Parental Gender Affirmation Model: A culturally informed framework.

Benefits of parental gender-affirming behaviors on the mental health and well-being of the broader gender-expansive youth population have been extensively documented. However, the nature and impact of these behaviors have not been explored by centering Black and Latine transgender/non-binary youth (BLTY). This article offers a new framework called the "Parental Gender Affirmation Model." This framework conceptualizes parental gender-affirming behaviors toward BLTY through the lenses of intersectional stigma and cultural gender norms and uses the Theory of Planned Behavior and Modified Gender Affirmation Model as foundational frameworks. We analyzed qualitative data from 43 interviews with BLTY, parents of BLTY, and Black and Latine transgender/non-binary young adults from California in the United States to develop the framework. The "Parental Gender Affirmation Model" starts with behavioral antecedents and ends with impacts of these behaviors on BLTY's well-being. This framework will inform the development of critically needed, culturally-informed interventions to support parental gender affirmation of BLTY.

Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective.

BACKGROUND: Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. METHODS: We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. RESULTS: Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. DISCUSSION: To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.

Improving Knowledge and Competency in Gender-Affirming Patient Care Among New Nurses in Sexual and Reproductive Health Care.

OBJECTIVE: To improve knowledge and competency in providing gender-affirming patient care among newly licensed registered nurses (RNs) working in sexual and reproductive health (SRH). DESIGN: Pilot, pretest/posttest, descriptive design. SETTING AND PARTICIPANTS: Participating RNs were employed at a large academic health center in the southeastern United States. All RNs were providing SRH nursing and participating in the health center's new nurse residency program. METHODS AND INTERVENTION: Participants completed an online synchronous training that introduced topics such as sex versus gender, gender dysphoria, and health disparities. This education was followed by in-person training, where an unfolding case study applied concepts to theoretical patient scenarios specific to reproductive health. Participants completed a 20-item survey with a single assessment retrospective pre-post design to measure change in knowledge and competency. RESULTS: Twelve RNs participated in this pilot study. Fewer than half had previously received instruction on providing care to trans∗ persons. Seven self-perceived knowledge and competency areas were evaluated with paired retrospective pre-post design questions. All areas measured showed increases from pretraining to posttraining. Participants also had the opportunity to respond to open-ended questions. Common themes identified in these responses include participants planning to maintain a greater awareness and intentionality with language and abandoning cisgender assumptions. Several participants also described health care-specific systemic barriers that could prevent a trans∗ patient from feeling comfortable. CONCLUSION: Providing new graduate nurses with education specific to trans∗ patients may help them to feel more knowledgeable and competent when caring for these individuals in SRH settings.

Contraceptive uptake among gender-expansive individuals in the HER Salt Lake Contraceptive Initiative.

OBJECTIVES: We examined differences in contraceptive uptake and discontinuation between gender-expansive individuals and cis-women in the HER Salt Lake Contraceptive Initiative. STUDY DESIGN: We used self-reported survey data to assess associations between gender identity, contraceptive uptake, and discontinuation. RESULTS: Of participants (n = 4289), 178/4289 (4%) identified as gender-expansive with 157/178 (88%) reporting recent sexual activity with men. Selection of IUD or Implant was most common, with 109/178 (61%) of gender-expansive individuals choosing these options. We observed similar methods selected (p = 0.2) and discontinuation rates at three years between participants (OR: 0.93, p = 0.8). CONCLUSION: Gender-expansive individuals had similar method selection and discontinuation rates as cis-women. IMPLICATIONS: Our finding of no difference in the uptake of contraception between cis-women and gender-expansive individuals should empower providers to openly discuss contraception with patients regardless of gender identity.

Intention to Use Different Formulations of Longer Acting HIV Pre-Exposure Prophylaxis Among Transgender and Gender Expansive Individuals: The Roles of Social Vulnerability and Medical Mistrust.

