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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What happens to queer and gender-non-conforming community, bodily expression and identity when many queer spaces are closed and communities move to online spaces? In this article, we critically reflect on our collaborative project bois of isolation (boi) – a platform within Instagram for people to share selfies of the spaces and processes through which they queer gender binaries during the COVID-19 pandemic. We ask to what extent online social media spaces can disrupt normative, binarized gender identity and provide ways of reimagining the selfie. Operating within digital capitalism, selfies often serve to circulate and reproduce dominant 'desirable' subjectivities in 'gender appropriate' places. However, we argue through interventions like boi young people carve out small spaces of dissent and respite in/from social media platforms and create forms of community during lockdown. By queering the visual representations of binarized gender and questioning the neoliberal individualized 'self' in 'selfies', young people construct communal aesthetic spaces in which gender plurality and fluidity are expressed and celebrated. [ABSTRACT FROM AUTHOR]

Objectives To examine patient education, counselling practices, decision aids, and education resources related to fertility preservation for transgender and gender diverse (TGD) youth and young adults. Methods A scoping review was conducted using a comprehensive literature search (Ovid MEDLINE, PubMed Medline, OVID Embase, Ovid PsychoINFO, and Cochrane Central Register of Controlled Trials) conducted from 1806 to October 21, 2022. Inclusion criteria involved abstracts and articles on patient education, counselling, decision aids or education resources regarding fertility preservation for TGD youth and adults. Results Of 1,228 identified articles and abstracts, only six articles met inclusion criteria. Three key themes were identified: (1) patient education and counselling practices (n = 4), with majority of patients receiving fertility preservation counselling at their respective centres; (2) decision aids and strategies for clinicians on fertility preservation for TGD individuals (n = 2) and; (3) patient education resources (n = 1). There was a paucity of literature on decision aids and patient education resources. Conclusions This study highlights the need to further develop and evaluate decision aids for healthcare providers and patient education resources, including eLearning modules, around fertility preservation for TGD individuals. [ABSTRACT FROM AUTHOR]

This study investigates associations between minority stressors, traumatic stressors, and post-traumatic stress disorder (PTSD) symptom severity in a sample of transgender and gender diverse (TGD) adults. We utilized surveys and clinical interview assessments to assess gender minority stress exposures and responses, and PTSD. Our sample (N = 43) includes adults who identified as a minoritized gender identity (i.e., 39.5% trans woman or woman, 25.6% trans man or man, 23.3% genderqueer or nonbinary, 11.6% other identity). All participants reported at least one traumatic event (i.e., life threat, serious injury, or sexual harm). The most common trauma events reported by the sample were sexual (39.5%) and physical violence (37.2%), with 40.9% of participants anchoring their symptoms to a discrimination-based event. PTSD symptom severity was positively correlated with both distal (r = 0.36, p =.017) and proximal minority stressors (r = 0.40, p <.01). Distal minority stress was a unique predictor of current PTSD symptom severity (b = 0.94, p =.017), however, this association was no longer significant when adjusting for proximal minority stress (b = 0.18, p = 0.046). This study suggests that minority stress, especially proximal minority stress, is associated with higher PTSD symptom severity among TGD adults. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to explore between‐group differences across different stages of gender‐affirming care, and associations between appearance congruence, gender‐related motivations for weight loss, and disordered eating in transgender and gender expansive (TGE) individuals. Method: A total of 160 TGE adults (aged 18–30) were recruited across the United States. Participants completed a comprehensive online survey. Data were analyzed using generalized linear models and bivariate correlations. Results: Significant differences in appearance congruence among participants at different transition stages were revealed, with the group that achieved their desired transition reporting the highest appearance congruence compared to all other groups. Furthermore, gender‐related motivations for weight loss were significantly lower in individuals who achieved their desired transition compared to those with no plans to transition. Discussion: Findings suggest significantly higher appearance congruence in those who achieved their desired transition compared to other groups, and individuals who attained their desired transition exhibited significantly reduced gender‐related motivations for weight loss compared to those with no plans to transition. These findings underscore the potential psychological benefits associated with successful gender‐affirming care, highlighting its role not only in fostering appearance congruence but also in mitigating gender‐related motivations for weight loss among TGE individuals. Future research should include larger and more diverse samples, longitudinal designs, and considerations of other factors influencing body image outcomes in this population. Public Significance: This study sheds light on the crucial relationship between gender‐affirming care and body image outcomes in TGE individuals. Understanding how appearance congruence and gender‐related motivations for weight loss are associated with disordered eating can inform tailored support and interventions. By recognizing the association of gender affirming care and well‐being, healthcare providers can enhance care for TGE individuals. [ABSTRACT FROM AUTHOR]

