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Following the recent proliferation of anti-discrimination protections supporting LGBTIQ+ youth internationally, backlash periods have ensued. Whilst liberal-progressive rights models theorise 'backlash' as an expected consequence of rights recognitions progress, some post-colonial and Queer scholars frame backlash within enduring authoritarian anti-rights tendencies, and question assumptions of progress. To understand backlash more adequately, this paper explores state-level anti-LGBTIQ+ Bills potentially impacting youth proposed in the USA between 2018 and 2022. Critical discourse analysis is used to map the different types, locations, conceptual arrangements and outcomes of 543 anti-LGBTIQ+ rights US state-level proposed Bills. Bill attempts were mainly concentrated in Republican-governed states including Tennessee (48), Missouri (40), Iowa (39), Oklahoma (32) and Texas (32). Overly extended claims concerning girls/women's religious and parental rights were advanced in opposition to LGBTIQ+ youth rights, and as part of wider rights attacks. Bills used anti-rights and pro-rights discourses to mask as 'backlash' the rights claims advanced by elite-led anti-rights mobilisations. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) students on university campuses experience high rates of sexual violence relative to their cisgender peers and are less likely to utilize campus resources. Despite this, TGD students' voices are often left out of conversations about campus sexual violence. To learn about TGD students' experiences of university sexual violence prevention and response infrastructure, we conducted focus groups with 21 TGD students at a large university in the northeastern United States. Informed by abolition feminism and critical trans politics, we undertook this thematic analysis to examine the limits of current systems to respond to TGD students' needs and reduce their victimization. Our findings highlight how carceral logic contributes to TGD students' exclusion from and distrust of university systems to address sexual violence. Further, our findings illustrate how TGD students' visions for healing-oriented approaches to sexual violence on campuses align with transformative justice principles. These findings suggest that feminist social work must support the development of campus sexual violence prevention and response infrastructure that moves away from a reliance on carceral logic and toward approaches developed by community-led transformative justice organizations to inform inclusive, intersectional, campus sexual violence prevention and response efforts. [ABSTRACT FROM AUTHOR]

Sexually and gender diverse (SGD) youth experience more peer bullying victimization than heterosexual, cisgender youth during adolescence, yet the emergence and persistence of these disparities remain underexplored. Also, it is unclear which factors are associated with these disparities across development, and how these disparities are linked to late adolescent health discrepancies. This study utilized the sample from the Millennium Cohort Study in Britain (N = 10,080; 51.3% assigned female at birth; Mage = 2.28, SDage = 0.46 at Wave 2), in which 23.74% of youth reported non-heterosexual attraction, 21.59% reported non-heterosexual identity, and 1.08% reported gender identity not in line with the sex assigned at birth. Using latent class growth modeling, four peer bullying victimization trajectories were identified, with early peak (7.2%), late childhood peak (6.3%), adolescence onset (12.8%), and low (73.6%) rates of victimization. SGD youth, compared to heterosexual and cisgender youth, were found to have increased odds of being in the victimization-involved classes, especially the adolescence onset class. The study further revealed that SGD youth reported more mental health and relational difficulties in childhood, which were linked to their heightened risk of longer-lasting victimization. Further, long-term victimization was found to partially account for the disparities in health and well-being for SGD youth in late adolescence. In conclusion, SGD youth were more likely to experience longer-lasting bullying victimization during childhood and adolescence, its related mental and relational vulnerabilities were already established in childhood, and such victimization disparities were further linked to their detrimental health and well-being in late adolescence. The design, hypotheses, and target analyses of the current study were preregistered on 21st April 2023 at https://osf.io/f2zxy. [ABSTRACT FROM AUTHOR]

Participating in sport and physical exercise (SPE) can be challenging for transgender and non-binary people. Previous research has identified some of the barriers trans people face in schools, leisure spaces and competitive sports (e.g. gender segregation, gendered language, sports clothing, and transphobia), and the resultant poor rates of participating in everyday SPE compared to the cisgender population. Yet, despite the ways in which sport, the experience of being trans, and being trans in sport are often framed as intensely focused on the body, less attention has been paid to the embodied experience of trans people as they engage in SPE. This paper draws on selected data examples from a qualitative study examining trans adults' experiences of engaging in everyday SPE and looks towards Wellard's [(2012). Body-reflexive pleasures: Exploring bodily experiences within the context of sport and physical activity. Sport, Education and Society, 17(1), 21–33. ] concept of circuits of body-reflexive pleasure, to explore how participants' make sense of their embodied selves. Sitting at the intersection of social, physiological and psychological experiences of sport, we explore how circuits of body-reflexive pleasure (and displeasures) in SPE can induce feelings of gender dysphoria as well as feelings of pleasure and gender euphoria. [ABSTRACT FROM AUTHOR]

Background: Transgender patients often cannot access a provider who is knowledgeable about providing gender-affirming hormone therapy (GAHT). This study evaluated primary care provider (PCP) comfort and experience with, opinions about, and knowledge of prescribing GAHT to adults. Methods: An anonymous Qualtrics survey was distributed to PCPs in San Diego County. Fisher's exact test assessed any association between age, years in practice, or practice setting and 1) comfort in prescribing GAHT and 2) favorable statements about learning about, providing, and benefitting from training in GAHT. T-tests determined relationship between age, years in practice, or practice type setting with number of correctly answered multiple choice knowledge-based questions out of 4. Results: Out of 220 responses, median age was 41, 60% had practiced for ≤ 10 years, and 19% had practiced in an academic setting. Forty-two percent did not receive any education about transgender healthcare during medical training. The most commonly reported barrier to providing GAHT was lack of training (74%). PCPs age ≤ 41 (67% vs 49%, p = 0.009), PCPs practicing for ≤ 10 years (65% vs 51%, p = 0.037), and PCPs in non-academic settings (64% vs. 41%, p = 0.013) were more likely to report being comfortable with prescribing GAHT. PCPs age ≤ 41 (89% vs 62%, p < 0.001) and PCPs practicing for ≤ 10 years (86% vs 66%, p < 0.001) were more likely to show interest in learning about GAHT. PCPs age ≤ 41 (74% vs 46%, p < 0.001) and PCPs practicing for ≤ 10 years (70% vs 50%, p = 0.003) were more likely to show interest in prescribing GAHT. Knowledge scores were higher for PCPs age ≥42 (mean 1.7 vs 1.4, p = 0.033) and PCPs working in academic centers (mean 2.0 vs 1.4, p = 0.002). Conclusion: Younger (age ≤ 41) and early career (practicing for ≤ 10 years) PCPs reported being more comfortable with prescribing GAHT and had more favorable opinions in learning about, providing, and benefitting from training in GAHT. They are interested in providing GAHT; however, few prescribe GAHT with most reporting lack of training as a major barrier. This was evident with overall low knowledge scores regardless of age, experience, or clinical setting and underscores the need for increased educational efforts in transgender care throughout medical training. [ABSTRACT FROM AUTHOR]

