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Transgender and gender diverse individuals face health disparities such as higher HIV prevalence, but limited studies have found low PrEP uptake among these populations. To understand both patient and provider perspectives regarding PrEP care for transgender and gender diverse individuals, we conducted a mixed-methods study at Kaiser Permanente Southern California from September 2020 to October 2021. Transgender and gender diverse adults (N = 396) participated in a web-based survey, and qualitative interviews were subsequently conducted with a subset of survey respondents (N = 32) and healthcare providers (N = 8). Among survey respondents, > 75% were familiar with PrEP, and > 40% reported at least one HIV risk factor, but < 5% had taken PrEP. Interview themes included increasing providers' inclusivity in primary care for transgender and gender diverse patients, and reducing logistical barriers and costs associated with PrEP-related visits. To improve PrEP uptake among transgender and gender diverse individuals, barriers across patient, provider, and health system levels must be addressed. [ABSTRACT FROM AUTHOR]

Gendered racism is a source of stress and, in some cases, traumatic stress for women and girls of color as well as gender expansive people of color. Gendered racism is a form of oppression rooted in both White Supremacy and patriarchy. Along with interpersonal and internalized forms of gendered racism, mental health professionals must attend to systemic forms of gendered racism that manifest in every social system from education to criminal (in)justice. The consequences for women and girls of Color, as well as non-binary persons are multi-layered, including but not limited to physical, psychological, financial, and political. Frameworks that attend to both the context of oppression and the wisdom of women of Color are necessary for individual healing and societal transformation; these frameworks include but are not limited to liberation psychology, womanist psychology, and mujerista psychology. Examples of indigenizing individual, group, and community level programs are provided as well as implications for necessary future directions for advancing anti-oppression interventions, honoring indigenous science, dismantling gendered racism, and birthing liberation for all people. Finally, the author acknowledges racial battle fatigue and patriarchy battle fatigue as well as the necessary care for mental health professionals who are engaged in this sacred work. [ABSTRACT FROM AUTHOR]

We describe the implementation and evaluation of an online sexuality psychoeducation group program for parents of young people attending the transgender and gender diverse outpatient service of a pediatric hospital. The 10 participants completed semi-structured pre- and post-intervention questionnaires assessing: whether they had ever discussed with their children about aspects of sexuality, or had the intention of doing it in the future; the level of knowledge and comfort in speaking about these topics; the perceived level of helpfulness of the intervention; and, by using open-ended items, the topics they considered to be most relevant. After attending the program, parents reported they had started talking with their children about issues which previously had been little or not discussed, such as sexting, sexually transmitted diseases, pregnancy, fertility, abuse, and healthy relationships. Participants reported increased levels of knowledge and comfort in addressing these topics and highlighted the importance of being emotionally available to their children. We discuss implications for future intervention development. [ABSTRACT FROM AUTHOR]

Research has presented a dual-sided reality of the positive and negative influences of religion in the lives of transgender and gender expansive (TGE) individuals. This qualitative study utilises a phenomenological approach to explore how positive experiences in faith communities impact TGE individuals. Using inductive, thematic analysis of interviews with nine TGE participants, we look at why participants entered into faith communities and what factors lead them to stay. TGE participants described four main factors that influenced them to seek out a faith community: interpersonal relationships, LGBTQ + visibility, importance of community in personal meaning-making, and connection with God. TGE participants chose to stay in their faith communities because of acceptance and affirmation, major anchoring events, and opportunities for participation. This research provides mental health clinicians with information about the positive religious experiences of TGE individuals and suggestions to support clients at the intersection of religious and TGE identities. [ABSTRACT FROM AUTHOR]

In recent decades, there has been a steady increase in the number of people, including adolescents, undergoing medical body modification (MBM) to alter their physically healthy bodies in invasive and nearly irreversible ways through medical treatment (e.g. surgery). While MBM is often recommended for youth with persisting gender dysphoria (GD), in body dysmorphic disorder (BDD) it has been considered contraindicated. Here, we outline the current controversies surrounding MBM practice and recommendations in adolescents with GD versus those with BDD in order to better understand under what circumstances we may or may not support adolescents who want to change their bodies medically and often irreversibly. We compare the two disorders in terms of the overlap and uniqueness of their behavioural and psychological features. In doing so, we discuss limitations of the existing (often low‐quality) evidence for and against MBM in young patients. We conclude that the currently available evidence is too preliminary and far from conclusive to make any robust recommendations in terms of benefits and harms of MBM in youth with persisting GD or BDD. However, we strongly recommend further urgent scientific discussions and systematic research efforts into more robust evaluations and the identification of more precise psychological characteristics that may serve as decision criteria for or against MBM – particularly in those adolescents who did not respond to non‐MBM, that is, psychiatric/psychological treatment and psychosocial support, if available at all. This will greatly benefit youth healthcare professionals in their challenging clinical practice of making decisions regarding MBM today and in the future. [ABSTRACT FROM AUTHOR]

This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students. In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks. Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity. Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education. [ABSTRACT FROM AUTHOR]

Visual and text-based art plays a role in constituting and sustaining international harm reduction social movements based on drug user rights. The digital arts of harm reduction examined in this article counter sociological discomfort with pleasure by performing the artisanal pleasures of craft, context, and practice. Through close examination of the Instagram hashtag #celestialheartbreak, the article centers work by artist Jamie Harary, whose queer feminist harm reduction art places women and gender-nonconforming people at the center of harm reduction in life-affirming ways. The work expands the visual repertoire for speculative narcofeminist imaginaries, moving beyond rights-based formations to consider the play of emotional intensity. This article meditates upon the movement of affective neuroscience as supplement to feminist and queer drug research, as well as harm reduction practice, in offering socially situated accounts for getting at the lived dimensions of affective lives and claims to making sense of social worlds by living well with drugs. [ABSTRACT FROM AUTHOR]

Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify. [ABSTRACT FROM AUTHOR]

This paper explores how neoliberal ideologies inform both social and political agendas that influence how social workers can provide support to trans and gender diverse people attempting to access gender-affirming healthcare, using an analysis of social workers' experiences working in mental health in Nova Scotia, Canada. Qualitative semi-structured interviews provide a perspective of the experiences of social workers in Nova Scotia and how their ability to provide mental health services to trans and gender diverse people is impacted by neoliberalism. Most social workers attributed the structural context of working within a bio-medical system as contributing to social workers being disempowered, undermined, and not able to practice according to the values of their profession thus limiting their ability to provide affirming mental health supports to trans and gender diverse people in ways that align with their social work professional ethics and values. Through examining how neoliberal ideologies create notions of ideal social citizens by controlling the body, the paper explores how lived experience of neoliberal practices in mental health social work reinforce transnormativity. This paper highlights the necessity for social workers to resist dominant neoliberal and medicalized discourses which serve as mechanisms of power and control. The paper concludes with recommendations for social work practice with trans and gender diverse populations. [ABSTRACT FROM AUTHOR]

Cyberbullying has become an ever-pressing topic for young people in a time of ubiquitous media. Some of the existing, mostly quantitative studies reveal that (cyber-)bullying is gendered and that female and genderqueer young people are bullied more often and differently than males. However, there is a lack of qualitative studies that look into the specific reproduction and dynamics of gendered discourses in bullying that stretches across entangled socio-material-technological spaces. Informed by insights from digital geographies, gender(-queer) geographies, and interdisciplinary research on (cyber-)bullying, and taking a feminist perspective, this article investigates gendered discourses in young adults' narratives about (cyber-)bullying. The analysis is based upon 42 written narratives produced by young adults attending upper secondary schools in Austria describing (cyber-)bullying they were involved in as (co-)perpetrators, targets or bystanders. (Cyber-)bullying reported ranges from early undesired reception of sexual content to hypersexualized harassment (by peers) to sexual grooming (by unknown adults). Rather than focusing on the narrators' active or passive roles in the bullying practices themselves, through narrative analysis we reveal how, in their accounts of (cyber-)bullying attacks, our participants—often unintentionally—reproduce gender roles and ideals of femininity and masculinity, and therewith deeply ingrained heteronormative discourses that prevail in Austrian society. For female young people, the persistent and complex 'sexual double standard' is particularly harmful in serving to legitimize undesired hypersexualization of their bodies online while simultaneously prohibiting their right to self-determined sexual practices online. [ABSTRACT FROM AUTHOR]

Purpose: To date, transgender and gender-diverse voice clients’ perceptions and individual goals have been missing in discussions and research on genderaffirming voice therapy. Little is, therefore, known about the client’s expectations of therapy outcomes and how these are met by treatments developed from views of vocal gender as perceived by cisgender persons. This study aimed to explore clients’ individual motives and perceived barriers to undertaking gender-affirming voice therapy. Method: Individual, semistructured interviews with 15 transgender and genderdiverse voice clients considering voice therapy were conducted and explored using qualitative content analysis. Results: Three themes were identified during the analysis of the participants’ narratives. In the first theme, “the incongruent voice setting the rules,” the contribution of the voice on the experienced gender dysphoria is put in focus. The second theme, “to reach a voice of my own choice,” centers around anticipated personal gains using a modified voice. The third theme, “a voice out of reach,” relates to worries and restricting factors for not being able to reach one’s set goals for voice modification. Conclusions: The interviews clearly indicate a need for a person-centered voice therapy that starts from the individuals’ expressed motives for modifying the voice yet also are affirmative of anticipated difficulties related to voice modification. We recommend that these themes should form the basis of the pretherapy joint discussion between the voice client and the speech-language pathologist to ensure therapy goals that are realistic and relevant to the client. [ABSTRACT FROM AUTHOR]

Previous research has suggested that older trans and gender non-conforming (TGNC) people may face particular challenges related to stigma, social exclusion and discrimination in later life. However, direct data on social support and needs in older TGNC population both internationally and within the UK is limited due to the small, dispersed nature of this population, and the absence of specific data collection on aging TGNC populations. During the UK COVID-19 lockdown in summer 2020, older people and those with long-term health conditions were advised to adopt particular precautions. This study aimed to explore older TGNC people's social support networks, key concerns and unmet needs during the COVID-19 'lockdown'. A UK cross-sectional survey of LGBT + people aged 60+ (n = 375) was undertaken during the lockdown. This paper analyses responses from the subset (n = 38) of TGNC participants. The majority of TGNC respondents described diverse social networks, often centered around friends and non-kin social networks, although partners and adult children were also significant for some. In most cases, those with existing strong networks continued to maintain social connections during lockdown, albeit with some regrets about loss of activities and face-to-face connection. However, a minority of respondents had experienced greater challenges prior to lockdown, and may have been at increased vulnerability during the pandemic, for example indicating that they had no-one to call on for practical support in an emergency. When asked about unmet needs and challenges, social isolation was repeatedly raised as the most frequent concern. Several respondents also mentioned issues specifically affecting TGNC communities, including access to gender affirming care and a perceived rise in social intolerance. Health and social care providers should be aware of the diversity of support networks within TGNC communities. There may also be benefits in community sector interventions to help older TGNC build and maintain strong social networks. [ABSTRACT FROM AUTHOR]

