Trans narratives on school experiences-This is how we feel.

Introduction: The school environment remains unsafe for many trans people, where they are victims of discrimination, aggression, and bullying, resulting in socioemotional and physical harm to trans individuals. Intersectionality and minority stress are contributing factors in this already challenging education environment. In many cases, the voices of trans people are not heard or listened to at school; therefore, this study aims to listen to their school experiences in order to identify key areas for improvement. Method: This study implemented a narrative research approach where six in-depth interviews were completed with trans participants from the Basque Country, Europe, and the United States of America that focused on five dimensions: being a trans, the role of school, lack of teacher education and training, segregation by gender, and socioemotional wellbeing. The transcriptions of these interviews were coded using Nvivo software in categorical systems in a deductive and inductive way. Results: The results clearly showed that the binary society has a negative impact on trans people. In addition, the educational environment is still hostile for most of them, in which the lack of teacher training and gender identity content in the curriculum has a negative impact on trans people and their experiences at school. Discussion: The findings support the idea that socially ingrained binarism is detrimental to all those who step outside the norm. It can also be said that the earlier the transition is made, the better the effect (clinical as well as socioemotional) on their personal lives. For this early transition to occur, it is necessary to have access to information from an early age.

"We're still alive, much to everyone's surprise": The experience of trans older adults living with dementia in an ageist, cisgenderist, and cogniticist society.

Trans and non-binary older adults living with dementia experience forms of marginalization, pathologization, and discrimination embedded in epistemic violence that leads them to be mistreated and dismissed as knowledgeable subjects. Based on empirical findings from a Canadian study examining the experiences of trans and non-binary people living with dementia and their carers, we combat this epistemic violence by focusing on the first-hand narratives of this population and their carers. Narrative interviews were conducted with six participants (N = 6): four carers of trans and non-binary adults living with dementia and two trans (binary) people living with dementia. Through a thematic analysis, we examine the unique aspects of living with dementia as a trans or non-binary person. First, the findings show how cogniticism impacts the experience of gender identity and cisgenderism, for example through blocked surgeries, excessive gatekeeping, and not being taken seriously by practitioners. Second, the findings discuss how dementia impacts gender identity and cisgenderism, for example, by increasing the need for formal care that can in turn increase vulnerability to structural violence. Third, the findings illustrate how cisgenderism and gender identity impact the experience of dementia and cogniticism, for example by limiting care options and the ability to advocate for oneself. Fourth, the findings highlight the silo mentality among practitioners, since most of them do not work with an intersectional lens. The article concludes by offering recommendations.

La atención sanitaria a personas trans: una reflexión bioética / Health care for trans people: a bioethical reflection

La atención sanitaria a personas transexuales no ha estado dentro de las prioridades de la Bioética, de tal forma que en la mayoría de los manuales de esta disciplina no se hace alusión a esta cuestión, o se pasa por ella de una forma bastante simple o comedida. Sin embargo, es preciso hacer constar que en el último decenio el debate bioético, sobre cuestiones de género en general y sobre transexualismo en particular, se ha incrementado notablemente. Este trabajo persigue ofrecer a la persona transexual, al profesional sanitario o al estudioso sobre el tema trans, herramientas para articular una reflexión bioética. Tiene dos partes claramente diferenciadas. En la primera, se exponen los aspectos que se estima necesario considerar cuando se valora la eticidad de una intervención de cambio de género. En la segunda parte, se ofrece una reflexión sobre las líneas argumentales que, sobre este punto, sustentan las distintas corrientes bioéticas (AU)

Health care for trans people has not been among the priorities of Bioethics, so that in most of the ma nuals of this discipline there is no reference to this issue, or it is covered in a rather simple or measured way. However, it is necessary to note that in the last decade the bioethical debate, on gender issues in general and on transsexualism in particular, has increased significantly. This work seeks to offer the transsexual per son, the health professional or the student on the trans topic tools to articulate their particular bioethical reflection. It has two clearly differentiated parts. In the first, the aspects that are considered necessary to consider when assessing the ethics of a gender change intervention are presented. In the second part, a reflection is offered on the lines of argument that support the different bioethical currents (AU)

Opening a portal to pleasure based sexual and reproductive health around the globe; a qualitative analysis and best practice development study.

Pleasure is often left out of sexual and reproductive health and rights (SRHR) interventions. The expanding evidence base suggests that the inclusion of pleasure can improve SRHR outcomes and increase safer sex practices. However, there is a lack of research into how to include pleasure in applied SRHR work, particularly outside of key groups. This study aims to present the experiences of a cohort of pleasure implementers and develop a series of implementation best practices. Data were gathered from a structured survey filled out by pleasure implementers (n = 8) twice between September 2021 and October 2022 at 6-month intervals. Focus group discussions (FGDs) were carried out remotely with pleasure implementers, those that funded their pleasure work (n = 2) or provided technical support (n = 2) in January 2023. Pleasure implementers, based in Central, East and Southern Africa and India, reported tangible outcomes of their pleasure-based work in various contexts and across diverse groups. Themes that emerged from analysis of the FGDs and survey responses included pleasure as a portal to positive outcomes, barriers to a pleasure approach, and mechanisms by which pleasure allows for open and non-judgmental discussion about sex and pleasure. A series of best practices emerged from pleasure implementer experiences. This study concludes that a pleasure-based approach can be introduced to a wide range of groups and communities, even those assumed too conservative to accept a pleasure approach. The best practices developed offer a range of practically driven recommendations, that others can lean on when integrating a pleasure approach into their work.

