Standardizing Injustice in Transition-related Medicine?: An Institutional Ethnography of How Assessment Protocols Coordinate Inequitable Access to Hormones and Surgeries in Canada

Transgender (trans) people experience barriers to transition medicine such as cross-sex hormones and sex reassignment surgeries. In response, standardized care protocols, such as the World Professional Association of Transgender Health standards of care (WPATH-SOC), are recommended to improve gaps in care. To better understand how standardized care protocols shape access to transition medicine in Canada, I draw on institutional ethnography as a critical research strategy. In this dissertation I thus explicate how the main protocols used to assess trans people’s psychosocial readiness for hormones or surgeries serve a powerful coordinating function. Although significant advocacy targets the Diagnostic and Statistical Manual for Mental Disorders for pathologizing trans identity through the gender dysphoria diagnosis, my research demonstrates that the WPATH-SOC standardizes an entire model of care based in pathologization. This research project uses data obtained through talking with twenty-two trans people, clinicians, clinician-educators, and hospital administrators, observing clinician-education workshops, and analyzing pertinent assessment protocols and healthcare policy texts. My dissertation makes three substantive contributions to the areas of public health, trans studies, and health professions education research. First, I show that standardized readiness assessments previously understood as innocuous instead contribute to inequities and further pathologize trans people. Second, I argue that in the absence of trans health in the formal health professions education curricula, standardized assessment protocols serve as a form of curriculum, coordinating how health professionals learn and teach this clinical sub-specialty. Third, the results of this research hold the potential to bolster trans health advocacy efforts by identifying how assessment protocols rule health professionals’ and trans people’s resistance practices. In the spirit of activist institutional ethnography this dissertation concludes with a discussion on recommended future advocacy and systems change in the areas of policy, education, and practice.Ph.D.2020-11-14 00:00:0

Examining TikTok’s Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups

Social media is increasingly being leveraged by researchers to engage in public debates and rapidly disseminate research results to health care providers, health care users, policy makers, educators, and the general public. This paper contributes to the growing literature on the use of social media for digital knowledge mobilization, drawing particular attention to TikTok and its unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities (eg, equity-seeking groups). Setting the TikTok platform apart from other social media are the unique audiovisual video editing tools, together with an impactful algorithm, that make knowledge dissemination and exchange with large global audiences possible. As an example, we will discuss digital knowledge mobilization with trans and nonbinary (trans) communities, a population that experiences barriers to health care and is engaged in significant peer-to-peer health information sharing on the web. To demonstrate, analytics data from 13 selected TikTok videos on the topic of research on gender-affirming medicine (eg, hormonal therapy and surgeries) are presented to illustrate how knowledge is disseminated within the trans community via TikTok. Considerations for researchers planning to use TikTok for digital knowledge mobilization and other related community engagement with equity-seeking groups are also discussed. These include the limitations of TikTok analytics data for measuring knowledge mobilization, population-specific concerns related to community safety on social media, the spread of disinformation, barriers to internet access, and commercialization and intellectual property issues. This paper concludes that TikTok is an innovative social media platform that presents possibilities for achieving transformative, community-engaged knowledge mobilization among researchers, underserved health care users, and their health care providers, all of whom are necessary to achieve better health care and population health outcomes

Mapping low-wage and precarious employment among lesbian, gay, bisexual, and transgender people in Organization for Economic Co-operation and Development countries: A scoping review protocol

Background: Low-wage and precarious employment are prevalent and on the rise, disproportionately impacting marginalized populations. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations have been largely left out of economic justice movements and scholarly literature on precarious employment and its deleterious social and health impacts. Methods: This scoping review protocol will guide a theoretical and narrative mapping of the literature on low-wage and precarious employment among LGBTQ+ people to better understand the extent and nature of this phenomenon. We will include empirical literature that discuss dimensions of this phenomenon in Organisation and Economic Co-operation and Development countries published on/after January 1, 2000. PRISMA-ScR guidelines structure this protocol. We will search 10 bibliographic databases to locate literatures across disciplines: EconLit, Sociological Abstracts, Scopus, PsycInfo, Social Work Abstracts, ABI/Inform, Business Source Premier, LGBTQ+ Source, Gender Studies Database, and Web of Science, with support from a Public Health Research Librarian. A rigorous search strategy was developed for PsycInfo (OVID) and will be adapted for subsequent database searches. Titles and abstracts will be independently screened by a subset of co-authors, followed by a full text review. Data abstraction and charting will be conducted using a standardized abstraction tool

