Being Trans Without Medical Transition: Exploring Characteristics of Trans Individuals from Germany Not Seeking Gender-Affirmative Medical Interventions.

Until recently, trans persons were expected to align their sex characteristics as much as possible with the opposite sex. Today, research and health care, as well as the diagnostic criteria from DSM-5 and ICD-11, reflect a broader understanding of trans individuals. It encompasses diverse identities and treatment requests, including trans individuals not wanting or having decided against gender-affirmative medical interventions (GAMI). The present study explored this insufficiently studied group by (1) reviewing the existing literature regarding trans individuals not seeking GAMI and by (2) exploring their demographic and trans-related characteristics in a non-clinical online convenience sample from Germany. The literature review found one large survey with a single question on trans individuals not seeking GAMI. Beyond that, only community literature addressed the topic. The analyzed sample consisted of 415 trans participants, of whom 220 were assigned female at birth (AFAB) and 195 were assigned male at birth (AMAB). Fourteen (3.4%) reported neither previous nor planned GAMI (AFAB = 9, AMAB = 5). Trans individuals not seeking GAMI were significantly older and more often reported to identify with a non-binary gender. The two interdependent, central reasons for refusing GAMI were the avoidance of transition-related suffering and the lack of necessity for treatment. The diversification of gender, as reflected in the increasing visibility of non-binary or genderqueer gender identities, seems to go hand in hand with a diversification of transition-related treatment, including the option not to seek GAMI.

Genders and Individual Treatment Progress in (Non-)Binary Trans Individuals.

BACKGROUND: Health care for transgender and transsexual (ie, trans) individuals has long been based on a binary understanding of gender (ie, feminine vs masculine). However, the existence of non-binary or genderqueer (NBGQ) genders is increasingly recognized by academic and/or health care professionals. AIM: To gain insight into the individual health care experiences and needs of binary and NBGQ individuals to improve their health care outcomes and experience. METHODS: Data were collected using an online survey study on experiences with trans health care. The non-clinical sample consisted of 415 trans individuals. An individual treatment progress score was calculated to report and compare participants' individual progress toward treatment completion and consider the individual treatment needs and definitions of completed treatment (ie, amount and types of different treatments needed to complete one's medical transition). OUTCOMES: Main outcome measures were (i) general and trans-related sociodemographic data and (ii) received and planned treatments. RESULTS: Participants reported binary (81.7%) and different NBGQ (18.3%) genders. The 2 groups differed significantly in basic demographic data (eg, mean age; P < .05). NBGQ participants reported significantly fewer received treatments compared with binary participants. For planned treatments, binary participants reported more treatments related to primary sex characteristics only. Binary participants required more treatments for a completed treatment than NBGQ participants (6.0 vs 4.0). There were no differences with regard to individual treatment progress score. CLINICAL TRANSLATION: Because traditional binary-focused treatment practice could have hindered NBGQ individuals from accessing trans health care or sufficiently articulating their needs, health care professionals are encouraged to provide a holistic and individual treatment approach and acknowledge genders outside the gender binary to address their needs appropriately. STRENGTHS AND LIMITATIONS: Because the study was made inclusive for non-patients and individuals who decided against trans health care, bias from a participant-patient double role was prevented, which is the reason the results are likely to have a higher level of validity than a clinical sample. However, because of the anonymity of an online survey, it remains unclear whether NBGQ individuals live according to their gender identity in their everyday life. CONCLUSION: The study highlights the broad spectrum of genders in trans-individuals and associated health care needs and provides a novel approach to measure individual treatment progress in trans individuals. Koehler A, Eyssel J, Nieder TO. Genders and Individual Treatment Progress in (Non-)Binary Trans Individuals. J Sex Med 2018;15:102-113.

[Quality development within interdisciplinary transgender healthcare : Results and implications of a participatory research project]. / Qualitätsentwicklung in der interdisziplinären Trans-Gesundheitsversorgung : Ergebnisse und Implikationen partizipativer Versorgungsforschung.

