10 results on '"Baer Karrington"'
Search Results
2. Navigating Evolving Ethical Questions in Decision Making for Gender-Affirming Medical Care for Adolescents
- Author
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Laura Kimberly, Kelly McBride Folkers, Baer Karrington, Jeremy Wernick, Samantha Busa, and Caroline Salas-Humara
- Subjects
Male ,Parents ,Informed Consent ,Adolescent ,Research Design ,Infant, Newborn ,Gender Identity ,Humans ,Female ,General Medicine ,Decision Making, Shared - Abstract
As more young people feel safe to outwardly identify as transgender or gender expansive (TGE), meaning that their gender identity does not align with the sex they were assigned at birth, an increasing number of youth who identify as TGE seek gender-affirming medical care (GAMC). GAMC raises a number of ethical questions, such as the capacity of a minor to assent or consent, the role of parents or legal guardians in decisions about treatment, and implications for equitable access to care when differing parental or custodial viewpoints are present. These questions are further complicated by the difficulties in explaining the limits of long-term research in GAMC, with regard to the preservation of fertility, for example. We present two de-identified composite case studies to highlight dilemmas that may arise and offer recommendations to better support patient- and family-centered decision making for GAMC. These include employing a multidisciplinary shared decision-making approach, disentangling informed consent and assent from chronological age, developing a consistent approach to the assessment of decisional capacity, and developing age-appropriate informational materials.
- Published
- 2021
3. ACR Appropriateness Criteria® Transgender Breast Cancer Screening
- Author
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Ana Lourenço, Samantha L. Heller, Maxine S. Jochelson, Daymen S Tuscano, Jennifer F. Tseng, Tejas S. Mehta, Ashley R Stuckey, Juliana E. Hansen, Katherine A. Klein, Baer Karrington, Bethany L. Niell, Mary S. Newell, Maggie L DiNome, Linda Moy, Mary E Swain, Mita Sanghavi Goel, Beth Cronin, Elizabeth H. Dibble, Ann L. Brown, and Loren S. Schechter
- Subjects
education.field_of_study ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Population ,medicine.disease ,Appropriate Use Criteria ,Breast cancer screening ,Breast cancer ,Family medicine ,Transgender ,Medicine ,Radiology, Nuclear Medicine and imaging ,Hormone therapy ,business ,education ,Medical literature ,Cohort study - Abstract
Breast cancer screening recommendations for transgender and gender nonconforming individuals are based on the sex assigned at birth, risk factors, and use of exogenous hormones. Insufficient evidence exists to determine whether transgender people undergoing hormone therapy have an overall lower, average, or higher risk of developing breast cancer compared to birth-sex controls. Furthermore, there are no longitudinal studies evaluating the efficacy of breast cancer screening in the transgender population. In the absence of definitive data, current evidence is based on data extrapolated from cisgender studies and a limited number of cohort studies and case reports published on the transgender community. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- Published
- 2021
4. In Response to Howe’s 'Caring for Transgender Adolescents'
- Author
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Laura Kimberly, Kelly McBride Folkers, Baer Karrington, Jeremy Wernick, Samantha Busa, and Caroline Salas-Humara
- Subjects
General Medicine - Published
- 2022
5. Defining Desistance: Exploring Desistance in Transgender and Gender Expansive Youth Through Systematic Literature Review
- Author
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Baer Karrington
- Subjects
Gender Studies ,Gender identity ,Systematic review ,Transgender ,Medicine (miscellaneous) ,Review ,Criminology ,Psychology ,Expansive - Abstract
BACKGROUND: Desistance is a concept that has been poorly defined in the literature, yet greatly impacts the arguments for and against providing gender-affirming care for transgender and gender expansive (TGE) youth. This literature review aims to provide an overview of the literature on desistance and how desistance is defined. METHODS: A systematically guided literature review was conducted on March 27, 2020, using CINAHL, Embase, LGBT Life, Medline, PsychINFO, and Web of Science to identify English language peer-reviewed studies, editorials, and theses that discuss desistance concerning TGE pre-pubertal youth for a minimum of three paragraphs. Articles were divided based on methodology and quantitative data were quality assessed and congregated. Definitions of desistance were compiled and analyzed using constant comparative method. RESULTS: One qualitative study, 2 case studies, 5 quantitative studies, 5 ethical discussions, and 22 editorials were assessed. Quantitative studies were all poor quality, with 83% of 251 participants reported as desisting. Thirty definitions of desistance were found, with four overarching trends: desistance as the disappearance of gender dysphoria (GD) after puberty, a change in gender identity from TGE to cisgender, the disappearance of distress, and the disappearance of the desire for medical intervention. CONCLUSIONS: This review demonstrates the dearth of high-quality hypothesis-driven research that currently exists and suggests that desistance should no longer be used in clinical work or research. This transition can help future research move away from attempting to predict gender outcomes and instead focus on helping reduce distress from GD in TGE children.
