Evaluation of health status of transgender sex workers in Turkey: A qualitative study.

OBJECTIVE: Sex workers can be disadvantaged in terms of overall health due to challenging living and working conditions. This research aimed to evaluate the health status and experiences related to sexually transmitted infections (STDs) of unregistered transgender sex workers in Turkey. DESIGN: It employed a phenomenological qualitative research design. SITE: Data were collected in Istanbul between March 2021 and November 2021. PARTICIPANTS: Data were collected through in-depth interviews involving 24 people (19 sex workers and 5 physicians). METHODS: Key statements were listed during data analysis, and clusters of meanings were formed based on these statements. The participants' statements were used for contextual and structural descriptions. RESULTS: Sex workers suffer from chronic illnesses such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, allergic diseases, and neurological disorders. Among the health issues affecting them, the most notable ones are STDs, psychological problems, and the risk of suicide. Sex workers also face a dilemma between choosing public hospitals and private hospitals. Majority of sex workers undergo regular testing for STDs, with the frequency varying from person to person. Reasons for not undergoing regular testing include lack of social security coverage, financial constraints, lack of information, and feeling undervalued. Some individuals are being subjected to mandatory testing. CONCLUSIONS: It is recommended that sex workers who seek and request healthcare services should be provided with detailed information and education, particularly regarding psychological problems and STDs.

Between Vulnerability and Resilience: Parents of Transgender Young Adults.

This study explores the lived experiences of Israeli parents of transgender young adults, depicting gender diversity as a family-relational phenomenon. The analysis of 18 in-depth, semi-structured interviews with Israeli parents of trans young adults suggests that the parents' experiences were characterized by a dialectic between feelings of vulnerability and resilience. The parents' vulnerability was shaped by their social positioning as a minority group as well as their socio-political environment, and their ability to cope with these hardships enhanced their resilience. As the parents developed their resilience through meaning-making, social support, and activism, they gained a new sense of agency alongside a deep sense of vulnerability, suggesting that vulnerability and resilience are not objective, opposite binaries but rather fluid categories that are continually constructed through the intersection of micro- and macro-level factors.

En este estudio se analizan las experiencias vividas por padres israelitas de adultos jóvenes transgénero y se describe la diversidad de género como fenómeno relacional familiar. El análisis de 18 entrevistas profundas semiestructuradas con padres israelitas de jóvenes transgénero indica que las experiencias de los padres estuvieron caracterizadas por una dialéctica entre los sentimientos de vulnerabilidad y de resiliencia. La vulnerabilidad de los padres estuvo determinada por su situación social como grupo minoritario, así como por su entorno sociopolítico, y su capacidad para afrontar estas dificultades mejoró su resiliencia. A medida que los padres desarrollaron su resiliencia mediante la creación de significado, el apoyo social y el activismo, adquirieron una nueva sensación de acción junto con una sensación profunda de vulnerabilidad, lo cual sugiere que la vulnerabilidad y la resiliencia no son binarios objetivos y opuestos, sino categorías variables que se construyen continuamente mediante la intersección de factores a nivel micro y macro.

Demonstrating Attachment-Based Family Therapy for Transgender and Gender Diverse Youth with Suicidal Thoughts and Behavior: A Case Study.

Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.

El suicidio es un problema de salud pública cada vez mayor entre los adolescentes. Si bien la mayoría de los jóvenes transgénero y de géneros diversos (TGD) son saludables, muchos tienen pensamientos y conductas suicidas. Debido a la discriminación y al estigma, los índices de intento de suicidio en los jóvenes TGD son más altos que en los jóvenes heterosexuales, cisgénero e incluso LGBQ cisgénero. A pesar de esta vulnerabilidad al suicidio, se han desarrollado y se han evaluado pocos tratamientos para esta población. Un tratamiento, la terapia familiar basada en el apego (TFBA), se ha adaptado para trabajar con jóvenes LGBQ y puede ser prometedor para adolescentes TGD en riesgo de suicidio. Este artículo ofrece un resumen de nuestras modificaciones a la TFBA para los jóvenes TGD con pensamientos de suicidio. Específicamente, ilustramos cómo los resultados del tratamiento, en un solo caso práctico, se relacionan con los procesos dentro de las tareas del tratamiento clínico. El caso práctico demuestra la aplicación de estas modificaciones de la TFBA con un adolescente que se identificó como de género no conforme (y que recientemente había intentado suicidarse) y sus cuidadores. Se recopilaron las valoraciones de una evaluación del tratamiento durante el transcurso de 24 semanas para ilustrar el avance clínico del joven. Los síntomas de suicidio del joven disminuyeron notablemente al final del tratamiento. Además, la familia informó una mayor capacidad para resolver problemas y una comunicación más abierta al concluir el tratamiento.

