One of the most influential factors that affect the quality of life of transgender individuals is whether they can be perceived by others to "pass" in their felt gender. Voice and communication style are two important identifying dimensions of gender and many transgender individuals wish to acquire a voice that matches their gender. Evidence shows that few transgender individuals access voice therapy, and that this is caused by their concerns about stigmatization or negative past experiences within healthcare services. In order to address the negative experiences faced by transgender populations we need a better understanding of healthcare services' current levels of knowledge and LGBT awareness. Some studies of Speech-Language Therapists' (SLTs') experience and confidence working with transgender individuals have recently been undertaken in the United States (US). However, little research has been carried out in Asia. To investigate Taiwanese SLTs' knowledge, attitudes and experiences of providing transgender individuals with relevant therapy. A cross-sectional self-administered web-based survey hosted on the Qualtrics platform was delivered to 140 Taiwanese SLTs. Taiwanese SLTs were, (i) more familiar with the terminology used to address "lesbian, gay, and bisexual groups" than with "transgender" terminology, (ii) generally positive in their attitudes toward transgender individuals, and (iii) comfortable about providing clinical services to transgender clients. However, the majority of participants did not feel that they were sufficiently skilled in working with transgender individuals, even though most believed that providing them with voice and communication services fell within the SLT scope of practice. It is important for clinicians to both be skilled in transgender voice and communication therapy and to be culturally competent when providing services to transgender individuals. This study recommends that cultural competence relating to gender and sexual minority groups should be addressed in SLTs' university education as well as in their continuing educational programs.

Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic ( = 291). Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one's life. Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.

Research has shown that sexual risk behavior, as well as transition-related risk behavior, such as uncontrolled hormone use, auto-medication, and silicone injections, may lead to several adverse health outcomes for transgender persons. Transgender sex workers are a vulnerable group within the transgender population, who are at increased risk for these health risk behaviors. However, European research into this topic and risk population remains largely absent. This study explores the prevalence of uncontrolled gender-affirming hormone use, silicone injections, and inconsistent condom use among transgender sex workers working in Antwerp, Belgium. A descriptive analysis of a survey sample of 46 transgender sex workers, supplemented with nine in-depth interviews with transgender sex workers. This population of transgender sex workers has specific socio-demographic characteristics: they are all assigned male at birth, 83% identifies as female and 76% is from Latin-American descent, mainly from Ecuador. Transition-related and sexual risk behaviors are prevalent. Current uncontrolled hormone use rate is 32%, which should be seen in light of their work as well as their migration status. Inconsistent condom use with clients is reported by 33% of the sample. Of all participants, 65% has silicone injections in one or more parts of the body, and 43% of them cites health problems due to these injections. The specific characteristics of this largely invisible but highly vulnerable population should be taken in account when addressing this population's health risk behavior. Access to health care and social services should be ensured, and culturally tailored health interventions that take into account their social context as well as their gender identity should be developed.

Trans youth have been reported to have high rates of self-harm, depression and bullying, and find it difficult to seek support. However, much of this research comes from gender identity clinics; non-clinical samples and those who reject gender binaries remain under-researched. This study investigated the experiences of a community school-based sample of Trans, identifying youth, Other, and cis-gendered adolescents in relation to their experiences of low mood, bullying, associated support, self-harm ideation and peer-related self-harm. An online survey was completed by 8440 13-17 year olds (3625 male, 4361 female, 227 Other, and 55 Trans). Trans and Other students had significantly higher rates of self-harm ideation and peer self-harm, in comparison to cis-gendered students. These Trans and Other students reported significantly higher rates of bullying and self-reported depression and significantly less support from teachers and staff at school, in fact these students did not know where to go to access help. This community sample confirms findings of high rates of self-harm ideation, self-reported depression and bullying for Trans youth as previously reported in clinic-based samples. However, by accessing a community sample, the salience of the category "Other" was established for young people today. While Other and Trans identified students both struggled to find support, those who identified as Trans were more likely to have been bullied, and have experienced self-reported depression and thoughts of self-harm. Thus, those who identify as transgender represent a high-risk group that needs targeted support within schools and by statutory and nonstatutory community services. Unpacking the category of Other would be beneficial for future research, as well as exploring resilience within this group and intersecting identities such as sexuality, Autism, or experiences such as earlier abuse.

Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate. This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions. The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery. Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions. : The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.

