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Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males (MSM), male sex workers (MSW), and transgender women (hijra) under HIV intervention coverage. 10 key-informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key-informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.

Introduction: There has been much debate recently on the participation of transgender and gender-diverse (TGD) athletes in sport, particularly in relation to fairness, safety and inclusion. The 2021 IOC Framework on Fairness, Inclusion and Non-discrimination acknowledges the central role that eligibility criteria play in ensuring fairness, particularly in the female category, and states that athletes should not be excluded solely on the basis of their TGD identity. Aims: To identify policies that address TGD athlete participation in the 15 major United Kingdom (UK) sporting organisations and to summarise the evidence for each of these policies. Methods: A scoping review of TGD policies from the 15 major UK sporting organisations. Results: Eleven of the governing bodies had publicly available TGD policies. Most of the sporting associations drew guidance from the official 2015 IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism, particularly with regard to physiological testosterone levels. Many organisations referenced their policies as a guide for decision making but stated that they ultimately made case-by-case decisions on an athlete’s eligibility. Relevant considerations not addressed in most policies included pre- versus post-pubertal athletes, justification for testosterone thresholds, the length of time out of competitive action (if any) for transitioning athletes, the irreversible advantage from male puberty (if any), the responsibility for and frequency of follow up for hormonal testing and the consequences for athletes outside set testosterone limits. Conclusions: There is a lack of consensus among the top 15 UK sporting organizations relating to elite sport participation for TGD athletes. It would be useful for sport organizations to work together to develop greater standardization/consensus for TGD athlete policies, taking into consideration fairness, safety and inclusion in each sport.

The field of trans health is fast growing, interdisciplinary, and global. The education needs of providers are also growing to keep apace of this expanding discipline. Scant education on trans health is available in undergraduate and resident curricula, or continuing medical education. In addition to the World Professional Association for Transgender Health's (WPATH) Standards of Care (SOC), Transgender Health Guidelines recently published by the Endocrine Society, WPATH has developed foundational and advanced educational programming in the areas of endocrinology and other specialties within interdisciplinary care. This article describes the history of transgender health care professional education and outlines the competencies related to this area.

Background Gender-affirming hormone therapy and surgery are important medically necessary approaches to transgender care. However, few related data exist in China. Aim To understand the desire and access of transgender cares in the Chinese transgender men and women population. Methods A cross-sectional self-selecting survey targeting the Chinese transgender population was conducted in 2017 using a snowball sampling method. Participants completed an online questionnaire anonymously. Gender identity was verified by specifically designed questions. Data analysis of this study was performed in 2019. Outcomes The main outcome was the status of receiving transgender medical care, including the desire vs actual state of receiving gender-affirming hormone treatment and gender-affirmation surgery, methods of accessing hormonal therapy and surgery, and risky behaviors associated with obtaining treatments. Results Of the total 2060 valid questionnaires, there were 1,304 transgender individuals (626 transgender men and 678 transgender women), with a median age of 22 (interquartile range, 19–26) years. Among them, 1,036 (79.4%) expressed desires for hormonal therapy, but of 1,036, 741 (71.5%) considered it difficult to obtain medications from doctors. Of 1,036 individuals, 275 (26.5%) and 172 (16.6%) had thoughts or behaviors of self-injury, respectively, when lacking access to hormone therapy. Of 1,036 individuals, 602 (58.1%) had used hormones. Of those 602 hormone users, 407 (67.6%) had ever obtained medications from informal drug dealers, and 372 (61.8%) of them did not perform regular monitoring. 868 of 1,303 (66.6%) participants had received or wanted to undergo gender-affirming surgeries, but 710 of 868 (81.8%) considered the surgery resources not adequate or very scarce. Clinical Implications The transgender medical resources in China are scarce, and many transgender individuals have engaged in high-risk activities to access care. Strengths & Limitations This is the first study to focus on the current status of gender-affirming hormone therapy and surgery in the Chinese transgender population, providing valuable and real-world data for understanding the need for transgender health care in China. But, the online questionnaire could not provide the prevalence and other epidemiologic information about transgender individuals in China, and the survey did not address specific medication regimens, dosages, sex hormone levels, and specific hormone therapy–related or surgery-related adverse events. Conclusion Significant improvement in access to gender-affirming medical and surgery care is needed in China.

Language and terminology are essential issues in the field of transgender health. The field is moving toward a gender-affirming practice away from one based on pathology. Over the last two decades, the field has moved from a binary model of gender identity to one embracing a gender spectrum. This has been mirrored in the significant classification manuals published by the World Health Organization (WHO), the American Psychiatric Association (APA), and the World Professional Association for Transgender Health (WPATH).This chapter will provide a brief overview of the classification systems (WHO, APA, and WPATH) which include diagnostic codes related to gender identity. It will then include a glossary of the terms used by people in the non-Western and Western cultures to describe what Western cultures would consider transgender. Finally, a glossary of standard surgical terms will be included.

This article defines a standard of care, describes their purpose in general, and then provides an overview of the World Professional Association for Transgender Health's Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People Version 7. After a brief history of the document, past and future challenges associated with these Standards including ideas moving forward into the eighth version are presented.

In 2010, the World Professional Association for Transgender Health (WPATH) released a statement declaring the Association's opposition to surgery or sterilization as requirements to change legal ge...