Objective: Eating disorder (ED), depression, and anxiety symptoms at admission and discharge were compared, as were admission‐to‐discharge changes, for transgender and gender diverse (TGD), and cisgender adolescents receiving intensive treatment for EDs. Method: Participants were 44 TGD and 573 cisgender adolescents admitted to a treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE‐Q), Patient Health Questionnaire‐9 (PHQ‐9), and Generalized Anxiety Disorder‐7 (GAD‐7) at admission and discharge. Results: Both groups had elevated EDE‐Q scores at admission (TGD: M = 3.78, standard deviation [SD] = 1.70; cisgender: M = 3.33, SD = 1.74) that improved by discharge (TGD: M = 2.27, SD = 1.83, Cohen's d =.98; cisgender: M = 2.10, SD = 1.54, Cohen's d =.79); there were no differences in EDE‐Q between groups at admission (p =.09; odds ratio [OR] = 1.18, 95% confidence interval [CI] [.98, 1.44]) or discharge (p =.48; OR = 1.07, 95% CI [.88, 1.30]). On admission, TGD adolescents had higher suicidality, measured by PHQ‐9, item 9 (p <.001; OR = 1.94, 95% CI [1.51, 2.52]), and depression (p <.001; OR = 1.10, 95% CI [1.05, 1.16]) than cisgender participants. Severity decreased over treatment for all measures. Both groups showed similar improvement on suicidality (p =.93; OR =.98, 95% CI [.70,1.36]), depression (p =.42; OR = 1.02, 95% CI [.97, 1.07]), and anxiety (p =.14; OR = 1.05, 95% CI [.99, 1.12]). However, at discharge, suicidality (p =.02; OR = 1.40, 95% CI [1.04, 1.85]), depression (p <.01; OR = 1.06, 95% CI [1.02, 1.11]), and anxiety (p =.02; OR = 1.06, 95% CI [1.01, 1.12]) were higher for TGD adolescents than their cisgender peers. Discussion: All participants had similar ED symptom severity and improvement. Depression, anxiety, and suicidality remained elevated for TGD adolescents compared to their cisgender peers at discharge, suggesting the need for targeted treatment. Public Significance: Transgender and gender diverse (TGD) adolescents have increased risk of eating disorders (EDs); few studies examine how they respond to ED treatment. We examine treatment outcomes of TGD adolescents receiving ED treatment compared to their cisgender peers. We measured ED symptoms along with depression, anxiety, and suicidality at the beginning and end of treatment. While TGD adolescents showed similar improvement in ED symptoms, measures of depression, anxiety, and suicidality remained elevated at the time of discharge. [ABSTRACT FROM AUTHOR]

LGBTQ + people are often studied as a uniform population. This study sought to examine health factors and outcomes across cisgender (CG) minorities, transgender (TG) minorities, and nonbinary/genderqueer (NBGQ) minorities. A self-reporting, cross-sectional survey was distributed to a sample of LGBTQ + people in a Midwest state. Binary logistic regressions were analyzed to identify significant minority subgroup differences in health factors and outcomes across gender identity. Compared to CG minorities (n = 520), TG minorities (n = 42) had higher odds (ORs = 2.0 to 3.9) of having a depression diagnosis, overall poor health, suicide ideation, and victimization. Likewise, compared to CG minorities, NBGQ minorities (n = 69) had higher odds (ORs = 1.9 to 4.2) of having depression symptoms, disability, a suicide attempt, and victimization. There were no significant differences in health factors and outcomes between TG minorities and NBGQ minorities. These gender-specific disparities may be secondary to unique obstacles (e.g., gender minority-related systemic discrimination) that gender diverse minorities face much more often than CG minorities. Further investigation into these distinctive minority subgroups is needed to establish future guidance for understanding and optimizing healthcare in LGBTQ + communities. [ABSTRACT FROM AUTHOR]

