Walter P Bouman

Nottinghamshire Healthcare NHS Trust and University of Nottingham

Objectives Various procedures and techniques for genital surgery are available to transgender and gender diverse individuals. Prior research on feminizing (i.e., vaginoplasty, vulvoplasty, labiaplasty, and clitoroplasty) and masculinizing (i.e. phalloplasty, metoidioplasty, scrotoplasty and coronaplasty) genital gender affirming surgery measures an...

A description of the meaning and terminology as well as population estimates of nonbinary gender identities is given. Respectful use of language, names and pronouns of people who identify as nonbinary is discussed. The chapter further includes the need for access to gender-affirming care and barriers to care; gender-affirming medical treatment inte...

Introduction: Identities that lie outside of exclusively male and female, such as non-binary and genderqueer, have become increasingly more prevalent and visible within recent years. However, to date, the role of terminology in the development of such gender identities has been under-researched. This study aims to: (1) Examine what role terminolog...

While positive changes in mental health have been found following gender-affirming hormone treatment (GAHT), it is unclear how pre-GAHT mental health and social support can influence treatment outcomes. To address this, a retrospective longitudinal design was used in which 137 participants completed measures of social support, anxiety, and depressi...

This editorial provides a broad introduction to transgender health for transgender and gender-diverse people. Following a brief description of the history of transgender and gender-diverse people, the development of medical treatment is discussed, together with the use of appropriate terminology and language. The content largely draws attention to...

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this are...

Purpose Although cross-sectional studies have demonstrated that trans people present with lower quality of life and wellbeing than the general population, few studies have explored the factors associated with this, particularly in those who have medically transitioned some time ago. This paper aims to fill the gap in the literature on what factors...

The third edition of the Oxford Textbook of Endocrinology and Diabetes is an up-to-date, objective and comprehensive text that covers the full scope of endocrinology and diabetes. It contains wide ranging and pragmatic advice on diagnosis and clear guidelines for recommended management, while also covering the scientific principles that underlie th...

This chapter provides an introduction to transgender health. It starts with a brief historical and cultural overview concerning those people who identify as transgender or gender diverse, followed by a description of current language and terminology in transgender health with a glossary of transgender-related nomenclature. The classification of tra...

Background This paper presents an analysis of 32 narratives written by patients waiting for assessment at a transgender health clinic (THC) in England. Narratives are autobiographical free texts, designed to allow patients to describe in their own words their experiences of their gender identity and/or transition prior to a clinic appointment, as p...

Background Cross‐sectional studies show that transgender people are more likely than cisgender people to experience depression and anxiety before Gender Affirming Hormone Treatment (GAHT). However, the effect of GAHT on mental health in transgender people, and the role of other factors that may have a predictive effect, is poorly explored. Objecti...

Background: Recent research has shown that a high percentage of treatment-seeking transgender adults who were assigned female at birth (AFAB) reported scores above the clinical cutoff for autistic traits. It is unclear whether those scores reflect a stable trait or may be inflated by the high levels of anxiety typically associated with transgender...

Some people have a gender which is neither male nor female and may identify as both male and female at one time, as different genders at different times, as no gender at all, or dispute the very idea of only two genders. The most often heard umbrella terms for such genders are ‘non-binary’ or ‘genderqueer’ genders. This book looks to bring together...

Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking. Aim: To com...

Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking. Aim: To com...

Purpose: Bullying in the adult transgender population is well documented, but less is known about bullying in transgender and gender-diverse (TGD) youth. Studies have begun to explore experiences of bullying and the associated psychological distress in TGD youth; however, they often fail to distinguish among the separate groups within LGBT samples....

AIM: Anger is a state of emotions ranging from irritation to intense rage. Aggression is the externalization of anger through destructive/punitive behaviour. The World Professional Association for Transgender Health (WPATH) Standards of Care, Edition 7 (SOC7) guidelines warn about aggression in transgender men (TM) on testosterone treatment. We aim...

Background: Binary transgender people access gender affirming medical interventions to alleviate gender incongruence and increase body satisfaction. Despite the increase in nonbinary transgender people, this population are less likely to access transgender health services compared to binary transgender people. No research has yet understood why by...

The present study aimed to compare prevalence of autistic traits as measured by the Autism Spectrum Quotient-Short (AQ-Short) in a transgender clinical population (n=656) matched by age and sex assigned at birth to a typical cisgender community sample. Transgender people assigned female at birth were approximately twice as likely to have clinically...

Background: Although research on the relation between testosterone and aggression in humans is inconclusive, guidelines (including the World Professional Association for Transgender Health Standards of Care, edition 7) have warned for an increase in aggression in transgender men taking testosterone treatment. Aims: To investigate the association...