Trans and gender diverse individuals (people who identify with a gender different to what was presumed for them at birth) are one of the most medically and socially marginalized groups in our community. The COVID-19 pandemic may compound preexisting depression and thoughts of self-harm or suicide. We aimed to explore the impact of the COVID-19 pandemic on the Australian trans community. An online cross-sectional survey was conducted between 1st May 2020 and 30th June 2020, amidst strict Australia-wide social restrictions. Australian trans people aged ≥16 years were eligible to participate. Survey questions explored the impact of the COVID-19 pandemic on living situation, employment, financial situation, and healthcare. Logistic regression to assess negative impacts due to COVID-19 on depression and thoughts of self-harm or suicide (measured by Patient Health Questionnaire-9 (PHQ-9) are presented as odds ratios (95% confidence interval)). Of 1019 participants, 49.6% reported experiencing financial strain, 22% had reduced working hours, and 22.4% were unemployed (three times the national rate). Concerningly, 61.1% experienced clinically significant symptoms of depression (Patient Health Questionnaire-9 score ≥10), considerably higher than pre-COVID rates for the trans community and over twice the national rate. Moreover, 49% reported thoughts of self-harm or suicide (over three times the national rate) which was more likely if a person experienced cancelation or postponement of gender-affirming surgery (OR 1.56 (1.04, 2.35)), financial strain (OR 1.80 (1.36, 2.38)), or felt unsafe or afraid in their household (OR 1.96 (1.23, 3.08)). Given rates of clinically significant depression and thoughts of self-harm or suicide are far higher in trans people than the general population, specific strategies to improve mental health in the trans community during the COVID-19 pandemic must be made a priority for policymakers, researchers, and health service providers to prevent suicide. Supplemental data for this article is available online at [ABSTRACT FROM AUTHOR]

Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention. To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK. In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression. This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health. The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed. [ABSTRACT FROM AUTHOR]

A paucity of research persists surrounding disordered eating among sub-populations of athletes with diverse identities. In this commentary, we argue that in the absence of extensive research to understand the nuances embedded in sub-populations of athletes, using a culturally humble approach is preferable and recommended in identifying and preventing disordered eating in athletes. Cultural humility is a powerful guiding framework for sport psychology professionals to navigate the underrepresented, "unheard voices" of disordered eating in sport. Specifically, engaging in the 5 Rs of cultural humility (Reflection, Respect, Regard, Relevance, and Resiliency) may help sport psychology professionals: a) become aware of and help reduce stereotypes that label certain athletes as disordered, and b) listen deeply to the individual experiences of the athlete while remaining aware of the inherent sport professional-athlete power imbalance. We offer recommendations based on current eating disorder research, gaps in this body of literature, and highlight recent publications on cultural humility for professionals to consider when addressing and preventing disordered eating concerns. Lay summary: Sport psychology professionals may benefit from a culturally humble approach to disordered eating in athletes. We acknowledge that more research needs to be conducted on disordered eating in athletes with intersecting identities. We propose that a cultural humility framework can inform a richer understanding of diverse presentations of disordered eating. Enhance early identification of disordered eating and reduce instances of missed identification by engaging in a culturally humble approach to working with athletes Promote a sport culture that listens to the needs of individual athletes rather than focusing on body, weight, or appearance [ABSTRACT FROM AUTHOR]

This essay argues that Mary Robinson's subversion of gender in her Gothic novel Walsingham (1797) is more radical than critics have suggested. I offer a trans reading of Walsingham that focuses on the evolution of Sir Sidney Aubrey's nonnormative gender identity and behavior. Along with emphasizing transformation and embodiment, trans theory disrupts essentializing categories such as male, female, heterosexual, gay, and lesbian. It thus provides a useful lens through which to examine Walsingham, in which Sidney and the title character transition from one identity to another. I examine the transgender Sidney's conception of themself as a monster and the eponymous protagonist's psychosexual development: throughout the novel, both characters see themselves as metamorphic, not-quite-human subjectivities driven by self-destructive passions. The novel's conclusion presents a scenario in which gender transition occurs rapidly, a trans person finds acceptance, and the conflicted male protagonist immediately falls in love with them. [ABSTRACT FROM AUTHOR]

Background: Gender-diverse young people experience a cisnormative world and are subject to unique minority stressors, which have been found to contribute to adverse mental health. This research aims to understand the social and personal context unique to gender-diverse people that young people navigate prior to attending specialised services. Methods: The baseline measure of a newly developed questionnaire, the GIDS Gender Questionnaire (GIDS-GQ), was sent to all young people (or caregivers for those aged under 12) attending the Gender Identity Development Service (GIDS). Eighty-four young people and caregivers completed the questionnaire, with eighty-one included in the final sample (M = 15.77 years, SD = 1.83, range = 9–17; assigned female at birth = 72, assigned male at birth = 9). Questionnaires were emailed to participants via an online survey between one and three appointments with the Service. Data were collected between April 2021 and February 2022. Results: All young people had initiated a social transition, with 75.3% categorised as fully socially transitioned. More young people reported experiencing transphobic bullying (64.2%) and a lack of acceptance of their gender identity (85.1%) in the past (lifetime) than in the 6 months prior to attending the service (transphobic bullying: 12.3%; non-acceptance: 49.4%). 94.5% of the sample reported disliked body parts, most commonly breasts (80.8%), genitals (37%), and hips (31.5%). Participants most commonly reported a decrease in their mood (61.25%) and most areas of social connectedness. Conclusions: The majority of this sample had socially transitioned, were supported in their identification, and had experienced less transphobic bullying and non-acceptance prior to commencing services. However, young people continued to dislike their bodies, and experience low mood and social connectedness. Future research is needed to understand how clinical support can help reduce the impact of these external/distal minority stressors by promoting social connectedness, incorporating such learnings into clinical practice and subsequent policy in clinical work with gender-diverse young people. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse youth (TGD youth; i.e., children and adolescents who do not identify with their birth-assigned sex) face a variety of traumas and adversities, including those explicit to their gender identity and/or expression (hereafter "gender"; e.g., gender-related victimization, caregiver rejection). However, few studies or clinical assessment measures capture the full spectrum of adversities TGD youth experience. A comprehensive examination of gender- and non-gender-related adversities faced by TGD youth is critical to understand their high risk for mental health problems and to inform best practices for clinical assessment and care. The present study sought to qualitatively examine gender- and non-gender-related adversities using clinical interview data from a sample of TGD youth (N = 49; ages 11–20; 76% White) seeking services at a pediatric gender center. Interview data were analyzed using deductive content analysis. To support future measure development, existing measures of adversity and gender minority stress informed the analysis. Results highlighted the saliency of gender-related adversities among TGD youth, the themes of which included verbal abuse, threats or acts of physical and sexual assault, discrimination, nonaffirmation, and rejection. Implications for clinical assessment with TGD youth and future avenues in measure development are discussed. [ABSTRACT FROM AUTHOR]

Google Scholar Crossref Search ADS WorldCat 23 Hildebrand-Chupp R. More than "canaries in the gender coal mine": a transfeminist approach to research on detransition. The population of trans and gender-diverse (TGD) people is undergoing two significant changes relevant to health professionals worldwide: (1) a significant increase in TGD people seeking gender-affirming medical treatment (GAMT),[1] and (2) the diversification of genders (ie, nonbinary) and GAMT requests.[2] Numerous studies have shown that the number of TGD people has increased over time: a recent systematic review found a range of 17 to 33 per 100 000 for TGD people presenting in clinical settings.[3] At the same time, evidence gaps have shown up, because the group of treatment-seeking nonbinary people has little representation in previous studies.[4] As of now, it remains unclear to what extent the increase in numbers also represents nonbinary people seeking treatment. Google Scholar Crossref Search ADS WorldCat 7 Expósito-Campos P. A typology of gender detransition and its implications for healthcare providers. Google Scholar OpenURL Placeholder Text WorldCat 8 Whyte S, Brooks RC, Torgler B. Man, woman, "other": factors associated with nonbinary gender identification. [Extracted from the article]

This study explores the relevance of the brief Child and Youth Resilience Measure (CYRM-12) for sexual and gender minority youth (SGMY) aged 14–23 (N = 4,810), compares their patterns of resilience with general youth populations, and explores distinctions between key subgroups of SGMY. SGMY reported significantly lower scores, indicating poorer outcomes, than non-SGMY in several CYRM-12 items, especially those addressing familial and community support. Older SGMY (aged 19–23) reported significantly higher CYRM-12 scores than younger SGMY (aged 14–18; t = 11.00, p <.001). Compared with their non-SGMY counterparts, SGMY reported significantly lower scores regarding supportive parental relationships, connection to offline community, and school belongingness yet reported higher scores regarding the importance of education. Three factors contributed to SGMY resilience: (1) peer and community belonging, (2) familial and cultural support, and (3) youth's personal attributes and self-efficacy. The results of this study also suggest that measuring resilience in SGMY should incorporate online as well as offline sources. Recommendations to enhance the CYRM-12 to capture the experiences of SGMY for social work research and practice are provided. [ABSTRACT FROM AUTHOR]

This study investigates how transfeminine crossplay—imagined or enacted crossdressing as feminine characters from anime and manga—offers aesthetic resources for genderqueer experimentation. We situate this investigation in Singapore, an Asian sociopolitical context which privileges social harmony and penalizes vocal dissent. Through interviews with six crossplay fans (some identifying as transgender but not others), we unpack how they harness aesthetics in crossplay to negotiate genderqueer trajectories. Crossplay aesthetics clarified gendered feelings and prospective gendered futures. It created gendered-aesthetic styles, forming new trajectories. But for some, it counterproductively constricted gender experimentation's inventiveness. We argue that aesthetic play constitutes a holding space to silently cultivate gender nonconformity, sidestepping Singapore society's demonization of dissent. By momentarily suspending ties to futural demands of gender identities, crossplay installs a sense of atemporality within gendered aesthetics, encouraging fans to engage gender as aesthetic considerations dissociated from personal and social histories of shame, suffering, and discrimination. [ABSTRACT FROM AUTHOR]

The article focuses on the outcomes of menstrual suppression methods used by transgender and gender-diverse adolescents. It mentions the study found that most individuals had high rates of method continuation, amenorrhea, improved bleeding, and a reduction in dysphoria and mood symptoms when using various menstrual management methods.

The presence of minority stress has been well-documented among members of the transgender and gender nonconforming community, as has the effect of minority stress on their psychological distress. Little attention has been given to transgender and gender nonconforming people who identify as asexual. This study examined the relationships among minority stressors and psychological distress among individuals holding the intersecting identities of transgender and gender nonconforming and asexual. Data were collected from 300 adults using various listservs and social media platforms. It was hypothesized that all minority stressors assessed would predict psychological distress. However, multiple regression results revealed that only vigilance (β = .22, p < .001) and gender expression minority stress (β = .24, p < .001) were significant positive predictors of psychological distress, F(11, 258) = 10.21, p < .001, f² = .43; the overall model accounted for approximately 30% (R² = .30) of the total variance in psychological distress. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

Trans, gender diverse and gender questioning adults are highly likely to experience mental health difficulties, for multiple reasons including transphobia or minority stress. However, gender diverse adults often describe having negative experiences accessing mental healthcare in the UK. Concurrently, health professionals have described feeling inadequately skilled, and lacking confidence in their ability to support gender diverse people. There has been limited research exploring the experiences of mental health professionals who provide care for gender diverse people in mainstream mental health services, and even less in the UK. In this study, the accounts of seven mental health professionals from a range of disciplines were analysed with a constructionist narrative analysis, to better understand the nature of stories and positioning of individuals, within the local, social and historical contexts of the narratives' construction. This paper focuses on participants' narratives of feeling inadequately skilled when working with gender diverse individuals, which were drawn on and resisted in their stories. Implications for clinical practice and training are suggested. [ABSTRACT FROM AUTHOR]

The article outlines strategic priority areas for interrupting multilevel violence against African American and Brown transgender and gender-diverse communities, its intersecting drivers, and its downstream consequences. These include empowerment self-defense (ESD) approaches, equitable community-government partnerships, and funding grassroots community-based organizations.

Terminology describing transgender and gender diverse identities has evolved over the past 80 years, becoming progressively less pathologizing and less stigmatizing. While transgender health care no longer uses terms such as gender identity disorder or classifies gender dysphoria as a mental health condition, the term gender incongruence continues to be a source of oppression. An all-encompassing term, if one can be found, might be experienced by some as either empowering or abusive. This article draws on historical perspectives to suggest how clinicians might use diagnostic and intervention language that is harmful to patients. [ABSTRACT FROM AUTHOR]

The article provides information on the history and development of gender affirmation surgery over the past 90 years. It discusses how the procedure evolved from a rarely performed and stigmatized treatment to an accepted medical intervention, with milestones such as the first recorded surgery in 1931 and the well-known case of Christine Jorgensen in 1952.

Iphigenia is not one. She is multiple. Central to Wayne Shorter and esperanza spalding's opera titled ...(Iphigenia) is the layered multiplicity of Iphigenias who are sacrificed/martyred, time and again, for the cause of Grecian nation building. Unlike other stage and filmic renditions of the opera that tell Iphigenia's story once, emphasizing the psychic drama of what it means to give one's blood for the ideological cause of nation building, ...(Iphigenia) repeats the story piling up bodies on stage. Dressed in pink, red, white, silver, fur and more (Fig. 4), Iphigenia's body becomes multiple, becomes collective, becomes sisterhood, becomes interspecies. [ABSTRACT FROM AUTHOR]

Nonbinary is an umbrella term that encompasses any person whose gender identity is outside the binary construct of man or woman. An estimated 1.2 million people in the United States identify as nonbinary, a number that most likely will continue to increase as the visibility of people who live outside binary gender increases in our society. Healthcare providers are likely to encounter nonbinary patients but may lack confidence in treating these patients appropriately. This article describes terminology, concepts, and suggestions for clinicians to provide basic respectful and competent care for nonbinary patients. [ABSTRACT FROM AUTHOR]

Scientific knowledge on the impact of a gender-affirming transition on intimate partners of transgender and gender diverse (TGD) individuals is limited. It is unclear which care needs partners have and which role health care professionals can play during this transition process. The aim of this study was to explore the unique experiences and care needs of people partnering with TGD people in the context of a gender-affirming transition. A qualitative research method was chosen, and a semi-structured interview was conducted with a sample of nine participants. After transcription, thematic analysis was used to analyse the data. Three main themes, with three subthemes each, were identified: (1) intrapersonal processes, with (1a) the process of acceptance, (1b) concerns surrounding the medical transition and (1c) impact on sexual orientation as subthemes; (2) dyadic processes, with (2a) the importance of mutual commitment, (2b) experiences regarding intimacy and (2c) relational growth as subthemes; and (3) perception of support, with (3a) need for support, (3b) the importance of support and (3c) evaluation of support as subthemes. The results suggest that health care providers can help partners to navigate the process of a gender-affirming transition; however, the care needs of partners are currently not satisfied with the available professional support. [ABSTRACT FROM AUTHOR]