Evaluación del focus group con personas trans realizado en el proyecto "Igualdad y no discriminación en la atención farmacéutica a personas transexuales en España. Elaboración de un libro blanco" / Evaluation of the focus group with trans people carried out in the project "Equality and non-discrimination in pharmaceutical care for transsexual people in Spain. Preparation of a white paper"

El artículo aborda el análisis de los resultados de la realización de un focus group con personas trans en el contexto del proyecto de investigación “Igualdad y no discriminación en la atención farmacéutica a personas transexuales en España. Elaboración de un libro blanco”. Se establece la metodología empleada, distinguiéndola de otras afines, describiendo su desarrollo y posterior evaluación de su aplicación. Se describe la contribución de los participantes en el focus group, mostrando los resultados más relevantes del focus. Estos resultados se comparan con otro focus group realizado en el contexto del mismo proyecto con farmacéuticos comunitarios en su atención a persona trans. Se concluye que la realización de ambos focus group ha sido una fuente de información y de base de trabajo muy adecuada para intentar dar respuesta a una necesidad no cubierta y dar al farmacéutico comunitario una herramienta que le permita realizar la mejor atención a las personas trans, pudiendo abordar los múltiples aspectos que puedan estar relacionados con sus necesidades y particularidades. (AU)

The article deals with the analysis of the results of the realization of a focus group with trans people in the context of the research project «Equality and non-discrimination in pharmaceutical care for transsexual people in Spain. Preparation of a white paper». The methodology used is established, distinguishing it from other related ones, describing its development and subsequent evaluation of its application. The contribution of the participants in the focus group is described, showing the most relevant results of the focus. These results are compared with another focus group carried out in the context of the same project with community pharmacists in their care for trans people. It is concluded that the realization of both focus groups has been a source of information and a very adequate work base to try to respond to an unmet need and give the community pharmacist a tool that allows him to perform the best care for trans people, being able to address the multiple aspects that may be related to their needs and particularities. (AU)

Estudio sociodemográfico comparativo de los períodos 2007-2009 y 2015-2019 de la Unidad de Tratamiento de Identidad de Género del Principado de Asturias / Sociodemographic comparative between the periods 2007-2009 and 2015-2019 of the Gender Identity Treatment Unit of Asturias

Antecedentes y objetivo: La elevada demanda asistencial sanitaria realizada por las personas trans en los últimos años ha dirigido el foco de la investigación hacia el estudio de sus aspectos clínicos y sociodemográficos. Este trabajo tuvo por objetivo comparar y analizar algunas variables sociodemográficas en personas trans en 2 períodos temporales: el período de inicio de funcionamiento de la unidad y el período más reciente. Materiales y método: Se comparó una muestra de 131 usuarios que asistió a la Unidad de Tratamiento de Identidad de Género del Principado de Asturias (UTIGPA) entre 2015-2019, con una muestra de 33 que acudió entre 2007-2009. Los datos se extrajeron de historias clínicas. Resultados: Respecto al período 2007-2009 entre 2015-2019 la ratio se invierte a favor de los hombres trans (HT). Los usuarios de ambos géneros solicitan consulta a edades más tempranas (especialmente los HT), provienen menos del extranjero, alcanzan una mayor cualificación educativa y laboral, presentan menos paro y solicitan más el cambio registral; y aunque las mujeres trans (MT) continúan siendo las que, mayoritariamente, se dedican a la prostitución y se autohormonan, en este período más reciente lo reportan menos y, además, conviven más acompañadas. Conclusiones: Se observan cambios en las variables sociodemográficas de los usuarios de la UTIGPA entre 2007-2009 y 2015-2019, en dirección a una mayor inclusión. No obstante, las condiciones sociodemográficas de las MT siguen en desventaja en comparación con las de los HT. (AU)

Background and objective: The high demand of assistance made by trans people in recent years has directed the focus of research towards the study of their clinical and sociodemographic aspects. The objective of this work was to compare and analyze some sociodemographic variables in trans people in two periods: the period when the unit began to operate and the most recent period. Materials and method: A sample of 131 users who attended the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) between 2015-2019 was compared with a sample of 33 who attended between 2007-2009. Data were extracted from medical records. Results: Regarding 2007-2009, in 2015-2019 the ratio is inverted in favor of Trans Men (TM). Users of both genders request consultation at an earlier age (specially TM), come less from abroad, achieve higher educational and work qualifications, are less unemployed and request more name changes. And, although Trans Women (TW) continue to be those who are mostly engaged in prostitution and self-administration of hormones, in the most recent period they report it less and, furthermore, they live more accompanied tan in the past. Conclusions: Changes are observed in the sociodemographic variables of UTIGPA users between 2007-2009 and 2015-2019, in the direction of a greater inclusion. However, the sociodemographic conditions of the TW are still at a disadvantage in comparison to those of the TM. (AU)

[Sociodemographic comparative between the periods 2007-2009 and 2015-2019 of the Gender Identity Treatment Unit of Asturias]. / Estudio sociodemográfico comparativo de los períodos 2007-2009 y 2015-2019 de la Unidad de Tratamiento de Identidad de Género del Principado de Asturias.