- Published
- 2022
6. The Experiences of Transmasculine People with Contraception and Menstruation: A Literature Review of Qualitative and Mixed Method Studies
- Author
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Baer Karrington
- Subjects
Gender Studies ,Menstruation ,Transgender ,medicine ,Medicine (miscellaneous) ,Review Article ,medicine.symptom ,Psychology ,Dysphoria ,Clinical psychology - Abstract
Purpose: A paucity of research exists concerning transmasculine experience with contraception and menstruation, despite these being possible sources of dysphoria. Understanding how transmasculine people navigate contraception and menstruation can help improve the quality of care provided for this community. This literature review consequently aims to synthesize the existing qualitative and mixed methodology literature on how transmasculine people experience and navigate contraception and menstruation. Methods: A systematically guided literature review was conducted on March 15, 2020, using CINAHL, EMBASE, Medline, PsychINFO, and Web of Science. Qualitative and mixed method studies written in English were included if (i) participants were transmasculine and older than 11 years, (ii) the research question focused on contraception and/or menstruation in the transmasculine community, and (iii) the study incorporated primary data. No publication time restrictions were placed. The analysis followed a meta-ethnographic approach, with the minority stress model and social norms theory used for guidance. Results: Five studies were found eligible for review, all published after 2015 and conducted in the United States. The majority of the total 360 participants were White and of a higher socioeconomic position. Three main thematic categories were present: (i) concerns with hormonal contraception use, including gender dysphoria and worries about interactions with testosterone; (ii) discrimination and fears around seeking health care, especially concerning the assumptions made by practitioners; and (iii) community as a positive influence, particularly for normalizing menstruation for transmasculine people. Conclusion: The data collected support the need for increased research concerning the interaction between hormonal contraception and testosterone. Reflection on assumptions, even ones made in an attempt to be supportive, can improve physician and transmasculine patient relationships. Finally, community normalization can be a powerful tool to decrease feelings of dysphoria around menstruation, and community voices should be included in all educational material concerning menstruation and contraception.
- Published
- 2021
7. Access to Care for Transgender and Nonbinary Youth: Ponder This, Innumerable Barriers Exist
- Author
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David J. Inwards-Breland, Gina M. Sequeira, and Baer Karrington
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Gender Identity ,Transgender Persons ,Health Services Accessibility ,Family medicine ,Pediatrics, Perinatology and Child Health ,Transgender ,medicine ,Humans ,Transgender Person ,business ,Transsexualism - Published
- 2021
8. Improving Equitable Transition to Adult Care for Transgender and Gender Expansive Adolescents and Young Adults
- Author
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Baer Karrington, Marshall Hamilton, and David J Inwards-Breland
- Subjects
General Medicine - Published
- 2022
9. Allostatic Stress and Inflammatory Biomarkers in Transgender and Gender Expansive Youth: Protocol for a Pilot Cohort Study (Preprint)
- Author
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Mara Cohen, Baer Karrington, Howard Trachtman, and Caroline Salas-Humara
- Abstract
BACKGROUND A growing number of adolescents are coming out as transgender and gender expansive (TGE). These teenagers have been shown to have significantly worse health outcomes than their cisgender peers. Hypotheses to explain this discrepancy are based on increased stress levels surrounding the societal acceptance of gender identity. In this context, elevated allostatic load (AL), which describes the wear and tear sustained by the body in response to repeated exposure to stress, has been associated with adverse long-term health outcomes. OBJECTIVE This protocol aims to measure AL among TGE adolescents compared with their cisgender peers and assess how AL varies depending on psychological stress and perceived societal acceptance. METHODS This is an observational proof-of-concept pilot study in which AL will be measured by assaying an array of inflammatory cytokines and cortisol in urine, saliva, and hair samples of TGE youth, and these parameters will be compared with those of age-matched control participants. A questionnaire will assess 4 aspects of psychosocial well-being: presence and management of depression and anxiety, gender identity support