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In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.

Background In China, sexual health and behaviors of young people have become a growing public concern but few studies have been conducted to investigate the prevalence and psychosocial correlates of the phenomenon. Methods A self-reported questionnaire survey on youth sexual behaviors was conducted among 1,500 university students in 2011 at Hefei, a middle-size city in eastern China. A total of 1,403 students (age = 20.30 ± 1.27 years) completed the questionnaire with a high response rate of 93.5%. Results Among the respondents, 12.6% (15.4% of male versus 8.6% of female) students reported having pre-marital heterosexual intercourse; 10.8% (10.5% of males versus 11.2% females) had oral sex; 2.7% (3.4% of males versus 1.7% females) reported same-sex activities; 46% (70.3% of males versus 10.8% of females) reported masturbation behaviors; 57.4% (86.2% of males versus 15.6% females) students viewed pornography. In terms of sexual communication about sexual knowledge acquisition, 13.7% (10.7% of males versus 18% of females) talked to their parents about sex; 7.1% (6.1% of males versus 8.4% of females) students reported having conversation with parents on contraception. About forcing sexual behavior, 2.7% (4% of males versus 0.9% of females) reported forcing their sexual partners to have sex, and 1.9% (2.4% of males versus 1.2% of females) reported being forced to have sex. Gender was found to be significant predictor of sexual behaviors in university students: males reported more sexual behaviors including sexual fantasy, heterosexual intercourse, masturbation, viewing pornography and talking about sex with friends. Several correlates of sexual behaviors were identified for students of different gender separately. For males, having romantic relationships, past sex education experiences, low educational aspirations, time spent on the Internet, and urban native settings were significantly associated with more sexual behaviors. For female students, having romantic relationships and urban native settings predicted sexual behaviors. Conclusion Sexual behavior among University students in China is not uncommon, although there are limited ways for students to acquire sex-related knowledge: male students showed significantly more sexual behaviors than female students. Having romantic relationships and more time spent online were important predictors of sexual behaviors among university students. To guide healthy sexual behaviors in young people, comprehensive sex education programs that provide necessary sexual health knowledge about safe sex should be developed and implemented in universities in China, particularly for students who have romantic relationships and those who spend long periods of time on the Internet.

Romantic chemistry is an important indicator of compatibility between prospective romantic partners, but, despite theoretical work, lay understandings of romantic chemistry that could inform theory are still unclear. We used an online survey question to collect romantic chemistry conceptualisations from 571 Australian adults who were currently looking for a romantic partner, of whom 53.06% identified with minority gender and/or sexual identities. We analysed responses using inductive content analysis, which resulted in the construction of categories and sub-categories concerning the multifaceted nature of romantic chemistry, the importance of mutual feelings, and central concepts of interactivity, connection, and attraction. We performed a deductive content analysis using these categories and sub-categories to re-code responses and observed little evidence of differences between groups based on assigned sex, gender, sexual, and minority identities. Our findings suggest that romantic chemistry is only perceivable when multiple facets are experienced and that experiences of facets vary individually, which provides ample grounds for future investigation and measurement of romantic chemistry.

Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population.

Background: General practitioners (GPs) do not typically receive education regarding gender diversity despite the increasing number of trans, gender diverse and non-binary (TGDNB) patients presenting to general practice. It is important for GPs, as the first point of entry into the healthcare system, to provide a safe and affirming environment for TGDNB patients to reduce ill-health later in life. Objective: The aim of this article is to clarify how GPs can improve their care of TGDNB patients to be more inclusive and thereby promote a positive relationship with the health system, assist in gender-affirming care and reduce illness within this population. The authors provide simple suggestions for clinical practice and encourage clinicians to seek professional development in this rapidly developing field. Discussion: Care of TGDNB patients extends beyond gender-affirming care to include mental health and community supports to ensure the overall wellbeing of the patient. Central to this care is respect of the patient's gender identity and expression.

