Polish mental and sexual health specialists working with transgender and gender diverse persons - who are they and what is their background? / Polscy specjalisci i specjalistki w dziedzinie zdrowia psychicznego i seksualnego pracujacy z osobami transplciowymi i róznorodnymi plciowo ­ kim sa i jakie maja przygotowanie?

OBJECTIVES: This study aimed to present the demographic and professional characteristics of Polish mental and sexual health specialists (MSHS) and their experience in clinical work with transgender and gender diverse (TGD) people. METHODS: This cross-sectional study was conducted using the LimeSurvey platform. A total of 239 MSHS with a diverse professional background, at different stages of their careers, with experience of working with TGD patients, completed the survey. Participants were asked to provide demographic (e.g., gender and sexual identity) and professional (e.g., knowledge of leading standards and guidelines of care) data. Descriptive statistics were used. RESULTS: The mean age of participants was 39.5 years (SD 7.92) and the majority were assigned female at birth (73.2%). The sample was composed predominantly of psychotherapists (70%), then psychologists (53%), medical doctors (31%) and certified sexologists (5.9%). The majority (72%) practised in large cities (>500,000); 68.6% reported female gender identity, 24.7% a male identity and 6.3% were TGD; 63.2% were heterosexual, 12.1% homosexual, 12.6% bisexual, and 12.1% reported other sexual identity. Both the significance of religion and religious practice were significantly decreased compared to general Polish population. Most participants declared that they either do not know the basic guidelines of care for TGD people at all or know them very little. The majority of MSHS rated their professional training as insufficient. CONCLUSIONS: People providing clinical services to TGD patients are a professionally diverse group. There is an urgent need to expand and intensify professional training directed at MSHS on topics related to the health care dedicated to TGD people.

Psychometric assessment of the Polish Translation of the Transgender Positive Identity Measure (T-PIM). / Ocena psychometryczna polskiego tlumaczenia kwestionariusza Transgender Positive Identity Measure (T-PIM).

OBJECTIVES: Research conducted in transgender and gender diverse individuals focused mainly on the challenges and health disparities affecting this population. One reason for this situation is the lack of questionnaires capturing positive aspects and experiences related to being a transgender person. The Transgender Positive Identity Measure (T-PIM) is one of a very few measures designed to explore such experiences. The aim of the study was to investigate the structure, reliability and validity of the Polish translation of the T-PIM questionnaire. METHODS: A group of 89 transgender and gender diverse participants completed an online survey including the T-PIM questionnaire, resilience measurement scale (SPP-25) and depression (CESD-R) measures. Hierarchical item clustering method (ICLUST), Horn's parallel analysis and Velicer's minimum average partial test (MAP) were employed to investigate the structure of the questionnaire. RESULTS: The analyses showed that the Polish translation of the T-PIM questionnaire was characterized by a 5-factor structure consistent with the original publication (Authenticity, Intimacy, Community, Social Justice, Insights). Cronbach's alpha and Guttman's lambda-6 reliability coefficients reached satisfactory levels for all five factors and for the whole questionnaire. CONCLUSIONS: The Polish translation of the T-PIM questionnaire is characterized by satisfying psychometric properties and can be used in studies on transgender and gender diverse communities.

Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men.

BACKGROUND: Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group. METHODS: Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session. RESULTS: Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants. CONCLUSIONS: Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.

Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals.

BACKGROUND: Gender diverse individuals constitute a substantial yet still understudied population. Particularly little is known about gender non-binary people whose health needs have only recently gained attention from clinicians. AIM: To investigate needs for gender-affirming interventions, selected health indicators and determinants in Polish gender non-binary individuals as compared to transgender men and transgender women. METHODS: We analyzed a subset of data from an online study on health in members of the Polish LGBTQ community. The sample consisted of 53 persons who self-identified as non-binary and 45 transgender men and transgender women. The uptake and the desire for gender-affirming medical interventions as well as selected health indicators were compared in non-binary and transgender persons. Additionally, regression models were conducted for depression, self-esteem and somatic symptoms severity as dependent variables, age as a covariate, and perceived stigma exposure, resilience and discomfort associated with current gender expression as predictors. OUTCOMES: Outcomes such as desire for gender-affirming medical interventions and legal gender reassignment, symptoms of depression, resilience, physical symptoms severity, and perceived stigma exposure were captured in self-reported questionnaires. RESULTS: Compared to the transgender men and transgender women, the non-binary participants of the study significantly less often pursued or desired gender-affirming medical interventions and legal gender reassignment. The non-binary participants also felt significantly more discomfort with their current gender expression. They were also characterized by increased expectations of rejection, vicarious trauma associated with being an LGBTQ person, and by decreased resilience compared to the transgender men and transgender women. Non-binary identity and individual resilience predicted higher self-esteem and decreased depression in the sample. The severity of physical symptoms was predicted by perceived stigma exposure (positively) and by resilience (negatively). CLINICAL IMPLICATIONS: Polish non-binary individuals may constitute a vulnerable population in terms of greater perceived exposure to stigma and decreased individual resilience. Both transgender and non-binary individuals seek gender-affirming interventions and legal gender reassignment; the latter group, however, does so significantly less often. STRENGTHS & LIMITATIONS: We analyzed the data from a unique and understudied Polish population. By exploring the diversity within the transgender and non-binary community, we add to the ongoing discussion on transgender and non-binary health. The major limitations of the study are convenience sampling, cross-sectional design, and limited sample size. CONCLUSION: Non-binary individuals constitute a distinct population in terms of psychosocial and health-related characteristics. Clinicians should be aware of their needs and the challenges they face in association with living in a predominantly gender binary-oriented society. Koziara K, Mijas M. Wycisk J, et al. Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals. J Sex Med 2021;18:1110-1121.