alicia; Moreno, Megan A.; Ahrens, Kym; Breland, David J.

2017-01-01

Abstract Purpose: This study assessed what online resources transgender youth and their caregivers use to acquire information about transgender health. Methods: Through a variety of settings, including subspecialty clinics, support groups, and online solicitation, we recruited caregivers of transgender youth aged 22 years or younger and self-identified transgender youth aged 14–22 years. We used a mixed methods approach of conducting in-person focus groups, interviews in person or through phone, and an online survey that allowed for increased flexibility for participants and to triangulate key themes from multiple data sources. Scripts were semistructured, and prompts were focused on resources accessed by transgender youth and their caregivers. Results: We had a total of 65 participants, including 50 caregivers and 15 youth. Five main themes emerged from participants on why they sought out information on the Internet and what they found in their online searches. These themes include (1) exploring gender identity, (2) filling knowledge gaps, (3) seeking support networks, (4) finding transgender-friendly providers, and (5) encountering misinformation. Conclusion: Our findings demonstrate the need for reliable trustworthy content online, the importance of the virtual community to support both youth and caregivers, and the challenge of navigating misinformation that is often faced by transgender youth as they navigate online resources. We propose partnering with professional organizations, such as the American Academy of Pediatrics or World Professional Association of Transgender Health, to promote evidence-based guidelines, position statements, and online information on healthcare for transgender youth. PMID:29082333

Prevalence of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infections Among Transgender Persons Referred to an Italian Center for Total Sex Reassignment Surgery.

PubMed

Luzzati, Roberto; Zatta, Marta; Pavan, Nicola; Serafin, Maurizia; Maurel, Cristina; Trombetta, Carlo; Barbone, Fabio

2016-07-01

The burden of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in transgender population is an underestimated issue. We performed a study to evaluate the prevalence of such infections in transgender persons addressed our center for total sex reassignment surgery (SRS). All transgender persons undergoing SRS from 2000 to 2014 were evaluated retrospectively. Participant characteristics and results of HIV, HBV, and HCV testing were collected. Exact Fisher test, Cochran-Armitage tests for trend and correct prevalence ratios were estimated. Among 498 transgender persons, 243 had confirmed serological data. Of them, 25 were female-to-male and 218 male-to-female (MtF) subjects. The prevalence of HIV, HBV and HCV infections was 0%, 4.0%, and 8.0% in female-to-male, and 12.1%, 4.6%, and 3.7% in MtF. Among MtF, younger age and earlier year of SRS were associated with lower HIV prevalence. From the multivariate model, the mutually adjustment prevalence ratios were 1.9 (95% confidence interval [95% CI], 1.2-3.1) for SRS in 2005-2010 and 3.6 (95% CI, 1.3-9.4) in 2010-2014, as compared with SRS in 2000-2004; and 4.7 (95% CI, 2.4-9.4) for South Americans as compared with others. Among the HCV-positive MtF, 57.1% were also HIV-positive. Regarding HBV, the immunity was 38.5% and, after mutual adjustment, the prevalence ratios were 2.1 (95% CI, 1.3-3.4) for South Americans versus others and 2.2 (95% CI, 1.6-3.1) for year of birth ≥ 1980. The prevalence of HBV and HCV infections among our transgender persons overlaps that reported in the general population, but HCV prevalence was much higher in HIV-infected MtF. The high burden of HIV infection among MtF and its recent incremented prevalence points out that social and medical support should be strongly promoted in such population.

Transactional Pathways of Transgender Identity Development in Transgender and Gender Nonconforming Youth and Caregivers from the Trans Youth Family Study

PubMed Central

Katz-Wise, Sabra L.; Budge, Stephanie L.; Fugate, Ellen; Flanagan, Kaleigh; Touloumtzis, Currie; Rood, Brian; Perez-Brumer, Amaya; Leibowitz, Scott

2017-01-01

Background A growing body of research has examined transgender identity development, but no studies have investigated developmental pathways as a transactional process between youth and caregivers, incorporating perspectives from multiple family members. The aim of this study was to conceptualize pathways of transgender identity development using narratives from both transgender and gender nonconforming (TGN) youth and their cisgender (non-transgender) caregivers. Methods The sample included 16 families, with 16 TGN youth, ages 7–18 years, and 29 cisgender caregivers (N = 45 family members). TGN youth represented multiple gender identities, including trans boy (n = 9), trans girl (n = 5), gender fluid boy (n = 1), and girlish boy (n = 1). Caregivers included mothers (n = 17), fathers (n = 11), and one grandmother. Participants were recruited from LGBTQ community organizations and support networks for families with transgender youth in the Midwest, Northeast, and South regions of the United States. Each family member completed a one-time in-person semi-structured qualitative interview that included questions about transgender identity development. Results Analyses revealed seven overarching themes of transgender identity development, which were organized into a conceptual model: Trans identity development, sociocultural influences/societal discourse, biological influences, family adjustment/impact, stigma/cisnormativity, support/resources, and gender affirmation/actualization. Conclusions Findings underscore the importance of assessing developmental processes among TGN youth as transactional, impacting both youth and their caregivers. PMID:29527139

Exploring the Needs, Expectations, and Realities of Mental Healthcare for Transgender Adults: A Grounded Theory Study on Experiences in Sweden

PubMed Central

Carroll-Beight, Debra; Larsson, Markus

2018-01-01

Abstract Purpose: Transgender persons experience a disproportionate representation in adverse mental health conditions globally. In Sweden, there are tangible efforts to improve mental healthcare overall, but transgender persons still struggle with meeting their mental healthcare needs and there is an absence of understanding the role of mental healthcare for this population and how services are being utilized. Thus, the aim of this study was to gain knowledge from transgender individuals in Sweden concerning their mental healthcare, their needs, expectations, and realities, regardless of transition status. Methods: Eleven in-depth interviews were conducted with persons who identified as transgender, older than 18 years, at some stage of transition in Sweden. Data were collected, analyzed, and interpreted using constructivist ground theory. Results: Three categories emerged from the analysis, Feeling Objectification Rather than Subjectivity, Constructing the Narrative, and Reflecting on Aspects of Care that illustrate the dual tensions at play in transgender visibility, communication with mental healthcare professionals, and expectations of care. Six subcategories further delineate the specific forces at work that construct the mental healthcare experiences for trans persons. Conclusion: Increased knowledge and visibility of transgender persons are needed to adequately serve the mental healthcare needs for this population. Currently, there are barriers that inhibit transgender persons from getting the mental healthcare assistance desired and needed, as they do not view the healthcare system as safe space. As steps are being taken to depathologize transgender identities, momentum should be continued to create space for trans persons that enables unencumbered mental health assistance. PMID:29806033

76 FR 39879 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

... Have Sex with Men and Young Transgender Persons of Color, Funding Opportunity Announcement (FOA) PS11... Prevention Projects for Young Men of Color Who Have Sex with Men and Young Transgender Persons of Color, FOA...

A Novel Method for Estimating Transgender Status Using Electronic Medical Records

PubMed Central

Roblin, Douglas; Barzilay, Joshua; Tolsma, Dennis; Robinson, Brandi; Schild, Laura; Cromwell, Lee; Braun, Hayley; Nash, Rebecca; Gerth, Joseph; Hunkeler, Enid; Quinn, Virginia P.; Tangpricha, Vin; Goodman, Michael

2016-01-01

Background We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records (EMR) of an integrated health system. Methods A SAS program scanned Kaiser Permanente Georgia EMR from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., “transgender” or “transsexual”) in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second SAS program and another round of text string reviews. Results Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37-54%), 56% (35-75%), and 100% (96-100%), respectively. Of the 185 definitely transgender people, 99 (54%, 95% CI: 46-61%) were MTF, 84 (45%, 95% CI: 38-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. Conclusions The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems. PMID:26907539

African American Transgender Women's Individual, Family, and Organizational Relationships: Implications for Nurses.

PubMed

Cornelius, Judith B; Whitaker-Brown, Charlene D

2017-06-01

Guided by the relational cultural theory, we conducted a qualitative study to examine the relationship experiences of African American transgender women living in North Carolina. A convenience sample of 15 transgender women participated in the study. Semi-structured interviews, guided by an investigator-developed interview guide, were used to explore the personal experiences of transgender women on individual, family, and organizational levels. The findings provide a scheme for understanding the process through which transgender women's relationships hinder or enhance their ability to connect with individuals, family, and organizations. Nurses can use these findings to better understand the connectedness that occurs or does not occur in transgender women's relationships and provide culturally competent care to empower them to become resilient.

Influences of peers, teachers, and climate on students' willingness to intervene when witnessing anti-transgender harassment.

PubMed

Wernick, Laura J; Kulick, Alex; Inglehart, M H

2014-08-01

Transgender young people are at increased risk for bullying, harassment, and negative mental health and academic outcomes compared to the general population as well as compared to other members of lesbian, gay, bisexual, transgender, queer, questioning, and similarly identified (LGBTQQ) communities. To inform interventions to support transgender students, the present study investigates students' willingness to intervene when witnessing anti-transgender harassment, using data collected from a participatory action research project investigating school climate. Multi-step linear regression was used to test the impacts of hearing transphobic language and witnessing teachers and others students intervene, while controlling for demographics and school. Hostile climate negatively predicted intervention intentions while witnessing peer intervention positively predicted likelihood to intervene. Witnessing teacher intervention did not significantly predict the outcome. These findings suggest that youth-led interventions in peer networks might be effective in diminishing transphobic bullying and supporting the healthy development of transgender young people. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Exploring barriers and facilitators to participation of male-to-female transgender persons in preventive HIV vaccine clinical trials.

PubMed

Andrasik, Michele Peake; Yoon, Ro; Mooney, Jessica; Broder, Gail; Bolton, Marcus; Votto, Teress; Davis-Vogel, Annet

2014-06-01

Observed seroincidence and prevalence rates in male-to-female (MTF) transgender individuals highlight the need for effective targeted HIV prevention strategies for this community. In order to develop an effective vaccine that can be used by transgender women, researchers must understand and address existing structural issues that present barriers to this group's participation in HIV vaccine clinical trials. Overcoming barriers to participation is important for ensuring HIV vaccine acceptability and efficacy for the MTF transgender community. To explore barriers and facilitators to MTF transgender participation in preventive HIV vaccine clinical trials, the HIV Vaccine Trials Network conducted focus groups among transgender women in four urban areas (Atlanta, Boston, Philadelphia, and San Francisco). Barriers and facilitators to engagement of transgender women in preventive HIV vaccine clinical trials led to the following recommendations: (a) transgender cultural competency training, (b) creating trans-friendly environments, (c) true partnerships with local trans-friendly organizations and health care providers, (d) protocols that focus on transgender specific issues, and (e) data collection and tracking of transgender individuals. These results have implications for the conduct of HIV vaccine trials, as well as engagement of transgender women in research programs in general.

A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action

PubMed Central

Glynn, Tiffany R.; van den Berg, Jacob J.

2017-01-01

Abstract Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work. PMID:28861547

Examining transgender health through the International Classification of Functioning, Disability, and Health's (ICF) Contextual Factors.

PubMed

Jacob, Melissa; Cox, Steven R

2017-12-01

For many transgender individuals, medical intervention is necessary to live as their desired gender. However, little is known about Contextual Factors (i.e., Environmental and Personal) that may act as facilitators and barriers in the health of transgender individuals. Therefore, this paper sought to examine Contextual Factors of the World Health Organization's International Classification of Functioning, Disability, and Health that may facilitate or negatively impact the physical, psychological, and social functioning of transgender individuals. A literature review was conducted to identify Environmental and Personal Factors that may influence transgender individuals' physical, psychological, and social functioning. Seven electronic databases were searched. In total, 154 records were reviewed, and 41 articles and other records met inclusion criteria. Three general themes emerged for Environmental Factors: family and social networks, education, and health care. Three general themes also emerged for Personal Factors: socioeconomic status, race, and age. Transgender individuals benefit from gender-affirming services, improved family and social support systems, and competent provider care. Educational training programs, including medical curricula or workshops, might provide the greatest benefit in improving transgender health by increasing the knowledge and cultural competency of health professionals working with this population. Given the diversity of gender expression, differences in lived experiences, and potential for enduring persistent "double discrimination" due to the intersectional relationships between socioeconomic status, race, and/or age, health professionals must approach transgender health using a holistic lens such as the World Health Organization's International Classification of Functioning, Disability, and Health.

Psychiatrists' and Psychiatry Residents' Attitudes Toward Transgender People.

PubMed

Ali, Nareesa; Fleisher, William; Erickson, Julie

2016-04-01

Gender minority groups, such as transgender individuals, frequently encounter stigma, discrimination, and negative mental health outcomes, which can result in contact with mental health professionals. Recent studies suggest that negative attitudes toward transgender individuals are prevalent and measurable within the general population. The Genderism and Transphobia scale (GTS) measures anti-transgender feelings, thoughts, and behaviors. The purpose of this study was to use the GTS to conduct an investigation of psychiatrists' attitudes toward transgender individuals. A cross-sectional survey of n = 142 faculty members and residents from the Department of Psychiatry at the University of Manitoba was conducted. Respondents completed an online survey consisting of demographic questions and the GTS. Responses were analyzed descriptively and compared to previously published data on the GTS. There was a trend for psychiatrists and psychiatry residents within this sample to endorse less negative attitudes toward transgender people compared to other published data using a sample of undergraduate students. Descriptive analyses suggest that psychiatrists' and psychiatry residents' GTS scores may be related to gender identity, political ideology, religiosity, and levels of both professional and personal contact. These data evoke optimism regarding psychiatrists' and psychiatry residents' attitudes toward transgender individuals. Additional larger-scale studies comparing this medical specialty group with other specialty groups will further elucidate factors that modify physician attitudes toward this patient population. These findings may contribute to the development of educational strategies to ensure that the transgender population receives medical treatment without stigma or attitudinal compromise.

Behavioral and Health Outcomes for HIV+ Young Transgender Women Linked To and Engaged in Medical Care

PubMed Central

Matone, Meredith; Luan, Xianqun; Lee, Susan; Belzer, Marvin; Fernandez, Maria Isabel; Rubin, David

2016-01-01

Abstract We describe health and psychosocial outcomes of HIV+ young transgender women (YTW) engaged in care across the United States. When compared to other behaviorally infected youth (BIY), YTW reported higher rates of unemployment (25% vs. 19%), limited educational achievement (42% vs 13%), and suboptimal ART adherence (51% vs. 30%). There was no difference in likelihood of having a detectable viral load (38% vs. 39%) between groups. However, particular isolating psychosocial factors (unstable housing, depression, and lack of social support for attending appointments) increased predicted probability of viral detection to a greater extent among YTW that may have important health implications for this marginalized youth population. PMID:26789394

Teaching Transgender

ERIC Educational Resources Information Center

Wentling, Tre; Windsor, Elroi; Schilt, Kristen; Lucal, Betsy

2008-01-01

The recent visibility of transgender lives demonstrates the dawning of a new period in the potential to include transgender topics in sociology courses. The focus on transgender individuals, communities, and inclusive initiatives are gaining momentum on many public and private college and university campuses, awakening old and new curiosities,…

Being transgender: the experience of transgender identity development.

PubMed

Levitt, Heidi M; Ippolito, Maria R

2014-01-01

This article is based on a grounded theory analysis of interviews with transgender-identified people from different regions of the United States. Participants held a variety of gender identities under the transgender rubric (e.g., crossdresser, transman, transwoman, butch lesbian). Interviews explored the participants' experiences in arriving at their gender identity. This article presents three clusters of findings related to the common processes of transgender identity development. This process was made possible by accessibility of transgender narratives that injected hope into what was a childhood replete with criticism and scrutiny. Ultimately, participants came to their identities through balancing a desire for authenticity with demands of necessity--meaning that they weighed their internal gender experience with considerations about their available resources, coping skills, and the consequences of gender transitions. The implications of these findings are considered in terms of their contribution to gender theory, research, and clinical support for transgender clients.

Inconsistent condom use among young men who have sex with men, male sex workers, and transgenders in Thailand.

PubMed

Chemnasiri, Tareerat; Netwong, Taweesak; Visarutratana, Surasing; Varangrat, Anchalee; Li, Andrea; Phanuphak, Praphan; Jommaroeng, Rapeepun; Akarasewi, Pasakorn; van Griensven, Frits

2010-04-01

Young men who have sex with men (MSM) are at risk for HIV infection. We investigated inconsistent condom use among 827 sexually active young MSM (15-24 years), enrolled using venue-day-time sampling in Bangkok, Chiang Mai and Phuket, Thailand. Data was collected using palmtop computer-assisted self-interviewing. Of participants, 33.1% were regular MSM, 37.7% were male sex workers (MSWs) and 29.1% were transgenders (TGs). Of MSM, 46.7%, of MSWs, 34.9% and of TGs, 52.3% reported recent inconsistent condom use. In multivariate analysis, receptive anal intercourse (MSM, MSWs), receptive and insertive anal intercourse, living alone and a history of sexual coercion (MSWs), not carrying a condom when interviewed (MSM, TGs), lower education, worrying about HIV infection and a history of sexually transmitted infections (TGs) were significantly and independently associated with inconsistent condom use. Interventions for young MSM are needed and must consider the distinct risk factors of MSM, MSWs, and TGs.

Video gaming and gaming addiction in transgender people: An exploratory study.

PubMed

Arcelus, Jon; Bouman, Walter Pierre; Jones, Bethany Alice; Richards, Christina; Jimenez-Murcia, Susana; Griffiths, Mark D

2017-03-01

Background There is anecdotal clinical evidence that transgender people use the online world - such as forums and online video gaming - for the purpose of experiencing their gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. Aims To describe gaming behavior, degree of problematic gaming behavior and associated factors with problematic gaming in a comparatively large group of transgender people accessing transgender health services. Methods Every individual referred to a national transgender health service in the United Kingdom during a 12-month period was invited to complete a series of questionnaires to measure gaming behavior, interpersonal functioning, severity of autistic features, and anxiety and depressive symptoms. Results A total of 245 people agreed to participate in the study with 154 (62.9%) describing themselves as current gamers. Gaming behavior in the transgender population attending transgender health services was prevalent, but less than 1% of them presented with clinical scores for Internet Gaming Disorder, with no differences according to gender. Problematic gaming behavior was associated with general interpersonal problems, depression, and young age. Discussion and conclusions Transgender people who engage in problematic gaming behavior are younger, and present with high interpersonal problems, and depression, which can affect a successful transition. In view of the high levels of gaming activity in this population games that are designed to address these psychological problems may be well received by transgender people.

Video gaming and gaming addiction in transgender people: An exploratory study

PubMed Central

Arcelus, Jon; Bouman, Walter Pierre; Jones, Bethany Alice; Richards, Christina; Jimenez-Murcia, Susana; Griffiths, Mark D.

2017-01-01

Background There is anecdotal clinical evidence that transgender people use the online world – such as forums and online video gaming – for the purpose of experiencing their gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. Aims To describe gaming behavior, degree of problematic gaming behavior and associated factors with problematic gaming in a comparatively large group of transgender people accessing transgender health services. Methods Every individual referred to a national transgender health service in the United Kingdom during a 12-month period was invited to complete a series of questionnaires to measure gaming behavior, interpersonal functioning, severity of autistic features, and anxiety and depressive symptoms. Results A total of 245 people agreed to participate in the study with 154 (62.9%) describing themselves as current gamers. Gaming behavior in the transgender population attending transgender health services was prevalent, but less than 1% of them presented with clinical scores for Internet Gaming Disorder, with no differences according to gender. Problematic gaming behavior was associated with general interpersonal problems, depression, and young age. Discussion and conclusions Transgender people who engage in problematic gaming behavior are younger, and present with high interpersonal problems, and depression, which can affect a successful transition. In view of the high levels of gaming activity in this population games that are designed to address these psychological problems may be well received by transgender people. PMID:28198637

Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults.

PubMed

Mahan, Rebecca J; Bailey, Trista Askins; Bibb, Teryn J; Fenney, Megan; Williams, Tara

2016-12-01

Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

The role of gender affirmation in psychological well-being among transgender women.

PubMed

Glynn, Tiffany R; Gamarel, Kristi E; Kahler, Christopher W; Iwamoto, Mariko; Operario, Don; Nemoto, Tooru

2016-09-01

High prevalence of psychological distress, including greater depression, lower self-esteem, and suicidal ideation, has been documented across numerous samples of transgender women and has been attributed to high rates of discrimination and violence. According to the gender affirmation framework (Sevelius, 2013), access to sources of gender-affirmative support can offset such negative psychological effects of social oppression. However, critical questions remain unanswered in regards to how and which aspects of gender affirmation are related to psychological well-being. The aims of this study were to investigate the associations between three discrete areas of gender affirmation (psychological, medical, and social) and participants' reports of psychological well-being. A community sample of 573 transgender women with a history of sex work completed a one-time self-report survey that assessed demographic characteristics, gender affirmation, and mental health outcomes. In multivariate models, we found that social, psychological, and medical gender affirmation were significant predictors of lower depression and higher self-esteem while no domains of affirmation were significantly associated with suicidal ideation. Findings support the need for accessible and affordable transitioning resources for transgender women in order to promote better quality of life among an already vulnerable population. As the gender affirmation framework posits, the personal experience of feeling affirmed as a transgender person results from individuals' subjective perceptions of need along multiple dimensions of gender affirmation. Personalized assessment of gender affirmation may thus be a useful component of counseling and service provision for transgender women.

[Violence and social distress among transgender persons in Santa Maria, Rio Grande do Sul State, Brazil].

PubMed

Souza, Martha Helena Teixeira de; Malvasi, Paulo; Signorelli, Marcos Claudio; Pereira, Pedro Paulo Gomes

2015-04-01

The authors conducted an ethnographic research with transgender persons in Santa Maria, Rio Grande do Sul State, Brazil, in 2012, using participant observation, semi-structured interviews, and following their everyday lives. These individuals invariably experienced physical and symbolic violence and the resulting distress, a condition they had to deal with in their careers and daily practices and tasks. The article discusses the violence experienced by transvestites (in the family, school, police precincts, and health services), specifically seeking to understand how such violence relates to their experiences with health services and how the latter respond.

The Mental Health of Transgender Youth: Advances in Understanding.

PubMed

Connolly, Maureen D; Zervos, Marcus J; Barone, Charles J; Johnson, Christine C; Joseph, Christine L M

2016-11-01

This review provides an update on the growing body of research related to the mental health of transgender youth that has emerged since the 2011 publication of the Institute of Medicine report on the health of lesbian, gay, bisexual, and transgender people. The databases PubMed and Ovid Medline were searched for studies that were published from January 2011 to March 2016 in English. The following search terms were used: transgender, gender nonconforming, gender minority, gender queer, and gender dysphoria. Age limits included the terms youth, child, children, teenager*, and adolescen*. The combined search produced 654 articles of potential relevance. The resulting abstracts went through a tiered elimination system, and the remaining 15 articles, which presented quantitative data related to the prevalence of transgender youth and their mental health, were included in the present review. In addition to providing new estimates of the number of young people who identify as transgender (.17%-1.3%), studies since 2011 have shown that transgender youth have higher rates of depression, suicidality and self-harm, and eating disorders when compared with their peers. Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents. Recent research has demonstrated increased rates of psychiatric morbidity among transgender youth compared to their peers. Future work is needed to understand those youth who identify as gender nonbinary, improve methods to capture and understand diverse gender identities and related health disparities, and delineate the social determinants of such disparities. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

How young is too young: ethical concerns in genital surgery of the transgender MTF adolescent.

PubMed

Milrod, Christine

2014-02-01

During the last decade, the age of youths presenting for gender confirmation has steadily fallen. Transgender adolescents are being treated with gonadotropin-releasing hormone analogues and subsequently cross-sex hormones at early or midpuberty, with genital surgery as the presumed final step in treatment for female-affirmed (male-to-female) individuals. Despite the minimum age of 18 as eligibility to undergo irreversible procedures, anecdotal reports show that vaginoplasties of female-affirmed patients under 18 have been performed by surgeons, thereby contravening the World Professional Association for Transgender Health Standards of Care. The purpose of this article is (i) to provide a review of salient factors regarding genital surgery in transgender adolescents; (ii) to review various ethical protocols for determining maturity in gender dysphoric individuals under 18; and (iii) to present a new systematic set of ethical principles largely derived from the surgical management of youths with disorders of sex development and adapted to the needs of transitioning adolescents. A literature review of the topic was performed. Ethical guidelines derived from applied treatment protocols of children with disorders of sex development were written. Progressing from the current state of ethical standards and clinical assumptions, a new development of ethical guidelines for genital surgery in the female-affirmed transgender adolescent was created. There were no controlled studies of vaginoplasties performed on female-affirmed adolescents under 18 years of age. A new set of ethical guidelines was created in order to support treatment professionals in their decision making process. Professionals across disciplines treating female-affirmed adolescents can utilize the proposed ethical guidelines to facilitate decision making on a case-by-case basis in order to protect both patients and practitioners. These guidelines may also be used in support of more open discussions and

Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer.

PubMed

Wallace, Sumer Allensworth; Blough, Kiara L; Kondapalli, Laxmi A

2014-01-01

While the field of oncofertility raised awareness about fertility concerns in oncology patients, new applications for fertility preservation are emerging, such as transgender medicine. As transgender medicine evolves, the number of individuals seeking gender reassignment hormone therapy is drastically increasing, generating a population of patients with unmet fertility needs and unknown reproductive potential. We present the first case report of a female-to-male (FtM) transgender patient to undergo oocyte cryopreservation before initiating androgen therapy. Our patient is a 17-year-old FtM transgender person undergoing gender transition throughout adolescence with an endocrinologist. The patient wished to complete androgen therapy before starting his first year of college to avoid gender ambiguity. After extensive consultation and psychological assessment, the patient was considered an appropriate candidate and proceeded with oocyte cryopreservation. He underwent baseline fertility testing followed by successful ovarian stimulation and surgical retrieval. We recommend that a discussion of reproductive health concerns and fertility preservation options be incorporated into the comprehensive care of transgender patients.

A Review of the Content and Format of Transgender-Related Webpages

PubMed Central

Horvath, Keith J.; Iantaffi, Alex; Grey, Jeremy A.; Bockting, Walter

2013-01-01

Transgender persons represent a highly diverse group of individuals who have been historically underserved, despite being disproportionately at risk for HIV (human immunodeficiency virus) and other health conditions. Despite the need for more research on transgender health issues, no review of online transgender-related resources has been conducted. The purpose of this study was to broadly characterize (1) the types of transgender-related webpages that appear as a result of keyword searches, and (2) the extent to which webpages differ in content and format depending on whether the intended audience for the webpage was transgender individuals, health professionals, or the general population. An online search using 28 keywords yielded 204 eligible webpages, of which 58% targeted transgendered individuals, 23% targeted health professionals, and 39% targeted the general public. The highest percentage of webpages appeared to be operated and/or created by transgender individuals or groups (46%), followed by for-profit businesses (17%). The majority of mental health (80%), HIV-related (89%), and primary care (100%) webpages targeted health professionals. Although various features are available that may increase user interest in and perceived credibility of a webpage, the results show that many of these features were underutilized. There appears to be significant opportunity to develop web resources that directly target unique subgroups within the transgender community to improve their health outcomes, increase the visibility of features that increase user interest and perceived credibility of webpages, and possibly train transgender individuals to seek relevant online information. PMID:22007970

Advances in the Care of Transgender Children and Adolescents

PubMed Central

Shumer, Daniel E; Nokoff, Natalie J; Spack, Norman P

2016-01-01

Children and adolescents with gender dysphoria are presenting for medical attention at increasing rates. Standards of Care have been developed which outline appropriate mental health support and hormonal interventions for transgender youth. This article defines terminology related to gender identity, reviews the history of medical interventions for transgender persons, outlines what is known about gender identity development, and reviews mental health disparities faced by this patient population. We provide an overview of medical management options for transgender adolescents meeting diagnostic criteria for gender dysphoria including pubertal suppression, cross-sex hormones, longitudinal screening and anticipatory guidance. We describe current challenges in the field and provide information about how care is currently being provided in the US and Canada. We conclude with 5 brief case examples. PMID:27426896

Young persons with visual impairment: challenges of participation.

PubMed

Salminen, Anna-Liisa; Karhula, Maarit E

2014-07-01

To describe the challenges to activity and participation faced by young people with visual impairment within the framework of the International Classification of Functioning (ICF). 14 young persons (aged 16-22 years) with visual impairment and their parents (n = 22) participated in the study. The Canadian Occupational Performance Measure (COPM) was used to describe challenges of participation as perceived by the young persons themselves. Individual interviews with the young persons and their parents were used to investigate in more depth the challenges the young persons face with regard to participation. Young persons with visual impairment face challenges to participation most frequently with regard to mobility, domestic life, interpersonal interaction and relationships, major life areas, and leisure activities. The environment in which they live has a central role as a barrier or facilitator of participation. The challenges related to activities and participation that young persons with visual impairment face are diverse. It is important that these challenges are assessed individually and with the help of subjective measures. Serving as a broad framework for classifying the data, the ICF proved to be a useful tool, but used strictly at category level it may limit the coding of data and narrow interpretation.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

PubMed

Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

2018-01-01

Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia

PubMed Central

Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.

2018-01-01

Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183

Transgender in China

ERIC Educational Resources Information Center

Jun, Pi

2010-01-01

This autobiographical essay of a Chinese transgender who has grown up in a special social background involves the Chinese family, religion, and some social background to demonstrate the current situation of lesbian, gay, bisexual, and transgender groups, especially the condition of female-to-male transgender.

Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009-2014.

PubMed

Lemons, Ansley; Beer, Linda; Finlayson, Teresa; McCree, Donna Hubbard; Lentine, Daniel; Shouse, R Luke

2018-01-01

To present the first national estimate of the sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men receiving medical care in the United States. This analysis included pooled interview and medical record data from the 2009 to 2014 cycles of the Medical Monitoring Project, which used a 3-stage, probability-proportional-to-size sampling methodology. Transgender men accounted for 0.16% of all adults and 11% of all transgender adults receiving HIV medical care in the United States from 2009 to 2014. Of these HIV-positive transgender men receiving medical care, approximately 47% lived in poverty, 69% had at least 1 unmet ancillary service need, 23% met criteria for depression, 69% were virally suppressed at their last test, and 60% had sustained viral suppression over the previous 12 months. Although they constitute a small proportion of all HIV-positive patients, more than 1 in 10 transgender HIV-positive patients were transgender men. Many experienced socioeconomic challenges, unmet needs for ancillary services, and suboptimal health outcomes. Attention to the challenges facing HIV-positive transgender men may be necessary to achieve the National HIV/AIDS Strategy goals of decreasing disparities and improving health outcomes among transgender persons.

The HIV Risk Profiles of Latino Sexual Minorities and Transgender Persons Who Use Websites or Apps Designed for Social and Sexual Networking.

PubMed

Sun, Christina J; Reboussin, Beth; Mann, Lilli; Garcia, Manuel; Rhodes, Scott D

2016-02-01

The use of websites and GPS-based mobile applications ("apps") designed for social and sexual networking has been associated with increased HIV risk; however, little is known about Latino sexual minorities' and transgender persons' use of these websites and apps and the risk profiles of those who use them compared with those who do not. Data from 167 participants who completed the baseline survey of a community-level HIV prevention intervention, which harnesses the social networks of Latino sexual minorities and transgender persons, were analyzed. One quarter of participants (28.74%, n = 48) reported using websites or apps designed for social and sexual networking, and 119 (71.26%) reported not using websites or apps designed for social and sexual networking. Those who used websites or apps were younger and reported more male sex partners, a sexually transmitted disease diagnosis, and illicit drug use other than marijuana. HIV prevention interventions for those who use websites or apps should consider addressing these risks for HIV. © 2015 Society for Public Health Education.

The HIV Risk Profiles of Latino Sexual Minorities and Transgender Persons Who Use Websites or Apps Designed for Social and Sexual Networking

ERIC Educational Resources Information Center

Sun, Christina J.; Reboussin, Beth; Mann, Lilli; Garcia, Manuel; Rhodes, Scott D.

2016-01-01

The use of websites and GPS-based mobile applications ("apps") designed for social and sexual networking has been associated with increased HIV risk; however, little is known about Latino sexual minorities' and transgender persons' use of these websites and apps and the risk profiles of those who use them compared with those who do not.…

Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas.

PubMed

Palazzolo, Sarah L; Yamanis, Thespina J; De Jesus, Maria; Maguire-Marshall, Molly; Barker, Suyanna L

2016-04-01

The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18- to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population.

Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas

PubMed Central

Palazzolo, Sarah L.; De Jesus, Maria; Maguire-Marshall, Molly; Barker, Suyanna L.

2016-01-01

Abstract Purpose: The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. Methods: We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18- to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Results: Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Conclusions: Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population. PMID:26669583

Improving Transgender Healthcare in the New York City Correctional System.

PubMed

Jaffer, Mohamed; Ayad, John; Tungol, Jose Gabriel; MacDonald, Ross; Dickey, Nathaniel; Venters, Homer

2016-04-01

Correctional settings create unique challenges for patients with special needs, including transgender patients, who have an increased rate of overall discrimination, sexual abuse, healthcare disparities, and improper housing. As part of our correctional health quality improvement process, we sought to review and evaluate the adequacy of care for transgender patients in the New York City jail system. Using correctional pharmacy records, transgender patients receiving hormonal treatment were identified. A brief in-person survey was conducted to evaluate their care in the community before incarceration, medical care in jail, and experience in the jail environment. Survey findings and analysis of transgender patient healthcare-related complaints revealed opportunities for improvements in the provision of care and staff understanding of this population. Utilizing these findings, we conducted lesbian, gay, bisexual, and transgender (LGBT) trainings in all 12 jail clinics for medical, nursing, and mental health staff. Three months after LGBT training, patient complaints dropped by over 50%. After the development and implementation of a newly revised transgender healthcare policy, complaints dropped to zero within 6 months. Our efforts to assess the quality of care provided to transgender patients revealed significant areas for improvement. Although we have made important gains in providing quality care through the implementation of policies and procedures rooted in community standards and the express wishes of our patients, we continue to engage this patient population to identify other issues that impact their health and well-being in the jail environment.

Translating Personality Psychology to Help Personalize Preventive Medicine for Young-Adult Patients

PubMed Central

Israel, Salomon; Moffitt, Terrie E.; Belsky, Daniel W.; Hancox, Robert J.; Poulton, Richie; Roberts, Brent; Thomson, W. Murray; Caspi, Avshalom

2014-01-01

The rising number of newly insured young adults brought on by healthcare reform will soon increase demands on primary-care physicians. Physicians will face more young-adult patients which presents an opportunity for more prevention-oriented care. In the current study, we evaluated whether brief observer reports of young adults’ personality traits could predict which individuals would be at greater risk for poor health as they entered midlife. Following the Dunedin Study cohort of 1,000 individuals, we show that very brief measures of young adults’ personalities predicted their midlife physical health across multiple domains (metabolic abnormalities, cardiorespiratory fitness, pulmonary function, periodontal disease, and systemic inflammation). Individuals scoring low on the traits of Conscientiousness and Openness-to-Experience went on to develop poorer health even after accounting for preexisting differences in education, socioeconomic status, smoking, obesity, self-reported health, medical conditions, and family medical history. Moreover, personality ratings from peer informants who knew participants well, and from a nurse and receptionist who had just met participants for the first time, predicted health decline from young adulthood to midlife despite striking differences in level of acquaintance. Personality effect sizes were on par with other well-established health-risk factors such as socioeconomic status, smoking, and self-reported health. We discuss the potential utility of personality measurement to function as an inexpensive and accessible tool for healthcare professionals to personalize preventive medicine. Adding personality information to existing healthcare electronic infrastructures could also advance personality theory by generating opportunities to examine how personality processes influence doctor-patient communication, health service use, and patient outcomes. PMID:24588093

Mortality Among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000-2009.

PubMed

Blosnich, John R; Brown, George R; Wojcio, Sybil; Jones, Kenneth T; Bossarte, Robert M

2014-12-01

The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status. The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5,117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000-2009 for 1,277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3,840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups. Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide

Marginalization and social change processes among lesbian, gay, bisexual and transgender persons in Swaziland: implications for HIV prevention.

PubMed

H Logie, Carmen; Perez-Brumer, Amaya; Jenkinson, Jesse; Madau, Veli; Nhlengethwa, Winnie; Baral, Stefan

2018-05-30

Swaziland has among the highest national adult HIV prevalence globally. There is limited knowledge of HIV vulnerabilities and prevention engagement among lesbian, gay, bisexual and transgender (LGBT) persons in the context of Swaziland's criminalization of consensual same-sex practices. This study explored social processes of marginalization to assess how they could potentiate HIV vulnerabilities and limit engagement in HIV prevention services. Additionally, we assessed positive change to better understand existing strategies employed by LGBT persons to challenge these HIV prevention barriers. Guided by community-based research methodology and conducted in Mbabane and Manzini, Swaziland, data were collected by LGBT peer-research assistants (PRA) in collaboration with an LGBT community organization in Manzini. Semi-structured interviews were conducted by trained PRAs and explored HIV prevention, including experiences of stigma and coping. Audio files were transcribed verbatim, translated to English, and analyzed using thematic techniques. Among participants (n = 51; mean age: 26.47, SD: 4.68), 40 self-identifed as gay or lesbian (78.4%), 11 bisexual (22.6%), and 12 (23.5%) identified as transgender. Findings highlighted three primary processes of marginalization and positive change in structural, community, and internal domains. First, structural marginalization, which included criminalization, healthcare discrimination, and a scarcity of LGBT tailored HIV prevention resources was challenged by grassroots networks created to access and share specific HIV resources with LGBT persons and the Ministry of Health. Second, community marginalization included stigma and multi-dimensional forms of violence, however, this was met with LGBT persons providing mutual peer support, including for accessing HIV testing services. Thirdly, internal marginalization comprised of self-stigma and associated sexual risk practices was contrasted with coping strategies focused on self

Gender identity and the management of the transgender patient: a guide for non-specialists.

