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Health and Healthcare for Transgender and Gender Diverse Communities

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (7 April 2023) | Viewed by 37427

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Special Issue Editors

Dr. Shanna K. Kattari

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Guest Editor

School of Social Work and the Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI 48109, USA
Interests: transgender; gender diverse; nonbinary; health; mental health; sexual and reproductive health; disability; ableism

Dr. Brittanie Atteberry-Ash

E-Mail Website
Co-Guest Editor

School of Social Work, University of Texas – Arlington, Arlington, TX 76019, USA
Interests: LGBTQ+; gender identity; policy; health; social work education; social justice

Special Issue Information

Dear Colleagues,

Transgender and gender-diverse individuals go through differential experiences of health and healthcare across a variety of contexts. This can take the form of lower mental health outcomes as a response to cissexism and transphobia, issues with insurance covering needed medical procedures, challenges in finding healthcare providers who are both knowledgeable about trans-specific healthcare needs and affirming to this population, and even horrible instances of discrimination and victimization in healthcare settings. Much of the extant research has focused on viewing transgender and gender-diverse individuals as one homogeneous group and often uses secondary data where the initial questions may not have been as inclusive of these identities and experiences as is possible.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge at the intersection of health, healthcare, and the transgender/gender-diverse population. In order to better understand the lived experiences of transgender and gender-diverse individuals around their health and accessing healthcare, we are interested in papers that continue to move this conversation forward, explore new areas of healthcare experiences that have not yet been explored (whether through difference healthcare contexts or in geographic regions that have previously published little research), look at gender differences within the transgender and gender-diverse population, advocate for supporting the training and development of trans-affirming healthcare providers, focus on the resilience of transgender and gender-diverse individuals when it comes to their health, center the experiences of diverse populations within this group, and/or use innovative research methods not often used with this population. The main article types are Articles, Reviews and Case Reports.

Dr. Shanna K. Kattari
Guest Editor

Dr. Brittanie Atteberry-Ash
Co-Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

healthcare
transgender health
nonbinary health
trans-inclusive healthcare
trans-affirming healthcare
mental health
sexual and reproductive health
gender-diverse health
trans youth health
healthcare providers

Published Papers (11 papers)

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Research

17 pages, 364 KiB

Open AccessArticle

“How Do I Exist in This Body…That’s Outside of the Norm?” Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia

by Erin N. Harrop, Hillary K. Hecht, Vern Harner, Jarrod Call and Brendon T. Holloway

Int. J. Environ. Res. Public Health 2023, 20(2), 1156; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20021156 - 09 Jan 2023

Cited by 7 | Viewed by 2604

Abstract

Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark’s thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

16 pages, 362 KiB

Open AccessArticle

History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults

by Ajay Keshav Pandey and Kristie Seelman

Int. J. Environ. Res. Public Health 2022, 19(23), 15908; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192315908 - 29 Nov 2022

Cited by 2 | Viewed by 4824

Abstract

Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

13 pages, 1375 KiB

Open AccessArticle

Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens

by Anna Baleige, Mathilde Guernut and Frédéric Denis

Int. J. Environ. Res. Public Health 2022, 19(20), 13257; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013257 - 14 Oct 2022

Cited by 2 | Viewed by 1464

Abstract

Depsychopathologization of transgender and gender diverse (TGD) individuals in the eleventh revision of the International Classification of Diseases (ICD-11) called for a shift in care delivery models, based on free and informed consent. Public health policies face epistemic and discriminatory challenges and consensus built on evidence-based data is needed. TGD communities were consulted but did not actively participate in ICD-11 and the following public health debates. There is a need for TGD perspective—both in research and practice. This study draws on a peer-led participatory approach and explores TGD participants’ recommendations based on unexploited French data from ICD-11, in which 72 TGD gave feedback on public policies. Lexicometric analyses were conducted using the ALCESTE method and resulted in a two-step double Descending Hierarchical Classification. Sex, gender, and health consumption were analyzed as secondary variables. The first classification highlighted five main topics: care pathways, training of professionals, access, literacy, and civil status change, developed into 12 targets in the second classification. While sex and gender appeared to have little impact on discourses, recommendations varied according to received care. This study supports the growing scientific consensus of a public health approach to face TGD health challenges and emphasizes TGD individuals’ expertise. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

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11 pages, 368 KiB

Open AccessArticle

Trans Expertise and the Revision and Translation of ICD-11: An Analysis of Available French Data from a Trans Perspective

by Anna Baleige, Mathilde Guernut and Frédéric Denis

Int. J. Environ. Res. Public Health 2022, 19(19), 11983; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191911983 - 22 Sep 2022

