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Objective Recent literature has raised an important ethical concern relating to the way in which surgeons approach people with gender dysphoria (GD): it has been suggested that referring transsexual patients to mental assessment can constitute a form of unjust discrimination. The aim of this paper is to examine some of the ethical issues concerning the role of the mental health professional in gender reassignment surgeries (GRS). Method The role of the mental health professional in GRS is analyzed by presenting the Standards of Care by the World Professional Association of Transgender Health, and discussing the principles of autonomy and non-discrimination. Results Purposes of psychotherapy are exploring gender identity; addressing the negative impact of GD on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; promoting resilience; and assisting the surgeons with the preparation prior to the surgery and the patient’s follow-up. Offering or requesting psychological assistance is in no way a form of negative discrimination or an attack to the patient’s autonomy. Contrarily, it might improve transsexual patients’ care, and thus at the most may represent a form of positive discrimination. To treat people as equal does not mean that they should be treated in the same way, but with the same concern and respect, so that their unique needs and goals can be achieved. Conclusions Offering or requesting psychological assistance to individuals with GD is a form of responsible care, and not unjust discrimination. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

At a time when lesbian, gay, bisexual, and transgender individuals-often referred to under the umbrella acronym LGBT-are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.

Examining trans- healthcare as a key site through which struggles for health and justice take shape Over the past two decades, medical and therapeutic approaches to transgender patients have changed radically, from treating a supposed pathology to offering gender-affirming care. Based on ethnographic fieldwork in New York City and Buenos Aires, Care without Pathology moves across the Americas to show how trans- health activists have taken on the project of depathologization. In New York, Christoph Hanssmann examines activist attempts to overturn bans on using public health dollars to fund trans- health care. In Argentina, he traces how trans- activists marshaled medical statistics and personal biographies to reveal state violence directed against trans- people and travestis. Hanssmann also demonstrates the importance of understanding transphobia in the broader context of gendered racism, ableism, and antipoverty, arguing for the rise of a thoroughly coalition-based mass mobilization. Care without Pathology highlights the distributive arguments activists made to access state funding for health care, combating state arguments that funding trans- health care is too specialized, too expensive, and too controversial. Hanssmann situates trans- health as a crucible within which sweeping changes are taking place-with potentially far-reaching effects on the economic and racial barriers to accessing care.

Objectives. To document transgender Floridians’ service needs before and after antitransgender state legislation. Methods. We conducted descriptive and change point analyses of intake survey data collected by a transgender-led community-based organization in Florida from 701 clients who requested services between 2018 and 2024. Results. Findings show enrollment for services increased during the rise in antitransgender legislation, with pressing needs for legal and financial support for name changes and gender-affirming health care. The percentage of clients requesting sexual health resources increased, especially among Black clients. Conclusions. Findings underscore the urgency of (1) understanding the impact of antitransgender legislation on service needs, and (2) understanding the sequelae, including the ability for organizations to meet needs and the impact on psychosocial health outcomes. Findings emphasize the crucial role of community-based organizations in supporting transgender people in a discriminatory environment and generating data to inform policy. Public Health Implications. Antitransgender legislation constitutes a public health crisis by restricting life-saving care and exacerbating health disparities. Community-based organizations can resist these laws and act as a protective buffer for affected individuals. ( Am J Public Health. 2025;115(10):1642–1651. https://doi.org/10.2105/AJPH.2025.308171 )

The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people.

Transgender people face numerous barriers when utilizing health care in the United States. The current study sought to highlight transgender consumer perspectives in order to present theoretically informed, concrete recommendations for increasing transgender health care utilization. The search yielded several prominent themes associated with barriers to health care for transgender people: 1) provider lack of knowledge concerning transgender identity issues and transgender health issues, 2) transgender patients' previous negative experiences with the health care system or anticipation of these experiences, 3) transgender patients' inability to pay for health care services, and 4) health care provider refusal to provide health care services to transgender people. We present a modified version of Adapted Behavioral Model of health care utilization for transgender people focused on transgender individuals as a guiding theoretical framework that informs our recommendations for increasing transgender health care utilization.

To improve health outcomes among transgender women of color living with HIV, the Health Resources and Services Administration’s Special Programs of National Significance program funded the Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative in 2012. Nine demonstration projects in four US urban areas implemented innovative, theory-based interventions specifically targeting transgender women of color in their jurisdictions. An evaluation and technical assistance center was funded to evaluate the outcomes of the access to care interventions, and these findings will yield best practices and lessons learned to improve the care and treatment of transgender women of color living with HIV infection.

Background Transgender and gender diverse (TGD) people in remote areas face structural barriers to accessing gender-affirming, interdisciplinary healthcare. These include limited specialised care, a shortage of TGD-informed healthcare professionals, long travel distances to urban care centres, and insufficient local crisis support. The i²TransHealth intervention addressed these gaps by offering video consultations, chat-based support, and a network of locally trained physicians (general practitioners, psychiatrists). This qualitative process evaluation identified enabling and hindering aspects to inform recommendations for improving and scaling i²TransHealth, and to support the implementation of e-health in other TGD-informed care contexts. Methods i²TransHealth was evaluated as an e-health intervention in a randomised controlled trial involving 174 TGD adult participants (aged 18 and above) from northern Germany. As part of the intervention group, service users received video consultations and chat-based support provided by study therapists, along with outpatient care from general practitioners and psychiatrists as needed. To capture the experiences of those involved in delivering and receiving the intervention, four online focus groups were conducted with service users ( n  = 4), study therapists ( n  = 5), general practitioners ( n  = 6), and psychiatrists ( n  = 7). Data were collected using semi-structured interview guides and analysed according to Kuckartz’s thematic text analysis. Results The process evaluation identified enabling and hindering aspects influencing the implementation of i²TransHealth. Focus group participants reported improved access to TGD-informed healthcare through i²TransHealth, though this was challenged by factors such as time constraints, administrative burdens, and limited referral options for specialised care. They highlighted the flexibility and support of study therapists, as well as reduced distress and increased wellbeing of service users. While video consultations facilitated access, they were considered challenging for assessing non-verbal cues and treating highly distressed individuals. The e-health platform enabled easily accessible communication, yet usability issues, inconsistent engagement, and high workload for study therapists were noted. Conclusions E-health interventions like i²TransHealth can enhance access to TGD-informed healthcare in remote areas, but require integration with in-person services for complex cases involving highly distressed individuals. Expanding training, strengthening networks, and refining digital tools are crucial for sustainability. Trial registration The trial was registered in ClinicalTrials.gov 28/02/2020 (NCT04290286).

Background Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals. Methods In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient ( n  = 11) and gender-affirming care clinician ( n  = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care. Results Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation. Conclusions This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care.