Research with transgender and gender-diverse (TGD) young people is essential to understand their experiences and to be able to propose, implement and adapt 'services' in the broadest sense to meet their needs. However, research outside clinical settings on current experiences and needs of youth under the age of 18 is limited which hinders the development of knowledge on TGD, as well as the development of research informed support practices. Acquiring parental consent for participatory research may present ethical and logistical difficulties, as it could jeopardize the safety, well-being, or confidentiality of adolescent participants. This creates a tension between the adolescent's right to autonomy, privacy, freedom, and all aspects related to the consent of the underage on the one hand, and the parents' right to protect their child on the other hand. This review aims to identify the methodological and ethical challenges associated with participatory research with transgender and gender-diverse young people. We systematically searched bibliometric databases for studies published between 2006 and 2022 and included 4 main conceptual groups: transgender and gender non-conforming, adolescence, qualitative research (including participatory research) and consent. This review was registered in PROSPERO (CRD42022368360) in November 2022. Of the 3,794 articles initially identified, 291 met the inclusion criteria and 48 were examined. The selected studies were analyzed in the light of four main ethical tensions: involving parents or a trusted person in the consent gathering process, ensuring the protection and safety of young people while respecting confidentiality, and ensuring that spaces are created for transgender and gender-diverse young people to express themselves freely as part of an empowering research process. At the same time, several methodological challenges concerning public and stakeholder participation and recruitment, data collection and analysis as well as research integrity emerged from the selected studies. The existing literature of participatory research involving young transgender and gender-diverse individuals underscores the intricate and conflicting aspects, especially concerning power dynamics, empowerment, and the researcher's role. The relevance of these findings extends across various legal frameworks and is applicable to multiple contexts and countries. [ABSTRACT FROM AUTHOR]

This article explores the intersectional perspectives of parents of transgender children in Aotearoa (New Zealand). The substantial body of research on parent experiences in this area has largely focused on parents who are white North American middle-class cisgender women. We seek to extend this research by taking an intersectional approach and examining the perspectives of a group of participants of different genders, sexual orientations, and cultural backgrounds. We asked 20 participants in Aotearoa who self-identified as gender-affirming parents to draw their experience of parenting a transgender child and discuss this with us in interview. The research resulted in rich visual and verbal depictions of gender-affirming parenting, drawing from the intersectional perspectives of Māori, Pākehā, Pacific, Asian, queer, straight, female, male and non-binary parents. Using visual and verbal discourse analysis, we explore how the participants constructed their experience from their uniquely situated perspectives, both specific and multilayered. We argue that the parents' perspectives reveal both challenges and strengths, reflecting the burdens of intersectional oppression, while also fostering the parents' capacity for engaging in discursive resistance to advance their children's interests. [ABSTRACT FROM AUTHOR]

Research on the daily experiences of transgender and gender diverse (TGD) youth 18 years or younger is limited, making it essential to gain a comprehensive understanding of their internal and external experiences related to gender identity. This systematic review and qualitative research synthesis fills this research gap by examining the lived experiences and coping of TGD youth, including prepubertal children. The review was pre-registered according to PROSPERO on the Open Science Framework and followed the ENTREQ reporting guidelines. A Qualitative research synthesis, according to Howell Major and Savin-Baden, was conducted. Seventeen peer-reviewed articles published between 2000 and 2023 fulfilled inclusion criteria and quality assessment. Synthesized themes were: (1) "Navigating gender identity", with two sub-themes, Meaning-making and Considering visibility (2) "Navigating relations", with four sub-themes: Longing for belonging, Supportive actions, Lack of safety and Coping inside out (3) "Navigating society with two sub-themes Inclusion and exclusion and Beyond control. Our findings demonstrate that TGD youth view gender identity as fluid and benefit from a supportive environment that facilitates genuine exploration. Coping strategies develop intricately, influenced by multifaceted factors. Unlike previous research on the negative effects of minority stress, our review underscores the cumulative impact of subtle daily stressors on TGD youth's well-being, highlighting the significance of an environment where gender is not a constant concern. By shedding light on these dynamics, this synthesis contributes to a comprehensive understanding of TGD youth's perspectives for professionals and a broader audience. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD.Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders.Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders.Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further. [ABSTRACT FROM AUTHOR]

