Live sobre Visibilidade Trans

Atendimento à população trans

Neste episódio do Saúde Para Todes, vocês vão acompanhar a conversa que levamos com o médico Tiago Oliveira, que trabalha na UBS Santa Cecília. No vídeo, ele conta como funciona o atendimento à população transexual no contexto de uma unidade básica de saúde.

Saiba a diferença entre cis e trans

Alguns termos como cisgênero e transgênero ainda causam dúvidas em quem não está tão familiarizado com as discussões que envolvem gênero e sexualidade. No episódio de hoje do #SaúdeParaTodes vamos explicar essas diferenças e mostrar com o #SUS está presente na vida de todes. Dá o play!

Afinal, qual a importância do Nome Social?

O nome social já é uma realidade no SUS, mas muitas pessoas ainda desconhecem a importância de se valer esse direito das pessoas trans. Respeitar o nome com o qual a pessoas quer ser identificada é um dever dos profissionais de saúde, mas também de todes nós na construção de uma sociedade mais igualitária. Vale lembrar que a cidade de São Paulo conta com decreto municipal que garante o uso do nome social em todos os serviços públicos.

Is gender primacy universal?

Emerging evidence suggests that gender is a defining feature of personhood. Studies show that gender is the primary social category individuals use to perceive humanness and the social category most strongly related to seeing someone-or something-as human. However, the universality of gender's primacy in social perception and its precedence over other social categories like race and age have been debated. We examined the primacy of gender perception in the Mayangna community of Nicaragua, a population with minimal exposure to Western influences, to test whether the primacy of gender categorization in humanization is more likely to be a culturally specific construct or a cross-cultural and potentially universal phenomenon. Consistent with findings from North American populations [A. E. Martin, M. F. Mason, J. Pers. Soc. Psychol. 123, 292-315 (2022)], the Mayangna ascribed gender to nonhuman objects more strongly than any other social category-including age, race, sexual orientation, disability, and religion-and gender was the only social category that uniquely predicted perceived humanness (i.e., the extent to which a nonhuman entity was seen as "human"). This pattern persisted even in the most isolated subgroup of the sample, who had no exposure to Western culture or media. The present results thus suggest that gender's primacy in social cognition is a widely generalizable, and potentially universal, phenomenon.

Discrimination based on gender identity against transgender women and travestis in Brazil: a latent class analysis and associated factors.

OBJECTIVE: To identify groups of transgender women and travestis (TGW) with specific patterns of gender-based discrimination (GBD) and analyze the factors associated with GBD. METHODS: A cross-sectional study was conducted with TGW recruited through respondent-driven sampling in five Brazilian cities (2019-2021). Latent class analysis was used to characterize GBD (low, medium, and high) using 14 observable variables. Descriptive analysis was performed, and associations between predictor variables and GBD were estimated by adjusted odds ratios (aOR) using ordinal logistic regression. RESULTS: Out of a total of 1,317 TGW, 906 (68.8%) answered questions about GBD. Most were under 34 years old, single, and had a Brown race/skin color. GBD was classified as "low," "medium," and "high," with estimates of 41.7, 44.5, and 13.8%, respectively. Variables positively associated with higher intensity of GBD included living in Manaus compared to São Paulo, being ≤34 years old compared to >34, being homeless compared to living in one's own house or rented apartment, not having legally changed one's name compared to those who had, and reporting physical or sexual violence compared to those who did not report. Variables negatively associated with higher intensity of GBD included having a Brown or Asian race/skin color compared to White and a monthly income ≥1 minimum wage compared to ³1. CONCLUSION: A high proportion of GBD was observed in Brazilian TGW, with this outcome associated with more vulnerable sociodemographic characteristics and a history of violence.

A deeper consideration of sex/gender in quantitative health research: a checklist for incorporating multidimensionality, variety, embodiment, and intersectionality throughout the whole research process.