Cited by 3 | Viewed by 2092

Abstract

Transgender and gender diverse (TGD) individuals’ depsychopathologization in the eleventh revision of the International Classification of Diseases (ICD-11) faces systemic discriminations built-in epistemic pipelines. Based on an analysis of unexploited data from ICD-11 and the French translation process, this article addresses power issues in participatory research and systemic discrimination within a socio-cultural context. We used a peer-driven participatory approach to conduct qualitative analyses of the French version of the ICD based on contributions from 72 TGD participants in the French study for ICD-11. The results highlight a major incongruence between participants’ propositions and the final official translation. Alternative terms were proposed and discussed by participants in regard to usage and concepts, but also encompassed participation and perceived futility of maintaining pathologization. We found discrepancies in the French publication and translation processes, respectively on gender categorization and back translation. These results question the relevance and implementation of ICD-11 for TGD communities and highlight failures at all three stages of the official French translation. Power issues have an impact on knowledge production and, while mechanisms vary, all relate to epistemic injustice. Involving TGD communities in all stages of medical knowledge production processes would reduce transphobic biases. Individuals with personal stakes involved in politicized research areas appear all the more necessary today. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

11 pages, 343 KiB

Open AccessArticle

Subjective Cognitive Decline Associated with Discrimination in Medical Settings among Transgender and Nonbinary Older Adults

by Nickolas H. Lambrou, Carey E. Gleason, Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Micah E. Lubensky and Jason D. Flatt

Int. J. Environ. Res. Public Health 2022, 19(15), 9168; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159168 - 27 Jul 2022

Cited by 9 | Viewed by 3240

Abstract

Background: Transgender and nonbinary (TNB) individuals report greater subjective cognitive decline (SCD) compared to non-TNB people. SCD involves self-reported problems with memory and thinking and is a potential risk for Alzheimer’s disease and related dementias (ADRD). We explored psychosocial factors, such as discrimination in medical settings, associated with SCD in a sample of TNB older adults. Methods: We utilized cross-sectional data on aging health, SCD (memory complaints and worsening memory in the past year), and discrimination in medical settings from The PRIDE Study for LGBTQ+ adults aged 50+ including TNB adults (n = 115). Associations were tested using multivariate logistic regression. Results: Nearly 16% of TNB participants rated their memory as poor/fair, and 17% reported that their memory was worse than a year ago. TNB older adults with SCD were more likely to report experiencing discrimination in medical settings. After adjustment, those reporting discrimination in medical settings had 4.5 times higher odds of reporting worsening memory than those who did not (OR: 4.5; 95%-CI: 1.5–13.2; p = 0.006), and 7.5 times more likely to report poor/fair memory (OR: 7.49; 95%-CI: 1.7–32.8; p = 0.008); Conclusions: TNB older adults reported high frequencies of SCD and discrimination in medical settings. Further research exploring affirmative cognitive screening and healthcare services is needed. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

22 pages, 2522 KiB

Open AccessArticle

“Truly Listen to Us”: Recommendations for Health Professionals to Bolster Wellbeing of Nonbinary Individuals

by M. Killian Kinney and Darren Cosgrove

Int. J. Environ. Res. Public Health 2022, 19(15), 9032; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159032 - 25 Jul 2022

Cited by 4 | Viewed by 2285

Abstract

Trans-affirming providers play significant roles in the health and wellbeing of nonbinary individuals. Yet, healthcare mistreatment is well-documented among gender-diverse patients, leading to clients withholding information and avoiding care for fear of experiencing bias. Concurrently, healthcare providers report feeling ill-equipped to serve nonbinary patients, often perpetuating cisnormative binary attitudes. The literature has established the challenges to accessing healthcare and the need for gender-affirming care. However, little is known about nonbinary people’s perspectives on how best to deliver gender-affirming care that is inclusive of nonbinary patients. This participatory action PhotoVoice study identified community member recommendations for healthcare providers to bolster the wellbeing of nonbinary individuals through improved access to gender-affirming healthcare. Data were collected through group discussions, photography, and photo-elicitation interviews. Drawing upon research results, the authors identify recommendations for improving interpersonal care, increasing access to gender-affirming care, and advocating for related environmental and policy changes. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

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16 pages, 484 KiB

Open AccessArticle

“We Are Doing the Absolute Most That We Can, and No One Is Listening”: Barriers and Facilitators to Health Literacy within Transgender and Nonbinary Communities

by C. Riley Hostetter, Jarrod Call, Donald R. Gerke, Brendon T. Holloway, N. Eugene Walls and Jennifer C. Greenfield

Int. J. Environ. Res. Public Health 2022, 19(3), 1229; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031229 - 22 Jan 2022

Cited by 10 | Viewed by 3694

Abstract

Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

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14 pages, 347 KiB

Open AccessArticle

Exploring the Experiences of Transgender and Gender Diverse Adults in Accessing a Trans Knowledgeable Primary Care Physician

by Shanna K. Kattari, Jarrod Call, Brendon T. Holloway, Leonardo Kattari and Kristie L. Seelman