Contemporalis homo sacer: Obstáculos para acceder a los servicios de salud papa las poblaciones trans

Esta es la versión final de un artículo publicado bajo la licencia de Creative Commons CC BY (https://creativecommons.org/licenses/by/4.0/). La versión en inglés de este artículo está disponible en el TSpace bajo el título: "Contemporalis homo sacer: barriers to accessing healthcare services for trans populations'"Objetivo: examinar las experiencias vividas por los individuos auto-identificados como trans al accesar a los servicios de salud mental y, en particular, sus percepciones sobre las barreras de acceso. Método: este estudio cualitativo se realizó mediante el análisis interpretativo fenomenológico (IPA) y apoyado en la teoría Tanatopolítica de Giorgio Agamben. Se realizaron 11 entrevistas semiestructuradas entre diciembre de 2009 y enero de 2010. Resultados: en nuestro análisis, identificamos las siguientes principales barreras de acceso al sistema de salud: desempeño de los proveedores de servicios de salud y, la tanatopolítica de la invisibilización. A través de las experiencias analizadas, identificamos la existencia de un despotismo (psiquiátrico) panóptico liderado por instituciones sanitarias, proveedores de atención médica y políticas públicas. La psiquiatrización tanatopolítica y otras estrategias de invisibilización pasiva tienen un impacto acumulativo porque los trans-cuerpos no se cuentan o no se reconocen plenamente como individuos sanos con condiciones de salud específicas. Conclusión: los hallazgos muestran que si bien se han producido algunos avances en la materia, todavía quedan muchos desafíos por superar con relación a las barreras al acceso a los servicios de salud.Este proyecto fue financiado por los Institutos Canadienses de Investigación en Salud en colaboración con Echo: Mejorando la Salud de la Mujer en Ontario, número de la concesión MPO-105685

Mapping low-wage and precarious employment among lesbian, gay, bisexual, and transgender people in Organization for Economic Co-operation and Development countries: A scoping review protocol

Scoping Review Protoco

Frequency of self-reported persistent post-treatment genital hypesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US

Purpose: Post-SSRI Sexual Dysfunction (PSSD) has been identified as an iatrogenic syndrome of enduring sexual dysfunction following the discontinuation of some antidepressants. We aimed to estimate the frequency of persistent post-treatment genital hypoesthesia (PPTGH) among past users of psychiatric treatments, particularly antidepressants. Methods: We used a subsample of UnACoRN, a US/Canada survey of sexual and gender minority youth aged 15 to 29. We included participants with history of psychiatric drug use. We excluded individuals with genital surgeries or without sexual experience. The analysis involved chi-square tests for initial group comparisons, post hoc tests for multiple comparisons, and logistic regression among those who had stopped taking medication. We exponentiated the regression to estimate the odds of PPTGH by drug type, adjusting for age, sex-assigned-at-birth, hormone treatment, and depression severity in three nested models. Results: 574 of 2179 survey participants reported genital hypoesthesia. They were older, more likely to report male sex assignment at birth, hormonal therapy history, and psychiatric drugs history. The frequency of PPTGH among antidepressant users was 13.2% (93/707) compared to 0.9% (1/102) among users of other medications; odds ratio: 14.2 (95% CI: 2.92 to 257). Conclusion: Antidepressant discontinuation strongly associated with PPTGH in two countries where SSRI/SNRI medications account for 80% of antidepressant prescriptions. We call for standardized international warnings and transparent, informed consent. Future research should expand upon our efforts to estimate the risk of PSSD by including all the proposed diagnostic criteria, including documentation of temporal changes in PSSD-related symptoms before and after treatment (3 months)