Transgender Youths and Sanctuaries for Gender-Affirming Care.

This Viewpoint suggests ways state and local governments can support transgender youths seeking gender-affirming care amid continued passage of antitransgender legislation.

Speech therapy assistance to the transgender population: an experience report / Atendimento fonoaudiológico à população transgênera: um relato de experiência

An incompatible voice with one's own identity is a theme frequently pointed out by the transgender population in speech therapy sessions. Speech therapy is a technique that allows the adjustment of the speaker's voice within a range of possibilities. The speech-language pathologist's role is to provide training, guidance, and counseling to this population, taking into account the specificities of each individual. In light of this, this study aims to report the experience of undergraduate students and speech-language professionals in providing care to the transgender population in a communication laboratory. Initially, key concepts, such as the differences between sex, gender, gender identity, and sexual orientation, are presented. Topics addressed include the violence suffered by the transgender population, the pursuit of vocal adaptation, the creation and development of the communication clinic, the support and assistance provided by professionals to the transgender population and their families, as well as the procedures adopted by the clinic. Among the conclusions, it is highlighted that speech therapy has demonstrated the importance of individual-centered care, legitimizing the guarantee of promoting the users' health. Furthermore, the importance of the speech-language professional in the vocal and communicative improvement of this population, which is often stigmatized, is emphasized (AU).

Voz incompatível com a própria identidade é um tema frequentemente apontado pela população transgênera em atendimentos fonoaudiológicos. A fonoterapia é uma técnica que permite a adequação da voz do falante, dentro de um campo de possibilidades. Ao fonoaudiólogo cabe o treinamento, a orientação e o aconselhamento dessa população, levando em conta as especificidades de cada indivíduo. Diante disso, este estudo tem como objetivo relatar a experiência de estudantes de graduação e profissionais de Fonoaudiologia no atendimento voltado à população transgênera em um laboratório de comunicação. Inicialmente são apresentados conceitos-chave, tais como as diferenças entre sexo, gênero, identidade de gênero, e orientação sexual. São abordados temas como a violência sofrida pela população trans, a busca pela adequação vocal, a criação e o desenvolvimento do ambulatório de comunicação, o acolhimento e o suporte prestado pelos profissionais à população trans e a seus familiares, além dos procedimentos adotados pelo ambulatório. Dentre as conclusões, destaca-se que a assistência fonoaudiológica tem mostrado a importância do cuidado centrado no indivíduo, legitimando a garantia da promoção de saúde dos usuários. Ademais, é destacada a importância do profissional de fonoaudiologia no aprimoramento vocal e comunicativo dessa população que é frequentemente estigmatizada (AU).

[Transitions, reinventing the genre]. / Transitions, une réinvention du genre.

Our consultations are saturated by an influx of requests from young people - and very often from their parents - for whom the binarity of the boy/girl classification has been shattered, and whose only watchword is: "I choose my gender, my sexuality, my body, my way of being, of moving and representing myself, I want to become what I am". For them, anatomy is no longer a fatality: hormones, mutilating and restorative surgeries, increasingly sophisticated aesthetic techniques make it possible to adapt their body and their gender to their intimate aspirations. Psychological support must help these patients to explore their gender identity, and allow them to live it as well as possible in their social and family environment.

State Restrictions and Geographic Access to Gender-Affirming Care for Transgender Youth.

This study estimates changes in geographic access and drive times to gender clinics following legislation enacted to restrict puberty-suppressing medications and hormones for those younger than 18 years.

Characteristics and gender affirming healthcare needs of transgender and non-binary students starting hormone therapy in a student health service in Aotearoa New Zealand.

Introduction Traditionally, gender-affirming hormonal therapy (GAHT) is initiated in secondary care, but a primary care based approach has been developed to reduce access barriers. Aim We aim to describe the demographics, hormone choices, and additional referrals made for young people initiating GAHT in a primary care setting in Aotearoa New Zealand. Methods Clinical notes were reviewed for all patients who commenced GAHT between 1 July 2020 to the end of 2022 at a tertiary education health service. Data were collected on age, ethnicity, gender, type of hormones prescribed, and any additional referrals. Results Eighty five patients commenced GAHT during the review period (64% assigned male at birth and starting oestrogen-based GAHT, 36% assigned female at birth and commencing testosterone-based GAHT). Fourty seven percent of patients identified as transgender female, 38% as non-binary, and 15% as transgender male. Spironolactone was the most common choice of testosterone blocker (81%). The choice of oestrogen formulation was fairly equal between patches (54%) and tablets (46%). Eighty percent of those assigned male at birth chose to preserve fertility, 54% requested voice therapy, and 87% of those assigned female at birth requested top surgery. Discussion There is a need for improved understanding of non-binary gender-affirmation needs, in particular those of Maori and Pasifika youth. An informed consent approach in primary care can reduce barriers and distress for transgender youth seeking GAHT. The high unmet need for top surgery for transgender people assigned female at birth requires attention.

