[I-CARE: a pioneering e-learning training program on LGBTIQ+ health]. / I-CARE : une formation pionnière par apprentissage en ligne sur la santé des personnes LGBTIQ.

While several recent studies suggest that approximately 1 in 6 young people in Switzerland are part of the rainbow diversity, a high proportion of health professionals have never had a course on LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex, queer, questioning or other) health. This situation leads to significant gaps in the medical care of LGBTIQ+ persons as well as difficulties in accessing equitable, culturally appropriate and quality care. This article presents the ambitious and novel e-learning project I-CARE (Improving Care and Access for Rainbow Equity) which should contribute, from the end of this year, to filling the current gaps in the undergraduate and continuing education of health professionals.

Alors que plusieurs études récentes suggèrent qu'environ 1 jeune sur 6 fait partie de la diversité arc-en-ciel en Suisse, une proportion élevée des professionnel-les de santé n'a jamais eu de cours sur la santé des personnes LGBTIQ+ (lesbiennes, gays, bisexuelles, transgenres, intersexuées, queers, en questionnement ou autres). Cette situation entraîne d'importantes lacunes dans la prise en charge médicale des personnes LGBTIQ+, ainsi qu'une difficulté d'accès à des soins équitables, culturellement appropriés et de qualité. Cet article présente l'ambitieux et inédit projet de formation par apprentissage en ligne I-CARE (Improving Care and Access for Rainbow Equity) qui devra contribuer, à partir de la fin de cette année, à combler les lacunes actuelles dans la formation prégraduée et continue des professionnel-les de santé.

[Giving a future to transgender youth What do we currently know of their needs, what are the best practices ?] / Un futur pour les enfants et les jeunes transgenres: Que savons-nous sur les besoins et les solutions ?

Since 2011, a significant amount of evidence has been published on transgender children and adolescents, highlighting their needs and the best health and social practices. They are more at risk of suicide, discrimination, depression. Today, we better understand that the main causal factor linked with negative experiences is to be found in direct and indirect discriminations, subsequently causing personal and relational difficulties. When transgender youth are fully accepted and supported in their desired gender, they do not significantly differ from other youth. We need to build informed and respectful practices. Three kind of interventions are now urgently needed in Switzerland: access to hormonal management of puberty (medical), family centered interventions (psychosocial), and prevention of bullying in schools (sociopolitical).

Depuis 2011, les besoins, enjeux et protocoles de soins destinés aux jeunes trans sont largement documentés et il ressort des travaux récents que ces jeunes sont plus à risque de suicide, discrimination, dépression, que leurs pairs. Or, la compréhension des facteurs causaux a changé, il devient évident que les expériences négatives liées à la discrimination sont responsables de ces difficultés psychiques et relationnelles. Lorsque les enfants sont acceptés et soutenus dans leur genre trans, ils ne diffèrent pas des autres enfants. Les structures de soins adaptées offrant un accompagnement respectueux et acceptant la différence de genre sont nécessaires. Trois axes d'intervention sont identifiés : les traitements hormonaux de retard de puberté, voire de puberté croisée, l'accompagnement des familles et la lutte contre le harcèlement scolaire.

A retrospective analysis of the gender trajectories of youth who have discontinued a transition.

Background: Detransition is frequently covered in the media as a return to a cis identity after transition. Detransition is often studied in isolation and fails to examine it in context of various stages leading to detransition. Aim: To present the perspectives and reflections of youth who have detransitioned on their journey from early transition to discontinuation, focusing on three key dimensions: gender modalities, sexual modalities, and dysphoria experiences, and their evolution during this journey. Method: We drew from 20 in-depth interviews with young people aged 16 to 25 who have discontinued a transition and examined various stages of the gender journey from early transition to detransition. Youth narratives were analyzed thematically and longitudinally. Results: We developed three main themes related to the gender journey: nonlinear gender modalities, navigating sexual modalities along with gender modalities, and coping with dysphoria and body discomfort. We found a great diversity of experiences with regard to these within each participant and across the sample. Discussion: Transition and detransition trajectories are nonlinear and heterogeneous, without any identified commonalities that enable the prediction of outcomes after transitions. However, transnormativity may influence how people who detransition are expected to conform to a certain narrative despite the diversity of experiences present in this community.

[Access to quality primary care for LGBT people]. / Vers un accès a des soins de qualité pour les personnes lesbiennes, gays, bisexuelles et transgenres.

This article offers a comprehensive approach to the health of lesbian, gay, bisexual and transgender (LGBT) people, where respect for diversity and non judgemental care play a central role. It calls for a health and medical vision that goes beyond HIV risk. For those who never had to question their own sexual orientation or gender identity, it is certainly difficult to understand how the discovery of one's identity trait in childhood or early adolescence can be transformed under social pressure into a burden which often remains invisible but is associated with considerable emotional and medical morbidity. This article raises the following question: How many LGBT patients go unnoticed every week, leaving the physician's office without an opportunity to receive appropriate listening, support and care?

"I knew that I wasn't cis, I knew that, but I didn't know exactly": Gender identity development, expression and affirmation in youth who access gender affirming medical care.

Background: Research about gender identity development is still in its infancy, especially among youth who experience gender dysphoria and are accessing gender-affirming medical care. Aims: This article contributes to the literature on how gender identity and gender dysphoria is experienced, expressed and addressed by youth who have started, or are just about to start, a gender-affirming medical intervention. Methods: The project draws from qualitative interviews with 36 trans children and youth of different ages and stages of puberty. The data were collected in three specialized Canadian clinics that offer gender-affirming care and they were analyzed through inductive thematic analysis. Results: Two interlinked dimensions of the youth's lives allow meaning-making of their gender identity: 1) internal or personal and 2) interactional or social processes. Careful analysis reveals three gender identity development pathways that may be taken by youth, from early questioning to the affirmation of their gender identity. A discussion of current models of gender identity development and their limitations concludes the article.

Pathways to gender affirmation in trans youth: A qualitative and participative study with youth and their parents.

How trans youth realize about their gender identity and come out to their significant others is under-researched and very few studies include both youth and parental perspectives. This study was developed in Switzerland, a country where families with trans youth are just beginning to break invisibility. The research protocol draws on grounded theory methodology, is participative and developed in collaboration with a local trans NGO and a pan Canadian project. We conducted 20 semi-structured interviews with 10 trans youth and their caregivers/parents (10 interview). At least three developmental pathways seem to emerge: a) the affirmed children who affirm themselves very early, (b) the silent children who spend their childhood in a state of internal tension without being able to position themselves and (c) the neutral children who become aware of their gender difference at puberty following a childhood in which gender was not problematic. In all cases puberty is a crossroads, lived painfully with significant manifestations of both social and body dysphoria. A better understanding of the process of gender development in trans children and youth will help improve our interventions to better serve young people and their families, and help them overcome the different levels of oppressions they face.