PubMed

Joseph, Albert; Cliffe, Charlotte; Hillyard, Miriam; Majeed, Azeem

2017-04-01

In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between a person's natal sex (that assigned to them at birth) and gender identity results in distress, with high associated rates of self-harm, suicidality and functional impairment. We show that gender reassignment can be a safe and effective treatment for gender dysphoria with counselling, exogenous hormones and surgery being the mainstay of treatment. The role of the general practitioner in the management of transgender patients is discussed and we consider whether hormone therapy should be initiated in primary care in the absence of specialist advice, as is suggested by recent General Medical Council guidance.

Personality-Relationship transaction in young adulthood.

PubMed

Neyer, F J; Asendorpf, J B

2001-12-01

Personality and social relationships were assessed twice across a 4-year period in a general population sample of 489 German young adults. Two kinds of personality-relationship transaction were observed. First, mean-level change in personality toward maturity (e.g., increase in Conscientiousness and decrease in Neuroticism) was moderated by the transition to partnership but was independent of other developmental transitions. Second, individual differences in personality traits predicted social relationships much better than vice versa. Specifically, once initial correlations were controlled for, Extraversion, Shyness, Neuroticism, self-esteem, and Agreeableness predicted change in various qualities of relationships (especially with friends and colleagues), whereas only quality of relationships with preschool children predicted later Extraversion and Neuroticism. Consequences for the transactional view of personality in young adulthood are discussed.

LifeSkills for Men (LS4M): Pilot Evaluation of a Gender-Affirmative HIV and STI Prevention Intervention for Young Adult Transgender Men Who Have Sex with Men.

PubMed

Reisner, Sari L; Hughto, Jaclyn M White; Pardee, Dana J; Kuhns, Lisa; Garofalo, Rob; Mimiaga, Matthew J

2016-02-01

Young adult transgender men who have sex with men (TMSM) engage in sexual behaviors that place them at risk of sexually transmitted infections (STIs) including HIV. To date, no HIV and STI prevention interventions have been developed specifically for young adult TMSM. To address this gap, the current study aimed to (1) adapt a small group-based behavioral HIV prevention intervention designed for young transgender women ("LifeSkills") to address the unique HIV and STI prevention needs of young TMSM ages 18-29 years and (2) conduct a pilot evaluation of the intervention ("LifeSkills for Men"; LS4M). LS4M was carried out in an iterative approach with community input along the way, which allowed for refinement of the intervention manual and enhanced participant acceptability. A LS4M Task Force was convened to guide intervention development/adaptation and study implementation. Initially, focus groups were conducted to examine the sexual health needs, concerns, and stressors facing young TMSM (n = 12; mean age = 23.8 years; 16.7% people of color). Next, LS4M was pilot tested (n = 17; mean age = 24.3 years; 23.5% people of color) to assess acceptability with the study population and feasibility of all study procedures. Overall attendance, participation rates, and positive feedback from participants demonstrate that LS4M is highly acceptable and feasible to carry out with young TMSM. Trends in outcome measures across 4 months of follow-up suggest that participation in the intervention may improve mental health, reduce internalized stigma, and reduce HIV- and STI-related risk behaviors. Further testing of the intervention enrolling young TMSM with recent sexual risk behavior at baseline and with a control group is warranted. Lessons learned for future work with young TMSM are discussed.

Novel approaches to HIV prevention and sexual health promotion among Guatemalan gay and bisexual men, MSM, and transgender persons.

PubMed

Rhodes, Scott D; Alonzo, Jorge; Mann, Lilli; Downs, Mario; Simán, Florence M; Andrade, Mario; Martinez, Omar; Abraham, Claire; Villatoro, Guillermo R; Bachmann, Laura H

2014-08-01

The burden of HIV is disproportionate for Guatemalan sexual minorities (e.g., gay and bisexual men, men who have sex with men [MSM], and transgender persons). Our bi-national partnership used authentic approaches to community-based participatory research (CBPR) to identify characteristics of potentially successful programs to prevent HIV and promote sexual health among Guatemalan sexual minorities. Our partnership conducted Spanish-language focus groups with 87 participants who self-identified as male (n=64) or transgender (n=23) and individual in-depth interviews with ten formal and informal gay community leaders. Using constant comparison, an approach to grounded theory, we identified 20 characteristics of potentially successful programs to reduce HIV risk, including providing guidance on accessing limited resources; offering supportive dialogue around issues of masculinity, socio-cultural expectations, love, and intimacy; using Mayan values and images; harnessing technology; increasing leadership and advocacy skills; and mobilizing social networks. More research is clearly needed, but participants reported needing and wanting programming and had innovative ideas to prevent HIV exposure and transmission.

Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center.

PubMed

Reisner, Sari L; Vetters, Ralph; White, Jaclyn M; Cohen, Elijah L; LeClerc, M; Zaslow, Shayne; Wolfrum, Sarah; Mimiaga, Matthew J

2015-01-01

The sexual health of transgender adolescents and young adults who present for health care in urban community health centers is understudied. A retrospective review of electronic health record (EHR) data was conducted from 180 transgender patients aged 12-29 years seen for one or more health-care visits between 2001 and 2010 at an urban community health center serving youth in Boston, MA. Analyses were restricted to 145 sexually active transgender youth (87.3% of the sample). Laboratory-confirmed HIV and sexually transmitted infections (STIs) seroprevalence, demographics, sexual risk behavior, and structural and psychosocial risk indicators were extracted from the EHR. Analyses were descriptively focused for HIV and STIs. Stratified multivariable logistic regression models were fit for male-to-female (MTF) and female-to-male (FTM) patients separately to examine factors associated with any unprotected anal and/or vaginal sex (UAVS). The mean age was 20.0 (SD=2.9); 21.7% people of color, 46.9% white (non-Hispanic), 21.4% race/ethnicity unknown; 43.4% MTF, and 56.6% FTM; and 68.3% were on cross-sex hormones. Prevalence of STIs: 4.8% HIV, 2.8% herpes simplex virus, 2.8% syphilis, 2.1% chlamydia, 2.1% gonorrhea, 2.8% hepatitis C, 1.4% human papilloma virus. Only gonorrhea prevalence significantly differed by gender identity (MTF 2.1% vs. 0.0% FTM; p=0.046). Nearly half (47.6%) of the sample engaged in UAVS (52.4% MTF, 43.9% FTM, p=0.311). FTM more frequently had a primary sex partner compared to MTF (48.8% vs. 25.4%; p=0.004); MTF more frequently had a casual sex partner than FTM (69.8% vs. 42.7% p=0.001). In multivariable models, MTF youth who were younger in age, white non-Hispanic, and reported a primary sex partner had increased odds of UAVS; whereas, FTM youth reporting a casual sex partner and current alcohol use had increased odds of UAVS (all p<0.05). Factors associated with sexual risk differ for MTF and FTM youth. Partner type appears pivotal to understanding

Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009–2014

PubMed Central

Lemons, Ansley; Beer, Linda; Finlayson, Teresa; McCree, Donna Hubbard; Lentine, Daniel; Shouse, R. Luke

2017-01-01

Objectives To present the first national estimate of the sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men receiving medical care in the United States. Methods This analysis included pooled interview and medical record data from the 2009 to 2014 cycles of the Medical Monitoring Project, which used a 3-stage, probability-proportional-to-size sampling methodology. Results Transgender men accounted for 0.16% of all adults and 11% of all transgender adults receiving HIV medical care in the United States from 2009 to 2014. Of these HIV-positive transgender men receiving medical care, approximately 47% lived in poverty, 69% had at least 1 unmet ancillary service need, 23% met criteria for depression, 69% were virally suppressed at their last test, and 60% had sustained viral suppression over the previous 12 months. Conclusions Although they constitute a small proportion of all HIV-positive patients, more than 1 in 10 transgender HIV-positive patients were transgender men. Many experienced socioeconomic challenges, unmet needs for ancillary services, and suboptimal health outcomes. Attention to the challenges facing HIV-positive transgender men may be necessary to achieve the National HIV/AIDS Strategy goals of decreasing disparities and improving health outcomes among transgender persons. PMID:29161069

Biotechnologies that empower transgender persons to self-actualize as individuals, partners, spouses, and parents are defining new ways to conceive a child: psychological considerations and ethical issues.

PubMed

Condat, Agnès; Mendes, Nicolas; Drouineaud, Véronique; Gründler, Nouria; Lagrange, Chrystelle; Chiland, Colette; Wolf, Jean-Philippe; Ansermet, François; Cohen, David

2018-01-17

Today, thanks to biomedical technologies advances, some persons with fertility issues can conceive. Transgender persons benefit also from these advances and can not only actualize their self-identified sexual identities but also experience parenthood. Based on clinical multidisciplinary seminars that gathered child psychiatrists and psychoanalysts interested in the fields of assisted reproduction technology (ART) and gender dysphoria, philosophers interested in bioethics, biologists interested in ART, and endocrinologists interested in pubertal suppression, we explore how new biotechnical advances, whether in gender transition or procreation, could create new ways to conceive a child possible. After reviewing the various medical/surgical techniques for physical gender transition and the current ART options, we discuss how these new ways for persons to self-actualize and to experience parenthood can not only improve the condition of transgender persons (and the human condition as a whole through greater equity) but also introduce some elements of change in the habitual patterns of thinking especially in France. Finally, we discuss the ethical issues that accompany the arrival of these children and provide creative solutions to help society handle, accept, and support the advances made in this area.

Access to fertility services by transgender persons: an Ethics Committee opinion.

PubMed

2015-11-01

This statement explores the ethical considerations surrounding the provision of fertility services to transgender individuals and concludes that denial of access to fertility services is not justified. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Transgender Youth

ERIC Educational Resources Information Center

Ludeke, Micah

2009-01-01

"Transgender" is an umbrella term for people who self-identify as other than their birth sex (male or female). The exploration of gender nonconformance occurs among people across all ethnic, racial, and socioeconomic groups. Transgender or questioning students may have unique challenges and stressors in their daily lives, including school. Often,…

HIV-related sexual risk behaviors among male-to-female transgender people in Nepal.

PubMed

Bhatta, Dharma Nand

2014-05-01

Transgender women are a vulnerable and key risk group for HIV, and most research has shown an increased frequency of HIV infection among this minority population. This study examined the prevalence of HIV-related sexual risk behaviors and the socio-demographic correlates with HIV-related sexual risk behaviors among male-to-female (MtF) transgender persons. Data were collected from a sample of 232 individuals through venue-based and snowball sampling and face-to-face interviews. The HIV-related sexual risk behaviors among the MtF transgender persons were: sex without using a condom (48.3%; 95% confidence interval (CI) 41.8-54.8), unprotected anal sex (68.1%; 95% CI 62.0-74.2), and unprotected sex with multiple partners (88.4%; 95% CI 84.3-92.5). Statistically significant differences were found for age, income, education, alcohol habit, and sex with more than two partners per day for these three different HIV-related sexual risk behaviors. MtF transgender persons with a secondary or higher level of education were three times (OR 2.93) more likely to have unprotected sex with multiple partners compared to those with a primary level or no education. Age, education, income, frequency of daily sexual contact, and an alcohol habit remain significant with regard to HIV-related sexual risk behavior. There is an urgent need for programs and interventions to reduce risky sexual behaviors in this minority population. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

Missives from the Adult World to LGBTQ Youth: A Review of "Gallup's Guide to Modern Gay, Lesbian, and Transgender Lifestyle"

ERIC Educational Resources Information Center

Taylor, Catherine G.

2012-01-01

"Gallup's Guide to Modern Gay, Lesbian, and Transgender Lifestyle" is a set of 15 volumes addressing lesbian, gay, transgender, queer, and questioning (LGTQ) topics of concern to young LGTQ readers. Each volume is attractively produced, is well presented, and answers questions systematically avoided in most school curricula. It would be a valuable…

Screening for Spiritual Struggle in an Adolescent Transgender Clinic: Feasibility and Acceptability.

PubMed

Grossoehme, Daniel H; Teeters, Alexis; Jelinek, Sue; Dimitriou, Sophia M; Conard, Lee Ann E

2016-01-01

Spiritual struggles are associated with poorer health outcomes, including depression, which has higher prevalence among transgender individuals than the general population. This study's objective was to improve the quality of care in an outpatient transgender clinic by screening patients and caregivers for spiritual struggle and future intervention. The quality improvement questions addressed were whether screening for spiritual struggle was feasible and acceptable; and whether the sensitivity and specificity of the Rush Protocol were acceptable. Revision of the screening was based on cognitive interviews with the 115 adolescents and caregivers who were screened. Prevalence of spiritual struggle was 38-47%. Compared to the Negative R-COPE, the Rush Protocol screener had sensitivities of 44-80% and specificities of 60-74%. The Rush Protocol was acceptable to adolescents seen in a transgender clinic, caregivers, and clinic staff; was feasible to deliver during outpatient clinic visits, and offers a straightforward means of identifying transgender persons and caregivers experiencing spiritual struggle.

Mental Health Disparities Within the LGBT Population: A Comparison Between Transgender and Nontransgender Individuals.

PubMed

Su, Dejun; Irwin, Jay A; Fisher, Christopher; Ramos, Athena; Kelley, Megan; Mendoza, Diana Ariss Rogel; Coleman, Jason D

2016-01-01

Purpose: This study assessed within a Midwestern LGBT population whether, and the extent to which, transgender identity was associated with elevated odds of reported discrimination, depression symptoms, and suicide attempts. Methods: Based on survey data collected online from respondents who self-identified as lesbian, gay, bisexual, and/or transgender persons over the age of 19 in Nebraska in 2010, this study performed bivariate t - or chi-square tests and multivariate logistic regression analysis to examine differences in reported discrimination, depression symptoms, suicide attempts, and self-acceptance of LGBT identity between 91 transgender and 676 nontransgender respondents. Results: After controlling for the effects of selected confounders, transgender identity was associated with higher odds of reported discrimination (OR=2.63, p <0.01), depression symptoms (OR=2.33, p <0.05), and attempted suicides (OR=2.59, p <0.01) when compared with nontransgender individuals. Self-acceptance of LGBT identity was associated with substantially lower odds of reporting depression symptoms (OR=0.46, p <0.001). Conclusion: Relative to nontransgender LGB individuals, transgender individuals were more likely to report discrimination, depression symptoms, and attempted suicides. Lack of self-acceptance of LGBT identity was associated with depression symptoms among transgender individuals.

The HIV Risk Profiles of Latino Sexual Minorities and Transgender Persons Who Use Websites or Apps Designed for Social and Sexual Networking

PubMed Central

Sun, Christina J.; Reboussin, Beth A.; Mann, Lilli; Garcia, Manuel; Rhodes, Scott D.

2018-01-01

The use of websites and GPS-based mobile applications (“apps”) designed for social and sexual networking has been associated with increased HIV risk; however, little is known about Latino sexual minorities’ and transgender persons’ use of these websites and apps and the risk profiles of those who use them compared with those who do not. Data from 167 participants who completed the baseline survey of a community-level HIV prevention intervention, which harnesses the social networks of Latino sexual minorities and transgender persons, were analyzed. One quarter of participants (28.74%, n = 48) reported using websites or apps designed for social and sexual networking, and 119 (71.26%) reported not using websites or apps designed for social and sexual networking. Those who used websites or apps were younger and reported more male sex partners, a sexually transmitted disease diagnosis, and illicit drug use other than marijuana. HIV prevention interventions for those who use websites or apps should consider addressing these risks for HIV. PMID:26272786

Transgender Inmates in Prisons.

PubMed

Routh, Douglas; Abess, Gassan; Makin, David; Stohr, Mary K; Hemmens, Craig; Yoo, Jihye

2017-05-01

Transgender inmates provide a conundrum for correctional staff, particularly when it comes to classification, victimization, and medical and health issues. Using LexisNexis and WestLaw and state Department of Corrections (DOC) information, we collected state statutes and DOC policies concerning transgender inmates. We utilized academic legal research with content analysis to determine whether a statute or policy addressed issues concerning classification procedures, access to counseling services, the initiation and continuation of hormone therapy, and sex reassignment surgery. We found that while more states are providing either statutory or policy guidelines for transgender inmates, a number of states are lagging behind and there is a shortage of guidance dealing with the medical issues related to being transgender.

Twitter: A Novel Tool for Studying the Health and Social Needs of Transgender Communities.

PubMed

Krueger, Evan A; Young, Sean D

2015-01-01

Limited research has examined the health and social needs of transgender and gender nonconforming populations. Due to high levels of stigma, transgender individuals may avoid disclosing their identities to researchers, hindering this type of work. Further, researchers have traditionally relied on clinic-based sampling methods, which may mask the true heterogeneity of transgender and gender nonconforming communities. Online social networking websites present a novel platform for studying this diverse, difficult-to-reach population. The objective of this study was to attempt to examine the perceived health and social needs of transgender and gender nonconforming communities by examining messages posted to the popular microblogging platform, Twitter. Tweets were collected from 13 transgender-related hashtags on July 11, 2014. They were read and coded according to general themes addressed, and a content analysis was performed. Qualitative and descriptive statistics are presented. There were 1135 tweets that were collected in total. Both "positive" and "negative" events were discussed, in both personal and social contexts. Violence, discrimination, suicide, and sexual risk behavior were discussed. There were 34.36% (390/1135) of tweets that addressed transgender-relevant current events, and 60.79% (690/1135) provided a link to a relevant news article or resource. This study found that transgender individuals and allies use Twitter to discuss health and social needs relevant to the population. Real-time social media sites like Twitter can be used to study issues relevant to transgender communities.

Twitter: A Novel Tool for Studying the Health and Social Needs of Transgender Communities

PubMed Central

Young, Sean D

2015-01-01

Background Limited research has examined the health and social needs of transgender and gender nonconforming populations. Due to high levels of stigma, transgender individuals may avoid disclosing their identities to researchers, hindering this type of work. Further, researchers have traditionally relied on clinic-based sampling methods, which may mask the true heterogeneity of transgender and gender nonconforming communities. Online social networking websites present a novel platform for studying this diverse, difficult-to-reach population. Objective The objective of this study was to attempt to examine the perceived health and social needs of transgender and gender nonconforming communities by examining messages posted to the popular microblogging platform, Twitter. Methods Tweets were collected from 13 transgender-related hashtags on July 11, 2014. They were read and coded according to general themes addressed, and a content analysis was performed. Qualitative and descriptive statistics are presented. Results There were 1135 tweets that were collected in total. Both “positive” and “negative” events were discussed, in both personal and social contexts. Violence, discrimination, suicide, and sexual risk behavior were discussed. There were 34.36% (390/1135) of tweets that addressed transgender-relevant current events, and 60.79% (690/1135) provided a link to a relevant news article or resource. Conclusions This study found that transgender individuals and allies use Twitter to discuss health and social needs relevant to the population. Real-time social media sites like Twitter can be used to study issues relevant to transgender communities. PMID:26082941

Affirmative Psychological Testing and Neurocognitive Assessment with Transgender Adults.

PubMed

Keo-Meier, Colton L; Fitzgerald, Kara M

2017-03-01

Neither consensus on best practice nor validated neuropsychological, intelligence, or personality testing batteries exist for assessment and psychological testing on the transgender population. Historically, assessment has been used in a gate-keeping fashion with transgender clients. There are no firm standards of care when considering the content and appropriateness of evaluations conducted presurgically. These evaluations are discussed in the setting of other presurgical evaluations, with a recommendation to move toward a competency to make a medical decisions model. Additional considerations are discussed, such as effects of transition on mood and how to interpret scores in a field where normative data are often gender stratified. Copyright © 2016 Elsevier Inc. All rights reserved.

Personality Profiles of Physically Impaired Young Adults.

ERIC Educational Resources Information Center

Richman, Lynn C.; Harper, Dennis C.

1980-01-01

Different forms of chronic observable disability may have differing impacts on adult personality adjustment. Young adults with cleft lip/palate display fewer personality adjustment problems than those with orthopedic impairment. (Author)

Understanding and Counseling Transgender Clients

ERIC Educational Resources Information Center

Kirk, James; Belovics, Robert

2008-01-01

Because transgender individuals experience widespread employment discrimination, counselors need to understand and be able to work with members of the gay, lesbian, bisexual, and transgender communities. The aim of this article is to help counselors become more transgender literate by (a) defining gender dysphoric disorder and related terms; (b)…

Young Transgender Women's Attitudes Toward HIV Pre-exposure Prophylaxis.

PubMed

Wood, Sarah M; Lee, Susan; Barg, Frances K; Castillo, Marne; Dowshen, Nadia

2017-05-01

Our primary aim was to explore themes regarding attitudes toward HIV pre-exposure prophylaxis (PrEP) among young transgender women (YTW), in order to develop a theoretical model of PrEP uptake in this population disproportionally affected by HIV. Qualitative study nested within a mixed-method study characterizing barriers and facilitators to health services for YTW. Participants completed an in-depth interview exploring awareness of and attitudes toward PrEP. Key themes were identified using a grounded theory approach. Participants (n = 25) had a mean age of 21.2 years (standard deviation 2.2, range 17-24) and were predominately multiracial (36%) and of HIV-negative or unknown status (68%). Most participants (64%) reported prior knowledge of PrEP, and 28% reported current use or intent to use PrEP. Three major content themes that emerged were variability of PrEP awareness, barriers and facilitators to PrEP uptake, and emotional benefits of PrEP. Among participants without prior PrEP knowledge, participants reported frustration that PrEP information has not been widely disseminated to YTW, particularly by health care providers. Attitudes toward PrEP were overwhelmingly positive; however, concerns were raised regarding barriers including cost, stigma, and adherence challenges. Both HIV-positive and negative participants discussed emotional and relationship benefits of PrEP, which were felt to extend beyond HIV prevention alone. A high proportion of YTW in this study had prior knowledge of PrEP, and attitudes toward PrEP were positive among participants. Our findings suggest several domains to be further explored in PrEP implementation research, including methods of facilitating PrEP dissemination and emotional motivation for PrEP uptake. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

HIV-Related Stigma and HIV Prevention Uptake Among Young Men Who Have Sex with Men and Transgender Women in Thailand.

PubMed

Logie, Carmen H; Newman, Peter A; Weaver, James; Roungkraphon, Surachet; Tepjan, Suchon

2016-02-01

HIV-related stigma is a pervasive structural driver of HIV. With an HIV epidemic among young men who have sex with men (MSM) and transgender women (TG) in Thailand characterized as explosive, we conducted a cross-sectional survey among MSM and TG aged 18-30 years. From April-August 2013, participants recruited using venue-based sampling from gay entertainment sites and community-based organizations completed a tablet-assisted survey interview in Thai language. We conducted multiple logistic regression to assess correlations between HIV-related stigma (felt-normative, vicarious domains) and socio-demographic variables, HIV vulnerabilities (gay entertainment employment, sex work, forced sex history), and HIV prevention uptake (condom use, HIV testing, rectal microbicide acceptability). Among participants (n = 408), 54% identified as gay, 25% transgender, and 21% heterosexual. Two-thirds (65.7%) were employed at gay entertainment venues, 67.0% had more than three male partners (past month), 55.6% had been paid for sex, and 4.5% were HIV-positive. One-fifth (21.3%) reported forced sex. Most participants reported experiencing felt-normative and vicarious HIV-related stigma. Adjusting for socio-demographics, participants with higher total HIV-related stigma scores had significantly lower odds of HIV testing and rectal microbicide acceptability, and higher odds of having experienced forced sex. Both vicarious and felt-normative dimensions of HIV-related stigma were inversely associated with HIV testing and rectal microbicide acceptability. Our findings suggest that HIV-related stigma harms the health of HIV-negative MSM and TG at high risk for HIV infection. HIV-related interventions and research among young MSM and TG in Thailand should address multiple dimensions of HIV-related stigma as a correlate of risk and a barrier to accessing prevention.

Online support for transgender people: an analysis of forums and social networks.

PubMed

Cipolletta, Sabrina; Votadoro, Riccardo; Faccio, Elena

2017-09-01

Transgender people face a range of personal and social conflicts that strongly influence their well-being. In many cases, the Internet can become the main resource in terms of finding support. The aim of this study was to understand how transgender people give and receive help online. Between 2013 and 2015, 122 online community conversations were collected on Italian forums and Facebook groups involving transgender people, and online interviews were conducted with 16 users of these communities. A qualitative content analysis was conducted by using the software package, NVivo10. The main categories that emerged were: motivations to join an online community, online help, differences between online and offline interactions, status, conflicts and professional help. Results indicate that participation in online communities often derives from the users' need for help. This help can be given by peers who have had similar experiences, and by professionals who participate in the discussions as moderator. The need to test one's own identity, to compare oneself with others and to share one's personal experiences made online communities at risk of exposing users to invalidation and transphobic messages. Administrators and moderators try to ensure the safety of users, and suggest that they ask for professional help offline and/or online when over-specific medical advice was sought. This study confirms that transgender people might find benefit from an online platform of help and support and might minimise distance problems, increase financial convenience and foster disinhibition. © 2017 John Wiley & Sons Ltd.

Using Photovoice, Latina Transgender Women Identify Priorities in a New Immigrant-Destination State

PubMed Central

Rhodes, Scott D.; Alonzo, Jorge; Mann, Lilli; Simán, Florence; Garcia, Manuel; Abraham, Claire; Sun, Christina J.

2016-01-01

Little is known about the immigrant Latino/a transgender community in the southeastern United States. This study used photovoice, a methodology aligned with community-based participatory research, to explore needs, assets, and priorities of Latina transgender women in North Carolina. Nine immigrant Latina male-to-female transgender women documented their daily experiences through photography, engaged in empowerment-based photo-discussions, and organized a bilingual community forum to move knowledge to action. From the participants’ photographs and words, 11 themes emerged in three domains: daily challenges (e.g., health risks, uncertainty about the future, discrimination, and anxiety about family reactions); needs and priorities (e.g., health and social services, emotional support, and collective action); and community strengths and assets (e.g., supportive individuals and institutions, wisdom through lived experiences, and personal and professional goals). At the community forum, 60 influential advocates, including Latina transgender women, representatives from community-based organizations, health and social service providers, and law enforcement, reviewed findings and identified ten recommended actions. Overall, photovoice served to obtain rich qualitative insight into the lived experiences of Latina transgender women that was then shared with local leaders and agencies to help address priorities. PMID:27110226

Transgender men and pregnancy

PubMed Central

Obedin-Maliver, Juno

2015-01-01

Transgender people have experienced significant advances in societal acceptance despite experiencing continued stigma and discrimination. While it can still be difficult to access quality health care, and there is a great deal to be done to create affirming health care organizations, there is growing interest around the United States in advancing transgender health. The focus of this commentary is to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy. Terms transgender and gender nonconforming specifically refer to those whose gender identity (e.g., being a man) differs from their female sex assigned at birth. Many, if not most transgender men retain their female reproductive organs and retain the capacity to have children. Review of their experience demonstrates the need for preconception counseling that includes discussion of stopping testosterone while trying to conceive and during pregnancy, and anticipating increasing experiences of gender dysphoria during and after pregnancy. The clinical aspects of delivery itself fall within the realm of routine obstetrical care, although further research is needed into how mode and environment of delivery may affect gender dysphoria. Postpartum considerations include discussion of options for chest (breast) feeding, and how and when to reinitiate testosterone. A positive perinatal experience begins from the moment transgender men first present for care and depends on comprehensive affirmation of gender diversity. PMID:27030799

Transgender men and pregnancy.

PubMed

Obedin-Maliver, Juno; Makadon, Harvey J

2016-03-01

Transgender people have experienced significant advances in societal acceptance despite experiencing continued stigma and discrimination. While it can still be difficult to access quality health care, and there is a great deal to be done to create affirming health care organizations, there is growing interest around the United States in advancing transgender health. The focus of this commentary is to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy. Terms transgender and gender nonconforming specifically refer to those whose gender identity (e.g., being a man) differs from their female sex assigned at birth. Many, if not most transgender men retain their female reproductive organs and retain the capacity to have children. Review of their experience demonstrates the need for preconception counseling that includes discussion of stopping testosterone while trying to conceive and during pregnancy, and anticipating increasing experiences of gender dysphoria during and after pregnancy. The clinical aspects of delivery itself fall within the realm of routine obstetrical care, although further research is needed into how mode and environment of delivery may affect gender dysphoria. Postpartum considerations include discussion of options for chest (breast) feeding, and how and when to reinitiate testosterone. A positive perinatal experience begins from the moment transgender men first present for care and depends on comprehensive affirmation of gender diversity.

Fertility Preservation for Transgender Adolescents.

PubMed

Chen, Diane; Simons, Lisa; Johnson, Emilie K; Lockart, Barbara A; Finlayson, Courtney

2017-07-01

To describe fertility preservation (FP) utilization by transgender adolescents within a pediatric gender clinic between July 2013 and July 2016. A retrospective chart review was conducted to abstract demographic and clinical information among adolescents initiating gender-affirming hormones, including patient age at initial FP consultation, birth-assigned sex, race/ethnicity, and outcome of FP consultation. In our sample of 105 transgender adolescents, a total of 13 (seven transgender men and six transgender women) between the age of 14.2 and 20.6 years were seen in formal consultation for FP before initiating hormones. Of these adolescents, four completed sperm cryopreservation and one completed oocyte cryopreservation. Rates of FP utilization among transgender youth were low, which is consistent with a recently published report of FP utilization among transgender youth at another pediatric institution. Identified barriers to FP in our sample included cost, invasiveness of procedures, and desire not to delay medical transition. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Sibling Experiences: Living with Young Persons with Autism Spectrum Disorders.

PubMed

Ward, Beth; Tanner, Brianna Smith; Mandleco, Barbara; Dyches, Tina T; Freeborn, Donna

2016-01-01

Like other young people, those with autism spectrum disorder (ASD) have an impact on siblings in both positive and negative ways. Research indicates positive attributes include maturity and responsibility; positive self-concept; less quarrelling and competition; admiration for the person with ASD; and satisfactory sibling relationships. Negative attributes include fear of frightening or violent behavior, decreased sibling intimacy, and social and emotional difficulties. However, most research relies on information from parents/teachers, rather than from siblings. Therefore, this qualitative descriptive study explored experiences of 11 brothers and 11 sisters living with a young person with ASD through audiorecorded semi-structured interviews. Analysis revealed the overall theme was contradiction. Participants recognized difficulties (decreased parental attention, extra responsibility, bothersome behaviors, communication difficulties) and positive aspects (became empathetic, loved and appreciated the child, realized the experience was life-changing) of living with a young person with ASD. Younger siblings frequently reflected on childhood experiences, wished they could play together, and mentioned what the young person could do. Adolescent siblings learned life lessons from the experience, talked about life changes when ASD was diagnosed, and seemed introspective and protective toward the young person with ASD. Male siblings often wished they played more often while growing up with the young person, and frequently mentioned the child/adolescent's aggressive behaviors; female siblings focused on relationship and communication difficulties of the young person ASD. Interventions to help siblings provide positive behavioral support, engage in developmentally appropriate play, and communicate reciprocally are warranted. Nurses can help parents understand siblings' perceptions and can encourage parents to support siblings.

Mental Health Disparities Within the LGBT Population: A Comparison Between Transgender and Nontransgender Individuals

PubMed Central

Su, Dejun; Irwin, Jay A.; Fisher, Christopher; Ramos, Athena; Kelley, Megan; Mendoza, Diana Ariss Rogel; Coleman, Jason D.

2016-01-01

Abstract Purpose: This study assessed within a Midwestern LGBT population whether, and the extent to which, transgender identity was associated with elevated odds of reported discrimination, depression symptoms, and suicide attempts. Methods: Based on survey data collected online from respondents who self-identified as lesbian, gay, bisexual, and/or transgender persons over the age of 19 in Nebraska in 2010, this study performed bivariate t- or chi-square tests and multivariate logistic regression analysis to examine differences in reported discrimination, depression symptoms, suicide attempts, and self-acceptance of LGBT identity between 91 transgender and 676 nontransgender respondents. Results: After controlling for the effects of selected confounders, transgender identity was associated with higher odds of reported discrimination (OR=2.63, p<0.01), depression symptoms (OR=2.33, p<0.05), and attempted suicides (OR=2.59, p<0.01) when compared with nontransgender individuals. Self-acceptance of LGBT identity was associated with substantially lower odds of reporting depression symptoms (OR=0.46, p<0.001). Conclusion: Relative to nontransgender LGB individuals, transgender individuals were more likely to report discrimination, depression symptoms, and attempted suicides. Lack of self-acceptance of LGBT identity was associated with depression symptoms among transgender individuals. PMID:29159294

Experiences of Transgender-Related Discrimination and Implications for Health: Results From the Virginia Transgender Health Initiative Study

PubMed Central

Reisner, Sari L.; Honnold, Julie A.; Xavier, Jessica

2013-01-01

Objectives. We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. Methods. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Results. Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Conclusions. Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers. PMID:23153142

Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

PubMed

Bradford, Judith; Reisner, Sari L; Honnold, Julie A; Xavier, Jessica

2013-10-01

We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.

Biological and psychological influences of cross sex hormone in transgender.

PubMed

Ling, Ling Shiao; Sidi, Hatta; Lope, Raja Adam Raja; Das, Srijit; Baharudin, Azlin

2018-05-11

Transgender is a complex state of bio-psycho-social dimension of human sexuality. It encompasses cognitive-emotional-behavior component that makes the person unique in his or her sexual expression. Transgender tend to use cross sex hormone in order to eradicate their secondary sexual characteristics and to facilitate the shift to their experienced gender. The common masculinising sex hormone use, i.e. Female to Male Treatment Options (FMTO) is testosterone and for feminising hormone i.e. Male to Female Treatment Options (MFTO) is a combination of estrogen with anti-androgen, respectively. Cross sex hormone, i.e. FMTO, or MFTO has biological and psychological influences on the transgender individuals. Nevertheless, cross sex hormone may also poses a range of side effect profiles, varies from the biological to psychosocial impact. The psychological impact can be paramount until it causes severe mental-health problems and even suicide. Numerous ranges of bio-psycho-social influence of cross-sex hormone were highlighted in this review as fundamental core knowledge in the art to know practice when dealing with the treatment options. In psychiatry, the change in the biological appearance may have great influence in the transgender individual, especially in the context of psychosocial and cultural perspective. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Transgender youth: current concepts

PubMed Central

2016-01-01

In many countries throughout the world, increasing numbers of gender nonconforming/transgender youth are seeking medical services to enable the development of physical characteristics consistent with their experienced gender. Such medical services include use of agents to block endogenous puberty at Tanner stage II with subsequent use of cross-sex hormones, and are based on longitudinal studies demonstrating that those individuals who were first identified as gender dysphoric in early or middle childhood and continue to meet the mental health criteria for being transgender at early puberty are likely to be transgender as adults. This review addresses terms and definitions applicable to gender nonconforming youth, studies that shed light on the biologic determinants of gender identity, current clinical practice guidelines for transgender youth, challenges to optimal care, and priorities for research. PMID:28164070

Recalled Sexual Experiences in Childhood with Older Partners: A Study of Brazilian Men Who Have Sex with Men and M-T-F Transgender Persons

PubMed Central

Carballo-Diéguez, Alex; Balan, Ivan; Dolezal, Curtis; Mello, Maeve B.

2013-01-01

This study assessed the prevalence of recalled childhood sexual experiences with an older partner among men who have sex with men (MSM) and/or male-to-female transgender persons recruited in Campinas, Brazil. It also analyzed associations between such recalled experiences and sexual risk behavior in adulthood. Participants recruited using respondent driven sampling completed a self-administered, computer-based questionnaire, and underwent HIV testing. For data analysis, raw scores were weighted based on participants’ reported network size. Of 575 participants (85% men and 15% transgender), 32% reported childhood sexual experiences with an older partner. Mean age at first experience was 9 years, partners being on average 19 years old, and mostly men. Most frequent behaviors were partners exposing their genitals, mutual fondling, child masturbating partner, child performing oral sex on partner, and child being anally penetrated. Only 29% of the participants who had had such childhood sexual experiences considered it abuse; 57% reported liking, 29% being indifferent, and only 14% not liking the sexual experience at the time it happened. Transgender participants were significantly more likely to report such experiences and, compared with men, had less negative feelings about the experience at the time of the interview. No significant associations were found between sexual experiences in childhood and unprotected receptive or insertive anal intercourse in adulthood. Results highlight the importance of assessing participants’ perception of abuse, regardless of researchers’ pre-determined criteria to identify abuse. MSM and transgender people may experience childhood sexual experiences with older partners differently from other populations (e.g., heterosexuals), particularly in countries with different cultural norms concerning sexuality than those prevalent in Europe and the U.S. PMID:21484505

Transgender People (For Parents)

MedlinePlus

... transgender is not the same thing as being gay. Being transgender is about gender identity — the way ... themselves and the gender they identify with. Being gay or lesbian is about sexual orientation — the gender ...

