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.

HIV pre-exposure prophylaxis (PrEP) for transgender and nonbinary persons. Literature review and guidelines for professionals. / Profilaktyka przedekspozycyjna HIV (PrEP) dla osób transplciowych i niebinarnych. Przeglad pismiennictwa i wskazówki dla praktyków.

Transgender and nonbinary (TG/NB) persons are listed as one of the key populations in the context of HIV, due to increased risk of HIV infection in this group. HIV prevention, which includes a variety of available methods, should therefore be included in the comprehensive health care for TG/NB persons. One such method is the pre-exposure prophylaxis (PrEP), whose high effectiveness in preventing HIV transmission has already been demonstrated in numerous studies conducted in the cisgender population. However, the available empirical data on its use in TG/NB persons are limited in many respects. This issue is also practically absent in the Polish literature; as a consequence, there are significant gaps in recommendations for professionals involved i n the prevention of HIV among TG/NB persons and professionals involved in the comprehensive health care for TG/NB persons. This article 1) outlines the issue of the use of PrEP among TG/NB persons, including the associated challenges for professionals (specialising in physical, as well as mental health); 2) demonstrates the possible applicability of PrEP in TG/NB populations based on available research findings; 3) summarises good practices in counselling and PrEP-related psychoeducational activities, as part of the comprehensive health care for TG/NB individuals.

It gets better with age: Resilience, stigma, and mental health among lesbian, gay, bisexual, transgender and queer persons from Poland.

Lesbian, gay, bisexual, transgender, and queer populations are disproportionately affected by chronic stress associated with stigma which contributes to health adversities including depression. Negative impact of stigma on health can be alleviated by factors such as resilience. Little is known however on how exposure to stigma, protective factors and mental health change with age among gender and sexually diverse persons. Our study aimed at investigating this issue. Our sample consisted of (i) 245 sexually diverse cisgender women, (ii) 175 sexually diverse cisgender men, and (iii) 98 transgender and gender diverse persons. We collected data through a web-based survey. Linear regression models were performed to investigate the interactions of age and each group of participants for resilience, stigma exposure, and mental health indicators (depression and self-esteem). We hypothesized that resilience and mental health indicators will be positively associated with age in all distinguished groups despite the continued exposure to minority stress. The analysis yielded no significant relationships between stigma exposure and age among study participants. However, we observed significant interaction effects of distinguished groups of participants and age in case of self-esteem, depression, and resilience. Self-esteem and resilience were related positively, and depression was negatively associated with age in all study groups. Additionally, we observed that sexually diverse cisgender men demonstrated significantly increased resilience, reduced depression and higher self-esteem compared to other groups. Although the exposure to stigma did not decrease with age, resilience and self-esteem increased, suggesting that LGBTQ persons manage to thrive despite adversities.

Characteristics and expectations of patients seeking help for gender dysphoria in one of the sexological outpatient clinics in Poland. / Charakterystyka i oczekiwania pacjentów szukajacych pomocy z powodu dysforii plciowej w jednej z poradni seksuologicznych w Polsce.

OBJECTIVES: The aim of the study was to present the characteristics of the convenience sample of the transgender people who registered in one of the sexological outpatient clinics, with particular emphasis on the needs of those seeking assistance. The division into persons with binary and non-binary identities was included. METHODS: A statistical analysis of the data obtained from the medical records of a group of 49 patients, including 35 patients declaring binary identity and 14 patients declaring non-binary identity, was conducted. The data included, among others, the reported gender identity, the process of its emergence and the range of expectations towards the outpatient clinic (hormone therapy, qualification for gender confirmation procedures, support in obtaining legal recognition of gender reassignment, assistance in the coming-out process, treatment of co-occurring psychiatric problems or psychological assistance). RESULTS: The results indicate a great diversity of the examined group in terms of the declared gender identity. In the group of non-binary persons, a different than in binary persons course of the emergence and consolidation of gender identity is noticeable. The expectations reported in terms of hormone therapy, surgical treatment, legal recognition, assistance in the coming-out process and mental health indicate that there are differences and heterogeneous needs in the study group. The results indicate that expectations for hormone therapy, gender confirmation surgeries and legal recognition are more common in binary patients. CONCLUSIONS: Despite the frequent perception of transgender people as a homogeneous group with similar experiences and expectations, the results indicate considerable diversity in the given range.

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.

Anthropometry and body composition of adolescents in cracow, poland.

BACKGROUND AND OBJECTIVE: The aim of the present study was to determine the level of adiposity and obesity in Polish adolescents and compare the results with earlier studies conducted in this population as well as those carried out in other populations. METHODS: The study group consisted of 456 boys and 514 girls aged 14-18 years living in Cracow chosen from randomly selected secondary schools. Weight, height, waist, and hip circumference (WC, HC) as well as triceps, biceps, subscapular, and suprailiac skinfold thickness (SFT) were measured. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), subscapular/triceps skinfold ratio (STR), and percentage body fat were computed. The prevalence of overweight and obesity based on Polish children growth reference were calculated and age-dependent and gender-specific smoothed percentile curves for BMI and ROC curves were generated. RESULTS: Weight, height, WC, HC (up 16yr), WHtR (up 15yr), and WHR were considerably higher in males than females. Weight, height, and HC increased with age; WHtR remained the same. The prevalence of overweight and obesity were 10.2% (boys 10.3%; girls 10.1%) and 4.2% (boys 5.3%; girls 3.3%). ROC analysis revealed that WHtR was the best tool for detection of obesity (AUC of 0.982±0.007) in males, whereas the sum of four SFTs (AUC: 0.968±0.011) and WHtR (AUC: 0.963±0.012) were the best predictors of obesity in females. CONCLUSIONS: The level of adiposity in Cracow adolescents increased during the last decade. However, it is still lower than in other well-developed societies struggling with obesity epidemics.