BACKGROUND AND OBJECTIVE: The high demand of assistance made by trans people in recent years has directed the focus of research towards the study of their clinical and sociodemographic aspects. The objective of this work was to compare and analyze some sociodemographic variables in trans people in two periods: the period when the unit began to operate and the most recent period. MATERIALS AND METHOD: A sample of 131 users who attended the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) between 2015-2019 was compared with a sample of 33 who attended between 2007-2009. Data were extracted from medical records. RESULTS: Regarding 2007-2009, in 2015-2019 the ratio is inverted in favor of Trans Men (TM). Users of both genders request consultation at an earlier age (specially TM), come less from abroad, achieve higher educational and work qualifications, are less unemployed and request more name changes. And, although Trans Women (TW) continue to be those who are mostly engaged in prostitution and self-administration of hormones, in the most recent period they report it less and, furthermore, they live more accompanied tan in the past. CONCLUSIONS: Changes are observed in the sociodemographic variables of UTIGPA users between 2007-2009 and 2015-2019, in the direction of a greater inclusion. However, the sociodemographic conditions of the TW are still at a disadvantage in comparison to those of the TM.

A narrative exploration of the importance of intersectionality in a Black trans woman's mental health experiences.

Background: The current United States presidential administration's statements and policies have, in a shockingly short time, catastrophically affected people of color and LGBTQIA + communities. And although these numerous discriminatory policies and policy revisions have negatively affected both US people of color and LGBTQIA + people, trans women of color have been disproportionately affected. Even more specifically, when focusing on vulnerability to violence-including murder-it is Black trans women who are most directly affected by the intersections of transphobia and racism in the US. This article explores a Black trans woman's experiences with mental health professionals across two decades and different regions of the US. Aims: This article argues for the necessity of understanding trans people's mental health experiences as necessarily intersectional, in order to more fully appreciate and address the degrees to which factors such as race, socioeconomic class, and geographic context matter in trans people's efforts to access ethical and effective mental healthcare. Methods: Using a theoretical framework informed by Kimberlé Crenshaw's single-axis concept, the authors fully center Aryah's intersectional experiences and counter a single-axis in exploring trans mental health issues, our article relies on a narrative-based approach. As narrative inquiry is a broad field, we selected Butler-Kisber's narrative analytic approach, "Starting with the Story" as our method. The narratives are pulled from approximately 10 intensive qualitative interviews over the course of several months. Discussion: These narratives disrupt the common threads in the literature that ignore the degrees to which race and class matter alongside being a trans woman. In addition, as we noted that nearly all of the mental health literature relied on large-scale survey-based data, this article offers a qualitative narrative exploration of Aryah's experiences and works to humanize trans mental health challenges and needs, while emphasizing the multilayered oppressions and obstacles that affected Aryah.

La disforia de género en menores trans: nicho ecológico / Gender dysphoria in trans minors: Ecological niche

Antecedentes y objetivo: El objetivo del presente estudio es investigar las características contextuales de la aparición de la disforia de género (DG) en menores trans.Materiales y método: Participaron todos los menores de edad que solicitaron consulta en la Unidad de Tratamiento de Identidad de Género desde marzo de 2007 hasta junio de 2019. Se procedió a la revisión de historias clínicas para la obtención de los datos. Se garantizó la confidencialidad.Resultados: Demandaron atención 64 menores, el 39,1% eran mujeres trans (MT) y el 60,9% hombres trans (HT). El rango de edad estuvo comprendido entre los 6 y los 17 años, con una media de 14,98. El 75% de los menores trans ubicaron el inicio de la DG en la infancia y el 25% en la adolescencia. La reacción de los progenitores fue de sospecha en un 55,6% de los casos y de sorpresa en un 36,5%. El 55,6% presentaron malestar psicológico importante previamente a acudir a la unidad.El apoyo familiar estuvo presente en el 57,1%. El papel de las redes sociales e Internet fue relevante para el 39,7% de la muestra. Tenían pertenencia o contacto con grupos de pares o asociaciones LGTBIQ el 44,4% de los menores. Se analizaron los resultados en función del género sentido.Conclusiones: Los menores continúan demandando atención en las unidades, sobre todo las MT. Aunque la DG aparece en ambos grupos fundamentalmente en la infancia, en la adolescencia es más frecuente en los HT. Los menores trans nacen, se desarrollan y construyen su identidad en un contexto determinado que está en interacción. (AU)

Background and objective: The objective of the present study is to investigate the contextual characteristics of the onset of gender dysphoria (GD) in trans minors.Materials and method: All minors who requested consultation in the Gender Identity Treatment Unit from March 2007 to June 2019 participated. Clinical histories were reviewed to obtain the information. Confidentiality was guaranteed.Results: Sixty-four minors required care, 39.1% were trans women (TW) and 60.9% trans men (TM). The age range was between 6-17 years, with a mean of 14.98. Seventy-five percent of the trans minors located the onset of DG in childhood and 25% in adolescence. Parental reaction was suspicious in 55.6% of cases and surprise in 36.5%; 55.6% presented significant psychological distress before going to the unit.Family support was present in 57.1%. The role of social networks and the Internet was relevant for 39.7% of the sample. Of the minors, 44.4% had membership or contact with peer groups or LGTBIQ associations. Results were analysed according to sense of gender.Conclusions: Minors continue to require care in the units, especially TW. Although GD onset in both groups is mainly in childhood, in adolescence it is more frequent in TM. Trans minors are born, develop and build their identity in a specific context, which is in interaction. (AU)

Towards action research with trans women sex workers: Policy, space and social challenges.

