Showing papers on "Transgender published in 2014"

Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment

Abstract: BACKGROUND: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach. METHODS: A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated. RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. CONCLUSIONS: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.

Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population

Abstract: Purpose: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population. Design and Methods: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework. Results: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes. Implications: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults’ distinct health and aging needs.

Doing Gender, Determining Gender: Transgender People, Gender Panics, and the Maintenance of the Sex/Gender/Sexuality System

Abstract: This article explores “determining gender,” the umbrella term for social practices of placing others in gender categories. We draw on three case studies showcasing moments of conflict over who counts as a man and who counts as a woman: public debates over the expansion of transgender employment rights, policies determining eligibility of transgender people for competitive sports, and proposals to remove the genital surgery requirement for a change of sex marker on birth certificates. We show that criteria for determining gender differ across social spaces. Gender-integrated spaces are more likely to use identity-based criteria, while gender-segregated spaces, like the sexual spaces we have previously examined (Schilt and Westbrook 2009), are more likely to use biology-based criteria. In addition, because of beliefs that women are inherently vulnerable and men are dangerous, “men’s” and “women’s” spaces are not policed equally—making access to women’s spaces central to debates over transgender rights.

The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities.

Abstract: National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model—a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.

Dating violence experiences of lesbian, gay, bisexual, and transgender youth.

Abstract: Media attention and the literature on lesbian, gay, and bisexual youth overwhelmingly focus on violence involving hate crimes and bullying, while ignoring the fact that vulnerable youth also may be at increased risk of violence in their dating relationships. In this study, we examine physical, psychological, sexual, and cyber dating violence experiences among lesbian, gay, and bisexual youth—as compared to those of heterosexual youth, and we explore variations in the likelihood of help-seeking behavior and the presence of particular risk factors among both types of dating violence victims. A total of 5,647 youth (51 % female, 74 % White) from 10 schools participated in a cross-sectional anonymous survey, of which 3,745 reported currently being in a dating relationship or having been in one during the prior year. Results indicated that lesbian, gay, and bisexual youth are at higher risk for all types of dating violence victimization (and nearly all types of dating violence perpetration), compared to heterosexual youth. Further, when looking at gender identity, transgender and female youth are at highest risk of most types of victimization, and are the most likely perpetrators of all forms of dating violence but sexual coercion, which begs further exploration. The findings support the development of dating violence prevention programs that specifically target the needs and vulnerabilities of lesbian, gay, and bisexual youth, in addition to those of female and transgender youth.

Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus.

Abstract: Background Transgender women have 49 times the odds of human immunodeficiency virus (HIV) infection compared to other groups, yet they are disproportionately underserved by current treatment efforts.

The 2013 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools

Abstract: "This newest report shows us accelerating progress in ending the daily victimization that is the most fundamental barrier LGBT youth face in schools. It also calls our attention to areas we have only begun to understand, such as entrenched, systemic discrimination against LGBT students that can often lead to these students being pushed out of school. And it shines a light on the dramatic power of curricular inclusion to open new fields of inquiry and career possibilities for LGBT youth."

The State of Transgender Health Care: Policy, Law, and Medical Frameworks

Abstract: 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.

You Can Form a Part of Yourself Online: The Influence of New Media on Identity Development and Coming Out for LGBTQ Youth

Abstract: Internet-based new media are increasingly utilized by lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, yet little is known about the ways in which it influences their identity development. Employing grounded theory, this study explores the influence of online media on the identity development and coming out processes (n = 19) of LGBTQ youth. Results indicate that new media enabled participants to access resources, explore identity, find likeness, and digitally engage in coming out. Participants also discussed the expansion of these newly developed identities into their offline lives. Practice implications are addressed.

Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless.

Abstract: A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions. (PsycINFO Database Record (c) 2014 APA, all rights reserved). Language: en

Research Funded by the National Institutes of Health on the Health of Lesbian, Gay, Bisexual, and Transgender Populations

Abstract: Objectives. We examined the proportion of studies funded by the National Institutes of Health (NIH) that focused on lesbian, gay, bisexual, and transgender (LGBT) populations, along with investigated health topics.Methods. We used the NIH RePORTER system to search for LGBT-related terms in NIH-funded research from 1989 through 2011. We coded abstracts for LGBT inclusion, subpopulations studied, health foci, and whether studies involved interventions.Results. NIH funded 628 studies concerning LGBT health. Excluding projects about HIV/AIDS and other sexual health matters, only 0.1% (n = 113) of all NIH-funded studies concerned LGBT health. Among the LGBT-related projects, 86.1% studied sexual minority men, 13.5% studied sexual minority women, and 6.8% studied transgender populations. Overall, 79.1% of LGBT-related projects focused on HIV/AIDS and substantially fewer on illicit drug use (30.9%), mental health (23.2%), other sexual health matters (16.4%), and alcohol use (12.9%). Only 202 studies examined LGB...

