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Journal of the American Medical... Jan 2022Two-step questions to assess gender identity are recommended for optimizing care delivery for gender-diverse individuals. As gender identity fields are increasingly...
OBJECTIVE
Two-step questions to assess gender identity are recommended for optimizing care delivery for gender-diverse individuals. As gender identity fields are increasingly integrated into electronic health records, guidance is needed on how to analyze these data. The goal of this study was to assess potential approaches for analyzing 2-step gender identity questions and the impact of each on suicidal ideation.
MATERIALS AND METHODS
A regional Youth Risk Behavior Survey in one Northeastern school district used a 2-step question to assess gender identity. Three gender measurement strategies (GMSs) were used to operationalize gender identity, (1) combining all gender-diverse youth (GDY) into one category, (2) grouping GDY based on sex assigned at birth, and (3) categorizing GDY based on binary and nonbinary identities. Mixed-effects logistic regression was used to compare odds of suicidal ideation between gender identity categories for each GMS.
RESULTS
Of the 3010 participants, 8.3% were GDY. Subcategories of GDY had significantly higher odds (odds ratio range, 1.6-2.9) of suicidal ideation than cisgender girls regardless of GMS, while every category of GDY had significantly higher odds (odds ratio range, 2.1-5.0) of suicidal ideation than cisgender boys.
CONCLUSIONS
The field of clinical informatics has an opportunity to incorporate inclusive items like the 2-step gender identity question into electronic health records to optimize care and strengthen clinical research. Analysis of the 2-step gender identity question impacts study results and interpretation. Attention to how data about GDY are captured will support for more nuanced, tailored analyses that better reflect unique experiences within this population.
Topics: Adolescent; Female; Gender Identity; Humans; Infant, Newborn; Male; Odds Ratio; Schools; Suicidal Ideation; Transgender Persons
PubMed: 34472616
DOI: 10.1093/jamia/ocab137 -
Developmental Science Nov 2021Children essentialize gender from a young age, viewing it as inborn, biologically based, unchanging, and predictive of preferences and behaviors. Children's gender...
Children essentialize gender from a young age, viewing it as inborn, biologically based, unchanging, and predictive of preferences and behaviors. Children's gender essentialism appears to be so pervasive that it is found within conservative and liberal communities, and among transgender and cisgender children. However, it remains unclear what aspect of gender the children participating in past studies essentialized. Such studies used labels such as "girl" or "boy" without clarifying how children (or researchers) interpreted them. Are they indicators of the target's biological categorization at birth (sex), the target's sense of their own gender (gender identity), or some third possible interpretation? This distinction becomes particularly relevant when transgender children are concerned, as their sex assigned at birth and gender identity are not aligned. In the present two studies, we discovered that 6- to 11-year-old transgender children, their cisgender siblings, and unrelated cisgender children, all essentialized both sex and gender identity. Moreover, transgender and cisgender children did not differ in their essentialism of sex (i.e., whether body parts would remain stable over time). Importantly, however, transgender children were less likely than unrelated cisgender children to essentialize when hearing an ambiguous gender/sex label ("girl" or "boy"). Finally, the two studies showed mixed findings on whether the participant groups differed in reasoning about the stability of a gender-nonconforming target's gender identity. These findings illustrate that a child's identity can relate to their conceptual development, as well as the importance of diversifying samples to enhance our understanding of social cognitive development.
Topics: Child; Female; Gender Identity; Humans; Infant, Newborn; Male; Siblings; Transgender Persons; Transsexualism
PubMed: 33932066
DOI: 10.1111/desc.13115 -
Current Opinion in Endocrinology,... Apr 2016The review summarizes relevant research focused on prevalence and natural history of gender nonconforming/transgender youth, and outcomes of currently recommended... (Review)
Review
PURPOSE OF REVIEW
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.
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 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.