Trans women face multiple social, economic and health inequalities and the impact of gender oppression and violence is even more profoundly experienced by trans women sex workers, although in culturally specific ways. This paper presents a pilot study conducted to explore and engage with the context of trans women sex workers in Lido Tre Archi, Italy. In line with the community psychology values of social justice, social change and participation, we outline our engagement process and key challenges observed when attempting action research with such a highly marginalised group. Data were collected in the form of ethnographic notes from informal consultations with different stakeholders and participant observations, and of documents (newspaper articles, picture captions) and were analysed using thematic analysis. Findings are organised in three themes relating to the social, policy and physical context in Lido Tre Archi demonstrating evidence of the contextual challenges and how they intertwine to generate a spiral of marginalisation and social exclusion for the participants. We take a collaborative and reflexive stance in our work and conclude with recommended steps and potential limitations to initiate an action research project.

[Gender dysphoria in trans minors: Ecological niche]. / La disforia de género en menores trans: nicho ecológico.

BACKGROUND AND OBJECTIVE: The objective of the present study is to investigate the contextual characteristics of the onset of gender dysphoria (GD) in trans minors. MATERIALS AND METHOD: All minors who requested consultation in the Gender Identity Treatment Unit from March 2007 to June 2019 participated. Clinical histories were reviewed to obtain the information. Confidentiality was guaranteed. RESULTS: Sixty-four minors required care, 39.1% were trans women (TW) and 60.9% trans men (TM). The age range was between 6-17 years, with a mean of 14.98. Seventy-five percent of the trans minors located the onset of DG in childhood and 25% in adolescence. Parental reaction was suspicious in 55.6% of cases and surprise in 36.5%; 55.6% presented significant psychological distress before going to the unit. Family support was present in 57.1%. The role of social networks and the Internet was relevant for 39.7% of the sample. Of the minors, 44.4% had membership or contact with peer groups or LGTBIQ associations. Results were analysed according to sense of gender. CONCLUSIONS: Minors continue to require care in the units, especially TW. Although GD onset in both groups is mainly in childhood, in adolescence it is more frequent in TM. Trans minors are born, develop and build their identity in a specific context, which is in interaction.

Processo transexualizador no sus: questões para a psicologia a partir de itinerários terapêuticos e despatologização / Proceso transexualizador en el sus: cuestiones para la psicología desde itinerarios terapêuticos y despatologización / Transexualizing process in the sus: questions for psychology from therapeutic itinetaries and depathologization

RESUMO. Trata-se de uma pesquisa qualitativa, des critiva e exploratória, realizada no Tratamento Fora de Domicílio, na cidade de Cuiabá-MT, Brasil, que objetivou levantar reflexões sobre os itinerários terapêuticos de pessoas trans, na busca pelo Processo Transexualizador. Participaram três homens trans, duas mulheres trans e uma mulher travesti, com faixa etária de 21 a 32 anos. Os da dos foram coletados por entrevistas semiestruturadas e analisados mediante análise de conteúdo. Os resultados mostram que essas pessoas trans seguem trajetórias diver sas, procurando serviços institucionalizados ou informais (redes de socialidade trans), para a afirmação de suas identidades de gênero. Destacam-se entraves atinentes à patologização, ao acolhimento, à continuidade do cuidado, à resolutividade e à referência na rede de atenção do processo transexualizador. Observaram-se importantes pontos críticos na assistência social, endocrinológica e para a psicologia, sendo a peregrinação pelos serviços de saúde demarcada por constantes discriminações institucionais, permitindo a compreensão de como o sistema de saúde se organiza em relação ao atendimento dessas pessoas, elencando questões para o trabalho da psicologia, nesse campo, a partir de uma perspectiva da experiência e materialidade do gênero.

RESUMEN. Esta es una investigación cualitativa, descriptiva y exploratoria realizada en el tratamiento fuera del domicilio en la ciudad de Cuiabá, Brasil, que tuvo como objetivo plantear reflexiones sobre los itinerarios terapéuticos de las personas trans en la búsqueda del proceso transexual. Participaron tres hombres trans, 2 mujeres trans y 1 mujer travesti de 21 a 32 años. Los datos fueron recogidos a través de entrevistas semiestructuradas y fueron analizados mediante el Análisis de Contenido. Los resultados muestran que estas personas trans siguen caminos divergentes en busca de servicios institucionalizados o informales (redes sociales trans) para afirmar sus identidades de género. Se destacan los obstáculos relacionados con la patologización, acogida, la continuidad de la atención, la resolución y la referencia en la red de atención del Proceso Transexualizador. Se observaron puntos críticos importantes en la asistencia social, la endocrinología y la psicología, em que la peregrinación por los servicios de salud es delimitada por la constante discriminación institucional que permite comprender cómo se organiza el sistema de salud en relación con la atención de estas personas que señalan los problemas para el trabajo de la Psicología en este campo desde una perspectiva de experiencia y materialidad de género

