Explore the vast range of titles available.

Objectives: This qualitative study explored the beliefs and values influencing healthcare providers’ delivery of gender-affirming care (GAC) to transgender and gender-diverse (TGD) youth amidst current social and political dynamics. Methods: The study PI conducted 43 semi-structured interviews with providers across states with varying GAC legislation. Responses from 41 providers were analyzed in this paper. A thematic approach to data analysis was employed using qualitative coding. Results: Key themes emerged: criteria for treatment, ethical and moral considerations, and professional and personal responsibility. Providers widely endorsed GAC as evidence-based and essential for alleviating distress and promoting autonomy. They emphasized the importance of respecting patients’ gender identities and viewing GAC as life-saving. Conclusion: Despite legislative challenges, the study highlights a strong consensus among providers on the medical necessity of GAC for TGD youth.

Trump and Republican candidates made rolling back federal protections for transgender people a big issue, spending hundreds of millions of dollars on TV ads, much of it focused on gender-affirming care for minors. Despite the attention, a new study finds that gender-affirming medications are very rarely prescribed to adolescents. John Yang speaks with KFF’s Lindsey Dawson to learn more.

Practicing Medicine in the Culture WarsLitigation over bans on gender-affirming care in various U.S. states could further establish the authority of politicians and courts to determine treatment options and exacerbate health disparities.

BackgroundTransgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae.ObjectiveTo demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program.DesignWe present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation.ParticipantsWe reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020.Main MeasuresClients reported all the types of care in which they were interested at the time of intake as their “reason for call” (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns).Key ResultsOf 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason.ConclusionsIndividuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals.

Background Globally, there is a notable increase in recognising the health needs of transgender and gender-diverse individuals. As a result, gender-affirming care services are evolving and expanding in many parts of the world, and this has provoked increased debate on various aspects of the interventions that comprise such care. Resolution of these debates depends on addressing important ethical issues. This scoping review aims to identify the key ethical issues and arguments regarding gender-affirming care across various medical interventions. Methods We searched Embase, PubMed and SCOPUS to identify peer-reviewed publications that could meet some eligibility criteria such as publications presenting an ethical issue, argument, or principle related to gender-affirming care for transgender and gender-diverse individuals and having been published from 2012 to 2023. We applied Arksey and O’Malley’s scoping review framework. The text of included publications was analysed inductively. Results Eighty-two publications were identified for inclusion. Sixty-two publications (76%) were published in or after 2019, and 20 (24%) between 2012 and 2018. Five aspects of gender-affirming care that draw ethical analysis or debates were identified: decision-making process, guideline and model of care, deletion of health data, funding, and fertility preservation and services. Ethical issues and arguments were identified within each aspect of care. The arguments are organised according to the four principles of biomedical ethics: autonomy, beneficence, non-maleficence and justice. Conclusion This scoping review captures the key ethical issues in various aspects of gender-affirming care. There were substantial differences in the depth to which each aspect of gender-affirming care was discussed, with ethical issues in decision-making processes receiving the most attention, and deletion of health data given the least attention. This review also characterises the dominant ethical arguments and underlying principles used to justify positions on the issues. Within each ethical issue, the four principles of biomedical ethics featured commonly, but were applied very differently and accorded unequal weighting. Additionally, in some discussions, arguments supporting medical interventions were given more attention; in others, the rationales opposing medical interventions were dominant. Perhaps unsurprisingly, there was limited resolution and increasing disagreement. Important constraints in the methodologies of argumentation used to support or oppose aspects of gender-affirming care were also identified.

Lesbian, gay, bisexual, trans, queer, intersex, asexual, and other diverse individuals (LGBTQIA+) people face lower healthcare utilization rates due to discrimination, poor experiences in healthcare, and barriers to accessing care. There is an increasing need to improve care and reduce health care disparities for the LGBTQIA+ population. The medical community can begin by educating themselves on LGBTQIA+ terminology, using inclusive language and developing cultural competence in clinical settings. In order to achieve this, it is first important to understand that sex and gender are distinct and that both sex and gender exist on continuums. This article will build on this understanding by introducing basic and widely accepted terminology that will provide a foundation for providing care to LGBTQIA+ populations. By thoughtfully incorporating this knowledge into our research and clinical practice, the radiology community will enhance the healthcare experiences of all patients.

