-
JAMA Network Open Jul 2022Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast,...
IMPORTANCE
Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition.
OBJECTIVE
To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice.
DESIGN, SETTING, AND PARTICIPANTS
Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed.
MAIN OUTCOMES AND MEASURES
In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions.
RESULTS
Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs.
CONCLUSIONS AND RELEVANCE
This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
Topics: Delivery of Health Care; Ethnicity; Female; Gender Identity; Humans; Infant, Newborn; Male; Transgender Persons; Transsexualism
PubMed: 35877120
DOI: 10.1001/jamanetworkopen.2022.24717 -
Current Opinion in Endocrinology,... Dec 2014To examine the sex assignment in patients with atypical external genitalia, a particularly challenging situation, especially when the genital appearance is not... (Review)
Review
PURPOSE OF REVIEW
To examine the sex assignment in patients with atypical external genitalia, a particularly challenging situation, especially when the genital appearance is not compatible with the sex chromosome.
RECENT FINDINGS
The most important factors that influence sex assignment include the definite diagnosis, genital appearance, surgical options, potential for fertility, risks of gonadal malignancy and, finally, the perception of the patients and their parents. Full disclosure and complete involvement of the parents in making decisions concerning gender assignment and/or genital surgery must be part of the basic medical care for children with disorder of sex development.
SUMMARY
Patients with disorder of sex development should receive long-term care provided by multidisciplinary teams in centers of excellence with ample experience in the management of this disorder.
Topics: Adult; Child Rearing; Decision Making; Disorders of Sex Development; Female; Gender Identity; Genetic Counseling; Genitalia, Female; Genitalia, Male; Humans; Infant, Newborn; Karyotyping; Male; Parent-Child Relations; Parents; Pregnancy; Psychosexual Development; Risk Assessment; Sex Determination Analysis; Ultrasonography, Prenatal; Urogenital Surgical Procedures
PubMed: 25354047
DOI: 10.1097/MED.0000000000000115 -
Reproduction & Fertility Apr 2024The rights of transgender and intersex people have become a contentious issue in our current political climate. Whether it be the rights of intersex athletes such as...
The rights of transgender and intersex people have become a contentious issue in our current political climate. Whether it be the rights of intersex athletes such as Caster Semenya (who identifies as a woman) to compete in elite sport, or the rights of transgender women to use women's only spaces, there is an increasingly fierce debate as to the legitimacy of people's gender and sexual identities and what parameters should be used to define them. A common argument accepted by most in our society is that while gender may be a spectrum, sex is an inalienable binary.
Topics: Animals; Female; Humans; Gender Identity; Sports; Athletes; Transsexualism; Transgender Persons
PubMed: 38492308
DOI: 10.1530/RAF-24-0005 -
Pediatric Annals Dec 2023
Topics: Humans; Adolescent; Transgender Persons; Gender Identity; Transsexualism; Pediatricians
PubMed: 38049187
DOI: 10.3928/19382359-20231016-01 -
Neuroscience and Biobehavioral Reviews Dec 2015Transsexualism describes the condition when a person's psychological gender differs from his or her biological sex and is commonly thought to arise from a discrepant... (Review)
Review
Transsexualism describes the condition when a person's psychological gender differs from his or her biological sex and is commonly thought to arise from a discrepant cerebral and genital sexual differentiation. This review intends to give an extensive overview of structural and functional neurobiological correlates of transsexualism and their course under cross-sex hormonal treatment. Research in this field enables insight into the stability or variability of gender differences and their relation to hormonal status. For a number of sexually dimorphic brain structures or processes, signs of feminisation or masculinisation are observable in transsexual individuals, which, during hormonal treatment, partly seem to further adjust to characteristics of the desired sex. Still, it appears the data are quite inhomogeneous, mostly not replicated and in many cases available for male-to-female transsexuals only. As the prevalence of homosexuality is markedly higher among transsexuals than among the general population, disentangling correlates of sexual orientation and gender identity is a major problem. To resolve such deficiencies, the implementation of specific research standards is proposed.