BACKGROUND: There is a growing awareness of the need to adequately integrate sex and gender into health-related research. Although it is widely known that the entangled dimensions sex/gender are not comprehensively considered in most studies to date, current publications of conceptual considerations and guidelines often only give recommendations for certain stages of the research process and - to the best of our knowledge - there is a lack of a detailed guidance that accompanies each step of the entire research process. The interdisciplinary project "Integrating gender into environmental health research" (INGER) aimed to fill this gap by developing a comprehensive checklist that encourages sex/gender transformative research at all stages of the research process of quantitative health research. In the long term this contributes to a more sex/gender-equitable research. METHODS: The checklist builds on current guidelines on sex/gender in health-related research. Starting from important key documents, publications from disciplines involved in INGER were collected. Furthermore, we used a snowball method to include further relevant titles. The identification of relevant publications was continued until saturation was reached. 55 relevant publications published between 2000 and 2021 were identified, assessed, summarised and included in the developed checklist. After noticing that most publications did not cover every step of the research process and often considered sex/gender in a binary way, the recommendations were modified and enriched based on the authors' expertise to cover every research step and to add further categories to the binary sex/gender categories. RESULTS: The checklist comprises 67 items in 15 sections for integrating sex/gender in quantitative health-related research and addresses aspects of the whole research process of planning, implementing and analysing quantitative health studies as well as aspects of appropriate language, communication of results to the scientific community and the public, and research team composition. CONCLUSION: The developed comprehensive checklist goes beyond a binary consideration of sex/gender and thus enables sex/gender-transformative research. Although the project INGER focused on environmental health research, no aspects that were specific to this research area were identified in the checklist. The resulting comprehensive checklist can therefore be used in different quantitative health-related research fields.

Effects of gender sensitive language in job listings: A study on real-life user interaction.

The possible impact of gender-sensitive language on readers is among the most controversially debated issues in linguistics and beyond. Previous studies have suggested that there is an effect of gender-sensitive language on mental representations, based on data gathered in laboratory settings with small groups of participants. We add a new perspective by examining correlations of authentic language use with authentic user interaction on a recruitment website. Drawing upon a large dataset provided by the recruitment platform StepStone, we evaluate whether job advertisements using certain kinds of gender-sensitive language in their titles correlate with higher proportions of views by female users. Our results indicate that there are differing effects depending on the type of gender-sensitive language that is used. Overall, the strongest correlation can be found with terms that include the feminine suffix -in.

Editorial: The Cass Review - implications and reassurance for practitioners.

This editorial perspective summarises the key findings of the independent review of gender identity services for children and young people commissioned by the National Health Service (NHS) in England (the Cass Review). Although the evidence underpinning endocrine interventions in this group of young people remains weak, there is much that mental health practitioners can do to improve their well-being and support their families. The controversies surrounding this group of young people have disempowered local professionals, who have lost confidence in their ability to provide care for them. The reality is that CAMHS professionals already have all the necessary transferrable skills and with a small amount of top up training, they can make a profound difference to the lives of this vulnerable group, which has been marginalised in our healthcare system.

Do Sex and Gender Have Separate Identities?

The largely binary nature of biological sex and its conflation with the socially constructed concept of gender has created much strife in the last few years. The notion of gender identity and its differences and similarities with sex have fostered much scientific and legal confusion and disagreement. Settling the debate can have significant repercussions for science, medicine, legislation, and people's lives. The present review addresses this debate though different levels of analysis (i.e., genetic, anatomical, physiological, behavioral, and sociocultural), and their implications and interactions. We propose a rationale where both perspectives coexist, where diversity is the default, establishing a delimitation to the conflation between sex and gender, while acknowledging their interaction. Whereas sex in humans and other mammals is a biological reality that is largely binary and based on genes, chromosomes, anatomy, and physiology, gender is a sociocultural construct that is often, but not always, concordant with a person' sex, and can span a multitude of expressions.