Data on the health of transgender and gender diverse (TGD) people are scarce. Researchers are increasingly turning to insurance claims data to investigate disease burden among TGD people. Since claims do not include gender self-identification or modality (i.e., TGD or not), researchers have developed algorithms to attempt to identify TGD individuals using diagnosis, procedure, and prescription codes, sometimes also inferring sex assigned at birth and gender. Claims-based algorithms introduce epistemological and ethical complexities that have yet to be addressed in data informatics, epidemiology, or health services research. We discuss the implications of claims-based algorithms to identify and categorize TGD populations, including perpetuating cisnormative biases and dismissing TGD individuals' self-identification. Using the framework of epistemic injustice, we outline ethical considerations when undertaking claims-based TGD health research and provide suggestions to minimize harms and maximize benefits to TGD individuals and communities. [ABSTRACT FROM AUTHOR]

Flora Renz's book, "Gender Recognition and the Law: Troubling Transgender People's Engagement with Legal Regulation," focuses on the Gender Recognition Act 2004 (GRA) in the UK and challenges the assumption that the legislation is groundbreaking and progressive. Renz conducted 30 qualitative interviews with trans people to explore the normative underpinnings of the GRA and the impact it has on their daily lives. The book highlights the voices of trans people who are often marginalized in public debates about their own identity. Renz also examines concepts such as legal consciousness, agency, and emotion in relation to the GRA. The book provides a vital contribution to the understanding of gender recognition and its effects on transgender individuals. [Extracted from the article]

Background: There is growing interest in investigating genetic explanations for transgender identity. In the spirit of a Community-Engaged Research Framework, which highlights the importance of involving community members who would be impacted by research throughout the entire research process, it is important for researchers to understand transgender and gender expansive individuals' views and concerns regarding the potential harms and benefits of transgender identity genetic research (TIGR). Aim: To evaluate the thoughts, opinions, and beliefs in the transgender and gender diverse communities toward TIGR Methods: We conducted an online survey study, asking 409 transgender and gender diverse individuals about their views regarding potential benefits and risks of TIGR. Results: Participants demonstrated a mixture of positive and negative opinions on the search for a genetic contribution to gender identity. Overall, there was a slight trend toward more positive views, with 71% agreeing or strongly agreeing that TIGR made them feel hopeful. Discussion: Given the varied and nuanced views held within the transgender and gender diverse communities toward transgender genetic research, we hope that this study can be one of many evaluating this topic, and that our findings, and those of future studies, can serve as a foundation for conducting transgender genetic research in a way that is in alignment with the ethos and priorities of the transgender and gender diverse communities. [ABSTRACT FROM AUTHOR]

Introduction: Transgender, non-binary, gender non-conforming, and other gender diverse individuals (TGN) may be at higher risk of sexually transmitted infections (STIs). Transgender women specifically bear a disproportionate burden of HIV and other STIs worldwide. This study describes STI knowledge, risks, and prevention practices among TGN to better characterize barriers to sexual health care and identify potential platforms for sexual health education focusing on STI prevention. Materials and Methods: Qualitative interviews were conducted with N = 14 TGN individuals until thematic saturation was reached. Transcripts were coded and analyzed using thematic analysis. Results: Four major themes emerged: (1) Sexual risk behaviors and STI prevention practices varied across participants; (2) individuals who demonstrated more knowledge about STIs either had a significant identifiable sexual educational experience or had a past personal experience with an STI; (3) individuals were interested in receiving information about STIs and sexual health from health care providers, school sexual education programs, and online resources based on a desire for accessible, private, factual, and inclusive content; and (4) public messaging around sexual health and STIs was seen both as potentially stigmatizing, but also important for increasing awareness of available services. Discussion: We found that while important, considering gender alone may not adequately characterize risk of STI infection for TGN populations, and more research is needed to better characterize risk profiles. Individuals were interested in learning about sexual health and STI prevention from school curricula, health care settings, online resources, and public messaging advertisements, and had recommendations to ensure that these forms of information sharing were relevant, inclusive, and non-stigmatizing. [ABSTRACT FROM AUTHOR]