Background: Traditionally, gender has been viewed through an essentialist lens with fixed biology-based traits or polarized gender norms between women and men. As awareness of gender diversity grows, increasingly more people are coming out as nonbinary – or not exclusively a man or woman. Little has been explored regarding experiences unique to nonbinary individuals, particularly beyond a focus on adverse risks and outcomes to understand their wellbeing. This article discusses gendered experiences and the construction of wellbeing among nonbinary individuals. Aim: The purpose of this study was to conceptualize wellbeing as a complex multidimensional phenomenon through nonbinary individuals' perspectives. Methods: A virtual PhotoVoice study was conducted with 17 nonbinary adults in the Midwestern United States who participated in online group discussions and in-depth semi-structured interviews, which were analyzed with thematic analysis. Results: The analysis identified five core dimensions of nonbinary wellbeing: 1) Security, 2) Mental and physical health, 3) Autonomy, 4) Belonging, and 5) Gender positivity. Exemplary definitions of wellbeing are also presented. Discussion: Understanding how nonbinary individuals thrive challenges the framing of gender diverse experiences in adversity and presents a more holistic portrayal that community members and allies can strive toward. This study contributes an intersectional understanding of wellbeing in relation to identities of race, culture, age, disability, neurodiversity, and sociopolitical geographical context. The findings of this study can aid in practice, advocacy, and research to bolster the wellbeing of nonbinary people. [ABSTRACT FROM AUTHOR]

Background: Pervasive health and healthcare disparities experienced by transgender (trans) and gender diverse (TGD) people require innovative solutions. Peer-based interventions may address disparities, and are an approach endorsed by TGD communities. However, the scope of the literature examining peer-based interventions to address health and healthcare access inclusive of TGD people is uncharted. Aim: This scoping review aimed to understand the extent of the literature about peer-based interventions conducted with and/or inclusive of TGD populations; specifically, study participants (e.g. sociodemographics), study designs/outcomes, intervention components (e.g. facilitator characteristics), and intervention effectiveness. Methods: Underpinned by Arksey and O'Malley's framework: (1) identifying the research question; (2) identifying studies; (3) study selection; (4) charting data; and (5) collating, summarizing, and reporting results, eligible studies were identified, charted, and thematically analyzed. Databases (e.g. ProQuest) and snowball searching were utilized to identify peer-reviewed literature published within 15 years of February 2023. Extracted data included overarching study characteristics (e.g. author[s]), methodological characteristics (e.g. type of research), intervention characteristics (e.g. delivery modality), and study findings. Results: Thirty-six eligible studies documented in 38 peer-reviewed articles detailing 40 unique peer-based interventions were identified. Forty-four percent (n = 16/36) of studies took place in United States (U.S.) urban centers. Over half (n = 23/40, 58%) focused exclusively on TGD people, nearly three-quarters of which (n = 17/23, 74%) focused exclusively on trans women/transfeminine people. Ninety-two percent (n = 33/36) included quantitative methods, of which 30% (n = 10/33) were randomized controlled trials. HIV was a primary focus (n = 30/36, 83.3%). Few interventions discussed promotion of gender affirmation for TGD participants. Most studies showed positive impacts of peer-based intervention. Discussion: Although promising in their effectiveness, limited peer-based interventions have been developed and/or evaluated that are inclusive of gender-diverse TGD people (e.g. trans men and nonbinary people). Studies are urgently need that expand this literature beyond HIV to address holistic needs and healthcare barriers among TGD communities. [ABSTRACT FROM AUTHOR]

Further research is urgently needed to address the disproportionately high rates of eating disorders (EDs) among transgender, gender diverse, and intersex (TGDI) individuals in comparison to cisgender, endosex (non-intersex) populations. As TGDI advocates, academics, and clinicians with lived/living experience with EDs, we propose a set of recommendations to guide ethical research specifically about EDs and disordered eating behaviors in TGDI populations. The guidelines included here aim to educate non-TGDI researchers and support TGDI researchers seeking to carry out such research. Considerations for study design, planning, data collection, and dissemination are included. [ABSTRACT FROM AUTHOR]

