Reflexiones sobre la aplicación de la "Ley Trans” en la atención sanitaria / Reflections on the application of the “trans law” in health care

En este artículo se reflexiona sobre la reciente ley aprobada por el Congreso de los Diputados conocida como Ley 4/2023 para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI (BOE-A-2023-5366, 2023). Se analizan inicialmente los artículos que más polémica han causado en el ámbito social, que son los relativos a la rectificación registral (Art. 43-51), y posteriormente los que hacen referencia directa o indirectamente a aspectos sanitarios; 1) el que prohíbe de métodos, programas o las llamadas terapias de conversión (Art. 17), 2) los que definen cómo debe ser en términos generales la atención sanitaria (Art. 56-59), y 3) finalmente el único artículo que menciona a los menores (Art 70). Se comenta que el término utilizado de persona trans, al englobar un amplio abanico de diversidades sexuales, variantes y expresiones de género, incluye tanto a personas que necesitan una atención médica como a otras que no. Se plantea que la rectificación registral acorde con esta ley 2023 al no precisar ningún requisito para su inscripción, ofrece menos garantías que la legislación ya existente de marzo 2007. Se considera que las directrices de la nueva ley se están traduciendo en una toma de decisiones por parte del usuario sin disponer de una valoración o diagnóstico por el equipo de profesionales que atienden el caso. Se destaca que la ley no incluye ninguna referencia a la atención por salud mental. Y en conjunto, se concluye que el texto aprobado, en el ámbito sanitario, puede mermar la calidad de la asistencia integral, sobre todo en menores, o personas con identidades complejas, dudosas, o con comorbilidades, que pueden generar discrepancia entre el criterio del profesional y la opinión del usuario.(AU)

Transgender Youths and Sanctuaries for Gender-Affirming Care.

This Viewpoint suggests ways state and local governments can support transgender youths seeking gender-affirming care amid continued passage of antitransgender legislation.

Características sociodemográficas, psicológicas y clínicas de una cohorte de personas transgénero de mediana y avanzada edad: importancia de la atención primaria en la asistencia a la transexualidad y diversidad de género / Socio-demographic, psychological and clinical characteristics of a cohort of middle-aged and older transgender persons: the importance of primary health care in supporting transsexuality and gender diversity. Characteristics of a cohort of older transgen

Objetivo: describir la proporción de las personas transgénero mayores de 45 años que solicitan acompañamiento médico o psicológico, así como sus características sociales, historia identitaria, presencia de factores de riesgo cardiovascular, tratamiento hormonal o quirúrgico afirmativo y comorbilidades psiquiátricas.Métodos: estudio transversal descriptivo. Se incluyeron 567 pacientes con incongruencia de género que demandaron atención por la Unidad de Identidad de Género (UIG) del Hospital Universitario Doctor Peset de Valencia en el entre 2012 y 2019 (inclusive).Resultados: un 4,2% de la muestra correspondía a personas mayores de 45 años con una mediana de edad de 52 (RIQ: 50,25-60,25) años. La gran mayoría había experimentado un sentimiento de incongruencia identitaria en la etapa prepuberal o adolescente e hizo el tránsito social durante la edad adulta. Un 25% de las mujeres transgénero se automedicaban antes de acudir a la UIG. Un 29,1% tenía antecedentes de ideación suicida y el 25% había llevado a cabo intentos suicidas. Más de la mitad presentaban al menos dos factores de riesgo cardiovascular y no recibían tratamiento farmacológico específico.Conclusiones: en nuestra muestra, existió una baja proporción de personas trans mayores de 45 años que consultaban en la UIG en comparación con el resto de las franjas etarias más jóvenes. Dicho colectivo se caracterizó por presentar altas tasas de factores de riesgo cardiovascular y comorbilidades psicológicas.(AU)

Aim: to report the proportion of transgender persons aged over 45 who requested medical or psychological care, as well as social characteristics, identity history, cardiovascular risk factors, hormonal or affirmative surgical treatment and psychiatric comorbidities.Methods: cross-sectional, descriptive study. We included 567 patients with gender incongruence who requested care at the Gender Identity Unit (UIG), at Doctor Peset University Hospital (Valencia), from 2012 to 2019.Results: a total of 4.2% of sample corresponded to persons aged over 45, with a median age of 52 [IQR 50.25-60.25]. The vast majority had experienced a feeling of identity incongruity in the prepubertal or adolescent stage and made the social transition during adulthood. A total of 25% of transgender women self-medicated before visiting the UIG; 29.1% had a history of suicidal ideation (IS) and 25% had attempted suicide. More than half presented at least two cardiovascular risk factors and did not receive specific pharmacological treatment.Conclusions: In our sample, there was a low proportion of transgender individuals over the age of 45 who sought care at the IUG compared to younger age groups. This particular group was characterized by high rates of cardiovascular risk factors and psychological comorbidities.(AU)

[Transitions, reinventing the genre]. / Transitions, une réinvention du genre.

Our consultations are saturated by an influx of requests from young people - and very often from their parents - for whom the binarity of the boy/girl classification has been shattered, and whose only watchword is: "I choose my gender, my sexuality, my body, my way of being, of moving and representing myself, I want to become what I am". For them, anatomy is no longer a fatality: hormones, mutilating and restorative surgeries, increasingly sophisticated aesthetic techniques make it possible to adapt their body and their gender to their intimate aspirations. Psychological support must help these patients to explore their gender identity, and allow them to live it as well as possible in their social and family environment.

State Restrictions and Geographic Access to Gender-Affirming Care for Transgender Youth.