Introduction The number of hours spent teaching sexual health content and skills in medical education continues to decrease despite the increase in sexual health issues faced by patients across the lifespan. In 2012 and 2014, experts across sexuality disciplines convened for the Summits on Medical School Education and Sexual Health to strategize and recommend approaches to improve sexual health education in medical education systems and practice settings. One of the summit recommendations was to develop sexual health competencies that could be implemented in undergraduate medical education curricula. Aim To discuss the process of developing sexual health competencies for undergraduate medical education in North America and present the resulting competencies. Methods From 2014 to 2016, a summit multidisciplinary subcommittee met through face-to-face, phone conference, and email meetings to review prior competency-based guidelines and then draft and vet general sexual health competencies for integration into undergraduate medical school curricula. The process built off the Association of American Medical Colleges' competency development process for training medical students to care for lesbian, gay, bisexual, transgender, and gender non-conforming patients and individuals born with differences of sex development. Main Outcome Measures This report presents the final 20 sexual health competencies and 34 qualifiers aligned with the 8 overall domains of competence. Results Development of a comprehensive set of sexual health competencies is a necessary first step in standardizing learning expectations for medical students upon completion of undergraduate training. Conclusions It is hoped that these competencies will guide the development of sexual health curricula and assessment tools that can be shared across medical schools to ensure that all medical school graduates will be adequately trained and comfortable addressing the different sexual health concerns presented by patients across the lifespan.

The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people.

The Board of Directors of the World Professional Association for Transgender Health (WPATH) and its members have been anticipating the American Psychiatric Association (APA) Paraphilias sub-work gr...

We would like to begin with expressing our respect for the work of the DSM 5 Work Group on Sexual and Gender Identity Disorders (WGSGID) of the American Psychiatric Association and the Gender Ident...

The World Professional Association for Transgender Health (WPATH) is recognized as the leading authority in the field of transgender health, through a membership that encompasses experts in this field and transgender community representatives. WPATH therefore is in an excellent position to give input on the DSM 5 section on gender identity disorders. To streamline the ideas of the membership, the authors, all elected officers of the association, organized a consensus-building process beginning January 2009 to arrive at recommendations for removal or reform of the DSM 5 diagnoses. This article describes this process, how the various work groups were formed, and the topics covered in the work group discussions. In addition, this article reports on a face-to-face meeting held with all of the consensus participants and work groups in conjunction with the 2009 biennial conference of WPATH in Oslo, Norway, where a consensus was reached on several issues. The outcome of this face-to-face meeting was subsequently...

This consensus statement is an executive summary of several papers resulting from a 2009 consensus process comprising nine work groups and 37 members of the World Professional Association for Transgender Health (WPATH). The purpose of this group was to put forth recommendations for the upcoming revision of the DSM with respect to the Gender Identity Disorder diagnoses. The consensus process was collaborative, interdisciplinary, and evidence based. A majority (but not all) of the participants believed that a diagnosis related to Gender Identity Disorder should remain in the DSM, and many advocated changes in name, diagnostic criteria, and placement within the DSM. The proposed name is Gender Dysphoria, and the diagnostic criteria should be distress based. Placement should be outside the chapter on Sexual Disorders and possibly within Psychiatric Disorders Related to a Medical Condition. If there were to be a diagnostic category for childhood, there should also be separate categories for adults and adolesce...

SUMMARY Increasingly, transgender individuals and loved ones (partners, family, and friends) are seeking assistance from mental health professionals working in the community rather than in university or hospital-based gender identity clinics. Drawing on published literature specific to transgender mental health, interviews with expert clinicians, the authors' clinical experience, and three key guiding principles (a transgender-affirmative approach, client-centered care, and a commitment to harm reduction), we suggest protocols for the clinician providing mental health services in the community setting. Practice areas discussed include assessment and treatment of gender concerns, trans-specific mental health issues, and trans-specific elements in general counseling of transgender individuals and their loved ones.

Few studies have focused on the prevalence and extent of childhood trauma in the transsexual population. In our study of 42 transsexual people (34 = natal males, 8 = natal females), 55% (n = 23) reported experiencing an unwanted sexual event before the age of 18, with the average age of initial sexual contact being 13. This sexual event differs from other clinical populations in that the unwanted sexual experiences in this sample were the consequence of adolescents satisfying their curiosity about the gender of the transsexual rather than for their own sexual gratification. Consequently, the sequalae of the unwanted sexual touches in our sample did not lead to sexualised behaviours described in the sexual abuse literature of clinical samples. Our sample also reported being: verbally abused (77%), insulted (81%), embarrassed in front of others (55%), made to feel guilty by their parents (58%) before their fifteenth birthday.

Importance In 2014, the US Department of Health and Human Services decided that its 1981 exclusion of transsexual surgical treatments from Medicare coverage was based on outdated, incomplete, and biased science and did not reflect current evidence or standards of care, and the exclusion was therefore lifted. As a direct result of this decision, surgeons nationwide are seeing an increase in consultations for surgical therapy to help transgender and gender-nonconforming individuals. Although some clinicians may have the technical training for such surgical procedures, in many cases, they may not have a full understanding of the complex and comprehensive care required to provide optimal health care for transgender individuals. Observations Gender confirmation surgery is a developing field in the United States and other areas of the world. The World Professional Association for Transgender Health started a global education initiative intended to provide surgeons and other health care professionals with the necessary background knowledge to understand and treat this patient population. This article provides an overview of best practices as set forth in the seventh edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People by the World Professional Association for Transgender Health, including mental health, endocrinology, and surgery for trans women and trans men. Conclusions and Relevance Experts in each aspect of transgender health have summarized the content of the global education initiative in this article. It provides valuable information to surgeons of all disciplines and other health care professionals to help guide the treatment and management of transgender individuals.

The Board of Directors of the World Professional Association for Transgender Health (WPATH) and its members are pleased to read the changes proposed in the American Psychiatric Association (APA) Ge...