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The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various po...
Contexts in source publication
Context 1
... of the Kruskal-Wallis H test determined that there were statistically significant differences in scores for the total sample and the binary participants for the variable 'desire for aftercare' (See Table 3). Subsequent post hoc analysis revealed statistically significant differences between the 0% ITPS and 51-100% ITPS groups for the total sample and binary participants (See Table 2). ...Context 2
... of the Kruskal-Wallis H test determined that there were statistically significant differences in scores for the total sample and the binary participants for the variable 'desire for aftercare' (See Table 3). Subsequent post hoc analysis revealed statistically significant differences between the 0% ITPS and 51-100% ITPS groups for the total sample and binary participants (See Table 2). ...Similar publications
Background: Barriers to healthcare and negative healthcare experiences are frequently reported by transgender people, which is known to be compounded by intersectional issues including racism.
Aims: The present study aimed to explore the experiences of trans people of color accessing a national Gender Service in the United Kingdom, to better under...
Citations
... For example, one of the reviewed studies that mentions treatment appropriateness emphasized that "culturally appropriate examples and language were used to reflect life experiences and context among African American women" [45]. However, most reviewed studies did not account for gender and cultural identity, economic background, or other equity, diversity, and inclusion factors to improve treatment appropriateness for participants, which may impact other indices of quality (acceptability, effectiveness, accessibility, and safety) [75][76][77]. ...
... 41 The analyses on the effects of ITPS determined that for the total sample and assigned male at birth participants in particular, individuals with no treatment experience (psychological assessment and/or TRMIs) desired significantly less involvement in decision-making processes (desired passive decision-making role) in comparison with those much further along in transition. 45 ...
... Based on previous research showing high desires for active decision making, 32,45 we hypothesized that the current study's participants would desire an active role in decision-making processes, with little variation between participants. ...
... Further, studies on general populations show differences in desires for decision making, with younger, 46,47 more educated, [46][47][48] and employed 46 women 47 choosing a more active role in decision-making processes. Desire for involvement in decision making was also found to change over time in the general 47 and trans population, 45 with desire for a more active role increasing as individuals gain experience or enter different stages of their treatment. Thus, we hypothesized that participant characteristics such as age, education level, sex assigned at birth, country of residence, gender identity, ITPS, or treatment status may play a role in participants' desired involvement in decision making. ...
Background
Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people’s desired decision-making role within TRMI and factors that influence these desires.
Aims
The study investigated trans people’s desired level of decision making during medical transition as well as possible sociodemographic predictors and correlations between decision-making desires and satisfaction with treatment.
Methods
Data were collected from a clinical sample from 3 trans health care centers, as part of the larger ENIGI study. The data consisted of 568 trans individuals (60.2% assigned male at birth) 20 to 82 years of age (mean age = 38.58 years) who took part in the study 4 to 6 years after initial clinical contact. Binary logistic regressions were conducted to determine whether independent variables predicted group membership in decision-making role subgroups while a Spearman rank-order correlation was conducted to determine the relationship between desired decision-making involvement and satisfaction with care.
Outcomes
Main measures were desired decision-making role, satisfaction with treatment, age, education level, country of residence, treatment status, individual treatment progress score (ITPS), gender identity, and sex assigned at birth.
Results
The vast majority of participants wanted to make medical decisions themselves. Age, education level, country of residence, treatment status, gender identity, and sex assigned at birth showed no significant effects in desired level of decision making, while the ITPS neared significance. Satisfaction with treatment was overall very high. For participants assigned male at birth, desire for a more active role in decision making was negatively correlated with satisfaction of labia surgery.
Clinical Implications
A desired decision-making role cannot be predicted based on the trans person’s sociodemographic characteristics. More involvement from health professionals addressing medical information and education obligations may be needed when offering surgical construction of labia to individuals assigned male at birth.
Strengths and Limitations
This study builds on the few existing analyses of desired levels of decision-making role among trans people during transition. It is the first to investigate the role of education level and treatment status/ITPS on the desire of decision-making role. Gender identity and influence of nonbinary identity were not investigated for treatment satisfaction as these items were presented based on sex assigned at birth.
Conclusion
This study highlights that trans people in 3 European trans health care centers during medical transition desire a more active role in decision making. Satisfaction with treatment received was overall very high.
... For example, one of the reviewed studies that mentions treatment appropriateness emphasized that "culturally appropriate examples and language were used to reflect life experiences and context among African American women" [45]. However, most reviewed studies did not account for gender and cultural identity, economic background, or other equity, diversity, and inclusion factors to improve treatment appropriateness for participants, which may impact other indices of quality (acceptability, effectiveness, accessibility, and safety) [75][76][77]. ...
