A critical view of transgender health care in Germany: Psychopathologizing gender identity – Symptom of ‘disordered’ psychiatric/psychological diagnostics?

Güldenring, Annette

doi:10.3109/09540261.2015.1083948

Cited by 14 publications

(10 citation statements)

References 10 publications

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“…The majority of participants, regardless of transition progress or gender identity, desired psychotherapy, corroborating findings from other studies [35,36,38]. This finding is important, as mandatory psychotherapy and diagnoses have been heavily criticized [45,69,70]. It appears that participants in the sample are aware of psychotherapy’s benefits [3,5].…”

Section: Discussionsupporting

confidence: 82%

How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

Mayer

Koehler

Eyssel

et al. 2019

JCM

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The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.

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Section: Discussionsupporting

confidence: 82%

How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

Mayer

Koehler

Eyssel

et al. 2019

JCM

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“…Transition‐related healthcare traditionally has been ethically problematic, as trans individuals were, and often still are, subjected to strict clinical assessment before being granted access to treatment (Güldenring, ; Reisner, Poteat, et al, ). Consequently, trans individuals, organisations, and allies have strongly criticised transition‐related treatment regulations and practices (Cabral & Eisfeld, ; GATE, ).…”

Section: Discussionmentioning

confidence: 99%

“…Trans individuals can only have certain transition‐related interventions covered by health insurance companies if their trans experience and need for these interventions have been confirmed by a mental health professional. This system has been causing distress and conflict on individual and stakeholder levels (Degner & Nomanni, ; Güldenring, ; Hamm & Sauer, ), making the sector of trans healthcare (TH) a field of diverse and oftentimes conflicting interests.…”

Section: Introductionmentioning

confidence: 99%

Mapping key stakeholders’ position towards interdisciplinary transgender healthcare: A stakeholder analysis

Nieder

Koehler

Briken

et al. 2019

Health Soc Care Community

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Trans individuals experience an incongruence between their sex characteristics and their gender which might cause significant distress called gender dysphoria. Gender dysphoria is commonly treated using transition‐related healthcare services, like sex hormones and surgeries, ideally in interdisciplinary settings. The stakeholder environment of an interdisciplinary transgender healthcare centre (ITHC) is considered key in delivering high‐quality healthcare. Therefore, a stakeholder analysis was performed seeking to improve stakeholder relationships and service quality through an evidence‐based approach. Quantitative data were collected using a questionnaire administered cross‐sectionally, and covering attitude towards the ITHC, influence of and influence on stakeholders, level of knowledge about the ITHC, importance of the ITHC for stakeholders and types of interests. The analysis used primary data, collected July to August 2015. N = 79 key stakeholders were identified and n = 42 (53.2%) participated in the survey. Participants were categorised analytically into four stakeholder groups: trans groups, trans health experts, healthcare system and admin departments of the ITHC. Although participants reported low values (e.g. average values on a 5‐point Likert scale; importance: 2.54; influence on the ITHC: 2.43), the attitude of the four stakeholder groups towards the ITHC were positive overall. The attitudes varied, however, depending on the group, for example trans health experts and trans groups reported the highest values for most items. The results demonstrate the importance of systematically analyzing stakeholder positions in order to make appropriate policy decisions, improving stakeholder relationships and assuring long‐term high‐quality healthcare provision. Subsequently, an action plan was developed, focusing on the two groups with the highest values (trans health experts, trans groups). Selected measures are discussed. If stakeholders are to play their part in providing high‐quality, interdisciplinary trans healthcare, they need regular information on the latest developments and recurring feedback of their interests and requirements for the ITHC.

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“…As gender identity is very personal and only the individual knows this, it can be argued as to whether a professional is able to assess it. 4,48 As a consequence, HCPs working in trans health services may not assess the individual's gender identity but their ability to understand the role of GAMI and their capacity to consent to treatment. Decisions on the necessity and sequence of interventions should be made in a participatory manner in the sense of agreement between treatment seekers and HCPs.…”

Section: Evidencementioning

confidence: 99%

European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People, with Attention for Sexual Function and Satisfaction”

T’Sjoen

Arcelus

Vries

et al. 2020

The Journal of Sexual Medicine

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Background: There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice. Aim: We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction. Methods: The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available. Outcomes: The foci of the study are assessment and hormonal aspects of trans health care. Results: As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were developed based on clinical experiences and the available literature. With the multiple barriers to care that many trans people experience, basic care principles still need to be stressed. We recommend that health-care professionals (HCPs) working with trans people recognize the diversity of genders, including male, female, and nonbinary individuals. In addition, HCPs assessing gender diverse children and adolescents should take a developmental approach that acknowledges the difference between prepubescent gender diverse children and pubescent gender diverse adolescents and trans adults. Furthermore, trans people seeking gender-affirming medical interventions should be assessed by HCPs with expertise in trans health care and gender-affirming psychological practice. If masculinization is desired, testosterone therapy with monitoring of serum sex steroid levels and signs of virilization is recommended. Similarly, if feminization is desired, we recommend estrogens and/or antiandrogen therapy with monitoring of serum sex steroid levels and signs of feminization. HCPs should be aware of the influence of hormonal therapy on sexual functioning and satisfaction. We recommend HCPs be aware of potential sexual problems during all surgical phases of treatment. Clinical Implications: This is an up-to-date ESSM position statement. Strengths & Limitations: These statements are based on the data that are currently available; however, it is vital to recognize that this is a rapidly changing field and that the literature, particularly in the field of sexual functioning and satisfaction, is limited. Conclusion: This ESSM position statement provides relevant information and references to existing clinical guidelines with the aim of informing relevant HCPs on best practices when working with transgender people.

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A critical view of transgender health care in Germany: Psychopathologizing gender identity – Symptom of ‘disordered’ psychiatric/psychological diagnostics?

Cited by 14 publications

References 10 publications

How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

Mapping key stakeholders’ position towards interdisciplinary transgender healthcare: A stakeholder analysis

European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People, with Attention for Sexual Function and Satisfaction”

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