Informal Mentoring for Lesbian, Gay, Bisexual, and Transgender Students

ERIC Educational Resources Information Center

Mulcahy, Molly; Dalton, Sarah; Kolbert, Jered; Crothers, Laura

2016-01-01

The authors identified the process that 10 lesbian, gay, bisexual, and transgender (LGBT) high school students used to establish an informal adult-mentor relationship with a school personnel member. Five major themes emerged: (a) how LGBT students determined whether this person would be a safe mentor, (b) a listing of the important qualities of…

HIV Epidemics among Transgender Women

PubMed Central

Poteat, Tonia; Reisner, Sari L.; Radix, Anita

2018-01-01

Purpose of review Recent data on the high burden of HIV among transgender women has stimulated interest in addressing HIV in this vulnerable population. This review situates the epidemiologic data on HIV among transgender women in the context of the social determinants of health and describes opportunities for effective interventions. Recent findings Transgender women experience unique vulnerability to HIV that can be attributed to multi-level, intersecting factors that also influence the HIV treatment and care continuum. Stigma and discrimination, lack of social and legal recognition of their affirmed gender, and exclusion from employment and educational opportunities represent fundamental drivers of HIV risk in transgender women worldwide. Summary Interventions to improve engagement in HIV prevention, testing, care, and treatment among transgender women should build on community strengths and address structural factors as well as psychosocial and biologic factors that increase HIV vulnerability and prevent access to HIV services. PMID:24322537

Perioperative Care of the Transgender Patient.

PubMed

Smith, Francis Duval

2016-02-01

Transgender patients are individuals whose gender identity is not related to their biological sex. Assuming a new gender identity that does not conform to societal norms often results in discrimination and barriers to health care. The exact number of transgender patients is unknown; however, these patients are increasingly seen in health care. Transgender individuals may experience provider-generated discrimination in health care facilities, including refusal of service, disrespect, and abuse, which contribute to depression and low self-esteem. Transgender therapies include mental health counseling for depression and low self-esteem, hormone therapy, and sex reassignment surgery. Health care professionals require cultural competence, an understanding of the different forms of patient identification, and adaptive approaches to care for transgender patients. VA (Veterans Affairs) hospitals provide a model for the care for transgender patients and staff. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Experiences of female partners of masculine identifying trans persons

PubMed Central

Theron, Liesl; Collier, Kate L.

2013-01-01

This study explores the intimate relationship experiences of cisgender (i.e., not transgender) female partners of masculine identifying transgender persons, with a particular focus on these partners’ self-understanding of their sexual orientation. Limited research about this topic has been conducted to date. Semi-structured interviews were conducted with eight South African women who are or have been cisgender female partners of masculine identifying trans persons. Although the interviews showed that the relationship experiences of female partners of masculine identifying trans persons are diverse, several common themes emerged in the narratives. The way that participants labelled their sexual orientation did not change from before to after their relationship with a transgender partner. The participants reported varied family and community responses to their relationships. Specific emotional and informational support needs for women with transgender partners were identified. PMID:23668602

Experiences of female partners of masculine-identifying trans persons.

PubMed

Theron, Liesl; Collier, Kate L

2013-01-01

This paper explores the intimate relationship experiences of the cisgender (i.e., not transgender) female partners of masculine-identifying transgender persons, with a particular focus on these partners' self-understanding of their sexual orientation. Limited research about this topic has been conducted to date. Semi-structured interviews were conducted with eight South African women who are or have been cisgender female partners of masculine-identifying trans persons. Although the interviews showed that the relationship experiences of female partners of masculine-identifying trans persons are diverse, several common themes emerged in the narratives. The way that participants labelled their sexual orientation did not change from before to after their relationship with a transgender partner. The participants reported varied family and community responses to their relationships. Specific emotional and informational support needs for women with transgender partners were identified.

Toward Transgender Affirmative Social Work Education

ERIC Educational Resources Information Center

Austin, Ashley; Craig, Shelley L.; McInroy, Lauren B.

2016-01-01

Social work has professional and academic standards consistent with transgender affirmative education and practice. Nevertheless, a growing body of research suggests that transgender issues are largely absent from social work education, resulting in practitioners who are uninformed or biased against transgender issues. The present study expands…

Abjection and Alterity in the Imagining of Transgender in Physical Education and Sport: A Pedagogical Approach in Higher Education

ERIC Educational Resources Information Center

Pérez-Samaniego, Víctor; Fuentes-Miguel, Jorge; Pereira-García, Sofía; Devís-Devís, José

2016-01-01

In physical education (PE) and sports there is little theoretical and empirical knowledge about transgender people, and particularly, on how they are and can be imagined within this context. In this paper, we present and analyze a pedagogical activity based on the reading and discussion of a fictional representation of a transgender person within…

Sexual Victimization and Subsequent Police Reporting by Gender Identity Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults.

PubMed

Langenderfer-Magruder, Lisa; Walls, N Eugene; Kattari, Shanna K; Whitfield, Darren L; Ramos, Daniel

2016-01-01

Prevalence of sexual victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons is frequently found to be higher than the prevalence reported by their heterosexual peers. Transgender individuals are often included solely as part of larger LGBTQ research samples, potentially obfuscating differences between sexual orientation and gender identity. In this study, the authors examined sexual assault/rape in a large convenience sample of LGBTQ adults (N = 1,124) by respondents' gender identity (cisgender, transgender) to determine whether differences exist in lifetime prevalence of sexual assault/rape and subsequent police reporting. Findings indicate transgender individuals report having experienced sexual assault/rape more than twice as frequently as cisgender LGBQ individuals. Authors found no statistically significant difference in reporting sexual violence to police. Implications for research and practice are discussed.

Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth.

PubMed

Gridley, Samantha J; Crouch, Julia M; Evans, Yolanda; Eng, Whitney; Antoon, Emily; Lyapustina, Melissa; Schimmel-Bristow, Allison; Woodward, Jake; Dundon, Kelly; Schaff, RaNette; McCarty, Carolyn; Ahrens, Kym; Breland, David J

2016-09-01

Few transgender youth eligible for gender-affirming treatments actually receive them. Multidisciplinary gender clinics improve access and care coordination but are rare. Although experts support use of pubertal blockers and cross-sex hormones for youth who meet criteria, these are uncommonly offered. This study's aim was to understand barriers that transgender youth and their caregivers face in accessing gender-affirming health care. Transgender youth (age 14-22 years) and caregivers of transgender youth were recruited from Seattle-based clinics, and readerships from a blog and support group listserv. Through individual interviews, focus groups, or an online survey, participants described their experiences accessing gender-affirming health care. We then used theoretical thematic analysis to analyze data. Sixty-five participants (15 youth, 50 caregivers) described barriers spanning six themes: (1) few accessible pediatric providers are trained in gender-affirming health care; (2) lack of consistently applied protocols; (3) inconsistent use of chosen name/pronoun; (4) uncoordinated care and gatekeeping; (5) limited/delayed access to pubertal blockers and cross-sex hormones; and (6) insurance exclusions. This is the first study aimed at understanding perceived barriers to care among transgender youth and their caregivers. Themed barriers to care led to the following recommendations: (1) mandatory training on gender-affirming health care and cultural humility for providers/staff; (2) development of protocols for the care of young transgender patients, as well as roadmaps for families; (3) asking and recording of chosen name/pronoun; (4) increased number of multidisciplinary gender clinics; (5) providing cross-sex hormones at an age that permits peer-congruent development; and (6) designating a navigator for transgender patients in clinics. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Barriers to Gender Transition-Related Healthcare: Identifying Underserved Transgender Adults in Massachusetts

PubMed Central

White Hughto, Jaclyn M.; Rose, Adam J.; Pachankis, John E.; Reisner, Sari L.

2017-01-01

Abstract Purpose: The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults. Method: In 2013, 364 transgender residents of Massachusetts completed an electronic web-based survey online (87.1%) or in person (12.9%). A multivariable logistic regression model tested whether individual, interpersonal, and structural factors were associated with access to transition-related care. Results: Overall, 23.6% reported being unable to access transition-related care in the past 12 months. In a multivariable model, younger age, low income, low educational attainment, private insurance coverage, and healthcare discrimination were significantly associated with being unable to access transition-related care (all p<0.05). Discussion: Despite state nondiscrimination policies and universal access to healthcare, many of the Massachusetts transgender residents sampled were unable to access transition-related care. Multilevel interventions are needed, including supportive policies and policy enforcement, to ensure that underserved transgender adults can access medically necessary transition-related care. PMID:29082331

Transgender Patients: What Radiologists Need to Know.

PubMed

Sowinski, John S; Gunderman, Richard B

2018-05-01

The purposes of this article are to examine a few of the barriers the transgender population faces in achieving equitable health care, to suggest ways radiologists and radiology staff can help to address these obstacles and provide high-quality care to transgender patients, and to discuss a number of evidence-based guidelines regarding appropriate imaging and screening tests for the transgender population. Lesbian, gay, bisexual, and transgender individuals face numerous health care disparities, including stigmatization and discrimination in health care environments. Radiology personnel can help to remove such barriers by providing a welcoming clinical environment, practicing cultural humility, and staying up-to-date with rapidly changing recommendations related to transgender care. Continued research will help to provide even stronger evidence-based guidelines for transgender care.

Sex and Gender Diversity Among Transgender Persons in Ontario, Canada: Results From a Respondent-Driven Sampling Survey

PubMed Central

Scheim, Ayden I.; Bauer, Greta R.

2015-01-01

Recent estimates suggest that as many as 1 in 200 adults may be trans (transgender, transsexual, or transitioned). Knowledge about dimensions of sex and gender in trans populations is crucial to development of inclusive policy, practice, and research, but limited data have been available, particularly from probability samples. The Trans PULSE community-based research project surveyed trans Ontarians (n = 433) in 2009–2010 using respondent-driven sampling. Frequencies were weighted by recruitment probability to produce estimates for the networked Ontario trans population. An estimated 30% of trans Ontarians were living their day-to-day lives in their birth gender, and 23% were living in their felt gender with no medical intervention. In all, 42% were using hormones, while 15% of male-to-female spectrum persons had undergone vaginoplasty and 0.4% of female-to-male spectrum persons had had phalloplasty. Of those living in their felt gender, 59% had begun to do so within the past four years. A minority of trans Ontarians reported a linear transition from one sex to another, yet such a trajectory is often assumed to be the norm. Accounting for this observed diversity, we recommend policy and practice changes to increase social inclusion and service access for trans persons, regardless of transition status. PMID:24750105

Sex and gender diversity among transgender persons in Ontario, Canada: results from a respondent-driven sampling survey.

PubMed

Scheim, Ayden I; Bauer, Greta R

2015-01-01

Recent estimates suggest that as many as 1 in 200 adults may be trans (transgender, transsexual, or transitioned). Knowledge about dimensions of sex and gender in trans populations is crucial to development of inclusive policy, practice, and research, but limited data have been available, particularly from probability samples. The Trans PULSE community-based research project surveyed trans Ontarians (n=433) in 2009-2010 using respondent-driven sampling. Frequencies were weighted by recruitment probability to produce estimates for the networked Ontario trans population. An estimated 30% of trans Ontarians were living their day-to-day lives in their birth gender, and 23% were living in their felt gender with no medical intervention. In all, 42% were using hormones, while 15% of male-to-female spectrum persons had undergone vaginoplasty and 0.4% of female-to-male spectrum persons had had phalloplasty. Of those living in their felt gender, 59% had begun to do so within the past four years. A minority of trans Ontarians reported a linear transition from one sex to another, yet such a trajectory is often assumed to be the norm. Accounting for this observed diversity, we recommend policy and practice changes to increase social inclusion and service access for trans persons, regardless of transition status.

Measuring Transgender Individuals' Comfort with Gender Identity and Appearance: Development and Validation of the Transgender Congruence Scale

ERIC Educational Resources Information Center

Kozee, Holly B.; Tylka, Tracy L.; Bauerband, L. Andrew

2012-01-01

Our study used the construct of congruence to conceptualize the degree to which transgender individuals feel genuine, authentic, and comfortable with their gender identity and external appearance. In Study 1, the Transgender Congruence scale (TCS) was developed, and data from 162 transgender individuals were used to estimate the reliability and…

Transgender women in Malaysia, in the context of HIV and Islam: a qualitative study of stakeholders' perceptions.

PubMed

Barmania, Sima; Aljunid, Syed Mohamed

2017-10-18

Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia. Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context. In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis. Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; 'Cure', 'Correction' and finally, Stigma and Discrimination. Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations. The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in

Sociodemographic Differences by Survey Mode in a Respondent-Driven Sampling Study of Transgender People in Ontario, Canada.

PubMed

Scheim, Ayden I; Bauer, Greta R; Coleman, Todd A

2016-10-01

To describe survey mode uptake and sociodemographic differences by mode among respondents to a respondent-driven sampling survey of transgender people in Ontario, Canada. Survey mode was left to participant choice. Data were collected from 433 transgender Ontarians in 2009-2010 through a self-administered questionnaire, available online, by paper copy, or by telephone with language interpretation. Paper respondents (9.5%) were significantly more likely to be Aboriginal or persons of color, underhoused, sex workers, and unemployed or receiving disability benefits. In Canada and similar high-income countries, sampling transgender populations that are diverse with respect to social determinants of health may be best carried out with multimode surveys.

Characteristics of Transgender Individuals Entering Substance Abuse Treatment

PubMed Central

Heck, Nicholas C.; Sorensen, James L.

2014-01-01

Little is known about the needs or characteristics of transgender individuals in substance abuse treatment settings. Transgender (n=199) and non-transgender (cisgender, n=13440) individuals were compared on psychosocial factors related to treatment, health risk behaviors, medical and mental health status and utilization, and substance use behaviors within a database that documented individuals entering substance abuse treatment in San Francisco, CA from 2007–2009 using logistic and linear regression analyses (run separately by identified gender). Transgender men (assigned birth sex of female) differed from cisgender men across many psychosocial factors, including having more recent employment, less legal system involvement, greater incidence of living with a substance abuser, and greater family conflict, while transgender women (assigned birth sex of male) were less likely to have minor children than cisgender women. Transgender women reported greater needle use and HIV testing rates were greater among transgender women. Transgender men and women reported higher rates of physical health problems, mental health diagnoses, and psychiatric medications but there were no differences in service utilization. There were no differences in substance use behaviors except that transgender women were more likely to endorse primary methamphetamine use. Transgender individuals evidence unique strengths and challenges that could inform targeted services in substance abuse treatment. PMID:24561017

Supporting the Health and Well-Being of Transgender Students.

PubMed

Cicero, Ethan C; Wesp, Linda M

2017-04-01

Throughout the United States, there has been a rise in public discourse about transgender people and transgender issues. Much of this attention stems from passed and proposed anti-LGBTQ (lesbian, gay, bisexual, transgender, queer or questioning) legislation, including "bathroom bills" that would require transgender people to use public facilities corresponding with the sex designated on their birth certificates. With the recent discussion and legislation impacting school-aged children and adolescents, what does this mean for school nurses and how can they care and advocate for their transgender students? In this article, we aim to empower school nurses to join the discussion, advocate for inclusive and equitable school policies, and deliver gender-affirming care to transgender students. We will explain transgender identities; transgender-related stigma, prejudice, discrimination, and health concerns; gender-affirming approaches in caring for transgender youth; and implications for school nurses. School nurses play a key role in creating a space that is welcoming and affirming where transgender students can thrive.

Social Branding to Decrease Lesbian, Gay, Bisexual, and Transgender Young Adult Smoking

PubMed Central

Fallin, Amanda; Neilands, Torsten B.; Jordan, Jeffrey W.

2015-01-01

Introduction: Lesbian, gay, bisexual, and transgender (LGBT) individuals are more likely to smoke than the general population. This study evaluated a Social Branding intervention, CRUSH, which included an aspirational brand, social events, and targeted media to discourage smoking among LGBT young adults in Las Vegas, NV. Methods: Cross-sectional surveys (N = 2,395) were collected in Las Vegas LGBT bars at 2 time points 1 year apart. Multivariate logistic regressions examined associations between campaign exposure, message understanding, and current (past 30 days) smoking, controlling for demographics. Results: LGBT individuals were significantly more likely to report current (past 30 day) smoking than heterosexual/straight, gender-conforming participants. Overall, 53% of respondents reported exposure to CRUSH; of those exposed, 60% liked the campaign, 60.3% reported they would attend a CRUSH event on a night when they usually went somewhere else, and 86.3% correctly identified that the campaign was about “partying fresh and smokefree.” Current smoking was reported by 47% of respondents at Time 1 and 39.6% at Time 2. There were significant interactions between time and campaign exposure and campaign exposure and understanding the message. Among those who understood the CRUSH smokefree message, the highest level of campaign exposure was significantly associated with 37%–48% lower odds for current smoking. Conclusions: While longitudinal studies would better assess the impact of this intervention, CRUSH shows promise to reduce tobacco use among LGBT bar patrons. PMID:26180223

Challenges in Transgender Healthcare: The Pathology Perspective

PubMed Central

Gupta, Sarika; Imborek, Katherine L.; Krasowski, Matthew D.

2016-01-01

Background: The transgender community is one of the most marginalized sections of our society. The literature is scarce regarding the pathology and laboratory medicine challenges associated with caring for transgender patients. Objective: To summarize the available gender-transitioning options and to discuss healthcare challenges, from a pathology/laboratory medicine perspective, in the care of transgender patients. Method: We reviewed the current terminology and epidemiology relevant to the transgender population in preparing our analysis. Conclusions: The main transgender healthcare challenges in pathology/laboratory medicine practice include the inflexibility of electronic medical records in documenting affirmed gender, unfamiliarity among medical and laboratory professional with the needs of and terminology related to the transgender population, lack of reference ranges for laboratory tests, unclear guidelines regarding gender classification for blood donation eligibility criteria, and paucity of experience in handling and interpreting surgical and cytologic specimens from gender-transitioning individuals. Directed efforts to overcome these shortcomings, coupled with a more welcoming posture, are essential to achieving the highest standards of care for the transgender population. PMID:27287942

“I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women

PubMed Central

Gordon, Allegra R.; Austin, S. Bryn; Krieger, Nancy; White Hughto, Jaclyn M.; Reisner, Sari L.

2016-01-01

The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18–31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants’ access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention. PMID:27518756

Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population

PubMed Central

Miner, Michael H.; Swinburne Romine, Rebecca E.; Hamilton, Autumn; Coleman, Eli

2013-01-01

Objectives. We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population. Methods. In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Guided by the minority stress model, we evaluated associations between stigma and mental health and tested whether indicators of resilience (family support, peer support, identity pride) moderated these associations. Results. Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. We found few differences by gender identity. Conclusions. Our findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience. PMID:23488522

Enhancing Pediatric Trainees' and Students' Knowledge in Providing Care to Transgender Youth.

PubMed

Vance, Stanley R; Deutsch, Madeline B; Rosenthal, Stephen M; Buckelew, Sara M

2017-04-01

To enhance pediatric trainees' and students' knowledge of the psychosocial and medical issues facing transgender youth through a comprehensive curriculum. During the 2015-2016 academic year, we administered a transgender youth curriculum to fourth-year medical students, pediatric interns, psychiatry interns, and nurse practitioner students on their 1-month adolescent and young adult medicine rotation. The curriculum included six interactive, online modules and an observational experience in a multidisciplinary pediatric gender clinic. The online modules had a primary care focus with topics of general transgender terminology, taking a gender history, taking a psychosocial history, performing a sensitive physical examination, and formulating an assessment, psychosocial plan, and medical plan. At the completion of the curriculum, learners completed an evaluation that assessed change in perceived awareness and knowledge of transgender-related issues and learner satisfaction with the curriculum. Twenty learners participated in the curriculum with 100% completing the curriculum evaluations, 100% reporting completing all six online modules, and 90% attending the gender clinic. Learners demonstrated a statistically significant improvement in all pre-post knowledge/awareness measures. On a Likert scale where 5 indicated very satisfied, learners' mean rating of the quality of the curriculum was 4.5 ± .7; quality of the modules was 4.4 ± .7; and satisfaction with the observational experience was 4.5 ± .8. A comprehensive curriculum comprised interactive online modules and an observational experience in a pediatric gender clinic was effective at improving pediatric learners' perceived knowledge of the medical and psychosocial issues facing transgender youth. Learners also highly valued the curriculum. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Supporting and caring for transgender and gender nonconforming youth in the urology practice.

PubMed

Conard, L E

2017-06-01

Gender identity is a person's internal sense of gender, which may be different than the sex they were assigned at birth. Pediatric urologists are starting to see more transgender and gender non-conforming (TGN) youth and need to be able to provide culturally competent and appropriate care for these patients and their caregivers. This review will discuss common transgender terminology, specific health concerns and treatment options. A systematic literature review was performed on Medline ® , PubMed ® , and Google Scholar™ for key words transgender, gender dysphoria and gender identity disorder. Original research articles and relevant reviews were examined as well as transgender treatment guidelines from several organizations. These studies and expert opinion are summarized in this review. In this rapidly growing area of medicine, there is very little literature and few evidence-based studies. Treatment guidelines are based on small studies and expert opinion. Transgender and gender nonconforming youth are at high risk for mental health concerns and other health disparities based on their gender identity. Pediatric urologists can create a safe and welcoming environment for these patients and their caregivers to discuss these matters. Providers who are able to provide competent care for TGN youth can improve outcomes for this group. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

'They wrote "gay" on her file': transgender Ugandans in HIV prevention and treatment.

PubMed

Minor Peters, Melissa

2016-01-01

This paper examines the ways in which HIV-related programmes for heterosexual Ugandans and also for men who have sex with men work to deny healthcare services to transgender people in Uganda. Contrary to current conventional wisdom, the study found that the widespread use of the term 'men who have sex with men' produces greater barriers to healthcare for queer Ugandans than identity categories such as 'lesbian' or 'transgender'. Interventions for men who have sex with men assume a male-identified sexual subject with agency over sexual practices, such as frequency of condom use. Based on two years of ethnographic research in Kampala, I suggest that the focus on individual sexual practices harms transgender people in two ways. First, current HIV prevention and treatment programmes fail to account for risk factors that accrue to both male and female transgender Ugandans due to the social enforcement of gender norms. Second, the term men who have sex with men directs attention towards stigmatised sexual practices, producing the neglect and abuse of non-heteronormative individuals. In the context of Ugandan healthcare, terms such as 'transgender' and kuchu instead focus attention on the dignity and humanity of the rights-bearing person. These findings emphasise how health practitioners must pay attention to emic categories in order to address the ways in which vulnerability is distributed along social vectors of difference.

Resilience to Discrimination and Rejection Among Young Sexual Minority Males and Transgender Females: A Qualitative Study on Coping With Minority Stress.

PubMed

Bry, Laura Jane; Mustanski, Brian; Garofalo, Robert; Burns, Michelle Nicole

2017-09-13

Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection. Semistructured interviews were conducted with 10 sexual minority males and transgender females aged 18-22 years, who currently met criteria for an operationalized definition of resilience to depression and anxiety. Data were analyzed qualitatively, yielding information related to a wide variety of problem-solving, support-seeking, and accommodative coping strategies employed by youth in the face of social stigma. Results are discussed in light of their clinical implications.

Mobile phone use on a young person's unit.

PubMed

Bell, Jacquelyn; Finlay, Fiona; Baverstock, Anna

2009-09-01

To ascertain information about the use of mobile phones on a young person's hospital unit and to obtain the views of nursing staff and young people about the benefits of their use. A qualitative study using a pre-piloted questionnaire was given to 50 young people admitted consecutively to the young person's unit of district general hospital in a four-week period. A separate questionnaire was given to nine members of the nursing team over the same time period. Most young people had access to a mobile phone while on the ward. A total of 30 per cent were told they could use their phone, 75 per cent of those had made calls or sent texts while on the ward, 80 per cent had received calls or texts, and 20 per cent had used the ward phone at the nursing station. All staff agreed that it was helpful for young people to use their phones on the ward to keep in contact with friends and family, to avoid isolation and ease boredom. Young people have different social needs to younger children and appreciate the opportunity to use mobile phones. A more flexible approach should be adopted. The advantages of phone use clearly outweigh the risks.

Educational Strategies to Help Students Provide Respectful Sexual and Reproductive Health Care for Lesbian, Gay, Bisexual, and Transgender Persons.

PubMed

Walker, Kelly; Arbour, Megan; Waryold, Justin

2016-11-01

Graduate medical, nursing, and midwifery curricula often have limited amounts of time to focus on issues related to cultural competency in clinical practice, and respectful sexual and reproductive health care for all individuals in particular. Respectful health care that addresses sexual and reproductive concerns is a right for everyone, including those who self-identify as lesbian, gay, bisexual, or transgender (LGBT). LGBT persons have unique reproductive health care needs as well as increased risks for poor health outcomes. Both the World Health Organization and Healthy People 2020 identified the poor health of LGBT persons as an area for improvement. A lack of educational resources as well as few student clinical experiences with an LGBT population may be barriers to providing respectful sexual and reproductive health care to LGBT persons. This article offers didactic educational strategies for midwifery and graduate nursing education programs that may result in reducing barriers to the provision of respectful sexual and reproductive health care for LGBT clients. Specific ideas for implementation are discussed in detail. In addition to what is presented here, other educational strategies and clinical experiences may help to support students for caring for LGBT persons prior to entrance into clinical practice. © 2016 by the American College of Nurse-Midwives.

"I have to constantly prove to myself, to people, that I fit the bill": Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women.

PubMed

Gordon, Allegra R; Austin, S Bryn; Krieger, Nancy; White Hughto, Jaclyn M; Reisner, Sari L

2016-09-01

The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18-31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants' access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shedding light on thirteen years of darkness: content analysis of articles pertaining to transgender issues in marriage/couple and family therapy journals.

PubMed

Blumer, Markie L C; Green, Mary S; Knowles, Sarah J; Williams, April

2012-06-01

What is the extent to which marriage/couple and family therapy (M/CFT) journals address transgender issues and how many of them say they are inclusive of transgender persons when they are not? To answer these queries, a content analysis was conducted on articles published in M/CFT literature from 1997 through 2009. Of the 10,739 articles examined in 17 journals, only nine (0.0008%) focused on transgender issues or used gender variance as a variable. Findings support the assertion that transgender issues are ignored and marginalized by M/CFT scholars and researchers alike. © 2012 American Association for Marriage and Family Therapy.

Transgender youth and life-threatening behaviors.

PubMed

Grossman, Arnold H; D'Augelli, Anthony R

2007-10-01

Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide attempts. Factors significantly related to having made a suicide attempt included suicidal ideation related to transgender identity; experiences of past parental verbal and physical abuse; and lower body esteem, especially weight satisfaction and thoughts of how others evaluate the youths' bodies. Sexual minority status is a key risk factor for life-threatening behaviors among transgender youth.

Challenges in Transgender Healthcare: The Pathology Perspective.

PubMed

Gupta, Sarika; Imborek, Katherine L; Krasowski, Matthew D

2016-08-01

The transgender community is one of the most marginalized sections of our society. The literature is scarce regarding the pathology and laboratory medicine challenges associated with caring for transgender patients. To summarize the available gender-transitioning options and to discuss healthcare challenges, from a pathology/laboratory medicine perspective, in the care of transgender patients. We reviewed the current terminology and epidemiology relevant to the transgender population in preparing our analysis. The main transgender healthcare challenges in pathology/laboratory medicine practice include the inflexibility of electronic medical records in documenting affirmed gender, unfamiliarity among medical and laboratory professional with the needs of and terminology related to the transgender population, lack of reference ranges for laboratory tests, unclear guidelines regarding gender classification for blood donation eligibility criteria, and paucity of experience in handling and interpreting surgical and cytologic specimens from gender-transitioning individuals. Directed efforts to overcome these shortcomings, coupled with a more welcoming posture, are essential to achieving the highest standards of care for the transgender population. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Dyadic effects of gender minority stressors in substance use behaviors among transgender women and their non-transgender male partners.

PubMed

Reisner, Sari L; Gamarel, Kristi E; Nemoto, Tooru; Operario, Don

2014-03-01

Despite evidence that interpersonal processes shape health behaviors, research concerning the dyadic effects of gender minority stressors on substance use behaviors of transgender people is scarce. The objective of this study was to use dyadic analysis to examine whether transgender discrimination was associated with substance use among transgender women and their male partners. Transgender women and their male partners ( N =191 couples; N =382 individuals) completed questionnaires. Participants' mean age was 37.1; 79.1% were racial/ethnic minority; 61.3% earned <$500 per-month. The mean relationship duration was 37.9 months. Actor-Partner Interdependence Models were used to examine the associations between transgender-related discrimination and past 30-day non-marijuana illicit drug use adjusting for age, relationship length, financial hardship, and depressive distress among partners in these dyads. Illicit drug use was reported by 31.4% of transgender women and 25.1% of their male partners. Perceived transgender discrimination was independently associated with increased odds of illicit drug use for transgender women (actor effect) but not for their male partners. Financial hardship statistically predicted drug use for both partners (actor effects). There were no partner effects for financial hardship on drug use. Overall, 34.5% of dyads had discrepant substance use. Discrimination scores of male partners differentiated dyads who reported discrepant substance use. Gender minority stressors are critical to understanding substance use among transgender women and their male partners. Integrating socioeconomic status into gender minority stress frameworks is essential. Results have implications for substance use prevention and treatment, including the need to incorporate gender minority stressors into interventions.

Male-to-Female Transgender and Transsexual Clients of HIV Service Programs in Los Angeles County, California

PubMed Central

Edwards, Jordan W.; Fisher, Dennis G.; Reynolds, Grace L.

2007-01-01

Data on HIV risk were collected with the Countywide Risk Assessment Survey from 2126 participants; 92 were male-to-female transgender persons (i.e., cross-dressers, and those who identify with the opposite sex), and 9 were male-to-female transsexual individuals (i.e., those who have undergone gender-reassignment surgery or other procedures). Transgender-identified individuals were more likely than the rest of the sample to have received hormone injections, offensive comments, and HIV testing; injected hormones with a used needle; been Asian or American Indian; been paid for sexual intercourse; and lived in unstable housing but less likely to have used heroin. Transgender-identified individuals are at high risk for HIV infection because of reuse of needles and being paid for sexual intercourse. PMID:17463365

Male-to-female transgender and transsexual clients of HIV service programs in Los Angeles County, California.

PubMed

Edwards, Jordan W; Fisher, Dennis G; Reynolds, Grace L

2007-06-01

Data on HIV risk were collected with the Countywide Risk Assessment Survey from 2126 participants; 92 were male-to-female transgender persons (i.e., cross-dressers, and those who identify with the opposite sex), and 9 were male-to-female transsexual individuals (i.e., those who have undergone gender-reassignment surgery or other procedures). Transgender-identified individuals were more likely than the rest of the sample to have received hormone injections, offensive comments, and HIV testing; injected hormones with a used needle; been Asian or American Indian; been paid for sexual intercourse; and lived in unstable housing but less likely to have used heroin. Transgender-identified individuals are at high risk for HIV infection because of reuse of needles and being paid for sexual intercourse.

The impact of exposure to transphobia on HIV risk behavior in a sample of transgendered women of color in San Francisco.

PubMed

Sugano, Eiko; Nemoto, Tooru; Operario, Don

2006-03-01

This study examined the relationship between exposure to transphobia--societal discrimination and stigma of individuals who do not conform to traditional notions of gender--and risk for engaging in unprotected receptive anal intercourse (URAI) among 327 transgendered women of color. Overall, 24% of participants had engaged in URAI at least once in the past 30 days. Individuals who self-identified as pre-operative transsexual/transgendered women were significantly more likely than self-identified females to have engaged in URAI. Although exposure to transphobia was not independently related to URAI, an interaction between age and experiencing discrimination was observed. Among transgendered women 18-25 years old, those reporting higher levels of exposure to transphobia had a 3.2 times higher risk for engaging in URAI compared to those reporting lower levels. Findings from this study corroborate the importance of exposure to transphobia on HIV risk, particularly among transgendered young adults.

Transgender people: health at the margins of society.

PubMed

Winter, Sam; Diamond, Milton; Green, Jamison; Karasic, Dan; Reed, Terry; Whittle, Stephen; Wylie, Kevan

2016-07-23

In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty. Copyright © 2016 Elsevier Ltd. All rights reserved.

Dyadic effects of gender minority stressors in substance use behaviors among transgender women and their non-transgender male partners

PubMed Central

Reisner, Sari L.; Gamarel, Kristi E.; Nemoto, Tooru; Operario, Don

2014-01-01

Background Despite evidence that interpersonal processes shape health behaviors, research concerning the dyadic effects of gender minority stressors on substance use behaviors of transgender people is scarce. The objective of this study was to use dyadic analysis to examine whether transgender discrimination was associated with substance use among transgender women and their male partners. Methods Transgender women and their male partners (N=191 couples; N=382 individuals) completed questionnaires. Participants’ mean age was 37.1; 79.1% were racial/ethnic minority; 61.3% earned <$500 per-month. The mean relationship duration was 37.9 months. Actor-Partner Interdependence Models were used to examine the associations between transgender-related discrimination and past 30-day non-marijuana illicit drug use adjusting for age, relationship length, financial hardship, and depressive distress among partners in these dyads. Results Illicit drug use was reported by 31.4% of transgender women and 25.1% of their male partners. Perceived transgender discrimination was independently associated with increased odds of illicit drug use for transgender women (actor effect) but not for their male partners. Financial hardship statistically predicted drug use for both partners (actor effects). There were no partner effects for financial hardship on drug use. Overall, 34.5% of dyads had discrepant substance use. Discrimination scores of male partners differentiated dyads who reported discrepant substance use. Discussion Gender minority stressors are critical to understanding substance use among transgender women and their male partners. Integrating socioeconomic status into gender minority stress frameworks is essential. Results have implications for substance use prevention and treatment, including the need to incorporate gender minority stressors into interventions. PMID:25642440

Mental Health Disparities Among Canadian Transgender Youth.

PubMed

Veale, Jaimie F; Watson, Ryan J; Peter, Tracey; Saewyc, Elizabeth M

2017-01-01

This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25). A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Social Branding to Decrease Lesbian, Gay, Bisexual, and Transgender Young Adult Smoking.

PubMed

Fallin, Amanda; Neilands, Torsten B; Jordan, Jeffrey W; Ling, Pamela M

2015-08-01

Lesbian, gay, bisexual, and transgender (LGBT) individuals are more likely to smoke than the general population. This study evaluated a Social Branding intervention, CRUSH, which included an aspirational brand, social events, and targeted media to discourage smoking among LGBT young adults in Las Vegas, NV. Cross-sectional surveys (N = 2,395) were collected in Las Vegas LGBT bars at 2 time points 1 year apart. Multivariate logistic regressions examined associations between campaign exposure, message understanding, and current (past 30 days) smoking, controlling for demographics. LGBT individuals were significantly more likely to report current (past 30 day) smoking than heterosexual/straight, gender-conforming participants. Overall, 53% of respondents reported exposure to CRUSH; of those exposed, 60% liked the campaign, 60.3% reported they would attend a CRUSH event on a night when they usually went somewhere else, and 86.3% correctly identified that the campaign was about "partying fresh and smokefree." Current smoking was reported by 47% of respondents at Time 1 and 39.6% at Time 2. There were significant interactions between time and campaign exposure and campaign exposure and understanding the message. Among those who understood the CRUSH smokefree message, the highest level of campaign exposure was significantly associated with 37%-48% lower odds for current smoking. While longitudinal studies would better assess the impact of this intervention, CRUSH shows promise to reduce tobacco use among LGBT bar patrons. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

An Overview of Depression among Transgender Women

PubMed Central

2014-01-01

Rates of depression are higher in transgender women than in the general population, warranting an understanding of the variables related to depression in this group. Results of the literature review of depression in transgender women reveal several variables influencing depression, including social support, violence, sex work, and gender identity. The theoretical constructs of minority stress, coping, and identity control theory are explored in terms of how they may predict depression in transgender women. Depression and depressive symptoms have been used to predict high-risk sexual behaviors with mixed results. The implications of the findings on treating depression in transgender women include taking into account the stress of transition and the importance of supportive peers and family. Future studies should explore a model of depression and high-risk behaviors in transgender women. PMID:24744918

Gender cognition in transgender children.

PubMed

Olson, Kristina R; Key, Aidan C; Eaton, Nicholas R

2015-04-01

A visible and growing cohort of transgender children in North America live according to their expressed gender rather than their natal sex, yet scientific research has largely ignored this population. In the current study, we adopted methodological advances from social-cognition research to investigate whether 5- to 12-year-old prepubescent transgender children (N = 32), who were presenting themselves according to their gender identity in everyday life, showed patterns of gender cognition more consistent with their expressed gender or their natal sex, or instead appeared to be confused about their gender identity. Using implicit and explicit measures, we found that transgender children showed a clear pattern: They viewed themselves in terms of their expressed gender and showed preferences for their expressed gender, with response patterns mirroring those of two cisgender (nontransgender) control groups. These results provide evidence that, early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity. © The Author(s) 2015.

Supporting the Health and Well-Being of Transgender Students

ERIC Educational Resources Information Center

Cicero, Ethan C.; Wesp, Linda M.