ABSTRACT. This qualitative, descriptive and exploratory research conducted in the Away from Home Treatment (Tratamento Fora de Domicílio [TFD]), in Cuiabá, Brazil, aimed to raise reflections on the therapeutic process itineraries of trans people in the search for the Transsexualizer Process (Processo Transexual [PT]). Three transgender men, two transgender women and one transvestite woman participated. They were aged between 21 and 32 years. Data were collected through semi-structured interviews and analyzed using Content Analysis. The results show that trans people follow different itineraries, looking for institutionalized or informal services (trans sociality networks) to affirm their gender identities. Obstacles related to pathologization, reception, continuity of care, resolution and reference in the care network of the Transsexualizer Process stand out. Important critical points were observed in social, endocrinological and psychological care. The pilgrimage by health services was marked by constant institutional discrimination, allowing for the understanding of how the health system is organized concerning the care of these people, listing issues for the work of Psychology, in this field, from a perspective of the experience and materiality of gender.

Impacto do estresse de minoria em sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans / Impact of minority stress in depressive symptoms, suicide idea and try suicide in trans

Resumo O estresse de minoria aborda a relação entre preconceito (percebido, antecipado e internalizado) e saúde mental em pessoas pertencentes a grupos minoritários, assim como fatores de proteção aos estressores. Este trabalho avaliou a prevalência de sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans brasileiras, e sua relação com estresse de minoria, passabilidade, apoio social e apoio à identidade trans. Participaram 378 pessoas, por meio de questionário respondidos on-line e nos serviços hospitalares a que frequentavam. Desses, 67,20% apresentaram sintomas depressivos, 67,72% ideação suicida e 43,12% tentativa de suicídio. Foram realizadas três análises de regressão de Poisson, em dois passos, conforme os desfechos. Nos três desfechos houve associação positiva com o preconceito internalizado e negativa com o apoio social, sendo essas as únicas associações na tentativa de suicídio. Nos sintomas depressivos e na ideação suicida, também se associou positivamente o preconceito antecipado e negativamente a passabilidade e o apoio à identidade trans. Percebe-se a vulnerabilidade das pessoas trans para os desfechos negativos de saúde mental e a importância de enfrentar o preconceito em nível individual e social, assim como promover o apoio social e à identidade trans.

Abstract Minority stress comprehends the relationship between prejudice (perceived, anticipated and internalized) and mental health in people belonging to minority groups, as well as protective factors for stressors. This study evaluated the prevalence of depressive symptoms, suicidal ideation and attempted suicide in Brazilian trans people, and it`s relationship with minority stress, passability, social support and trans identity support. 378 people participated through a questionnaire answered online and in the hospital services they attended. Of these, 67.20% had depressive symptoms, 67.72% suicidal ideation and 43.12% attempted suicide. Three Poisson regression analyzes were performed in two steps, according to the outcomes. In the three outcomes there was a positive association with internalized prejudice and a negative association with social support, which were the only associations in the suicide attempt. Depressive symptoms and suicidal ideation were also positively associated with anticipated prejudice and negatively passability and support for trans identity. The vulnerability of transgender people to negative mental health outcomes and the importance of addressing prejudice on an individual and social level, as well as promoting social support and transgender identity support are perceived.

Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study.

CONTEXT: Cyproterone acetate (CPA) is a competitive inhibitor of the androgen receptor and exerts negative hypothalamic feedback. It is often used in combination with estrogens in trans women to achieve feminization. However, CPA has been associated with side effects such as changes in liver enzyme concentrations and increases in prolactin concentrations. The question is whether the testosterone-lowering effect, as well as these side effects, are dose dependent. OBJECTIVE: To assess the lowest effective dose of CPA in trans women to prevent side effects. METHODS: This longitudinal study, conducted at gender identity centers in Amsterdam, Ghent, and Florence, is part of the European Network for the Investigation of Gender Incongruence (ENIGI), a multicenter prospective cohort study. Participants were trans women (n = 882) using estrogens only or in combination with 10, 25, 50, or 100 mg CPA daily. The primary outcome measure was the concentration of testosterone at 3 and/or 12 months of hormone therapy. RESULTS: Using estrogens only (without CPA) led to testosterone concentrations of 5.5 nmol/L (standard error of the mean [SEM] 0.3). All doses of CPA resulted in testosterone concentrations below the predefined threshold of suppression of 2 nmol/L (10 mg, 0.9 nmol/L, SEM 0.7; 25 mg, 0.9 nmol/L, SEM 0.1; 50mg, 1.1 nmol/L, SEM 0.1; 100 mg, 0.9 nmol/L, SEM 0.7). Higher prolactin and lower high-density lipoprotein concentrations were observed with increasing doses of CPA. No differences in liver enzyme concentrations were found between the doses. CONCLUSION: Compared with higher doses of CPA, a daily dose of 10 mg is equally effective in lowering testosterone concentrations in trans women, while showing fewer side effects.

Not your unicorn: trans dating app users' negotiations of personal safety and sexual health.

This article reflects on 14 Australian trans dating app users' accounts of feeling safer (and less safe) when using apps, as well as their experiences of sexual healthcare. We explore both app use and healthcare in the context of the interdisciplinary field of 'digital intimacies', considering the ways that digital technologies and cultures of technological use both shape and are shaped by broader professional and cultural norms relating to sexuality and gender. Drawing on Preciado's [(2013). Testo junkie: Sex, drugs and biopolitics in the pharmacopornographic era. The Feminist Press] framework of 'pharmacopornographisation', the analysis aims to contextualise participants' experiences of being 'seen' and 'known' by health professionals and other app users. Our findings indicate that both dating apps and sexual health services rely on reductive systems of sorting and categorisation that reinforce binary understandings of genders and sexualities in order to facilitate data management and information sharing practices. Yet these same sorting and filtering technologies can also help trans app users avoid harassment, form intimate connections and seek appropriate healthcare.