Background: It is vital that the treatment offered at transgender health services can be evaluated to ensure a high quality of care. However, the tools currently used to evaluate treatment at transgender health services are limited by mainly focusing on mental health or because they have been developed for binary transgender people only. This study...

Background: Depression is a serious disorder which significantly impacts wellbeing and quality of life. Studies exploring mental wellbeing in the transgender population are mostly limited by small, non-homogenous samples and lack of matched controls. This study aimed to address these limitations and explore depression rates in a large sample of tr...

This chapter discusses the psychiatric aspects of non-binary genders. In particular, it describes the history and current psychiatric classification of trans and non-binary genders; the prevalence of non-binary identities; the relationship between non-binary gender identities and trans binary identities; the relationship between non-binary identiti...

Many transgender people experience high levels of body dissatisfaction, which is one of numerous factors known to increase vulnerability to eating disorder symptoms in the cisgender (non-trans) population. Cross-sex hormones can alleviate body dissatisfaction so might also alleviate eating disorder symptoms. This study aimed to explore risk factors...

In recent years, an unprecedented increase in clinical research in transgender health linked to a substantial increase in the clinical need of transgender people (in the broadest sense, ie, transgender, transsexual, and gender diverse) has been reported. In consequence, new professional networks such as the European Professional Association for Tra...

This Handbook is written for transgender people, their families and friends; for professionals who in their day-to-day job may encounter transgender people; and for students, teachers, educators, academics, and members of the public at large with an interest in transgender people. This Handbook gives an in-depth overview on a wide spectrum of issue...

This book addresses the emerging field of genderqueer or non-binary genders - that is, individuals who do not identify as male or female. It considers theoretical, research, practice, and activist perspectives; and outlines a basis for good practice when working with non-binary individuals. The first section provides an overview of historical, leg...

Background: Physical activity has been found to alleviate mental health problems and could be beneficial for at-risk populations, such as transgender people. This study had three aims. First, to explore the amount of physical activity that treatment seeking transgender people engage in, and to compare this to matched cisgender people. Second, to d...

An overall increased prevalence of eating disorders psychopathology has been reported among the LGBTQ population, particularly among gay men. For some transgender people transitioning post puberty, pressure to conform to a social gender role with the body of their assigned gender may precipitate body dissatisfaction and eating disorders as a conseq...

This poster explores the levels, and factors statistically associated with physical activity in treatment seeking transgender people who have and have not taken cross-sex hormone treatment

This Handbook is written for transgender people, their families and friends; for professionals who in their day-to-day job may encounter transgender people; and for students, teachers, educators, academics, and members of the public at large with an interest in transgender people. This Handbook gives an in-depth overview on a wide spectrum of issue...

Background: Transgender people (those who feel incongruence between the gender they were assigned at birth and their gender identity) engage in lower levels of physical activity compared to cisgender (non-transgender) people. Several factors have been shown to affect physical activity engagement in the cisgender population; however, the physical ac...

Background Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advan...

Background There is anecdotal clinical evidence that transgender people use the online world – such as forums and online video gaming – for the purpose of experiencing their gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. Aims To describe gaming behavior, degree of problematic gaming beha...

The World Health Organization (WHO) is revising the tenth version of the International Classification of Diseases and Related Health Problems (ICD-10). This includes a reconceptualization of the definition and positioning of Gender Incongruence of Childhood (GIC). This study aimed to: 1) collect the views of transgender individuals and professional...

The UK Survey (this article reports on the questions marked in yellow). (DOCX)

Additional information on the background of the respondents. (DOCX)

The ICD-11 draft criteria of ‘Gender Incongruence of Childhood’ of the WGSDSH criteria used in this study. (DOCX)

Background: Anxiety disorders pose serious public health problems. The data available on anxiety disorders in the transgender population is limited by the small numbers, the lack of a matched controlled population and the selection of a nonhomogenous group of transgender people. Aims: The aims of the study were (1) to determine anxiety symptomatolo...

Video gaming has become an established area of psychological research over the last two decades. Over the past few years there has been increasing research into online gender swapping, showing that for many groups or individuals it can have positive psychological benefits (e.g., as a way to explore gender roles and boundaries in a safe environment)...

The World Health Organization (WHO) is currently updating the tenth version of their diag- nostic tool, the International Classification of Diseases (ICD, WHO, 1992). Changes have been proposed for the diagnosis of Transsexualism (ICD-10) with regard to terminology, placement and content. The aim of this study was to gather the opinions of transgen...

The World Health Organization (WHO) is currently updating the tenth version of their diagnostic tool, the International Classification of Diseases (ICD, WHO, 1992). Changes have been proposed for the diagnosis of Transsexualism (ICD-10) with regard to terminology, placement and content. The aim of this study was to gather the opinions of transgende...

About the Book There is a significant increase in people who self-diagnose as having gender dysphoria and gender incongruence. The number of people with gender dysphoria and gender incongruence who seek assessment, support and treatment at gender identity clinic services has increased substantially over the years globally, and in Europe, North Ame...