Background
The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues.
Objective
This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention.
Methods
This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.
Results
From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome.
Conclusions
In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
... The demographics of this sample show that 19% of the 602 individuals identified as NBGQ, in accordance with previous studies. [3][4][5]9,17 Perhaps surprisingly, the results show that most people received conventional HT regardless of identifying in a binary or nonbinary manner: the overall percentage of NBGQ individuals not receiving conventional HT was only 18%. NBGQ individuals did receive tailored HT significantly more often than BT. ...
Purpose:
Hormone treatment (HT) is a cornerstone of gender-affirming therapy in transgender and gender nonconforming people. Nonbinary and genderqueer (NBGQ) people, individuals identifying outside the male to female binary, are increasingly recognized. Not all trans people and NBGQ individuals seek full HT. Current guidelines for HT of transgender and gender nonconforming people do not include specific regimens for NBGQ people who seek tailored treatment. We aimed to compare HT prescribed to NBGQ and binary trans people.
Methods:
We performed a retrospective study in 602 applicants for gender care in 2013-2015 at a referral clinic for gender dysphoria. GenderQueer Identity questionnaires at entry were used to categorize people as NBGQ or binary transgender (BT). Medical records were assessed until the end of 2019 with regard to HT.
Results:
A total of 113 individuals identified as nonbinary and 489 as BT before the start of HT. NBGQ persons were less likely to receive conventional HT (82% vs. 92%, p=0.004) and more likely to be prescribed tailored HT than BT people (11% vs. 4.7%, p=0.02). None of the NBGQ individuals who received tailored HT had undergone gonadectomy. A subgroup of NBGQ individuals assigned male at birth using exclusively estradiol had similar estradiol and higher testosterone serum concentrations compared with NBGQ individuals using conventional HT.
Conclusion:
NBGQ individuals more often receive tailored HT compared with BT people. In the future, individualized endocrine counseling may further shape customized HT regimens for NBGQ individuals. For these purposes, qualitative and prospective studies are needed.
... When TGD-related dysphoria, stressors, or distress are a focus of treatment, we recommend tracking progress through validated measures: Bowman and colleagues (2021) offer a review of gender dysphoriarelated measures, while Shulman and colleagues (2017) offer a review of TGD-affirming measures of a range of experiences including minority stress, community belongingness, and resiliency. Overall, in helping the patient work through their difficulties, the clinician should acknowledge that the patient is a unique individual with unique goals for their treatment, and that these goals may change as the patient experiences different stages of the transition process (Mayer et al., 2019). ...
While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) servicemembers requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender servicemember who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.
... The use of continuous scales or validated questionnaires may shed further light on the associations in this study. This cross-sectional sub-study only reflects the desires at one point during the evaluation process, whereas a recently published cross-sectional study of a German convenience sample of 415 transgender persons implies that needs and wishes regarding decision-making and supportive interventions may fluctuate during the treatment process (Mayer et al., 2019). ...
Introduction
Gender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.
Methods
Cross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.
Results
The proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.
Conclusions
In this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.
Policy Implications
The study findings underline the need for individualized care and flexible gender affirming treatment options. The role of somatic comorbidities should be further explored, and support should be offered to transgender people in need. There is an unmet need for facial surgery among aM.
... 9 Goodquality aftercare is thought to improve the aesthetic and functional outcomes of GAS: adequate wound care promotes healing and lifelong dilation is fundamental in maintaining the opening in the pelvic diaphragm, 10 which both are of importance for satisfaction with surgical results. 5,9,11 Furthermore, routine cancer screening, long-term postoperative monitoring of breast implants after breast augmentation, and evaluation of sexual function are some of many examples of care that could be applied after gender-affirming procedures. 9 Satisfaction with the results of surgery is beneficial for quality of life and in reducing psychological symptoms. ...
... 15 Targets for aftercare could be coping with unfavorable postoperative outcomes alongside attention for mental health challenges. Mental health services are considered to be helpful in the transitioning process by most treatment-seeking transgender (TSTG) individuals 11,16 as they may give support, assist adaptation and promote mental health and self-growth. According to the Standards of Care by the World Professional Association for Transgender Health (WPATH), surgeons ought to ensure direct aftercare and consultation with other health care providers after GAS. ...
... A majority of TSTG individuals mention the desire for post-GAS aftercare according to recent Dutch and German community sample studies. 11,17 While aftercare is viewed as pivotal to good treatment outcomes, a substantial share of transgender individuals receives limited clinical follow-up, 18 which may be the result of insufficient capacity. Also, little is known about the individual experiences and needs for care in the period after GAS from transgender individuals' perspectives. ...
Background:
While much emphasis has been put on the evaluation of gender-affirming surgery (GAS) approaches and their effectiveness, little is known about the health care needs after completion of these interventions.
Aim:
To assess post-GAS aftercare needs using a mixed-method approach and relate these to participant characteristics.
Methods:
As part of the ENIGI follow-up study, data was collected 5 years after first contact for gender-affirming treatments in 3 large European clinics. For the current analyses, only participants that had received GAS were included. Data on sociodemographic and clinical characteristics was collected. Standard aftercare protocols were followed. The study focused on participants' aftercare experiences. Participants rated whether they (had) experienced (predefined) aftercare needs and further elaborated in 2 open-ended questions. Frequencies of aftercare needs were analyzed and associated with participant characteristics via binary logistic regression. Answers to the open-ended questions were categorized through thematic analysis.
Outcomes:
Aftercare needs transgender individuals (had) experienced after receiving GAS and the relation to sociodemographic and clinical characteristics.
Results:
Of the 543 individuals that were invited for the ENIGI follow-up study, a total of 260 individuals were included (122 (trans) masculine, 119 (trans) feminine, 16 other, 3 missing). The most frequently mentioned aftercare need was (additional) assistance in surgical recovery (47%), followed by consultations with a mental health professional (36%) and physiotherapy for the pelvic floor (20%). The need for assistance in surgical recovery was associated with more psychological symptoms (OR=1.65), having undergone genital surgery (OR=2.55) and lower surgical satisfaction (OR=0.61). The need for consultation with a mental health professional was associated with more psychological symptoms and lower surgical satisfaction. The need for pelvic floor therapy was associated with more psychological symptoms as well as with having undergone genital surgery. Thematic analysis revealed 4 domains regarding aftercare optimization: provision of care, additional mental health care, improvement of organization of care and surgical technical care.
Clinical implications:
Deeper understanding of post-GAS aftercare needs and associated individual characteristics informs health care providers which gaps are experienced and therefore should be addressed in aftercare.
Strengths & limitations:
We provided first evidence on aftercare needs of transgender individuals after receiving GAS and associated these with participant characteristics in a large multicenter clinical cohort. No standardized data on aftercare received was collected, therefore the expressed aftercare needs cannot be compared with received aftercare.
Conclusion:
These results underline a widely experienced desire for aftercare and specify the personalized needs it should entail. IJ de Brouwer, E Elaut, I Becker-Hebly et al. Aftercare Needs Following Gender-Affirming Surgeries: Findings From the ENIGI Multicenter European Follow-Up Study. J Sex Med 2021;XX:XXX-XXX.
... Further, SGM individuals may face unique treatment concerns that differ from heterosexual and cisgender patients. For example, the relative focus on gender dysphoria would be expected to reduce as treatment progresses, becoming less of a concern for psychotherapeutic intervention (Mayer et al., 2019). In addition, SGM individuals face a syndemic of health conditions that do not occur in isolation and mutually exacerbate any individual form of malaise, thereby presenting a unique challenge to clinicians (Pachankis, 2015;Rodriguez-Seijas, Burton, et al., 2019;Stall et al., 2003). ...
Sexual and gender minority individuals (SGM) experience higher rates and greater severity of psychopathology than cisgender heterosexual persons. SGM individuals also seek mental health treatment with greater frequency than cisgender heterosexual individuals. Studies have investigated types of SGM affirmative mental health treatment, but few studies have examined whether standard mental health treatment is satisfactory for the SGM community. The current study took place in a general partial hospital program and compared satisfaction with an initial psychiatric meeting and with end-of-treatment satisfaction between cisgender heterosexual and SGM patients. We compared initial satisfaction between (a) cisgender heterosexual patients (N = 1253) and SGM patients (N = 334) and (b) cisgender heterosexual patients and cisgender but not heterosexual patients (N = 276), and transgender or gender diverse (TGD) patients (N = 58). We compared end-of-treatment satisfaction between (a) cisgender heterosexual patients (N = 1044) and SGM patients (N = 284) and (b) cisgender heterosexual patients and cisgender but not heterosexual patients (N = 235), TGD patients (N = 49). SGM patients were less satisfied with their initial psychiatric meeting than non-SGM patients. We found no overall differences in satisfaction between the two groups, but breakdown analyses revealed SGM patients were less satisfied with certain group therapies than non-SGM patients. This exploratory study adds to the nascent research investigating SGM patient satisfaction within one standard acute care setting. Future research into the development of assessment measures for SGM patient satisfaction is encouraged, particularly given the dearth of existing tailored satisfaction measures.