Topics: Biomedical Research; Delivery of Health Care; Female; Gender Identity; Health Priorities; Health Services Needs and Demand; Health Status Disparities; Healthcare Disparities; Humans; Male; Minority Groups; Minority Health; Needs Assessment; Sex Reassignment Procedures; Transgender Persons; Transsexualism
PubMed: 26825472
DOI: 10.1097/MED.0000000000000236 -
Pediatric Annals Dec 2023
Topics: Humans; Adolescent; Transgender Persons; Gender Identity; Transsexualism; Pediatricians
PubMed: 38049187
DOI: 10.3928/19382359-20231016-01 -
Fertility and Sterility Oct 2021The medical profession is deeply involved in designating and amending the sex designations on legal records that themselves are not used clinically. The assumptions... (Review)
Review
The medical profession is deeply involved in designating and amending the sex designations on legal records that themselves are not used clinically. The assumptions inherent in the current legal sex designation system and the criteria for amending such are being reexamined. The harms of the current legal sex designation system, especially for transgender people, have become increasingly recognized. Consequently, the appropriateness of the health care professional's participation in recording legal sex designations has been called into question. Herein, we describe the medicolegal challenges surrounding legal sex designations and their potential solutions.
Topics: Female; Gender Dysphoria; Gender Identity; Health Services for Transgender Persons; Human Rights; Humans; Male; Sex Reassignment Procedures; Transgender Persons; Transsexualism
PubMed: 34579827
DOI: 10.1016/j.fertnstert.2021.08.020 -
Med (New York, N.Y.) May 2021Radix and Harris discuss the current state of transgender health and the challenges to equitable medical access experienced by transgender and gender-diverse patients....
Radix and Harris discuss the current state of transgender health and the challenges to equitable medical access experienced by transgender and gender-diverse patients. Transgender medicine has evolved significantly since the first clinical practice guidelines were developed more than 40 years ago, but important research gaps exist.
Topics: Gender Identity; Humans; Medicine; Plant Roots; Transgender Persons; Transsexualism
PubMed: 35590227
DOI: 10.1016/j.medj.2021.04.025 -
Dialogues in Clinical Neuroscience 2021This article is a historical review of the medical and psychiatric diagnoses associated with transgender people across epochs. Ancient Greek and Roman writings already... (Review)
Review
This article is a historical review of the medical and psychiatric diagnoses associated with transgender people across epochs. Ancient Greek and Roman writings already mention gender change. Before a diagnosis even existed, historical documents described the lives of numerous people whom we would consider transgender today. The development of medical classifications took off in the nineteenth century, driven by the blooming of natural sciences. In the nineteenth century, most authors conflated questions of sexual orientation and gender. For example, the psychiatrist Krafft-Ebing reported cases of transgender people but understood them as paranoia, or as the extreme degree of severity in a dimension of sexual inversion. In the early 1900s, doctors such as Magnus Hirschfeld first distinguished homosexual and transgender behaviour. The usual term for transgender people was transvestite, before Harry Benjamin generalised the term transsexual in the mid-20th century. The term transgender became common in the 1970s. This article details the evolution of diagnoses for transgender people from DSM-III and ICD-10 to DSM-5 and ICD-11.
Topics: Female; Gender Dysphoria; Gender Identity; Humans; International Classification of Diseases; Male; Transgender Persons; Transsexualism
PubMed: 35860172
DOI: 10.1080/19585969.2022.2042166 -
Biology of Sex Differences May 2022Epidemiologists need tools to measure effects of gender, a complex concept originating in the social sciences which is not easily operationalized in the discipline. Our... (Review)
Review
BACKGROUND
Epidemiologists need tools to measure effects of gender, a complex concept originating in the social sciences which is not easily operationalized in the discipline. Our aim is to clarify useful concepts, measures, paths, effects, and analytical strategies to explore mechanisms of health difference between men and women.
METHODS
We reviewed concepts to clarify their definitions and limitations for their translation into usable measures in Epidemiology. Then we conducted methodological research using a causal framework to propose methodologically appropriate strategies for measuring sex and gender effects in health.