To explore themes regarding work-related barriers to access to health care, we conducted 32 interviews, 16 with third gender people and 16 with cisgender women, all of whom were all living with HIV in Hyderabad, India. Most respondents were members of Dalit castes and had been living with HIV for several years at the time of the interview. Using thematic content analysis, interviews were coded by two researchers using a social determinants of health conceptual framework. Themes highlighted in this study include the burden of taking time off from work, the loss of pay associated with missing work, and the interruption of gendered care work responsibilities that respondents faced when seeking treatment. Findings from this study support the claim that equitable work policies and practices for marginalized laborers can increase access to medical care for people living with HIV. [ABSTRACT FROM AUTHOR]

Background: Gender-diverse youth experience twice the risk for homelessness as their same-age cisgender peers and report experiencing discrimination in homeless shelters and supported housing. Method: Eighteen participants (9 gender-diverse residents and 9 staff members) were interviewed individually to understand their experience of and needs in these settings. Results: The major findings included: (a) Gender-diverse service recipients felt unsafe and vulnerable in these facilities. Sharing space in which to carry out occupations of vulnerability often triggered anxiety and PTSD. (b) Gender-diverse service recipients felt that staff members did not understand how cumulative trauma adversely affected participation in programmatic activities. (c) Staff members reported that their facilities did not provide formal training needed to understand and address the unique needs of gender-diverse residents. (d) Gender-diverse service recipients commonly sustained trauma throughout their lives that compromised their ability to attain desired daily life skills and adult occupational roles. Such ruptures in their knowledge base likely served to maintain their homelessness despite repeated shelter admissions and housing placements. Conclusion: Occupational therapists could provide essential intervention to a gender-diverse youth population, including assisting with the attainment of skills needed for apartment management, employment seeking, maintenance, and health management. [ABSTRACT FROM AUTHOR]

Abstract screenings, 95 articles were reviewed in full, and 63 articles were included within this analysis. Consistent antecedents of SRB were socioeconomic status, race, gender, violence, alcohol/drug use, and mental health. Attributes included several ways of defining SRBs such as frequency of condom use and type of partners. The most consistent outcome of SRBs was contraction of STIs and subsequent health problems. Few studies examined mental health outcomes of SRBs. Future research should create a standardized tool for measuring SRBs to inform policy for providing sexual health education to TGD populations, which will ultimately decrease disparities in STIs. [ABSTRACT FROM AUTHOR]

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). METHODS: The PEDSnet sample included 14- to 17-years-old patients who had ≥2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or selfreported transgender identity (YRBS). RESULTS: The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. CONCLUSIONS: GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision. [ABSTRACT FROM AUTHOR]

Background: Rough sex refers to consensual sexual activities that incorporate playful aggression, such as hair pulling, spanking, or choking. It is relevant in the context of sexual health as it can enhance sexual arousal, pleasure, and intimacy among consenting partners. However, it can also be associated with consent violations, discomfort, and injuries ranging from mild to severe or even fatal. The prevalence of rough sex in Germany is widely unknown. Our study aims to establish, for the first time, the overall age‐related and gender‐related prevalence rates of active and passive rough sex involvement among adults in Germany. Methods: A national online sample of 1101 adults from Germany, aged 18–69 years (50% men, 49% women, 1% gender‐diverse individuals) gave informed consent and reported on their lifetime engagement in rough sex in active and passive roles. We recruited participants through a professional panel provider for a multi‐themed sexual health survey. Data analysis was conducted using R, with 95% confidence intervals of prevalence rates computed to answer the research questions. Results: Lifetime prevalence of rough sex involvement was 29%. Adults below the age of 40 reported higher rates of involvement (up to 43%) than people over 40 (up to 26%). Men reported predominantly active role involvement and women reported primarily passive role involvement. Discussion: Results show that rough sex is common. Sexual health professionals, educators, and researchers should be prepared to guide current and aspiring practitioners of rough sex, helping them understand potential benefits, risks, and age‐ and gender‐related differences. [ABSTRACT FROM AUTHOR]