2017-01-01

Throughout the United States, there has been a rise in public discourse about transgender people and transgender issues. Much of this attention stems from passed and proposed anti-LGBTQ (lesbian, gay, bisexual, transgender, queer or questioning) legislation, including "bathroom bills" that would require transgender people to use public…

Shedding Light on Thirteen Years of Darkness: Content Analysis of Articles Pertaining to Transgender Issues in Marriage/Couple and Family Therapy Journals

ERIC Educational Resources Information Center

Blumer, Markie L. C.; Green, Mary S.; Knowles, Sarah J.; Williams, April

2012-01-01

What is the extent to which marriage/couple and family therapy (M/CFT) journals address transgender issues and how many of them say they are inclusive of transgender persons when they are not? To answer these queries, a content analysis was conducted on articles published in M/CFT literature from 1997 through 2009. Of the 10,739 articles examined…

Gender Creative or Transgender Youth and Advanced Nursing Practice.

PubMed

Kirouac, Nicole; Tan, Mabel

2017-06-01

The World Professional Association for Transgender Health (WPATH) defines gender dysphoria as "Discomfort or distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)" (WPATH, 2016). Gender creative (GC) and transgender (TG) youth are at high risk for severe mental health disparities if they don't receive competent and timely gender transitioning care. Although awareness and early care of TG youth in specialty clinics is improving and increasing, there is still much effort that is required to eliminate barriers to care at many levels and thus improve outcomes. Nurses, particularly advanced practice nurses, are poised to lead the way in creating safe, inclusive, family centered spaces for TG and GC children, youth and their families as well as acting as vital mentors for other nurses. The purpose of this paper is to discuss the increasing prevalence of GC and TG youth, the significance of inclusive care for GC and TG youth, treatment guidelines, and the impact parents and advanced practice nurses can have on the journey of these youth as they explore and find their place on the gender spectrum. Copyright© of YS Medical Media ltd.

Lesbian, Gay, Bisexual and Transgender Health

MedlinePlus

... Form Controls Cancel Submit Search The CDC Lesbian, Gay, Bisexual, and Transgender Health Note: Javascript is disabled ... Facebook Tweet Share Compartir People who are lesbian, gay, bisexual, or transgender (LGBT) are members of every ...

Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care.

PubMed

Blosnich, John R; Brown, George R; Shipherd Phd, Jillian C; Kauth, Michael; Piegari, Rebecca I; Bossarte, Robert M

2013-10-01

We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.

Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

PubMed Central

Brown, George R.; Shipherd, PhD, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M.

2013-01-01

Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care. PMID:23947310

Testosterone treatment and MMPI-2 improvement in transgender men: a prospective controlled study.

PubMed

Keo-Meier, Colton L; Herman, Levi I; Reisner, Sari L; Pardo, Seth T; Sharp, Carla; Babcock, Julia C

2015-02-01

Most transgender men desire to receive testosterone treatment in order to masculinize their bodies. In this study, we aimed to investigate the short-term effects of testosterone treatment on psychological functioning in transgender men. This is the 1st controlled prospective follow-up study to examine such effects. We examined a sample of transgender men (n = 48) and nontransgender male (n = 53) and female (n = 62) matched controls (mean age = 26.6 years; 74% White). We asked participants to complete the Minnesota Multiphasic Personality Inventory (2nd ed., or MMPI-2; Butcher, Graham, Tellegen, Dahlstrom, & Kaemmer, 2001) to assess psychological functioning at baseline and at the acute posttreatment follow-up (3 months after testosterone initiation). Regression models tested (a) Gender × Time interaction effects comparing divergent mean response profiles across measurements by gender identity; (b) changes in psychological functioning scores for acute postintervention measurements, adjusting for baseline measures, comparing transgender men with their matched nontransgender male and female controls and adjusting for baseline scores; and (c) changes in meeting clinical psychopathological thresholds. Statistically significant changes in MMPI-2 scale scores were found at 3-month follow-up after initiating testosterone treatment relative to baseline for transgender men compared with female controls (female template): reductions in Hypochondria (p < .05), Depression (p < .05), Hysteria (p < .05), and Paranoia (p < .01); and increases in Masculinity-Femininity scores (p < .01). Gender × Time interaction effects were found for Hysteria (p < .05) and Paranoia (p < .01) relative to female controls (female template) and for Hypochondria (p < .05), Depression (p < .01), Hysteria (p < .01), Psychopathic Deviate (p < .05), Paranoia (p < .01), Psychasthenia (p < .01), and Schizophrenia (p < .01) compared with male controls (male template). In addition, the proportion of

Determinants of and Barriers to Hormonal and Surgical Treatment Receipt Among Transgender People

PubMed Central

Sineath, R. Craig; Woodyatt, Cory; Sanchez, Travis; Giammattei, Shawn; Gillespie, Theresa; Hunkeler, Enid; Owen-Smith, Ashli; Quinn, Virginia P.; Roblin, Douglas; Stephenson, Robert; Sullivan, Patrick S.; Tangpricha, Vin; Goodman, Michael

2016-01-01

Abstract Purpose: Medical gender confirmation therapy (GCT) plays an important role in transgender health; however, its prevalence and determinants constitute an area of uncertainty. Methods: Data for this cross-sectional study were obtained from an online survey distributed from October 2012 through the end of 2013 among persons who visited the social media sites of a transgender education and social networking meeting. Eligible respondents (n=280) were persons whose gender identity was different from their sex assigned at birth and who responded to questions about previously received or planned hormonal therapy (HT), chest reconstruction, or genital surgery. Multivariable logistic regression models examined how receipt and plans to receive different GCT types were associated with participants' characteristics and gender identity. Results: The respective percentages of ever and current HT were 58% and 47% for transwomen and 63% and 57% for transmen. Genital surgery was reported by 11 participants; all transwomen. Relative to transmen, transwomen were thrice more likely to report plans to undergo genital surgery. By contrast, transmen were more than 10 times as likely as transwomen to have had or planned chest surgery. Older participants and those who were in a committed relationship were less likely to plan future GCT. Having health insurance was not associated with GCT receipt. Treatment cost was named as the main problem by 23% of transwomen and 29% of transmen. Accessing a qualified healthcare provider for transgender-related care was listed as the primary reason for not receiving surgery by 41% of transmen and 2% of transwomen. Conclusions: Prevalence of GCT differed across subgroups of participants and was lower than corresponding estimates reported elsewhere. The variability of results may reflect differences in recruitment procedures and response rates; however, it is also possible that it may be driven by geographic, socioeconomic, and health

Recommendations from Transgender Healthcare Consumers in Rural Areas

PubMed Central

Knutson, Douglas; Martyr, Meredith A.; Mitchell, Travis A.; Arthur, Tori; Koch, Julie M.

2018-01-01

Abstract Purpose: Scholars indicate that rates of mental and physical health issues (e.g., substance use, anxiety, depression) may be much higher among transgender individuals relative to the general population. This disparity may be even greater for transgender individuals in rural areas. Clinical researchers suggest using affirmative therapeutic approaches and interventions to address the health concerns of transgender individuals, specifically to connect individuals with the transgender community. However, little is known about the content of information that is shared in transgender communities in rural areas. Method: For this qualitative study, researchers asked transgender individuals in rural areas (n=10) what recommendations they would offer to other transgender individuals in rural areas regarding healthcare access. Results: Results were organized into four domains: Access care, Quality control, Difficulties, and Mentorship. Within these domains, we identified 11 sub-domains: Get physical healthcare, Get mental healthcare, Provider search, Provider vetting, Treatment verification, It will be difficult, Know who you are, Believe in yourself, Move, Connect to community, and Other. Conclusions: We discuss implications of our findings for healthcare provision in rural areas, and we provide recommendations for future research.

Addressing Transgender Issues in Schools

ERIC Educational Resources Information Center

Cavanagh, Marian

2016-01-01

As mainstream media focus more attention on transgender issues, and as anti-discrimination laws evolve, a shift is taking place on campuses. Many schools now include gender identity and expression in their inclusivity work and seek to establish policies and procedures to support transgender students and their families. It's not an easy task. In…

Transgender Rights as Human Rights.

PubMed

Powell, Tia; Shapiro, Sophia; Stein, Ed

2016-11-01

Arguments to support transgender rights often rely on "born that way" arguments, which assert that gender identity is innate, immutable, and unassociated with choice. These arguments are vulnerable to attack on several grounds, including on the basis of emerging scientific data. Stronger support for transgender rights arises from human rights arguments. © 2016 American Medical Association. All Rights Reserved.

Self-Authoring Gender outside the Binary: A Narrative Analysis of (Trans)gender Undergraduates

ERIC Educational Resources Information Center

Ashton, Kasey

2013-01-01

This narrative inquiry explored how transgender college students construct, experience, and make meaning of gender. Gender is not constructed or understood in isolation; it is therefore essential to consider how personal cognition intersects with and is influenced by an internal sense of self and relationships with others when exploring how…

Meeting the healthcare needs of transgender people within the armed forces: putting UK military policy into practice.

PubMed

Whybrow, Dean; New, Chris; Coetzee, Rik; Bickerstaffe, Paul

2016-12-01

To explain how the healthcare needs of transgender personnel are met within the United Kingdom Armed Forces. It may be that when transgender people disclose their gender preference that they are at increased risk of social exclusion. The United Kingdom Armed Forces has an inclusive organisational policy for the recruitment and management of transgender personnel. This is a position paper about how the healthcare needs of transgender military personnel are met by the United Kingdom Armed Forces. United Kingdom Armed Forces policy was placed into context by reviewing current research, discussing medical terminology and describing the policy. This was followed by an account of how UK AF policy is applied in practice. Where armed forces had an inclusive policy for the management of transgender personnel, there seemed to be little cause for secrecy and zero tolerance of discrimination when compared to nations where this was not the case. Medical terminology has changed to reflect a more inclusive, less stigmatising use of language. The United Kingdom Armed Forces policy has been described as progressive and inclusive. The application of this policy in practice may be dependent upon strong leadership and training. The wider United Kingdom Armed Forces seems capable of adopting a pragmatic and flexible approach to meeting the healthcare needs of transgender personnel. The United Kingdom Armed Forces value diversity within their workforce and have a progressive, inclusive policy for the recruitment and management of transgender personnel. When supporting a transgender military person, healthcare professionals, civilian organisations and military line managers should consider referring to United Kingdom Armed Forces policy as early as possible. Other military and uniformed services may wish to examine the United Kingdom Armed Forces exemplar in order to consider the applicability within their own organisational setting. © 2016 John Wiley & Sons Ltd.

Prevalence and correlates of smoking and e-cigarette use among young men who have sex with men and transgender women.

PubMed

Gerend, Mary A; Newcomb, Michael E; Mustanski, Brian

2017-10-01

Although the prevalence of cigarette smoking in the United States has decreased, rates remain elevated among sexual and gender minorities (SGMs). This study examined rates and correlates of tobacco use among young men who have sex with men (YMSM) and transgender women. Participants (N=771) were drawn from the baseline assessment of an ongoing longitudinal cohort study of racially diverse MSM aged 16-29 years. Data collection took place in 2015-2016. Socio-demographic and SGM-specific (e.g., gender identity, sexual identity, physical attraction) correlates of cigarette smoking and electronic cigarette (e-cigarette) use were identified using logistic regression. Twenty-one percent were current cigarette smokers. Nearly 40% ever tried an e-cigarette, but regular e-cigarette use was low (3.8%). Smokers were more likely to be older (vs. aged 16-18), less educated, homeless, bisexual or identify as some other sexual minority (vs. gay), attracted to males and females equally or more attracted to females than males (vs. males only), and HIV-positive. E-cigarette users were more likely to be transgender women (vs. cisgender men), White (vs. Black), more educated, and mostly attracted to females. Findings highlight important risk factors for tobacco use among SGM youth. Correlates of smoking mirrored findings observed in the general population, but also included factors specific to SGM youth (e.g., sexual orientation, HIV status, homelessness). Although some variables (gender identity, attraction) demonstrated similar relationships with smoking and e-cigarette use, others (race/ethnicity, education) demonstrated opposite patterns. Findings underscore the urgent need for tobacco prevention and cessation interventions for SGM youth. Copyright © 2017 Elsevier B.V. All rights reserved.

Cyberbullying and Suicide among a Sample of Lesbian, Gay, Bisexual, Transgender, and Questioning Young Adults

ERIC Educational Resources Information Center

Schwickrath, Heather M.

2012-01-01

After an extensive literature review, results indicated research has been conducted examining the links between traditional bullying and suicide, lesbian, gay, bisexual, transgendered, and questioning (LGBTQ) identification and cyberbullying, as well as LGBTQ identification and suicide. However, it appears as though there is a dearth of studies…

Development and Validation of the Transgender Inclusive Behavior Scale (TIBS).

PubMed

Kattari, Shanna K; O'Connor, Ashley A; Kattari, Leonardo

2018-01-01

Transgender-inclusive behaviors are actions and communication supporting transgender individuals. Examples include using language not reinforcing the gender binary, asking for and using correct pronouns, creation of spaces that welcome members of the transgender community, and acknowledging cisgender (non-transgender) privilege. A survey was developed measuring this behavior in individuals to examine the impact of transgender-inclusive behavior and the potential effect of interventions on promoting inclusive behavior. Data were collected utilizing an online survey (N = 1,051). The sample was split in half to run two sets of cases in a principal components analysis. Analysis of the full sample showed Cronbach's alpha to be .93 (n = 918). Findings suggest that the Transgender Inclusive Behavior Scale (TIBS) may be a useful instrument for identifying behaviors related to being inclusive of transgender individuals, groups, and communities. It may also be used to measure behavior change before and after transgender-specific educational and behavioral interventions.

Survey of community pharmacy residents' perceptions of transgender health management.

PubMed

Leach, Caitlin; Layson-Wolf, Cherokee

2016-01-01

1) To measure the general perceptions and attitudes of community pharmacy residents toward transgender patients and health; 2) to identify gaps in didactic education regarding transgender health care among residents; and 3) to evaluate residents' level of support for pharmacists receiving education in transgender health care. This study was a cross-sectional survey delivered online. Community residency directors were e-mailed a cover letter and a 34-question online survey. The directors were asked to forward the survey to their residents for completion within 4 weeks. Responses were anonymous with no identifiers collected on the survey. Survey responses used a combination of open-response, multiple-choice, and Likert-scale questions aimed at gathering respondents' demographic information, perceptions of managing transgender patients and the need for receiving additional education in transgender health care. Overall, the results of the survey indicated that community pharmacy residents support integrating transgender health management into pharmacy education and recognize that the overwhelming barriers to care for these patients include discrimination and lack of provider knowledge. Significant findings include: 82.7% of community residents think that community pharmacists play an important role in providing care for transgender patients; 98.2% think that they have a responsibility to treat transgender patients; and 71.4% were not educated about transgender patient issues in pharmacy school. Only 36.2% of community residents felt confident in their ability to treat transgender patients. Community pharmacy residents list discrimination and lack of provider knowledge as the major barriers to care for transgender patients. Residents do not feel confident in their ability to treat and manage transgender patients. The majority of residents were not educated about transgender patient issues while in pharmacy school and think that community pharmacists need more education

Clinical Exposure to Transgender Medicine Improves Students' Preparedness Above Levels Seen with Didactic Teaching Alone: A Key Addition to the Boston University Model for Teaching Transgender Healthcare.

PubMed

Park, Jason A; Safer, Joshua D

2018-01-01

Purpose: Transgender individuals are medically underserved in the United States and face many documented disparities in care due to providers' lack of education, training, and comfort. We have previously demonstrated that specific transgender medicine content in a medical school curriculum increases students' willingness to treat transgender patients. However, we have also identified that those same students are less comfortable with transgender care relative to care for lesbian, gay, and bisexual patients. We aimed to demonstrate that clinical exposure to care for transgender patients would help close this gap. Methods: At Boston University School of Medicine, we piloted a transgender medicine elective where students rotate on services that provide clinical care for transgender individuals. Pre- and postsurveys were administered to students who participated in the elective. Results: After completing the elective, students who reported "high" comfort increased from 45% (9/20) to 80% (16/20) ( p =0.04), and students who reported "high" knowledge regarding management of transgender patients increased from 0% (0/20) to 85% (17/20) ( p <0.001 ) . Conclusion: Although integrating evidence-based, transgender-specific content into medical curricula improves student knowledge and comfort with transgender medical care, gaps remain. Clinical exposure to transgender medicine during clinical years can contribute to closing that gap and improving access to care for transgender individuals.

Personality traits of a group of young adults from different family structures.

PubMed

Du Toit, J; Nel, E M; Steel, H R

1992-07-01

The impact of parental divorce and remarriage and young adults' gender on second-order personality traits, such as extraversion, anxiety, tough poise and independence, was examined. The responses of 227 young adults on the Sixteen Personality Factor Questionnaire (16PF; Cattell, Eber, & Tatsuoka, 1970) were subjected to a parametric multivariate analysis of variance. Results revealed significant differences between the anxiety scores of the young men and women as well as between those of the three different family-structure groups, but divorce and remarriage was not associated with either positive or negative personality development in this sample.

"Boys Don't Cry," a Movie Review: Implications for Counseling Persons Who Are Transgendered

ERIC Educational Resources Information Center

Aguilar, Jinnelle Veronique

2010-01-01

People who fall under the umbrella of transgender belong to one of the most marginalized groups within society. Many who do not pass within the gender binary categories imposed by social norms experience discrimination and marginalization. In this article, the author discusses the film "Boys Don't Cry" and introduces the reader to the varieties of…

Hormone therapy for inmates: a metonym for transgender rights.

PubMed

Maruri, Silpa

2011-01-01

The issue of hormone therapy for transgender inmates, while seemingly limited in importance, is one that involves issues of greater importance for the transgender community. The greatest issue at the heart of the matter is the legal argument that is traditionally used to gain access to hormone therapy: the Eighth Amendment. The Eighth Amendment prohibits deliberate indifference to the medical needs of inmates. Traditionally, transgender inmates have gained access to hormone therapy by appealing to the DSM-IV's classification of Gender Identity Disorder (GID) as a mental illness, and by establishing that prison officials' failure to provide hormone therapy constitutes deliberate indifference to a serious medical need. However, appeal to GID is a double-edged sword: while it allows access to hormone therapy, it does so by describing transgender individuals as somehow sick or infirm. This description is at odds with the transgender community's conceptualization of itself. This Note seeks to square the legal arguments for provision of hormone therapy to transgender inmates with the philosophical backdrop that shapes the transgender rights movement by using Plyler v. Doe as a model. This Note argues that access to hormone therapy by transgender inmates involves the intersection of a quasi-fundamental right with a quasi-suspect class. By utilizing such an argument, the transgender community is not bound by the negative expressive effect that the law may have in describing it as infirm or deficient.

The Effects of Cumulative Victimization on Mental Health Among Lesbian, Gay, Bisexual, and Transgender Adolescents and Young Adults.

PubMed

Mustanski, Brian; Andrews, Rebecca; Puckett, Jae A

2016-03-01

To examine the effects of the cumulative victimization experienced by lesbian, gay, bisexual, and transgender youths on mental disorders. We recruited 248 participants from the Chicago, Illinois, area in 7 waves of data collected over 4 years, beginning in 2007 (83.1% retention rate). Mean age at enrollment was 18.7 years, and 54.7% were Black. We measured depression and posttraumatic stress disorder using structured psychiatric interviews. Latent class analyses of victimization over time identified a 4-class solution. Class 1 (65.4%) had low, decreasing victimization. Class 2 (10.3%) had moderate, increasing victimization. Class 3 (5.1%) had high, steady victimization. Class 4 (19.2%) had high, decreasing victimization. Controlling for baseline diagnoses and birth sex, lesbian, gay, bisexual, and transgender youths in classes 2 and 3 were at higher risk for depression than were those in class 1; youths in classes 2, 3, and 4 were at elevated risk for posttraumatic stress disorder. Lesbian, gay, bisexual, and transgender youths with steadily high or increasing levels of victimization from adolescence to early adulthood are at higher risk for depression and posttraumatic stress disorder.

The Effects of Cumulative Victimization on Mental Health Among Lesbian, Gay, Bisexual, and Transgender Adolescents and Young Adults

PubMed Central

Andrews, Rebecca; Puckett, Jae A.

2016-01-01

Objectives. To examine the effects of the cumulative victimization experienced by lesbian, gay, bisexual, and transgender youths on mental disorders. Methods. We recruited 248 participants from the Chicago, Illinois, area in 7 waves of data collected over 4 years, beginning in 2007 (83.1% retention rate). Mean age at enrollment was 18.7 years, and 54.7% were Black. We measured depression and posttraumatic stress disorder using structured psychiatric interviews. Results. Latent class analyses of victimization over time identified a 4-class solution. Class 1 (65.4%) had low, decreasing victimization. Class 2 (10.3%) had moderate, increasing victimization. Class 3 (5.1%) had high, steady victimization. Class 4 (19.2%) had high, decreasing victimization. Controlling for baseline diagnoses and birth sex, lesbian, gay, bisexual, and transgender youths in classes 2 and 3 were at higher risk for depression than were those in class 1; youths in classes 2, 3, and 4 were at elevated risk for posttraumatic stress disorder. Conclusions. Lesbian, gay, bisexual, and transgender youths with steadily high or increasing levels of victimization from adolescence to early adulthood are at higher risk for depression and posttraumatic stress disorder. PMID:26794175

Clinical Exposure to Transgender Medicine Improves Students' Preparedness Above Levels Seen with Didactic Teaching Alone: A Key Addition to the Boston University Model for Teaching Transgender Healthcare

PubMed Central

Park, Jason A.; Safer, Joshua D.

2018-01-01

Abstract Purpose: Transgender individuals are medically underserved in the United States and face many documented disparities in care due to providers' lack of education, training, and comfort. We have previously demonstrated that specific transgender medicine content in a medical school curriculum increases students' willingness to treat transgender patients. However, we have also identified that those same students are less comfortable with transgender care relative to care for lesbian, gay, and bisexual patients. We aimed to demonstrate that clinical exposure to care for transgender patients would help close this gap. Methods: At Boston University School of Medicine, we piloted a transgender medicine elective where students rotate on services that provide clinical care for transgender individuals. Pre- and postsurveys were administered to students who participated in the elective. Results: After completing the elective, students who reported “high” comfort increased from 45% (9/20) to 80% (16/20) (p=0.04), and students who reported “high” knowledge regarding management of transgender patients increased from 0% (0/20) to 85% (17/20) (p<0.001). Conclusion: Although integrating evidence-based, transgender-specific content into medical curricula improves student knowledge and comfort with transgender medical care, gaps remain. Clinical exposure to transgender medicine during clinical years can contribute to closing that gap and improving access to care for transgender individuals. PMID:29344576

Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach.

PubMed

Lo Russo, Giulia; Tanini, Sara; Innocenti, Marco

2017-04-01

Chest-wall contouring surgery is one of the first steps in sexual reassignment in female-to-male (FtM) transsexuals that contributes to strengthening of the self-image and facilitates living in the new gender role. The main goal is to masculinize the chest by removing the female contour. Chest contour, scar placement, scar shape, scar length, nipple-areola position, nipple size and the areola size are the key points. Between July 2013 and June 2016, 25 FtM transgender patients underwent surgical procedures to create a masculine chest-wall contour. In our study, we just considered 16 patients who have undergone chest surgery with the double incision method. The patients' survey revealed a high satisfaction rate with the aesthetic result. In our group, no complications occurred, and two patients have undergone supplementary surgery for axillary dog-ear revision and nipple reconstruction. The authors propose a new technical approach and indications for FtM transgender patients' surgery. A longer scar that emphasizes the pectoralis muscle, a smaller nipple and a resized and refaced areola are the key points of our technique to give a masculine appearance to the chest. The scars are permanent, but most of them will fade and the patients are enthusiastic with their new "male" chest appearance. The high level of satisfaction, the great aesthetic result and the low rate of complications suggest to us the use of this technique in medium- and large-size breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Electronic health records and transgender patients--practical recommendations for the collection of gender identity data.

PubMed

Deutsch, Madeline B; Buchholz, David

2015-06-01

Transgender (Trans, Trans*) persons may have a gender identity and a preferred name that differ from those assigned at birth, and/or those listed on their current legal identification (Gender ID, Birth-assigned Sex, Legal Sex). Transgender people who are referred to in a clinical setting using the wrong pronoun or name may suffer distress, ridicule or even assault by others in the waiting area, and may not return for further care. Furthermore, failure to accurately document (and therefore count) transgender identities has negative implications on quality improvement and research efforts, funding priorities and policy activities. The recent announcement that gender identity data may be included in Meaningful Use Stage 3 has accelerated the need for guidance for both vendors and local implementation teams on how to best record and store these data. A recent study demonstrated wide variation in current practices. This manuscript provides a description of identifiers associated with gender identity, and makes practical and evidence based recommendations for implementation and front-end functionality.

Young Children with Developmental Delays as Young Adults: Predicting Developmental and Personal-Social Outcomes

ERIC Educational Resources Information Center

Bernheimer, Lucinda P.; Keogh, Barbara K.; Guthrie, Donald

2006-01-01

We report on a 20-year follow-up of 30 children with developmental delays identified at age 3. Our purpose was to assess the relationship of early indicators of delay to cognitive and personal-social status in young adulthood. Predictors were Developmental and Personal-Social factors derived from standardized tests and parent questionnaires…

How Much Power Does a Higher Ed Institution Have over Including Transgender Students in Greek Life?

ERIC Educational Resources Information Center

Nguyen, AiVi

2016-01-01

Different images come to mind when thinking about college fraternities and sororities, depending on who you are. Whether your images are positive or negative, one thing is constant: You envision a group of same-sex young people. But one of the major social issues that this country is dealing with is the treatment of transgender people, and…

Transgender health care: improving medical students' and residents' training and awareness.

PubMed

Dubin, Samuel N; Nolan, Ian T; Streed, Carl G; Greene, Richard E; Radix, Asa E; Morrison, Shane D

2018-01-01

A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017. Transgender health has yet to gain widespread curricular exposure, but efforts toward incorporating transgender health into both undergraduate and graduate medical educations are nascent. There is no consensus on the exact educational interventions that should be used to address transgender health. Barriers to increased transgender health exposure include limited curricular time, lack of topic-specific competency among faculty, and underwhelming institutional support. All published interventions proved effective in improving attitudes, knowledge, and/or skills necessary to achieve clinical competency with transgender patients. Transgender populations experience health inequities in part due to the exclusion of transgender-specific health needs from medical school and residency curricula. Currently, transgender medical education is largely composed of one-time attitude and awareness-based interventions that show significant short-term improvements but suffer methodologically. Consensus in the existing literature supports educational efforts to shift toward

Transgender health care: improving medical students’ and residents’ training and awareness

PubMed Central

Streed, Carl G; Greene, Richard E; Radix, Asa E; Morrison, Shane D

2018-01-01

Background A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. Methods We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017. Results Transgender health has yet to gain widespread curricular exposure, but efforts toward incorporating transgender health into both undergraduate and graduate medical educations are nascent. There is no consensus on the exact educational interventions that should be used to address transgender health. Barriers to increased transgender health exposure include limited curricular time, lack of topic-specific competency among faculty, and underwhelming institutional support. All published interventions proved effective in improving attitudes, knowledge, and/or skills necessary to achieve clinical competency with transgender patients. Conclusion Transgender populations experience health inequities in part due to the exclusion of transgender-specific health needs from medical school and residency curricula. Currently, transgender medical education is largely composed of one-time attitude and awareness-based interventions that show significant short-term improvements but suffer methodologically. Consensus in the existing literature supports

Development, risk, and resilience of transgender youth.

PubMed

Stieglitz, Kimberly A

2010-01-01

Transgender youth face unique and complex issues as they confront cultural expectations of gender expression and how these fit with what is natural for them. Striving for balance, learning to cope, questioning, and eventually becoming comfortable with one's gender identity and sexual orientation are of paramount importance for healthy growth and development. Ineffective management of intense challenges over time without adequate social support places youth at risk for a number of unhealthy behaviors, including risk behaviors associated with acquiring HIV. This article explores early foundations of gender identity development, challenges in the development of transgender youth, and the limited data that exist on transgender youth and HIV risks. The concept of resilience is introduced as a counterbalancing area for assessment and intervention in practice and future research with transgender youth.

The Significance of Personal Names for Very Young Children

ERIC Educational Resources Information Center

Ostler, Teresa

2014-01-01

Personal names are more than just a sound or word. From the earliest stages of development, names are closely connected to a child's attachment figures and sense of identity. Like words of magic, young children first use names to beckon the parent to them. Experiences with others provide the necessary backdrop for young children to infuse names…

Transgender Youth and Life-Threatening Behaviors

ERIC Educational Resources Information Center

Grossman, Arnold H.; D'Augelli, Anthony R.

2007-01-01

Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide…

Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables.

PubMed

Nemoto, Tooru; Bödeker, Birte; Iwamoto, Mariko; Sakata, Maria

2014-04-01

It is urgent to develop efficacious HIV prevention programs to curb the reported extremely high HIV prevalence and incidence among transgender women (male-to-female transgender persons) who reside in large cities in the USA. This study aimed to describe unprotected receptive anal sex (URAS) and unprotected insertive anal sex (UIAS) among high-risk transgender women in relation to partner types, psychosocial factors, and background variables. Based on purposive sampling from the targeted communities and AIDS service organizations in San Francisco and Oakland, a total of 573 transgender women who had a history of sex work were recruited and individually interviewed using a structured survey questionnaire. Significant correlates with URAS with primary, casual, and commercial sex partners were found (e.g., needs for social support, frequency of social support received, exposure to transphobia, self-esteem, economic pressure, norms toward practicing healthy behaviors, and self-efficacy toward practicing safe sex). Multiple logistic regression analyses revealed that transgender women who had engaged in URAS with commercial partners were more likely to have higher levels of transphobia or lower levels of the norms or self-efficacy to practice safe sex. Among the participants who did not have vaginoplasty (preoperative transgender women), 16.4% had engaged in insertive anal sex (IAS) with commercial partners in the past 30 days. The participants who were HIV positive and had engaged in IAS were more likely to be African-American or Caucasians, coinfected with sexually transmitted infections, or identified themselves as homosexual. Practices of IAS among transgender women have not been thoroughly investigated in relation to sexual and gender identity. UIAS with homosexual and bisexual men in addition to URAS may be a cause for high HIV incidence among transgender women. An HIV prevention intervention study must be developed and evaluated, which aims to reduce HIV

Exposure to and Attitudes Regarding Transgender Education Among Urology Residents.

PubMed

Dy, Geolani W; Osbun, Nathan C; Morrison, Shane D; Grant, David W; Merguerian, Paul A

2016-10-01

Transgender individuals are underserved within the health care system but might increasingly seek urologic care as insurers expand coverage for medical and surgical gender transition. To evaluate urology residents' exposure to transgender patient care and their perceived importance of transgender surgical education. Urology residents from a representative sample of U.S. training programs were asked to complete a cross-sectional survey from January through March 2016. Respondents were queried regarding demographics, transgender curricular exposure (didactic vs clinical), and perceived importance of training opportunities in transgender patient care. In total, 289 urology residents completed the survey (72% response rate). Fifty-four percent of residents reported exposure to transgender patient care, with more residents from Western (74%) and North Central (72%) sections reporting exposure (P ≤ .01). Exposure occurred more frequently through direct patient interaction rather than through didactic education (psychiatric, 23% vs 7%, P < .001; medical, 17% vs 6%, P < .001; surgical, 33% vs 11%, P < .001). Female residents placed greater importance on gender-confirming surgical training than did their male colleagues (91% vs 70%, P < .001). Compared with Western section residents (88%), those from South Central (60%, P = .002), Southeastern (63%, P = .002), and Mid-Atlantic (63%, P = .003) sections less frequently viewed transgender-related surgical training as important. Most residents (77%) stated transgender-related surgical training should be offered in fellowships. Urology resident exposure to transgender patient care is regionally dependent. Perceived importance of gender-confirming surgical training varies by sex and geography. A gap exists between the direct transgender patient care urology residencies provide and the didactic transgender education they receive. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All

An Older Transgender Woman's Quest for Identity.

PubMed

Walker, Charles A; Cohen, Harriet; Jenkins, David

2016-02-01

Despite sensationalized media attention, transgender individuals are the most marginalized and misunderstood group in the lesbian, gay, bisexual, and transgender (LGBT) community. The current article presents a case study of one woman's quest for identity. Narrative inquiry was used to analyze data from interview transcripts and four themes emerged during analysis: (a) naming the ambiguity, (b) revealing-concealing the authentic self, (c) discovering the transgender community, and (d) embracing the "T" identity. Lifespan and empowerment theories were used to harvest meanings from these themes. Implications for nursing practice and research were examined based on study findings. Participatory action research offers an approach for future studies in which researchers advocate for transgender individuals and remove obstacles to their health care access. [Journal of Psychosocial Nursing and Mental Health Services, 54(2), 31-38.]. Copyright 2016, SLACK Incorporated.

Gender violence: transgender experiences with violence and discrimination.

PubMed

Lombardi, E L; Wilchins, R A; Priesing, D; Malouf, D

2001-01-01

There is a pervasive pattern of discrimination and prejudice against transgendered people within society. Both economic discrimination and experiencing violence could be the result of a larger social climate that severely sanctions people for not conforming to society's norms concerning gender; as such, both would be strongly associated with each other. Questionnaires were distributed to people either through events or through volunteers, and made available upon the World Wide Web. A sample of 402 cases was collected over the span of 12 months (April 1996-April 1997). We found that over half the people within this sample experienced some form of harassment or violence within their lifetime, with a quarter experiencing a violent incident. Further investigation found that experiencing economic discrimination because one is transgendered had the strongest association with experiencing a transgender related violent incident. Economic discrimination was related to transgendered people's experience with violence. Therefore, both hate crimes legislation and employment protections are needed for transgendered individuals.

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action.

PubMed

Poteat, Tonia; Malik, Mannat; Scheim, Ayden; Elliott, Ayana

2017-08-01

The purpose of this review is to summarize the available evidence-based HIV prevention interventions tailored for transgender people. A limited number of evidence-based HIV prevention interventions have been tested with transgender populations. Most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Studies addressing biomedical interventions for transgender women are ongoing. Few interventions address social and structural barriers to HIV prevention, such as stigma, discrimination, and poverty. Evidence-based multi-level interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence. Future research should address not only pre-exposure prophylaxis uptake and condom use but also structural barriers that limit access to these prevention strategies.

Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults

PubMed Central

Seelman, Kristie L.; Colón-Diaz, Matthew J.P.; LeCroix, Rebecca H.; Xavier-Brier, Marik; Kattari, Leonardo

2017-01-01

Abstract Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B=−0.26, p<0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation (p<0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare. PMID:28861545

Health care providers' comfort with and barriers to care of transgender youth.

PubMed

Vance, Stanley R; Halpern-Felsher, Bonnie L; Rosenthal, Stephen M

2015-02-01

To explore providers' clinical experiences, comfort, and confidence with and barriers to providing care to transgender youth. An online survey was administered to members of the Society for Adolescent Health and Medicine and the Pediatric Endocrine Society with items querying about clinical exposure to transgender youth, familiarity with and adherence to existing clinical practice guidelines, perceived barriers to providing transgender-related care, and comfort and confidence with providing transgender-related care. The response rate was 21.9% (n = 475). Of the respondents, 66.5% had provided care to transgender youth, 62.4% felt comfortable with providing transgender medical therapy, and 47.1% felt confident in doing so. Principal barriers to provision of transgender-related care were lack of the following: training, exposure to transgender patients, available qualified mental health providers, and insurance reimbursement. This study suggests that more training in transgender-related care, available qualified mental health providers, and insurance reimbursement for transgender-related care are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Healthcare Experiences Among Young Adults Who Identify as Genderqueer or Nonbinary.

PubMed

Lykens, James E; LeBlanc, Allen J; Bockting, Walter O

2018-04-01

Research on healthcare among gender-diverse populations has largely focused on people who describe their gender in binary terms, either as trans men or trans women. This qualitative study examined the healthcare experiences of young adults who identify as genderqueer or nonbinary (GQ/NB). Participants (N = 10) were interviewed about experiences seeking and accessing healthcare. All were young adults (ages 23-33) in the San Francisco Bay area who had accessed healthcare at least once in the prior 6 months. A semistructured interview guide elicited conversations about gender identity and experiences of healthcare. Interview transcripts were analyzed using emergent coding analysis to identify themes. Participants faced unique challenges even at clinics specializing in gender-affirming healthcare. They felt misunderstood by providers who approached them from a binary transgender perspective and consequently often did not receive care sensitive to nonbinary identities. In response to this perceived bias, participants sometimes "borrowed" a binary transgender label to receive care, modified the healthcare they were prescribed, or went without healthcare. The GQ/NB young adults in our study regularly felt disrespected and frustrated as they sought and accessed healthcare. Participants felt that the binary transgender narrative pressured them to conform to binary medical narratives throughout healthcare interactions. GQ/NB young adults have unique healthcare needs but often do not feel understood by their providers. There is a need for existing healthcare systems to serve GQ/NB young adults more effectively.

Identifying the Transgender Population in the Medicare Program

PubMed Central

Proctor, Kimberly; Haffer, Samuel C.; Ewald, Erin; Hodge, Carla; James, Cara V.

