The implications of the gender-based prohibitions relating to human germline genome editing in the Human Fertilisation and Embryology Act.

RESEARCH QUESTION: What are the implications of the gender-based prohibitions relating to human germline genome editing (hGGE) in the Human Fertilisation and Embryology (HFE) Act 1990, as amended in 2008? DESIGN: A three-phase primary research design consisting of a mixed-methods online public survey of 521 UK citizens aged 16-82 years, 13 semi-structured interviews with experts and professionals involved in the future of hGGE, and structured interviews with 21 people affected by genetic conditions. The research was conducted between March 2018 and October 2019. RESULTS: Gender-based prohibitions in the HFE Act weaken its intent to prevent germline cells that have been altered from resulting in a pregnancy and the possible birth of people with edited genomes. This weakness could become increasingly problematic as genome editing technologies develop and social advances seek to eradicate gendered expectations and gendered binaries. CONCLUSION: The HFE Act should be amended to avoid gender-based discrimination and the potential gender-based prohibitions have to circumvent germline genome editing being used before the technology is considered safe enough to prevent disease.

Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations.

Case Scenerio: A 26-year-old patient presents to the dermatology clinic with severe nodulocystic scarring acne. The patient identifies as a transgender male and notes that he has been receiving hormone replacement therapy for the past 4 years with weekly intramuscular testosterone injections.

Trans Parenthood and the Meaning of 'Mother', 'Father' and 'Parent'-R (McConnell and YY) v Registrar General for England and Wales [2020] EWCA Civ 559.

In R (McConnell and YY) v Registrar General for England and Wales [2020] EWCA Civ 559, the Court of Appeal held the Registrar General was correct to register a trans man, who had given birth after the issuing of his gender recognition certificate, as 'mother' on his son's birth certificate. In their judgement, the court rejected the appellants' contention that the Gender Recognition Act 2004 should be construed to allow registration as either 'father' or 'parent'. The court further held that the interference with the appellants' Article 8 rights which resulted from the registration as 'mother' was proportionate and justified.

State-Level Transgender-Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender-Diverse People in the United States.

Policy Points Protective transgender-specific policies (including those related to experiences of discrimination, health insurance coverage, and changing legal documents) are associated with increased access to medical gender affirmation services (hormone treatment, therapy/counseling) for transgender and other gender-diverse people. Restrictive transgender-specific policies are associated with less access to these services. The relationship between race/ethnicity and use of medical gender affirmation services varies across states and is context specific, indicating that race/ethnicity also plays a role in access to these types of care across states. Advocacy is needed to prevent or overturn restrictive policies and promote protective policies for transgender and other gender-diverse people, especially for people of color. CONTEXT: In the 2010s, the number of federal, state, and local transgender-specific policies increased. Some of these policies advanced protections for transgender and other gender-diverse (TGGD) people, and others were restrictive. Little is known about the relationships between these policies and use of medical gender affirmation services (eg, hormone treatment, therapy/counseling), or about how these associations may vary among different racial and ethnic groups. METHODS: Multilevel modeling was used to examine the associations between state-level transgender-specific policies and the use of medical gender affirmation services among TGGD people in the United States. Data are from the 2015 U.S. Trans Survey of nearly 28,000 TGGD people. The medical gender affirmation services examined in this study were hormone treatment and therapy/counseling. The state policies we analyzed addressed discrimination, health insurance coverage, and changing legal documents; these policies were measured individually and as a composite index. Race/ethnicity was included in the multilevel regression models as a random slope to determine whether the relationship between race/ethnicity and the use of medical gender affirmation services varied by state. FINDINGS: Individual policies and the policy index were associated with both outcomes (use of therapy/counseling and hormone treatment services), indicating that protective policies were associated with increased care. Broad religious exemption laws and Medicaid policies that excluded transgender-specific care were both associated with less use of therapy/counseling, whereas transgender-care-inclusive Medicaid policies were associated with more use of therapy/counseling. Nondiscrimination protections that include gender identity were associated with increased use of hormone treatment services. The relationship between race/ethnicity and medical gender affirmation services varied across states. CONCLUSIONS: State-level transgender-specific policies influence medical gender affirmation service use and seem to affect use by non-Hispanic white TGGD people and TGGD people of color differently. Advocacy is needed to repeal restrictive policies and promote protective policies in order to reduce health inequities among TGGD people, especially people of color.

Care of the Transgender Patient.

Transgender persons are a diverse group whose gender identity differs from their sex recorded at birth. Some choose to undergo medical treatment to align their physical appearance with their gender identity. Barriers to accessing appropriate and culturally competent care contribute to health disparities in transgender persons, such as increased rates of certain types of cancer, substance abuse, mental health conditions, infections, and chronic diseases. Thus, it is important that clinicians understand the specific medical issues that are relevant to this population.

The Effects of Health Care Policies: LGBTQ Aging Adults.

Projected estimates for lesbian, gay, bisexual, transgender, queer (LGBTQ) populations in the United States reach 4 to 8 million older adults by 2030. Healthy People 2020 created goals to improve the health, safety, and well-being of these individuals. However, not all political agendas point to resolutions favorable for this population. Provisions under the Affordable Care Act once considered status quo protections for the LGBTQ community are now threatened as law makers are rolling back health care mandates, exposing members of the LGBTQ community to potential exacerbations of prejudice, discrimination, and stigmatization previously seen as historical violations of human rights. The purpose of this article is to identify how current health care policies have created legal windows of opportunity for persons to discriminate and create juxtaposition with goals and objectives of Healthy People 2020, promoting barriers in the health care continuum for LGBTQ aging adults. [Journal of Gerontological Nursing, 46(3), 9-13.].

Debate: You can't take politics out of the debate on gender-diverse children.

The focus of concern in the public conversation about the care of gender-diverse children and adolescents is to some degree a matter of politics: that is, the dynamics of power and 'voice' in our modern world. There are questions relating to child and parent autonomy in making identity-driven life decisions; the counterbalancing need to safeguard children when new technologies enable new life choices to be made; the role of professional 'experts' (e.g. in claiming to evaluate the 'authenticity' of a young person's gender identity); and the significance, and credibility, of different kinds of evidence in making treatment decisions. All these weighty and wide-ranging considerations come to the fore in the United Kingdom and elsewhere when discussing what might be an ethical, safe and just response to gender-diverse children in our changing society.

HIV and transgender women in Kampala, Uganda - Double Jeopardy.

Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use.

The Right to Trans-Specific Healthcare in Norway: Understanding the Health Needs of Transgender People.

Human rights discourse on the rights of transgender people has to a large extent focused on access to correction of legal gender and medical preconditions for this change. Jurisdictions across the world are now beginning to free legal gender recognition from medical interventions and examinations. State bodies have, however, done little to realise the rights of transgender people to adequate healthcare. A key issue is whether international law obliges states to ensure access to trans-specific healthcare. This article examines the right to healthcare appropriate to transgender persons' needs. Drawing on in-depth interviews with transgender people living in Norway, it investigates how individuals explain their needs for trans-specific healthcare. It shows that Norwegian healthcare practice uses the diagnosis of 'transsexualism' to determine a person's needs for trans-specific healthcare and as such excludes many from receiving the healthcare they need. The article analyses whether trans-specific healthcare falls within the ambit of the right to health under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the right to necessary healthcare under the Norwegian Patients' Rights Act. It concludes that the Norwegian authorities are obliged to provide equal access to adequate trans-specific healthcare to those who need it.

Transgender adolescents and legal reform: How improved access to healthcare was achieved through medical, legal and community collaboration.

Transgender children and adolescents face hardships in all domains of their lives, with many experiencing family rejection, social exclusion, discrimination, bullying and assaults. The mental health implications of these experiences include high rates of depression, anxiety, self-harm and attempted suicide. Gender-affirming social support and medical treatment has been shown to ameliorate the poor mental health outcomes of transgender youth, with those who are supported in their social and medical transition reporting rates of depression and self-worth equivalent to general population levels. Advocacy efforts that improve access to support and medical treatment are therefore likely to produce significant positive health and well-being outcomes for this vulnerable population. The transgender community in Australia identified the legal restrictions placed on children and adolescents accessing medical treatment as a significant barrier to positive psychological well-being. Australian law, unique internationally, required the parents of transgender adolescents to apply for court authorisation prior to the commencement of their child's gender-affirming medical treatment. Concerned by the harm created by this process, a coalition of experts, including transgender children, adolescents and their parents, as well as academic and clinical experts in the fields of law and medicine, was created to advocate for reform. Over a period of approximately 4 years, a collaborative process was undertaken, which ultimately led to law reform and improved access to medical treatment for the transgender community.

Critical consciousness moderates the relationship between transphobia and "bathroom bill" voting.

In recent years, antitransgender legislation that focuses on gender and the use of public restrooms-so-called bathroom bills-has been considered in many states in the United States. The present study was designed to extend research on transphobic attitudes and elucidate links between religious fundamentalism, social dominance orientation, transphobia, and voting for bathroom bills. Further, we examined the moderating influence of critical consciousness on the relationship between transphobic attitudes and voting on a hypothetical bathroom bill. Results of a moderated mediation multinomial logistic regression path analysis using data from a sample of 282 college students (154 women and 128 men) indicated that religious fundamentalism and social dominance orientation were associated with transphobic attitudes. Transphobia was associated with lower likelihood to vote against or abstain from voting on the bill, compared to voting for it. Critical consciousness was also associated with greater likelihood of voting against the bill rather than for it. The interaction between transphobia and critical consciousness was associated with voting against rather than for the bill, such that at higher levels of transphobia, those higher in critical consciousness were more likely to vote against the bill rather than for it. Implications for incorporating critical consciousness into advocacy efforts to promote transgender rights are discussed. (PsycINFO Database Record

Streamlining Interstate Access to Gender-Affirming Surgeries.

This Viewpoint explains the obstacles faced by individuals seeking gender-affirming care and summarizes needed changes to improve quality of care and access to care.

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.