In 2012, the Federal Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for HIV prevention in adults. Longer acting injectable PrEP (LA PrEP) has been approved and other formulations are in development. A successful LA PrEP rollout requires examining potential facilitators and barriers to PrEP uptake. Given that transgender and gender expansive (TGE) individuals experience more social vulnerability and higher levels of medical mistrust compared to other populations, examining the role of these two factors in LA PrEP uptake is important. This study, PrEP for ALL, is a community-based participatory research project in Texas that engaged TGE community members and organizational partners through a community advisory board. In total, 482 TGE individuals were recruited and responded to all relevant questions in an online survey, including their intentions to use three formulations: a monthly oral pill, a bimonthly intramuscular injection, and an annual subdermal implant. Multiple regression analysis was used to examine the influence of social vulnerability and medical mistrust on intention to use each LA PrEP formulation adjusting for other relevant factors. Findings suggest that individuals with higher levels of social vulnerability had greater intentions to use the monthly oral pill (ß = 0.12, p = 0.009), the bimonthly intramuscular injection (ß = 0.18, p < 0.001), and annual subdermal implant (ß = 0.17, p < 0.001), whereas medical mistrust reduced intentions to use the bimonthly intramuscular injection (ß = -0.18, p < 0.001) and annual subdermal implant (ß = -0.11, p = 0.021). Improvements in gender-affirming clinical care are needed along with LA PrEP formulations that allow for greater autonomy and reduced clinical contact. Clinical Trial Registration number: NCT05044286.

LGBTQ+ inequity in crowdfunding cancer costs: The influence of online reach and LGBTQ+ state policy.

BACKGROUND: Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non-LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost-coping behaviors such as crowdfunding is understudied. METHODS: We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community-engaged and technology-based methods. Crowdfunding campaigns were web-scraped from GoFundMe and classified as cancer-related and LGBTQ+ or non-LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy. RESULTS: A total of N = 188,342 active cancer-related crowdfunding campaigns were web-scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019-2022), LGBTQ+ campaigns raised $1608 (95% CI: -2139, -1077) less than non-LGBTQ+ campaigns. LGBTQ+ campaigns with low (26-45 donors), moderate (46-87 donors), and high (88-240 donors) online reach raised on average $1152 (95% CI: -$1589, -$716), $1050 (95% CI: -$1737, -$364), and $2655 (95% CI: -$4312, -$998) less than non-LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti-LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: -2640, -1182) less than non-LGBTQ+ campaigns from the same states. CONCLUSIONS AND RELEVANCE: Our findings revealed LGBTQ+ inequity in cancer-related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non-LGBTQ+ cancer survivors-potentially widening existing economic inequities.

A Resource Compendium for Embedding LGBTQIA+ Patient Care in the Professional Identity of Community Pharmacists.

OBJECTIVES: Cultural, clinical, social, and legally competent patient care for lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) patients is currently scarcely incorporated in pharmacy curricula. Furthermore, clinical, legal, and socio-cultural training that prepares pharmacists on the job to provide LGBTQIA+ competent patient care is scant. Here, our objectives were to (1) systematically review the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify trends in community pharmacists' professional identity development related to the provision of competent LGBTQIA+ patient care, and (2) create a reference guide for community pharmacists for self-directed learning. The literature search focused on 4 professional identity domains common to most pharmacists: academic and clinical competence, cultural sensitivity, knowledge of state and federal laws, and continuing professional development. FINDINGS: A total of 207 articles were identified, with 93 retrieved, of which 26 articles were included in the final analysis based on title and abstract and other inclusion criteria. SUMMARY: Overall, our search identified that the LGBTQIA+ health professions literature focused on the following themes: guidance for appropriate drug selection and therapy, creation of cultural sensitivity training curricula, community pharmacists' perceptions of their ability to provide LGBTQIA+ care, health system interventions, and Allyship education for advancing LGBTQIA+ care, the need for enhanced training of pharmacists for understanding the federal and state laws and requirements while providing care, and the need for a resource compendium to help community pharmacists access self-directed learning information, for which we have created a self-help resource guide for pharmacists in these 4 professional pharmacist identity domains.

Implicit and Explicit Spirituality in the Lives of Transgender and Gender Expansive Older Adults.

