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Social Science & Medicine (1982) Jun 2024This final commentary, in comic format, frames this special issue using Graphic Medicine methodologies to explore broader themes and meanings related to the scientific...
This final commentary, in comic format, frames this special issue using Graphic Medicine methodologies to explore broader themes and meanings related to the scientific study of gender and health. Comics can be seen as a way to introduce complex human narratives and as an exploratory tool to ask broader social-contextual and ethical questions about health and medicine. This piece is also constructed through the lens of queer scholarship, which, together with the comics format, provides opportunities to build more embodied, complicated narratives about gender, sexuality and health. Most importantly, comics are used as a modality to tell compelling narratives about how individuals, rather than populations, may be impacted by biomedical conceptualizations of gender and health. The commentary includes a series of graphic narratives containing hypothetical stories and cases: stories of how individuals may be harmed within healthcare systems by rigid framings of gender, sex and sexuality, and stories about how gender socialization may impact health in subtle ways. These narratives furthermore examine the inextricable link between gender and power, illustrating how overt and covert manifestations of power may shape a person's health over the life course. Finally, the piece explores how expansive views of gender may contribute to positive health care experiences. The intention of this piece is to nudge scientific researchers and clinicians alike to approach the topic of gender, sexuality and health with nuance and curiosity.
Topics: Humans; Narration; Graphic Novels as Topic; Sexuality; Gender Identity; Female; Male
PubMed: 38825376
DOI: 10.1016/j.socscimed.2023.116436 -
BMC Public Health Jun 2024Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations...
Accuracy, potential, and limitations of probabilistic record linkage in identifying deaths by gender identity and sexual orientation in the state of Rio De Janeiro, Brazil.
BACKGROUND
Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro.
METHODS
This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy.
RESULTS
The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother's name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs.
CONCLUSION
With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.
Topics: Humans; Brazil; Female; Male; Gender Identity; Sexual Behavior; Medical Record Linkage; Data Accuracy; Death Certificates; Adult
PubMed: 38824562
DOI: 10.1186/s12889-024-19002-x -
Body Image Sep 2024Among gender-expansive individuals and transgender men, body appreciation can play a protective role against minority stressors and is associated with gender euphoria....
Among gender-expansive individuals and transgender men, body appreciation can play a protective role against minority stressors and is associated with gender euphoria. The Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015) is a leading measure of body appreciation that has been mainly validated in cisgender and mixed-gender samples; however, it has not been validated among Brazilian gender-expansive individuals and transgender men. Therefore, we evaluated the psychometric properties of the BAS-2 among adult Brazilian gender-expansive individuals and transgender men. Participants (158 gender-expansive individuals and 138 transgender men) were recruited through social media in Brazil. Confirmatory Factor Analysis (CFA) supported the original 10-item, unidimensional solution. Multigroup CFA showed configural, metric, and scalar invariance of the BAS-2 between gender-expansive individuals and transgender men. Moreover, the BAS-2 demonstrated significant negative associations, ranging from small to large, with self-objectification, drive for muscularity, and appearance-ideal internalization. We also found good internal consistency and test-retest reliability of the measure. Taken together, our results support the psychometric properties of the BAS-2 among Brazilian gender-expansive individuals and transgender men. The present work offers a valuable contribution towards better understanding facets of positive body image across gender-expansive and transgender populations.
Topics: Humans; Transgender Persons; Male; Brazil; Psychometrics; Adult; Female; Reproducibility of Results; Young Adult; Body Image; Factor Analysis, Statistical; Surveys and Questionnaires; Gender Identity; Adolescent; Self Concept; Middle Aged; Body Dissatisfaction
PubMed: 38815454
DOI: 10.1016/j.bodyim.2024.101724 -
Frontiers in Endocrinology 2024Gender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with...
BACKGROUND
Gender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies have examined how current GAHT initiation compares to recommended GAHT initiation.
OBJECTIVE
This study assessed guideline concordance around feminizing and masculinizing GAHT initiation in the Veterans Health Administration (VHA).
METHODS
The sample included 4,676 veterans with a gender identity disorder diagnosis who initiated feminizing (=3,547) and masculinizing (=1,129) GAHT between 2007 and 2018 in VHA. Demographics and health conditions on veterans receiving feminizing and masculinizing GAHT were assessed. Proportion of guideline concordant veterans on six VHA guidelines on feminizing and masculinizing GAHT initiation were determined.