Topics: Brain; Gender Identity; Homosexuality; Humans; Sex Characteristics; Sexual Behavior; Transsexualism
PubMed: 26429593
DOI: 10.1016/j.neubiorev.2015.09.008 -
Clinics in Plastic Surgery Jul 2018All physicians are likely to encounter gender diverse patients, and some of these patients require medically necessary surgical procedures. It is optimal for surgeons to... (Review)
Review
All physicians are likely to encounter gender diverse patients, and some of these patients require medically necessary surgical procedures. It is optimal for surgeons to collaborate with other providers who interact with this patient population. Primary care physicians initiate treatment with consultation from mental health professionals and refer to surgeons when necessary. Best practices consist of preventative care, hormone therapy induction when indicated, monitoring of all health parameters, and continuing care medically and postoperatively.
Topics: Gender Identity; Humans; Primary Health Care; Transgender Persons; Transsexualism
PubMed: 29908616
DOI: 10.1016/j.cps.2018.03.001 -
The Journal of Adolescent Health :... Mar 2021This study examined whether transmasculine, transfeminine, and nonbinary adolescents and young adults (AYA) experience different levels of gender minority stress and...
PURPOSE
This study examined whether transmasculine, transfeminine, and nonbinary adolescents and young adults (AYA) experience different levels of gender minority stress and resilience.
METHODS
Demographic and clinical information were abstracted from medical charts from AYA initiating gender-affirming care. Group comparisons between transgender and nonbinary groups were examined using one-way analyses of variance and Tukey's honestly significant difference post hoc tests.
RESULTS
Participants were 638 transgender and nonbinary AYA (65.5% transmasculine, 24.6% transfeminine, and 9.9% nonbinary). Transmasculine and transfeminine AYA reported more discrimination (ps = .008 and .006, respectively) compared to non-binary AYA. Transfeminine and nonbinary AYA reported more negative future expectations (ps = .006 and .016, respectively) and pride (ps ≤ .001 and .032, respectively) than transmasculine AYA.
CONCLUSIONS
Findings suggest that transmasculine, transfeminine, and nonbinary AYA experience different levels of gender minority stress and resilience. Future research is warranted to further examine between-group differences and differential impact on mental health outcomes.
Topics: Adolescent; Gender Identity; Humans; Sexual and Gender Minorities; Transgender Persons; Transsexualism; Young Adult
PubMed: 33046360
DOI: 10.1016/j.jadohealth.2020.06.014 -
Advances in Life Course Research Sep 2022Transgender and nonbinary people's life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on...
Transgender and nonbinary people's life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on lifeline interviews from 87 transgender and nonbinary adults in Atlanta, New York City, and San Francisco. We find that the type, timing, and relative importance of these experiences varied across categories. For example, experiences related to "Rejection and violence" were more often identified in childhood and in the past, whereas experiences related to "Gender-affirming medical interventions" were more often in adulthood and anticipated futures. Experiences related to "Community involvement," "Extracurriculars," "Gender exploration and revelation," and "Gender-affirming medical interventions" were labeled by respondents as relatively more important compared to other experiences, whereas experiences related to "Family of origin relationships," "Place of residence," "Rejection and violence," and "Sexuality" less important. These experiences were patterned according to the respondents' gender, birth cohort, race/ethnicity, and geographic location. In analyzing these lifeline data, we advance theoretical understandings of the salience of a variety of key experiences for transgender and nonbinary people at different points in the life course. Our life course approach provides empirical analyses of intra-individual processes over time for transgender and nonbinary people and provides insight into the usefulness of a lifeline method for life course studies more generally as it draws attention to within-person assessments of the distribution and importance of events over the course of a lifetime.