2016-01-01

Abstract Purpose: To identify and describe the transgender population in the Medicare program using administrative data. Methods: Using a combination of International Classification of Diseases ninth edition (ICD-9) codes relating to transsexualism and gender identity disorder, we analyzed 100% of the 2013 Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service (FFS) “final action” claims from both institutional and noninstitutional providers (∼1 billion claims) to identify individuals who may be transgender Medicare beneficiaries. To confirm, we developed and applied a multistage validation process. Results: Four thousand ninety-eight transgender beneficiaries were identified, of which ∼90% had confirmatory diagnoses, billing codes, or evidence of a hormone prescription. In general, the racial, ethnic, and geographic distribution of the Medicare transgender population tends to reflect the broader Medicare population. However, age, original entitlement status, and disease burden of the transgender population appear substantially different. Conclusions: Using a variety of claims information, ranging from claims history to additional diagnoses, billing modifiers, and hormone prescriptions, we demonstrate that administrative data provide a valuable resource for identifying a lower bound of the Medicare transgender population. In addition, we provide a baseline description of the diversity and disease burden of the population and a framework for future research. PMID:28861539

Cancer in Transgender People: Evidence and Methodological Considerations

PubMed Central

Braun, Hayley; Nash, Rebecca; Tangpricha, Vin; Brockman, Janice; Ward, Kevin; Goodman, Michael

2017-01-01

Abstract Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population. PMID:28486701

Anti-transgender prejudice: a structural equation model of associated constructs.

PubMed

Tebbe, Esther N; Moradi, Bonnie

2012-04-01

This study aimed to identify theoretically relevant key correlates of anti-transgender prejudice. Specifically, structural equation modeling was used to test the unique relations of anti-lesbian, gay, and bisexual (LGB) prejudice; traditional gender role attitudes; need for closure; and social dominance orientation with anti-transgender prejudice. Social desirability was controlled as a covariate in the model. Analyses of data from 250 undergraduate students indicated that anti-LGB prejudice, traditional gender role attitudes, and need for closure each had positive unique relations with anti-transgender prejudice beyond the negative association of social desirability with such prejudice. By contrast, social dominance orientation was not related uniquely to anti-transgender prejudice. Additional analyses indicated that women's mean level of anti-transgender prejudice was lower than that of men's, but the pattern of relations between the predictor variables and anti-transgender prejudice did not differ between women and men. A confirmatory factor analysis also supported the unidimensional structure of anti-transgender prejudice as operationalized by Nagoshi et al.'s (2008) Transphobia Scale.

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults.

PubMed

Katz-Wise, Sabra L; Reisner, Sari L; White Hughto, Jaclyn M; Budge, Stephanie L

2017-07-01

This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.

Discrimination and resilience and the needs of people who identify as Transgender: A narrative review of quantitative research studies.

PubMed

McCann, Edward; Brown, Michael

2017-12-01

To examine discrimination and resilience experiences of people who identify as transgender and establish potential health service responses. People who identify as transgender face many challenges in society in terms of the knowledge, understanding and acceptance of a person's gender identity. A narrative review of quantitative empirical research. A comprehensive search of CINAHL, MEDLINE, PsycINFO and Sociological Abstracts electronic databases from 2006-2016 was conducted. The search yielded 1,478 papers and following the application of rigorous inclusion and exclusion criteria a total of 19 papers were included in the review. The findings reveal that there is a need to ensure that the needs of transgender people are represented, fully integrated and clearly linked to outcomes that improve their health and quality of life. Discrimination experiences can result in poorer health outcomes; however, many people have developed resilience and positive coping strategies. Nurses need to recognise and respond appropriately to the care and treatment needs of this population. Comprehensive nursing assessments and plans of care that encompass all aspects of the person should be in place supported by clear policy guidelines and evidence-based research. The education requirements of practitioners are outlined. © 2017 John Wiley & Sons Ltd.

Transgender men's experiences of fertility preservation: a qualitative study.

PubMed

Armuand, G; Dhejne, C; Olofsson, J I; Rodriguez-Wallberg, K A

2017-02-01

How do transgender men experience fertility preservation (FP) by cryopreservation of oocytes? The procedures required prior to oocyte cryopreservation, such as hormonal ovarian stimulation and transvaginal ultrasound (TVS), have a negative impact on gender dysphoria as they are closely linked to the men's female assigned sex at birth, which is incompatible with their current status. Transgender persons often have high dissatisfaction with assigned sex-specific body features, such as the genital organs and androgen/oestrogen-responsive features. Thus, undergoing FP that requires genital-specific examinations, aimed at obtaining oocytes to cryopreserve, could be distressing. As no previous studies have investigated transgender men's experiences of FP involving cryopreservation of oocytes, little is known about their experience of the procedures. This is a prospective study among adult transgender men referred for FP between March 2014 and December 2015. Individual in-depth qualitative interviews were conducted shortly after FP treatment. The interviews lasted between 62 and 111 min (mean 81 min) and were digitally recorded and transcribed verbatim. Participants were recruited on their first visit to the assisted reproduction clinic for reproductive counseling. There were 15 men, scheduled for FP, who chose to participate in the study (age 19-35); none had given birth and eight had a partner. Data were analyzed by thematic content analysis. The analysis resulted in three main categories: the journey to FP, reactions to the FP proceedings and strategies for coping. The referral for FP was an important part of the assessment and diagnosis and sometimes lined with frustrating waits and doubts. The reaction to the FP proceedings revealed that the genital examinations and the physical changes associated with discontinuation of testosterone or hormonal stimulation treatment triggered gender incongruence and dysphoria. However, for some, the negative expectations were not

Homeless Gay and Transgender Youth of Color in San Francisco: "No One Likes Street Kids"--Even in the Castro

ERIC Educational Resources Information Center

Reck, Jen

2009-01-01

This study, focused on five transgender and gay youth of color from San Francisco, explored how family problems, poverty, homophobia, and transphobia propelled them into homelessness and made gay-friendly spaces and resources especially meaningful to them. These young people describe seeking support in San Francisco's well-known gay enclave, the…

Individual, social and community-level predictors of wellbeing in a US sample of transgender and gender non-conforming individuals.

PubMed

Stanton, Megan C; Ali, Samira; Chaudhuri, Sambuddha

2017-01-01

In the last decade, increased attention has been paid to the physical and mental health needs of transgender and gender non-conforming individuals. However, despite this surge of research, scant literature addresses factors associated with wellbeing among members of this population. Using data from the US Social Justice Sexuality Survey, this study examines predictors of wellbeing in a sample of transgender and gender non-conforming individuals. Results indicate that higher levels of wellbeing are predicted by education, older age and a greater sense of connectedness to the lesbian, gay, bisexual and transgender community. Additionally, although health insurance did not have a significant impact on wellbeing, increased general health was associated with greater wellbeing, as was perceived comfort of the healthcare provider regarding the respondent's sexual identity. These findings can inform multi-level intervention with transgender and gender non-conforming persons to promote their wellbeing, as well as guide policies and practices around healthcare provider training. Future research should further examine the interconnected predictors of wellbeing among members of this population.

Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey.

PubMed

Bauer, Greta R; Scheim, Ayden I; Deutsch, Madeline B; Massarella, Carys

2014-06-01

Transgender, transsexual, or transitioned (trans) people have reported avoiding medical care because of negative experiences or fear of such experiences. The extent of trans-specific negative emergency department (ED) experiences, and of ED avoidance, has not been documented. The Trans PULSE Project conducted a survey of trans people in Ontario, Canada (n=433) in 2009 to 2010, using respondent-driven sampling, a tracked network-based method for studying hidden populations. Weighted frequencies and bootstrapped 95% confidence intervals (CIs) were estimated for the trans population in Ontario and for the subgroup (n=167) reporting ED use in their felt gender. Four hundred eight participants completed the ED experience items. Trans people were young (34% aged 16 to 24 years and only 10% >55 years); approximately half were female-to-male and half male-to-female. Medically supervised hormones were used by 37% (95% CI 30% to 46%), and 27% (95% CI 20% to 35%) had at least 1 transition-related surgery. Past-year ED need was reported by 33% (95% CI 26% to 40%) of trans Ontarians, though only 71% (95% CI 40% to 91%) of those with self-reported need indicated that they were able to obtain care. An estimated 21% (95% CI 14% to 25%) reported ever avoiding ED care because of a perception that their trans status would negatively affect such an encounter. Trans-specific negative ED experiences were reported by 52% (95% CI 34% to 72%) of users presenting in their felt gender. This first exploratory analysis of ED avoidance, utilization, and experiences by trans persons documented ED avoidance and possible unmet need for emergency care among trans Ontarians. Additional research, including validation of measures, is needed. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Barriers to Care Among Transgender and Gender Nonconforming Adults.

PubMed

Gonzales, Gilbert; Henning-Smith, Carrie

2017-12-01

Policy Points: Transgender and gender nonconforming (GNC) adults may experience barriers to care for a variety of reasons, including discrimination and lack of awareness by providers in health care settings. In our analysis of a large, population-based sample, we found transgender and GNC adults were more likely to be uninsured and have unmet health care needs, and were less likely to have routine care, compared to cisgender (nontransgender) women. Our findings varied by gender identity. More research is needed on transgender and GNC populations, including on how public policy and provider awareness affects health care access and health outcomes differentially by gender identity. Very little population-based research has examined health and access to care among transgender populations. This study compared barriers to care between cisgender, transgender, and gender nonconforming (GNC) adults using data from a large, multistate sample. We used data from the 2014-2015 Behavioral Risk Factor Surveillance System to estimate the prevalence of having no health insurance, unmet medical care needs due to cost, no routine checkup, and no usual source of care for cisgender women (n = 183,370), cisgender men (n = 131,080), transgender women (n = 724), transgender men (n = 449), and GNC adults (n = 270). Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for each barrier to care while adjusting for sociodemographic characteristics. Transgender and GNC adults were more likely to be nonwhite, sexual minority, and socioeconomically disadvantaged compared to cisgender adults. After controlling for sociodemographic characteristics, transgender women were more likely to have no health insurance (OR = 1.60; 95% CI = 1.07-2.40) compared to cisgender women; transgender men were more likely to have no health insurance (OR = 2.02; 95% CI = 1.25-3.25) and no usual source of care (OR = 1.84; 95% CI = 1.18-2.88); and GNC

Flexible queers, serious bodies: transgender inclusion in queer spaces.

PubMed

Stone, Amy L

2013-01-01

Queer spaces are significant for understanding transgender inclusion as "queer spaces were places where individuals were expected to be attentive to or aware of alternative possibilities for being, including non-normative formulations of bodies, genders, desires and practices" ( Nash, 2011 , p. 203). Indeed, in this interview study of members of a queer leather group called the Club, members described a flexible "sexual landscape" that easily includes transgender members. However, these same queer spaces have been criticized for the way they regulate queer bodies and organize queer subjectivities. In this study, queer members of the Club also contrasted playful queer flexibility with serious transgender bodies. This article argues that, although there is a reiterative relation between transgender inclusion and queer spaces, the idealization of flexibility within queer spaces can also serve to marginalize and regulate transgender bodies.

Constructing an Alternative Pedagogy of Islam: The Experiences of Lesbian, Gay, Bisexual and Transgender Muslims

ERIC Educational Resources Information Center

Shah, Shanon

2016-01-01

There is growing media interest in how lesbian, gay, bisexual or transgender (LGBT) Muslims negotiate their seemingly incompatible religious and sexual identities. Thus, there is a need to investigate how some LGBT Muslims utilise Islam as a resource for alternative pedagogical strategies to reconcile their personal beliefs and values. Their…

Transgender social inclusion and equality: a pivotal path to development

PubMed Central

Divan, Vivek; Cortez, Clifton; Smelyanskaya, Marina; Keatley, JoAnne

2016-01-01

Introduction The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished. Discussion The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere. Conclusions The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote

Transgender social inclusion and equality: a pivotal path to development.

PubMed

Divan, Vivek; Cortez, Clifton; Smelyanskaya, Marina; Keatley, JoAnne

2016-01-01

The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished. The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere. The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote gender equality, strengthen social and

Lesbian, gay, bisexual, and transgender youths: who smokes, and why?

PubMed

Remafedi, Gary

2007-01-01

Existing research indicates the rate of smoking among lesbian, gay, bisexual, and transgender (LGBT) youths exceeds the general population's, possibly due to stress, habitual substance abuse, socializing in smoky venues, and tobacco marketing. The study's overall aim was to conduct qualitative research regarding tobacco use and avoidance by LGBT youths. This report focuses on identifying priority subpopulations and corresponding risk and resiliency factors. Purposive and maximum variation sampling were used to select 30 LGBT youths and 30 interactors for face-to-face interviews. Almost a third of participants said that all LGBT youths are at risk for smoking. Other respondents specified a range of high-risk groups, encompassing many subpopulations. Contributing factors for smoking included personal characteristics, interpersonal issues, environmental conditions, and structural issues. More than a third of young smokers were not acquainted with LGBT nonsmokers and could not imagine how they avoid using tobacco. Half of the interactors and four youths ascribed favorable qualities to nonsmokers--such as self-esteem, will power, and concern for personal health, appearance, and well-being. In conclusion, smoking is a pervasive problem among LGBT youths. The findings corroborate prior explanations and implicate new ones. Some risks (e.g., limited opportunities to socialize with LGBT peers outside of smoking venues, the desire to appear more masculine, and sexuality-related stress) and resiliency factors (e.g., positive sexual identity) are unique to LGBT populations, reinforcing the need for culturally specific approaches to prevention and cessation. Highlighting the positive attributes of nonsmokers and nonsmoking might prove useful in prevention campaigns.

Sociodemographic Characteristics of Trans Persons in Belgium: A Secondary Data Analysis of Medical, State, and Social Data.

PubMed

Motmans, Joz; Ponnet, Koen; De Cuypere, Griet

2015-07-01

By performing secondary data analyses of existing medical, social, and state data, this study examined the sociodemographic profile of trans persons in Belgium and gains knowledge on those who are functionally invisible in traditional epidemiological studies or clinical samples. Based on medical interventions, post-operative transsexual persons were selected from a social survey data set, to compare their sociodemographic profile with available data on legal sex changes from the Belgian National Register and with published data on clinical samples of post-operative transsexual persons. Furthermore, based on self-chosen gender identity categories in the social survey data, transsexual participants were compared with the transgender participants (those people feeling neither female nor male, or both female and male, or otherwise). The sociodemographic data on the post-operative transsexual persons from the three datasets appeared to be very similar. Based on identity categories, the data on transsexual and transgender persons from the social survey showed differences in marital status and employment. Transsexual persons were significantly more often divorced than transgender persons. Both groups differed significantly in employment status. Information about transgender people (or the "in-between" group) is too often lacking from studies but can be obtained when identity instead of medical criteria are used in research.

Making Campuses More Inclusive of Transgender Students

ERIC Educational Resources Information Center

Beemyn, Brett Genny

2005-01-01

This article examines a number of areas of campus life where transgender students experience discrimination because of gender-exclusive policies and practices: health care, residence halls, bathrooms, locker rooms, records and documents, public inclusion, and programming, training, and support. The specific obstacles faced by transgender students…

Judgments toward male and transgendered victims in a depicted stranger rape.

PubMed

Davies, Michelle; Hudson, Jenefer

2011-01-01

There has been an increasing amount of research interest into perceptions of male rape in recent years. However, no research has assessed how people react when a transgendered person is raped. The aim of this study was to investigate the effects of transgendered status and sexuality on victim blame and perceived severity in a depicted rape scenario. The sexuality of the victim was manipulated to include a heterosexual, homosexual, cross-dresser, female-to-male transsexual, and male-to-female transsexual. It was predicted that the heterosexual victims would be judged the most positively and that heterosexual male participants would make the most anti-victim judgments. One hundred thirty-three lesbian, gay male, and heterosexual members of the general population read a scenario depicting a rape and then completed a questionnaire measuring victim blame and perceived severity of the assault. Results conformed to the predictions. Results are discussed in relation to traditional gender roles and homophobia.

Education Creates Welcoming Environment for Transgender Patients.

PubMed

Ehrenfeld, Jesse; Gridley, Samantha

2016-08-01

The ED often is the access point of choice for transgender patients who may be reluctant to interact with providers. Experts say there is a need for training and education of how to present a gender-affirming healthcare environment. Recommended steps include a review of policies, along with corresponding changes to electronic and paper intake forms to ensure that the language used is inclusive of all genders. While blanket discrimination may be declining, experts note that some providers are uncertain about how to interact with a transgender patient. It's always best to ask patients for their preferred name and pronoun and to repeat this exercise every three to six months for return patients, as gender identify can be fluid. To ease anxiety for transgender patients, consider developing a navigator program that will pair any transgender patient who requests the service with a trained advocate who can support and guide the patient through the system.

The Role of Personality Traits in Young Adult Fruit and Vegetable Consumption.

PubMed

Conner, Tamlin S; Thompson, Laura M; Knight, Rachel L; Flett, Jayde A M; Richardson, Aimee C; Brookie, Kate L

2017-01-01

This project investigated how individual differences in the big-five personality traits (neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness) predicted plant-food consumption in young adults. A total of 1073 participants from two samples of young adults aged 17-25 reported their daily servings of fruits, vegetables, and two unhealthy foods for comparison purposes using an Internet daily diary for 21 or 13 days (micro-longitudinal, correlational design). Participants also completed the Neuroticism, Extraversion, Openness Five Factor Inventory (NEO-FFI) measure of personality, and demographic covariates including gender, age, ethnicity, and body mass index (BMI). Analyses used hierarchical regression to predict average daily fruit and vegetable consumption as separate dependent variables from the demographic covariates (step 1) and the five personality traits (step 2). Results showed that young adults higher in openness and extraversion, and to some extent conscientiousness, ate more fruits and vegetables than their less open, less extraverted, and less conscientious peers. Neuroticism and agreeableness were unrelated to fruit and vegetable consumption. These associations were unique to eating fruit and vegetables and mostly did not extend to unhealthy foods tested. Young adult women also ate more fruit and vegetables than young adult men. Results suggest that traits associated with greater intellect, curiosity, and social engagement (openness and extraversion), and to a lesser extent, discipline (conscientiousness) are associated with greater plant-food consumption in this population. Findings reinforce the importance of personality in establishing healthy dietary habits in young adulthood that could translate into better health outcomes later in life.

Review of the Transgender Literature: Where Do We Go from Here?

PubMed

Wanta, Jonathon W; Unger, Cecile A

2017-01-01

Purpose: The "transgender tipping point" has brought transgender social and health issues to the forefront of American culture. However, medical professionals have been lagging in academic research with a transgender-specific focus resulting in significant knowledge gaps in dealing with the care of our transgender patients. The aim of this article is to analyze all published Medline-available transgender-specific articles, identify these knowledge gaps, and direct future research to where it is most needed. Methods: We surveyed all Medline-available articles up to June 2016 using a combination of medical subject headings and keywords in titles and abstracts. Articles meeting inclusion criteria were reviewed, categorized, and analyzed for content and study design. Results: In our review of the literature, we identified 2405 articles published from January 1950 to June 2016 that focused on transgender health, primarily in the fields of surgery, mental health, and endocrinology. Conclusion: Significant knowledge gaps were found across the subspecialties, and there was a lack of prospective robust research and representation of transgender-specific data in the core medical journals. More data and research are needed to bridge the knowledge gaps that currently exist and improve the care of the transgender community.

Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People

PubMed Central

Scheim, Ayden; Xavier, Jessica; Reisner, Sari; Baral, Stefan

2016-01-01

Introduction: Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations. Methods: A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations. Results: Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations. Discussion: Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people. PMID:27429185

Avenue T: Using Film as "Entree" in Teaching about Transgender

ERIC Educational Resources Information Center

Walters, Andrew S.; Rehma, Kae

2013-01-01

Educators from a variety of disciplines include the concept of transgender and multiple gender identities in course curricula. The "T" (denoting the specific inclusion of transgender) in the popular acronym LGBT (lesbian, gay, bisexual, transgender) often is given less pedagogical attention than is sexual orientation, and the transgender…

Mothers' Temperament and Personality: Their Relationship to Parenting Behaviors, Locus of Control, and Young Children's Functioning.

PubMed

Puff, Jayme; Renk, Kimberly

2016-10-01

There appears to be a lack of construct clarity and a dearth of studies that have examined both mothers' temperament and personality in conjunction with parenting behaviors when predicting young children's functioning. As a result, this study examined these constructs jointly so that a further understanding of how mothers' temperament and personality may work together to predict young children's functioning could be gained. As part of this study, 214 diverse mothers with young children who ranged in age from 2- to 6-years rated their own temperament and personality, their parenting characteristics, and their young children's functioning (i.e., temperament and emotional and behavioral functioning). Based on the findings of hierarchical regression analyses completed in this study, both mothers' temperament and personality may be important individual predictors of young children's temperament but may be important joint predictors, along with parenting behaviors, of young children's behavior problems. Consequently, future research should examine the role that mothers' temperament and personality characteristics may play in conjunction with their parenting behaviors when trying to understand young children's functioning. These findings will be particularly helpful for professionals providing parenting interventions to families with young children who have difficult temperament styles and/or emotional and behavioral problems.

76 FR 59133 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... Have Sex with Men and Young Transgender Persons of Color, Funding Opportunity Announcement (FOA) PS11... application received in response to ``HIV Prevention Projects for Young Men of Color Who Have Sex with Men and...

Crisis, Acceptance, and Advocacy: A Supportive Guide for Parents of Trans and Gender-Nonconforming Youth--A Review of "The Transgender Child"

ERIC Educational Resources Information Center

Wyss, Shannon E.

2013-01-01

The first nonpathologizing book for parents on trans and gender-nonconforming young people, Stephanie Brill and Rachel Pepper's "The Transgender Child: A Handbook for Families and Professionals", urges unconditional love and acceptance of both trans youth and gender-nonconforming children. The authors encourage parents not only to support their…

Review of the Transgender Literature: Where Do We Go from Here?

PubMed Central

Wanta, Jonathon W.; Unger, Cecile A.

2017-01-01

Abstract Purpose: The “transgender tipping point” has brought transgender social and health issues to the forefront of American culture. However, medical professionals have been lagging in academic research with a transgender-specific focus resulting in significant knowledge gaps in dealing with the care of our transgender patients. The aim of this article is to analyze all published Medline-available transgender-specific articles, identify these knowledge gaps, and direct future research to where it is most needed. Methods: We surveyed all Medline-available articles up to June 2016 using a combination of medical subject headings and keywords in titles and abstracts. Articles meeting inclusion criteria were reviewed, categorized, and analyzed for content and study design. Results: In our review of the literature, we identified 2405 articles published from January 1950 to June 2016 that focused on transgender health, primarily in the fields of surgery, mental health, and endocrinology. Conclusion: Significant knowledge gaps were found across the subspecialties, and there was a lack of prospective robust research and representation of transgender-specific data in the core medical journals. More data and research are needed to bridge the knowledge gaps that currently exist and improve the care of the transgender community. PMID:29082332

Transgender sexual health in China: a cross-sectional online survey in China

PubMed Central

Zhang, Ye; Best, John; Tang, Weiming; Tso, Lai Sze; Liu, Fengying; Huang, Shujie; Zheng, Heping; Yang, Bin; Wei, Chongyi; Tucker, Joseph D

2016-01-01

Objective Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China. Methods We recruited participants (born biologically male, ≥16 years old, ever engaged in anal sex with men and agreed to provide cell phone number) from three web platforms in 2014. Data on sociodemographics, IPV and sexual behaviours were collected. Logistic regressions were performed to compare the differences between transgender individuals and non-transgender MSM. Results Overall, 1424 eligible participants completed our online survey. Of these participants, 61 (4.3%) were transgender individuals, including 28 (2.0%) identifying as women and 33 (2.3%) identifying as transgender. Compared with MSM, transgender individuals were more likely to have experienced IPV and sexual violence (economic abuse, physical abuse, threat to harm loved ones, threat to ‘out’, forced sex). In addition, transgender individuals were more likely to have engaged in commercial sex (21.3% vs 5.1%, aOR 4.80, 95% CI 2.43 to 9.51) and group sex (26.2% vs 9.2%, aOR 3.47, 95% CI 1.58 to 6.48) in the last 12 months. Conclusions Our study is consistent with the emerging literature demonstrating increased sexual risk behaviours and high levels of IPV among transgender individuals. Future research should further investigate transgender individuals’ experiences of IPV and explore ways to promote disclosure of gender identity to healthcare providers. Furthermore, transgender research in China should be expanded independently of MSM research. PMID:27052037

Gynecologic Care of the Female-to-Male Transgender Man

PubMed Central

Dutton, Lauren; Koenig, Karel; Kristopher, Fennie

2016-01-01

Transgender men are a vulnerable population whose health care needs have been difficult to identify because of limited research and an inability to identify the population. Limited evidence suggests that transgender men are at increased risk of having polycystic ovarian syndrome, contracting HIV, experiencing violence, and committing suicide. This qualitative study, conducted through face-to-face interviews of a convenient sample, was a three-part interview containing a demographic and health questionnaire, the Norbeck Social Support Questionnaire, as well as the Health Care Relationship Trust Scale. Audio recordings and written notes were reviewed and common themes were identified via content analysis. Six self-identified transgender men between the ages of 19 and 45 years were enrolled in the study. Participants were at varying degrees of social and medical transition. Four major themes were identified: 1) receiving gynecologic care was perceived to be important; 2) breasts caused the most gender identity conflict; 3) transgender men struggle with revealing their gender identity to health care providers; and 4) the male/female boxes on health intake forms, as well as pronoun usage by medical staff, were barriers to receiving health care. This gynecologic health care needs assessment of transgender men begins to characterize the barriers transgender men face when seeking health care. PMID:18586186

Transgender Veterans' Satisfaction With Care and Unmet Health Needs.

PubMed

Lehavot, Keren; Katon, Jodie G; Simpson, Tracy L; Shipherd, Jillian C

2017-09-01

Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. We used data from transgender Veterans collected in 2014 through an online, national survey. In total, 298 transgender Veterans living in the United States. We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.

Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey.

PubMed

Christian, Robin; Mellies, Amy Anderson; Bui, Alison Grace; Lee, Rita; Kattari, Leo; Gray, Courtney

2018-05-15

Transgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender-inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited. The Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado. The Colorado Transgender Health Survey, based on the Behavioral Risk Factor Surveillance System (BRFSS), was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender-inclusive events and organizations. Responses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data. Results from 406 transgender or gender-nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender-inclusive provider were more likely to receive wellness exams (76 versus 48%), less likely to delay care due to discrimination (24 versus 42%), less depressed (38 versus 54%), and less likely to attempt suicide (7 versus 15%) than those without. The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into

The mental health of Canadian transgender youth compared with the Canadian population

PubMed Central

Veale, Jaimie F.; Watson, Ryan J.; Peter, Tracey; Saewyc, Elizabeth M.

2017-01-01

Objectives This study documents the prevalence of mental health concerns among Canadian transgender youth and makes comparisons with cisgender or mostly-cisgender population-based studies. This study also compares gender identity subgroups (transgender girls/women, boys/men, and non-binary) and age subgroups (14–18 year olds and 19–25 year olds) on mental health outcomes. Methods A nonprobability sample of 923 transgender youth from across Canada completed a bilingual online survey. Participants were recruited through community organizations, healthcare settings, social media, and the researchers’ networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Results Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episode, suicidal ideation, and suicide attempts. Risk ratios ranged from 3.8 to 16.1. Transgender boys/men and non-binary youth were most likely to report self-harm and non-binary youth also reported lower overall mental health. Rates of self-harm and suicide were lower in the 19–25 age group than the 14–18 age group, but reported overall mental health was the same across these age groups. Conclusions Although a notable minority of transgender youth reported good mental health, this study shows the mental health disparities faced by transgender youth in Canada are considerable. Policy Implications These findings underscore the need for policies and laws protecting transgender people from discrimination, training for transgender competency for mental healthcare providers, providers, and further development of transgender-specific interventions to promote positive mental health and reduce mental health problems among transgender youth. PMID:28007056

Transgender Stigma and Health: A Critical Review of Stigma Determinants, Mechanisms, and Interventions

PubMed Central

White Hughto, Jaclyn M.; Reisner, Sari L.; Pachankis, John E.

2015-01-01

Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. PMID:26599625

On the Border: Young Adults with LGBQ Parents Navigate LGBTQ Communities

ERIC Educational Resources Information Center

Goldberg, Abbie E.; Kinkler, Lori A.; Richardson, Hannah B.; Downing, Jordan B.

2012-01-01

Little research has examined the perspectives of young adults with lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents, particularly in relation to their identification with the LGBTQ community. To address this gap, we conducted a qualitative study of 42 young adults (ages 18-29) who were raised by LGBQ parents. We found that…

Global health burden and needs of transgender populations: a review.

PubMed

Reisner, Sari L; Poteat, Tonia; Keatley, JoAnne; Cabral, Mauro; Mothopeng, Tampose; Dunham, Emilia; Holland, Claire E; Max, Ryan; Baral, Stefan D

2016-07-23

Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly. Copyright © 2016 Elsevier Ltd. All rights reserved.

HIV Prevention Service Utilization in the Los Angeles House and Ball Communities: Past Experiences and Recommendations for the Future

ERIC Educational Resources Information Center

Holloway, Ian W.; Traube, Dorian E.; Kubicek, Katrina; Supan, Jocelyn; Weiss, George; Kipke, Michele D.

2012-01-01

African-American young men who have sex with men and transgender persons are at elevated risk for HIV infection. House and Ball communities, networks of mostly African-American gay, bisexual, and transgender individuals who compete in modeling and dance, represent a prime venue for HIV prevention with these difficult-to-reach populations; however,…

Advancing Methods for U.S. Transgender Health Research

PubMed Central

Reisner, Sari L.; Deutsch, Madeline B.; Bhasin, Shalender; Bockting, Walter; Brown, George R.; Feldman, Jamie; Garofalo, Rob; Kreukels, Baudewijntje; Radix, Asa; Safer, Joshua D.; Tangpricha, Vin; T’Sjoen, Guy; Goodman, Michael

2016-01-01

Purpose of Review To describe methodological challenges, gaps, and opportunities in U.S. transgender health research. Recent Findings Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of gender affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and intervention-testing studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidence-based clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities. Summary Transgender health research faces challenges that include standardization of lexicon, agreed-upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population. PMID:26845331

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data.

PubMed

Dragon, Christina N; Guerino, Paul; Ewald, Erin; Laffan, Alison M

2017-12-01

Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age.

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

PubMed Central

Guerino, Paul; Ewald, Erin; Laffan, Alison M.

2017-01-01

Abstract Purpose: Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. Methods: Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). Results: Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. Conclusion: This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age. PMID:29125908

Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions.

PubMed

White Hughto, Jaclyn M; Reisner, Sari L; Pachankis, John E

2015-12-01

Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. This critical review aims to integrate the literature on stigma towards transgender people in the U.S. This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.

Transgender across the Curriculum: A Psychology for Inclusion

ERIC Educational Resources Information Center

Case, Kim A.; Stewart, Briana; Tittsworth, Josephine

2009-01-01

Neumann (2005) called for an analysis of marginalization and inclusion of lesbian, gay, and bisexual students in psychology. As psychology instructors begin to infuse such content, the curriculum still overwhelmingly neglects the transgender community. This invisibility of transgender people within psychology courses allows for perpetuation of…

Project Gel a Randomized Rectal Microbicide Safety and Acceptability Study in Young Men and Transgender Women

PubMed Central

Cranston, Ross D.; Mayer, Kenneth H.; Febo, Irma; Duffill, Kathryn; Siegel, Aaron; Engstrom, Jarret C.; Nikiforov, Alexyi; Park, Seo-Young; Brand, Rhonda M.; Jacobson, Cindy; Giguere, Rebecca; Dolezal, Curtis; Frasca, Timothy; Leu, Cheng-Shiun; Schwartz, Jill L.; Carballo-Diéguez, Alex

2016-01-01

Objectives The purpose of Project Gel was to determine the safety and acceptability of rectal microbicides in young men who have sex with men (MSM) and transgender women (TGW) at risk of HIV infection. Methods MSM and TGW aged 18–30 years were enrolled at three sites; Pittsburgh, PA; Boston, MA; and San Juan, PR. Stage 1A was a cross-sectional assessment of sexual health and behavior in MSM and TGW. A subset of participants from Stage 1A were then enrolled in Stage 1B, a 12-week evaluation of the safety and acceptability of a placebo rectal gel. This was followed by the final phase of the study (Stage 2) in which a subset of participants from Stage 1B were enrolled into a Phase 1 rectal safety and acceptability evaluation of tenofovir (TFV) 1% gel. Results 248 participants were enrolled into Stage 1A. Participants’ average age was 23.3 years. The most common sexually transmitted infection (STIs) at baseline were Herpes simplex (HSV)-2 (16.1% by serology) and rectal Chlamydia trachomatis (CT) (10.1% by NAAT). 134 participants were enrolled into Stage 1B. During the 12 week period of follow-up 2 HIV, 5 rectal CT, and 5 rectal Neisseria gonorrhea infections were detected. The majority of adverse events (AEs) were infections (N = 56) or gastrointestinal (N = 46) and were mild (69.6%) or moderate (28.0%). Of the participants who completed Stage 1B, 24 were enrolled into Stage 2 and randomized (1:1) to receive TFV or placebo gel. All participants completed Stage 2. The majority of AEs were gastrointestinal (N = 10) and of mild (87.2%) or moderate (10.3%) severity. Conclusions In this study we were able to enroll a sexually active population of young MSM and TGW who were willing to use rectal microbicides. TFV gel was safe and acceptable and should be further developed as an alternative HIV prevention intervention for this population. Trial Registration ClinicalTrials.gov NCT01283360 PMID:27362788

The process of developing a community-based research agenda with lesbian, gay, bisexual, transgender and queer youth in the Northwest Territories, Canada.

PubMed

Logie, Carmen H; Lys, Candice

2015-01-01

Youth in Canada's Northwest Territories (NWT) experience sexual and mental health disparities. Higher rates of sexual and mental health concerns among lesbian, gay, bisexual, transgender and queer (LGBTQ) youth in comparison with heterosexual and cisgender peers have been associated with stigma and discrimination. Although LGBTQ youth in the NWT are situated at the nexus of Northern and LGBTQ health disparities, there is little known about their health, well-being and experiences of stigma. This short communication discusses the process of developing a LGBTQ youth community-based research programme in the NWT. We developed an interdisciplinary research team of LGBTQ and allied young adults, including indigenous and non-indigenous researchers, community organisers and service providers in the NWT. We conducted meetings in Yellowknife with LGBTQ youth (n=12) and key stakeholders (n=15), including faculty, students, community groups and health and social service providers. Both meetings included LGBTQ and allied participants who were LGBTQ, indigenous, youth and persons at the intersection of these identities. LGBTQ youth participants discussed community norms that devalued same sex identities and stigma surrounding LGBTQ-specific services and agencies. Stigma among LGBT youth was exacerbated for youth in secondary schools, gender non-conforming and transgender youth and young gay men. In the stakeholder meeting, service providers discussed the importance of integrating LGBTQ issues in youth programmes, and LGBTQ community groups expressed the need for flexibility in service delivery to LGBTQ youth. Stakeholders identified the need to better understand the needs of indigenous LGBTQ youth in the NWT. Community-based LGBTQ groups, researchers and health and social service providers are interested in addressing LGBTQ youth issues in the NWT. The emergence of LGBTQ community building, support groups and activism in Northern Canada suggests that this is an opportune time

Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention

ERIC Educational Resources Information Center

Swanbrow Becker, Martin A.; Nemeth Roberts, Stacey F.; Ritts, Sam M.; Branagan, William Tyler; Warner, Alia R.; Clark, Sheri L.

2017-01-01

This study examines the experiences of transgender college students in coping with stress in comparison to their cisgender peers. Undergraduate and graduate students from 73 colleges, totaling 26,292 participants, of which 47 identified as transgender completed an online survey. Transgender students reported greater exposure to trauma and higher…

77 FR 33599 - Lesbian, Gay, Bisexual, and Transgender Pride Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-07

..., Gay, Bisexual, and Transgender Pride Month, 2012 By the President of the United States of America A... live and love as we see fit. The lesbian, gay, bisexual, and transgender (LGBT) community has written a... coverage to someone just because they are lesbian, gay, bisexual, or transgender. Because we understand...

Hormonal and Surgical Treatment Options for Transgender Men (Female-to-Male).

PubMed

Gorton, Ryan Nicholas; Erickson-Schroth, Laura

2017-03-01

Untreated transgender men face serious negative health care outcomes. Effective medical, surgical, and mental health treatment ameliorates these risks. Although the research is not as robust as would be ideal, hormone treatment is effective and generally well tolerated with few serious medical risks. Surgeries carry serious risks; but for most transgender men, the benefits outweigh the risks. This review describes current evidence-based medical treatments for transgender men and provides an overview of surgical therapy to enable practitioners to discuss these options with their transgender male patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Prevalence of Transgender Depends on the "Case" Definition: A Systematic Review.

