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

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

Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults

Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B = 0.26, p \u3c 0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation ( p \u3c 0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare

Suicide Attempts Among a Cohort of Transgender and Gender Diverse People

INTRODUCTION: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings

Differential Experiences of Mental Health among Trans/Gender Diverse Adults in Michigan

Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of mental health concerns; 72.2% had been diagnosed with depression in their lifetime and 73.0% had been diagnosed with anxiety in their lifetime. In the past year, 49.9% had had non-suicidal self-injury (NSSI) thoughts, 45.4% had suicidal thoughts, 26.3% engaged in NSSI, and 7.7% had attempted suicide. Bivariate regressions showed some nuanced experiences of rates of mental health diagnoses and experiences, such as greater odds of experiencing all mental health disparities among those with disabilities, and differential odds across gender in regard to ever having a depression diagnosis, non-suicidal self-injury thoughts and engaging in non-suicidal self-injury behavior. This indicates a need for social workers, counselors, therapists, and other human services professionals to act more intentionally and with an intersectional lens when it comes to exploring the mental health of transgender and gender diverse persons

Increased Prevalence, Predictors, and In-Group Differences of Forced Sex and Physical Dating Violence among Trans/Gender Diverse Youth

Forced sex and dating violence are too common among young people and rates are higher for young transgender and gender diverse (TGD) individuals. However, the TGD youth population has differential experiences across gender, race, age, sexual orientation, and other identity factors. This study, using data from the 2015 Healthy Kids Colorado Survey, explores these differential within-group experiences of forced sex and dating violence. Findings indicate that sexual minorities who are also TGD are 2.45–3.73 times more likely to experience forced sex and physical dating violence than their TGD heterosexual peers. Individuals who are transfeminine (4.49 times), transmasculine (2.52 times), and nonbinary (3.86 times) are more likely to experience forced sex, as well as physical dating violence (transfeminine (4.01 times), transmasculine (2.91 times), and nonbinary (4.77 times)), as compared to those individuals questioning their gender. Black individuals (3.93 times) and Multiracial individuals (2.39 times) are more likely to experience dating violence than their White counterparts. Age was related to increased experience of forced sex, with individuals being 1.34 times more likely to have experienced this per year increase of age. These findings indicate the need for more trans-inclusive youth programing around sexual violence and dating violence, as well as taking a more intersectional and personalized approach to prevention work

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

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

HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community-based survey

IntroductionTransgender (trans) and nonbinary people (TNB) are disproportionately impacted by HIV. HIV testing is critical to engage TNB people in HIV prevention and care. Yet, scant literature has examined social and structural factors associated with HIV testing among TNB people of diverse genders and in geographies with potentially lower trans acceptance. We: (1) characterized the prevalence of never having been tested for HIV; and (2) identified associated factors, among TNB people in Michigan, United States.MethodsData were from a community-based participatory cross-sectional survey (n = 539 sexually experienced TNB people). The prevalence of never having had an HIV test was reported overall and compared across socio-demographic, clinical, social and structural factors using bivariable and multivariable logistic regression analyses.Results and discussionApproximately one-quarter (26.2%) of participants had never had an HIV test (20.8% transfeminine; 30.0% transmasculine; 17.8% nonbinary assigned male at-birth; and 32.0% nonbinary assigned female at-birth). In a multivariable socio-demographic model, older age (adjusted odds ratio [aOR] for 1-year increase: 0.93, 95% CI: 0.90, 0.96, p<0.001) and Black/African American race (vs. White) (aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05) were associated with increased odds of HIV testing (aORs for never testing). In separate multivariable models controlling for socio-demographics, ever experiencing sexual violence (aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001), not accessed sexual/reproductive healthcare in the past 12 months (aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001) and reporting a very/somewhat inclusive primary care provider (PCP) (aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001) were associated with HIV testing (aORs for never testing).ConclusionsFindings contribute to scant literature about gender-based differences in HIV testing inclusive of transmasculine and nonbinary people. Lack of statistically significant gender differences suggests that broad TNB interventions may be warranted. These could include training healthcare providers in trans-inclusive practices with sexual violence survivors and PCPs in trans-inclusive HIV prevention and care. Findings showing Black participants were less likely to have never had an HIV test suggest the promise of culturally tailored services, though further investigation is needed. Findings identify social and structural factors associated with HIV testing and can inform multi-level interventions to increase TNB person’s HIV testing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175060/1/jia225972.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175060/2/jia225972_am.pd