This study estimates changes in geographic access and drive times to gender clinics following legislation enacted to restrict puberty-suppressing medications and hormones for those younger than 18 years.

Characteristics and gender affirming healthcare needs of transgender and non-binary students starting hormone therapy in a student health service in Aotearoa New Zealand.

Introduction Traditionally, gender-affirming hormonal therapy (GAHT) is initiated in secondary care, but a primary care based approach has been developed to reduce access barriers. Aim We aim to describe the demographics, hormone choices, and additional referrals made for young people initiating GAHT in a primary care setting in Aotearoa New Zealand. Methods Clinical notes were reviewed for all patients who commenced GAHT between 1 July 2020 to the end of 2022 at a tertiary education health service. Data were collected on age, ethnicity, gender, type of hormones prescribed, and any additional referrals. Results Eighty five patients commenced GAHT during the review period (64% assigned male at birth and starting oestrogen-based GAHT, 36% assigned female at birth and commencing testosterone-based GAHT). Fourty seven percent of patients identified as transgender female, 38% as non-binary, and 15% as transgender male. Spironolactone was the most common choice of testosterone blocker (81%). The choice of oestrogen formulation was fairly equal between patches (54%) and tablets (46%). Eighty percent of those assigned male at birth chose to preserve fertility, 54% requested voice therapy, and 87% of those assigned female at birth requested top surgery. Discussion There is a need for improved understanding of non-binary gender-affirmation needs, in particular those of Maori and Pasifika youth. An informed consent approach in primary care can reduce barriers and distress for transgender youth seeking GAHT. The high unmet need for top surgery for transgender people assigned female at birth requires attention.

Ley Trans, liberum arbitrium / Transgender law, liberum arbitrium

La nueva ley sobre la igualdad de las personas trans y la garantía de derechos de las personas LGTBI (Ley 4/2023, de 28 de febrero) ha sido una ley discutida y criticada por algunos grupos de profesionales de la medicina que atienden a la población infantil. Las críticas desde el ámbito médico y pediátrico se pueden hacer siempre ante cualquier ley que consideremos que afecta a los derechos sanitarios de los menores. Lo que sucede es que algunas de esas críticas son sobre aspectos que no se recogen en la ley. En el siguiente artículo analizaremos lo que dice la ley, lo que dicen algunas asociaciones de profesionales y lo que dice la legislación sobre los derechos sanitarios del menor, con el fin de contribuir al debate de esos controvertidos aspectos de la ley (AU)

The new law on the equality of trans people and the guarantee of rights of LGTBI people (Law 4/2023, February 28th) has been discussed by some groups of medical professionals that have shown their disagreement.In relation to any law, criticism can be made from the medical or pediatric field; whenever it affects the rights of minors. However, criticisms, if they exist, should be made about what the law says, not about other aspects.In the following article we will analyze what the law says, what some professional associations say and what the legislation says about the health rights of minors, in order to contribute to the debate on these controversial aspects of the law. (AU)

[Taking care of trans minors]. / Prendre en charge les mineurs trans.

The issue of trans minors is becoming more and more important as a new issue of care, especially in the health field. The nursing world is no stranger to these requests for support, at school or in specialized centers. This is why, through this article, it seemed necessary to go back over some definitions and to deconstruct some prejudices concerning this population.

Guidance for Research with Trans and Gender-Diverse People.

When engaging in research with marginalized communities, it is important for researchers to reflect on their practice and consider what steps they can take to avoid perpetuating inequality or causing harm. This article provides guidance for researchers working with trans and gender-diverse individuals from the perspective of two speech-language pathologists. Key considerations presented by the authors include the importance of engaging in reflexive research practices-thinking deeply about and acknowledging impacts of one's personal beliefs, values, and practices on one's research-and developing an awareness of factors that contribute to the trans and gender-diverse community's ongoing minority stress. Specific suggestions to redress power imbalance between the researcher and the researched community are provided. Finally, practical methods for implementing the guidance are presented: the community-based participatory research model and an example in speech-language pathology research with trans and gender-diverse individuals.

Transnational Trans Woman Inspires and Informs Evidence-Informed Interventions.

Transitional Care Coordination is an evidence-informed model program developed by New York City Correctional Health Services as a Health Resources and Services Administration Special Projects of National Significance Correctional Health Linkage Intervention. Using implementation science under this and subsequent demonstration projects, interventions were adapted and enhanced to address the transitional needs of people of Puerto Rican ancestry and to expand the network of care across the islands of Puerto Rico. These interventions were informed, in part, by a transnational trans woman of color of Puerto Rican ancestry living with HIV. A socioecological model framework and case study are used to illustrate how evidence-informed interventions are developed and adapted to address the needs of those served.

Gender-affirming hormonal therapy for transgender and gender-diverse people-A narrative review.

As the number of transgender and gender-diverse (TGD) people accessing gender-affirming care increases, the need for healthcare professionals (HCPs) providing gender-affirming hormonal therapy (GAHT) also increases. This chapter provides an overview of the HCPs interested in getting involved in providing GAHT.

Improving the inclusion of transgender and nonbinary individuals in the planning, completion, and mobilization of cardiovascular research.

Cardiovascular disease is the leading cause of morbidity and mortality globally. Transgender and nonbinary (TNB) individuals face unclear but potentially significant cardiovascular health inequities, yet no TNB-specific evidence-based interventions for cardiovascular risk reduction currently exist. To address this gap, we propose a road map to improve the inclusion of TNB individuals in the planning, completion, and mobilization of cardiovascular research. In doing so, the adoption of inclusive practices would optimize cardiovascular health surveillance and care for TNB communities.