Instituting Sexual Orientation and Gender Identity Training and Documentation to Increase Inclusivity at a Pediatric Health System.

In this mixed-methods quality improvement project, we implemented and evaluated sexual orientation and gender identity (SOGI) form rollout in the electronic medical record. Families in our gender diversity program completed a baseline survey in 2017 (55/328 responded) and follow-up in 2020 (180/721 responded) to evaluate the frequency of affirmed name and pronoun use in the hospital. Survey feedback informed system-wide inclusivity efforts and training. SOGI was implemented in 2020 after 1,662 providers completed an online training and 11,090 team members completed gender and sexual orientation inclusivity training. We recommend similar trainings for health systems utilizing SOGI.

Short sleep, insomnia symptoms, and evening chronotype are correlated with poorer mood and quality of life in adolescent transgender males.

OBJECTIVE: Poor sleep is common among adolescents and associated with impaired mood and health-related quality of life (HRQOL). Transgender individuals are at increased risk of mood problems hypothesized to be due to minority stress; however, no research has investigated associations between sleep and mood in this population. We aimed to examine sleep, mood, and HRQOL in transgender adolescent males. DESIGN & SETTING: Transgender males age 13-16 were recruited from a U.S. gender diversity clinic. MEASUREMENTS: Participants completed one week of home actigraphy monitoring. Questionnaires assessed insomnia symptoms, chronotype, mood, and HRQOL. Pearson correlations between sleep, mood, and HRQOL were examined. RESULTS: A total of 10 participants completed study measures during the school year. Participants obtained less than the recommended 8-10 hours of sleep per night, and half of participants endorsed insomnia symptoms. Greater insomnia symptoms were correlated with higher anxiety (P = .04) and depression (P = .04) symptoms, and poorer Psychosocial HRQOL (P = .03). Earlier weekday and weekend bed and wake times and earlier weekday sleep midpoint were associated with better Wellbeing HRQOL. No other significant correlations between sleep and mood or HRQOL variables were found. CONCLUSIONS: Anxiety and depression symptoms were associated with self-reported insomnia symptoms, while HRQOL was associated with both insomnia symptoms and objective sleep timing in this sample of adolescent transgender males. Clinicians should assess both sleep and mood symptoms in this population and future research should evaluate the impact of improved sleep and gender-affirming care on mood and HRQOL for transgender adolescents.