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Transgender Health

Zowie Davy, Michael Toze
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association has changed the diagnosis of gender identity disorder to gender dysphoria (GD). In this critical narrative review we ask: What is gender dysphoria? We report on some of the inconsistencies in the articles that foreground distress while obfuscating the fact that not all trans and intersex people suffer stress or impaired functioning, and the inappropriate referencing to intersex people in the diagnostic criterion, claims about the GD diagnosis contributing to the depathologization of and reducing stigma surrounding trans people, the conceptualizations of "gender dysphoric" research subjects, and finally we question the etiological approaches using GD as a conceptual framework...
2018: Transgender Health
Jay P Pierce
Purpose: To evaluate the prevalence of synesthesia in transgender versus cisgender individuals. Methods: A 10-question, self-administered written survey, developed to assess the prevalence of synesthesia, was distributed to transgender individuals ( n =96) attending support groups as well as to cisgender participants ( n =103) identified among individuals accompanying transgender attendees. Demographic data and prevalence of synesthesia were analyzed using descriptive statistics. Differences between groups were analyzed using a chi-square test...
2018: Transgender Health
Ken C Pang, Debi Feldman, Ralph Oertel, Michelle Telfer
Purpose: The presence of a disorder of sexual development (DSD) acts as a diagnostic specifier for gender dysphoria (GD) under DSM-5, while the International Classification of Diseases (ICD)-10 specifically states that its equivalent diagnosis, gender identity disorder (GID), must not be the result of a chromosomal abnormality. For these reasons, routine karyotyping has been previously advocated in the clinical work-up of children and adolescents with suspected GD or GID. However, the utility of such testing remains unclear...
2018: Transgender Health
Richard A Crosby, Laura F Salazar, Brandon J Hill
Purpose: This study tested three psychosocial measures for their potential to serve as counseling goals for promoting ART to transgender women living with HIV (TWLH). Methods: Among 69 TWLH, 17.4% were not taking ART; these volunteers were compared to the remainder using multivariate regression analyses. Results: Only one psychosocial measure achieved significance: Personal Competence (Adjusted Odds Ratio = 0.80, 95% CI = 0.67-0.97, P  = 0.02). Because this was a continuous measure, assessed on a 7-point scale, the protective adjusted odds ratio of 0...
2018: Transgender Health
Pamela Klein, Supraja Narasimhan, Joshua D Safer
Despite increasing appreciation for the medical needs of transgender individuals, the organization of transgender medical care remains suboptimal. Transgender individuals report difficulty in finding providers who have adequate expertise in caring for transgender patients, a lack of provider cultural competence, health system barriers, and discrimination in healthcare settings. At Boston Medical Center (BMC), we sought to address these gaps within an existing academic medical center. In February 2016, BMC established a Center for Transgender Medicine and Surgery (CTMS) to provide a single address for patients to obtain transgender-specific services across a spectrum of healthcare needs...
2018: Transgender Health
Oralia Loza, Paulina Hernandez, Jessica Calderon-Mora, Shaked Laks, Marie Leiner, Sireesha Reddy, Patricia Lara, Hector Granados
Purpose: Gender-nonconforming patients are at higher risk for medical problems that require prompt medical and mental health intervention. Barriers to healthcare for transgender individuals have been well characterized in the literature, but not in low resource settings. The purpose of this paper is to present the barriers encountered when bringing healthcare to transgender children, adolescents, and adults in a medically underserved, predominantly Hispanic area of the United States. Methods: In this medically underserved area on the U...
2018: Transgender Health
Jennifer L Glick, Katherine M Andrinopoulos, Katherine P Theall, Carl Kendall
Purpose: Gender Minority (GM) individuals experience healthcare access barriers, including financial concerns and discrimination, which influence their health seeking behaviors. This study explores the alternative navigation strategies used by GM individuals to cope with these barriers and access care, both biomedical and complementary and alternative medicine (CAM). Methods: In-depth interviews were conducted with GM individuals ( n =18) and healthcare providers ( n =5) identified through purposive sampling...
2018: Transgender Health
Douglas Knutson, Meredith A Martyr, Travis A Mitchell, Tori Arthur, Julie M Koch
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...
2018: Transgender Health
Kristin B de Haseth, Marlon E Buncamper, Müjde Özer, Lian Elfering, Jan Maerten Smit, Mark-Bram Bouman, Wouter B van der Sluis
Background: Vaginoplasty is performed as gender-affirming surgery in transgender women. While multiple surgical techniques exist for this goal, penile inversion vaginoplasty is performed most frequently. Neovaginal symptoms may impede sexual functioning after surgery. Methods: A total of five consecutive patients with symptoms and positive swabs for neovaginal candida infection were described. Results: All patients presented with white-colored neovaginal discharge and some with neovaginal itching and/or malodor...
2018: Transgender Health
Debra Carroll-Beight, Markus Larsson
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...