Differential Experiences of Mental Health among Transgender and Gender-Diverse Youth in Colorado

Young people experience a variety of mental health concerns, including depression, non-suicidal self-injury, and suicidal ideation. These issues are at even higher rates among transgender and gender-diverse (TGD) young people, due to the additional burden of having to navigate a world in which transphobia impacts them at the individual, organizational, and policy levels. However, much of the extant research focuses only on comparing TGD youth to cisgender counterparts. This study explores the nuance within the TDG youth population regarding mental health, examining how gender, race/ethnicity, and sexual orientation change the likelihood of experiencing each of these mental health concerns. Among a sample of over 400 young people, findings indicate that those TGD young people who do not identify themselves within the masculine/feminine binary and those with marginalized sexual orientations were two to three times more likely to experience adverse mental health outcomes, as compared to their peers who are questioning their gender, and who are heterosexual. The implications for mental health professionals and others who work with young people are to recognize that mental health is not a one-size-fits all model for young TGD people, and that the intersection of multiple marginalized identities, must be addressed in order to improve the mental health of this group of young people. Findings can also be used to better understand issues of stigma, discrimination, and victimization in education, health care, and beyond

Emergency Clinicians\u27 Comfort Levels in Caring for Transgender Patients

OBJECTIVE: Transgender individuals report negative experiences in emergency department settings, but little is known about emergency clinicians\u27 barriers to treating transgender patients. The purpose of this study was to explore emergency clinicians\u27 experiences with transgender patients to better understand their comfort with caring for this population. METHODS: We conducted a cross-sectional survey of emergency clinicians in an integrated health system in the Midwest. To assess the relationship between each independent variable and the outcome variables (i.e., comfort level generally and comfort level asking transgender patients about their body parts specifically), Mann-Whitney U test or Kruskal-Wallis analysis of variance was conducted for categorical independent variables and Pearson correlations were conducted for continuous independent variables. RESULTS: Most participants (90.1%) were comfortable caring for transgender patients, whereas two-thirds (67.9%) were comfortable asking transgender patients about body parts. Although none of the independent variables was associated with increased clinician comfort level caring for transgender patients in general, White clinicians and those who were unsure how to ask patients about their gender identity or transgender-specific care they had received were less comfortable asking about body parts. CONCLUSION: Having skills to communicate with transgender patients was associated with emergency clinicians\u27 comfort levels. In addition to offering traditional classroom-based didactics about transgender health care, providing opportunities for clinical rotations that allow clinicians-in-training to treat, and perhaps more importantly, learn from transgender patients will likely be higher yield in bolstering clinician confidence in serving this patient population

Emergency Clinicians\u27 Comfort Levels in Caring for Transgender Patients

Objective: Transgender individuals report negative experiences in emergency department settings, but little is known about emergency clinicians\u27 barriers to treating transgender patients. The purpose of this study was to explore emergency clinicians\u27 experiences with transgender patients to better understand their comfort with caring for this population. Methods: We conducted a cross-sectional survey of emergency clinicians in an integrated health system in the Midwest. To assess the relationship between each independent variable and the outcome variables (i.e., comfort level generally and comfort level asking transgender patients about their body parts specifically), Mann-Whitney U test or Kruskal-Wallis analysis of variance was conducted for categorical independent variables and Pearson correlations were conducted for continuous independent variables. Results: Most participants (90.1%) were comfortable caring for transgender patients, whereas two-thirds (67.9%) were comfortable asking transgender patients about body parts. Although none of the independent variables was associated with increased clinician comfort level caring for transgender patients in general, White clinicians and those who were unsure how to ask patients about their gender identity or transgender-specific care they had received were less comfortable asking about body parts. Conclusion: Having skills to communicate with transgender patients was associated with emergency clinicians\u27 comfort levels. In addition to offering traditional classroom-based didactics about transgender health care, providing opportunities for clinical rotations that allow clinicians-in-training to treat, and perhaps more importantly, learn from transgender patients will likely be higher yield in bolstering clinician confidence in serving this patient population