Topics: Adult; Humans; Transgender Persons; Transsexualism; Gender Identity; Ethnicity; New York City
PubMed: 36381170
DOI: 10.1016/j.alcr.2022.100482 -
Journal of Health Care Chaplaincy 2023Spiritual support has been a staple of healthcare before hospitals in western civilizations were established by communities of faith. Research has demonstrated that... (Review)
Review
Spiritual support has been a staple of healthcare before hospitals in western civilizations were established by communities of faith. Research has demonstrated that wellbeing is associated with balanced care for the body, mind, and spirit. Healthcare disparities are being identified as disproportionally impacting transgender and gender nonconforming (TGNC) individuals. The root cause of this disparity is being studied as are medical and wellbeing interventions, including the benefit of spiritual support. This author's objective was two-fold. First, to identify opportunities for extending spiritual support to TGNC individuals in healthcare by chaplains. Secondly, to identify evidence of current spiritual support advocacy initiatives and interventions for TGNC patients in healthcare by chaplains.
Topics: Humans; Transgender Persons; Transsexualism; Gender Identity; Healthcare Disparities
PubMed: 35776733
DOI: 10.1080/08854726.2022.2080965 -
The Journal of Sexual Medicine Jun 2021Gender diverse individuals constitute a substantial yet still understudied population. Particularly little is known about gender non-binary people whose health needs...
BACKGROUND
Gender diverse individuals constitute a substantial yet still understudied population. Particularly little is known about gender non-binary people whose health needs have only recently gained attention from clinicians.
AIM
To investigate needs for gender-affirming interventions, selected health indicators and determinants in Polish gender non-binary individuals as compared to transgender men and transgender women.
METHODS
We analyzed a subset of data from an online study on health in members of the Polish LGBTQ community. The sample consisted of 53 persons who self-identified as non-binary and 45 transgender men and transgender women. The uptake and the desire for gender-affirming medical interventions as well as selected health indicators were compared in non-binary and transgender persons. Additionally, regression models were conducted for depression, self-esteem and somatic symptoms severity as dependent variables, age as a covariate, and perceived stigma exposure, resilience and discomfort associated with current gender expression as predictors.
OUTCOMES
Outcomes such as desire for gender-affirming medical interventions and legal gender reassignment, symptoms of depression, resilience, physical symptoms severity, and perceived stigma exposure were captured in self-reported questionnaires.
RESULTS
Compared to the transgender men and transgender women, the non-binary participants of the study significantly less often pursued or desired gender-affirming medical interventions and legal gender reassignment. The non-binary participants also felt significantly more discomfort with their current gender expression. They were also characterized by increased expectations of rejection, vicarious trauma associated with being an LGBTQ person, and by decreased resilience compared to the transgender men and transgender women. Non-binary identity and individual resilience predicted higher self-esteem and decreased depression in the sample. The severity of physical symptoms was predicted by perceived stigma exposure (positively) and by resilience (negatively).
CLINICAL IMPLICATIONS
Polish non-binary individuals may constitute a vulnerable population in terms of greater perceived exposure to stigma and decreased individual resilience. Both transgender and non-binary individuals seek gender-affirming interventions and legal gender reassignment; the latter group, however, does so significantly less often.
STRENGTHS & LIMITATIONS
We analyzed the data from a unique and understudied Polish population. By exploring the diversity within the transgender and non-binary community, we add to the ongoing discussion on transgender and non-binary health. The major limitations of the study are convenience sampling, cross-sectional design, and limited sample size.
CONCLUSION
Non-binary individuals constitute a distinct population in terms of psychosocial and health-related characteristics. Clinicians should be aware of their needs and the challenges they face in association with living in a predominantly gender binary-oriented society. Koziara K, Mijas M. Wycisk J, et al. Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals. J Sex Med 2021;18:1110-1121.
Topics: Cross-Sectional Studies; Female; Gender Identity; Humans; Male; Poland; Transgender Persons; Transsexualism
PubMed: 34108108
DOI: 10.1016/j.jsxm.2021.04.001