Background: Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. Methods: We conducted a multi‐stage thematic analysis of 33 in‐depth interviews among transgender and gender diverse youth (ages 15–24) living in the southeastern United States on their sexual health education experiences. Results: Our study participants described school‐based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white‐centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment‐free information while holding positive framing around sexuality and gender. Conclusion: There is much work needed to improve the breadth, quality, and relevance of school‐based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community‐based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer‐friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways. [ABSTRACT FROM AUTHOR]

Election officials across the country are turning away voters when they perceive a mismatch between the sex listed on the voter’s identification and the voter’s gender presentation. The problem is particularly acute for transgender and gender nonconforming voters. This Note presents a fifty-state survey of voter ID laws and shows that there is no legal basis for using a mismatch or perceived mismatch between a voter’s documented sex and their gender presentation to deny the franchise. No language in any state statute indicates that an individual’s sex is required as evidence of their identity. Furthermore, this Note argues that changing the statutes to require sex as an identity qualifier would violate the Equal Protection Clause of the Fourteenth Amendment in at least two ways. First, such a requirement would amount to sex discrimination as that term is best understood in light of Bostock v. Clayton County. Second, under the Supreme Court’s voting rights jurisprudence, such a requirement would constitute an invidious restriction on the right to vote, triggering strict scrutiny under Harper v. Virginia Board of Elections. Even if it did not amount to such a restriction, the requirement of sex as a voter qualification would still be struck down under the sliding scale scrutiny of the Anderson-Burdick doctrine. Thus, hinging the right to vote on the verification of one’s sex is almost certainly unconstitutional. [ABSTRACT FROM AUTHOR]

In daily interactions, individuals use irony and prosocial lies for various reasons, for example, to be humorous, to criticize, or to be polite. While some studies have examined individual differences in perceiving the politeness of such language, research using naturalistic, context-rich materials is lacking. To address this gap, we utilized short videos to assess politeness perception in literal, ironic, and prosocial lie scenarios while also exploring differences based on age, gender, and geographical location. Our sample included 288 participants from the United States and the United Kingdom. We focused on five different types of language: literal positive, blunt, sarcastic, teasing, and prosocial lies. Participants rated the politeness of these statements and completed surveys on communication preferences (Self-Reported Sarcasm Questionnaire and Conversational Indirectness Scale Questionnaire). While the demographic groups showed similarities, individual factors also shaped politeness perception. Older adults perceived teasing as less polite than middle-aged and younger adults, and male participants rated blunt and sarcastic statements as more polite. Geographical variations were found for prosocial lies, with U.K. participants rating them more polite than their U.S. counterparts. These findings underscore the importance of considering context-rich materials and individual factors in understanding the social functions of irony and prosocial lies. [ABSTRACT FROM AUTHOR]

The merits and means of accommodating non-binary populations into UK law is becoming an increasingly important issue for policymakers, judges, scholars and legal professionals. Following Elan-Cane's Supreme Court challenge to binary passport sex markers in 2021, the UK Government face another challenge this year concerning non-binary recognition on birth certificates. While an additional third sex option is perhaps the most well-known reform option for the current binary system, other options have been suggested, including additional multiple sex options and/or removing sex from the birth certificate. While scholars and policymakers debate the merits of these, little is known about non-binary people's own preferences towards these options. This paper therefore presents original empirical data on non-binary attitudes towards these options, demonstrating the various perceived opportunities and drawbacks of each, and reflecting on the possible consequences of reform. [ABSTRACT FROM AUTHOR]

The article discusses the importance of language activism in relation to the transgender community. It highlights the changes in norms around gender-inclusive language and the innovations in linguistic forms by trans, queer, and gender nonconforming individuals. The article emphasizes the need for intersectional coalitions in addressing linguistic issues faced by trans people, as transphobia is intensified by other forms of oppression. It also explores the challenges faced by trans language activism, including limited circulation, language ideologies, and the unequal impact of trans-affirming language. The article concludes by discussing the complex relationship between trans-affirming language and resistance to colonialism and cultural imperialism. [Extracted from the article]