An Exploratory Study of Predictors of Relationship Commitment for Cisgender Female Partners of Transgender Individuals.

The current exploratory study investigates which variables predict commitment among cisgender women currently in a relationship with a transgender-identified partner. This study includes variables specific to gender diverse couples such as years in the relationship, amount of prior knowledge about transgender identity, and gender role beliefs. Also included are the general relationship factors of satisfaction, quality of alternatives, investment size, and the outcome variable of commitment, as described in the Investment Model of Commitment. Using convenience sampling from online support groups, the sample was n = 138 cisgender female partners. The findings of the regression analyses indicate one's personal resilience and the number of years in the relationship prior to transition are significantly related to partner commitment, with satisfaction mediating both associations. The longer a participant was in the relationship at the time of a gender transition of a partner, the less satisfaction they report, thus reducing commitment to the relationship. Additionally the more personal resilience a partner endorses, the higher the relationship satisfaction, and in turn, more commitment is reported. The results offer information about the important factors related to staying in relationships during and after a gender transition.

El presente estudio exploratorio investiga qué variables predicen el compromiso entre las mujeres cisgénero que están actualmente en una relación con una pareja identificada como transgénero. Este estudio incluye variables propias de las parejas de ambos géneros, como los años de relación, la cantidad de conocimiento previo acerca de la identidad transgénero y las creencias sobre los roles de género. También están incluidos los factores de satisfacción, la calidad de las alternativas, el tamaño de la inversión y el criterio de valoración del compromiso de las relaciones generales, según se describen en el "Modelo de inversión de compromiso" (Rusbult, 1980). Utilizando un muestreo de conveniencia de grupos de apoyo en línea, la muestra estuvo integrada por n=138 parejas de femeninas cisgénero. Los resultados de los análisis de regresión indican que la resiliencia personal individual y el número de años de relación previos a la transición están relacionados significativamente con el compromiso de la pareja, con la satisfacción como mediadora de ambas asociaciones. Cuanto más tiempo un participante estuvo en la relación al momento de una transición de género del otro integrante de la pareja, menos satisfacción informa, reduciendo así el compromiso con la relación. Además, cuanta más resiliencia personal aprueba un integrante de la pareja, mayor es la satisfacción con la relación y, a su vez, más compromiso se informa. Los resultados ofrecen información acerca de los factores importantes relacionados con la permanencia en las relaciones durante y después de una transición de género.

Resilience Factors and Suicide Risk for a Sample of Transgender Clients.

This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.

Este estudio exploró cómo los factores de resiliencia basados en individuos y comunidades operaron en conjunto para reducir el riesgo de suicidio en una muestra de clientes de terapia transgénero. Recopilamos datos de una encuesta transversal de 106 clientes de terapia transgénero en un centro comunitario local, incluyendo información demográfica, experiencias de apoyo relacional, estabilidad emocional de los participantes y riesgo de suicidio. Los resultados de nuestro análisis de mediación indicaron que niveles altos de apoyo relacional percibido se asociaban a un riesgo de suicidio reducido, y que esto se daba mediante la estabilidad emocional de la persona. Se discuten las implicaciones clínicas para terapeutas familiares basado del efecto indirecto significativo arrojado por el estudio.

Difficulties of gender affirming treatment in trans women with BRCA1+ mutation: A case report.

Gender affirming treatment in transgender women is based on a combination of antiandrogens and estrogens, with the latter maintained over the long term. When prescribing these treatments, we must consider the possibility of developing estrogen-dependent breast cancer. In transgender women, a breast cancer incidence of 4.1 per 100,000 has been estimated, which would increase the risk by 46% in relation to cisgender men but decrease it by 70% in relation to cisgender women. It is known that certain gene mutations such as BRCA1 imply an increased risk of breast cancer, but at present the risk in transgender women with BRCA1 treated with estrogens is not well established. We present the case of a transgender woman with a family history of breast cancer and BRCA1 mutation and the therapeutic decisions made in a multidisciplinary team. Following this case, we review and discuss the published literature.

[Recommendations for Primary Health Care for transgender people]. / Recomendaciones para la atención de la salud en Atención Primaria de las personas transgénero.

The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination. With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.

Executive summary: Quality standards of care units for people with sexual and gender diversity.

Comprehensive biopsychosocial care for people with gender incongruence (ICD 11) who are transgender (trans) or gender diverse is a complex process in which the quality of the medical transition can only be guaranteed after a multidisciplinary approach, through teams that integrate professionals with training and experience not only in medicine but also in diversity and gender identity. Based on this, the Gonad, Identity and Sexual Differentiation working group of the Spanish Society of Endocrinology and Nutrition (GT-GIDSEEN) has established minimum care requirements that aim to guarantee adequate health care for these people by professionals. A position paper has been produced and is available at https://www.seen.es/portal/documentos/estandares-calidad-gidseen-2024.

Humanizing Different Archetypal Expressions of Gender Expansiveness.

This article explores the concept of gender expansiveness. This term refers to a person's self-identifying as gender fluid, genderqueer, transgender, non-binary, gender diverse, or gender nonconforming. Young people, including older children and adolescents, increasingly are experimenting with crossing gender lines. This trend can be understood as a sociocultural process for humanizing more terrifying archetypal forms of gender diversity. Using Henderson's (1988) concept of the cultural unconscious, the author posits that current social developments among youth are attempting to bring gender expansiveness more into collective consciousness. This issue has occasioned a strong counterreaction with panicked appeals to upholding traditional gender norms and needing restrictions on gender-affirming care. Examples from myth, literature and clinical practice help to contextualize the intense emotions aroused by gender diversity. A case example shows how gender fantasies are worked through within an empathic analytic relationship. The author makes an appeal for updating and humanizing older psychological theories that have relied heavily on splits, polarities, and oppositions, all of which are more characteristic of a 20th century way of thinking about the psyche. A potential approach to incorporate gender expansiveness is through a model of the psyche as a mosaic.

Cet article explore le concept d'expansivité du genre. Ce terme fait référence à l'auto­identification d'une personne comme étant de genre fluide, genderqueer, transgenre, non binaire, de genre divers ou ne se conformant pas au genre. Les jeunes, y compris les grands enfants et les adolescents, expérimentent de plus en plus le franchissement des frontières entre les genres. Cette tendance peut être comprise comme un processus socioculturel visant à humaniser des formes archétypales plus terrifiantes de diversité de genre. En utilisant le concept de l'inconscient culturel de Henderson, l'auteur postule que les développements sociaux actuels chez les jeunes tentent d'amener l'expansivité du genre dans la conscience collective. Cette question a provoqué une forte contre­réaction; des exhortations paniquées au respect des normes de genre traditionnelles et à la nécessité de restrictions concernant les soins d'affirmation de genre. Des exemples tirés des mythes, de la littérature et de la pratique clinique aident à contextualiser les émotions intenses suscitées par la diversité des genres. Un exemple de cas montre comment les fantasmes de genre sont travaillés dans le cadre d'une relation analytique empathique. L'auteur lance un appel à la mise à jour et à l'humanisation des anciennes théories psychologiques qui se sont fortement appuyées sur des divisions, des polarités et des oppositions, et qui sont toutes caractéristiques d'une façon de penser la psyché au XXe siècle. Une approche potentielle pour intégrer l'expansivité du genre consiste à utiliser un modèle de la psyché en tant que mosaïque.

Este artículo explora el concepto de expansividad de género. Este término se refiere a la identificación de una persona como género fluido, género queer, transgénero, no­binario, género diverso o inconformidad de género. Los jóvenes, incluyendo niños mayores y adolescentes, están experimentando de manera creciente el cruzar las fronteras de género. Esta tendencia puede entenderse como un proceso sociocultural de humanización de las formas arquetípicas más aterradoras de la diversidad de género. Utilizando el concepto de Henderson del inconsciente cultural, el autor postula que los actuales desarrollos sociales entre los jóvenes intentan traer más a la consciencia colectiva, la expansividad de género. Esta cuestión ha provocado una fuerte reacción en contra, apelando al mantenimiento de las normas de género tradicionales junto a la necesidad de restringir las prácticas de cuidado dirigidas a la afirmación de género. Ejemplos de mitos, literatura y práctica clínica ayudan a contextualizar las intensas emociones que despierta la diversidad de género. Un caso clínico muestra cómo las fantasías de género pueden ser trabajadas en una relación analítica empática. El autor invita a actualizar y humanizar las antiguas teorías psicológicas que se han basado en gran medida en escisiones, polaridades y oposiciones, todas ellas más características de una forma de pensar la psique propia del siglo XX. Un enfoque potencial para incorporar la expansividad de género es a través de un modelo de la psique a modo de un mosaico.