To describe the use of hormonal contraceptives for menstrual management and/or pregnancy prevention in a clinic-based series of transgender adolescents and young adults who were assigned female at birth (transmasculine identity). We performed a chart review of post-menarchal transgender assigned-female-at-birth (AFAB) patients, age 10-25 years, seen at CCHMC Transgender Health Clinic for at least 2 visits between July 1, 2013 and September 17, 2016, and who were not on a puberty suppression method. We collected data including choice of hormonal contraceptive and indication (menstrual suppression, pregnancy prevention, or both), duration of use, initiation of sexual activity, reported sexual partners, and use of gender-affirming hormone therapy (i.e., testosterone). We present simple descriptive statistics. A total of 231 patients met inclusion criteria, with ages from 11 to 25 years. Of those, 135 (59%) were using a hormonal contraceptive method. Most patients (67%) used hormonal contraception for the indication of menstrual suppression. Most commonly used method was depot medroxyprogesterone (DMPA) (49 patients), followed by combined oral contraceptives (COC) and norethindrone (progestin-only pill, POP) (34 patients each). Thirteen patients used 52 mg levonorgestrel IUD (LNG-IUD). Of the total sample ( = 231), 82 (36%) reported sexual activity, 35 of whom (43% of sexually active patients) reported sexual intercourse with assigned-male-at-birth (AMAB) partners and/or penile-vaginal intercourse. Among 35 patients at risk for pregnancy, only 21 (60%) were using hormonal contraception. Over half (54%) of sexually active patients taking testosterone discontinued their hormonal contraceptive method once they stopped having menses. Within a sample of transgender AFAB adolescents, half of whom were taking testosterone, a variety of contraceptives were used, including depot medroxyprogesterone, combined oral contraceptives, and levonorgestrel IUD. Among those taking testosterone, many patients discontinued contraception once they stopped having menses.

Recently, a multitude of terms have emerged, especially within North America and Western Europe, which describe identities that are not experienced within the culturally accepted binary structure of gender which prevails within those cultures. As yet, there is no clear single umbrella term to describe such identities and a mixture of words have been used in scholarly work to date. To explore the origins and track the emergence of newer terms and definitions for identities between, outside and beyond the gender binary, to outline current trends in descriptors within scholarly work and to suggest a term which is wide enough to encompass all identities. A comprehensive systematic review was made, following the PRISMA guidelines. Several relevant key terms were used to search Web of Science, ScienceDirect, PubMed, and the . The descriptions each title gives for identities outside of the binary are extracted for analysis. Several terms have been used over the years to describe identities outside of the binary. "Non-binary" and "genderqueer" are currently mostly used as umbrella terms. However, "gender diverse" is emerging as a more suitable wide-ranging inclusive term for non-male and non-female identities. Identity outside of "male" and "female" is an emerging concept which currently has several identifiers and little academic agreement on which is the most pertinent. The two leading descriptors are "non-binary" and "genderqueer." Gender diverse is emerging as a new term which has the aim of including all other terms outside of male and female within it and this article suggests the increase in its use to describe gender identities outside of the binary.

Healthcare encounters are important in ensuring safe access to medical or surgical care for transgender people. Previous literature suggests many transgender people have had negative encounters with healthcare professionals. In Australia, there is limited research about this population and their healthcare, and less from regional locations. This study primarily aimed to explore both transgender client and clinician perspectives and experiences of healthcare interactions. A secondary aim was to investigate increased presentations to sexual health clinics in North Queensland by people wishing to transition. Semi-structured, in-depth interviews were used to gather data from 23 participants. Interview transcripts were inductively analyzed and themes developed. Results: Four themes emerged relating to healthcare encounters and the regional setting of North Queensland. These showed that support from family and peers is important for transgender mental health and wellbeing, and that person-centered clinicians who acknowledge a holistic approach to transgender care also form part of the support network for transgender individuals particularly in the regional setting. The internet was found to play a significant role in this study's findings. A collaborative holistic approach to transgender healthcare should be taken by client and clinician to best support the transgender individual during transition. The establishment of Australian guidelines and online peer support groups would facilitate this approach, particularly in rural or regional areas where specialist services are limited.

Previous research has suggested that gender diversity affects everyone in the family, with positive mental health and global outcomes for gender diverse youth reliant on receiving adequate family support and validation. Although the individual mental health, treatment and outcomes for gender diverse youth have received recent research attention, much less is known about a family perspective. Hence, a review of the literature exploring youth gender diversity from a family perspective is warranted. To systematically identify, appraise and summarize all published literature primarily exploring gender diversity in young people under the age of 18 years, as well as selected literature pertaining to a family understanding. Six electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science) were searched for relevant literature pertaining to youth under the age of 18 years. Research evidence was consistently found to support the beneficial effects of a supportive family system for youth experiencing gender diversity, and a systemic understanding and approach for professionals. Conversely, lack of family support was found to lead to poorer mental health and adverse life outcomes. Few articles explored the experience of siblings under the age of 18 years. This literature review is the first to critically evaluate and summarize all published studies which adopted a family understanding of youth gender diversity. The review highlighted a lack of current research and the need for further targeted research, which utilizes a systemic clinical approach to guide support for gender diverse youth and family members.