by family members, gender minority stress, and degree of perceived safety in the surrounding community. Samples and surveys will be collected at 3 visits (baseline, 6 months, and 12 months). This study will incorporate TGE coinvestigators to inform all aspects of design, data collection, and analysis and ensure that practices are carried out in a respectful and sensitive manner. RESULTS As of May 2021, the start of data collection for this project has continued to be postponed as a result of the COVID-19 pandemic, which has both impacted the functioning of the clinic and funding requests. We hope to begin participant recruitment and interviews with coinvestigators soon. CONCLUSIONS We hypothesize that AL will be primarily influenced by psychological well-being and perceived support and that it will be similar in TGE adolescents and in age-matched cisgender control participants when acceptance and perceived support are high. The results of this study have the potential to increase our understanding of the health challenges faced by TGE individuals during adolescence as well as to show that low levels of acceptance may have detrimental health outcomes secondary to elevated ALs; this may lead to the development of a biomarker profile to assess allostatic stress in TGE patients that can be used to guide management. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/24100
- Published
- 2020
10. Allostatic Stress and Inflammatory Biomarkers in Transgender and Gender Expansive Youth: Protocol for a Pilot Cohort Study
- Author
-
Mara Cohen, Howard Trachtman, Baer Karrington, and Caroline Salas-Humara
- Subjects
Computer applications to medicine. Medical informatics ,participatory ,R858-859.7 ,Context (language use) ,stress ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Transgender ,Protocol ,stress biomarkers ,gender ,Medicine ,0501 psychology and cognitive sciences ,participatory action research ,business.industry ,05 social sciences ,biomarkers ,General Medicine ,transgender ,Minority stress ,Allostatic load ,gender diverse ,Anxiety ,adolescence ,Observational study ,medicine.symptom ,business ,Psychosocial ,allostatic load ,050104 developmental & child psychology ,Cohort study ,Clinical psychology - Abstract
Background A growing number of adolescents are coming out as transgender and gender expansive (TGE). These teenagers have been shown to have significantly worse health outcomes than their cisgender peers. Hypotheses to explain this discrepancy are based on increased stress levels surrounding the societal acceptance of gender identity. In this context, elevated allostatic load (AL), which describes the wear and tear sustained by the body in response to repeated exposure to stress, has been associated with adverse long-term health outcomes. Objective This protocol aims to measure AL among TGE adolescents compared with their cisgender peers and assess how AL varies depending on psychological stress and perceived societal acceptance. Methods This is an observational proof-of-concept pilot study in which AL will be measured by assaying an array of inflammatory cytokines and cortisol in urine, saliva, and hair samples of TGE youth, and these parameters will be compared with those of age-matched control participants. A questionnaire will assess 4 aspects of psychosocial well-being: presence and management of depression and anxiety, gender identity support by family members, gender minority stress, and degree of perceived safety in the surrounding community. Samples and surveys will be collected at 3 visits (baseline, 6 months, and 12 months). This study will incorporate TGE coinvestigators to inform all aspects of design, data collection, and analysis and ensure that practices are carried out in a respectful and sensitive manner. Results As of May 2021, the start of data collection for this project has continued to be postponed as a result of the COVID-19 pandemic, which has both impacted the functioning of the clinic and funding requests. We hope to begin participant recruitment and interviews with coinvestigators soon. Conclusions We hypothesize that AL will be primarily influenced by psychological well-being and perceived support and that it will be similar in TGE adolescents and in age-matched cisgender control participants when acceptance and perceived support are high. The results of this study have the potential to increase our understanding of the health challenges faced by TGE individuals during adolescence as well as to show that low levels of acceptance may have detrimental health outcomes secondary to elevated ALs; this may lead to the development of a biomarker profile to assess allostatic stress in TGE patients that can be used to guide management. International Registered Report Identifier (IRRID) PRR1-10.2196/24100
- Published
- 2021
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