[Psychometric Properties of the Scale of Negative Attitudes Towards Trans People in Healthcare Providers in Puerto Rico]. / Propiedades psicométricas de la Escala de Actitudes Negativas hacia Personas Trans en proveedores de salud en Puerto Rico.

The ignorance towards the Trans people can cause healthcare providers to assume negative attitudes towards this population. It is relevant to understand with more amplitude the manifestations of stigma towards the Trans population using instruments whose psychometry is adequate. The main objective of the present study was to evaluate the reliability of the Scale of Negative Attitudes towards Trans People (EANT, in Spanish) and its factorial structure in healthcare providers in Puerto Rico. As a secondary objective, differences in attitudes towards Trans people between physical healthcare providers and mental healthcare providers were evaluated. The sample consisted of 67 healthcare providers recruited according to their availability. A point-biserial correlation, a Cronbach's alpha analysis, a Confirmatory Factor Analysis (CFA), and the non-parametric Mann-Whitney test were carried out to examine our objectives. The results confirmed that the EANT has a one-dimensional structure. The Cronbach's alpha internal consistency index of the scale was .75. No significant differences were found in attitudes towards Trans people between physical healthcare providers and mental healthcare providers. Finally, a discussion of the research findings is presented, as well as its limitations and contributions.

[Sex/gender ratio of adolescents with gender dysphoria of the Gender Identity Treatment Unit of Asturias]. / Ratio sexo/género de los adolescentes con disforia de género de la Unidad de Tratamiento de Identidad de Género de Asturias.

BACKGROUND AND OBJECTIVE: Demand from minors with complaints of gender dysphoria has increased in recent years. This increase has been more pronounced in adolescent trans men in some international research studies. The first objective of this research study was to determine the sex/gender ratio of minors requesting a consultation in the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) and presenting complaints of gender dysphoria. The second objective was to analyse the relationship of the sex/gender ratio with the age variable at which they requested the first consultation and the year in which they requested it. MATERIALS AND METHOD: The sample consisted of 42 children under 18, attended between January 2016 and January 2019. The medical records were then reviewed to obtain information. Descriptive statistics were analysed with the collected data. RESULTS: The sex / gender ratio over the period was 2/1 in favour of trans men. The average age at the request for consultation was 15.02 years (SD=1.84), with a range of 6 to 17 years. A higher percentage of applications was recorded (35.7%) in 2018, mostly made by trans men (93.3%). CONCLUSIONS: There was an inversion of the sex/gender ratio, a favour of trans men, over the last 3years, and an increase in the number of applications by adolescent trans men, coinciding with several international investigations.

Itinerários terapêuticos da população trans em um município do nordeste brasileiro / Therapeutic Itineraries of the Transgender in a Northeastern Brazilian City / Itinerarios terapéuticos de la población transexual en una ciudad del noreste de Brasil

Resumo O artigo apresenta resultados de pesquisa qualitativa sobre os itinerários terapêuticos da população trans no município de Timon - Maranhão a partir da realização de entrevistas individuais e semiestruturadas com oito pessoas trans (dois homens e seis mulheres). A análise dos dados foi realizada com base no referencial teórico da hermenêutica de Paul Ricoeur. A partir das narrativas dos participantes da pesquisa, foram reconhecidas três unidades de significado: "a construção do ser-trans", "o acesso à saúde da população trans" e, também, "itinerários terapêuticos (trans)formados". Os itinerários mencionados não apresentaram vínculos formais entre os serviços, nem tampouco garantia de acesso e continuidade do cuidado.

Abstract A qualitative research was carried out on the therapeutic itineraries followed by the trans population in the municipality of Timon - Maranhão, through individual and semistructured interviews with eight trans people (two men and six women). Data analysis was performed based on the theoretical framework of Paul Ricoeur's hermeneutics. From the narratives of the research participants, three units of meaning were recognized: "the construction of the being-trans", "the access to health of the trans population" and, also, "therapeutic (trans) formed itineraries". The mentioned itineraries did not present formal links between the services, nor guarantee access and continuity of care.

Resumen Se realizó una investigación cualitativa sobre los itinerarios terapéuticos de la población trans en el municipio de Timón - Maranhão, a través de entrevistas individuales y semiestructuradas a ocho personas trans (dos hombres y seis mujeres). El análisis de los datos se realizó con base en el marco teórico de la hermenéutica de Paul Ricoeur. A partir de las narrativas de los participantes de la investigación, se reconocieron tres unidades de significado: "la construcción del ser-trans", "el acceso a la salud de la población trans" y, también, "itinerarios terapéuticos (trans) formados". Los itinerarios mencionados no presentaban vínculos formales entre los servicios, ni garantizaban el acceso y la continuidad de la atención.