PubMed

Collin, Lindsay; Reisner, Sari L; Tangpricha, Vin; Goodman, Michael

2016-04-01

A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates. To evaluate the epidemiology of transgender and examine how various definitions of transgender affect prevalence estimates and to compare findings across studies that used different methodologies, in different countries, and over different periods. PubMed, EMBASE, and Medline were searched to identify studies reporting prevalence estimates of transgender in a population. All studies were grouped based on the case definition applied to the numerator. Summary estimates were derived using a random-effects model for total prevalence of transgender and for male-to-female and female-to-male subgroups. Overall and stratum-specific meta-prevalence estimates (mPs) and 95% confidence intervals (CIs) were accompanied by tests for heterogeneity and meta-regressions to assess sources of heterogeneity. The main outcome measure was population prevalence of transgender. Secondary outcomes included gender-specific prevalence estimates for male-to-female and female to male subgroups. Thirty-two studies met the inclusion criteria for systematic review. Of those, 27 studies provided necessary data for a meta-analysis. Overall mP estimates per 100,000 population were 9.2 (95% CI = 4.9-13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6-9.1) for transgender-related diagnoses. Of studies assessing self-reported transgender identity, the mP was 871 (95% CI = 519-1,224); however, this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI = 144-566). Significant heterogeneity was observed in most analyses. The empirical literature on the prevalence of transgender highlights the importance of adhering to specific case definitions because the results can range by orders of magnitude. Standardized and routine collection of data on transgender status and gender identity is

‘It’s really a hard life’: Love, gender and HIV risk among male-to-female transgender persons

PubMed Central

MELENDEZ, RITA M.; PINTO, ROGÉRIO

2012-01-01

Scientific studies demonstrate high rates of HIV infection among male-to-female (MTF) transgender individuals and that stigma and discrimination place MTFs at increased risk for infection. However, there is little research examining how gender roles contribute to HIV risk. This paper reports on in-depth interviews with 20 MTFs attending a community clinic. Data reveal that stigma and discrimination create a heightened need for MTFs to feel safe and loved by a male companion and that in turn places them at a higher risk for acquiring HIV. Male-to-female transgender individuals appear to turn to men to feel loved and affirmed as women; their main HIV risk stems from their willingness to engage with sexual partners who provide a sense of love and acceptance but who also may also request unsafe sexual behaviours. A model illustrating how HIV risk is generated from stigma and discrimination is presented. PMID:17457728

7 Reasons for Accommodating Transgender Students at School

ERIC Educational Resources Information Center

Arenas, Alberto; Gunckel, Kristin L.; Smith, William L.

2016-01-01

Schools have become ground zero for clashes over transgender rights, and critics are denouncing academic institutions--and more recently, the Obama administration--for supporting transgender students in their right to use restrooms and locker rooms that match their gender identity. This article responds to the seven most common claims made by…

Coverage for Gender-Affirming Care: Making Health Insurance Work for Transgender Americans.

PubMed

Padula, William V; Baker, Kellan

2017-08-01

Many transgender Americans continue to remain uninsured or are underinsured because of payers' refusal to cover medically necessary, gender-affirming healthcare services-such as hormone therapy, mental health counseling, and reconstructive surgeries. Coverage refusal results in higher costs and poor health outcomes among transgender people who cannot access gender-affirming care. Research into the value of health insurance coverage for gender-affirming care for transgender individuals shows that the health benefits far outweigh the costs of insuring transition procedures. Although the Affordable Care Act explicitly protects health insurance for transgender individuals, these laws are being threatened; therefore, this article reviews their importance to transgender-inclusive healthcare coverage.

Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes.

PubMed

Blosnich, John R; Cashy, John; Gordon, Adam J; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Fine, Michael J

2018-04-04

Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status. The objective of this study was to determine the extent to which patients' clinician notes in EMR contained transgender-related terms that could corroborate ICD-coded transgender identity. Data are from the US Department of Veterans Affairs Corporate Data Warehouse. Transgender patients were defined by the presence of ICD9 and ICD10 codes associated with transgender-related clinical services, and a 3:1 comparison group of nontransgender patients was drawn. Patients' clinician text notes were extracted and searched for transgender-related words and phrases. Among 7560 patients defined as transgender based on ICD codes, the search algorithm identified 6753 (89.3%) with transgender-related terms. Among 22 072 patients defined as nontransgender without ICD codes, 246 (1.1%) had transgender-related terms; after review, 11 patients were identified as transgender, suggesting a 0.05% false negative rate. Using ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR.

Involving a young person in the development of a digital resource in nurse education.

PubMed

Fenton, Gaynor

2014-01-01

Health policies across western societies have embedded the need for service user and carer perspectives in service design and delivery of educational programmes. There is a growing recognition of the need to include the perspectives of children and young people as service users in the design and delivery of child focused educational programmes. Digital storytelling provides a strategy for student nurses to gain insight into the lived experiences of children and young people. Engaging with these stories enables students to develop an understanding of a young persons' experience of healthcare. This paper outlines a project that developed a digital learning object based upon a young person's experience of cancer and student evaluations of the digital learning object as a teaching and learning strategy. Over 80% of students rated the digital learning object as interesting and were motivated to explore its content. In addition, the evaluation highlighted that listening to the young person's experiences of her treatment regimes was informative and assisted understanding of a patients' perspective of care delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.

ESTROGEN LEVELS DO NOT RISE WITH TESTOSTERONE TREATMENT FOR TRANSGENDER MEN.

PubMed

Chan, Kelly J; Jolly, Divya; Liang, Jennifer J; Weinand, Jamie D; Safer, Joshua D

2018-04-01

Existing transgender treatment guidelines suggest that for transmasculine treatment, there is a possible need for estrogen-lowering strategies adjunct to testosterone therapy. Further, guidelines advocate consideration of prophylactic female reproductive tissue surgeries for transgender men to avoid the possibility of estrogen-related health risks. Despite the paucity of objective data, some transgender men seek conversion inhibitors. We sought to determine estradiol levels in transgender men treated with testosterone therapy and the change in those levels with treatment, if any. Estradiol levels were extracted from the electronic medical records of 34 anonymized transgender men treated with testosterone therapy at the Endocrinology Clinic at Boston Medical Center. Data were sufficient to observe 6 years of follow-up. With increased testosterone levels in trans-gender men, a significant decrease in estradiol levels was noted. There was a significant negative correlation between testosterone levels and body mass index, which may serve to explain part of the mechanism for the fall in estradiol levels. Even though the fall in estradiol levels was significant statistically, the actual levels remained within the normal male range, even with 6 years of follow-up. These data suggest that when exogenous testosterone is used to achieve normal serum male testosterone levels for transgender men, it is converted to normal male levels of estradiol, with some decline in those estradiol levels that might be attributable to a fall in fat mass. There appears to be no role for aromatase conversion inhibitors or other estrogen-reducing strategies in trans-gender men. Abbreviation: BMI = body mass index.

Researching Special Populations: Retention of Latino Gay and Bisexual Men and Transgender Persons in Longitudinal Health Research

ERIC Educational Resources Information Center

Kuhns, L. M.; Vazquez, R.; Ramirez-Valles, J.

2008-01-01

Few studies have sought to assess predictors of retention of racial/ethnic or sexual minorities in longitudinal health research. The purpose of this study is to investigate predictors of retention of Latino gay and bisexual men and transgender (GBT) research participants after the baseline interview. Data come from a sample of 643 Latino GBT…

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance.

PubMed

Wolf, R Cameron; Adams, Darrin; Dayton, Robyn; Verster, Annette; Wong, Joe; Romero, Marcela; Mazin, Rafael; Settle, Edmund; Sladden, Tim; Keatley, JoAnne

2016-01-01

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools - supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups - provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance

PubMed Central

Wolf, R Cameron; Adams, Darrin; Dayton, Robyn; Verster, Annette; Wong, Joe; Romero, Marcela; Mazin, Rafael; Settle, Edmund; Sladden, Tim; Keatley, JoAnne

2016-01-01

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools – supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups – provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender

Assembling Transgender Moments

ERIC Educational Resources Information Center

Greteman, Adam J.

2017-01-01

In this article, the author seeks to assemble moments--scholarly, popular, and aesthetic--in order to explore the possibilities that emerge as moments collect in education's encounters with the needs, struggles, and possibilities of transgender lives and practices. Assembling moments, the author argues, illustrates the value of "moments"…

Oestrogen and anti-androgen therapy for transgender women

PubMed Central

Tangpricha, Vin; den Heijer, Martin

2016-01-01

Transgender women experience lifelong gender dysphoria due to a gender assignment at birth that is incongruent with their gender identity. They often seek hormone therapy, with or without surgery, to improve their gender dysphoria and to better align their physical and psychological features with a more feminine gender role. Some of the desired physical changes from oestrogen and anti-androgen therapy include decreased body and facial hair, decreased muscle mass, breast growth, and redistribution of fat. Overall the risks of treatment are low, but include thromboembolism, the risk of which depends on the dose and route of oestrogen administration. Other associated conditions commonly seen in transgender women include increased risks of depression and osteoporosis. The risk of hormone-sensitive cancer seems to be low in transgender women, with no increased risk of breast cancer compared with women and no increase in prostate cancer when compared with men. The evidence base for the care of transgender women is limited by the paucity of high-quality research, and long-term longitudinal studies are needed to inform future guidelines. PMID:27916515

Twenty Years of Public Health Research: Inclusion of Lesbian, Gay, Bisexual, and Transgender Populations

PubMed Central

Boehmer, Ulrike

2002-01-01

Objectives. This study determined to what extent lesbian, gay, bisexual, and transgender (LGBT) populations have been studied over the past 20 years of public health research. Methods. From MEDLINE English-language articles on human subjects published between 1980 and 1999, I identified articles that included LGBT individuals. The abstracts were analyzed with a coding procedure that categorized the content by topic, sexual orientation, and race/ethnicity. Results. LGBT issues were addressed by 3777 articles, or 0.1% of all Medline articles; 61% of the articles were disease-specific, and 85% omitted reference to race/ethnicity. Research unrelated to sexually transmitted diseases addressed lesbians and gay men with similar frequency, whereas bisexual persons were less frequently considered, and the least amount of research focused on transgender individuals. Conclusions. Findings supported that LGBT issues have been neglected by public health research and that research unrelated to sexually transmitted diseases is lacking. PMID:12084696

Health Care Use and HIV-Related Behaviors of Black and Latina Transgender Women in 3 US Metropolitan Areas: Results From the Transgender HIV Behavioral Survey.

PubMed

Denson, Damian J; Padgett, Paige M; Pitts, Nicole; Paz-Bailey, Gabriela; Bingham, Trista; Carlos, Juli-Ann; McCann, Pamela; Prachand, Nikhil; Risser, Jan; Finlayson, Teresa

2017-07-01

HIV prevalence estimates among transgender women in the United States are high, particularly among racial/ethnic minorities. Despite increased HIV risk and evidence of racial disparities in HIV prevalence among transgender women, few data are available to inform HIV prevention efforts. A transgender HIV-related behavioral survey conducted in 2009 in 3 US metropolitan areas (Chicago, Houston, and Los Angeles County), used respondent-driven sampling to recruit 227 black (n = 139) and Latina (n = 88) transgender women. We present descriptive statistics on sociodemographic, health care, and HIV-risk behaviors. Of 227 transgender women enrolled, most were economically and socially disadvantaged: 73% had an annual income of less than $15,000; 62% lacked health insurance; 61% were unemployed; and 46% reported being homeless in the past 12 months. Most (80%) had visited a health care provider and over half (58%) had tested for HIV in the past 12 months. Twenty-nine percent of those who reported having an HIV test in the past 24 months self-reported being HIV positive. Most of the sample reported hormone use (67%) in the past 12 months and most hormone use was under clinical supervision (70%). Forty-nine percent reported condomless anal sex in the past 12 months and 16% reported ever injecting drugs. These findings reveal the socioeconomic challenges and behavioral risks often associated with high HIV risk reported by black and Latina transgender women. Despite low health insurance coverage, the results suggest opportunities to engage transgender women in HIV prevention and care given their high reported frequency of accessing health care providers.

Enacted Stigma, Mental Health, and Protective Factors Among Transgender Youth in Canada

PubMed Central

Veale, Jaimie F.; Peter, Tracey; Travers, Robb; Saewyc, Elizabeth M.

2017-01-01

Abstract Purpose: We aimed to assess the Minority Stress Model which proposes that the stress of experiencing stigma leads to adverse mental health outcomes, but social supports (e.g., school and family connectedness) will reduce this negative effect. Methods: We measured stigma-related experiences, social supports, and mental health (self-injury, suicide, depression, and anxiety) among a sample of 923 Canadian transgender 14- to 25-year-old adolescents and young adults using a bilingual online survey. Logistic regression models were conducted to analyze the relationship between these risk and protective factors and dichotomous mental health outcomes among two separate age groups, 14- to 18-year-old and 19- to 25-year-old participants. Results: Experiences of discrimination, harassment, and violence (enacted stigma) were positively related to mental health problems and social support was negatively associated with mental health problems in all models among both age groups. Among 14–18 year olds, we examined school connectedness, family connectedness, and perception of friends caring separately, and family connectedness was always the strongest protective predictor in multivariate models. In all the mental health outcomes we examined, transgender youth reporting low levels of enacted stigma experiences and high levels of protective factors tended to report favorable mental health outcomes. Conversely, the majority of participants reporting high levels of enacted stigma and low levels of protective factors reported adverse mental health outcomes. Conclusion: While these findings are limited by nonprobability sampling procedures and potential additional unmeasured risk and protective factors, the results provide positive evidence for the Minority Stress Model in this population and affirm the need for policies and programs to support schools and families to support transgender youth. PMID:29279875

Transgender women and the sex work industry: roots in systemic, institutional, and interpersonal discrimination.

PubMed

Nadal, Kevin L; Davidoff, Kristin C; Fujii-Doe, Whitney

2014-01-01

Because transgender people face discrimination on systemic, institutional, and interpersonal levels, the previous literature has supported that many transgender women view the sex work industry as their only viable career option. The current article reviews the literature on discrimination against transgender people, explores how discrimination influences their participation in sex work, and discusses how institutional discrimination against transgender women manifests within the criminal justice system. Furthermore, recommendations are provided for advocating for the rights of transgender people while promoting healthy behaviors and higher quality of life. Throughout the article, quotes from previous qualitative research are used to illustrate the experiences of transgender women through their own voices and perspectives.

Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services.

PubMed

Witcomb, Gemma L; Bouman, Walter Pierre; Claes, Laurence; Brewin, Nicola; Crawford, John R; Arcelus, Jon

2018-08-01

Depression is a serious disorder which significantly impacts wellbeing and quality of life. Studies exploring mental wellbeing in the transgender population are mostly limited by small, non-homogenous samples and lack of matched controls. This study aimed to address these limitations and explore depression rates in a large sample of transgender people, compared with matched controls from the general population, as well as factors predicting depression in those taking cross-sex hormone treatment (CHT) compared to those not. Transgender individuals (n = 913) completed a measure of depression, measures which predict psychopathology (self-esteem, victimization, social support, interpersonal problems), and information regarding CHT use. Participants were matched by age and experienced gender with adults from the general population who had completed the measure of depression. Individuals were categorized as having no, possible or probable depressive disorder. Transgender individuals not on CHT had a nearly four-fold increased risk of probable depressive disorder, compared to controls. Older age, lower self-esteem, poorer interpersonal function and less social support predicted depressive disorder. Use of CHT was associated with less depression. Participants were attending a national gender identity service and therefore represent only a sub-group of transgender people. Due to the cross-sectional design, longitudinal research is required to fully confirm the finding that CHT use reduces depression. This study confirms that non-treated transgender individuals have an increased risk of a depressive disorder. Interventions offered alongside gender affirming treatment to develop interpersonal skills, increase self-esteem and improve social support may reduce depression and prepare individuals for a more successful transition. Copyright © 2018. Published by Elsevier B.V.

On the Margins: A Study of the Experiences of Transgender College Students

ERIC Educational Resources Information Center

McKinney, Jeffrey S.

2005-01-01

Transgender students are becoming more visible on college campuses. This qualitative study examines the experiences of undergraduate and graduate students who self-identify as transgender. Most of the participants reported that a hostile climate for transgender students exists on their campuses and that their colleges lack resources and education…

Using Gender Role Conflict Theory in Counseling Male-to-Female Transgender Individuals

ERIC Educational Resources Information Center

Wester, Stephen R.; McDonough, Tracy A.; White, Maureen; Vogel, David L.; Taylor, Lareena

2010-01-01

Ignoring gender socialization while counseling transgender clients neglects a significant aspect of the transgender experience. To address this, the authors review the literature on gender role conflict (GRC) theory as it pertains to the transgender experience of biological males whose authentic self is female. They explore the main types of…

Measures of clinical health among female-to-male transgender persons as a function of sexual orientation.

PubMed

Meier, S Colton; Pardo, Seth T; Labuski, Christine; Babcock, Julia

2013-04-01

The present study examined the sexual orientation classification system that was used in the DSM-IV-TR for categorizing those who met the Gender Identity Disorder diagnostic criteria in order to determine the extent to which female-to-male transgender persons (FTMs) differ on psychological variables as a function of sexual orientation. Participants were 605 self-identified FTMs from 19 different countries (83 % U.S.) who completed an internet survey assessing their sexual orientation, sexual identity, symptoms of depression and anxiety, stress (Depression Anxiety Stress Scales), social support (Multidimensional Scale of Perceived Social Support), and health related quality of life (SF-36v2 Health Survey). Over half the sample (52 %) reported sexual attractions to both men and women. The most common sexual identity label reported was "queer." Forty percent of FTMs who had begun to transition reported a shift in sexual orientation; this shift was associated with testosterone use. Overall, FTMs ranged from normal to above average on all psychological measures. FTMs did not significantly differ by sexual attraction on any mental health variables, except for anxiety. FTMs attracted to both men and women reported more symptoms of anxiety than those attracted to men only. Results from the present study did not support a sexual orientation classification system in FTMs with regard to psychological well-being.

Mental Health and the Transgender Population.

PubMed

Carmel, Tamar C; Erickson-Schroth, Laura

2016-12-01

Although research into the physical and mental health disparities faced by transgender and gender nonconforming (TGNC) populations is becoming more popular, historically it has been limited. It is now recognized that TGNC people experience disproportionate rates of negative mental health outcomes relative to both their gender-normative, heterosexual peers, as well as their gender-normative lesbian, gay, and bisexual (LGB) peers. The theoretical basis of current transgender mental health research is rooted in the Minority Stress Model, which postulates that we live in a hetero-centric, gender-normative society that stigmatizes and discriminates against lesbian, gay, bisexual, and transgender (LGBT) people, subjecting them to chronic stress (Hendricks & Testa, 2012; Meyer, 1995). This chronic, potentially compounding stress, is responsible for the increased risk of negative mental health outcomes in LGBT populations. TGNC people, in particular, may experience more adverse outcomes than their LGB peers due to rejection and discrimination within society at large as well as within the LGB community. [Journal of Psychosocial Nursing and Mental Health Services, 54(12), 44-48.]. Copyright 2016, SLACK Incorporated.

Transgender Health in Endocrinology: Current Status of Endocrinology Fellowship Programs and Practicing Clinicians.

PubMed

Davidge-Pitts, Caroline; Nippoldt, Todd B; Danoff, Ann; Radziejewski, Lauren; Natt, Neena

2017-04-01

The transgender population continues to face challenges in accessing appropriate health care. Adequate training of endocrinologists in this area is a priority. Assess the status of transgender health care education in US endocrinology fellowship training programs and assess knowledge and practice of transgender health among practicing US endocrinologists. Mayo Clinic and the Endocrine Society developed and administered a Web-based anonymous survey to 104 endocrinology fellowship program directors (PDs; members of the Association of Program Directors in Endocrinology, Diabetes and Metabolism) and 6992 US medical doctor members of Endocrine Society. There were 54 total responses from 104 PDs (51.9%). Thirty-five of these 54 programs (72.2%) provide teaching on transgender health topics; however, 93.8% respondents indicated that fellowship training in this area is important. Barriers to provision of education included lack of faculty interest or experience. The most desired strategies to increase transgender-specific content included online training modules for trainees and faculty. Of 411 practicing clinician responders, almost 80% have treated a transgender patient, but 80.6% have never received training on care of transgender patients. Clinicians were very or somewhat confident in terms of definitions (77.1%), taking a history (63.3%), and prescribing hormones (64.8%); however, low confidence was reported outside of the hormonal realm. The most requested methods of education included online training modules and presentation of transgender topics at meetings. Confidence and competence in transgender health needs to increase among endocrinologists. Strategies include the development of online training modules, expansion of formal transgender curricula in fellowship programs, and presentations at national and international meetings. Copyright © 2017 by the Endocrine Society

Mental Health of Transgender Children Who Are Supported in Their Identities

PubMed Central

Durwood, Lily; DeMeules, Madeleine; McLaughlin, Katie A.

2016-01-01

OBJECTIVE: Transgender children who have socially transitioned, that is, who identify as the gender “opposite” their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children. METHODS: A community-based national sample of transgender, prepubescent children (n = 73, aged 3–12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures. RESULTS: Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms. CONCLUSIONS: Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex. PMID:26921285

Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons.

PubMed

Burgess, Diana; Tran, Alisia; Lee, Richard; van Ryn, Michelle

2007-01-01

Previous research has found that lesbian, gay, bisexual and transgender (LGBT) individuals are at risk for a variety of mental health disorders. We examined the extent to which a recent experience of a major discriminatory event may contribute to poor mental health among LGBT persons. Data were derived from a cross-sectional strata-cluster survey of adults in Hennepin County, Minnesota, who identified as LGBT (n=472) or heterosexual (n=7,412). Compared to heterosexuals, LGBT individuals had poorer mental health (higher levels of psychological distress, greater likelihood of having a diagnosis of depression or anxiety, greater perceived mental health needs, and greater use of mental health services), more substance use (higher levels of binge drinking, greater likelihood of being a smoker and greater number of cigarettes smoked per day), and were more likely to report unmet mental healthcare needs. LGBT individuals were also more likely to report having experienced a major incident of discrimination over the past year than heterosexual individuals. Although perceived discrimination was associated with almost all of the indicators of mental health and utilization of mental health care that we examined, adjusting for discrimination did not significantly reduce mental health disparities between heterosexual and LGBT persons. LGBT individuals experienced more major discrimination and reported worse mental health than heterosexuals, but discrimination did not account for this disparity. Future research should explore additional forms of discrimination and additional stressors associated with minority sexual orientation that may account for these disparities.

Living on the Societal Edge: India's Transgender Realities.

PubMed

Agoramoorthy, Govindasamy; Hsu, Minna J

2015-08-01

The transgendered people have played an important role in ancient Indian culture over millennia. They were portrayed in famous Hindu religious scriptures such as Ramayana and Mahabharata. They were given imperative roles in the royal courtyards of Mughal emperors. Their downfall came only at the onset of British rule during the eighteenth century when they were blacklisted and treated as criminal elements in society. Only in 2014, India's Supreme Court has made a landmark ruling by declaring that the transgendered people must have access to equal opportunity in society. In spite of this legal recognition, transgenders at large have been forced to live on the fringes of the contemporary Indian society. This article explores their past glories, present struggles and future ambitions in the world's largest democracy.

HIV Risk Perception, HIV Knowledge, and Sexual Risk Behaviors among Transgender Women in South Florida.

PubMed

De Santis, Joseph P; Hauglum, Shayne D; Deleon, Diego A; Provencio-Vasquez, Elias; Rodriguez, Allan E

2017-05-01

Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk. © 2016 Wiley Periodicals, Inc.

The Experiences and Needs of Transgender Community College Students

ERIC Educational Resources Information Center

Beemyn, Genny

2012-01-01

The experiences and needs of college students who identify on the transgender spectrum (androgynous, gender nonconforming, genderqueer, transfeminine, transmaculine, transgender, etc.) have begun to be explored in recent years, but this work has largely been limited to four-year colleges and universities. Virtually no research has considered the…

Examining Victimization and Psychological Distress in Transgender College Students

ERIC Educational Resources Information Center

Effrig, Jessica C.; Bieschke, Kathleen J.; Locke, Benjamin D.

2011-01-01

Treatment-seeking and non-treatment-seeking transgender college students were examined with regard to victimization and psychological distress. Findings showed that transgender college students had elevated rates of distress as compared with college students who identified as men or women. Results indicated that treatment-seeking and non-treatment…

Impact of Anticipated Bias from Healthcare Professionals on Perceived Successful Aging Among Transgender and Gender Nonconforming Older Adults.

PubMed

Walker, Ruth V; Powers, Sara M; Witten, Tarynn M

2017-12-01

Transgender and gender nonconforming (TGNC) persons have routinely experienced high rates of violence and discrimination. Discrimination in healthcare can affect the ability of TGNC persons to age successfully as it often deters them from seeking care. The purpose of this study was to determine if anticipation of bias from healthcare professionals, as well as other variables, predicted perceived successful aging in a sample of TGNC adults. A total of 384 (of the original 1963) participants older than 50 years completed the relevant parts of an 83-item online survey as part of the Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals. Larger social support networks and higher levels of confidence that a healthcare professional will treat them with dignity and respect as a TGNC person at the end of their life were associated with increased odds of perceiving that they were aging successfully. With high rates of discrimination and prejudice toward TGNC persons in various contexts (e.g., healthcare, education, and housing), it is imperative that practitioners, researchers, policymakers, and institutions work together to eradicate healthcare disparities, promote social change, and support an environment that encourages successful aging. This calls for a coordinated, proactive outreach effort to put trust back into a system that has historically let down an entire subset of the population.

Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study.

PubMed

Buchting, Francisco O; Emory, Kristen T; Scout; Kim, Yoonsang; Fagan, Pebbles; Vera, Lisa E; Emery, Sherry

2017-07-01

Tobacco use among transgender adults continues to be an area of research with few reported findings. The limited literature indicates higher cigarette use among transgender adults, compared with the general population. This national study is the first to report on cigarettes, cigars, and e-cigarettes by examining differences in transgender tobacco use independent of sexual orientation. Data were collected in 2013 using a nationally cross-sectional online survey of U.S. adults (cisgender, n=17,164; transgender, n=168) and analyzed in 2015. Past 30-day tobacco use point estimates and adjusted logistic regression while controlling for false discovery rate were reported for transgender and cisgender respondents. Transgender adults reported higher past 30-day use of any cigarette/cigar/e-cigarette product (39.7% vs 25.1%) and current use of cigarettes (35.5% vs 20.7%), cigars (26.8% vs 9.3%), and e-cigarettes (21.3% vs 5.0%) compared with cisgender adults (all p-values ≤0.003). Transgender respondents had significantly higher odds of past 30-day tobacco product use for any cigarette/cigar/e-cigarette product (OR=1.97, 95% CI=1.25, 3.1), e-cigarettes (OR=5.15, 95% CI=3.36, 7.88), cigars (OR=3.56, 95% CI=2.27, 5.59), and cigarettes (OR=2.10, 95% CI=1.35, 3.28) versus cisgender respondents (all p-values ≤0.0035). Transgender adults are at higher risk for tobacco use than cisgender adults and risk of specific product use varies by gender. This is the first U.S. national study to assess differences in use of various tobacco products using questions that specifically ask for gender identity separately from sexual orientation. This study provides data that can inform targeted interventions to promote transgender health. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Managing uncertainty: a grounded theory of stigma in transgender health care encounters.

PubMed

Poteat, Tonia; German, Danielle; Kerrigan, Deanna

2013-05-01

A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider-patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain

76 FR 9785 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Human...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Human Immunodeficiency Virus (HIV) Prevention Projects for Young Men of Color Who Have Sex With Men and Young Transgender Persons of Color...

Gender Panics about Transgender Children in Religious Right Discourse

ERIC Educational Resources Information Center

Stone, Amy L.

2018-01-01

This paper is a content analysis of political flyers and messages developed by Religious Right campaigns between 1974 and 2013 to fight legislation supportive of lesbian, gay, bisexual, and transgender (LGBT) individuals. The analysis focuses on 16 campaigns in which Religious Right groups made claims about transgender adults and children. In…

Adolescent Male-to-Female Transgender Voice and Communication Therapy

ERIC Educational Resources Information Center

Hancock, Adrienne; Helenius, Lauren

2012-01-01

Current research to describe and evaluate effectiveness of voice and communication therapy for male-to-female transgender people is limited to adults. This paper provides rationale, procedures, and outcomes from voice and communication therapy for a male-to-female transgender adolescent 15 years of age. Treatment addressed vocal hygiene, breath…

Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women With Penoscrotal Hypoplasia.

PubMed

Bouman, Mark-Bram; van der Sluis, Wouter B; van Woudenberg Hamstra, Leonora E; Buncamper, Marlon E; Kreukels, Baudewijntje P C; Meijerink, Wilhelmus J H J; Mullender, Margriet G

2016-09-01

Puberty-suppressing hormonal treatment may result in penoscrotal hypoplasia in transgender women, making standard penile inversion vaginoplasty not feasible. For these patients, intestinal vaginoplasty is a surgical alternative, but knowledge on patient-reported postoperative outcomes and quality of life is lacking. To assess patient-reported functional and esthetic outcomes, quality of life, satisfaction, and sexual well-being after primary total laparoscopic intestinal vaginoplasty in transgender women. A survey study was performed on transgender women who underwent primary total laparoscopic intestinal vaginoplasty with at least 1 year of clinical follow-up. Thirty-one transgender women completed the questionnaires (median age at time of surgery = 19.1 years, range = 18.3-45.0) after a median clinical follow-up of 2.2 years (range = 0.8-7.5). Consenting women were asked to complete a combined questionnaire of the Subjective Happiness Scale, the Satisfaction With Life Scale, Cantril's Ladder of Life Scale, the Female Sexual Function Index, the Female Genital Self-Imaging Scale, the Amsterdam Hyperactive Pelvic Floor Scale-Women, and a questionnaire addressing postoperative satisfaction. Patient-reported functional and esthetic outcomes and postoperative quality of life. Patients graded their life satisfaction a median of 8.0 (range = 4.0-10.0) on Cantril's Ladder of Life Scale. Patients scored a mean total score of 27.7 ± 5.8 on the Satisfaction With Life Scale, which indicated high satisfaction with life, and a mean total score of 5.6 ± 1.4 on the Subjective Happiness Scale. Functionality was graded a median score of 8.0 of 10 (range = 1.0-10.0) and esthetics a score of 8.0 out of 10 (range = 3.0-10.0). The mean Female Sexual Function Index total score of sexually active transgender women was 26.0 ± 6.8. This group of relatively young transgender women reported satisfactory functional and esthetic results of the neovagina and a good quality of life

The psychologist's role in transgender-specific care with U.S. veterans.

PubMed

Johnson, Laura; Shipherd, Jillian; Walton, Heather M

2016-02-01

Psychologists are integral to the care of transgender individuals. This article details the many roles for psychologists in transgender-specific care, including diagnosing and treating gender dysphoria; providing treatment for comorbid conditions; referring to medical services such as gender confirmation surgeries, voice modification, and cross-sex hormone therapies; serving as consultants within health care systems; and advocating for addressing barriers in systems in which transgender individuals live and work. Transgender veterans have unique experiences and vulnerabilities related to their military service that are detailed from a review of the literature, and we make the case that Veterans Health Administration (VHA) and community psychologists are well-positioned to provide care to transgender veterans (trans-vets). In this article, the authors describe the experiences that many trans-vets have faced, identify the importance of treatment for gender dysphoria (and draw the distinction between gender identity disorder and gender dysphoria) as well as psychologists' roles, and clarify which transgender-related services are available to eligible veterans though VHA per policy and how VHA providers have access to training to provide that care. In addition, we describe how veterans can connect to the VHA, even if they have (and want to continue working with) non-VHA psychologists or other community providers. (c) 2016 APA, all rights reserved).

Improving HIV Surveillance Among Transgender Populations in Tennessee.

PubMed

Sizemore, Lindsey A; Rebeiro, Peter F; McGoy, Shanell L

2016-06-01

HIV prevalence and outcome disparities among sexual and gender minorities are profound in the United States. Tennessee HIV surveillance practices have not been uniform for transgender status, although data collection capabilities exist. We, therefore, describe current reporting of data on transgender individuals in Tennessee to identify targets for improvement. Data for all HIV-diagnosed individuals living in Tennessee as of December 31, 2013, were extracted from the Enhanced HIV/AIDS Reporting System (eHARS). The birth_sex ("Male" or "Female") and current_gender ("Male," "Female," "Male-to-Female," "Female-to-Male," or "Additional Gender Identity") variables were examined, and proportion missing current_gender data by region was ascertained. Transgender individuals were defined as having different birth_sex and current_gender values. To ensure the protection of health information, data were cleaned, deidentified, and aggregated using Statistical Analysis Software (SAS) Version 9.3 (SAS Institute, Inc., Cary, NC). Among 16,063 HIV-diagnosed individuals in Tennessee, 27 were transgender: 52% (n = 14) with "Male-to-Female," 26% (n = 7) with "Female," and 22% (n = 6) with "Male" as their current_gender values. Proportions missing current_gender differed significantly by region across Tennessee (global, P < 0.01). While HIV-positive transgender individuals should be recognized as integral members of the LGBT community, they should also be acknowledged as a separate subgroup when appropriate. Collecting information about current self-identified gender identity should no longer be optional in Tennessee HIV surveillance. Although making efforts to collect both birth_sex and current_gender mandatory with each interview will improve surveillance, it is critical to train all staff properly on the correct way to inquire about gender identity in a culturally sensitive manner. Revamping data collection methods will not only improve inconsistent methods currently

Improving HIV Surveillance Among Transgender Populations in Tennessee

PubMed Central

Rebeiro, Peter F.; McGoy, Shanell L.

2016-01-01

Abstract Purpose: HIV prevalence and outcome disparities among sexual and gender minorities are profound in the United States. Tennessee HIV surveillance practices have not been uniform for transgender status, although data collection capabilities exist. We, therefore, describe current reporting of data on transgender individuals in Tennessee to identify targets for improvement. Methods: Data for all HIV-diagnosed individuals living in Tennessee as of December 31, 2013, were extracted from the Enhanced HIV/AIDS Reporting System (eHARS). The birth_sex (“Male” or “Female”) and current_gender (“Male,” “Female,” “Male-to-Female,” “Female-to-Male,” or “Additional Gender Identity”) variables were examined, and proportion missing current_gender data by region was ascertained. Transgender individuals were defined as having different birth_sex and current_gender values. To ensure the protection of health information, data were cleaned, deidentified, and aggregated using Statistical Analysis Software (SAS) Version 9.3 (SAS Institute, Inc., Cary, NC). Results: Among 16,063 HIV-diagnosed individuals in Tennessee, 27 were transgender: 52% (n = 14) with “Male-to-Female,” 26% (n = 7) with “Female,” and 22% (n = 6) with “Male” as their current_gender values. Proportions missing current_gender differed significantly by region across Tennessee (global, P < 0.01). Conclusion: While HIV-positive transgender individuals should be recognized as integral members of the LGBT community, they should also be acknowledged as a separate subgroup when appropriate. Collecting information about current self-identified gender identity should no longer be optional in Tennessee HIV surveillance. Although making efforts to collect both birth_sex and current_gender mandatory with each interview will improve surveillance, it is critical to train all staff properly on the correct way to inquire about gender identity in a culturally sensitive manner

Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes.

PubMed

Olson-Kennedy, Johanna; Cohen-Kettenis, Peggy T; Kreukels, Baudewijntje P C; Meyer-Bahlburg, Heino F L; Garofalo, Robert; Meyer, Walter; Rosenthal, Stephen M

2016-04-01

The review summarizes relevant research focused on prevalence and natural history of gender nonconforming/transgender youth, and outcomes of currently recommended clinical practice guidelines. This review identifies gaps in knowledge, and provides recommendations foci for future research. Increasing numbers of gender nonconforming youth are presenting for care. Clinically useful information for predicting individual psychosexual development pathways is lacking. Transgender youth are at high risk for poor medical and psychosocial outcomes. Longitudinal data examining the impact of early social transition and medical interventions are sparse. Existing tools to understand gender identity and quantify gender dysphoria need to be reconfigured to study a more diverse cohort of transgender individuals. Increasingly, biomedical data are beginning to change the trajectory of scientific investigation. Extensive research is needed to improve understanding of gender dysphoria, and transgender experience, particularly among youth. Recommendations include identification of predictors of persistence of gender dysphoria from childhood into adolescence, and a thorough investigation into the impact of interventions for transgender youth. Finally, examining the social environments of transgender youth is critical for the development of appropriate interventions necessary to improve the lives of transgender people.

Research Priorities for Gender Nonconforming/Transgender Youth: Gender Identity Development and Biopsychosocial Outcomes

PubMed Central

Olson-Kennedy, J; Cohen-Kettenis, P. T.; Kreukels, B.P.C; Meyer-Bahlburg, H.F.L; Garofalo, R; Meyer, W; Rosenthal, S.M.

2016-01-01

This review summarizes relevant research focused on prevalence and natural history of gender non-conforming / transgender youth, and outcomes of currently recommended clinical practice guidelines. This review identifies gaps in knowledge, and provides recommendations foci for future research. Recent findings Increasing numbers of gender nonconforming youth are presenting for care. Clinically useful information for predicting individual psychosexual development pathways is lacking. Transgender youth are at high risk for poor medical and psychosocial outcomes. Longitudinal data examining the impact of early social transition and medical interventions are sparse. Existing tools to understand gender identity and quantify gender dysphoria need to be reconfigured in order to study a more diverse cohort of transgender individuals. Increasingly, biomedical data are beginning to change the trajectory of scientific investigation. Summary Extensive research is needed to improve understanding of gender dysphoria, and transgender experience, particularly among youth. Recommendations include identification of predictors of persistence of gender dysphoria from childhood into adolescence, and a thorough investigation into the impact of interventions for transgender youth. Finally, examining the social environments of transgender youth is critical for the development of appropriate interventions necessary to improve the lives of transgender people. PMID:26825472

Perceptions of Barriers to and Facilitators of Participation in Health Research Among Transgender People.