RESULTS
Compared to veterans receiving masculinizing GAHT, a higher proportion of veterans receiving feminizing GAHT were older (≥60 years: 23.7% vs. 6.3%), White non-Hispanic (83.5% vs. 57.6%), and had a higher number of comorbidities (≥7: 14.0% vs. 10.6%). A higher proportion of veterans receiving masculinizing GAHT were Black non-Hispanic (21.5% vs. 3.5%), had posttraumatic stress disorder (43.0% vs. 33.9%) and positive military sexual trauma (33.5% vs.16.8%; all p-values<0.001) than veterans receiving feminizing GAHT. Among veterans who started feminizing GAHT with estrogen, 97.0% were guideline concordant due to no documentation of contraindication, including venous thromboembolism, breast cancer, stroke, or myocardial infarction. Among veterans who started spironolactone as part of feminizing GAHT, 98.1% were guideline concordant as they had no documentation of contraindication, including hyperkalemia or acute renal failure. Among veterans starting masculinizing GAHT, 90.1% were guideline concordant due to no documentation of contraindications, such as breast or prostate cancer. Hematocrit had been measured in 91.8% of veterans before initiating masculinizing GAHT, with 96.5% not having an elevated hematocrit (>50%) prior to starting masculinizing GAHT. Among veterans initiating feminizing and masculinizing GAHT, 91.2% had documentation of a gender identity disorder diagnosis prior to GAHT initiation.
CONCLUSION
We observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT. Findings suggest that VHA clinicians are initiating feminizing GAHT in concordance with clinical guidelines. Future work should assess guideline concordance on monitoring and management of GAHT in VHA.
Topics: Humans; Female; United States; Male; Middle Aged; Practice Guidelines as Topic; Transgender Persons; Adult; United States Department of Veterans Affairs; Veterans; Sex Reassignment Procedures; Guideline Adherence; Aged; Gender Dysphoria; Transsexualism; Veterans Health; Hormone Replacement Therapy; Practice Patterns, Physicians'
PubMed: 38800485
DOI: 10.3389/fendo.2024.1086158 -
Early Human Development Jul 2024The left-cradling bias (i.e., the motor asymmetry for cradling infants on the left side) has often been associated to the right-hemispheric social-emotional...
The left-cradling bias (i.e., the motor asymmetry for cradling infants on the left side) has often been associated to the right-hemispheric social-emotional specialization, and it has often been reported to be stronger in females than in males. In this study we explored the effects of sexual orientation and gender identity on this lateral bias by means of a web-based investigation in a sample of adults (485 biological females and 196 biological males) recruited through LGBTQIA+ networks and general university forums. We exploited a cradling imagery task to assess participants' cradling-side preference, and standardized questionnaires to assess participants' homosexuality (Klein Sexual Orientation Grid) and gender nonconformity (Gender Identity/Gender Dysphoria Questionnaire for Adults and Adolescents). Results confirmed the expected left-cradling bias across all sexual orientation groups except for heterosexual males. Importantly, higher homosexuality scores were associated with higher proportions of left cradling in males. These results suggest that sexual orientation can influence cradling preference in males, indicating a complex interaction between biological and psychological factors in the laterality of social-emotional processing. Finally, the left-cradling bias seems to confirm its role as a behavioral proxy of social-emotional functional lateralization in humans.
Topics: Humans; Male; Female; Adult; Functional Laterality; Gender Identity; Sexual Behavior; Emotions; Adolescent; Young Adult
PubMed: 38781713
DOI: 10.1016/j.earlhumdev.2024.106049 -
Obstetrics and Gynecology Clinics of... Jun 2024Surgical treatment for gender dysphoria consists of facial, chest, and genital surgery. Chest and genital gender affirmation surgeries alter the form and function of the... (Review)
Review
Surgical treatment for gender dysphoria consists of facial, chest, and genital surgery. Chest and genital gender affirmation surgeries alter the form and function of the native organs. This can have a profound impact on sexual function for transgender and gender- diverse individuals. In this article, the authors will discuss the impacts that chest and genital gender affirmation surgeries can have on sexual function.
Topics: Humans; Female; Male; Transgender Persons; Gender Dysphoria; Sex Reassignment Surgery; Sexual Behavior; Transsexualism; Sex Reassignment Procedures
PubMed: 38777493
DOI: 10.1016/j.ogc.2024.03.005 -
Obstetrics and Gynecology Clinics of... Jun 2024Adolescence is a unique time where there are many developmental changes occurring. Teenagers are striving to establish their personal identity as they are also... (Review)
Review
Adolescence is a unique time where there are many developmental changes occurring. Teenagers are striving to establish their personal identity as they are also developing a better understanding of their gender and sexual identity while navigating social expectations both in person and online. Therefore, clinicians must continue to support adolescent patients and their families by providing accurate and timely information so that they can have the tools they need to avoid the pitfalls of an uninformed adolescent experience.
Topics: Humans; Adolescent; Female; Adolescent Behavior; Sexual Behavior; Male; Sexuality; Gender Identity; Sex Education
PubMed: 38777485
DOI: 10.1016/j.ogc.2024.02.004 -
JAMA Network Open May 2024Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to...
IMPORTANCE
Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health.
OBJECTIVE
To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023.
EXPOSURE
Gender identity trajectories and gender identity variability.