Background: The phenomenon of the māhū and raerae of French Polynesia represents a long-standing historical recognition of a third gender status that makes space for a level of respect and integration within a broader society. Raerae is a more recent type of māhū who more overtly express themselves as women in society. Aim: This article describes the gender identity, gender expression, sexual behavior, and sexual orientation of gender diverse individuals in French Polynesia, including the Society, Tuamotus, and the Marquesas Islands. By studying cultures with protective factors, this research seeks to contribute to the development of effective approaches to sexual and gender health promotion, including HIV/STI prevention. Method: Our analysis is based on ethnographic work, field observation, in depth interviews, and survey data. The focus of this study was specifically on the māhū and raerae (gender diverse individuals). Results: We collected data from ten islands in French Polynesia and included 47 participants. The results include demographics, information about self-identification, gender identity development and family and social acceptance, current gender identity, expression, early and current sexual experiences, relationships, involvement in sex work, and health status, including HIV risk and status. Conclusion: While not a utopia for gender variant individuals living in French Polynesia, this cultural recognition serves as a protective factor as compared to other cultures that greatly stigmatize transgender and gender diverse individuals or those who transgress socially defined roles for men. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is described as a gynecological disease that can severely impact on people's quality of life. Much of endometriosis research and literature is focused on cis women, although gender diverse people and cis men have been diagnosed with this disease. Cis women have reported problems in their healthcare for endometriosis due to delays in diagnosis and a lack of support in their treatment. Gender diverse people have reported to experience discrimination in healthcare settings. There is a lack of research on gender diverse people's experience of living with endometriosis and little is known about their experience of healthcare for endometriosis. Aim: Our aim in this article is to report on the healthcare experiences of transgender and non-binary people with endometriosis. Methods: We used a phenomenological lens to explore the experiences of transgender and non-binary people with endometriosis' perceptions of healthcare. Eleven participants were recruited through social media internationally. We recruited participants that identified as transgender and/or non-binary, had suspected/diagnosed endometriosis and were 18 years old or older. Participants took part in three online semi-structured interviews and completed a diary for three months. We used Hermeneutic Analysis to analyze the data via themes. Phenomenology of embodiment was used as a theoretical point of departure in understanding the data. Results: From the analysis, the following themes were created that captured participants' healthcare experiences: (1) Medical Gaslighting of Endometriosis and Gender Diverse Experiences, (2) Misgendering and Gendered Language, (3) Medical Discrimination, and (4) Validating Experiences with Health Care Providers (HCPs) and Recommendations by Participants. The findings revealed that medical gaslighting, misgendering and experiences of discrimination in healthcare settings had a psychological effect on participants, with reports of dysphoria, self-doubt, fear and a trauma response. Discussion: Experiences of medical gaslighting, misgendering and discrimination in the healthcare of endometriosis may limit communication between HCPs and patients through limited treatment options being communicated, assumptions in healthcare and participants not feeling safe to disclose their gender identity for a disease that already from cis women's reports has difficulties in diagnosis and treatment. This highlights additional barriers for gender diverse people to overcome in their healthcare for endometriosis. We recommend that HCPs may benefit from further awareness and training with working with gender diverse people with endometriosis. [ABSTRACT FROM AUTHOR]

Background: The current research builds on a previous review of the literature which explored sexuality during gender transition. There has been increased attention toward TGNC people across academic, political, and healthcare fields since the previous review, as well as shifts in language use and health interventions, justifying a need for more contemporary understandings. Aim: The current systematic review explores the experience of sexuality during gender transition. Methods: A meta-ethnography was conducted on 16 papers that focused specifically on TGNC people's experiences of their sexualities. Results: The main findings were the intersection of gender and sexuality; the importance of re-writing labels around sexuality, bodies and relationships; (re)negotiating changes in sexual, romantic and/or physical relationships due to transitioning; and changes in a sense of community and belonging. Discussion: The results have implications for supporting TGNC people navigating their identities by recognizing the multiple and intersecting levels of influence within which they are situated. [ABSTRACT FROM AUTHOR]

Background: Past research has demonstrated that transgender and gender diverse (TGD) people often have negative experiences of healthcare. Exploratory research is needed to provide in-depth understanding of the healthcare experiences of TGD people. Primary care is a crucial element of healthcare, but past research has tended to overlook what contributes specifically to positive experiences of primary care for TGD adults. Aim: The aim of this study was to explore positive experiences of TGD adults when engaging with primary care in Aotearoa New Zealand. Methods: Semi-structured email interviews were conducted with 11 TGD adults aged 20- to 62-years-old, with a range of binary or non-binary genders living across Aotearoa New Zealand. The email interview method allowed nationwide recruitment and flexible interaction. All aspects of the study were led by a researcher who is part of the TGD community. Results: Three themes were formulated to explain TGD participants' positive experiences with primary care. In order to contextualize positive experiences, participants described past negative experiences of healthcare and low expectations (Theme 1: The Sad State of Care). Participants also described exerting autonomy, for example by carefully selecting a general practitioner (GP) or choosing when to disclose transgender status to their GP (Theme 2: The Sphere of Control). Three levels were evident in positive experiences (Theme 3: The Gradient of Positive Experiences): basic professionalism, more desirable experiences of trans-specific competencies, and GPs as advocates for systemic change. Discussion: TGD people experience positive interactions in primary care in a variety of ways, all of which are contextualized by the negative state of healthcare at present. TGD people create opportunity for autonomy while navigating healthcare, which requires a form of interacting that can be termed reactive self-determination. Training for health professionals could apply the gradient of positive experiences to scaffold appropriate primary care for TGD adults. [ABSTRACT FROM AUTHOR]

Studies of the U.S. population in general and transgender and gender diverse (TGD) communities specifically suggest that religion and spirituality (R/S) can function in both positive and negative ways, including on health outcomes. Patients recovering from gender-affirming surgeries were asked by chaplains, during the course of spiritual care visits, to describe their R/S identities in their own words. Seventy-five responses were included in the study and were coded. Six themes and 10 sub-themes were identified. The themes were (1) centeredness in self; (2) transcendent belief system; (3) non-religious belief systems; (4) importance of prayer; (5) R/S identity and practice as fixed and consistent; and (6) R/S identity and practice as flexible, contextual, and transforming. The findings broadly reflected national data about R/S belonging, including trends related to the growing share of the population that identifies as atheist, agnostic, or spiritual but not religious; ambivalent relationships with R/S communities due to transphobia; and R/S beliefs and practices as supportive. Implications for chaplaincy practice are discussed, including the need for chaplains to understand both demographic trends and the intersections of R/S and transphobia. [ABSTRACT FROM AUTHOR]

Transgender and gender-diverse (TGD) adolescents experience limited access to gender-affirming care (GAC) and information and use social media platforms for informational and social support. We conducted conventional content analysis of posts on the platform, Tumblr and applied univariate statistics to characterize health and wellness themes represented by this content. Content was predominantly transmasculine-relevant. Posts addressing the trans health care paradigm often co-occurred with content referencing affirmation logs, the physical and emotional impact of affirmation, surgery, and unspecified medical interventions. Gender-affirming hormone therapy was the most prevalent intervention referenced in posts related to non-professional/non-licensed medical care and advice requests. Transgender and gender-diverse youth-serving individuals can use this information to mitigate harm, enhance patient education, and improve the overall well-being of TGD youth. Further research is needed to characterize the effect of content encountered on social media on pediatric patient experiences and on outcomes of GAC. [ABSTRACT FROM AUTHOR]

The article comments on a research paper on puberty suppression with gonadotropin-releasing hormone agonists in transgender and gender-diverse (TGD) youth. Topics discussed include a background on mental health in TGD youth, the use of language for medical professionals in an affirming practice setting, and suppression of puberty in TGD youth.