Here, we report the prevalence of loneliness and social isolation and investigate the levels of loneliness and social isolation among transgender and gender diverse people using cross-sectional data from the HH-TPCHIGV study. Using the De Jong Gierveld tool, we assess loneliness, using the Bude and Lantermann tool, we assess perceived social isolation and using the Lubben Social Network Scale, we assess objective social isolation. The prevalence rate of loneliness was 83.3% (perceived social isolation: 77.7%; objective social isolation: 34.4%). Regressions revealed that favorable outcomes (i.e., lower loneliness levels, lower perceived social isolation, and lower objective social isolation) were consistently associated with higher school education. Beyond that, we identify an association between particularly poor health-related factors and higher loneliness and objective social isolation levels. We also report that unemployment was significantly associated with higher levels of perceived social isolation. In conclusion, we show high prevalence rates of loneliness and social isolation among transgender and gender diverse people. Additionally, important correlates (e.g., education, health-related factors, or unemployment) were identified. Such knowledge may provide help to address transgender and gender diverse people at risk for loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) youth, particularly transgender youth of color, experience barriers to most, if not all, types of care across the United States. Consequently, clinicians are concerned about the increase of anti-transgender policies in the United States, with many states now restricting gender-affirming care. In this manuscript, we suggest several empirically based techniques to provide quality clinical care. We also share resources to support TGD youth and their families, while accommodating for some of these newer restrictions on the care that clinicians are able to provide. Ongoing training and awareness in these techniques will allow clinicians and their health care institutions to more effectively and immediately respond to anti-transgender policies and be able to provide care. By continuing to advocate for some of these strategies, there is potential to reduce the health inequities that many TGD youth experience. Prioritizing screening for gender discrimination, creating a safe space for TGD youth, and providing immediate clinical strategies to reduce distress can reduce symptoms of depression and suicide. These changes, albeit small, will allow clinicians to feel more comfortable providing gender affirming care through holistic changes in clinical practices and care. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to examine the public response to public health and media messaging during the human monkeypox virus (MPXV) outbreak in the UK, focusing on at‐risk communities. Methods: A co‐produced, cross‐sectional survey was administered in June and July 2022 using community social media channels and the Grindr dating app. Basic descriptive statistics, logistic regression, and odds ratio p values are presented. Results: Of 1932 survey respondents, 1750 identified as men, 88 as women, and 64 as gender non‐conforming. Sexual identity was described as gay/lesbian/queer (80%), bisexual (12%), heterosexual (4%), and pansexual (2%); 39% were aged <40 years; 71% self‐identified as White, 3% as Black, 8% as Asian, 2%as LatinX, and 11% as 'Mixed or Other' heritage groups. In total, 85% were employed and 79% had completed higher education. A total of 7% of respondents identified themselves as living with HIV. Overall, 34% reported limited understanding of public health information, 52% considered themselves at risk, 61% agreed that people with MPXV should isolate for 21 days, 49% reported they would first attend a sexual health clinic if symptomatic, 86% reported they would accept a vaccine, and 59% believed that MPXV originated from animals. The most trusted sources of information were healthcare professionals (37%), official health agencies (29%), and mainstream media (12%). Conclusions: Vaccine acceptability was very high, yet the understanding and acceptance of public health information varied. Social determinants of health inequalities already shaping the UK landscape risk were compounded in this new emergency. Engagement with structurally disadvantaged members of affected communities and better dissemination of public health messaging by trusted healthcare professionals are essential for the public health response. [ABSTRACT FROM AUTHOR]

Psychology has a long history of perpetuating scientific racism and pathologizing gender and sexually diverse individuals. The field has been criticized for the reproduction of racism, sexism, cissexism, and other social inequities. This intersectional epistemological exclusion has led to a lack of appreciation for the work of Black sexual and gender diverse (SGD) scholars within the field of psychology. To highlight and center the contributions of Black SGD scholars in the field, we conducted an in-depth literature search of the work of 62 Black SGD scholars whose names and curricula vitae were obtained through email listservs, Twitter, and snowball sampling. In analyzing the work of the scholars, a total of 34 Black SGD scholars met inclusion criteria and had their research included in our review. We summarize their major contributions to the field of psychology in this article. Implications of these scholars’ works and their potential to help address the lack of visibility of Black SGD scholars in mainstream psychology journals are discussed. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) assessment among transgender and gender diverse (TGD) adults is complex because the literature offers little guidance on affirming assessment that accurately captures both trauma- and discrimination-related distress. This study aimed to characterize threats to precise PTSD assessment that arose during the Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (CAPS-5). Our sample (N = 44) included trans women (38%), trans men (25%), nonbinary people (23%), and other TGD identities (14%). Participants were mostly White (75%), non-Latinx (82%), educated (91% at least some college), with a mean age of 37 years (SD = 15.5). Demographic and CAPS-5 scoring data as well as content analysis of audio-recorded CAPS-5 interviews are reported. All participants reported trauma exposure, and nearly half met PTSD diagnostic criteria (49%). Interpersonal assault was a common trauma type linked to posttraumatic symptoms (77%); 41% were sexual assaults; and 41% were discrimination-based (e.g., linked to gender identity) physical or sexual assaults. Qualitative findings suggest how and when discrimination-related experiences may threaten PTSD assessment accuracy, leading to overpathologizing or underdetection of symptoms, for example, (a) initial selection of a noncriterion A discrimination event as "worst event," (b) linking symptoms to internalized transphobia (rather than trauma), and (c) linking victimization to gender identity/expression. Threats to PTSD assessment were more common when symptoms were linked to discrimination-based traumatic events, suggesting the importance of understanding contextual factors of index events. We offer a framework for understanding unique challenges to the assessment of PTSD among TGD people and provide recommendations for improving assessment. Public Significance Statement: We are the first to characterize the complexities of assessing posttraumatic stress disorder (PTSD) among transgender and gender diverse (TGD) adults, using the gold standard clinician interview assessment. All participants reported trauma exposure, with 48% meeting PTSD diagnostic criteria. Our study details how and when discrimination-related experiences may threaten PTSD assessment accuracy, leading to overpathologizing or underdetection of symptoms. We also provide recommendations for assessing PTSD in TGD adults. [ABSTRACT FROM AUTHOR]