Análise do processo e dos conflitos éticos da implementação da Política Nacional de Saúde Integral LGBT no município do Rio de Janeiro / Analysis of the process and ethical conflicts in the implemetation of the National Policy on Comprehensive Health of LGBT in the city of Rio de Janeiro / Análisis del proceso y conflictos éticos en la implemetación de la Politica Nacional de Salud Integral de LGBT en la ciudad de Rio de Janeiro

O Sistema Único de Saúde (SUS) e suas políticas são regidos por princípios norteadores, porém, o acesso universal não é garantia do atendimento das demandas de todos. As políticas públicas voltadas aos LGBT foram criadas para combater o preconceito, a discriminação e a exclusão. Em 2011, foi instituída a Política Nacional de Saúde Integral LGBT (PNSI LGBT) entretanto, a carência de informações sobre a implementação desta no Rio de Janeiro-RJ evidencia as dificuldades de atender essa população. Esta Tese objetivou analisar o processo de implementação e os conflitos éticos envolvidos da PNSI LGBT, no município do Rio de Janeiro, através da perspectiva do acesso aos serviços de saúde. Realizou-se uma revisão sistemática da literatura e abordagem metodológica qualitativa por meio de entrevistas semiestruturadas com gestores, profissionais de saúde e usuários LGBT. As entrevistas foram gravadas e os dados analisados numa perspectiva hermenêutica dialética. A revisão da literatura ressaltou as demandas específicas de saúde LGBT, e os desafios que a PNSI LGBT enfrenta para sua plena implementação, além de ainda ser pouco explorada. As narrativas foram agrupadas em quatro categorias abordando as questões de vínculo; percepções a respeito da orientação sexual e identidade de gênero; demandas para a atenção integral à saúde LGBT; e as questões éticas sobre justiça, igualdade e equidade no acesso à saúde LGBT. As entrevistas demonstraram como os gestores, profissionais de saúde e usuários percebem o acesso à saúde da população LGBT, e o quanto a PNSI LGBT ainda é pouco conhecida. Percebeu-se a ausência de desdobramentos práticos para a implementação da PNSI LGBT por parte do poder público, uma dubiedade dos entrevistados em reconhecer discursos discriminatórios, ou mesmo a importância da identificação da orientação sexual e da identidade de gênero no acesso à saúde, o que acarreta a invisibilização das demandas LGBT. As narrativas apontaram para um atendimento aparentemente não discriminatório, embora reconheçam que o preconceito não atinge todos da mesma forma. Houve a percepção de que as pessoas LGBT são previamente identificadas pelos profissionais de saúde como portadores do vírus HIV, sendo um estigma infelizmente ainda persistente. Evidenciou-se nas narrativas conflitos éticos relacionados à garantia do direito à saúde; da igualdade no acesso e no atendimento; e da equidade, reconhecendo que a saúde deve ser ofertada na medida das necessidades das pessoas, respeitando sua diversidade. A PNSI LGBT foi percebida no que compete ao eixo do acesso à saúde, entretanto ela ainda necessita de estratégias que promovam desdobramentos práticos para sua plena implementação, capazes de promover e garantir o direito à saúde, rompendo a perspectiva equivocada de que a igualdade universal no acesso seria suficiente e sinônimo de equidade.

The Unified Health System (SUS) and its policies are governed by guiding principles, however, universal access is not a guarantee of meeting everyone's demands. Public policies aimed at LGBT were created to combat prejudice, discrimination and exclusion. In 2011, the National Policy on Comprehensive Health of LGBT (PNSI LGBT) was instituted, however, the lack of information about its implementation in Rio de Janeiro-RJ highlights the difficulties of serving this population. This Thesis aimed to analyze the implementation process and the ethical conflicts involved in the PNSI LGBT, in the city of Rio de Janeiro, through the perspective of access to health services. A systematic review of the literature and qualitative methodological approach was carried out through semi-structured interviews with managers, health professionals and LGBT users. The interviews were recorded and the data analyzed in a dialectic hermeneutic perspective. The literature review highlighted the specific demands of LGBT health, and the challenges that the PNSI LGBT faces for its full implementation, in addition to being still little explored. The narratives were grouped into four categories addressing bonding issues; perceptions regarding sexual orientation and gender identity; demands for comprehensive care for LGBT health; and ethical questions about justice, equality and equity in LGBT healthcare access. The interviews showed how managers, health professionals and users perceive access to health care for the LGBT population, and how little is known about the PNSI LGBT. It was noticed the absence of practical developments for the implementation of the PNSI LGBT by the public power, a dubiousness of the interviewees in recognizing discriminatory discourses, or even the importance of identifying sexual orientation and gender identity in access to health, which leads to the invisibility of LGBT demands. The narratives pointed to an apparently non-discriminatory service, although they recognize that prejudice does not affect everyone in the same way. There was a perception that LGBT people are previously identified by health professionals as having the HIV virus, which is unfortunately still a persistent stigma. It was evident in the narratives ethical conflicts related to the guarantee of the right to health; equality in access and care; and equity, recognizing that health should be offered according to people's needs, respecting their diversity. The PNSI LGBT was perceived in terms of the axis of access to health, however it still needs strategies that promote practical developments for its full implementation, capable of promoting and guaranteeing the right to health, breaking with the mistaken perspective that universal equality in the access would be sufficient and synonymous with equity.