Int. J. Environ. Res. Public Health 2021, 18(24), 13057; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182413057 - 10 Dec 2021

Cited by 16 | Viewed by 3602

Abstract

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

13 pages, 331 KiB

Open AccessArticle

Trans*Forming Access and Care in Rural Areas: A Community-Engaged Approach

by Megan E. Gandy, Kacie M. Kidd, James Weiss, Judith Leitch and Xavier Hersom

Int. J. Environ. Res. Public Health 2021, 18(23), 12700; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312700 - 02 Dec 2021

Cited by 13 | Viewed by 4180

Abstract

Research indicates that rural transgender and gender diverse (TGD) populations have a greater need for health services when compared with their urban counterparts, face unique barriers to accessing services, and have health disparities that are less researched than urban TGD populations. Therefore, the primary aim of this mixed-methods study (n = 24) was to increase research on the health care needs of TGD people in a rural Appalachian American context. This study was guided by a community-engaged model utilizing a community advisory board of TGD people and supportive parents of TGD children. Quantitative results indicate that travel burden is high, affirming provider availability is low, and the impacts on the health and mental health of TGD people in this sample are notable. Qualitative results provide recommendations for providers and health care systems to better serve this population. Integrated mixed-methods results further illustrate ways that rural TGD people and families adapt to the services available to them, sometimes at significant economic and emotional costs. This study contributes to the small but growing body of literature on the unique needs of rural TGD populations, including both adults and minors with supportive parents, by offering insights into strategies to address known disparities. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

17 pages, 372 KiB

Open AccessArticle

Trans Adults Amidst the COVID-19 Pandemic: Quality of Life, Pandemic Impact, and Vaccine Preferences

by Vern Harner, Ascher K. Munion and Jama Shelton

Int. J. Environ. Res. Public Health 2021, 18(23), 12536; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312536 - 28 Nov 2021

Cited by 4 | Viewed by 2334

Abstract

The ongoing COVID-19 pandemic is disproportionately impacting marginalized communities, such as Black, Indigenous, and people of color (BIPOC), disabled individuals, and transgender/nonbinary (i.e., trans) individuals. As trans individuals may be multiply marginalized, it is necessary to examine within group differences among trans individuals of different genders, races, socioeconomic statuses, and abilities. This study examines the following research questions: (1) What is the quality of life of trans adults during the COVID-19 pandemic? (2) How does the self-reported impact of the pandemic vary across groups within the trans community? (3) What preferences do trans adults have regarding receiving a COVID-19 vaccine? Survey data were collected in August/September of 2020. Among a sample of 449 trans adults, findings suggest that the profound impact of the pandemic was not consistent across all community members. Being a woman predicted a higher self-reported impact of the pandemic while being a masc(uline) white respondent tended to predict a lower impact of the pandemic. Higher income was associated with a higher quality of life and being a disabled white respondent predicted a lower quality of life. The majority (99%) of the sample reported wanting to receive a COVID-19 vaccine should one become available. Implications for practice include the importance of considering the holistic experiences of clients and community members, as opposed to having homogenized perspectives of even subsets of the trans community. Future research related to barriers faced when attempting to access a vaccine is needed to inform future public health responses to epidemics/pandemics impacting this community. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

15 pages, 322 KiB

Open AccessFeature PaperArticle

“I Have Nowhere to Go”: A Multiple-Case Study of Transgender and Gender Diverse Youth, Their Families, and Healthcare Experiences

by Megan S. Paceley, Jennifer Ananda, Margaret M. C. Thomas, Isaac Sanders, Delaney Hiegert and Taylor Davis Monley

Int. J. Environ. Res. Public Health 2021, 18(17), 9219; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179219 - 01 Sep 2021

Cited by 6 | Viewed by 4439

Abstract

Transgender and gender diverse (TGD) youth experience health disparities due to stigma and victimization. Gender-affirming healthcare mitigates these challenges; yet, we have limited understanding of TGD youth’s healthcare experiences in the U.S. Midwest and South. Using a multiple case study design, we aimed to develop an in-depth and cross-contextual understanding of TGD youth healthcare experiences in one Midwestern state. Families with a TGD child under 18 were recruited with the goal of cross-case diversity by child age, gender, race, and/or region of the state; we obtained diversity in child age and region only. Four white families with TGD boys or non-binary youth (4–16) in rural, suburban, and small towns participated in interviews and observations for one year; public data were collected from each family’s community. Thematic analysis was used within and across cases to develop both family-level understanding and identify themes across families. Findings include a summary of each family as it relates to their child’s TGD healthcare experiences as well as the themes identified across cases: accessibility and affirming care. Although limited by a small sample with lack of gender and race diversity, this study contributes to our understanding of TGD youth healthcare in understudied regions. Full article

(This article belongs to the Special Issue Health and Healthcare for Transgender and Gender Diverse Communities)

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