2018: Transgender Health
David D Menino, Sabra L Katz-Wise, Ralph Vetters, Sari L Reisner
Purpose: Gender-affirming medical interventions have been associated with mental health improvements among transgender individuals. However, little is known about optimal timing of these interventions as they relate to stress-sensitive behaviors such as smoking. Methods: We analyzed electronic health record data from transgender youth and young adults to examine whether longer duration from transgender identity recognition to hormone initiation was associated with smoking behaviors. Results: Longer duration from age of identity recognition to age of cross-sex hormone initiation was associated with increased odds of current and lifetime smoking...
2018: Transgender Health
Matthew C Leinung, Paul J Feustel, Jalaja Joseph
Purpose: Maintaining cross-sex hormone levels in the normal physiologic range for the desired gender is the cornerstone of transgender hormonal therapy, but there are limited data on how to achieve this. We investigated the effectiveness of oral estradiol therapy in achieving this goal. Methods: We analyzed data on all transgender females seen in our clinic since 2008 treated with oral estradiol. We looked at the success of achieving serum levels of testosterone and 17-β estradiol in the normal range on various doses of estradiol (with and without antiandrogens spironolactone and finasteride)...
2018: Transgender Health
James J Sabra, Celestia X Fang, Roopal V Kundu
Dermatologic care plays an important role in the transitioning process for transgender women, with changes occurring to the skin from hormone therapy (HT) and gender affirming procedures. We sought to identify knowledge gaps in a group of transgender women pertaining to both skin and hair changes during the transitioning process. The study was conducted as a cross-sectional survey. Our results demonstrate potential gaps in knowledge that transgender women have regarding HT and gender affirming procedures.
2018: Transgender Health
William Byne, Dan H Karasic, Eli Coleman, A Evan Eyler, Jeremy D Kidd, Heino F L Meyer-Bahlburg, Richard R Pleak, Jack Pula
Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition)...
2018: Transgender Health
Catherine Paradiso, Robin M Lally
Purpose: The aim of this study was to explore Nurse Practitioner (NP) knowledge, attitudes, and beliefs when working with transgender people and to inform about Practitioner education needs. Methods: A qualitative descriptive design was used to explore (NP) experiences. Focused semistructured interviews were conducted in 2016 with 11 ( N =11) NPs in the northeastern United States who represent various years of experience and encounters with transgender patients. The interviews explored NP knowledge attitudes and beliefs when caring for transgender patients and described their overall experiences in rendering care in the clinical setting...
2018: Transgender Health
Donna M Eade, Michelle M Telfer, Michelle A Tollit
The Royal Children's Hospital Gender Service offers support, assessment, and medical care to transgender and gender diverse children and adolescents in Victoria, Australia. Referrals have rapidly increased leading to extended wait times. In response, a single-session nurse-led assessment clinic (SSNac) was introduced as the clinical entry point to the service, during which a biopsychosocial assessment is undertaken, and information, education, and support are provided. Outcomes of the SSNac include a significant reduction in wait times and a timely clinical triage system...
2018: Transgender Health
Sophia Geffen, Tim Horn, Kimberleigh Joy Smith, Sean Cahill
Hormone therapy is medically necessary for many transgender individuals. The U.S. Food and Drug Administration (FDA) and pharmaceutical companies' failure to guarantee a supply of injectable estrogen in 2016 and 2017 for transgender individuals is a violation of their right to comprehensive medical treatment, free of discrimination. A series of advocacy actions eventually led to all formulations of injectable estrogen being restored to market; however, long-term solutions to supply interruptions of injectable estrogen are needed...
2018: Transgender Health
Erin McCauley, Kristen Eckstrand, Bethlehem Desta, Ben Bouvier, Brad Brockmann, Lauren Brinkley-Rubinstein
Purpose: To document the health-related experiences and needs of jail detainees who self-identified as transgender women. Methods: Semistructured interviews with 10 transgender women of color were conducted in a county jail in a mid-sized southern city between 2015 and 2016. Interviews were recorded and transcribed, and later analyzed using a general inductive approach. Results: Participants experienced high levels of abuse and harassment, solitary confinement, mental health issues, and lack of access to hormone treatment...
2018: Transgender Health
Samantha Busa, Aron Janssen, Mallika Lakshman
In addition to the high prevalence of gender dysphoria among transgender youth, this population is at greater risk of suffering from additional mental health disorders, including social anxiety disorder, compared to their cisgender peers. Cognitive behavioral therapy (CBT) has been established as an effective form of treatment for social anxiety disorder. It is recommended that therapists modify and adapt CBT when working with minority groups such as transgender youth to ensure that the treatment is efficacious and culturally sensitive...
2018: Transgender Health
Tamar Reisman, Zil Goldstein
Objective: Our report describes a case of nonpuerperal induced lactation in a transgender woman. Methods: We present the relevant clinical and laboratory findings, along with a review of the relevant literature. Results: A 30-year-old transgender woman who had been receiving feminizing hormone therapy for the past 6 years presented to our clinic with the goal of being able to breastfeed her adopted infant. After implementing a regimen of domperidone, estradiol, progesterone, and breast pumping, she was able to achieve sufficient breast milk volume to be the sole source of nourishment for her child for 6 weeks...
2018: Transgender Health
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