Purpose: The aim of this study was to explore the gap between the need for gender-affirming voice and communication services (GAVCS) and insurance coverage within one state. Method: An electronic, cross-sectional survey of transgender/gender-diverse (TGD) adults assessed the incidence of insurance and cost barriers to GAVCS. Then, policies from 22 major insurers were reviewed using a web-based search and telephone inquiries. Finally, a tool was developed for clinicians to share available coverage for GAVCS by insurer. Results: Over half (53%) of 115 respondents reported vocal incongruence, but only 19.1% had pursued GAVCS. Of those who had not, 57% reported cost and/or insurance coverage were barriers (most of whom were commercially insured). Less than half of major Ohio insurance plans mentioned GAVCS coverage, and of those who did, less than half would consider covering it on a caseby- case basis. Creation of a tool that explained coverage across insurance companies was helpful, but challenging and labor-intensive. Conclusions: TGD individuals often experience a mismatch between their gender identity and societal perceptions of their voice, which can worsen dysphoria and compromise safety. GAVCS align voice with gender identity but are inconsistently covered by health insurance and can be costly, particularly for individuals who face socioeconomic marginalization. Inconsistent transparency in communicating coverage criteria further exacerbates access to GAVCS. Poor insurance coverage of GAVCS is an important barrier to accessing this evidence-based care, and more transparency and consistency in coverage is critical. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about depression treatment for transgender and gender diverse (TGD) older adults or TGD people with disabilities. The purpose of this study was to characterize receipt of minimally recommended depression treatment and outcomes for TGD Medicare beneficiaries. Methods: Using Medicare claims data from 2009 to 2016, we identified potential TGD beneficiaries with depression (n=2223 TGD older adult beneficiaries and n=8752 TGD beneficiaries with a disability) and compared their rates of minimally recommended mental health treatment, inpatient mental health hospitalizations, psychotropic medication fills, and suicide attempt to a group of Comparison beneficiaries with depression (n=499,888 adults aged 65+ years and n=287,583 who qualified due to disability). We estimated disparities in outcomes between TGD and non-TGD beneficiaries (separately by original reason for Medicare eligibility: age 65+ years vs. a disability) using a rank-and-replace method to adjust for health needs. Results: After adjustment, rates of minimally recommended mental health treatment and psychotropic medication fills were higher among TGD versus Comparison beneficiaries, as were rates of inpatient mental health visits and suicide attempts (predicted mean of disparities estimates for older adult subgroup: 0.092, 0.096, 0.006, and 0.002, respectively, all p<0.01; and in subgroup with disability: 0.091, 0.115, 0.015, and 0.003, respectively, all p<0.001). Conclusion: Despite higher mental health treatment rates, TGD beneficiaries with depression in this study had more adverse mental health outcomes. Minimum recommended treatment definitions derived in general population samples may not capture complex mental health needs of specific marginalized populations. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to determine the prevalence of certain autoimmune diseases in transgender and gender diverse (TGD) youth. Methods: A multicenter, retrospective analysis was conducted from January 2013 to January 2019 of youth ≤26 years of age with concurrent diagnoses of gender dysphoria (GD) and at least one of the studied autoimmune diseases. Prevalence rates were calculated and compared to previously reported rates. Statistical significance was determined using second generation p-values as pooled estimates of prevalence rates across study sites compared to a range of rates reported in the literature. Results: During the study period, 128 of 3812 (3.4%) youth evaluated for GD had a concurrent diagnosis of at least one of the studied autoimmune diseases. Three autoimmune diseases had prevalence rates significantly higher than those previously documented in the literature (second generation p-value=0.000): type 1 diabetes mellitus (112.8/10,000, 95% confidence interval [CI]: 83.8–151.8), systemic lupus erythematosus (13.1/10,000, 95% CI: 5.5–31.5), and Graves' disease (12.3/10,000, 95% CI: 4.0–38.4). Conclusion: There is an increased prevalence of certain autoimmune diseases in youth who identify as TGD presenting for subspecialty care. Limitations such as retrospective study design, selection bias, and reliance on electronic medical records make it difficult to draw wide-reaching conclusions about these findings. This study highlights the need for more research to delineate the impacts of unrecognized or untreated GD on autoimmune disease development and control. [ABSTRACT FROM AUTHOR]