Background Specialized medical care for transgender patients during the transition process can substantially improve mental and physical health for this population, due to the multitude of changes they may experience in both areas. Minimally invasive aesthetic procedures (MIPs) on the face can promote the anatomical changes and skin quality improvements necessary for gender affirmation, increasing gender congruence and, consequently, improving patients' quality of life. Given that gender‐affirming hormone therapy (GAHT) impacts skin quality, MIPs may offer valuable complementary benefits during the transition process. Objective Here we describe a novel treatment plan to improve skin quality in transgender patients who are or are not undergoing GAHT. Method The combination of incobotulinumtoxinA (Xeomin; Merz Pharmaceuticals GmbH, Frankfurt, Germany), calcium hydroxylapatite‐carboxymethylcellulose (Radiesse; Merz North America Inc., Franksville, WI, USA), and Cohesive Polydensified Matrix hyaluronic acid with glycerol (CMP‐HA20G, Belotero Revive; Anteis S.A., Plan‐les‐Ouates, Switzerland, a company of the Merz Aesthetics group) should be administered in a single session to improve skin quality. Photographs were taken at baseline and follow‐up to assist with 3‐dimensional reconstructions for evaluation of skin quality according to the four emergent perceptual categories (EPCs) defining skin quality. Outcomes EPC monitoring may help to guide MIP treatments, support future evaluation of treatment efficiency, and assist in delivering personalized gender‐affirming care. Conclusion This new treatment plan for skin quality improvement offers gender‐affirming care to the transgender community, based on clinical expertise.

This article examined the growing polarization, misinformation, and disinformation surrounding gender diversity, with a focus on detransition. In the current sociopolitical climate of divisiveness, the misrepresentation of detransition experiences fuels moral panic, negatively affecting social attitudes towards detransitioners and gender-diverse individuals while being weaponized to restrict access to gender-affirming care. In response, this article seeks to offer a more accurate and nuanced understanding of detransition, challenge disinformation-driven panic, and reduce stigma experienced by detransitioners. Drawing from multiple sources of knowledge, the article meticulously dissects the underpinnings of disinformation-fuelled detransition panic, revealing an interplay of cisnormative and transnormative biases. By exposing these biases, the article encourages a more open and reflective approach to understanding gender and nonlinear gender trajectories, highlighting the multiplicity of factors contributing to detransition as well as the diversity of detransition experiences. It concludes with recommendations and invitations for readers to expand their perspectives on gender towards one that depathologizes detransition and nonlinear gender trajectories and moves beyond the trans-cis binary. Cet article examine la polarisation croissante, la mésinformation et la désinformation entourant la diversité de genre, en mettant particulièrement l'accent sur la détransition. Dans le contexte actuel de dissensions sociopolitiques, la représentation trompeuse des expériences de détransition incite à la panique morale, alimente les attitudes sociales négatives envers les personnes qui détransitionnent et les individus issus de la pluralité des genres, tout en étant instrumentalisée pour restreindre l'accès aux soins d'affirmation du genre. En réponse, cet article vise à offrir une compréhension plus juste et nuancée de la détransition, à contrer la panique induite par la désinformation, et à réduire la stigmatisation vécue par les personnes concernées. S'appuyant sur de multiples sources de savoir, l'article déconstruit méticuleusement les fondements de la panique morale liée à la détransition, révélant une interaction de biais cisnormatifs et transnormatifs. En exposant ces biais, l'article encourage une approche plus réfléchie et inclusive face au genre et aux trajectoires de genre non linéaires, met en lumière la diversité des expériences vécues ainsi que la multiplicité des facteurs pouvant motiver la détransition. Il se conclut par une série de recommandations et d'invitations, notamment à élargir notre regard sur le genre, vers une perspective qui « dépathologise » la détransition et les trajectoires de genre non linéaires, et qui va au-delà de la binarité trans-cis. Public Significance Statement Growing polarization, misinformation, and disinformation surrounding gender-particularly detransition-fuel moral panic. In the current divisive sociopolitical climate, the misrepresentation of detransition experiences distorts public understanding, reinforces stigma, and harms detransitioners and gender-diverse individuals. This article challenges disinformation-driven narratives by offering a nuanced perspective on detransition and cuts through the noise by exposing the underlying biases shaping public discourse. By fostering an informed and reflective approach, this work contributes to depathologizing detransition and nonlinear gender trajectories and promotes practices and policies that support all gender trajectories.

Introduction Although HIV prevalence among transgender women who have sex with men in Vietnam is high (16–18%), uptake of pre‐exposure prophylaxis (PrEP) is low compared to other populations. When PrEP was initiated in 2017, gender‐affirming healthcare was largely unavailable. Lack of access to competent, stigma‐free healthcare is a well‐documented barrier to transgender women's uptake of PrEP and primary healthcare (PHC). We aimed to demonstrate the utility of a PrEP quality improvement intervention in pinpointing and addressing barriers to PrEP use among transgender women in Vietnam. Methods We applied a real‐world participatory continuous quality improvement (CQI) and Plan‐Do‐Study‐Act (PDSA) methodology to ascertain barriers to PrEP uptake among transgender women and determine priority actions for quality improvement. A CQI team representing transgender women leaders, key population (KP)‐clinic staff, public‐sector HIV managers and project staff applied PDSA to test solutions to identified barriers that addressed the primary quality improvement outcome of the monthly change in PrEP uptake among transgender women and secondary outcomes, including month‐3 PrEP continuation, the impact of offering PHC on PrEP uptake and unmet PrEP need. We utilized routine programmatic data and a descriptive cross‐sectional study enrolling 124 transgender women to measure these outcomes from October 2018 to September 2021. Results Five key barriers to PrEP uptake among transgender women were identified and corresponding solutions were put in place: (1) offering gender‐affirming care training to KP‐clinics and community‐based organizations; (2) integrating gender‐affirming services into 10 KP‐clinics; (3) offering PHC through five one‐stop shop (OSS) clinics; (4) implementing a campaign addressing concerns related to hormone use and PrEP interactions; and (5) developing national HIV and transgender healthcare guidelines. New PrEP enrolment and month‐3 PrEP continuation increased significantly among transgender women. Of 235 transgender women who initially sought healthcare other than PrEP at OSS clinics, 26.4% subsequently enrolled in PrEP. About one‐third of transgender women reported unmet PrEP need, while two‐thirds indicated an interest in long‐acting cabotegravir. Conclusions Offering gender‐competent, integrated PHC can increase PrEP enrolment and continuation, and can be an entry‐point for PrEP among those seeking care within PHC clinics. More work is needed to expand access to transgender women‐led and ‐competent healthcare in Vietnam.