Instagram may be a novel context in which vocational identity construction occurs by posting content about one's profession. Yet, the content of such posts is unclear. Therefore, we performed a content analysis of 1,260 Instagram public feed posts that included a hashtag referring to gender-stereotypical professions (i.e. stereotypically male/female, gender-neutral) at multiple status levels (low, medium, high). We examined the posters' sex and ethnicity in relation to the profession in which they portrayed themselves and whether individual differences (i.e. sex, ethnicity, gender typicality/status of the job) were reflected in references to work values (i.e. qualities a job can offer). No differences were observed in the types of jobs in which individuals portrayed themselves according to sex and ethnicity. Differences in work value portrayals were exhibited for users' sex, ethnicity, gender typicality, and status of the job. Differences according to sex, gender typicality, and status of the job emerged with respect to the extent to which individuals' posts referred to work values being (dis)satisfied. Our findings highlighted that work value posts of certain social groups (i.e. sex, ethnicity) reflect work value differences in the real-world. [ABSTRACT FROM AUTHOR]

Purpose: To examine changes in health-related quality of life (HRQOL), this 2-year follow-up study reassessed the HRQOL of transgender and gender expansive (TG/GE) young people enrolled in a patient registry at the Gender Wellness Center (GWC) in upstate New York. Methods: Registry patients had to have a gender-affirming care follow-up visit at the GWC within a 2 year window (+6 months) of their baseline survey to complete follow-up. Youth <18 years of age completed the Child Health Questionnaire-Child Form 87 (CHQ-CF87); youth >18 years of age completed the Short Form-36v2 (SF-36v2). We analyzed change from baseline to follow-up for 11 CHQ-CF87 subscales and 8 SF-36v2 subscales. We compared follow-up HRQOL results to U.S. population standards. We abstracted receipt of gender-affirming care from GWC electronic medical records. Results: Among the 173 patients who completed HRQOL assessments at baseline, 108 completed follow-up (62% response rate) from May 2019 to March 2022. The mean age for those completing the CHQ-CF87 was 14.6±2.2 years (range 10–17) and for the SF-36v2 was 19.7±2.3 years (range 18–24). CHQ-CF87 Behavior and Role/Social Physical Functioning subscale scores improved significantly among youth 8–17 years of age from baseline. Follow-up SF-36v2 scores for patients 18–24 years of age did not change significantly. Follow-up HRQOL mental health scores remained statistically significantly lower than U.S. population standards for both age groups. Conclusions: Two year follow-up HRQOL data from TG/GE youth receiving gender-affirming care improved in two domains, but did not change among young adults (>18 years of age). Mental health remains suboptimal compared to national standards. [ABSTRACT FROM AUTHOR]

The transgender population is a critically underresearched population in the United States, owing to rare measures on national and state-level surveys that ask about sex and gender or transgender identification. Consequently, we know relatively less about the sociodemographic, socioeconomic, family, and health lives of gender minorities. In this research note, I use population-level data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System to provide a data portrait of cisgender, transgender, and gender-nonconforming populations on a range of sociodemographic (e.g., sexual identity, race and ethnicity), socioeconomic (e.g., education, homeownership), family (e.g., union status), and health (e.g., number of poor mental health days) characteristics. Results reveal that gender minorities are younger than cisgender men and cisgender women and are disproportionately sexual minorities and people of color. Gender minority groups also experience lower socioeconomic status, report drastically different family lives, and bear the burden of worse health compared with cisgender people. I conclude by contending that descriptive research of this nature can illuminate compositional differences between cisgender and gender minority populations, provide rationales for adjusting for certain characteristics, and highlight potential explanatory mechanisms to make better sense of well-established findings (e.g., the transgender health disadvantage). [ABSTRACT FROM AUTHOR]

Purpose: Typically understood in the United States to be a "protective" institution, the family is often a site of isolation and rejection for many transgender (trans), gender nonconforming, and nonbinary (TGNCNB) people. This paper introduces the concept of the "bad parents narrative" to describe the connections between isolation and rejection of TGNCNB people as a form of gender-policing, particularly of TGNCNB young people of color, as a structural arrangement that goes beyond simple "bad parents". Method: Through a methodological framework coined Critical Ethnographic Criminology, which includes people-based methods of interviews, this article includes evidence from interviews with eight TGNCNB people living across the United States to express how their experiences with gender policing from family shows more of a nuanced understanding of policing from family than simply "bad parents". Results: Findings from Black TGNCNB peoples' experiences with gender-policing from family showed a noticeable understanding of their potential vulnerability to law enforcement and societal violence. Conclusions: This article encourages research in the areas of queer family policing to divert from the "bad parents narrative", because of its racialized suggestions and Black families particular understandings of their proximities to the carceral state. This article encourages more focus on the family as an institutional regime of power, and how that institution is permeated with policing and surveillance logics that are influenced by policing and law enforcement institutions. Ultimately, this paper seeks to contribute to criminological definitions of policing and surveillance, not only related to the experiences of TGNCNB people, but also for gendered and racialized people more broadly. [ABSTRACT FROM AUTHOR]

Research often finds persons with a disability, persons who are transgender non-conforming (TGNC), or who are sexual minorities experience increased victimization risk. Less research has examined how these identities intersect to impact victimization risk. Thus, our study adds to the literature by examining how these identities intersect to influence risk of violent, sexual, and intimate partner violence (IPV) victimization among a national-level sample of college students. In doing so, we explore the interactions between having any disability and being TGNC and being a sexual minority on victimization risk. In addition, specific disability types are explored for their potential interactive effects. Findings show increased risk of sexual victimization and IPV victimization among those who identify as TGNC and have a disability. Specific disability types, speech and mobility, interacted with gender identity to impact risk. Our findings suggest the need for universities to implement inclusive and culturally competent prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

We examined bullying victimization spanning from before the pandemic to the two school years post COVID-19 onset in adolescents. We used survey data from Canadian secondary school students collected during the 2019–20, 2020–21, and 2021–22 academic years. Generalized Estimating Equations models were used to estimate the population average odds of past 30-day bullying victimization by other students, using both longitudinal (N = 3716) and repeat cross-sectional (N = 23,862; 19,413; 21,897) data. The odds of bullying victimization were lower in 2020–21 and higher in 2021–22 relative to 2019–20. Elevated odds of bullying victimization were found among gender diverse, higher weight, and relatively less affluent students. While remote schooling during the pandemic may have provided a reprieve for some students, bullying appears to have rebounded with the lifting of COVID-19 restrictions to exceed pre-pandemic levels. More effective strategies are essential to prevent bullying and improve school contexts for equity denied populations. [ABSTRACT FROM AUTHOR]