Religion and spirituality for transgender and gender expansive people (whom we refer to collectively as trans) are complicated by mainstream religions' history of stigmatizing and marginalizing sexual and gender minorities. We conducted an interpretive content analysis of biographical interviews with 88 trans older adults from across the United States, applying six tenets of spiritual psychotherapy to their life narratives. Our findings suggest that some trans older adults' spirituality is experienced both implicitly and explicitly. Implicit spirituality reflects the ways in which meaning, purpose, and connection in one's life are nurtured with respect to one's gender identity. Explicit spirituality reflects the process of consciously renegotiating one's spiritual beliefs and religious practices to validate one's gender identity and place in society. This knowledge is potentially helpful for gerontological social workers who seek to nurture trans people's spirituality and well-being as they age.

Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people.

PURPOSE: Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study. METHODS: We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study. RESULTS: Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating. CONCLUSIONS: These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.

Gender-expansive describes gender identities that do not fit within the binary gender identity system, such as man or woman. We asked gender-expansive participants in The PRIDE Study to fill out a widely used survey about muscle dysmorphia (when someone is worried about not being muscular enough). We found that this issue about muscularity has three parts for gender-expansive people: (1) a desire to be bigger and more muscular, (2) dissatisfaction with the way their body looks, and (3) problems with normal life functions. We find that this survey is appropriate for use in gender-expansive people. These results can help providers and researchers understand the muscle-related problems that gender-expansive people face.

Protective Environments, Health, and Substance Use Among Transgender and Gender Expansive Youth.

Purpose: Transgender and gender expansive (TGE) youth experience elevated risk for substance use and other health inequities compared to cisgender peers. The purpose of this study was to examine associations between protective environments-perceived community tolerance, perceived family support, and housing stability-and recent binge drinking, lifetime high-risk substance use (HRSU; cocaine, methamphetamines, and/or heroin), and self-rated health in a sample of TGE youth. Methods: This secondary analysis of 1567 TGE youth aged 13-24 years draws from the Centers for Disease Control and Prevention's 2018 web-based Survey of Today's Adolescent Relationships and Transitions, which used a nonprobabilistic recruiting strategy via social media. Logistic regression was used to test the associations between protective environments and substance use and health outcomes. Results: Overall, 28.1% of participants reported that people who lived near them were tolerant of transgender people, 32.8% reported that their family was at least somewhat supportive of their TGE identity, and 77.0% were stably housed. In the logistic regression models, community tolerance and housing stability were associated with lower odds of self-rated poor health. Housing stability was associated with lower odds of recent binge drinking and lifetime HRSU. Conclusion: Perceived community tolerance and housing stability were associated with several health outcomes among TGE youth in this study. Protective factors, including safe, stable, nurturing relationships and environments, are critical to youth health and wellbeing. The findings in this study highlight the need for prevention strategies to promote protective environments and reduce known substance use and overall health inequities among TGE youth.

Explicit and Implicit Gender-Related Stereotyping in Transgender, Gender Expansive, and Cisgender Adults.

Little is known about gender-related stereotyping among transgender and gender expansive adults. Using the Ambivalent Sexism Inventory (AIS; Glick & Fiske, 1996), we examined explicit gender attitudes in 3298 cisgender, transgender, and gender expansive respondents designated female at birth (FAB; n = 1976 cisgender, n = 108 transgender, n = 188 gender expansive) and male at birth (MAB; n = 922 cisgender, n = 52 transgender, n = 52 gender expansive). In order to learn more about implicit gender-related stereotyping, a subset of 822 participants (FAB; n = 445 cisgender, n = 32 transgender, n = 51 gender expansive. MAB; n = 254 cisgender, n = 21 transgender, n = 19 gender expansive) completed the gender-leadership Implicit Association Test (IAT; Dasgupta & Asgari, 2004). Cisgender men scored significantly higher than all other groups on hostile sexism, but patterns of endorsement for benevolent sexism and implicit attitudes were more nuanced, with cisgender women and gender expansive FAB often scoring significantly below other groups. We observed that transgender men and transgender women, along with cisgender men and gender expansive MAB, moderately endorsed essentialist views regarding differences between men and women (i.e., complementary gender differentiation). These data reveal novel patterns of gender-related stereotyping, with some corresponding to sex designated at birth and others corresponding to current gender identification. Together, these findings suggest that one's experienced gender, designated sex at birth, and the intersection between them may relate to gender stereotyping, underscoring the importance of including transgender and gender expansive individuals in this research.

Defining Desistance: Exploring Desistance in Transgender and Gender Expansive Youth Through Systematic Literature Review.

Background: Desistance is a concept that has been poorly defined in the literature, yet greatly impacts the arguments for and against providing gender-affirming care for transgender and gender expansive (TGE) youth. This literature review aims to provide an overview of the literature on desistance and how desistance is defined. Methods: A systematically guided literature review was conducted on March 27, 2020, using CINAHL, Embase, LGBT Life, Medline, PsychINFO, and Web of Science to identify English language peer-reviewed studies, editorials, and theses that discuss desistance concerning TGE pre-pubertal youth for a minimum of three paragraphs. Articles were divided based on methodology and quantitative data were quality assessed and congregated. Definitions of desistance were compiled and analyzed using constant comparative method. Results: One qualitative study, 2 case studies, 5 quantitative studies, 5 ethical discussions, and 22 editorials were assessed. Quantitative studies were all poor quality, with 83% of 251 participants reported as desisting. Thirty definitions of desistance were found, with four overarching trends: desistance as the disappearance of gender dysphoria (GD) after puberty, a change in gender identity from TGE to cisgender, the disappearance of distress, and the disappearance of the desire for medical intervention. Conclusions: This review demonstrates the dearth of high-quality hypothesis-driven research that currently exists and suggests that desistance should no longer be used in clinical work or research. This transition can help future research move away from attempting to predict gender outcomes and instead focus on helping reduce distress from GD in TGE children.

Gender expansive listeners utilize a non-binary, multidimensional conception of gender to inform voice gender perception.

Few studies on voice perception have attempted to address the complexity of gender perception of ambiguous voices. The current study investigated how perception of gender varies with the complexity of the listener's own gender conception and identity. We explicitly recruited participants of all genders, including those who are gender expansive (i.e. transgender and/or non-binary), and directed them to rate ambiguous synthetic voices on three independent scales of masculine, feminine, and "other" (and to select one or multiple categorical labels for them). Gender expansive listeners were more likely to use the entire expanse of the rating scales and showed systematic categorization of gender-neutral voices as non-binary. We propose this is due to repeated use of reflective processes that challenge pre-existing gender categories and the incorporation of this decision-making process into their reflexive system. Because voice gender influences speech perception, the perceptual experience of gender expansive listeners may influence perceptual flexibility in speech.

Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice.

BACKGROUND: Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. OBJECTIVE: This study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. METHODS: We conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants' photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. RESULTS: We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. CONCLUSIONS: The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals.

A Comparison of Demographic and Psychosocial Characteristics Between Transgender Youth Enrolling Versus Not Enrolling in a Multisite Study.

Purpose: To characterize demographics, psychosocial functioning, and gender-related experiences in transgender youth enrolling versus declining participation in a multisite research study. Methods: Clinical data were abstracted from patient charts at two study sites. Continuous variables were compared using t-tests, and categorical variables were compared using χ 2 tests based on study enrollment status. Results: Few significant differences were observed between enrolled and nonenrolled youth. None of these differences (i.e., designated sex at birth/gender identity; parent-reported separation anxiety; and youth-reported attention deficit/hyperactivity disorder) was replicated across sites. Conclusion: Trans Youth Care findings are likely generalizable to transgender youth initiating hormone treatment at pediatric academic centers.

Take the T out, put the T in: Gender-affirming hormones in youth.

BACKGROUND: An increasing number of adolescents are seeking gender care at clinics and hospital programs, and requesting gender-affirming hormonal treatment. The interventions can either include suppression of testosterone and introduction of estrogen, or suppression of estrogen and introduction of testosterone. AIMS: This review article focuses on the psychosocial experiences of youth who have completed their endogenous puberty and are now requesting one of these two forms of gender-affirming hormonal treatment. We investigate the comparative profiles of these two subgroups of transgender/gender-expansive youth. MATERIALS AND METHODS: Review of research data, established standards of care and practice guidelines, and clinical observations. RESULTS: Differences and similarities are noted and discussed in several realms: gender-related experiences prior to receiving hormonal treatment; the relationship between the physical changes and psychological experiences that accompany the introduction of testosterone or suppression of testosterone with replacement with estrogen; the intrapersonal and interpersonal implications of the treatment; considerations of fertility preservation for future family building; the role of the family in the decision-making process prior to starting a course of hormone therapy; and the capacity of youth to make informed decisions about these partially irreversible medical interventions. DISCUSSION: Medical providers who offer gender-affirming hormonal care to youth should work with the family and allied professionals to assure that the youth's gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in. CONCLUSION: The cohort of youth who come to medical providers after completing puberty, and request gender-affirming hormones in the form of increases or reductions in T have a great deal in common, and also extensive variation among them.

Prevalence and Risk Factors for Nonsuicidal Self-Injury in Transgender and Gender-Expansive Youth at a Rural Gender Wellness Clinic.

Purpose: Transgender and gender-expansive (TGE) populations are at increased risk for nonsuicidal self-injury (NSSI). Rural TGE populations are understudied and underserved in terms of mental health services. The purpose of this study was to determine lifetime prevalence of NSSI among TGE youth at a rural gender wellness clinic and identify demographic and clinical characteristics associated with NSSI. Methods: The Gender Wellness Center Pediatric Patient Registry, a comprehensive database of 185 TGE youth ≤25 years of age, provided an estimate of the lifetime prevalence of NSSI. Univariate logistic regression models were utilized to test associations between patient demographic and clinical characteristics and NSSI. Variables that met the threshold for significance in the univariate analyses (p<0.05) were entered into a multivariate logistic regression model. All statistical analyses were conducted in SAS v.9.4. Results: Prevalence of NSSI in the sample was 36.8% (n=68). In unadjusted logistic regression models, risk factors for NSSI included female assigned sex at birth, transmasculine spectrum gender identity, history of mood disorder, history of suicidal ideation (SI) or attempt, and history of abuse (p<0.05). In the adjusted model, variables significantly associated with NSSI included female assigned sex at birth, history of mood disorder, and history of SI or attempt. Conclusion: NSSI was highly prevalent in this sample of rural TGE youth, confirming the need for screening and early interventions that target the unique vulnerabilities of TGE youth. The complex interplay of sex assigned at birth, mood disorders, and NSSI requires further research.

Perceptions of Support Among Transgender and Gender-Expansive Adolescents and Their Parents.

PURPOSE: To capture and compare the perspectives of parents and their transgender and gender expansive (TGE) adolescents during pivotal moments of gender identity development and to report the level of adjustment during these parental experiences. METHODS: We utilized a mixed-methods approach and interviewed 36 parents and 23 TGE adolescents at our Gender Clinic. Parents retrospectively identified "pivotal moments" in their child's gender identity development and rated their levels of support and adjustment. Adolescents independently rated their parent's level of support during these moments to allow for comparative analyses. RESULTS: The supportive behavior most frequently identified by parents was connecting the adolescent to services, while adolescents considered their parents' use of the affirmed name or pronouns to be most supportive. We found a positive correlation between the parents' perceptions of support and those of TGE adolescents during pivotal moments (r = 0.4, p < 0.001). Adolescents rated the degree of parental support to be 3.73 points (95% confidence interval: [2.67,4.8], p < 0.001) higher on a Likert scale than corresponding ratings provided by parents in a generalized estimating equation model. Parents experienced moderate need for adjustment during these moments. CONCLUSIONS: Providers may use these findings to guide parents toward gender affirmative behaviors that may protect against negative mental health outcomes.

Beyond the Binary: Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents.

Awareness and visibility of transgender individuals have grown exponentially. However, conceptualizing sexual and reproductive health (SRH) as "women's" or "men's" health services further marginalizes transgender and gender-expansive (TGE) youth. Multiple reviews and commentaries have been published on the topic of SRH care for adults under the umbrella term of sexual and gender minorities, all with a call to action for more inclusive care and the need for more clinical research involving TGE individuals, and notably, TGE youth. Results from adult TGE studies are often translated to describe adolescent models. However, models specific to adolescent TGE populations are needed to understand their unique SRH needs. This review will describe the current literature relating to SRH needs of TGE youth and adults, highlighting key areas with significant disparities in need of further research. This comprehensive summary will also provide recommendations for clinicians and researchers with the goal of improving SRH care and obtaining wider representation in both clinical settings and research directed toward TGE youth.