Health care disparities between transgender/gender non-binary individuals and the general population are well-documented and related to both interpersonal and institutional discrimination. Resilience has been found to buffer the negative health effects of discrimination among gender diverse individuals as well as other stigmatized populations. The purpose of this study was to identify and understand resilience related to health and health care among a community sample of transgender and gender non-binary individuals in the southern United States. We conducted 35 longitudinal photo elicitation interviews with 21 participants among a community sample of transgender and gender non-binary individuals in the Southern US. Interview transcripts were coded using thematic analysis and themes were organized according to the Resilience Activation Framework. Overall, individual and community-level resources within the domains of social and human capital were frequently activated to navigate challenges related to seeking and receiving health care. Lack of access to resources in economic and political capital domains constrained resilience. This work demonstrates how stakeholders can identify target areas for interventions and policy change aimed at improving resilience in transgender and gender non-binary communities by utilizing the Resilience Activation Framework. In our sample, we found that resources should be directed toward building economic and political capital at the community level so participants have the ability and opportunity to marshal such resources.

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. To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth. A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures. Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups. There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.

Gender affirming surgeries are increasingly accessible to transgender and non-binary individuals due to changes in health care coverage policies and rising numbers of trained providers. Improved access to care has led to an increase in the number of individuals pursuing gender affirming surgeries. Little is known about how to optimally prepare patients for these surgeries. This evaluation examined attendees' assessment of a four-hour single-session class developed to prepare transgender and non-binary patients and their caregivers for gender affirming surgeries in a multi-disciplinary transgender clinic within an integrated health care system. A multi-disciplinary group of providers within a health maintenance organization in Northern California designed and facilitated two separate curricula, one for patients preparing for metoidioplasty/phalloplasty and the other preparing for vaginoplasty. Between November 2015 and June 2017, 214 patients and caregivers took one of the two versions of the class and completed the post-class survey evaluating perceived favorability of the class and preparedness regarding surgery options, complications and postoperative care. Descriptive statistics were used to summarize the Likert scale questions, with 1 showing the least improvement and 5 showing the most. Of the 214 patients and caregivers that completed the survey, the majority reported that they were better informed about their surgical options (mean: 4.4, SD: 0.7), more prepared for surgery (mean: 4.5, SD: 0.6), better informed about possible complications (mean: 4.5, SD: 0.7), and better understood their postoperative care needs (mean: 4.6, SD: 0.6). Of the respondents, 204 (95%) reported they would recommend the course to a friend preparing for gender affirming surgery. Our findings demonstrate that a single-session class is a favorable method for preparing transgender and non-binary patients to make informed decisions regarding the perioperative gender affirming surgical process, from preoperative preparedness, to surgical complications, and postoperative care.

Genderqueer and nonbinary () people have remained largely invisible in health research. Previous research shows worse outcomes on health indicators for trans people when compared with cisgender controls, but the differences between binary trans and GQNB individuals are inconclusive. To compare overall health and well-being of GQNB people with controls of trans men and trans women, taking into account the impact of the additive effect of their socio-economic position, as well as their current need for gender affirming medical interventions. A community-driven survey was conducted in 2016 in five countries (Georgia, Poland, Serbia, Spain, and Sweden). Self-reported health and general well-being were analysed for differences between binary trans and GQNB respondents. The effects of multiple control variables (age, economic situation, educational level, belonging to an ethnic, religious, sexual or ability minority group, sex assigned at birth) as well as the current need for gender affirming medical interventions were controlled for. The sample consisted of 853 respondents aged 16 and older, with 254 trans women (29.8%), 369 trans men (43.2%), and 230 GQNB people (26%). GQNB respondents showed significantly worse self-reported health and worse general well-being in comparison to binary trans respondents. Additional negative impacts of having a lower educational level, having more economic stress, and belonging to a disability minority group were found. Being in need of gender affirming medical interventions contributed significantly to worse self-reported health, whereas being younger contributed to worse general well-being. In understanding health disparities between binary trans and GQNB people, it is necessary to take into account the additive effect of multiple socio-economic positions, and the current need for gender affirming medical interventions. The high proportion of GQNB respondents who report worse health outcomes highlights the need for policy makers and health-care providers in creating nonbinary-inclusive environments.

When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers.

Prejudice against transgender people is widespread, yet in spite of the prevalence of this negativity relatively little is known about the antecedents and predictors of these attitudes. One factor that is commonly related to prejudice is religion, and this is especially true for prejudice targets that are considered to be "value violating" (as is the case for transgender individuals). In this paper, we present the findings of our systematic search of the literature on this topic and present the synthesized evidence. Our search strategy was conducted across five databases and yielded 29 studies (across 28 articles). We found consistent evidence that self-identifying as with either being "religious" or as Christian (and to a lesser extent, being Muslim) was associated with increased transprejudice relative to being nonreligious (and to a lesser extent, being Jewish). Additionally, we found consistent evidence that certain forms of religiosity were also related to transprejudice - specifically religious fundamentalism, church attendance, and interpretations of the bible as literal (transprejudice was unrelated to religious education). Although this young, but important field of research is growing, more empirical exploration is needed to fully understand that nuances of the religion-transprejudice relationship.

While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group. This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables. : 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions. Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors. The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.