[Taking care of trans minors]. / Prendre en charge les mineurs trans.

The issue of trans minors is becoming more and more important as a new issue of care, especially in the health field. The nursing world is no stranger to these requests for support, at school or in specialized centers. This is why, through this article, it seemed necessary to go back over some definitions and to deconstruct some prejudices concerning this population.

Guidance for Research with Trans and Gender-Diverse People.

When engaging in research with marginalized communities, it is important for researchers to reflect on their practice and consider what steps they can take to avoid perpetuating inequality or causing harm. This article provides guidance for researchers working with trans and gender-diverse individuals from the perspective of two speech-language pathologists. Key considerations presented by the authors include the importance of engaging in reflexive research practices-thinking deeply about and acknowledging impacts of one's personal beliefs, values, and practices on one's research-and developing an awareness of factors that contribute to the trans and gender-diverse community's ongoing minority stress. Specific suggestions to redress power imbalance between the researcher and the researched community are provided. Finally, practical methods for implementing the guidance are presented: the community-based participatory research model and an example in speech-language pathology research with trans and gender-diverse individuals.

Improving the inclusion of transgender and nonbinary individuals in the planning, completion, and mobilization of cardiovascular research.

Cardiovascular disease is the leading cause of morbidity and mortality globally. Transgender and nonbinary (TNB) individuals face unclear but potentially significant cardiovascular health inequities, yet no TNB-specific evidence-based interventions for cardiovascular risk reduction currently exist. To address this gap, we propose a road map to improve the inclusion of TNB individuals in the planning, completion, and mobilization of cardiovascular research. In doing so, the adoption of inclusive practices would optimize cardiovascular health surveillance and care for TNB communities.

Gender-affirming hormonal therapy for transgender and gender-diverse people-A narrative review.

As the number of transgender and gender-diverse (TGD) people accessing gender-affirming care increases, the need for healthcare professionals (HCPs) providing gender-affirming hormonal therapy (GAHT) also increases. This chapter provides an overview of the HCPs interested in getting involved in providing GAHT.

Transnational Trans Woman Inspires and Informs Evidence-Informed Interventions.

Transitional Care Coordination is an evidence-informed model program developed by New York City Correctional Health Services as a Health Resources and Services Administration Special Projects of National Significance Correctional Health Linkage Intervention. Using implementation science under this and subsequent demonstration projects, interventions were adapted and enhanced to address the transitional needs of people of Puerto Rican ancestry and to expand the network of care across the islands of Puerto Rico. These interventions were informed, in part, by a transnational trans woman of color of Puerto Rican ancestry living with HIV. A socioecological model framework and case study are used to illustrate how evidence-informed interventions are developed and adapted to address the needs of those served.

Self-reported health conditions, quality of Primary Health Care and associated factors according to sexual and gender minorities / Condições de saúde autorreferidas, qualidade da Atenção Primária à Saúde e fatores associados segundo minorias sexuais e de gênero

Introduction: Lesbians, gays, bisexuals, transvestites, transsexuals, transgenders, queers, intersexes, asexuals, pansexuals, and other sexual and gender minorities constitute a population that has been little studied regarding the use and care of health services. Objective: From this perspective, the general objective of this study was to evaluate the quality of Primary Health Care according to members of sexual and gender minorities. Methods: This is evaluative research, with a cross-sectional and descriptive-analytical design and a quantitative approach, performed by a web survey in Brazil. The script for data collection addressed sociodemographic characteristics, sexual orientation, gender identity, self-reported health conditions, and the 23 items of the Primary Care Assessment Tool, a reduced version for adult users. Results: The results represent 314 LGBTQIAP+ people, predominantly young, white, cisgender, homosexual, and bisexual, from the five Brazilian regions, highlighting the states of Minas Gerais and São Paulo. The use of alcoholic beverages and other substances, weight change, and the presence of mental diseases were the most frequent self-reported health conditions. Primary health care was mainly evaluated with low overall scores, thus indicating low quality. The attributes "community guidance" and "coordination" (care integration) were marked by unfavorable evaluations, indicating small extensions. People belonging to sexual and gender minorities who worked had kidney problems, had been hospitalized recently, and that had their gender identity and sexual orientation known by health professionals were more likely to evaluate the Primary Health Care as good. Conclusion: This work points out weaknesses in the care of the LGBTQIAP+ population the following attributes: family guidance, accessibility, longitudinality, and available services, which can be prioritized to improve the quality of Primary Health Care in the Brazilian Unified Health System. (AU)

