The wellbeing and health needs of a cohort of transgender young people accessing specialist medical gender-affirming healthcare in Auckland.

INTRODUCTION: Increasing numbers of young people are seeking gender-affirming healthcare in Aotearoa New Zealand, and although international studies report health and wellbeing benefits of early medical intervention, we have no published reports on the impact of health services in this country. METHODS: Transgender young people accessing a specialist service providing medical gender-affirming healthcare were invited to take part in a survey about their health and wellbeing. RESULTS: High or very high psychological distress levels were reported by 74% of respondents, with 39% being unable to access mental health support when needed. DISCUSSION: Although the proportion of transgender young people with high or very high levels of psychological distress was five times greater (74%) than for the general population of young people (14.5%) in Aotearoa New Zealand, it was not as large as the proportion found for transgender young people in a community study (86%) in which an unmet need for hormones was reported by 29%. This highlights the need for clear referral pathways to access specialist gender-affirming healthcare services in order to reduce disparities in mental health outcomes.

Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey.

PURPOSE: We undertook a study to assess the associations between barriers to insurance coverage for gender-affirming hormones (either lack of insurance or claim denial) and patterns of hormone use among transgender adults. METHODS: We used data from the US Transgender Survey, a large national sample of 27,715 transgender adults, collected from August to September 2015. We calculated weighted proportions and performed multivariate logistic regression analyses. RESULTS: Of 12,037 transgender adults using hormones, 992 (9.17%) were using nonprescription hormones. Among insured respondents, 2,528 (20.81%) reported that their claims were denied. Use of nonprescription hormones was more common among respondents who were uninsured (odds ratio = 2.64; 95% CI, 1.88-3.71; P <.001) or whose claims were denied (odds ratio = 2.53; 95% CI, 1.61-3.97; P <.001). Uninsured respondents were also less likely to be using hormones (odds ratio = 0.37; 95% CI, 0.24-0.56; P <.001). CONCLUSIONS: Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.

Hormone Therapy and Discrimination in the Labor Market: Emerging Experimental Evidence on the Economics of Endocrinology.

BACKGROUND: Gender transitioning is increasingly common, but little is known about the extent to which individuals in transition and fully transitioned suffer from wage discrimination. Methods: Managers in the United States (n=204) were shown photos of white and Asian male and female "employees" at different stages of simulated hormone therapy and were asked to estimate their actual hourly wages based on appearance. RESULTS: The results suggest that Asian men and women "in transition" and fully transitioned do not suffer from significant wage discrimination. However, among the white stimuli, gender atypical ("in transition" and fully transitioned) men and women are estimated to earn significantly less than their gender typical (sexually dimorphic) counterparts, with some gender-specific nuances. CONCLUSIONS: The effects of hormone therapy may have a deleterious impact on the wages of white transgender individuals.

Qualitative Study of the Processes of Transgender-Men Identity Development.

OBJECTIVE: Describe and analyze the mental health service and medical needs of a group of transgender men from the point when they changed their gender identity to male. MATERIAL AND METHOD: Transgender men volunteers who attended a specialized care center in Mexico City answered a qualitative semi-structured interview to explore their needs as well as the adversities they unnecessarily face due to the lack of information and care for their condition. Interviews were audio-recorded and transcribed for thematic analysis. RESULTS: Respondents began to develop their transgender identity in childhood; however, during that time, almost none of them had any helpful contact with a health professional. Those who did receive some form of care received mistreatment rather than positive feedback. It was not until adulthood that they obtained facts about a specialized care center. CONCLUSION: It is necessary for health professionals to have information about sexual diversity and be trained to meet the needs of transgender children, in order to have information on places and professionals who accompany them and advise on available treatments such as hormone blockers or treatments. The study includes a small but important sample. However, the currently hostile, discriminatory environment, significantly exposes transgender people to developing mental health problems.

Increasing normality-persisting barriers: Current socio-demographic characteristics of 350 individuals diagnosed with gender dysphoria.