Objectives: Transgender, nonbinary, and gender expansive (TGE) persons experience pregnancies and have abortions, yet abortion care remains rooted in a gender binary, often centering the needs, experiences, and challenges of cisgender women. Despite guidance supporting gender-affirming sexual and reproductive healthcare (SRH), barriers for TGE people seeking abortions persist. We conducted an exploratory case study with key informants to understand their perception of TGE abortion seekers' needs with specific considerations for those in restrictive abortion settings. Methods: Qualitative interviews focused on gender-affirming care and abortion provision were conducted with U.S.-based key informant clinicians (n = 4) who could provide powerful insights into gaps and experiences faced by TGE individuals. Participants were eligible if they currently or previously provided abortions and had experience practicing gender-affirming care. Interviews focused on informants' perceptions of TGE patients' needs when seeking abortions. Results: Findings highlight the unique barriers TGE patients face when seeking abortions, including lack of provider knowledge, in-clinic stigmatization, and gender marginalization. It is notable that key informants who practiced in abortion-protective political environments have greater access to resources to implement gender-affirming care than those in restrictive contexts. Results are summarized in a clinical recommendations document which provides an accessible starting point for clinicians to begin building gender-inclusive abortion spaces. Conclusions: It is necessary to further understand barriers facing TGE abortion seekers and integrate recommendations and emerging evidence into abortion practice. This study contributes to a growing knowledge base which emphasizes the need for inclusive abortion spaces and highlights key considerations for improving access and quality for TGE abortions seekers. [ABSTRACT FROM AUTHOR]

Background: While research has emphasized the importance of parental support for LGBTQIA + youth wellbeing, there remains limited understanding of parental experiences with nonbinary children, particularly those prepubescent. This study aimed to explore how parents of nonbinary children ages 5–8 learn to support their child's identity, examining initial reactions, emotional processes, supportive behaviors, societal responses, and associated challenges and rewards. Methods: A qualitative study was conducted using Reflexive Thematic Analysis (RTA) within a framework of ontological relativism and epistemological constructivism. Nine parents of nonbinary children aged 5–8 from the Northeastern United States participated in semi-structured interviews lasting 60–80 min. Questions explored various aspects of parenting nonbinary children, including the child's gender identity, parental feelings, experiences sharing the child's identity, and challenges and rewards of raising a gender-diverse child. The research team, comprising individuals who identify as trans, genderqueer, and nonbinary, employed collaborative coding and thematic development. Results: Four main themes were constructed: (1) Parents hear and support their child's nonbinary identity, this theme highlights immediate acceptance and efforts parents make to affirm their child's gender; (2) Parents learn about ways cisnormative society harms their child, here, parents recognize the societal pressures and barriers their children face; (3) Parents take significant and proactive steps to affirm their child, this theme documents the actions parents take to support their child in environments that invalidate their identity; and (4) Gender is just one aspect of who my child is, this theme reflects on parental insights of gender as just one part of their child's overall personhood. Conclusions: This study provides insights into the experiences of parents supporting young nonbinary children, emphasizing the importance of affirming expressed identity, the parent-child relationship, and proactive support in navigating cisnormative societal structures. Findings highlight the transformative experience of parenting nonbinary children, with parents often challenging their own preconceptions of gender and coming to more nuanced understandings. These results can inform supportive interventions and policies for nonbinary children and their families, and we hope to contribute to a growing body of research that shifts narratives towards joy, resilience, and community in trans and nonbinary experiences. [ABSTRACT FROM AUTHOR]

The article focuses on creating an inclusive space for women and non-binary individuals in the field of political theology, addressing the historical male dominance in this area. It highlights a special issue from the Political Theology Network, which invites contributions that examine the intersections of politics, theology, and gender through innovative perspectives.

Objective: Research has documented the importance of parental support as a protective factor against depressive symptoms among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. In this study, we assessed the relations between LGBTQ-specific parental support and depressive symptoms. Method: Participants were 6,837 LGBTQ youth (ages 13–17) with diverse racial and ethnic, gender, and sexual identities. Main effect and moderation analyses examined interactions between LGBTQ-specific parental support with demographic variables on depressive symptoms, considering demographics as moderators. Results: We found that participants of color reported less LGBTQ-specific parental support than their White counterparts, that transgender and genderqueer participants reported less LGBTQ-specific parental support than their cisgender counterparts, and that non-monosexual participants reported less LGBTQ-specific parental support than their monosexual counterparts. Disparities in depressive symptoms were found for individuals who identified as Native American and Latinx, non-monosexual, and transgender and genderqueer, such that these groups reported higher levels of depressive symptoms. Further, we found a significant interaction between LGBTQ-specific parental support and ethnicity, with LGBTQ-specific parental support being less strongly associated with participants who identified as Latinx compared to those who did not identify as Latinx. We also found a significant interaction between LGBTQ-specific parental support and gender identity, with LGBTQ-specific parental support being more strongly related to depressive symptoms among participants who did not identify as boys compared to cisgender boys. Discussion: We discuss how to assess the impact of interlocking systems of oppression when working with LGBTQ youth and their parental figures. [ABSTRACT FROM AUTHOR]

Gender‐affirming hormone therapy (GAHT) is used by many transgender and gender‐diverse adults to align physical characteristics with their gender identity, reduce gender incongruence and improve psychological functioning. This narrative review provides an overview of the initiation and monitoring of GAHT in an Australian context. Trans individuals treated with testosterone typically receive standard testosterone doses and formulations recommended for cisgender men, whereas those receiving estradiol GAHT are typically treated with estradiol in combination with an anti‐androgen in those without orchidectomy. Proactive monitoring and mitigation of cardiovascular risk factors is pertinent in all transgender and gender‐diverse adults and bone health is an important consideration in those using estradiol GAHT. [ABSTRACT FROM AUTHOR]