Trans and gender diverse (TGD) young people worldwide experience high rates of poor mental health; however, these rates were unknown in Australia. In addition, how negative life events affect the mental health of TGD young people has been largely unexplored. This paper reports on novel mental health findings of Trans Pathways, the largest study ever conducted in Australia with trans (transgender) and gender diverse young people (N = 859; aged 14-25 years). The study was an anonymous online cross-sectional survey undertaken in 2016. Logistic and linear regression models were used to test associations between mental health outcomes and negative life experiences. TGD young people in Australia experience high levels of mental distress, including self-harming (79.7%), suicidal thoughts (82.4%), and attempting suicide (48.1%). Three in four participants had been diagnosed with depression and/or anxiety (74.6% and 72.2%, respectively). Many TGD young people had been exposed to negative experiences such as peer rejection (89.0%), precarious accommodation (22.0%), bullying (74.0%), and discrimination (68.9%). Most poor mental health outcomes were associated with negative experiences. The strongest associations were found for precarious accommodation and issues within educational settings. For example, participants with a prior suicide attempt were almost six times more likely to have experienced issues with accommodation, including homelessness. The current results highlight the urgent need for better mental health care and provide insight into areas for targeted mental health interventions. These findings are pertinent for clinicians working with trans young people and wider society.

The World Health Organization (WHO) is revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD). At the time of writing, and based on recommendations from its ICD Working Group on Sexual Disorders and Sexual Health, WHO is proposing a new ICD chapter titled Conditions Related to Sexual Health, and that the gender incongruence diagnoses (replacements for the gender identity disorder diagnoses used in ICD-10) should be placed in that chapter. WHO is proposing that there should be a Gender incongruence of childhood (GIC) diagnosis for children below the age of puberty. This last proposal has come under fire. Trans community groups, as well as many healthcare professionals and others working for transgender health and wellbeing, have criticised the proposal on the grounds that the pathologisation of gender diversity at such a young age is inappropriate, unnecessary, harmful and inconsistent with WHO’s approach in regard to other aspects of development in childhood and youth. Counter proposals have been offered that do not pathologise gender diversity and instead make use of Z codes to frame and document any contacts that young gender diverse children may have with health services. The author draws on his involvement in the ICD revision process, both as a member of the aforementioned WHO Working Group and as one of its critics, to put the case against the GIC proposal, and to recommend an alternative approach for ICD in addressing the needs of gender diverse children.

Research regarding how people choose their long-term romantic partners is extensive, but the understanding of the psychological processes behind these choices, and predicting who people choose, is elusive. This review attempts to examine potential reasons for this elusive nature by first outlining the current state of the literature and then highlighting issues within the current paradigm. First among these issues is a focus on singular perspectives and little attempt to integrate these perspectives with others. Second, many studies focus on increasingly complex designs to explore the predictive utility of trait preferences, attempts which have had only limited success. Third, novel findings appear to be unintegrated with established findings, leaving the potential combination of these ideas unrealized. Finally, long-term romantic partner selection is a complex psychological phenomenon, but current theory and research methodologies are not sufficiently addressing this complexity. This review concludes with suggestions for future research direction, including a focus on the psychology behind the partner selection process and the potential of qualitative enquiry to reveal novel pathways behind these psychological processes. There is a need for an integrative framework that permits the coexistence of established and novel ideas, and multiple perspectives, from both current and future research paradigms.

2015 was an unprecedented year in the recognition of transgender rights in some high-income countries. However, this recognition in the public domain has yet to translate to a concerted effort to support the right to health of transgender people around the world. Transgender people continue to face a range of challenges that deprive them of respect, opportunities, and dignity and have damaging effects on their mental and physical health and wellbeing, as shown in the Lancet Series on transgender health.

The literature studying individuals’ selection of long-term romantic partners predominantly focuses on samples of majority gender and sexual identity (cisgender, heterosexual), leaving a gap in our knowledge regarding minority populations. In this study, 554 Australian adults seeking romantic partners ( M age  = 32.06 years, 52.35% of whom reported minority gender and/or sexual identities) responded to an online survey regarding their partner selection experiences and beliefs, ideal and self-ratings on romantic partner traits, and self-perceived mate value. Factor analysis replicated established trait preference dimensions in this large, heterogeneous Australian sample, with dimensions remaining stable in majority and minority subsamples. Exploratory comparative and regression analyses generated preliminary insights into differences, similarities, interactions, and intersectional factors across identity groups. The commonly observed sex differences of men preferring aesthetic traits more than women, and women preferring empowered traits more than men were supported in comparative analyses. However, sex was not associated with preference for empowered traits in regression with identity, trait preferences, and self-perceived mate value. Self-perceived mate value findings replicated, challenged, and extended previous research, with asexual identity linked to lower self-perceptions. A preference for warm traits appeared to be a central factor through association with most other preferences and identities. As potential explanations, we discuss complex influences of evolutionary psychology, sociocultural factors, norms, and potential differences in partner selection processes. These findings contribute to our knowledge of partner selection experiences across majority and minority gender and sexual identity populations.