INTRODUCTION: The number of individuals requesting medical treatment for gender dysphoria has increased significantly within the past years. Our purpose was to examine current biographic and socio-demographic characteristics and aspects of legal gender reassignment. DESIGN: Medical files from n = 350 individuals of a German Endocrine outpatient clinic were collected from 2009 to 2017 and analysed retrospectively. RESULTS: Ratio of transwomen to transmen equates to 1:1.89 with a remarkable increase of transmen by the year 2013, showing a reversal of gender distribution compared with previous studies for the first time. Use of illegal substances or self-initiated hormone therapy was rare (4.6 and 2.1%). Satisfaction with gender-affirming hormone therapy was significantly higher in transmen than in transwomen (100% vs 96.2%, P = .005). Use of antidepressants declined significantly after onset of hormone treatment in transmen (13% vs 7%; P = .007). The number of individuals with a graduation diploma was only about half as high as in the general population (14.3% vs 27.3%), whereas unemployment rate was more than twice as high (14% vs 6.9%). Median latency between application for legal gender reassignment and definitive court decision was 9 months. CONCLUSIONS: Our data provide possible indications for a decline of psychosocial burden in individuals diagnosed with gender dysphoria over the last years. However, affected individuals are still limited in their occupational and financial opportunities as well as by a complex and expensive procedure of legal gender reassignment in Germany.

Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center.

PURPOSE: Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. METHODS: We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. RESULTS: Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98). CONCLUSION: Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.

The National Policy for Comprehensive Health of Lesbians, Gays, Bisexuals and Transgender (LGBT) and access to the Sex Reassignment Process in the Brazilian Unified Health System (SUS): progress and challenges. / A Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais e Transgêneros (LGBT) e o acesso ao Processo Transexualizador no Sistema Único de Saúde (SUS): avanços e desafios.

This study aimed to analyze how the Brazilian Ministry of Health (MS) is implementing the Sex Reassignment Process (SRP) in the Unified Health System (SUS), through research of public domain official documents, systematization of surgery's quantitative data and analysis of meeting reports of the LGBT Health Technical Committee (CTSLGBT) of the MS. We conducted exploratory research combining quantitative and qualitative methods, using as methodological basis the normative proposal of health programs and systems evaluation study. The study resulted in the total data calculation of sex reassignment surgeries performed by the SUS (2008-2016), which highlight no deaths and unequal regional access; and in the monitoring of the implementation of actions of the National LGBT Health Policy by a specific committee appointed by the MS. Despite considerable progress, challenges remain. Currently, the most threatening hurdle is the possibility of a setback imposed by conservative sectors from the Executive and Legislative branches. Therefore, the visibility of achievements is a decisive step toward maintaining and enhancing SRP in the SUS.

A Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais e Transgêneros (LGBT) e o acesso ao Processo Transexualizador no Sistema Único de Saúde (SUS): avanços e desafios / The National Policy for Comprehensive Health of Lesbians, Gays, Bisexuals and Transgender (LGBT) and access to the Sex Reassignment Process in the Brazilian Unified Health System (SUS): progress and challenges

Resumo Este estudo objetivou analisar como o Ministério da Saúde (MS) vem implementando o Processo Transexualizador (PrTr) no SUS, por meio da pesquisa de documentos oficiais de domínio público, sistematização de dados quantitativos e análise das memórias do Comitê Técnico de Saúde LGBT (CTSLGBT) do MS. A pesquisa exploratória combinou métodos quanti e qualitativos de estudo, tomando como base metodológica a proposta normativa de pesquisa de avaliação de programas e sistemas de saúde. O estudo resultou no cômputo total das cirurgias de redesignação sexual realizadas no SUS (2008-2016), que evidenciam nulidade de óbitos e desigualdades regionais de acesso; e no acompanhamento das ações de implementação da Política Nacional de Saúde Integral Lésbicas, Gays, Bissexuais, Travestis e Transexuais (PNSILGBT) por comitê específico designado pelo MS. Mesmo com avanços consideráveis, os desafios persistem, sendo o mais ameaçador, atualmente, a possibilidade de retrocesso imposta por setores conservadores do executivo e legislativo. Portanto, a visibilidade das ações já conquistadas é um passo decisivo para manutenção e potencialização do PrTr no SUS.

Abstract This study aimed to analyze how the Brazilian Ministry of Health (MS) is implementing the Sex Reassignment Process (SRP) in the Unified Health System (SUS), through research of public domain official documents, systematization of surgery’s quantitative data and analysis of meeting reports of the LGBT Health Technical Committee (CTSLGBT) of the MS. We conducted exploratory research combining quantitative and qualitative methods, using as methodological basis the normative proposal of health programs and systems evaluation study. The study resulted in the total data calculation of sex reassignment surgeries performed by the SUS (2008-2016), which highlight no deaths and unequal regional access; and in the monitoring of the implementation of actions of the National LGBT Health Policy by a specific committee appointed by the MS. Despite considerable progress, challenges remain. Currently, the most threatening hurdle is the possibility of a setback imposed by conservative sectors from the Executive and Legislative branches. Therefore, the visibility of achievements is a decisive step toward maintaining and enhancing SRP in the SUS.

PREVALENCE AND TYPES OF GENDER-AFFIRMING SURGERY AMONG A SAMPLE OF TRANSGENDER ENDOCRINOLOGY PATIENTS PRIOR TO STATE EXPANSION OF INSURANCE COVERAGE.

OBJECTIVE: Transgender individuals now have many options for medical intervention, including gender-affirmation surgeries. However, it is unknown how common it is for transgender individuals to undergo these surgeries. The purpose of this cross-sectional study was to assess the prevalence of gender-affirming surgeries among transgender patients in 2015, which was immediately prior to insurance changes that made gender-affirming surgery more affordable for Massachusetts residents. METHODS: A retrospective chart review of 99 transgender patients was performed at the Endocrinology Clinic at Boston Medical Center, an urban safety net hospital. The records for 99 transgender subjects who received treatment between 2004-2015, including 28 transmen and 71 transwomen, were examined. The outcome measures were the types of medical interventions chosen by transgender patients, which included hormone therapy, chest surgery, gonadectomy, genital surgery, and facial surgery. RESULTS: Thirty-five percent of subjects had undergone at least one gender-affirming surgery. Transmen were more likely to have had surgery than transwomen (54% vs. 28%). Twenty-five percent of patients had chest surgery, 13% had genital surgery or gonadectomy, and 8% had facial surgery. CONCLUSION: In 2015, a majority of transgender endocrinology clinic patients had not undergone any type of gender-affirmation surgery. Among those who did elect to have a surgery, genital surgery or gonadectomy were uncommon. The low rate of surgery among this sample of transgender patients may be attributable to the financial cost, lack of interest in surgery, or that genital surgery is not a high priority for transgender individuals relative to surgery to change visible features such as face and chest. Abbreviation: HT = hormone therapy.

The psychologist's role in transgender-specific care with U.S. veterans.

Psychologists are integral to the care of transgender individuals. This article details the many roles for psychologists in transgender-specific care, including diagnosing and treating gender dysphoria; providing treatment for comorbid conditions; referring to medical services such as gender confirmation surgeries, voice modification, and cross-sex hormone therapies; serving as consultants within health care systems; and advocating for addressing barriers in systems in which transgender individuals live and work. Transgender veterans have unique experiences and vulnerabilities related to their military service that are detailed from a review of the literature, and we make the case that Veterans Health Administration (VHA) and community psychologists are well-positioned to provide care to transgender veterans (trans-vets). In this article, the authors describe the experiences that many trans-vets have faced, identify the importance of treatment for gender dysphoria (and draw the distinction between gender identity disorder and gender dysphoria) as well as psychologists' roles, and clarify which transgender-related services are available to eligible veterans though VHA per policy and how VHA providers have access to training to provide that care. In addition, we describe how veterans can connect to the VHA, even if they have (and want to continue working with) non-VHA psychologists or other community providers.