A study exploring physical activity in transgender people compared to cisgender (non-trans) people

An in-depth study that looks at why transgender people may no engage in physical activity and sport during their medical transition

Research has yet to identify specific predictors of poor psychological well-being and quality of life in transgender people. This study aimed first to explore the predictive value of five factors known to be associated with poor psychological well-being in cis- and transgender people; age, self-esteem, victimisation, interpersonal problems, and bod...

Background: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor. Aims: To explore the prevalence of NSSI in a large group of young trans people, and to identify risk factors for this group. Main Outcome Measures: Socio-demographic variables and mea...

Introduction. As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. Aims. The aim of this study was to investigate the socio-demographic and clinical characteristics of older trans people attending a national service and to investigate...

Abstract Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this stud...

Some people have a gender which is neither male nor female and may identify as both male and female at one time, as different genders at different times, as no gender at all, or dispute the very idea of only two genders. The umbrella terms for such genders are 'genderqueer' or 'non-binary' genders. Such gender identities outside of the binary of fe...

ABSTRACT: Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this stu...

In this chapter we consider how the diagnostic criteria for Gender Dysphoria can be used with people who have ID who present with the phenomena of gender incongruence and those who present with cross-gender identification. A review of the literature found very little data to indicate prevalence in people with ID and also very little research litera...

Objectives: Trans people have been found to have high levels of depression. In view of the association between interpersonal problems and depression and the importance of interpersonal skills to navigate the transition of trans people, this study aims to investigate levels of interpersonal problems among treatment-seeking trans men and women, and t...

No abstract is available for this article.

Introduction: There is a growing clinical recognition that a significant proportion of patients with gender dysphoria have concurrent autism spectrum disorder (ASD). Aim: The purpose of this review is to systematically appraise the current literature regarding the co-occurrence of gender dysphoria and ASD. Methods: A systematic literature sear...

GENDER DYSPHORIA AND INTELLECTUAL DISABILITY: PRESENTATION, DIAGNOSIS AND COURSE Parkes G, Barrett J, Beail N, Bhasin S, Bouman W P, De Vries ALC, Wilson D. Parkes G, Consultant Psychiatrist in Intellectual Disability, Hertfordshire Partnership University NHS Trust, UK Barrett, J, Consultant Psychiatrist and Clinical Lead, West London Mental Heal...

Across the globe, both in developed and developing countries, the population is rapidly ageing. In the fields of sexual and relationship therapy and sexual health, ageing has not been an issue of priority. Too often, ageing is thought of as a process that relates to problems, deficits, and taboos, and less to pleasure, change, growth and diversity....

Background: Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, t...

High levels of body dissatisfaction have already been reported in the trans population; however, the root of this dissatisfaction, and its association with eating disordered behaviours, has not been studied in-depth. This study aims to assess eating disorder risk by comparing 200 trans people, 200 people with eating disorders and 200 control partic...

This study aims to determine the prevalence rate of current non-suicidal self-injury (NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and de...

Murjan and Bouman summarize the issues concerning diagnosis and classification of Gender Dysphoria. Links with mental health are discussed. Neurobiology findings suggest a biological basis to transgender, although mediated through complex psychosocial systems. They give a history of medical and psychological treatment of transgender people and desc...

Transgender is a broad term, coined by Virginia Prince, an activist (King & Ekins, 2000), and used to refer to a diverse group of individuals who cross or transcend culturally defined categories of gender, including transsexual people; people who cross-dress, drag queens and kings; non-binary people; and gender-variant or transgender people (Bockti...

IntroductionThere is a paucity of systematic research in the area of non-suicidal self-injury (NSSI) in trans people.AimThe aim of this study was to investigate the prevalence of NSSI in trans people and the associations with intra- and interpersonal problems.Methods Participants were 155 untreated individuals with a diagnosis of transsexualism (ac...

Introduction There is a scarcity of research into the use of non-physician-sourced cross-sex hormones in the transgender population. However, when medication is not prescribed by health professionals, users' knowledge of such medication may be adversely affected. Aims This study aims to define the prevalence of Internet-sourced sex hormone use in...

The commonly used Standards of Care for people with gender dysphoria, including those of the World Professional Association for Transgender Health and The Royal College of Psychiatrists in the United Kingdom, as well as those standards used in many other countries, usually require that two signatures of approval from qualified mental health profess...

Introduction: There is a paucity of research in the area of social support and psychological well-being among people with gender dysphoria. Aims: The present study aimed to investigate levels of social support among individuals with gender dysphoria compared with a matched control group. It also aimed to examine the relationship between social s...

The Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria is a publication of the Intercollegiate Committee of the Royal College of Psychiatrists. The overall goal of the Good Practice Guidelines is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming...