Query: transgender health

title: Facial Feminization Surgery: The Ethics of Gatekeeping in Transgender Health
abstract: The lack of access to gender affirming surgery represents a significant unmet health care need within the transgender community, frequently resulting in depression and self destructive behavior. While some transgender people may have access to gender reassignment surgery (GRS) an overwhelming majority cannot afford facial feminization surgery (FFS) The former may be covered as a "medical necessity," but FFS is considered "cosmetic" and excluded from insurance coverage. This demarcation between "necessity" and "cosmetic" in transgender health care based on specific body parts is in direct opposition to the scientific community's understanding of gender dysphoria and professional guidelines for transgender health. GRS affects one's ability to function in an intimate relationship, while FFS has the same impact on social interactions an, therefore may have a far greater implication for one's quality of life. FFS is a cost effective intervention that needs to be covered by insurance policies. The benefits of such coverage far exceed the insignificant costs.

title: Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey
abstract: BackgroundTransgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited. Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado. was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender inclusive events and organizations.Main MeasuresResponses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data.ResultsResults from 406 transgender or gender nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender inclusive provider were more likely to receive wellness exams (76 versus 48% less likely to delay care due to discrimination (24 versus 42% less depressed (38 versus 54% and less likely to attempt suicide (7 versus 15% than those without.ConclusionsThe transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender inclusive provider is associated with improved mental and physical health and health behaviors. Further population level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities.

title: Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research
abstract: The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines: (1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders; (2) language and framing of transgender health research should be non stigmatizing; (3) research should be disseminated back to the community; (4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected; (5) informed consent must be meaningful, without coercion or undue influence; (6) the protection of participant confidentiality should be paramount; (7) alternative consent procedures should be considered for TGGD minors; (8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and (9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject.

title: Characterizing transgender health issues in Twitter
abstract: Although there are millions of transgender people in the world, a lack of information exists about their health issues. This issue has consequences for the medical field, which only has a nascent understanding of how to identify and meet this population's health related needs. Social media sites like Twitter provide new opportunities for transgender people to overcome these barriers by sharing their personal health experiences. Our research employs a computational framework to collect tweets from self identified transgender users, detect those that are health related, and identify their information needs. This framework is significant because it provides a macro scale perspective on an issue that lacks investigation at national or demographic levels. Our findings identified 54 distinct health related topics that we grouped into 7 broader categories. Further, we found both linguistic and topical differences in the health related information shared by transgender men (TM) as compared to transgender women (TW) These findings can help inform medical and policy based strategies for health interventions within transgender communities. Also, our proposed approach can inform the development of computational strategies to identify the health related information needs of other marginalized populations.

title: Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population Based Study
abstract: This is the first large, population based study in which health concerns and care utilization are examined between TGNC versus cisgender adolescents and across gender expressions among TGNC adolescents.  Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study's purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample.  Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade (n 2168 TGNC, 2.7% Students self reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups.  We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (kh2 763.7, P .001) Among the TGNC sample, those whose gender presentation was perceived as very congruent with their birth assigned sex were less likely to report poorer health and long term mental health problems compared with those with other gender presentations.  Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers should screen for health risks and identify barriers to care for TGNC youth while promoting and bolstering wellness within this community.

title: A systematic review of social stress and mental health among transgender and gender non conforming people in the United States.
abstract: Transgender and gender non conforming (TGNC) populations, including those who do not identify with gender binary constructs (man or woman) are increasingly recognized in health care settings. Research on the health of TGNC people is growing, and disparities are often noted. In this review, we examine 77 studies published between January 1, 1997 and March 22, 2017 which reported mental health outcomes in TGNC populations to (a) characterize what is known about mental health outcomes and (b) describe what gaps persist in this literature. In general, depressive symptoms, suicidality, interpersonal trauma exposure, substance use disorders, anxiety, and general distress have been consistently elevated among TGNC adults. We also used the minority stress model as a framework for summarizing existing literature. While no studies included all elements of the Minority Stress Model, this summary gives an overview of which studies have looked at each element. Findings suggest that TGNC people are exposed to a variety of social stressors, including stigma, discrimination, and bias events that contribute to mental health problems. Social support, community connectedness, and effective coping strategies appear beneficial. We argue that routine collection of gender identity data could advance our understanding mental health risk and resilience factors among TGNC populations.

title: Serving transgender people: clinical care considerations and service delivery models in transgender health
abstract: 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.

title: Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers
abstract: The prevalence of mental health conditions among transfeminine and transmasculine youth 3 to 17 years old at initial presentation is estimated and compared with matched cisgender counterparts.  Understanding the magnitude of mental health problems, particularly life threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions.  Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3 9 years old) and adolescents (10 17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status) Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date.  Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15% transmasculine 16% and depressive disorders (transfeminine 49% transmasculine 62% respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs] for history of self inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4 82) to 144 (95% CI 36 1248) The corresponding range for suicidal ideation was 25 (95% CI 14 45) to 54 (95% CI 18 218)  TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.

title: Global health burden and needs of transgender populations: a review
abstract: Transgender people are a diverse population affected by a range of negative health indicators across high income, middle income, and low income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.

title: Transgender Health: A Practitioner's Guide to Binary and Non Binary Trans Patient Care
abstract: The number of people coming out as transgender continues to rise, and this book informs healthcare and medical practitioners on how to deliver excellent primary and secondary care to gender diverse patients. This guide shows how to sensitively treat and care for transgender patients in healthcare settings. Distilling cutting edge research into practical advice, it covers everything from referral procedures to respectful language and insights on the wider social and ethical issues experienced by this growing client group.