How the COVID-19 pandemic affects transgender health care - A cross-sectional online survey in 63 upper-middle-income and high-income countries.

Background: Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. Methods: As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. Results: 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Discussion: Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality.

[Autism Spectrum Disorders and Gender Dysphoria Among Children and Adolescents: Systematic Review on the Co-Occurrence]. / Autismus-Spektrum-Störungen und Geschlechtsdysphorie bei Kindern und Jugendlichen: Systematisches Review zur gemeinsamen Prävalenz.

OBJECTIVE: The review systematically reviews the literature on co-occurring gender dysphoria/gender variance and autism spectrum disorder among children and adolescents. METHODS: A systematic literature search was conducted for the years 1946 to December 2018. RESULTS: 144 publications could be identified in the literature search. Out of these, 22 publications met the inclusion criteria for the systematic review. 4.7 to 13.3 % of the children and adolescents with primarily diagnosed gender dysphoria/variance examined in the studies also had an autism diagnosis. In samples of children and adolescents with primarily diagnosed autism gender variance was overrepresented with a prevalence of 4 to 6.5 %. CONCLUSION: The results of the systematic review point towards an overrepresentation of co-occurring gender dysphoria/variance and autism spectrum disorder. Methodological and clinical implications are discussed.

[Treatment Experiences and Social Support in Individuals with Gender Incongruence/Gender Dysphoria - A ENIGI 5 Year Follow-Up Study in Three European Countries]. / Behandlungserfahrungen und soziale Unterstützung bei Personen mit Geschlechtsinkongruenz/Geschlechtsdysphorie: Eine ENIGI 5-Jahres-Follow-Up-Studie in drei europäischen Ländern.

INTRODUCTION: Gender Dysphoria (GD) refers to a distress resulting from an incongruence between the individual's sex characteristics and the experience of their gender (Gender Incongruence, GI). The interaction between medical treatment of GI/GD and social support in the long-term has not been investigated sufficiently so far. MATERIAL & METHODS: Using an online questionnaire, the present study investigated n=117 individuals with GI/GD assigned male and n=52 assigned female at birth that had been referred to one of the specialized clinics of the European Network for the Investigation of Gender Incongruence (ENIGI) in Belgium, the Netherlands, and Germany.They filled out a questionnaire at 2 time points within a follow-up time of 4 to 6 years after clinical entry (between 2007 and 2009). Two hierarchical regression analyses explored the effects of the sex assigned at birth, the treatment progress and social support on mental distress and satisfaction with life at follow-up in the sample. RESULTS: A female sex assigned at birth and higher degrees of social support significantly predicted the reduction in mental distress at follow-up. An advanced stage of the individual treatment and higher social support significantly predicted an increase in overall satisfaction with life. DISCUSSION: The results illustrate the importance of social support with regard to the outcome of medical treatment of GI/GD.

['How Much Sex do Medical Studies Need?' - A Survey of the Knowledge and Interest in Sexual Medicine of Medical Students.] / "Wie viel Sex braucht das Studium der Medizin?" - Eine Erhebung des Wissens und Interesses Medizinstudierender zum Thema Sexualmedizin.

Background: Because of the increasing need for medical care of problems concerning human sexuality, the International Society for Sexual Medicine (ISSM) in 2010 suggested to include sexual medicine in the current curricula of medical studies. Based on the ISSM's suggestions sexual medicine should be taught on a multidisciplinary basis throughout the whole study process. Furthermore, health care providers have repeatedly indicated that they have lacking knowledge concerning sexual medicine and patients have criticized that their health care providers only infrequently address their sexuality. Methods: 404 medical students from 2 German university medical centers answered an online questionnaire assessing the quality of sexual medicine education. The students were asked about their interest in and their knowledge about different issues concerning human sexuality in the following 4 domains: Sexual development, Sexual behavior, Sexual physiology and psychology, Sexual medicine and therapy of sexual disorders. Results: The great majority of students were interested in education about sexual medicine within medical studies, whereby most students were of the opinion that sexual medicine should be included in the already existing subjects. Furthermore, students mostly evaluated the current quality of sexual medicine education as insufficient and more than half of the students thought that they do not have enough knowledge about human sexuality for their future profession as medical health care providers. On average the students correctly answered 50% of the knowledge questions, however they showed some knowledge gaps especially in the domains of sexual development and sexual physiology and psychology. Discussion: The results of the present study suggest that medical students have lacking knowledge concerning important parts of human sexuality but at the same time express great interest in the field. Therefore, in Germany more structured educational programs in sexual medicine should be developed taking the suggestion of the ISSM into account. Conclusion: Besides medical education about pathological sexuality future educational efforts should also address healthy sexuality and its sociocultural meaning more frequently. Thereby, the students' wishes would be met and moreover, health care providers of all fields would be enabled to provide an unbiased, holistic and sensitive treatment of sexual problems.

[Clinical treatment of children and adolescents with gender dysphoria from international experts' point of view]. / Die Versorgung von Kindern und Jugendlichen mit Geschlechtsdysphorie aus der Sicht internationaler Expertise.

The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).

[Care of children and adolescents with gender dysphoria in the context of an interdisciplinary special consultation service]. / Versorgung von Kindern und Jugendlichen mit Geschlechtsdysphorie im Rahmen einer interdisziplinären Spezialsprechstunde.

In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, and gain of knowledge through research. After finishing a thorough interdisciplinary assessment an individualized, case-by-case treatment starts. Besides psychotherapy an interdisciplinary treatment (e. g. puberty suppression and cross-sex hormones) is provided if indicated. During childhood a watchful waiting and carefully observing attitude is necessary. If a marked increase of gender dysphoria occurs during the first phases of puberty development, puberty suppression and later cross sex-hormones might be indicated.

[Sexual orientation and partner-choice of transsexual women and men before gender-confirming interventions]. / Sexuelle Orientierung und Partnerwahl transsexueller Frauen und Männer vor körpermedizinischen geschlechtsanpassenden Maßnahmen.

Diverse partner relationship constellations of gender dysphoric women and men with different sexual orientations are explored in a sample of 93 persons before gender-confirming interventions in persons with female gender identity and male body characteristics (MF) and persons with male gender identity and female body characteristics (FM). While in both gender groups the majority is single, relationship patterns show differences. Apart from working life, FM already live predominantly in the new, male gender role and have partners by whom they are desired as males. In contrast, only a small proportion of MF already conduct their private lives in the new, female gender role, and they often have relationships with partners sexually attracted to males and not to their female gender identity. The findings indicate a need for differing resources for gender dysphoric women and men in the process of a transsexual course of development.