Background: Gender clinic and single‐item questionnaire‐based data report increased co‐occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under‐studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. Methods: Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4–12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi‐dimensionally using a well‐validated parent‐report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex‐assigned‐at‐birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. Results: Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC‐derived scores. Instead, higher early‐childhood dimensional autistic social‐communication traits correlated with higher current overall gender incongruence (as defined by GIQC‐14 score). This correlation was potentially moderated by sex‐assigned‐at‐birth: greater early‐childhood autistic social‐communication traits were associated with higher current overall gender incongruence in assigned‐males‐at‐birth, but not assigned‐females‐at‐birth. For fine‐grained gender diversity domains, greater autistic restricted‐repetitive behavior traits were associated with greater diversity in gender identity across sexes‐assigned‐at‐birth; greater autistic social‐communication traits were associated with lower stereotypical male expression across sexes‐assigned‐at‐birth. Conclusions: Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early‐childhood autistic social‐communication traits and overall current gender diversity was most evident in assigned‐males‐at‐birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender‐diverse populations. [ABSTRACT FROM AUTHOR]

Few studies have focused on evaluating the relationship between dating violence (DV) and suicide during the critical period of adolescence, particularly for transgender and gender-diverse (TGD) youth. The study examined the relationship between experiencing DV victimization and perpetration in the past 6 months and suicidality (ideation and attempts) among male, female, and TGD adolescents. This study used data from a longitudinal randomized trial examining the effectiveness of myPlan, a healthy relationship and safety planning app intervention for adolescents, to a control website. Data for this study was collected virtually, in which participants completed surveys through online platforms. A convenience sample was recruited through youth organizations and posting on online platforms including social media. N = 610 adolescents age 15–17 years, who resided in the U.S. experienced DV in the past 6 months, had access to a safe device, and were able to access online surveys were included in this study. The majority were female (63.8%) with (19.5%) TGD and 16.7% male. Nearly 22% of the sample identified as Hispanic/Latino and 61.0% as white. Participants completed an online survey consisting of measures of socio demographics, DV victimization and perpetration via the Conflict of Adolescent Dating Relationships Inventory (CADRI), and suicidality. The primary outcome was the association between DV victimization and perpetration on suicidality. Different forms of DV were accounted for including emotional/relational, physical, and sexual DV. Logistic regressions determined differences in the rate of DV victimization and perpetration on suicidality between gender groups (cisgender female, cisgender male, and TGD). A stratified analysis was conducted to test if the relationship between DV and suicidality differed across gender identity. Approximately one-third (32.2%) of adolescents reported suicidality in the past 6 months. TGD adolescents were more likely to report suicidality compared to males (20.6%, p <.05) and females (32.7%, p >.05). The overall odds of suicidality increased as frequency of emotional/relational DV victimization (OR = 1.37, p <.001), physical DV victimization (OR = 1.59, p <.001) and sexual DV victimization (OR = 1.42, p <.001) increased. These relationships were not significant for DV perpetration. When stratifying findings by gender groups, all forms of DV victimization significantly increased the odds of suicidality for females as well as female perpetration of physical violence. For males, all forms of DV victimization and perpetration were associated with increased odds of suicidality, although not significant due to the smaller sample size. While DV victimization is associated with increased odds of suicidality for TGD, perpetration of DV is associated with decreased odds of suicidality, although not significant due to small sample size. The findings from this study provide further insight into experiences of DV and suicidality among gender diverse youth and can guide future interventions aimed at preventing DV and suicide among adolescents. [ABSTRACT FROM AUTHOR]

The adult-centric concept of 'age-appropriateness' is an arbitrary signifier and yet it commands a powerful common-sense appeal in governing the shape of sexuality education. The visibility of LGBTQ+ lives in primary schools is deeply impacted by the cis-heteronormative ways in which age-appropriateness is commonly understood and mobilised; very often resulting in silence and delay. The concept of age-appropriateness also becomes entangled with moral panics about 'promoting' LGBTQ+ lives, or children being somehow 'recruited' to identify as LGBTQ+. This paper draws on findings from a study with the parents of eleven trans and gender diverse children (then aged between 5 and 13) conducted in 2017, as well as a follow-up study conducted with seven participants from the same group of parents and children in 2022. The paper explores how the politics of age and agency intersect and become intensified as trans and gender diverse children and their parents navigate and make decisions about their bodies, lives and everyday worlds in primary schools. These stories of trans and gender diverse children provide an arresting invitation to adults to attend closely to the rich stories of children themselves in (re)considering the potential of sexuality education across contexts. [ABSTRACT FROM AUTHOR]

In this article, we challenge the mainstream view of gender rooted in binary cisnormativity and suggest that the gender frameworks used to inform organizational research and practice are inadequate with respect to the range of transgender and gender nonconforming (TGNC) identities. We employ Hacking's "dynamic nominalism" to illustrate how evolving classifications of TGNC people operate as a discriminating factor that threatens their lived experiences. As an alternative to the binary cisnormative metaphor of gender as a spectrum, we adopt a more inclusive metaphor of a gender constellation and sketch out its potential conceptualization that promotes multidimensional, non‐hierarchical, and dynamic approaches to gender diversity. [ABSTRACT FROM AUTHOR]

In this article, I reflect on the APA citation practice of using last names and initials in references for psychological research. This practice reduces authors to their last names in the guise of gender-neutrality, thus making women and gender non-binary authors invisible despite being cited. Decades after Nancy Russo's commentary recommending the use of first names along with last names, there have been no changes in APA style, while other citation styles have incorporated the practice of using first names and last names in references to address this issue. In the changing global socio-cultural landscape that acknowledges gender fluidity, including first names and gender pronouns in end references and in-text citations can be one of the ways of making women and non-binary authors' works more visible in the field of Psychology or other disciplines that use APA style. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is an epidemic among transgender and gender diverse (TGD) people. However, intimate partner homicide (IPH) among TGD people is under researched. Thus, thematic content analysis was used to describe and examine antecedents of severe assault and IPH among TGD adults who have experienced IPV (N = 13), via community listening sessions. While some themes resembled known severe assault and IPH risks among cisgender women, several themes were unique to TGD people and should be considered when safety planning with TGD individuals or adapting IPV screening tools for this population. [ABSTRACT FROM AUTHOR]