Historically, presurgical assessment by a mental health provider has been required for trans+ people to access transition-related surgeries in most Canadian jurisdictions despite ongoing debate surrounding their clinical utility. As patient engagement is a crucial step in informing affirming and culturally responsive health care processes, a qualitative study was conducted to understand the experiences of trans+ adults who have completed presurgical mental health assessments for transition-related surgeries and their recommendations for improvements to referral processes. Participants (N = 21) recruited through posters at a gender clinic and social media participated in four in-person focus groups facilitated by trans+ researchers. Transcripts were analyzed using thematic analysis, and two overarching themes emerged. Firstly, in discussing their experiences of presurgical mental health assessment (Overarching Theme 1), trans+ people reported feeling uncertain about the assessment's purpose and turning to community for advice on how to \"pass\" their assessment. They reported having expectations that they would have to lie about their gender history and to downplay mental health symptoms to access surgery. Participants felt their assessment did not prepare them for surgery, set accurate postsurgical expectations, or improve mental health and wellness aftercare. Participants thought that presurgical mental health assessments pathologize trans+ experiences and identities. Secondly, participants shared their recommendations for systemic and procedural change (Overarching Theme 2). Most participants wanted to access surgeries through their family practitioner utilizing an informed consent model and peer mentors to assist with health system navigation. Implications for training, policy, and research are discussed. Historiquement, une évaluation préopératoire par un professionnel de la santé mentale a été exigée pour que les personnes trans+ puissent accéder aux chirurgies liées à la transition dans la plupart des juridictions canadiennes, malgré le débat actuel sur leur utilité clinique. L'engagement des patients est une étape cruciale pour informer les processus de soins de santé afin qu'ils soient appropriés et culturellement adaptés. Une étude qualitative a donc été menée pour comprendre les expériences des adultes trans+ qui ont subi des évaluations préopératoires de l'état de santé mentale pour des chirurgies liées à la transition et leurs recommandations pour améliorer les processus d'aiguillage. Les participants (N = 21), recrutés par l'intermédiaire d'affiches dans une clinique de santé sexuelle et de médias sociaux, ont participé à quatre groupes de discussion en personne animés par des chercheurs trans+. Les transcriptions ont été analysées à l'aide d'une analyse thématique, qui a permis de dégager deux thèmes principaux. Tout d'abord, en discutant de leurs expériences d'évaluation préopératoire de l'état de santé mentale (thème général 1), les personnes trans+ ont déclaré avoir ressenti de l'incertitude quant à l'objectif de l'évaluation et se sont tournées vers la communauté pour obtenir des conseils sur la manière de « réussir » leur évaluation. Elles ont déclaré s'attendre à devoir mentir sur leur histoire de genre et minimiser leurs symptômes de santé mentale pour pouvoir accéder à la chirurgie. Les participants ont indiqué que leur évaluation ne les avait pas préparés à l'opération, n'avait pas fixé d'attentes postopératoires claires et n'avait pas amélioré la santé mentale et le bien-être postopératoires. Les participants ont mentionné que les évaluations de santé mentale préopératoires avaient tendance à traiter les expériences et les identités trans+ comme des pathologies. Deuxièmement, les participants ont fait part de leurs recommandations en vue d'un changement systémique et procédural (thème général 2). La plupart des participants souhaitaient avoir accès à des chirurgies par l'intermédiaire de leur médecin de famille en utilisant un modèle de consentement éclairé et des pairs mentors pour les aider à s'orienter dans le système de santé. Les répercussions sur la formation, les politiques et la recherche y sont abordées. Public Significance Statement In the present study, trans and gender-diverse individuals seeking gender-affirming surgeries mostly reported that presurgical mental health assessment was not helpful in their preparation for gender-affirming surgeries or for their mental health/physical recovery after surgery despite provincial/territorial requirements for these assessments. Most participants wanted to access transition-related surgeries as they would other surgeries: discuss the risks and benefits with their family doctor and receive a direct referral to a surgeon. Results suggest that health care system reform and more flexible, affirming, and supportive presurgical processes may be needed.