PubMed

Owen-Smith, Ashli A; Woodyatt, Cory; Sineath, R Craig; Hunkeler, Enid M; Barnwell, La Tasha; Graham, Ashley; Stephenson, Rob; Goodman, Michael

2016-01-01

Purpose: Although transgender people may be at increased risk for a range of health problems, they have been the subject of relatively little health research. An important step toward expanding the evidence base is to understand and address the reasons for nonparticipation and dropout. The aim of this study was to explore the perceptions of barriers to and facilitators of participation in health research among a sample of transgender people in San Francisco, CA, and Atlanta, GA. Methods: Twelve in-person focus groups (FGs) were conducted; six (three with transwomen, three with transmen) were conducted in San Francisco and six FGs were conducted in Atlanta (three with transwomen and three with transmen). FGs were audiorecorded, transcribed, and uploaded to MaxQDA software for analysis. A codebook was used to code transcripts; new codes were added iteratively as they arose. All transcripts were coded by at least 2 of the 4 researchers and, after each transcript was coded, the researchers met to discuss any discrepancies, which were resolved by consensus. Results: Among 67 FG participants, 37 (55%) identified as transmen and 30 (45%) identified as transwomen. The average age of participants was ∼41 years (range 18-67) and the majority (61%) were non-Hispanic Whites. Several barriers that can hinder participation in health research were identified, including logistical concerns, issues related to mistrust, a lack of awareness about participation opportunities, and psychosocial/emotional concerns related to being "outed." A broad range of facilitators were also identified, including the opportunity to gain knowledge, access medical services, and contribute to the transgender community. Conclusion: These findings provide insights about the perceived barriers to and facilitators of research participation and offer some guidance for researchers in our ongoing effort to engage the transgender community in health research.

Transgenders in the U.S. Military: Policies, Problems, and Prospects

DTIC Science & Technology

2014-03-01

for further research are recommended. 14. SUBJECT TERMS Transgender(s), Transsexual (s), Transsexualism , Gender Identity Disorder (GID...9  2.  Transsexual (Also Transexual) .........................................................10  3.  Transsexual ...Male-to-Female) ..........................................................10  4.  Transsexual (Female-to-Male

A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community.

PubMed

Ginsberg, Brian A; Calderon, Marcus; Seminara, Nicole M; Day, Doris

2016-02-01

There are an estimated 700,000 or more transgender people in the United States, however their dermatologic needs are not fully established in the medical literature. Unique needs relate to hormone therapy, prior surgeries, and other aspects of physical transitioning. By examining attitudes and practices of transgender individuals, we aimed to identify areas for which dermatologists could contribute to their physical transformation. This cross-sectional study used an anonymous online survey, distributed via lesbian, gay, bisexual, and transgender organizations; social media; and at targeted locations and events. A total of 327 people completed the survey (63% men, 29% women, 9% other). Most transgender women indicated that their face was most imperative to have changed, whereas men noted their chest, in turn influencing procedures. Of women's facial procedures, hair removal predominated, followed by surgery then injectables, mostly performed by plastic surgeons. Hormone-induced facial effects varied, usually taking over 2 years for maximal effect. When choosing procedures, money was the major barrier and good aesthetic outcome the primary concern. Participants did not think that facial procedures necessitate the currently accepted prerequisites for chest and genital surgery. This study has limited size and convenience sampling. Dermatologists could contribute to the physical transformation of transgender patients through noninvasive procedures. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

School Belonging, School Victimization, and the Mental Health of LGBT Young Adults: Implications for School Psychologists

ERIC Educational Resources Information Center

Heck, Nicholas C.; Lindquist, Lauri M.; Machek, Greg R.; Cochran, Bryan N.

2014-01-01

This study investigates the mediating role of school victimization in the relationship between lesbian, gay, bisexual, and transgender (LGBT) young adults' feelings of high school belonging and current mental health (both depression and general psychological distress) outcomes. A total of 145 LGBT young adults were recruited from college LGBT…

Justice for All? A Report on Lesbian, Gay, Bisexual and Transgendered Youth in the New York Juvenile Justice System.

ERIC Educational Resources Information Center

Feinstein, Randi; Greenblatt, Andrea; Hass, Lauren; Kohn, Sally; Rana, Julianne

The first-ever study of its kind, this report chronicles the experiences of lesbian, gay, bisexual and transgendered (LGBT) youth in the New York juvenile justice system. This report combines existing social science research and personal interviews with juvenile justice professionals and LGBT youth and reveals that the system is plagued by…

Early development influences ontogeny of personality types in young laboratory rats.

PubMed

Rödel, Heiko G; Meyer, Susann

2011-09-01

Features of an individual's early development are frequently reported to alter the postnatal ontogeny in litter-bearing mammals with respect to various physiological parameters. We hypothesized that such effects might also apply to the ontogeny of personality types. On the one hand, litter size effects by means of more contacts with littermates, might lead to the development of more offensive types. On the other hand, smaller and less developed young from larger litters might be less offensive due to their lower physical capabilities to deal with challenging situations. We studied these contrasting hypotheses in young rats, which we tested in a battery of emotionality tests. There were clear indications for the existence of distinct behavioral types by means of consistencies in behavioral responses within and across contexts. Based on these responses, we calculated three new variables by PCA, which we interpreted to mainly reflect boldness, exploration, and anxiety. Overall, our results strongly suggest that the early development alters the ontogeny of personality types, with heavier individuals being bolder and more explorative. Furthermore, body mass and litter size influenced the changes in the behavioral responses in successive tests, further supporting the importance of the litter size-dependent body mass for the ontogeny of personalities. Anxiety also depended on litter size, however, in a nonlinear way. Animals born to litters of small or large sizes had higher scores, whereas individuals from medium-sized litters were less anxious. This optimum curve indicates that opposing effects of litter size are involved in shaping personalities in young rats. Copyright © 2011 Wiley Periodicals, Inc.

Young adults' use and output level settings of personal music systems.

PubMed

Torre, Peter

2008-10-01

There are growing concerns over noise exposure via personal music system use by young adults. One purpose of this study was to evaluate the prevalence of personal music system use and the listening patterns associated with these systems in a large sample of young adults. A second purpose of this study was to measure the dB SPL in the ear canal of young adults while they blindly set the volume of a personal music system to four settings. In the first study, the personal music system use survey was completed by 1016 students at various locations on the San Diego State University campus. Questions included sex, age, ethnicity, race, and whether or not they used a personal music system. Students who answered Yes to using a personal music system were instructed to complete the remaining 11 closed-set questions. These questions dealt with type of earphones used with the system, most common listening environment, length of time per day the system was used, and the volume setting. The differences between women and men and across ethnicity and race were evaluated for the questions. In the second study, a probe microphone placed in the ear canal of 32 participants was used to determine the dB SPL of four loudness categories at which the participants blindly set the level of a personal music system: low, medium or comfortable, loud, and very loud. In study 1, over 90% of the participants who completed the survey reported using a personal music system. Over 50% of those who use a personal music system reported listening between 1 and 3 hrs and almost 90% reported listening at either a medium or loud volume. Men were significantly more likely to report listening to their system for a longer duration compared with women and more likely to report listening at a very loud volume. There was a trend for Hispanic or Latino students to report listening for longer durations compared with Not Hispanic or Latino students, but this difference was not statistically significant. Black or

High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru.

PubMed

Allan-Blitz, Lao-Tzu; Konda, Kelika A; Calvo, Gino M; Vargas, Silver K; Leon, Segundo R; Segura, Eddy R; Caceres, Carlos F; Klausner, Jeffrey D

2018-05-01

Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.

HIV Testing by Transgender Status at Centers for Disease Control and Prevention–Funded Sites in the United States, Puerto Rico, and US Virgin Islands, 2009–2011

PubMed Central

Wang, Guoshen; Mulatu, Mesfin S.; Larish, Nili

2015-01-01

Objectives. We examined HIV testing services, seropositivity, and the characteristics associated with newly identified, confirmed HIV-positive tests among transgender individuals. Methods. We analyzed data (2009–2011) using bivariate and multivariable logistic regression to examine the relationships between HIV positivity and sociodemographic and risk characteristics among male-to-female transgender individuals. Results. Most of the testing was conducted in females (51.1%), followed by males (48.7%) and transgender individuals (0.17%). Tests in male-to-female transgender individuals had the highest, newly identified confirmed HIV positivity (2.7%), followed by males (0.9%), female-to-male transgender individuals (0.5%), and females (0.2%). The associated characteristics with an HIV-positive test among male-to-female transgender individuals included ages 20 to 29 and 40 to 49 years (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.4, 5.6 and AOR = 2.8; 95% CI = 1.3, 5.9, respectively), African American (AOR = 4.6; 95% CI = 2.7, 7.9) or Hispanic/Latino (AOR = 2.6; 95% CI = 1.5, 4.5) race/ethnicity, and reporting sex without condom within the past year (AOR = 1.9; 95% CI = 1.3, 2.6), sex with an HIV-positive person (AOR = 1.5; 95% CI = 1.1, 2.0), or injection drug use (AOR = 2.0; 95% CI = 1.3, 3.0). Conclusions. High levels of HIV positivity among transgender individuals, particularly male-to-female transgender individuals, underscore the necessity for targeted HIV prevention services that are responsive to the needs of this population. PMID:26180964

Development of Measures to Assess Personal Recovery in Young People Treated in Specialist Mental Health Services.

PubMed

John, Mary; Jeffries, Fiona W; Acuna-Rivera, Marcela; Warren, Fiona; Simonds, Laura M

2015-01-01

Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10-18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. All three measures had high internal consistency (alpha ≥ 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r = -0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. No tools exist to evaluate recovery-relevant processes in young people treated in specialist mental health services. This study reports on the development and psychometric evaluation of three self-report recovery-relevant assessments for young

Considering Transgender People in Education: A Gender-Complex Approach

ERIC Educational Resources Information Center

Rands, Kathleen E.

2009-01-01

Schools serve as a setting in which students come to understand gender, but transgender students (those who transgress societal gender norms) are largely left out of discussions of education. The high level of harassment that transgender students face poses sizable obstacles to school success. If the field of education is committed to equity and…

Addressing the Needs of Transgender Military Veterans: Better Access and More Comprehensive Care.

PubMed

Dietert, Michelle; Dentice, Dianne; Keig, Zander

2017-01-01

Purpose: There is a gap in social science literature addressing issues of access and quality of care for transgender military veterans. Psychologists, medical doctors, and other health professionals are beginning to address some of the barriers present in the Department of Veterans Affairs (VA) system that affect veterans who are also transgender and intersex. Over a 7-year period, between 2006 and 2013, 2600 transgender veterans were served by the VA. Data from several surveys revealed that most transgender veterans perceive the Veterans Health Administration (VHA) to be less than accommodating for their special needs. The goal of this study was to investigate the experiences of a sample of transgender veterans with regard to their experiences with healthcare services provided by the VHA. Methods: Using snowball sampling techniques, we were able to recruit 22 transgender military veterans to participate in our study. A combination of telephone interviews and questionnaires provided data from veterans in various branches of the military throughout the United States. Results: Findings indicate that even though the VHA is working to address issues of inequality for transgender veterans, our participants indicated that there are still some problems with administration of care, proper training of staff and physicians, and availability of comprehensive services for the unique healthcare needs of transgender individuals. Conclusion: Since our data were collected, the VA has worked to bridge the gap by focusing on increased training for VHA providers and staff and establishing LGBT programs at VA facilities. However, we suggest that one key area of importance should continue to focus on how mental health and medical providers and ancillary staff are trained to interact with and provide care for their transgender patients.

A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand.

PubMed

Newman, Peter A; Roungprakhon, Surachet; Tepjan, Suchon

2013-08-01

With HIV-incidence among men who have sex with men (MSM) in Bangkok among the highest in the world, a topical rectal microbicide would be a tremendous asset to prevention. Nevertheless, ubiquitous gaps between clinical trial efficacy and real-world effectiveness of existing HIV preventive interventions highlight the need to address multi-level factors that may impact on rectal microbicide implementation. We explored the social ecology of rectal microbicide acceptability among MSM and transgender women in Chiang Mai and Pattaya, Thailand. We used a qualitative approach guided by a social ecological model. Five focus groups were conducted in Thai using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim in Thai and translated into English. We conducted thematic analysis using line-by-line and axial coding and a constant comparative method. Transcripts and codes were uploaded into a customized database programmed in Microsoft Access. We then used content analysis to calculate theme frequencies by group, and Chi-square tests and Fisher's exact test to compare themes by sexual orientation/gender expression and age. Participant's (n=37) mean age was 24.8 years (SD=4.2). The majority (70.3%) self-identified as gay, 24.3% transgender women. Product-level themes (side effects, formulation, efficacy, scent, etc.) accounted for 42%, individual (increased sexual risk, packaging/portability, timing/duration of protection) 29%, interpersonal (trust/communication, power/negotiation, stealth) 8% and social-structural (cost, access, community influence, stigma) 21% of total codes, with significant differences by sexual orientation/gender identity. The intersections of multi-level influences included product formulation and timing of use preferences contingent on interpersonal communication and partner type, in the context of constraints posed by stigma, venues for access and cost. The intersecting influence of multi-level factors on

Gender Variance on Campus: A Critical Analysis of Transgender Voices

ERIC Educational Resources Information Center

Mintz, Lee M.

2011-01-01

Transgender college students face discrimination, harassment, and oppression on college and university campuses; consequently leading to limited academic and social success. Current literature is focused on describing the experiences of transgender students and the practical implications associated with attempting to meet their needs (Beemyn,…

Affirmative Cognitive Behavior Therapy with Transgender and Gender Nonconforming Adults.

PubMed

Austin, Ashley; Craig, Shelley L; Alessi, Edward J

2017-03-01

Although there is growing awareness in contemporary society regarding transgender and gender nonconforming (TGNC) identities, transgender people continue to be highly marginalized and subject to transphobic discrimination and victimization. As a result, authentically expressing and navigating a TGNC identity can be difficult. Psychiatrists and other mental health professionals can play a key role in supporting TGNC client health and well-being through the use of trans-affirmative approaches. Trans-affirmative practice recognizes all experiences of gender as equally healthy and valuable This article focuses on transgender affirmative cognitive behavior therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Policing Diversity: Examining Police Resistance to Training Reforms for Transgender People in Australia.

PubMed

Miles-Johnson, Toby

2016-01-01

Using field notes collected from participant observation of Australian police officers training to work with the transgender community, the current research builds on previous work examining social identity theory (Tajfel, 2010) to explain how one training program implemented to educate police about transgender people challenges police culture. This research determines that police culture, training procedures, and stereotypes of gender are equally influential on police perceptions of all transgender people. Overall, the results indicate that negative police perceptions toward police training reforms strengthen in-group identity of police, and negative out-group perceptions of transgender people.

Association between Personality Traits and Sleep Quality in Young Korean Women

PubMed Central

Kim, Han-Na; Cho, Juhee; Chang, Yoosoo; Ryu, Seungho

2015-01-01

Personality is a trait that affects behavior and lifestyle, and sleep quality is an important component of a healthy life. We analyzed the association between personality traits and sleep quality in a cross-section of 1,406 young women (from 18 to 40 years of age) who were not reporting clinically meaningful depression symptoms. Surveys were carried out from December 2011 to February 2012, using the Revised NEO Personality Inventory and the Pittsburgh Sleep Quality Index (PSQI). All analyses were adjusted for demographic and behavioral variables. We considered beta weights, structure coefficients, unique effects, and common effects when evaluating the importance of sleep quality predictors in multiple linear regression models. Neuroticism was the most important contributor to PSQI global scores in the multiple regression models. By contrast, despite being strongly correlated with sleep quality, conscientiousness had a near-zero beta weight in linear regression models, because most variance was shared with other personality traits. However, conscientiousness was the most noteworthy predictor of poor sleep quality status (PSQI≥6) in logistic regression models and individuals high in conscientiousness were least likely to have poor sleep quality, which is consistent with an OR of 0.813, with conscientiousness being protective against poor sleep quality. Personality may be a factor in poor sleep quality and should be considered in sleep interventions targeting young women. PMID:26030141

Is personality a driving force for socioeconomic differences in young adults' health care use? A prospective cohort study.

PubMed

Kraft, Maren; Arts, Koos; Traag, Tanja; Otten, Ferdy; Bosma, Hans

2017-09-01

To relate personality characteristics at the age of 12 to socioeconomic differences in health care use in young adulthood. And thereby examining the extent to which socioeconomic differences in the use of health care in young adulthood are based on differences in personality characteristics, independent of the (parental) socioeconomic background. Personality of more than 13,000 Dutch 12-year old participants was related to their health and socioeconomic position after a follow-up of 13 years (when the participants had become young adults). In young adulthood, low socioeconomic status was related to high health care use (e.g. low education -hospital admission: OR = 2.21; low income -GP costs: OR = 1.25). Odds ratios (for the socioeconomic health differences) did not decrease when controlled for personality. In this Dutch sample of younger people, personality appeared not to be a driving force for socioeconomic differences in health care use. Findings thus do not support the personality-related, indirect selection perspective on the explanation of socioeconomic differences in health.

An Exploratory Survey of the Experiences of Homophobic Bullying among Lesbian, Gay, Bisexual and Transgendered Young People in Ireland

ERIC Educational Resources Information Center

Minton, Stephen James; Dahl, Torunn; O' Moore, Astrid Mona; Tuck, Donnely

2008-01-01

While developments have been made concerning the understanding of general bullying behaviour in Irish schools, considerably less is known about homophobic bullying. Presented here are the findings of a study into the views and perspectives of a self-selected sample of 123 lesbian, gay, bisexual or transgendered (LGBT) secondary school-aged young…

Addressing the Needs of Transgender Military Veterans: Better Access and More Comprehensive Care

PubMed Central

Dietert, Michelle; Dentice, Dianne; Keig, Zander

2017-01-01

Abstract Purpose: There is a gap in social science literature addressing issues of access and quality of care for transgender military veterans. Psychologists, medical doctors, and other health professionals are beginning to address some of the barriers present in the Department of Veterans Affairs (VA) system that affect veterans who are also transgender and intersex. Over a 7-year period, between 2006 and 2013, 2600 transgender veterans were served by the VA. Data from several surveys revealed that most transgender veterans perceive the Veterans Health Administration (VHA) to be less than accommodating for their special needs. The goal of this study was to investigate the experiences of a sample of transgender veterans with regard to their experiences with healthcare services provided by the VHA. Methods: Using snowball sampling techniques, we were able to recruit 22 transgender military veterans to participate in our study. A combination of telephone interviews and questionnaires provided data from veterans in various branches of the military throughout the United States. Results: Findings indicate that even though the VHA is working to address issues of inequality for transgender veterans, our participants indicated that there are still some problems with administration of care, proper training of staff and physicians, and availability of comprehensive services for the unique healthcare needs of transgender individuals. Conclusion: Since our data were collected, the VA has worked to bridge the gap by focusing on increased training for VHA providers and staff and establishing LGBT programs at VA facilities. However, we suggest that one key area of importance should continue to focus on how mental health and medical providers and ancillary staff are trained to interact with and provide care for their transgender patients. PMID:28861546

"What Do You Say to Them?" Investigating and Supporting the Needs of Lesbian, Gay, Bisexual, Trans, and Questioning (LGBTQ) Young People

ERIC Educational Resources Information Center

Sherriff, Nigel S.; Hamilton, Wook E.; Wigmore, Shelby; Giambrone, Broden L. B.

2011-01-01

This study explores the experiences and support needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people living in Sussex (UK), and the training needs of practitioners working with LGBTQ young people. The aims were to explore the experiences of young people including bullying, "coming out," social service and…

Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City.

PubMed

Rael, Christine Tagliaferri; Martinez, Michelle; Giguere, Rebecca; Bockting, Walter; MacCrate, Caitlin; Mellman, Will; Valente, Pablo; Greene, George J; Sherman, Susan; Footer, Katherine H A; D'Aquila, Richard T; Carballo-Diéguez, Alex

2018-03-27

Transgender women may face a disparate risk for HIV/AIDS compared to other groups. In 2012, Truvada was approved for daily use as HIV pre-exposure prophylaxis (PrEP). However, there is a dearth of research about barriers and facilitators to PrEP in transgender women. This paper will shed light on transgender women living in New York City's perceived and actual challenges to using PrEP and potential strategies to overcome them. After completing an initial screening process, four 90-min focus groups were completed with n = 18 transgender women. Participants were asked what they like and dislike about PrEP. Participants identified the following barriers: uncomfortable side effects, difficulty taking pills, stigma, exclusion of transgender women in advertising, and lack of research on transgender women and PrEP. Facilitators included: reducing pill size, increasing the types of available HIV prevention products, and conducting scientific studies to evaluate PrEP in transgender women.

Experiences of Violence Among Transgender Women in Puerto Rico: An Underestimated Problem.

PubMed

Rodríguez-Madera, Sheilla L; Padilla, Mark; Varas-Díaz, Nelson; Neilands, Torsten; Vasques Guzzi, Ana C; Florenciani, Ericka J; Ramos-Pibernus, Alíxida

2017-01-01

Violence is a public health concern faced on a daily basis by transgender women. Literature has documented how it adversely affects quality of life and health and in some instances leads to homicide. Considering the lack of research documenting the experiences of violence among transgender women, the objective of this article was to explore manifestations of violence among this population in Puerto Rico. The data presented in this article are part of a larger study on transgender/transsexual health in Puerto Rico. For the purpose of this article we focus on the quantitative data analysis. Participants (N = 59 transgender women) were recruited via respondent driven sampling. Implications and specific recommendations are discussed in light of these findings.

Experiences of Violence Among Transgender Women in Puerto Rico: An Underestimated Problem

PubMed Central

Rodríguez-Madera, Sheilla L.; Padilla, Mark; Varas-Díaz, Nelson; Neilands, Torsten; Vasques Guzzi, Ana C.; Florenciani, Ericka J.; Ramos-Pibernus, Alíxida

2017-01-01

Violence is a public health concern faced on a daily basis by transgender women. Literature has documented how it adversely affects quality of life and health and in some instances leads to homicide. Considering the lack of research documenting the experiences of violence among transgender women, the objective of this article was to explore manifestations of violence among this population in Puerto Rico. The data presented in this article are part of a larger study on transgender/transsexual health in Puerto Rico. For the purpose of this article we focus on the quantitative data analysis. Participants (N = 59 transgender women) were recruited via respondent driven sampling. Implications and specific recommendations are discussed in light of these findings. PMID:27054395

Anti-Transgender Prejudice: A Structural Equation Model of Associated Constructs

ERIC Educational Resources Information Center

Tebbe, Esther N.; Moradi, Bonnie

2012-01-01

This study aimed to identify theoretically relevant key correlates of anti-transgender prejudice. Specifically, structural equation modeling was used to test the unique relations of anti-lesbian, gay, and bisexual (LGB) prejudice; traditional gender role attitudes; need for closure; and social dominance orientation with anti-transgender prejudice.…

Parents of Youth Who Identify as Transgender: An Exploratory Study

ERIC Educational Resources Information Center

Johnson, Danielle; Sikorski, Jonathon; Savage, Todd A.; Woitaszewski, Scott A.

2014-01-01

This article explores the experiences, perceptions, support systems, and coping strategies on which parents of youth who identify as transgender rely. Based on data gathered via interviews with parents of youth who identify as transgender and analyzed using the consensual qualitative research method, parental challenges and concerns about their…

Preferences for Injectable PrEP Among Young U.S. Cisgender Men and Transgender Women and Men Who Have Sex with Men.

PubMed

Biello, Katie B; Hosek, Sybil; Drucker, Morgan T; Belzer, Marvin; Mimiaga, Matthew J; Marrow, Elliot; Coffey-Esquivel, Julia; Brothers, Jennifer; Mayer, Kenneth H

2017-09-19

Young men who have sex with men account for approximately 20% of incident HIV infections in the U.S. Antiretroviral pre-exposure prophylaxis (PrEP) administered as a daily pill has been shown to decrease HIV acquisition in at-risk individuals. New modalities for PrEP are being developed and tested, including injectable PrEP; however, acceptability of these emerging modalities has not yet been examined in youth. We conducted six focus groups with 36 young men and transgender men and women who have sex with men in Boston, Chicago, and Los Angeles in 2016 to assess interest in and preference for different PrEP modalities. Youth were purposively recruited based on diversity of age, race/ethnicity, and prior PrEP experience. Data were coded using content coding based on key domains of the interview guide, in particular around the central themes of interest in and barriers and facilitators to injectable PrEP use. Participants were knowledgeable about oral PrEP but suggested barriers to broader uptake, including stigma, marginalization, and access to information. While participants were split on preference for injectable versus oral PrEP, they agreed quarterly injections may be more manageable and better for those who have adherence difficulties and for those who engage in sex more frequently. Concerns specific to injectable PrEP included: severity/duration of side effects, pain, level of protection prior to next injection, distrust of medical system and injections, and cost. Understanding barriers to and preferences for diverse prevention modalities will allow for more HIV prevention options, improved products, and better interventions, thus allowing individuals to make informed HIV prevention choices.

Stigmatization and Mental Health in a Diverse Sample of Transgender Women.

PubMed

Yang, Mei-Fen; Manning, David; van den Berg, Jacob J; Operario, Don

2015-12-01

Previous research indicates elevated risk for psychological distress in sexual and gender minority populations, and some research suggests that stigma contributes to elevated psychological distress among members of these groups. This study examined the hypothesis that exposure to transgender-related stigma (TRS) is associated with both higher levels of depression and anxiety among transgender women. We analyzed data from a diverse sample of 191 adult transgender women living or working in the San Francisco Bay area who were recruited using purposive sampling methods to participate in a cross-sectional survey, which included measures of stigmatization, depression, and anxiety. Higher levels of exposure to TRS were independently associated with higher levels of depression (β=0.31, P<.001) and anxiety (β=39, P<.001), adjusting for self-reported health and sociodemographic co-variates. Associations between stigmatization, depression, and anxiety were not moderated by participants' age or race/ethnicity. Findings suggest a need for counseling interventions to address the role of stigmatization as a factor potentially contributing to psychological distress among transgender women. This research further highlights the need to develop a stronger evidence base on effective counseling approaches to improve the mental health of transgender women.

Exploring Young Adult Sexual Minority Women's Perspectives on LGBTQ Smoking

ERIC Educational Resources Information Center

Youatt, Emily J.; Johns, Michelle M.; Pingel, Emily S.; Soler, Jorge H.; Bauermeister, José A.

2015-01-01

Smoking rates are higher among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals than among heterosexuals. These disparities are exacerbated during the transition from youth to young adulthood. The current study uses in-depth qualitative interviews to understand perceptions of LGBTQ smoking among LBQ-identified women (N = 30, ages…

Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study.

PubMed

Logie, Carmen H; Wang, Ying; Lacombe-Duncan, Ashley; Jones, Nicolette; Ahmed, Uzma; Levermore, Kandasi; Neil, Ava; Ellis, Tyrone; Bryan, Nicolette; Marshall, Annecka; Newman, Peter A

2017-04-06

Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica. In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting

Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study

PubMed Central

Logie, Carmen H; Wang, Ying; Lacombe-Duncan, Ashley; Jones, Nicolette; Ahmed, Uzma; Levermore, Kandasi; Neil, Ava; Ellis, Tyrone; Bryan, Nicolette; Marshall, Annecka; Newman, Peter A

2017-01-01

Abstract Introduction: Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica. Methods: In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. Results: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience

Depression among Transgender Older adults: General and Minority Stress

PubMed Central

Hoy-Ellis, Charles P.; Fredriksen-Goldsen, Karen I.

2017-01-01

Objectives This study aims to (1) examine the direct and indirect effects internalized heterosexism, concealment of gender identity, and perceived general stress in association with depression among transgender older adults; and (2) to assess the relative contribution of each relationship. Methods Secondary analyses of data from a large community-based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86-years old. Results Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Conclusion Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed. PMID:28369987

Depression Among Transgender Older Adults: General and Minority Stress.

PubMed

Hoy-Ellis, Charles P; Fredriksen-Goldsen, Karen I

2017-06-01

This study aims to (a) examine the direct and indirect effects internalized heterosexism, disclosure of gender identity, and perceived general stress in association with depression among transgender older adults; and (b) to assess the relative contribution of each relationship. Secondary analyses of data from a large community-based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86-years old. Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed. © Society for Community Research and Action 2017.

Music Teachers' Attitudes toward Transgender Students and Supportive School Practices

ERIC Educational Resources Information Center

Silveira, Jason M.; Goff, Sarah C.

2016-01-01

The purpose of this study was to measure music teachers' attitudes toward transgender individuals and toward school practices that support transgender students. Participants (N = 612) included men and women who teach a variety of music subjects in elementary, middle, and high schools, in urban, suburban, and rural areas. An online questionnaire…

Substance Use Among Transgender Students in California Public Middle and High Schools.

PubMed

De Pedro, Kris Tunac; Gilreath, Tamika D; Jackson, Christopher; Esqueda, Monica Christina

2017-05-01

Transgender adolescents face tremendous social stress in families and schools, which often leads to behavioral health disparities. This study assessed whether rates of substance use were higher among transgender adolescents when compared to nontransgender adolescents. This study is a secondary data analysis of the 2013-2015 California Healthy Kids Survey (CHKS) that examines whether rates of substance use are higher among transgender youth when compared to nontransgender youth. Participants included 4778 transgender and 630,200 nontransgender students in middle and high schools in nearly all school districts in California. The study outcomes were lifetime, recent, and in-school use of cigarettes, tobacco, alcohol, marijuana, cocaine, and ecstasy as well as nonmedical use of prescription painkillers, diet pills, Ritalin or Adderall, and cold medicine. Transgender students were about 2-1/2 times more likely as nontransgender students to use cocaine/methamphetamine in their lifetime (odds ratio [OR] = 2.53; 95% confidence interval [CI] = 2.18-2.95) and about 2.8 times as likely to report past 30-day inhalant use (OR = 2.80; 95% CI = 2.41-3.26). Transgender students were more than twice as likely to report past 30-day prescription pain medication use (OR = 2.19; 95% CI = 1.90-2.53) and more than 3 times as likely to use cigarettes in school (OR = 3.37; 95% CI = 2.84-3.99). The study's findings indicate a need for community- and school-based interventions that reduce substance use among transgender youth. © 2017, American School Health Association.

Personality and Temperament Correlates of Pain Catastrophizing in Young Adolescents

ERIC Educational Resources Information Center

Muris, Peter; Meesters, Cor; van den Hout, Anja; Wessels, Sylvia; Franken, Ingmar; Rassin, Eric

2007-01-01

Pain catastrophizing is generally viewed as an important cognitive factor underlying chronic pain. The present study examined personality and temperament correlates of pain catastrophizing in a sample of young adolescents (N = 132). Participants completed the Pain Catastrophizing Scale for Children, as well as scales for measuring sensitivity of…

Sexual Behaviors and HIV/Syphilis Testing Among Transgender Individuals in China: Implications for Expanding HIV Testing Services

PubMed Central

Best, John; Tang, Weiming; Zhang, Ye; Han, Larry; Liu, Fengying; Huang, Shujie; Yang, Bin; Wei, Chongyi; Tucker, Joseph D.

2015-01-01

Background HIV and syphilis are disproportionately common among transgender individuals globally, yet few studies have investigated transgender HIV/syphilis risk and testing in low and middle-income nations. We conducted an online survey of men who have sex with men (MSM) and transgender individuals to examine sexual behaviors, and HIV/syphilis testing in China. Methods We recruited MSM and transgender individuals from two-major Chinese lesbian, gay, bisexual, and transgender (LGBT) web platforms. Chi-square and logistic regression were used to compare risk behaviors, HIV and syphilis testing history, and prevalence between transgender individuals and other MSM. Results Among the 1320 participants, 52 (3·9%) self-identified as transgender. Demographics, including education, employment, and marital status were similar between both groups, while transgender individuals were older. Condomless anal intercourse rate was comparable between the groups. Transgender individuals were less likely to report ever testing for HIV (34·6% VS 62·0%) and syphilis (15·7% VS 31·2%) with adjusted ORs of 0·36 (95% CI 0·20–0·65) and 0·42 (95% CI 0·20–0·91), respectively. We found a trend towards higher HIV prevalence among transgender individuals (11·1% VS5·7%, P=0·12). Conclusion Transgender individuals have suboptimal HIV and syphilis testing rates in China. Given the substantial risk behaviors and burden of HIV/STI in the general Chinese MSM population and lack of knowledge about transgender individuals, enhanced HIV/syphilis testing programs for transgender individuals in China are needed. PMID:25868142

Elder transgender lesbians: exploring the intersection of age, lesbian sexual identity, and transgender identity.

PubMed

Witten, Tarynn M

2015-01-01

This study is the first to examine the experiences and needs of an international sample of current, English-speaking, lesbian, transgender-identified (trans-lesbian) adults around a number of later life and end-of-life perceptions, preparations, and concerns. I analyzed a subset (n = 276) of the cross-sectional data collected from the online Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (N = 1,963). I assessed perceptions and fears around aging, preparation for later life, and end-of-life as well as numerous demographic and psycho-social variables. Despite the overall feeling that they have aged successfully, the respondent trans-lesbian population harbors significant fears about later life. I found that this population, while better-prepared than the overall respondent trans-identified population, is still ill-prepared for the major legalities and events that occur in the later to end-of-life time periods.

Structural Connectivity Networks of Transgender People

PubMed Central

Hahn, Andreas; Kranz, Georg S.; Küblböck, Martin; Kaufmann, Ulrike; Ganger, Sebastian; Hummer, Allan; Seiger, Rene; Spies, Marie; Winkler, Dietmar; Kasper, Siegfried; Windischberger, Christian; Swaab, Dick F.; Lanzenberger, Rupert

2015-01-01

Although previous investigations of transsexual people have focused on regional brain alterations, evaluations on a network level, especially those structural in nature, are largely missing. Therefore, we investigated the structural connectome of 23 female-to-male (FtM) and 21 male-to-female (MtF) transgender patients before hormone therapy as compared with 25 female and 25 male healthy controls. Graph theoretical analysis of whole-brain probabilistic tractography networks (adjusted for differences in intracranial volume) showed decreased hemispheric connectivity ratios of subcortical/limbic areas for both transgender groups. Subsequent analysis revealed that this finding was driven by increased interhemispheric lobar connectivity weights (LCWs) in MtF transsexuals and decreased intrahemispheric LCWs in FtM patients. This was further reflected on a regional level, where the MtF group showed mostly increased local efficiencies and FtM patients decreased values. Importantly, these parameters separated each patient group from the remaining subjects for the majority of significant findings. This work complements previously established regional alterations with important findings of structural connectivity. Specifically, our data suggest that network parameters may reflect unique characteristics of transgender patients, whereas local physiological aspects have been shown to represent the transition from the biological sex to the actual gender identity. PMID:25217469

Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009-2014.

PubMed

Clark, Hollie; Babu, Aruna Surendera; Wiewel, Ellen Weiss; Opoku, Jenevieve; Crepaz, Nicole

2017-09-01

Publications on diagnosed HIV infection among transgender people have been limited to state- or local-level data. We analyzed data from the National HIV Surveillance System and present results from the first national-level analysis of transgender people with diagnosed HIV infection. From 2009 to 2014, HIV surveillance jurisdictions from 45 states plus the District of Columbia identified and reported at least one case of newly diagnosed HIV infection for transgender people; jurisdictions from 5 states reported no cases for transgender people. Of 2351 transgender people with newly diagnosed HIV infection during 2009-2014, 84.0% were transgender women (male-to-female), 15.4% were transgender men (female-to-male), and 0.7% were additional gender identity (e.g., gender queer, bi-gender). Over half of both transgender women (50.8%; 1002/1974) and men (58.4%; 211/361) with newly diagnosed HIV infection were non-Hispanic black/African American. Improvements in data collection methods and quality are needed to gain a better understanding of HIV burden among transgender people.

Nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations: an integrative review.

PubMed

Jackman, Kate; Honig, Judy; Bockting, Walter

2016-12-01

To conduct an integrative review of nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations to better understand the prevalence; to identify the lesbian, gay, bisexual and transgender subgroups at increased risk for nonsuicidal self-injury; and to examine the risk factors associated with nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations. Nonsuicidal self-injury, defined as intentional injury to the body's surface without intent to die, is a significant mental health concern among adolescents and adults. Mental health disparities in lesbian, gay, bisexual and transgender populations, including anxiety, depression and suicidality, have been documented in the scientific literature with little focus on findings about nonsuicidal self-injury. Integrative literature review of published quantitative and qualitative empirical research. A literature search of 11 on-line databases was conducted of articles published through April 2015. Keywords were used to identify articles about lesbian, gay, bisexual and transgender populations and nonsuicidal self-injury. After screening by title, abstract and full text, 26 articles were included in this review. The literature synthesised demonstrates a consistent pattern of increased prevalence of nonsuicidal self-injury among sexual and gender minority populations compared with heterosexual peers. This body of literature indicates which subgroups of the lesbian, gay, bisexual and transgender populations appear to be at increased risk for nonsuicidal self-injury and which specific factors contributing to vulnerability to nonsuicidal self-injury among these populations. Lesbian, gay, bisexual and transgender populations are at higher risk for nonsuicidal self-injury compared with the general population. Lesbian, gay, bisexual and transgender-specific and general risk factors appear to contribute to this heightened vulnerability. Clinical nurses should screen for nonsuicidal self

Queer and Trans-Themed Books for Young Readers: A Critical Review

ERIC Educational Resources Information Center

Bittner, Robert; Ingrey, Jennifer; Stamper, Christine

2016-01-01

As research on transgender and gender nonconforming children and youth becomes increasingly prevalent in literary scholarship, educational possibilities arise for teachers of children's and young adult (YA) literature in various classroom settings. This article provides a brief history of literature for children and teens containing queer and…

Experiences of Intimate Partner Violence and Subsequent Police Reporting Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults in Colorado: Comparing Rates of Cisgender and Transgender Victimization.