Gender minority stress, mental health, and relationship quality: a dyadic investigation of transgender women and their cisgender male partners.

Abstract: Research has demonstrated associations between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level influences relationship quality and mental health for transgender women and their cisgender (nontransgender) male partners. The present study sought to examine how experiences of transgender-related discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on one’s romantic affiliation) were associated with both partners relationship quality and mental health. Couples (n 191) were recruited to participate in cross-sectional survey. Dyadic analyses using actor–partner interdependence models were conducted to examine the influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partner’s higher relationship stigma scores were associated with lower relationship quality; however, among male partners, only their partner’s greater relationship stigma scores were associated with lower relationship quality. Findings provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners. Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners.

Do Ask, Do Tell: High Levels of Acceptability by Patients of Routine Collection of Sexual Orientation and Gender Identity Data in Four Diverse American Community Health Centers

Abstract: Background The Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist. Methods In order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad. Results There was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents—heterosexual and LGBT—answered the questions, and said that they would answer such questions in the future. While there were some age-related differences, respondents of all ages overwhelmingly expressed support for asking SOGI questions and understood the importance of providers' knowing their patients' SOGI. Conclusions Given current deliberations within national health care regulatory bodies and the government's increased attention to LGBT health disparities, the finding that patients can and will answer SOGI questions has important implications for public policy. This study provides evidence that integrating SOGI data collection into the meaningful use requirements is both acceptable to diverse samples of patients, including heterosexuals, and feasible.

Gender Identities and Gender Dysphoria in the Netherlands

Abstract: Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15-70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.

Creating a Vision for the Future: Key Competencies and Strategies for Culturally Competent Practice With Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the Health and Human Services

Abstract: Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.

Negative and Positive Factors Associated With the Well-Being of Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth

Abstract: Factors associated with the well-being of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth were qualitatively examined to better understand how these factors are experienced from the youths' perspectives. Largely recruited from LGBTQ youth groups, 68 youth participated in focus groups (n = 63) or individual interviews (n = 5). The sample included 50% male, 47% female, and 3% transgender participants. Researchers used a consensual methods approach to identify negative and positive factors across 8 domains. Negative factors were associated with families, schools, religious institutions, and community or neighborhood; positive factors were associated with the youth's own identity development, peer networks, and involvement in the LGBTQ community. These findings suggest a pervasiveness of negative experiences in multiple contexts, and the importance of fostering a positive LGBTQ identity and supportive peer/community networks. Efforts should work towards reducing and eliminating the prejudicial sentiments often present in the institutions and situations that LGBTQ youth encounter.

Suicide Attempts Among Transgender and Gender Non-Conforming Adults - eScholarship

Abstract: New analysis of responses to the National Transgender Discrimination Survey (NTDS) shows that transgender respondents who experienced rejection by family and friends, discrimination, victimization, or violence have a higher risk of attempting suicide. 78 percent of survey respondents who suffered physical or sexual violence at school reported suicide attempts, as did 65 percent of respondents who experienced violence at work. The study suggests that several minority stressors – negative experiences related to anti-transgender bias – may contribute to elevated prevalence of suicide attempts among transgender people, such as experiences of harassment, family rejection, housing instability, and discrimination in health care. Over half of those who experienced harassment or bullying in schools reported lifetime suicide attempts, as did 57 percent of those who reported that their family chose not to speak/spend time with them. High prevalence of suicide attempts was also found among those who had ever experienced homelessness (69%) and those who reported a doctor or healthcare provider refused to treat them (60%). The study utilized data collected through the National Transgender Discrimination Survey (NTDS), which was conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. 6,456 transgender and gender non-conforming people in the United States reported on their experiences of discrimination and abuse at work, at home, in school, and in the public sphere, amassing the largest transgender survey sample to date.