Transgender (trans) and gender diverse (TGD) people continue experiencing profound expressions of stigma and discrimination in their attempts at accessing care, including support from the social work profession. Incorporating the lived experience of TGD people as practice knowledge in social work may serve to enhance the profession's relationship with TGD communities and mitigate historical barriers of this population to relevant services. In this study, we draw on qualitative data based on individual interviews with 20 TGD people and 10 social workers in a Western Canadian province to explore the potential of leveraging the lived experience of TGD people as practice insight in social work. Our analysis, which is supported with the tenets of feminist standpoint theory, reveals that incorporating the lived experience of TGD people in social work as practice knowledge may inform and catalyze interventions that (1) validate TGD bodies, identities and experiences; (2) contribute to networks of advocacy and support founded on shared community knowledge and (3) promote resistance and transformation. In our discussion, we explore practical implications of our research for practice at multiple levels, including the potential of engaging TGD 'peers' with relevant lived experience in the direct delivery of certain psychosocial interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives Prior research has shown informal caregiving among older adults can negatively affect the caregiver's physical and psychological health. However, little is known about protective and risk factors associated with the health-related quality of life (HRQOL) of lesbian, gay, bisexual, transgender, and queer (LGBTQ) caregivers. Research Design and Methods Informed by the Health Equity Promotion Model and Caregiver Stress Process Model and utilizing longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this analysis examined modifiable risk and protective factors associated with psychological and physical HRQOL over time among 754 LGBTQ caregivers aged 50–98. Results Psychological and physical HRQOL declined over a 3-year period. After controlling for background characteristics, mastery, social support, socialization, LGBTQ community engagement, and physical activity were positively associated with psychological HRQOL while day-to-day discrimination, identity stigma, and insufficient food intake were negatively associated. Steeper declines were observed for older and with no physical activity. Mastery, social support, socialization, and physical activity were positively associated with physical HRQOL while day-to-day discrimination and insufficient food intake were negatively associated. Steeper declines were found for those with high mastery and no physical activity. Discussion and Implications Although generalized factors including mastery, socialization, and social support are protective for HRQOL among LGBTQ caregivers, factors including day-to-day discrimination and identity stigma are more unique to historically disadvantaged populations and should be considered in future research and practice. Caregiving interventions incorporating physical activity are promising given its buffering effect for decreased physical and psychological HRQOL over time. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) individuals often must undergo a psychosocial assessment and receive a letter of support from a mental health care provider to access gender-affirming medical care (GAMC). This study describes TGD individuals' perceptions of barriers and benefits of the assessment process and uses thematic analysis to explore TGD individuals' opinions on how mental health care should or should not be related to gender-affirming medical care. Two hundred and eighteen TGD participants completed an online survey. Participants endorsed benefits and negative impacts associated with the psychosocial assessment and provided qualitative responses to explain their support or opposition to involvement of mental health care and assessment in accessing GAMC. Nearly all participants identified both benefits (e.g. "experienced validation") and barriers (e.g. "experienced an increase in psychological distress") to the psychosocial assessment. Results are considered in the context of the historical marginalization and gatekeeping of TGD people by the medical system. [ABSTRACT FROM AUTHOR]

Although most clinicians believe that discussing sexuality is important clinically, most clinicians do not initiate these discussions. Further, for therapists working with transgender, nonbinary, and gender expansive (TNBGE) clients, discussing sexuality may feel challenging when therapists fear inadvertently stigmatizing or mischaracterizing their clients and their concerns. We propose a sexual wellbeing framework as an adjunctive to traditional feminist therapy, in which discussions about sexuality is comfortable and appropriate to the goals of therapy. We review existing evidence that suggests sexual wellbeing of TNBGE clients may be enhanced by (a) attending to the client's larger sociocultural context in which sexual wellbeing emerges, (b) understanding that sexual wellbeing is multiply determined, the contributing factors to sexual wellbeing are unique for each person, and sexual wellbeing changes over time and across situations, (c) challenging assumptions that genitals, hormones, and sexual functioning are the most important aspects of sexual wellbeing, (d) emphasizing sexual comfort and pleasure by enhancing immersive attention and facilitating gender affirming sexual experiences, and (e) conceptualizing consent as a means to ensure safe and pleasurable experiences. We conclude by offering clinical scenarios that present practical considerations when applying the sexual wellbeing framework to illustrate the ways in which conversations with TNBGE clients about sexuality can enhance sexual wellbeing. [ABSTRACT FROM AUTHOR]

Increasing visibility of transgender, nonbinary, and gender expansive (TNBGE) people in the United States and in higher education has coincided with a call for more affirming and appropriate mental health services. Group therapy has been connected to positive outcomes for college students, but appears less available to or less popular among TNBGE students. This article will summarize the history of feminist, queer, and trans theories, feminist group therapy, and therapeutic groups for TNBGE people. Recommendations for facilitating TNBGE groups will be presented, drawing from the work of three queer university counseling clinicians with collective experience in facilitating LGBTQ + and exclusively TNBGE groups using queer, trans, and multicultural feminist theories. Considerations for facilitating LGBTQ + groups for Black, Indigenous, People of Color (BIPOC) will also be included, based on relevant literature and clinical experience. Limitations of the authors' perspectives and recommendations will be outlined, as well as future directions for research and practice. [ABSTRACT FROM AUTHOR]

Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice. An interdisciplinary national team of experts collaborated to identify ways nurses could better uphold their professional responsibilities to TGNC individuals with serious illness. The purposes of this article are to: 1) describe elements of TGNC-inclusive palliative nursing care; and 2) present eight concrete recommendations to achieve affirmative clinical practice for TGNC patients living with life-limiting illness and their family of origin and/or family of choice. These recommendations address professional development, communication, medication reconciliation, mental health, dignity and meaning, social support and caregivers, spiritual beliefs and religion, and bereavement care. The authors discuss the need for nurses to provide gender-inclusive palliative nursing care to patients experiencing life-limiting illness or injury. [ABSTRACT FROM AUTHOR]

Research shows elevated gender variance among autistic people and more autistic traits among gender diverse people, each of which is related to mental health concerns. Little work has explored broad features of these presentations in a non-clinical sample. College students (n = 174) ages 18–22 years completed questionnaires assessing the broader autism phenotype (BAP), autistic features, nonconformity to gender norms, and internalizing symptoms. Those with more BAP features or autistic communication reported more nonconformity to gender norms. Higher levels of internalizing symptoms were related to more gender nonconformity, BAP, and autistic features. Gender nonconformity marginally moderated the effect of BAP on depression but not anxiety. The BAP, autistic features, and gender nonconformity are important in understanding mental well-being. [ABSTRACT FROM AUTHOR]

Background: Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people has been identified as a key factor in addressing rates of poor health outcomes in the trans and gender-diverse community. In Australia, GAHT is largely delivered via a medical model, and within acute care facilities. Medicalisation and pathologisation of gender-affirming care acts as a significant barrier to access for many trans and gender-diverse individuals. Methods: This project incorporated a case study approach using multiple methods to investigate a recent community sponsored, co-designed program providing GAHT that included a peer navigator (PN) model of care in a primary healthcare (community health) setting. Results: Service activity in Year 1 and Year 2 demonstrated acceptability of the model, with over 1000 appointments delivered. This was supported by client feedback survey data collected at their initial (n = 110) and then 6-months post visit (n = 78) with the PN, and 31 interviews with clients, staff and stakeholders. Conclusion: Findings highlight the integral nature of the PN to the sustainability of the program, with some key insights into potential barriers. Basing service design on an Informed Consent model recognises the agency of the individual and their right to equitable access to health care of their choosing. Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people is universally poor, with most services located in highly medicalised, culturally unsafe environments. Normalising GAHT by locating services within culturally safe mainstream primary healthcare services increases engagement for the trans and gender-diverse community. This project identifies the impact of a trans and gender-diverse co-designed and led GAHT service on client engagement and satisfaction. [ABSTRACT FROM AUTHOR]

Trans and gender-diverse individuals experience poor mental health, and face significant barriers when trying to access appropriate mental health care. Most seek treatment from mainstream primary care services, who have an ethical duty to provide care to all. Primary care practitioners can ameliorate traumatic harms by identifying helpful strategies and avoiding inappropriate or harmful strategies. However, there is limited robust, culturally sensitive evidence informing clinicians about the appropriateness and efficacy of psychological interventions for trans and gender-diverse clients. This forum article argues that the epistemological and ontological frameworks underlying psychotherapies can impact the therapeutic relationship, and are therefore important factors to consider in primary care practice with trans and gender-diverse clients. Our paper synthesises selected psychotherapies into four clusters. Each cluster is accompanied by discussion of the potential or demonstrated benefits and limitations of the underlying framework, in the context of primary care with trans and gender-diverse clients. We also explore power dynamics in therapeutic relationships with trans and gender-diverse clients, and the challenges these factors pose to developing a shared understanding of the client's needs and preferences. The article concludes with some practical considerations for managing these issues in primary care. Trans and gender-diverse individuals tend to experience poor mental health, often exacerbated by culturally unsafe services in primary care. This paper offers four key frameworks for understanding and anticipating the potential benefits and harms of different psychological therapies when caring for trans and gender-diverse clients. The article concludes with recommendations for implementing the frameworks in practice, and discussion of the scope for involving peer workers in multidisciplinary care teams. [ABSTRACT FROM AUTHOR]

While the impact of the COVID-19 pandemic on older people has been recognized, there is limited understanding of its impact on older trans and gender diverse people who often have different experiences of care and support than the general population. This article examines older trans and gender diverse people's experience of social support during the COVID-19 pandemic, based on a comparative mixed method survey administered in Australia and the United Kingdom. Using a non-probability sample of 84 participants who were connected to social media and service organizations in the United Kingdom and Australia, we found some commonalities and differences between experiences in these countries. Some participants were isolated, including almost 1 in 5 participants who said that they did not have someone they could call upon in an emergency. However, participants had rich networks of friends, partners, and family members. Religious organizations and the community also played an important role. Friends were reported as the main emergency contacts and as the main people to whom support is provided. This research supports previous findings that friends of trans and gender diverse people play an important role in well-being. [ABSTRACT FROM AUTHOR]

This bibliographic essay seeks to explore the experiences of transgender and/or gender non-conforming (tgnc) people on the use of psychotherapy services. We begin by reviewing the state of the art of existing guidelines for psychotherapeutic intervention with this population. Followed by a bibliographic review aimed at accessing narratives of tgnc people about their psychotherapeutic processes, selecting four articles that explore a total of 70 narratives of tgnc people. We present an integrative exploration of the main findings of these researches. Finally, from a critical social constructionist positioning, some considerations for a critical psychotherapeutic practice with tgnc people are presented. [ABSTRACT FROM AUTHOR]

Many individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people. This study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey. Composite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims. A total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P <.001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P <.001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants. The results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms. [ABSTRACT FROM AUTHOR]