Faculty Training on Navigating Gender and Sex in Medical Education.

Introduction: Language that assumes gender and sex are binary and aligned is pervasive in medicine and is often used when teaching on physiology and pathology. Information presented through this lens oversimplifies disease mechanisms and poorly addresses the health of gender and sexually diverse (GSD) individuals. We developed a training session to help faculty reference gender and sex in a manner that would be accurate and inclusive of GSD health. Methods: The 1-hour session for undergraduate and graduate medical educators highlighted cisgender and binary biases in medical teachings and introduced a getting-to-the-root mindset that prioritized teaching the processes underlying differences in disease profiles among gender and sex subpopulations. The training consisted of 30 minutes of didactic teaching and 20 minutes of small-group discussion. Medical education faculty attended and self-reported knowledge and awareness before and after the training. Results were compared using paired t tests. Expenses included fees for consultation and catering. Results: Forty faculty participated (pretraining survey n = 36, posttraining survey n = 21). After the training, there was a significant increase in self-reported awareness of the difference between gender and sex (p = .002), perceived relevance of gender to teachings (p = .04), and readiness to discuss physiological drivers of sex-linked disease (p = .005). Discussion: Participants reported increased understanding and consideration of gender and sex in medical education; feedback emphasized a desire for continued guidance. This easily adaptable session can provide an introduction to a series of medical teachings on gender and sex.

[The effects of changes in attitudes toward masculinity in the psychotherapy of depression].

INTRODUCTION: In recent decades, serious changes have been observed in social gender roles. More and more publications have been published regarding the connection between masculinity and mental disorders. Most of the professional guidelines related to major depression have not been adapted yet to social changes in gender roles, or only to a small extent. OBJECTIVE: The authors of the article present the possible influence of masculinity on psychotherapies, focusing on clients suffering from major depressive disorder. METHOD: In our manuscript, we first summarize the psychosocial changes that affect the male gender role in Western societies. After that, we review the possible impact of this transformation on psychotherapies. We mainly deal with the relationship between the onset of major depressive disorder and the male gender role. At the end of our publication, we make recommendations on how to integrate our knowledge of masculinity into the context of therapy. RESULTS: Individual socialization differences related to the male gender role and social expectations can greatly influence the appearance of mental illnesses. Internalized and externalized symptoms should also be taken into account in the recognition and treatment of major depressive disorder. Positive masculinity as a therapeutic framework can be successfully combined with specific psychotherapies in order to personalize the healing process. CONCLUSIONS: In recent years, mental health care sensitive to gender roles has gained more and more space. Although we already have more and more information about how masculinization affects the clinical picture of mental illness, such as major depressive disorder, further studies are needed for more effective diagnosis and therapy.

Gender and Sport.

Sport faces many challenges in creating fair, interesting, and meaningful competitions that highlight and reward the qualities widely valued in sport, such as natural talents, dedication, and competitive savvy. The Paralympic Games illuminate both the challenge and a thoughtful way of responding by organizing events that group athletes with comparable levels of impairment so that raw physical discrepancies don't overwhelm differences in talent or dedication. It may be helpful to reflect on how gender is used in decisions about who competes against whom. Gender has long served as a rough proxy for differences in size and strength. For sports where size and strength matter, those are the dimensions along which competitors should be matched, not their gender identity. In that sense, gender is incidental to fair competition in sport. Because playing sports is good for people in so many ways, we should provide abundant opportunities that are widely available and enjoyable for all people.

Childhood Gender Diversity and Mental Health: Protocol for the Longitudinal, Observational Gender Journey Project.

