Understanding Their Experiences: Psychosocial Functioning of Nonbinary and Binary Youth at the Time of Hormone Readiness Assessment.

Purpose: The unique psychosocial experiences of nonbinary individuals across the lifespan are understudied compared with those of binary transgender individuals. This study examined the psychosocial stressors faced by nonbinary youth compared with their binary transgender counterparts at the time of gender-affirming hormone (GAH) readiness assessment. Methods: This study compared the psychosocial functioning of nonbinary youth with their binary transgender peers, ages 14-18, utilizing the Youth Self Report (YSR) at the time of GAH readiness assessment. Clinically relevant subscale scores of the YSR were analyzed. Results: Data from 479 binary and 55 nonbinary individuals were analyzed for this study. Analysis found that nonbinary youth reported substantially more psychosocial distress in the form of total problems (ß = 2.86, 95% confidence interval [CI] [0.15-5.56]), internalizing problems (ß = 4.57, 95% CI [1.55-7.59]), depression (ß = 4.52, 95% CI [1.70-7.33]), and self-harm (odds ratio 2.65, 95% CI [1.26-5.56]) than their binary transgender peers. Conclusion: Nonbinary youth experienced higher psychosocial distress compared with their binary transgender counterparts. Future research is needed to better understand the possible health disparities experienced by nonbinary people across their lifespan so that their psychosocial needs can be better met.

Association of Pubertal Blockade at Tanner 2/3 With Psychosocial Benefits in Transgender and Gender Diverse Youth at Hormone Readiness Assessment.

PURPOSE: Compare psychosocial function at the time of hormone readiness assessment for transgender and gender diverse (TGD) youth who received pubertal blockade to prevent a nonaffirming puberty with those who did not. METHODS: Retrospective cohort study of psychological assessment data from hormone readiness evaluations conducted at a multispecialty gender clinic. Participants include all TGD youth between the ages of 13 and 17 assessed for hormone readiness between 2017 and 2021. RESULTS: Our cohort consisted of 438 TGD youth, 40 who were prescribed pubertal blockade at Tanner stage 2 or 3, and 398 who had not. The blocker population was younger, more likely to be assigned male and affirming a female identity, and had a different racial/ethnic identity distribution. Having puberty blocked was associated with significantly lower T-scores on the Youth Self Report for internalizing problems (ß = -7.4, p < .001), anxiety problems (ß = -4.6, p = .003), depressive problems (ß = -6.5, p < .001), stress problems (ß = -4.0, p = .01), and total problems (ß = -4.9, p = .003). The blocker population was also significantly less likely to report any suicidal thoughts (odds ratio = 0.38, p = .05). With the exception of increased risk of suicidal thoughts, these associations remained significant when adjusted for gender. DISCUSSION: At the time of hormone readiness evaluation, TGD youth who received pubertal blockade at Tanner 2 or 3 were found to have less anxiety, depression, stress, total problems, internalizing difficulties, and suicidal ideation than TGD peers who had been through more of a nonaffirming puberty.

Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment.

BACKGROUND: It has been well established that individuals who identify as lesbian, gay, bisexual, transgender, and queer are at increased risk for mental health pathology, including eating disorders/disordered eating behaviors (ED/DEB). However, less is understood about the unique experiences of transgender and gender diverse (TGD) people who struggle with ED/DEB. AIMS: The purpose of this literature review is to examine the literature regarding the unique risk factors for TGD individuals who experience ED/DEB through a lens informed by the minority stress model. Additionally, guidance around the assessment and clinical management of eating disorders for TGD individuals will be presented. RESULTS: TGD people are at increased risk for developing ED/DEB due to a number of factors including: gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care. CONCLUSION: While guidance around assessment and treatment of ED/DEB for TGD individuals is still limited, adhering to a gender affirmative care model is essential.

People who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) are more likely to have mental health difficulties, including eating disorders/disordered eating behaviors (ED/DEB). Much of the existing literature has focused on LGBTQ populations and not on the unique experiences of transgender and gender diverse (TGD) people. This literature review seeks to examine the unique risk factors for TGD people who experience ED/DEB. The minority stress model is used to better understand these risk factors, which include gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care. Research offering guidance for assessing and treating ED/DEB with TGD people is still limited but it is clear that a gender affirmative care model provides robust support for this population.

Team Effort: A Call for Mental Health Clinicians to Support Sports Access for Transgender and Gender Diverse Youth.

There has been an increase in the number of youth in the United States who identify as transgender and/or as nonbinary, which generally refers to people whose gender identity does not align with the one associated with their assigned sex at birth. Unfortunately, transgender and gender diverse (TGD) youth have higher rates of depression, suicidality, self-harm, and disordered eating compared to cisgender peers.1 It is critical to emphasize, however, that such health disparities are reflective of TGD people having to simultaneously navigate transphobic, homophobic, and racist social contexts; manage gender dysphoria, which is the distress resulting from an incongruence between gender identity and assigned sex at birth; and endure an onslaught of anti-transgender legislation that attacks the rights and bodies of TGD people. Given that TGD youth have had alarmingly high rates of suicide for the past decade, it is imperative that health care providers identify and increase access to opportunities and activities that promote positive socioemotional development to mitigate such risk. One resource that has the potential to boost mental health outcomes for this community is physical activity and sports (PA/S).