Both internationally and nationally, the objective has been set to offer specialized, coordinated, and interdisciplinary treatment to individuals with rare clinical needs, such as trans individuals (e. g., transsexual, transgender). The Interdisciplinary Transgender Health Care Center Hamburg (ITHCCH) is the first and only center in Germany to integrate all disciplines relevant to trans healthcare (THC).The research project seeks to generate valid information to support quality development and assure high-quality treatment at the ITHCCH. This was done by (a) investigating needs and concerns of trans individuals regarding interdisciplinary THC, and (b) analyzing attitudes and interests of key stakeholders.Using a participatory approach involving a work group (representatives of trans support groups and local THC professionals), researchers developed an online survey focusing on trans individuals' needs and concerns. Data from N = 415 trans-identified participants were analyzed using quantitative and qualitative methods. In addition, a short survey was used to record key stakeholders' attitudes and interests towards the ITHCCH.Healthcare offers accessed by trans individuals as part of transition related treatment vary in focus and number. For example, take-up numbers of genital surgery differ between binary and non-binary trans individuals. Crucial aspects impacting on THC quality are structural characteristics, communication/social aspects, individuality, and professionalism/quality.To ensure successful, high-quality interdisciplinary THC, feedback from (potential) patients and stakeholders is crucial. In addition, both structural development and optimizing individuality and flexibility throughout the treatment process are key. This poses a considerable challenge to the sector of THC provision.

Mapping key stakeholders' position towards interdisciplinary transgender healthcare: A stakeholder analysis.

Trans individuals experience an incongruence between their sex characteristics and their gender which might cause significant distress called gender dysphoria. Gender dysphoria is commonly treated using transition-related healthcare services, like sex hormones and surgeries, ideally in interdisciplinary settings. The stakeholder environment of an interdisciplinary transgender healthcare centre (ITHC) is considered key in delivering high-quality healthcare. Therefore, a stakeholder analysis was performed seeking to improve stakeholder relationships and service quality through an evidence-based approach. Quantitative data were collected using a questionnaire administered cross-sectionally, and covering attitude towards the ITHC, influence of and influence on stakeholders, level of knowledge about the ITHC, importance of the ITHC for stakeholders and types of interests. The analysis used primary data, collected July to August 2015. N = 79 key stakeholders were identified and n = 42 (53.2%) participated in the survey. Participants were categorised analytically into four stakeholder groups: trans groups, trans health experts, healthcare system and admin departments of the ITHC. Although participants reported low values (e.g. average values on a 5-point Likert scale; importance: 2.54; influence on the ITHC: 2.43), the attitude of the four stakeholder groups towards the ITHC were positive overall. The attitudes varied, however, depending on the group, for example trans health experts and trans groups reported the highest values for most items. The results demonstrate the importance of systematically analyzing stakeholder positions in order to make appropriate policy decisions, improving stakeholder relationships and assuring long-term high-quality healthcare provision. Subsequently, an action plan was developed, focusing on the two groups with the highest values (trans health experts, trans groups). Selected measures are discussed. If stakeholders are to play their part in providing high-quality, interdisciplinary trans healthcare, they need regular information on the latest developments and recurring feedback of their interests and requirements for the ITHC.

How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons.

The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which-next to the impact of gender identity on treatment desires-has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16-76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.

Needs and concerns of transgender individuals regarding interdisciplinary transgender healthcare: A non-clinical online survey.

This study investigates the needs and concerns transgender (short: trans) individuals have concerning trans healthcare (THC) in interdisciplinary THC centres. Trans individuals' gender does not (fully/constantly) match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients' satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH), Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC) specialists (N = 4). The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382) reported experience with transition related healthcare and 72.5% (n = 301) had (additional) treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They agreed moderately with concerns towards THC centres. 96.5% of participants would like high decision-making power concerning treatment-associated decisions. The results demonstrate the importance of patient-centred THC that takes patients' individual needs and realities into consideration and involves patients in decision-making processes.