“I Am My Own Gender”: Resilience Strategies of Trans Youth

Abstract: A growing body of literature has described the barriers trans youth experience related to gender identity and expression (Gonzalez & McNulty, 2010; Grossman & D'Augelli, 2007), yet less information is known about trans youth's resilience in terms of their ability to manage societal discrimination in their lives. The words trans or transgender have been used to describe individuals whose sex assigned at birth (i.e., male or female) is not in alignment with their gender identity (e.g., woman or man) and expression (American Counseling Association [ACA], 2010). The prevalence rates of trans youth are difficult to specify, especially because there has been little research with this group and the few youth surveys (e.g., Youth Risk Behavior Surveillance System) that typically assess attitudes and behaviors of young people have not included a place for trans youth to self-identify (Winter & Conway, 2011). In addition, knowledge about gender identity and trans health is very low among health providers (counselors, medical doctors, etc.), translating to inadequate or nonexistent health care access (Bockting, Robinson, Benner, & Scheltema, 2004). These deficits in trans competency became more relevant for the counseling profession, because for the first time the most recent Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (World Professional Association of Transgender Health, 2011) has included master's-level counselors as potential providers for writing letters for hormone replacement therapy and other trans-related surgeries. Recently, ACA endorsed the Competencies for Counseling with Transgender Clients (2010), which grounded counselor training competencies in strength-based, feminist, multicultural, and social justice theories. However, the focus of this document was primarily on trans adults, so there continues to be very little information about the resilience trans youth have developed to resist trans prejudice (i.e., discrimination against trans people) and adultism (the system of oppression where adults hold greater power regarding decision making in their lives than do young people; Bell, 2003). The purpose of this study was to explore the supports of and challenges to resilience that trans youth experience in their everyday lived experiences. We defined resilience as the strategies and contexts that assist trans youth to navigate life stressors related to their gender identity and/ or gender expression with success (Hartling, 2004; Mizcock & Lewis, 2008; Werner, 1995). * Challenges to Trans Youth Resilience To understand what helps trans youth develop resilience--what helps them "bounce back" from adversity (Reivich & Shatte, 2002)--to societal discrimination, it is important to understand the many challenges that trans youth currently face. Despite the efforts of national advocacy groups (e.g., National Center for Transgender Equality [NCTE]) that have helped to develop positive portrayals of and education about trans people in media and other contexts, many societal barriers still exist in a variety of areas that directly affect a trans person's quality of life. These barriers may reside in social and family structures, employment discrimination, health care access, or schools. The detrimental effects of these societal barriers can often put trans youth at risk for dropping out of school, running away from home, substance abuse, HIV/AIDS, and becoming homeless (Grossman & D'Augelli, 2006; Singh, Hays, & Watson, 2011). Furthermore, the National Transgender Discrimination Survey (Grant et al., 2011) reported that 78% of trans children in grades K-12 reported some form of harassment related to their gender identity and expression, 35% of the children reported incidences of physical violence, and 12% of the children reported sexual violence. Other challenges trans youth face include obtaining satisfactory medical care, instead encountering physicians' negative beliefs (Kitts, 2010), refusal of care, and a general lack of knowledge (Grant et al. …

HIV epidemics among transgender women.

Abstract: PURPOSE OF REVIEW Recent data on the high burden of HIV among transgender women have 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 multilevel, 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.

Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center.

Abstract: Purpose: U.S. health surveillance systems infrequently include measures to identify transgender respondents or monitor the health of this underserved and marginalized population. Methods: From 2001 to 2002, transgender and nontransgender adults were sampled at a Massachusetts clinic. Health differences were formatively examined by transgender identity using a cross-sectional, clinic-based sample (n=2,653) and a nested matched-pair subsample (n=155). Results: Both designs produced virtually identical findings: (1) the prevalence of HIV, substance abuse, and smoking did not differ significantly for transgender and nontransgender patients; (2) transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared with nontransgender patients (p<0.05); (3) transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to nontransgender patients (p<0.05). Conclusion: Findings suggest that a nested design may provide an ...

Being Transgender: The Experience of Transgender Identity Development

Abstract: 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.

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

Abstract: 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.

Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening.

Abstract: BACKGROUND Little is known about whether and how screening for cancers of natal reproductive structures, including cervical cancer, in female-to-male (FTM) transgender individuals differs from cancer screening among non-transgender females.