MAIN OUTCOMES AND MEASURES
The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants' gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time.
RESULTS
Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline (Β = 4.66; SE = 2.10; P = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account (Β = 3.31; SE = 2.36; P = .16). Gender identity variability was not associated with within-person change in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33).
CONCLUSIONS
These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.
Topics: Humans; Male; Female; Adolescent; Gender Identity; Depression; Longitudinal Studies; Sexual and Gender Minorities; Young Adult; United States; Self Report; Cohort Studies
PubMed: 38776085
DOI: 10.1001/jamanetworkopen.2024.11322 -
Journal of Pediatric Nursing May 2024The first year of life is known as the "Oral Stage" in psychosexual development theory. We investigated the impact of psychosexual development theory-based breastfeeding...
PURPOSE
The first year of life is known as the "Oral Stage" in psychosexual development theory. We investigated the impact of psychosexual development theory-based breastfeeding education on primiparous mothers' feeding attitudes and behaviors.
DESIGN AND METHODS
We conducted this randomized controlled study at a baby-friendly hospital between December 2022 and July 2023. Participants were randomized to intervention (n = 21) and control (n = 19) groups. All participants received the same standard discharge education in the hospital, and the intervention group received additional psychosexual development theory-based breastfeeding education. Data collection for both groups involved conducting face-to-face and telephone interviews, utilizing the Personal Information Form, IOWA Infant Feeding Attitude Scale (IIFAS), Breastfeeding Form, and Psychosexual Theory and Breastfeeding Knowledge Form. The study was recorded in the Clinicaltrials.gov PRS system (ID: NCT06009120).
RESULTS
The mean IIFAS score of mothers in the intervention group was 76.23 ± 4.10, while mothers in the control group was 66.31 ± 5.72, which was statistically significant (p < .001). Additionally, mothers in the intervention group fed their babies with formula less often on days 5 to 8 after birth (p < .05) and breastfed more frequently and for longer durations on days 3 to 8 compared to the control group (p < .05).
CONCLUSIONS
Psychosexual development theory-based breastfeeding education reduced the use of formula, increased mothers' attitudes towards breastfeeding, and increased the duration and frequency of breastfeeding.
PRACTICE IMPLICATION
Integrating psychosexual development theory-based breastfeeding education into routine maternal and infant care may enhance breastfeeding attitudes and practices, potentially improving infant feeding outcomes.
PubMed: 38762425
DOI: 10.1016/j.pedn.2024.05.016 -
Lipids in Health and Disease May 2024There is insufficient research on how gender-affirming hormone therapy (GAHT) affects body fat modifications in transwomen from China. It is unclear whether hormone...
BACKGROUND
There is insufficient research on how gender-affirming hormone therapy (GAHT) affects body fat modifications in transwomen from China. It is unclear whether hormone therapy affects the prevalence of obesity and blood lipid levels within this population. The current research aimed to assess how GAHT and treatment duration had an impact on the change in and redistribution of body fat in Chinese transwomen.
METHODS
This study included 40 transwomen who had not received GAHT and 59 who had. Body fat, blood lipid, and blood glucose levels were measured. GAHT is mainly a pharmacologic (estrogen and anti-androgen) treatment. The study also stratified participants based on the duration of GAHT to assess its impact on body fat distribution. The duration of GAHT was within one year, one to two years, two to three years, or more than three years.
RESULTS
After receiving GAHT, total body fat increased by 19.65%, and the percentage of body fat increased by 17.63%. The arm, corrected leg, and leg regions showed significant increases in fat content (+ 24.02%, + 50.69%, and + 41.47%, respectively) and percentage (+ 25.19%, + 34.90%, and + 30.39%, respectively). The total visceral fat content decreased (-37.49%). Based on the diagnostic standards for a body mass index ≥ 28 or total body fat percentage ≥ 25% or 30%, the chance of developing obesity did not change significantly. Blood glucose levels significantly increased (+ 12.31%). Total cholesterol levels (-10.45%) decreased significantly. Fat changes in those who received GAHT for one to two years were significantly different from those who did not receive GAHT.
CONCLUSION
After receiving GAHT, total body fat and regional fat increased in Chinese transwomen, and the body fat distribution changed from masculine to feminine, especially during the first two years. However, neither the increase in total body fat percentage nor the decrease in visceral fat content didn't bring about significant changes in the incidence of obesity, nor did triglycerides or low-density lipoprotein-cholesterol.
Topics: Adult; Female; Humans; Male; Adipose Tissue; Asian People; Blood Glucose; Body Fat Distribution; Body Mass Index; Case-Control Studies; China; East Asian People; Estrogens; Intra-Abdominal Fat; Obesity; Retrospective Studies; Sex Reassignment Procedures; Transgender Persons; Transsexualism
PubMed: 38760846
DOI: 10.1186/s12944-024-02131-y