BACKGROUND: Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TGD children experiences gender dysphoria, that is, distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present). OBJECTIVE: The objective of this National Institutes of Health-funded study is to provide evidence to inform clinical care for prepubertal TGD children by establishing a US longitudinal cohort (N=248) of prepubertal TGD children and their caregivers that is followed prospectively at 6-month intervals across 18 months. METHODS: At each timepoint, clinical and behavioral data are collected via web-based visit from child and caregiver reporters. Latent class analysis, among other methods, is used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TGD children. These models will define longitudinal patterns of gender identity stability and characterize the relationship between TGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present), on these associations. RESULTS: Baseline data collection (N=248) is complete, and the identification of TGD subgroups based on gender identity and expression using latent class analysis is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in July 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed by winter 2024. CONCLUSIONS: Through a longitudinal observational design, this research involving prepubertal TGD children and their caregivers aims to provide empirical knowledge on gender development in a US sample of TGD children, their mental health symptomology and functioning over time, and how family initiated social gender transition may predict or alleviate mental health symptoms or diagnoses. The research findings have promise for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55558.

Sexual orientation, gender identity and virologic failure among people with HIV: a cohort study in all of US research program.

BACKGROUND: Sexual and gender minorities (SGMs) are at higher risk of HIV incidence compared to their heterosexual cisgender counterparts. Despite the high HIV disease burden among SGMs, there was limited data on whether they are at higher risk of virologic failure, which may lead to potential disease progression and increased transmission risk. The All of Us (AoU) Research Program, a national community-engaged program aiming to improve health and facilitate health equity in the United States by partnering with one million participants, provides a promising resource for identifying a diverse and large volunteer TGD cohort. Leveraging various data sources available through AoU, the current study aims to explore the association between sexual orientation and gender identity (SOGI) and longitudinal virologic failure among adult people with HIV (PWH) in the US. METHODS: This retrospective cohort study used integrated electronic health records (EHR) and self-reported survey data from the All of Us (AoU) controlled tier data, version 7, which includes participants enrolled in the AoU research program from May 31, 2017, to July 1, 2022. Based on participants' sexual orientation, gender identity, and sex assigned at birth, their SOGI were categorized into six groups, including cisgender heterosexual women, cisgender heterosexual men, cisgender sexual minority women, cisgender sexual minority men, gender minority people assigned female at birth of any sexual orientation, and gender minority people assigned male at birth of any sexual orientation. Yearly virologic failure was defined yearly after one's first viral load testing, and individuals with at least one viral load test > 50 copies/mL during a year were defined as having virologic failure at that year. Generalized linear mixed-effects models were used to explore the association between SOGI and longitudinal virologic failure while adjusting for potential confounders, including age, race, ethnicity, education attainment, income, and insurance type. RESULTS: A total of 1,546 eligible PWH were extracted from the AoU database, among whom 1,196 (77.36%) had at least one viral failure and 773 (50.00%) belonged to SGMs. Compared to cisgender heterosexual women, cisgender sexual minority women (adjusted Odds Ratio [aOR] = 1.85, 95% CI: 1.05-3.27) were at higher risk of HIV virologic failure. Additionally, PWH who were Black vs. White (aOR = 2.15, 95% CI: 1.52-3.04) and whose insurance type was Medicaid vs. Private insurance (aOR = 2.07, 95% CI: 1.33-3.21) were more likely to experience virologic failure. CONCLUSIONS: Maintaining frequent viral load monitoring among sexual minority women with HIV is warranted because it allows early detection of virologic failure, which could provide opportunities for interventions to strengthen treatment adherence and prevent HIV transmission. To understand the specific needs of subgroups of SGMs, future research needs to examine the mechanisms for SOGI-based disparities in virologic failure and the combined effects of multi-level psychosocial and health behavior characteristics.

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use.

OBJECTIVE: Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people. METHODS: Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health. RESULTS: Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs. CONCLUSIONS: Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

Lucca e Benicio falam da mastectomia masculinizadora

Neste episódio do Saúde Para Todes vocês conferem a conversa que levamos com o Lucca Miranda e o Benicio Borim, eles são homens trans e realizaram a mastectomia masculinizadora no Hospital Municipal e Maternidade Prof. Mário Degni.