Sociologists have increasingly begun exploring the experiences of gender-expansive populations; however, these studies are oversaturated with negative experiences of prejudice and discrimination and do not accurately portray the joy that accompanies identifying outside of the gender binary. This omission of joy prevents a comprehensive exploration of gender-expansive lives, potentially reinforcing stereotypes and contributing to the marginalization of their diverse narratives. To address the growing concern about the “joy deficit” in sociology and trans studies, I conducted in-depth interviews with 28 nonbinary people in which they discussed their experiences of joy. This study identifies four key dimensions of nonbinary joy: 1) discovery of gender identity; 2) authentic expression of gender; 3) external affirmation of identity and expression; and 4) engagement with validating communities. However, interviewees also discussed individual and social factors that frequently created barriers to experiencing these forms of joy. By examining both the sources of nonbinary joy and obstacles to its realization, this research contributes to a more nuanced understanding of gender-expansive identities. Furthermore, this project reveals joy as a social constructed phenomenon, influenced by structural factors that govern its accessibility and manifestation, rather than an individual state of being. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusionSexual self-schema (SSS) are cognitive frameworks for one’s thoughts and feelings about oneself as a sexual being. These schema interpret and organize sexual information and attitudes, and can guide sexual behavior. This study examined how plurisexual attractions may interact with gender to predict SSS.I surveyed 602 young adults about their gender, patterns of attractions to men, women, and gender non-binary people, and SSS using the validated SSS Scale.In this sample, SSS were similar across participants with monosexual vs. plurisexual patterns of attraction. However, a few significant effects emerged. Cisgender women with low attraction to any gender reported significantly lower romantic/passionate self-schema relative to women with at least some attraction to one or more genders. In contrast, cisgender men with exclusively same-gender attractions reported higher open/liberal self-schema relative to men with either exclusively other-­gender or plurisexual attractions. Novel to this study, 22% of participants reported attractions to gender non-binary and gender non-conforming people, and these attractions significantly predicted SSS.These findings point to subtle gender differences in how attractions interact with young people’s conceptualization of their sexual selves. [ABSTRACT FROM AUTHOR]

The United States experienced a record number of homicides against transgender victims in 2020, six of which occurred in Puerto Rico. Of the victims, five were trans women, and one was a trans man. Through case-study analysis, we explore how gender nonconformity is stigmatized within the context of Puerto Rico. Using storyline analysis of the language used by offenders, news media, and police, several themes emerged: (1) framing trans people as deceitful; (2) deadnaming, misgendering, and victim-blaming, and (3) community advocacy for the murder victims. Using the framework of hetero-cis-normativity, we explore how hetero-cis-normative biases may explain why negative attitudes toward trans individuals vary. [ABSTRACT FROM AUTHOR]

Rates of suicidality and self‐harm are substantial among trans and gender diverse people, particularly among younger groups. The objective of this scoping review is to explore the state of the research conducted on determinants of mental distress, self‐harm and suicidality among trans and gender diverse (TGD) youth from culturally and linguistically diverse (CALD) backgrounds. The Joanna Briggs Institute methodology for scoping reviews was used as a methodology guide. Inclusion criteria for study selection comprehended: publications on the intersectionality between gender non‐conformity and cultural and linguistic diversity; focus on a young population (≤25 years of age); publications addressing self‐harm and/or suicidality. Searches were conducted on eight databases and a public web search engine and yielded 474 results. Publications were screened and selected by two independent reviewers. Thematic analysis was used to identify key themes overarching the findings. The screening process yielded seven peer‐reviewed studies and six research reports based on case studies, retrospective qualitative interviews, cross‐sectional and longitudinal survey analyses. The key themes approached in the retrieved literature include: (1) precipitating factors for suicidality; (2) pathways contributing to self‐harm and suicidality; and 3) barriers and facilitators for accessing services and mental health care. Practical actions to help mitigate suicidality among TGD youth from CALD backgrounds need to consider the impact of trauma and allow for the development of trust in the therapeutic relationship. Shifts in service delivery and policy formulation are necessary to reduce stigmatisation and potentialise the inclusion of different racial, ethnic, cultural, sexual and gender identity expressions in society. [ABSTRACT FROM AUTHOR]

Prejudice against Gender and Sexual Diversity (GenSex prejudice) is a significant issue of scientific study. Negative attitudes towards lesbians, gays, bisexuals, transgender and gender nonconforming people are prevalent in many countries. Gender, age, education, income, religion, and military enrolment are associated with higher prejudice levels. The present study measured GenSex prejudice in an all-male military sample of Brazilian soldiers. Participants were 354 recruits of the Brazilian Army between the ages of 18 and 20. Measures included a 5-point Likert scale to assess GenSex prejudice. Data was analyzed using descriptives and ANOVA with post-hoc Bonferroni comparisons. Being religious, having lower income, and being less educated were significantly associated with higher levels of prejudice. Soldiers with elementary education were more prejudiced than those with higher levels of education. Soldiers with a monthly family income of less than USD 530,36 had more GenSex prejudice than those with higher earnings. Also, religious soldiers had more prejudice than the nonreligious ones. Protestant soldiers had significantly more GenSex prejudice than all other religious groups measured. No significant differences were found between ethnic or racial groups. Results are discussed with the literature on human rights, educational practices, racial discrimination, religiosity and prejudice. [ABSTRACT FROM AUTHOR]

Many transgender young adults are unaware of the role of pre-exposure prophylaxis (PrEP) in HIV prevention. Our aim was to understand where transgender and gender-diverse young adults receive health information about HIV and PrEP and their preferences for future learning. Semistructured, qualitative individual and group interviews were done with 14 transgender and gender-diverse young adults. Interviews were transcribed verbatim and analyzed using thematic analysis. Four themes emerged from the interviews related to (1) making trustworthy education materials, (2) the importance of communities, (3) knowledge needed about PrEP, and (4) a lack of early and diverse classroom education. Transgender and genderdiverse persons are at higher risk for HIV than their cisgender peers, yet they have information gaps and hold misconceptions about preventative measures like PrEP. Such misconceptions may be addressed by early, inclusive conversations about HIV transmission and prevention. [ABSTRACT FROM AUTHOR]

Media stories have highlighted some devastating consequences of attacks on bodily autonomy (i.e., the fundamental right to make decisions about one's own body without constraints or violence), such as the surging maternal mortality rates among Black, Indigenous, and People of Color), a 10-year-old rape victim's travel out of state for an abortion, families' exodus from Texas to avoid child maltreatment charges in response to their children's gender-affirming care, and the dangerous effects of Missouri's ban of gender-affirming care for children and adults. To successfully fight attacks on bodily autonomy, social workers would benefit from applying an intersectional and rights-based, reproductive justice theoretical framework that blends under-explored theories of state violence: biopolitics, necropolitics, and debility. Our resulting framework elucidates the role white supremacy plays in state violence. After providing the theoretical framework, we connect the framework to the modern political landscape's rapidly spreading efforts to limit the sovereignty of People of Color, women, and transgender and non-binary communities in the latest iterations of state violence. Our article provides a necessary lens to understand and address the complex web of implications that emerge from attacks on bodily autonomy. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the prevalence and negative outcomes associated with simultaneous alcohol and cannabis use (i.e., marijuana [SAM] use, i.e., so that the effects of both alcohol and cannabis overlap) among college students, there is no comprehensive measure of SAM use, with past research relying on single items. The present study aimed to develop the Alcohol and Cannabis Simultaneous Use Scale (ACSUS), a comprehensive self-report measure of SAM use frequency, quantity, and problems in college students. College students at two Midwestern universities who used alcohol and cannabis (Study 1: N = 534; Mean age = 19; 71% female; 88% White; Study 2: N = 258; Mean age = 21; 81% female; 85% White) completed the newly developed ACSUS. Exploratory factor analysis (Study 1) revealed that the ACSUS fits best with 9-items representing two factors: Factor 1 measures frequency and quantity of SAM use and Factor 2 measures associated problems with SAM use. Confirmatory factor analysis (Study 2) supported the two-factor structure of the ACSUS, which was positively associated with measures of alcohol use, cannabis use, simultaneous use motives, and impulsivity. These data provide initial support for the ACSUS, developed to investigate the frequency, quantity, and associated problems with SAM use in college students. [ABSTRACT FROM AUTHOR]

Legislation undermining the human rights of transgender and gender-expansive (TGE) people is on the rise. Many U.S. states have passed or proposed laws that restrict gender-affirming health care (GAC), which are largely rooted in scientific disinformation, meaning intentional falsehood. Scientific disinformation presents a significant threat to TGE people, providers of GAC, health care professionals, and the general public. Clinicians, legal advocates, and others need effective strategies to rebut disinformation. This perspective reviews the status of GAC bans and the disinformation strategies that underlie them, and provides practical tools to challenge false claims. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate how adults, who started gender-affirming hormone treatment during adolescence, reflect on their reproductive decisions. Methods: We recruited transgender and gender-diverse (TGD) people who visited our gender identity clinic and commenced medical treatment in adolescence at least 9 years ago. We collected data through an online survey. Results: The cohort consisted of 89 participants (66 TGD people assigned female at birth (AFAB) and 23 TGD people assigned male at birth (AMAB) with a mean age of 32.4 years (range 25.5–51.2) at the time of study, and 15.6 years (range 11.5–20.6) at the start of medical treatment. All participants initiated medical treatment before 2014, when laws requiring sterilization for legal gender recognition were still in place, and only 30% of participants reported to have received information about fertility preservation, which none of them pursued. In addition, 96% of participants underwent gonadectomy and thus became permanently infertile, which was troublesome for 27%. With today's knowledge, 44% of TGD people AFAB and 35% of TGD people born AMAB would pursue fertility preservation. The percentage of participants with a (future) desire for children increased from 34% at the start of medical treatment (at adolescent age) to 56% at the time of this study (at adult age), of whom 23% had currently started a family. Conclusion: It is important to inform transgender adolescents about the effect of medical treatment on fertility and the options for fertility preservation since many may develop a desire for (biological) children when they reach adulthood. [ABSTRACT FROM AUTHOR]

The debate on the concept of gender in postcolonial studies is extremely complex and involves a variety of theoretical and practical perspectives. Postcolonial studies has shown the connection between gender identity, colonial power, and decolonisation processes. This paper will explore the social construction of gender in colonial contexts, the way in which colonial practises have influenced gender dynamics, and the struggles for resistance and freedom in which women and gender-nonconforming people have engaged in postcolonial countries. The issue will be raised of how gender is interpreted and experienced in different cultures and social contexts. Furthermore, the analysis of colonisation and decolonisation processes will provide a starting point to understand how gender hierarchies have been built and criticised in postcolonial contexts, leading to the development of the most recent ecofeminist and decolonial perspectives. [ABSTRACT FROM AUTHOR]

Objectives: To improve healthcare access for rural cisgender women and gender diverse Veterans, we created the "Boost Team," a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services. Methods: Between 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022. Results: The needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics. Discussion: Data from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program. [ABSTRACT FROM AUTHOR]

Background: Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals. Methods: In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care. Results: Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation. Conclusions: This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care. [ABSTRACT FROM AUTHOR]

Objectives: Treating gender identity as a fixed characteristic may contribute to considerable misclassification and hinder accurate characterization of health inequities and the design of effective preventive interventions for transgender and gender diverse (TGD) adolescents and young adults. We examined changes in how an ethnically and racially diverse sample of TGD adolescents and young adults reported their gender identity over time, the implications of this fluidity on public health, and the potential effects of misclassification of gender identity. Methods: We recruited 235 TGD adolescents and young adults (aged 15-24 y) in Los Angeles, California, and New Orleans, Louisiana, from May 2017 through August 2019 to participate in an HIV intervention study. We asked participants to self-report their gender identity and sex assigned at birth every 4 months for 24 months. We used a quantitative content analysis framework to catalog changes in responses over time and classified the changes into 3 main patterns: consistent, fluctuating, and moving in 1 direction. We then calculated the distribution of gender identity labels at baseline (initial assessment) and 12 and 24 months and described the overall sample by age, race, ethnicity, and study site. Results: Of 235 TGD participants, 162 (69%) were from Los Angeles, 89 (38%) were Latinx, and 80 (34%) were non-Latinx Black or African American. Changes in self-reported gender identity were common (n = 181; 77%); in fact, 39 (17%) changed gender identities more than twice. More than 50% (n = 131; 56%) showed a fluctuating pattern. Conclusions: Gender identity labels varied over time, suggesting that misclassification may occur if data from a single time point are used to define gender identity. Our study lays the foundation for launching studies to elucidate the associations between shifting gender identities and health outcomes. [ABSTRACT FROM AUTHOR]