RESULTS
(1) Concepts and measures. We define gender as a set of norms prescribed to individuals according to their attributed-at-birth sex. Gender pressure creates a systemic gap, at population level, in behaviors, activities, experiences, etc., between men and women. A pragmatic individual measure of gender would correspond to the level at which an individual complies with a set of elements constituting femininity or masculinity in a given population, place and time. (2) Main analytical strategy. Defining and measuring gender are not sufficient to distinguish the effects of sex and gender on a health outcome. We should also think in terms of mechanisms, i.e., how the variables are linked together, to define appropriate analytical strategies. A causal framework can help us to conceptualize "sex" as a "parent" of a gender or gendered variable. This implies that we cannot interpret sex effects as sexed mechanisms, and that we can explore gendered mechanisms of sex-differences by mediation analyses. (3) Alternative strategy. Gender could also be directly examined as a mechanism, rather than through a variable representing its realization in the individual, by approaching it as an interaction between sex and social environment.
CONCLUSIONS
Both analytical strategies have limitations relative to the impossibility of reducing a complex concept to a single or a few measures, and of capturing the entire effect of the phenomenon of gender. However, these strategies could lead to more accurate analyses of the mechanisms underlying health differences between men and women.
Topics: Female; Gender Identity; Humans; Male; Sex Characteristics
PubMed: 35550193
DOI: 10.1186/s13293-022-00430-6 -
Journal of General Internal Medicine May 2021Despite the growing number of adult transgender and gender diverse (TGD) patients seeking health services, there are many unknowns regarding how routine screening... (Review)
Review
Despite the growing number of adult transgender and gender diverse (TGD) patients seeking health services, there are many unknowns regarding how routine screening recommendations should be applied to TGD persons receiving gender-affirming hormone therapy (GAHT). Patients taking GAHT may have disease risks that differ from what is expected based on their sex assigned at birth or affirmed gender identity. We discuss two patient cases, one transgender man and one transgender woman who present for routine medical care, to review several conditions that may be impacted by the hormones utilized in masculinizing and feminizing GAHT and for which screening recommendations are available for TGD adults: cardiovascular risk factors, osteoporosis, breast cancer, cervical cancer, and prostate cancer. We reviewed the TGD-specific screening recommendations from several major medical organizations and programs and found them to be largely based upon expert opinion due to a lack of evidence. The goal of this narrative review is to assist healthcare professionals in counseling and screening their TGD patients when and where appropriate. Not all TGD adults have the ability or need to receive routine medical care from a specialized TGD health clinic; therefore, it is essential for all healthcare professionals involved in routine and gender-affirming care to have knowledge about these conditions and screenings.
Topics: Adult; Female; Gender Identity; Hormones; Humans; Infant, Newborn; Male; Mass Screening; Transgender Persons; Transsexualism
PubMed: 33547576
DOI: 10.1007/s11606-021-06634-7 -
American Journal of Epidemiology Jan 2023Along with age and race, sex has historically been a core stratification and control variable in epidemiologic research. While in recent decades research guidelines and...
Along with age and race, sex has historically been a core stratification and control variable in epidemiologic research. While in recent decades research guidelines and institutionalized requirements have incorporated an approach differentiating biological sex from social gender, neither sex nor gender is itself a unidimensional construct. The conflation of dimensions within and between sex and gender presents a validity issue wherein proxy measures are used for dimensions of interest, often without explicit acknowledgement or evaluation. Here, individual-level dimensions of sex and gender are outlined as a guide for epidemiologists, and 2 case studies are presented. The first case study demonstrates how unacknowledged use of a sex/gender proxy for a sexed dimension of interest (uterine status) resulted in decades of cancer research misestimating risks, racial disparities, and age trends. The second illustrates how a multidimensional sex and gender framework may be applied to strengthen research on coronavirus disease 2019 incidence, diagnosis, morbidity, and mortality. Considerations are outlined, including: 1) addressing the match between measures and theory, and explicitly acknowledging and evaluating proxy use; 2) improving measurement across dimensions and social ecological levels; 3) incorporating multidimensionality into research objectives; and 4) interpreting sex, gender, and their effects as biopsychosocial.
Topics: Male; Female; Humans; COVID-19; Gender Identity; Sexual Behavior; Epidemiologists; Social Environment
PubMed: 36193856
DOI: 10.1093/aje/kwac173