El Sistema Único de Salud (SUS) y sus políticas se rigen por principios rectores, pero el acceso universal no es garantía de atender las demandas de todos. Las políticas públicas dirigidas a LGBT se crearon para combatir los prejuicios, la discriminación y la exclusión. En 2011, se instituyó la Política Nacional de Salud Integral de LGBT (PNSI LGBT) todavía, la falta de información sobre su implementación en Rio de Janeiro-RJ destaca las dificultades para atender a esta población. Esta Tesis tuvo como objetivo analizar el proceso de implementación y los conflictos éticos involucrados en la PNSI LGBT, en la ciudad de Rio de Janeiro, a través de la perspectiva del acceso a los servicios de salud. Se realizó una revisión sistemática de la literatura y enfoque metodológico cualitativo a través de entrevistas semiestructuradas a directivos, profesionales de la salud y usuarios LGBT. Las entrevistas fueron grabadas y los datos analizados en una perspectiva hermenéutica dialéctica. La revisión de la literatura destacó las demandas específicas de la salud LGBT y los desafíos que enfrenta la PNSI LGBT para su plena implementación, además de ser aún poco explorada. Las narraciones se agruparon en cuatro categorías que abordan cuestiones de vinculación; percepciones sobre orientación sexual e identidad de género; demandas de atención integral a la salud LGBT; y cuestiones éticas sobre la justicia, la igualdad y la equidad en el acceso a la salud LGBT. Las entrevistas mostraron cómo los gestores, profesionales de salud y usuarios perciben el acceso a la salud de la población LGBT, y lo poco que se sabe sobre la PNSI LGBT. Se percibió la ausencia de desarrollos prácticos para la implementación de la PNSI LGBT por parte del poder público, un recelo de los entrevistados en reconocer discursos discriminatorios, o incluso la importancia de identificar la orientación sexual y la identidad de género en el acceso a la salud, lo que conduce a la invisibilidad de las demandas LGBT. Las narrativas apuntaron a un servicio aparentemente no discriminatorio, aunque reconocen que los prejuicios no afectan a todos de la misma manera. Existía la percepción de que los profesionales de la salud identificaban previamente a las personas LGBT como portadoras del VIH, lo que sigue siendo un estigma persistente. Se evidenció en las narrativas conflictos éticos relacionados con la garantía del derecho a la salud; igualdad en el acceso y la atención; y equidad, reconociendo que la salud debe ser ofrecida de acuerdo a las necesidades de las personas, respetando su diversidad. La PNSI LGBT fue percibida en términos del eje del acceso a la salud, aunque necesita estrategias que promuevan desarrollos prácticos para su plena implementación, capaces de promover y garantizar el derecho a la salud, rompiendo con la perspectiva equivocada de que la igualdad universal en el acceso sería suficiente y sinónimo de equidad.

Comparing the effects of HIV self-testing to standard HIV testing for key populations: a systematic review and meta-analysis.

BACKGROUND: We update a previous systematic review to inform new World Health Organization HIV self-testing (HIVST) recommendations. We compared the effects of HIVST to standard HIV testing services to understand which service delivery models are effective for key populations. METHODS: We did a systematic review of randomised controlled trials (RCTs) which compared HIVST to standard HIV testing in key populations, published from 1 January 2006 to 4 June 2019 in PubMed, Embase, Global Index Medicus, Social Policy and Practice, PsycINFO, Health Management Information Consortium, EBSCO CINAHL Plus, Cochrane Library and Web of Science. We extracted study characteristic and outcome data and conducted risk of bias assessments using the Cochrane ROB tool version 1. Random effects meta-analyses were conducted, and pooled effect estimates were assessed along with other evidence characteristics to determine the overall strength of the evidence using GRADE methodology. RESULTS: After screening 5909 titles and abstracts, we identified 10 RCTs which reported on testing outcomes. These included 9679 participants, of whom 5486 were men who have sex with men (MSM), 72 were trans people and 4121 were female sex workers. Service delivery models included facility-based, online/mail and peer distribution. Support components were highly diverse and ranged from helplines to training and supervision. HIVST increased testing uptake by 1.45 times (RR=1.45 95% CI 1.20, 1.75). For MSM and small numbers of trans people, HIVST increased the mean number of HIV tests by 2.56 over follow-up (mean difference = 2.56; 95% CI 1.24, 3.88). There was no difference between HIVST and SoC in regard to positivity among tested overall (RR = 0.91; 95% CI 0.73, 1.15); in sensitivity analysis of positivity among randomised HIVST identified significantly more HIV infections among MSM and trans people (RR = 2.21; 95% CI 1.20, 4.08) and in online/mail distribution systems (RR = 2.21; 95% CI 1.14, 4.32). Yield of positive results in FSW was not significantly different between HIVST and SoC. HIVST reduced linkage to care by 17% compared to SoC overall (RR = 0.83; 95% CI 0.74, 0.92). Impacts on STI testing were mixed; two RCTs showed no decreases in STI testing while one showed significantly lower STI testing in the intervention arm. There were no negative impacts on condom use (RR = 0.95; 95% CI 0.83, 1.08), and social harm was very rare. CONCLUSIONS: HIVST is safe and increases testing uptake and frequency as well as yield of positive results for MSM and trans people without negative effects on linkage to HIV care, STI testing, condom use or social harm. Testing uptake was increased for FSW, yield of positive results were not and linkage to HIV care was worse. Strategies to improve linkage to care outcomes for both groups are crucial for effective roll-out.