PubMed

Langenderfer-Magruder, Lisa; Whitfield, Darren L; Walls, N Eugene; Kattari, Shanna K; Ramos, Daniel

2016-03-01

Research indicates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at high risk of victimization by others and that transgender individuals may be at even higher risk than their cisgender LGBQ peers. In examining partner violence in particular, extant literature suggests that LGBTQ individuals are at equal or higher risk of partner violence victimization compared with their heterosexual peers. As opposed to sexual orientation, there is little research on gender identity and partner violence within the LGBTQ literature. In the current study, the authors investigated intimate partner violence (IPV) in a large sample of LGBTQ adults (N = 1,139) to determine lifetime prevalence and police reporting in both cisgender and transgender individuals. Results show that more than one fifth of all participants ever experienced partner violence, with transgender participants demonstrating significantly higher rates than their cisgender peers. Implications focus on the use of inclusive language as well as future research and practice with LGBTQ IPV victims. © The Author(s) 2014.

Lesbian, gay, bisexual, transgendered, or intersexed content for nursing curricula.

PubMed

Brennan, Ann Marie Walsh; Barnsteiner, Jane; Siantz, Mary Lou de Leon; Cotter, Valeri T; Everett, Janine

2012-01-01

There has been limited identification of core lesbian, gay, bisexual, transgendered, or intersexed (LGBTI) experience concepts that should be included in the nursing curricula. This article addresses the gap in the literature. To move nursing toward the goals of health equity and cultural humility in practice, education, and research, nursing curricula must integrate core LGBTI concepts, experiences, and needs related to health and illness. This article reviews LGBTI health care literature to address the attitudes, knowledge, and skills needed to address curricular gaps and provide content suggestions for inclusion in nursing curricula. Also considered is the need to expand nursing students' definition of diversity before discussing the interplay between nurses' attitudes and culturally competent care provided to persons who are LGBTI. Knowledge needed includes a life span perspective that addresses developmental needs and their impact on health concerns throughout the life course; health promotion and disease prevention with an articulation of unique health issues for this population; mental health concerns; specific health needs of transgender and intersex individuals; barriers to health care; interventions and resources including Internet sites; and legal and policy issues. Particular assessment and communication skills for LGBTI patients are identified. Finally, there is a discussion of didactic, simulation, and clinical strategies for incorporating this content into nursing curricula at the undergraduate and graduate levels. Copyright © 2012 Elsevier Inc. All rights reserved.

School Experiences of Transgender and Gender Diverse Students in Australia

ERIC Educational Resources Information Center

Jones, Tiffany; Smith, Elizabeth; Ward, Roz; Dixon, Jennifer; Hillier, Lynne; Mitchell, Anne

2016-01-01

Over the last decade, there has been an increase in global and local policy protections on the basis of gender identity and expression in education and a recent spate of coverage of transgender students on Australian television and news media. This paper explores the school experiences of Australian transgender and gender diverse students, with…

A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand

PubMed Central

Newman, Peter A; Roungprakhon, Surachet; Tepjan, Suchon

2013-01-01

Introduction With HIV-incidence among men who have sex with men (MSM) in Bangkok among the highest in the world, a topical rectal microbicide would be a tremendous asset to prevention. Nevertheless, ubiquitous gaps between clinical trial efficacy and real-world effectiveness of existing HIV preventive interventions highlight the need to address multi-level factors that may impact on rectal microbicide implementation. We explored the social ecology of rectal microbicide acceptability among MSM and transgender women in Chiang Mai and Pattaya, Thailand. Methods We used a qualitative approach guided by a social ecological model. Five focus groups were conducted in Thai using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim in Thai and translated into English. We conducted thematic analysis using line-by-line and axial coding and a constant comparative method. Transcripts and codes were uploaded into a customized database programmed in Microsoft Access. We then used content analysis to calculate theme frequencies by group, and Chi-square tests and Fisher's exact test to compare themes by sexual orientation/gender expression and age. Results Participant's (n=37) mean age was 24.8 years (SD=4.2). The majority (70.3%) self-identified as gay, 24.3% transgender women. Product-level themes (side effects, formulation, efficacy, scent, etc.) accounted for 42%, individual (increased sexual risk, packaging/portability, timing/duration of protection) 29%, interpersonal (trust/communication, power/negotiation, stealth) 8% and social–structural (cost, access, community influence, stigma) 21% of total codes, with significant differences by sexual orientation/gender identity. The intersections of multi-level influences included product formulation and timing of use preferences contingent on interpersonal communication and partner type, in the context of constraints posed by stigma, venues for access and cost. Discussion The intersecting

Career readiness, developmental work personality and age of onset in young adult central nervous system survivors.

PubMed

Strauser, David; Wagner, Stacia; Wong, Alex W K; O'Sullivan, Deidre

2013-04-01

The primary purpose of this paper is to undertake foundational research in the area of career readiness, work personality and age of onset with young adult central nervous system (CNS) survivors. Participants for this study consisted of 43 individuals whose age range from 18 to 30 (M = 21.64, SD = 3.46), an average age of brain tumor onset of 9.50 years (SD = 4.73) and average years off of treatment of 7.25 years (SD = 5.80). Packets were distributed to survivors who were participating in a psychosocial cancer treatment program. Participants completed multiple career instruments and a demographic form. Differences between groups and among the variables were examined and size effect sizes were analyzed. Young adult CNS survivors had significantly lower levels of work personality and career readiness when compared to young adult non-cancer survivors with CNS cancer with those between the ages of 6 and 12 reported significantly lower levels when compared to individuals diagnosed before age 6 and after the age of 13. Young adult CNS survivors at an increased risk for having lower levels of work personality and career readiness then a norm group comparison. Age of onset (between 6 and 12) may be at significant risk factor for developing poor or dysfunctional work and career behaviors. • Young adults with central nervous system (CNS) cancer are at particular risk for experiencing difficulties related to career and employment. • Work personality and career readiness are two constructs that have been found to be related to one's ability to meet the demands of work. • Young adult CNS cancer survivors have lower levels of work personality and career readiness. • Individuals diagnosed between the ages of 6 and 12 may be at particular risk and may need specific vocational rehabilitation interventions. • The results of this study point to the need for comprehensive career and vocational services for young adult CNS cancer survivors.

Experiences of Lesbian, Gay, Bisexual, Transgender, and Questioning or Queer Students at Evangelical Christian Colleges as Described in Personal Blogs

ERIC Educational Resources Information Center

Snow, Kevin C.

2018-01-01

Lesbian, gay, bisexual, transgender, and questioning or queer (LGBTQ) students at evangelical Christian colleges are a population frequently overlooked in the literature on the spiritual lives of college students. The author used qualitative content analysis within a phenomenological tradition to examine blog posts by such students, who face…

Transgender people attending a Sydney sexual health service over a 16-year period.

PubMed

Hounsfield, Victoria L; Freedman, Eleanor; McNulty, Anna; Bourne, Christopher

2007-09-01

Previous studies have concluded that transgender people are a marginalised and stigmatised group, with high rates of sexually transmissible infections (STI), sex work, injecting drug use and multiple sexual partners. To our knowledge, this is the first study in Australia to focus on the sexual behaviour and sexual health needs of transgender people attending an urban sexual health clinic. A retrospective case note review was undertaken of the transgender attendees of the Sydney Sexual Health Centre between 1990 and 2006. Demographics, gender characteristics, risk behaviours, sexual health morbidity, psychosocial information and other significant features of the transgender population were assessed. Forty clients were identified as transgender, of whom 36 (90%) were male-to-female and four (10%) were female-to-male. Seventeen (43%) had a history of sex work, 16 (40%) had injected drugs, 14 (35%) had had unprotected anal or vaginal sex in the past 3 months. Twenty (50%) clients had histories of a STI, including three (7.5%) that were HIV positive, and two were co-infected with hepatitis C. Genital warts and chlamydia were the most common diagnoses made during the study period. Physical examination was inadequately documented in 53% of first visits. Psychosocial morbidity was common. Transgender clients presented infrequently at this clinic. Although half reported few risks, the other half reported multiple risk behaviours and had most STI. These findings suggest that there needs to be improved sexual health service for transgender clients at our clinic.

The State of Transgender Health Care: Policy, Law, and Medical Frameworks

PubMed Central

2014-01-01

I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended. PMID:24432926

Assessing access to care for transgender and gender nonconforming people: a consideration of diversity in combating discrimination.

PubMed

Cruz, Taylor M

2014-06-01

Transgender and gender nonconforming people face stigma and discrimination from a wide variety of sources and through numerous social realms. Stigma and discrimination originating from biomedicine and health care provision may impact this group's access to primary care. Such stigma and discrimination may originate not only from direct events and past negative experiences, but also through medicine's role in providing treatments of transitioning, the development of formal diagnoses to provide access to such treatments, and the medical language used to describe this diverse group. This paper examines the postponement of primary curative care among this marginalized group of people by drawing from the National Transgender Discrimination Survey, one of the largest available datasets for this underserved group. This paper also proposes an innovate categorization system to account for differences in self-conceptualization and identity, which has been of considerable concern for transgender and gender nonconforming communities but remains underexplored in social and health research. Results suggest that experience, identity, state of transition, and disclosure of transgender or gender nonconforming status are associated with postponement due to discrimination. Other findings suggest that postponement associated with primary place of seeking care and health insurance has ties to both discrimination and affordability. These findings highlight the importance of combating stigma and discrimination generated from within or experienced at sites of biomedicine or health care provision in improving access to care for this group of people. Improving access to care for all gender variant people requires a critical evaluation of existing research practices and health care provision to ensure that care is tailored as needed to each person's perspective in relation to larger social processes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Stigmatization and Mental Health in a Diverse Sample of Transgender Women

PubMed Central

Yang, Mei-Fen; Manning, David; van den Berg, Jacob J.

2015-01-01

Abstract Purpose: Previous research indicates elevated risk for psychological distress in sexual and gender minority populations, and some research suggests that stigma contributes to elevated psychological distress among members of these groups. This study examined the hypothesis that exposure to transgender-related stigma (TRS) is associated with both higher levels of depression and anxiety among transgender women. Methods: We analyzed data from a diverse sample of 191 adult transgender women living or working in the San Francisco Bay area who were recruited using purposive sampling methods to participate in a cross-sectional survey, which included measures of stigmatization, depression, and anxiety. Results: Higher levels of exposure to TRS were independently associated with higher levels of depression (β=0.31, P<.001) and anxiety (β=39, P<.001), adjusting for self-reported health and sociodemographic co-variates. Associations between stigmatization, depression, and anxiety were not moderated by participants' age or race/ethnicity. Conclusion: Findings suggest a need for counseling interventions to address the role of stigmatization as a factor potentially contributing to psychological distress among transgender women. This research further highlights the need to develop a stronger evidence base on effective counseling approaches to improve the mental health of transgender women. PMID:26788771

Sex Partnership and Self-Efficacy Influence Depression in Chinese Transgender Women: A Cross-Sectional Study

PubMed Central

Yang, Xiaoshi; Wang, Lie; Hao, Chun; Gu, Yuan; Song, Wei; Wang, Jian; Chang, Margaret M.; Zhao, Qun

2015-01-01

Background Transgender women often suffer from transition-related discrimination and loss of social support due to their gender transition, which may pose considerable psychological challenges and may lead to a high prevalence of depression in this population. Increased self-efficacy may combat the adverse effects of gender transition on depression. However, few available studies have investigated the protective effect of self-efficacy on depression among transgender women, and there is a scarcity of research describing the mental health of Chinese transgender women. This study aims to describe the prevalence of depression among Chinese transgender women and to explore the associated factors. Methods A cross-sectional study was conducted in Shenyang, Liaoning Province of China by convenience sampling from January 2014 to July 2014. Two hundred and nine Chinese transgender women were interviewed face-to-face with questionnaires that covered topics including the Zung Self-Rating Depression Scale (SDS), demographic characteristics, transition status, sex partnership, perceived transgender-related discrimination, the Multidimensional Scale of Perceived Social Support (MSPSS) and the adapted General Self-efficacy Scale (GSES). A hierarchical multiple regression analysis was performed to explore the factors associated with SDS scores. Results The prevalence of depression among transgender women was 45.35%. Transgender women with regular partners or casual partners exhibited higher SDS scores than those without regular partners or casual partners. Regression analyses showed that sex partnership explained most (16.6%) of the total variance in depression scores. Self-efficacy was negatively associated with depression. Conclusions Chinese transgender women experienced high levels of depression. Depression was best predicted by whether transgender women had a regular partner or a casual partner rather than transgender-related discrimination and transition status. Moreover

Sex Partnership and Self-Efficacy Influence Depression in Chinese Transgender Women: A Cross-Sectional Study.

PubMed

Yang, Xiaoshi; Wang, Lie; Hao, Chun; Gu, Yuan; Song, Wei; Wang, Jian; Chang, Margaret M; Zhao, Qun

2015-01-01

Transgender women often suffer from transition-related discrimination and loss of social support due to their gender transition, which may pose considerable psychological challenges and may lead to a high prevalence of depression in this population. Increased self-efficacy may combat the adverse effects of gender transition on depression. However, few available studies have investigated the protective effect of self-efficacy on depression among transgender women, and there is a scarcity of research describing the mental health of Chinese transgender women. This study aims to describe the prevalence of depression among Chinese transgender women and to explore the associated factors. A cross-sectional study was conducted in Shenyang, Liaoning Province of China by convenience sampling from January 2014 to July 2014. Two hundred and nine Chinese transgender women were interviewed face-to-face with questionnaires that covered topics including the Zung Self-Rating Depression Scale (SDS), demographic characteristics, transition status, sex partnership, perceived transgender-related discrimination, the Multidimensional Scale of Perceived Social Support (MSPSS) and the adapted General Self-efficacy Scale (GSES). A hierarchical multiple regression analysis was performed to explore the factors associated with SDS scores. The prevalence of depression among transgender women was 45.35%. Transgender women with regular partners or casual partners exhibited higher SDS scores than those without regular partners or casual partners. Regression analyses showed that sex partnership explained most (16.6%) of the total variance in depression scores. Self-efficacy was negatively associated with depression. Chinese transgender women experienced high levels of depression. Depression was best predicted by whether transgender women had a regular partner or a casual partner rather than transgender-related discrimination and transition status. Moreover, self-efficacy had positive effects on

Mental Health Concerns and Insurance Denials Among Transgender Adolescents.

PubMed

Nahata, Leena; Quinn, Gwendolyn P; Caltabellotta, Nicole M; Tishelman, Amy C

2017-06-01

Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy. An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization. Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage. Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.

Risk Behaviors and Perceptions Among Self-identified Men Who Have Sex with Men (MSM), Bisexuals, Transvestites, and Transgender Women in Western Guatemala.

PubMed

Ikeda, Janet M; Racancoj, Oliver; Welty, Susie; Page, Kimberly; Hearst, Norman; McFarland, Willi

2018-06-15

Guatemala has a concentrated HIV epidemic disproportionately affecting men who have sex with men (MSM) and transgender women. We recruited 205 self-identified MSM, bisexuals, transvestites, and transgender women in western Guatemala using long-chain peer referral, wherein "seed" participants were asked to invite as many as three acquaintances to participate in the study. Self-reported sexual or gender identity was MSM, 46%; bisexual, 28%; transvestite, 21%, and transgender woman, 5%. Median age of the participants was 23 years, and 36% self-identified as being indigenous. Indigenous persons were more likely to self-identity as transvestite (32.9% vs 13.8%, P = 0.04), strongly perceive themselves at risk for HIV (87.7% vs 51.5%, P = 0.001), have had an HIV test in the last 12 months and know the result (97.3% vs 85.4%, P = 0.008), and experience barriers to testing and treatment (86.3% vs 67.7%, P = 0.004). HIV prevention services for indigenous MSM should especially target transvestites and how to overcome stigmatization and barriers to care.

Transgender HIV prevention: implementation and evaluation of a workshop.

PubMed

Bockting, W O; Rosser, B R; Scheltema, K

1999-04-01

Virtually no HIV prevention education has specifically targeted the transgender community. To fill this void, a transgender HIV prevention workshop was developed, implemented and evaluated. A 4 h workshop, grounded in the Health Belief Model and the Eroticizing Safer Sex approach, combined lectures, videos, a panel, discussion, roleplay and exercises. Evaluation using a pre-, post- and follow-up test design showed an increase in knowledge and an initial increase in positive attitudes that diminished over time. Due to the small sample size (N = 59) and limited frequency of risk behavior, a significant decrease in unsafe sexual or needle practices could not be demonstrated. However, findings suggested an increase in safer sexual behaviors such as (mutual) masturbation. Peer support improved significantly. Future prevention education should make special efforts to target the more difficult-to-reach, high-risk subgroups of the transgender population.

Epidemiology of gender dysphoria and transgender identity.

PubMed

Zucker, Kenneth J

2017-10-01

This review provides an update on the epidemiology of gender dysphoria and transgender identity in children, adolescents and adults. Although the prevalence of gender dysphoria, as it is operationalised in the fifth edtion of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), remains a relatively 'rare' or 'uncommon' diagnosis, there is evidence that it has increased in the past couple of decades, perhaps reflected in the large increase in referral rates to specialised gender identity clinics. In childhood, the sex ratio continues to favour birth-assigned males, but in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females. In both adolescents and adults, patterns of sexual orientation vary as a function of birth-assigned sex. Recent studies suggest that the prevalence of a self-reported transgender identity in children, adolescents and adults ranges from 0.5 to 1.3%, markedly higher than prevalence rates based on clinic-referred samples of adults. The stability of a self-reported transgender identity or a gender identity that departs from the traditional male-female binary among non-clinic-based populations remains unknown and requires further study.

The interaction of drug use, sex work, and HIV among transgender women.

PubMed

Hoffman, Beth R

2014-06-01

Transgender women have a higher prevalence of drug use, HIV, drug use, and sex work than the general population. This article explores the interaction of these variables and discusses how sex work and drug use behaviors contribute to the high rates of HIV. A model predicting HIV rates with sex work and drug use as well as these behaviors in the transgender woman's social network is presented. Challenges to intervening with transgender women, as well as suggestions and criteria for successful interventions, are discussed.

Transgender and Gender Diverse Clients with Mental Disorders: Treatment Issues and Challenges.

PubMed

Mizock, Lauren

2017-03-01

A number of transgender and gender diverse individuals face risks of mental health problems and suicidality, often as a result of transphobia and gender minority stress. There are many resilience and protective factors that transgender individuals use to cope with mental distress and thrive. In this article, a review of the literature on transgender and gender diverse individuals with mental health problems is provided, as well as a discussion of the protective factors that enhance resilience. Copyright © 2016 Elsevier Inc. All rights reserved.

Use of the Internet to Meet Sexual Partners, Sexual Risk Behavior, and Mental Health in Transgender Adults.

PubMed

Benotsch, Eric G; Zimmerman, Rick S; Cathers, Laurie; Heck, Ted; McNulty, Shawn; Pierce, Juan; Perrin, Paul B; Snipes, Daniel J

2016-04-01

The purpose of this study was to examine the use of the internet to meet sexual partners among transgender individuals and examine correlates of this use, including sexual risk behavior, discrimination experiences, and mental health. A sample of 166 transgender adults (112 male-to-female transgender women and 54 female-to-male transgender men) were recruited in community venues and anonymously completed measures assessing these variables. Most participants (64.5 %) were HIV-negative, 25.2 % were HIV-positive, and 10.3 % did not know their HIV status. Overall, 33.7 % of participants reported having met a sexual partner over the internet, which did not differ significantly between transgender women and men. Among these individuals, transgender women reported significantly more lifetime internet sexual partners (median = 3) than transgender men (median = 1). Use of the internet to meet sexual partners was associated with lower self-esteem but not with depression, anxiety, somatic distress or discrimination experiences. Among transgender women, use of the internet to meet sexual partners was associated with each of the 11 sexual risk behaviors examined, including having multiple partners, sex under the influence of drugs, number of unprotected anal or vaginal sex acts, and history of commercial sex work. The use of the internet to meet partners was not associated with sexual risk behavior among transgender men (0/11 variables assessed). Although the internet is a common mode of meeting sexual partners among some transgender adults, it may also be a potential venue for prevention interventions targeting transgender individuals at particularly high risk for HIV acquisition.

Prolactin levels during short- and long-term cross-sex hormone treatment: an observational study in transgender persons.

PubMed

Nota, N M; Dekker, M J H J; Klaver, M; Wiepjes, C M; van Trotsenburg, M A; Heijboer, A C; den Heijer, M

2017-08-01

The cause of prolactin alterations in transgender persons is often assigned to oestrogens, but the precise cause and time course during different phases of cross-sex hormone treatment (CHT) remain unclear. In this study, we prospectively examined prolactin levels in 55 female-to-males (FtMs) and 61 male-to-females (MtFs) during the first year of CHT. Because long-term prolactin data were not available in this population, we studied these levels in a retrospective population of 25 FtMs and 38 MtFs who underwent gonadectomy. FtMs were treated with testosterone and MtFs with estradiol, with or without the anti-androgen cyproterone acetate (CPA) (after gonadectomy CPA is cessated). During the first year of CHT, prolactin decreased with 25% (95CI: -33%, -12%) in FtMs and increased with 193% (95CI: 156%, 219%) in MtFs. Eighteen MtFs developed hyperprolactinemia (≥0.6 IU L -1 ). In the retrospective population, post-gonadectomy levels in FtMs were lower than baseline levels (-39%; 95CI: -51%, -20%) while in MtFs post-gonadectomy levels and baseline levels were comparable (-6%; 95CI: -24%, 15%). No hyperprolactinemia was found after gonadectomy. In conclusion, in FtMs, prolactin decreased consistently during CHT and in MtFs, prolactin increased during pre-surgical CHT but normalised after gonadectomy. It is likely that CPA induces increasing prolactin levels in MtFs. © 2016 Blackwell Verlag GmbH.

Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009–2014

PubMed Central

Clark, Hollie; Babu, Aruna Surendera; Wiewel, Ellen Weiss; Opoku, Jenevieve; Crepaz, Nicole

2017-01-01

Publications on diagnosed HIV infection among transgender people have been limited to state- or local-level data. We analyzed data from the National HIV Surveillance System and present results from the first national-level analysis of transgender people with diagnosed HIV infection. From 2009 to 2014, HIV surveillance jurisdictions from 45 states plus the District of Columbia identified and reported at least one case of newly diagnosed HIV infection for transgender people; jurisdictions from 5 states reported no cases for transgender people. Of 2351 transgender people with newly diagnosed HIV infection during 2009–2014, 84.0% were transgender women (male-to-female), 15.4% were transgender men (female-to-male), and 0.7% were additional gender identity (e.g., gender queer, bi-gender). Over half of both transgender women (50.8%; 1002/1974) and men (58.4%; 211/361) with newly diagnosed HIV infection were non-Hispanic black/African American. Improvements in data collection methods and quality are needed to gain a better understanding of HIV burden among transgender people. PMID:28035497

Finding Self: A Qualitative Study of Transgender, Transitioning, and Adulterated Silicone

ERIC Educational Resources Information Center

Wallace, Phyllis M.

2010-01-01

Objective: To describe the development and testing of a theory-based interview guide. To increase awareness of adulterated silicone use among Transgender. Design: A qualitative study based on semi-structured interviews. Setting: Interviews were conducted in Chicago, Illinois, USA. Method: Seven transgender adults aged 18 and over were interviewed…

The Role of School Counsellors and Psychologists in Supporting Transgender People

ERIC Educational Resources Information Center

Riggs, Damien W.; Bartholomaeus, Clare

2015-01-01

As growing numbers of transgender people--including students, parents, and educators--become visible within schools, so comes with this the requirement that schools ensure their full inclusion. This article suggests that school counsellors and psychologists have an important role to play in supporting transgender people within schools. As an…

Difficulties in everyday life: young persons with attention-deficit/hyperactivity disorder and autism spectrum disorders perspectives. A chat-log analysis.

PubMed

Ahlström, Britt H; Wentz, Elisabet

2014-01-01

This study focuses on the everyday life of young persons with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). There are follow-up studies describing ADHD, and ASD in adults, and residual impairments that affect life. Few qualitative studies have been conducted on the subject of their experiences of everyday life, and even fewer are from young persons' perspectives. This study's aim was to describe how young persons with ADHD and ASD function and how they manage their everyday life based on analyses of Internet-based chat logs. Twelve young persons (7 males and 5 females aged 15-26) diagnosed with ADHD and ASD were included consecutively and offered 8 weeks of Internet-based Support and Coaching (IBSC). Data were collected from 12 chat logs (445 pages of text) produced interactively by the participants and the coaches. Qualitative content analysis was applied. The text was coded and sorted into subthemes and further interpreted into themes. The findings revealed two themes: "fighting against an everyday life lived in vulnerability" with the following subthemes: "difficult things," "stress and rest," and "when feelings and thoughts are a concern"; and the theme "struggling to find a life of one's own" with the following subthemes: "decide and carry out," "making life choices," and "taking care of oneself." Dealing with the problematic situations that everyday encompasses requires personal strength and a desire to find adequate solutions, as well as to discover a role in society. This study, into the provision of support and coaching over the Internet, led to more in-depth knowledge about these young persons' everyday lives and revealed their ability to use IBSC to express the complexity of everyday life for young persons with ADHD and ASD. The implications of the findings are that using online coaching makes available new opportunities for healthcare professionals to acknowledge these young persons' problems.

Transgender, Mental Health, and Older People: An Appreciative Approach Towards Working Together.

PubMed

Page, Sean; Burgess, Jenny; Davies-Abbott, Ian; Roberts, Debbie; Molderson, Jaanika

2016-12-01

It cannot be assumed by healthcare providers that transgender people routinely receive care and treatment that is of the quality and sensitivity that should be expected. In particular there are concerns from within the transgender community that they experience discrimination and disrespect from both individual practitioners and the healthcare system as a whole. This causes an avoidance of contact that is undesirable for both users and providers of healthcare services. Older transgender people are vulnerable to a range of mental health problems and, like all elderly, increasingly to dementia; failure to access specialist services in a timely manner may result in unnecessary distress and potentially to crisis. This paper reports on the use of an appreciative inquiry approach towards identifying the opportunities for one health board in North Wales to work more closely with older members of the transgender community it serves.

Adult Attachment and Transgender Identity in the Italian Context: Clinical Implications and Suggestions for Further Research

PubMed Central

Amodeo, Anna Lisa; Vitelli, Roberto; Scandurra, Cristiano; Picariello, Simona; Valerio, Paolo

2016-01-01

Introduction Although attachment theory has been recognized as one of the main reference for the study of the general wellbeing, little research has been focused on the attachment styles of transgender people. Attachment styles are deeply influenced by the earliest relationships with caregivers, which, for gender nonconforming children, are often characterized by parental rejection. Consequently, transgender children and adults likely internalize societal stigma, developing internalized transphobia. The current research was aimed to explore the link between adult attachment and internalized transphobia. Method 25 male-to-female (MtF) and 23 female-to-male (FtM) transgender people participated in the survey filling in two self-report questionnaires: the Attachment Style Questionnaire and the Transgender Identity Survey. A cluster analysis, T-Test and multiple regression analysis were conducted to explore the link between attachment styles and internalized transphobia. Results A greater prevalence of secure attachment styles was detected. Participants with secure attachment styles reported higher levels of positive transgender identity than those with insecure attachment styles. Secure attachment styles significantly affect positive transgender identity, while insecure attachment styles influence internalized transphobia. Conclusions A clinical focus on the redefinition of the Internal Working Models of transgender people can inform psychologically-focused interventions, which transgender people can benefit from. PMID:26937224

75 FR 32079 - Lesbian, Gay, Bisexual, and Transgender Pride Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

..., Gay, Bisexual, and Transgender Pride Month, 2010 By the President of the United States of America A... equality on behalf of the lesbian, gay, bisexual, and transgender (LGBT) community. This month, as we.... That is why we must give committed gay couples the same rights and responsibilities afforded to any...

Transgender People at Four Big Ten Campuses: A Policy Discourse Analysis

ERIC Educational Resources Information Center

Dirks, Doris Andrea

2016-01-01

This article examines the language used to discuss transgender people on university campuses. This study asks how, despite seemingly benefitting transgender people, the discourses carried by the documents that discuss trans people may actually undermine the intended goals of policy initiatives. For example, a report on the status of transgender…

The ethics of helping transgender men and women have children.

PubMed

Murphy, Timothy F

2010-01-01

A transgender man legally married to a woman has given birth to two children, raising questions about the ethics of assisted reproductive treatments (ARTs) for people with cross-sex identities. Psychiatry treats cross-sex identities as a disorder, but key medical organizations and the law in some jurisdictions have taken steps to protect people with these identities from discrimination in health care, housing, and employment. In fact, many people with cross-sex identities bypass psychiatric treatment altogether in order to pursue lives that are meaningful to them, lives that sometimes include children. Cross-sex identification does not render people unfit as parents, because transgender identities do not undercut the ability to understand the nature and consequences of pregnancy or necessarily interfere with the ability to raise children. Moreover, no evidence suggests that being born to and raised by transgender parents triggers the kind of harm that would justify exclusion of trans-identified men and women from ARTs as a class. The normalization of transgender identities by the law and professional organizations contributes, moreover, to the need to reassess pathological interpretations of cross-sex identities, and trans-parenthood puts those interpretations into sharp relief.

Putting the "T" in "Resource": The Benefits of LGBT-Related School Resources for Transgender Youth

ERIC Educational Resources Information Center

Greytak, Emily A.; Kosciw, Joseph G.; Boesen, Madelyn J.

2013-01-01

This study examines the availability and effectiveness of lesbian, gay, bisexual, and transgender (LGBT)-related school resources for a national sample of transgender youth (N = 409), as compared to a national sample of LGB cisgender (non-transgender) youth (N = 6,444). All four examined resources--gay-straight alliances (GSAs), supportive…

Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies.

PubMed

Jones, Bethany Alice; Arcelus, Jon; Bouman, Walter Pierre; Haycraft, Emma

2017-04-01

Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation. To the authors' knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature. Eight research articles and 31 sport policies were reviewed. In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport's policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based. Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.

The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health.

PubMed

Miller, Lisa R; Grollman, Eric Anthony

2015-09-01

Research suggests that transgender people face high levels of discrimination in society, which may contribute to their disproportionate risk for poor health. However, little is known about whether gender nonconformity, as a visible marker of one's stigmatized status as a transgender individual, heightens trans people's experiences with discrimination and, in turn, their health. Using data from the largest survey of transgender adults in the United States, the National Transgender Discrimination Survey (N = 4,115), we examine the associations among gender nonconformity, transphobic discrimination, and health-harming behaviors (i.e., attempted suicide, drug/alcohol abuse, and smoking). The results suggest that gender nonconforming trans people face more discrimination and, in turn, are more likely to engage in health-harming behaviors than trans people who are gender conforming. Our findings highlight the important role of gender nonconformity in the social experiences and well-being of transgender people.

Intervention to Increase HIV Testing Among Substance-Using Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial.

PubMed

Stephenson, Rob; Bonar, Erin E; Carrico, Adam; Hunter, Alexis; Connochie, Daniel; Himmelstein, Rebecca; Bauermeister, Jose

2018-04-30

Young men who have sex with men (YMSM) and transgender people in the Detroit Metro Area are the only risk group for whom the incidence of HIV and sexually transmitted infections (STI) has increased since 2000, with HIV incidence nearly doubling among youth. Substance use (including alcohol), which is relatively frequent among YMSM and transgender people, creates barriers to the optimal delivery of HIV prevention and care services. Standard HIV counseling, testing, and referral (CTR) is limited in providing strategies to identify and address substance use. Hence, in its current form, CTR may not be serving the prevention needs of substance-using YMSM and transgender people. Brief counseling interventions, grounded in principles of motivational interviewing, may offer a mechanism to meet the HIV prevention and care needs of substance-using YMSM and transgender people. This prospective, 4-arm, factorial randomized controlled trial aims to examine the efficacy of an motivational interviewing-based substance use brief intervention (SUBI) on participants' substance use and engagement in HIV prevention. The research implements a prospective randomized controlled trial (Project Swerve) of 600 YMSM and transgender people recruited both online and in person. Eligibility criteria include participants who (1) are between the ages of 15 to 29 years, (2) live in the Detroit Metro Area, (3) self-identify as a man or transgender man or woman, (4) have had sexual contact with a man in the 6 months before enrollment, (5) self-report binge drinking or any substance use in the 3 months before enrollment, and (6) self-report an unknown or negative HIV status upon enrollment. Participants are randomized to receive, 3-months apart starting at baseline, 2 individual sessions. Sessions are CTR-only, SUBI-only, CTR followed by SUBI, or SUBI followed by CTR. Project Swerve was launched in April 2017 and enrollment is ongoing. Incorporating a SUBI that utilizes the principles of motivational

The Association of Multiple Identities with Self-directed Violence and Depression among Transgender Individuals

PubMed Central

Lytle, Megan C.; Blosnich, John R.; Kamen, Charles

2016-01-01

Transgender individuals have a high prevalence of self-directed violence; however, there is scant literature focusing on their unique experiences. This study examined the differences in self-harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorse self-directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non-Hispanic white individuals. PMID:26916366

Development and Validation of the Transgender Attitudes and Beliefs Scale.

PubMed

Kanamori, Yasuko; Cornelius-White, Jeffrey H D; Pegors, Teresa K; Daniel, Todd; Hulgus, Joseph

2017-07-01

In recent years, issues surrounding transgender have garnered media and legal attention, contributing to rapidly shifting views on gender in the U.S. Yet, there is a paucity of data-driven studies on the public's views of transgender identity. This study reports the development and validation of the Transgender Attitudes and Beliefs Scale (TABS). After constructing an initial 96-item pool from consulting experts and existing scales, Phase 1 of the study was launched, involving an exploratory factor analysis of 48 items. The initial factor analysis with 295 participants revealed three factors across 33 items-16 items on interpersonal comfort, 11 on sex/gender beliefs, and 6 on human value. The internal consistency of each factor was high-α = .97 for Factor 1, α = .95 for Factor 2, and α = .94 for Factor 3. A confirmatory factor analysis was conducted in the second phase with an independent sample consisting of 238 participants. The Attitudes Toward Transgender Individual Scale and the Genderism and Transphobia Scale were also included to test for convergent validity, and the Rosenberg Self-Esteem Scale and the short form of the Marlowe-Crowne Social Desirability Scale were utilized to test discriminant validity. Both of the data collection phases employed MTurk, a form of online sampling with increased diversity compared to college student samples and more generalizability to the general U.S. TABS represents an addition to the literature in its ability to capture a more nuanced conceptualization of transgender attitude not found in previous scales.

Intonation and gender perception: applications for transgender speakers.

PubMed

Hancock, Adrienne; Colton, Lindsey; Douglas, Fiacre

2014-03-01

Intonation is commonly addressed in voice and communication feminization therapy, yet empirical evidence of gender differences for intonation is scarce and rarely do studies examine how it relates to gender perception of transgender speakers. This study examined intonation of 12 males, 12 females, six female-to-male, and 14 male-to-female transgender speakers describing a Norman Rockwell image. Several intonation measures were compared between biological gender groups, between perceived gender groups, and between male-to-female (MTF) speakers who were perceived as male, female, or ambiguous gender. Speakers with a larger percentage of utterances with upward intonation and a larger utterance semitone range were perceived as female by listeners, despite no significant differences between the actual intonation of the four gender groups. MTF speakers who do not pass as female appear to use less upward and more downward intonations than female and passing MTF speakers. Intonation has potential for use in transgender communication therapy because it can influence perception to some degree. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

76 FR 32853 - Lesbian, Gay, Bisexual, And Transgender Pride Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-07

..., Gay, Bisexual, And Transgender Pride Month, 2011 By the President of the United States of America A Proclamation The story of America's Lesbian, Gay, Bisexual, and Transgender (LGBT) community is the story of..., Don't Tell'' policy. With this repeal, gay and lesbian Americans will be able to serve openly in our...

The Role of Personal Resources in Work-Family Conflict: Implications for Young Mothers' Well-Being

ERIC Educational Resources Information Center

Braunstein-Bercovitz, Hedva; Frish-Burstein, Smadar; Benjamin, Benny A.

2012-01-01

The purpose of the current study was to examine the role that personal resources (person-environment [PE] congruence and personality types associated with resilience) and work-family conflict (WFC) play in the sense of well-being (as reflected by burnout and life-satisfaction) of mothers of young children. A sample of 146 mothers holding demanding…

Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada.

PubMed

Bauer, Greta R; Scheim, Ayden I; Pyne, Jake; Travers, Robb; Hammond, Rebecca