Introdução: Lésbicas, gays, bissexuais, travestis, transexuais, transgêneros, queer, intersexos, assexuais, pansexuais e outras minorias sexuais e de gênero constituem uma população pouco estudada no que se refere ao uso e atendimento em serviços de saúde. Objetivo: Nessa perspectiva, o objetivo geral deste estudo foi avaliar a qualidade da Atenção Primária à Saúde segundo integrantes de minorias sexuais e de gênero. Método: Trata-se de uma pesquisa avaliativa, com delineamento transversal, descritivo-analítico, de abordagem quantitativa, por meio de web survey no Brasil. O roteiro de coleta abordou características sociodemográficas, de orientação sexual, identidade de gênero, condições de saúde autorreferidas e os 23 itens do instrumento Primary Care Assessment Tool, versão reduzida para usuários adultos. Resultados: Os resultados representam 314 pessoas LGBTQIAP+, predominantemente jovens, brancos, cisgêneros, homossexuais e bissexuais, provenientes das cinco regiões brasileiras, com destaque para os estados de Minas Gerais e São Paulo. O uso de bebidas alcoólicas e outras substâncias, a alteração ponderal e a presença de doenças mentais foram as condições de saúde autorreferidas que mais se destacaram. A atenção primária à saúde foi majoritariamente avaliada com baixa pontuação geral, indicando baixa qualidade. Assinalam-se os atributos orientação comunitária e coordenação (integração de cuidados) pelas avaliações negativas, indicando pequena extensão. As pessoas de minorias sexuais e de gênero que trabalhavam, possuíam problema renal, haviam sido internadas recentemente e sua identidade de gênero e orientação sexual eram conhecidas pelos profissionais de saúde apresentaram mais chance de avaliar bem a Atenção Primária à Saúde. Conclusão: Este trabalho aponta como fragilidades no cuidado da população LGBTQIAP+ os atributos de orientação familiar, acessibilidade, longitudinalidade e serviços disponíveis que podem ser priorizadas para a melhoria da qualidade da Atenção Primária à Saúde do Sistema Único de Saúde brasileiro. (AU)

Guías para el abordaje de infancias y adolescencias trans en el primer nivel de atención / Guidelines for approaching trans children and adolescents at primary care level / Recomendações para lidar com pais de crianças e adolescentes trans no primeiro nível de atenção

Introducción: en muchas oportunidades el/la pediatra o médica/o de familia será la primera persona a la que consulten los niños/as y adolescentes trans a fin de plantear sus dudas y experiencias, por lo tanto es fundamental que el/la profesional aborde en la consulta esta temática sin prejuicios, con una mirada actualizada en el marco de los derechos de niñas, niños y adolescentes. Objetivo: brindar herramientas para un adecuado acompañamiento y seguimiento en la atención en salud a las infancias y adolescencias trans en el primer nivel de atención. Metodología: para la elaboración de esta guía se hizo una revisión bibliográfica en Pubmed y Scielo. Se realizó dicha búsqueda desde 2010 a la fecha con el prescriptor "infancias trans", "adolescencias trans", en inglés y en idioma español. Resultados: se elaboraron guías para el abordaje en la atención en el primer nivel de atención de niños/as y adolescentes trans aportando herramientas para la historia clínica, teniendo en cuenta la entrevista, el examen físico y el abordaje multi e interdisciplinario. Conclusiones: las experiencias trans en las infancias y adolescencias no deben ser miradas desde un enfoque patologizador sino como vivencias legítimas. El/la profesional de la salud juega un rol fundamental en la función de acompañamiento y como garante de sus derechos promoviendo la autonomía en la toma de decisiones.

Introduction: many times pediatricians or family doctors are the first people trans-children and adolescents consult and raise questions and experiences to. Therefore, it is key for doctors to have an unbiassed approach to this issue in the consultation, with an updated view of the framework of children and adolescents. Objective: provide tools for proper health care support and follow-up ifor trans children and adolescents at primary care. Methodology: for the preparation of these guidelines, we made a bibliographic review in Pubmed, Scielo. This search was carried out from 2010 to date using "trans children", "trans adolescents" prescribers, in English and in Spanish. Results: guidelines were created for primary care regarding the care of trans children and adolescents, providing tools for medical records and considering the interview, the physical examination and the multi-interdisciplinary approach. Conclusions: trans experiences in childhood and adolescence should not be viewed from a pathologizing perspective, but rather as legitimate experiences. Health professionals play a key role in accompanying and guarding the rights of children and adolescents and promoting their autonomy in decision-making instances.

Introdução: em muitas ocasiões, o pediatra ou médico de família é a primeira pessoa que as crianças e adolescentes trans consultam para compartilhar suas dúvidas e vivências, por isso é fundamental que ele aborde a consulta sobre esse assunto sem preconceitos, com uma perspectiva atualizada no marco dos direitos de crianças e adolescentes. Objetivo: fornecer ferramentas para suporte e acompanhamento adequados no atendimento da saúde de crianças e adolescentes trans no primeiro nível de atenção. Metodologia: para a elaboração deste guia, foi feita uma revisão bibliográfica no Pubmed, Scielo. A pesquisa com as palavras "crianças trans", "adolescentes trans", vem sendo realizada desde 2010 até hoje em inglês e espanhol. Resultados: foram elaboradas diretrizes para a abordagem do cuidado no primeiro nível de atenção a crianças e a adolescentes trans, fornecendo instrumentos para a história clínica, levando em consideração a entrevista, o exame físico e a abordagem multidisciplinar. Conclusões: as experiências trans na infância e adolescência não devem ser vistas a partir de uma abordagem patologizante, mas sim como experiências legítimas. O profissional de saúde tem papel fundamental na função de acompanhamento e como garantidor de seus direitos, promovendo autonomia na tomada de decisões.

Saúde mental de mulheres transgêneras: uma revisão integrativa de literatura / Salud mental de las mujeres transgénero: una revisión integradora de la literatura / Mental health of transgender women: an integrative literature review

Objetivo: conhecer a produção científica nacional e internacional acerca da saúde mental das mulheres transgêneras de 2007 a 2017. Método: revisão integrativa realizada na Biblioteca Virtual em Saúde, em abril de 2018. Analisaram-se os estudos em seis fases, agrupando-os em categorias temáticas. Resultados: dos 30 estudos selecionados emergiram sete categorias temáticas, a saber: "necessidades de saúde mental", "vulnerabilidade psicossocial", "processo transexualizador", "mulheres transgêneras jovens e na terceira idade", "relações sociais", "direitos civis e cidadania" e "relações entre as mulheres transgêneras e os serviços de saúde". Conclusões: mulheres transgêneras estão expostas a maiores riscos de desenvolverem transtornos mentais, em relação às pessoas cisgêneras parecendo ter relação com o preconceito, estigma, discriminação, e negação de direitos civis. São transtornos mais prevalentes nesta população: depressão, ansiedade, ideação/ tentativa de suicídio, abuso de álcool e outras drogas, os quais estão diretamente relacionados com o não acesso aos serviços de saúde.(AU)

Objetivo: conocer la producción científica nacional e internacional sobre la salud mental de mujeres transgénero de 2007 a 2017. Método: revisión realizada en la Biblioteca Virtual en Salud utilizando los filtros listados en las bases de datos de Literatura Latinoamericana y Brasileña, en abril de 2018. Se analizaron en seis fases, agrupándolos en categorías temáticas. Resultados: de los 30 estudios seleccionados surgieron siete categorías: "necesidades de salud mental", "vulnerabilidad psicosocial", "proceso transexual", "mujeres trans jóvenes y ancianas", "relaciones sociales", "derechos civiles y ciudadanía" y "relaciones entre mujeres transgénero y servicios de salud". Conclusiones: mujeres transgénero están expuestas a mayores riesgos de desarrollar trastornos mentales, en relación con las personas cisgénero que parecen estar relacionadas con prejuicios, estigma, discriminación y negación de los derechos civiles. Los trastornos más prevalentes: depresión, ansiedad, ideación/ intento suicida, abuso de drogas, estando relacionados con la falta de acceso a servicios de salud.(AU)

Objective: to know the national and international scientific production about the mental health of transgender women from 2007 to 2017. Method: this is an integrative review conducted at the Virtual Health Library, April 2018. The studies were analyzed in six phases, grouping them into thematic categories. Results: from the 30 selected studies, seven thematic categories emerged: "mental health needs", "psychosocial vulnerability", "transsexualising process", "young and old transgender women", "social relations", "civil rights and citizenship" and "relationships between transgender women and health services". Conclusions: transgender women are at greater risk of developing mental disorders than cisgender people appearing to be related to prejudice, stigma, discrimination, and denial of civil rights. The most prevalent disorders in this population are depression, anxiety, suicidal ideation / attempt, alcohol, and other drug abuse, which are directly related to non-access to health services.(AU)