A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals

Hughto, Jaclyn M. White; Reisner, Sari L.

doi:10.1089/trgh.2015.0008

Cited by 321 publications

(215 citation statements)

References 17 publications

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“…However, surprisingly in the full sample, those who had medically transitioned were more likely to report self-harm. This is inconsistent with previous research, which has indicated the positive benefits of medically transitioning to mental health (White Hughto & Reisner, 2016). Although medical transition is important for bringing one’s body in line with one’s gender identity, it is possible that the stigma that persists after medical transition, particularly for those with high visual gender nonconformity (i.e., those who are not recognized as their affirmed gender), negatively affects health in the form of self-harm.…”

Section: Discussioncontrasting

confidence: 99%

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults

et al. 2016

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This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated Adjusted Risk Ratios (aRR) and 95% Confidence Intervals (95% CI) to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all p’s < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.

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Section: Discussioncontrasting

confidence: 99%

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults

et al. 2016

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“…4,5,9,25,36,51,54,59,60 Our findings uniquely demonstrate that, in addition to individual-level demographic and behavioral factors, the social climate of a state as measured through partisan voting practices is a strong indicator of experiencing care refusal among U.S. transgender individuals. By identifying areas where access to care barriers exist, these findings pave the way for the development of targeted public health research, programming, and intervention efforts aimed at achieving transgender health equity.…”

Section: Resultsmentioning

confidence: 58%

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

et al. 2016

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Purpose: To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. Methods: Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. Results: Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values <0.05). Adjusting for individual-level factors, variation was observed across U.S. states, with a greater proportion of states in the Southern and Western United States with transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01). Conclusion: Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services.

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“…Medically affirming ones gender can include the use of exogenous hormone therapy (e.g., estrogen) or surgery (e.g., medical confirmation surgery) to feminize the body, with hormone therapy often being the first and sometimes only gender transition-related intervention sought (Coleman et al, 2012). Hormone therapy is an essential component of healthcare delivery for some transgender people, as it alleviates the psychological distress of gender dysphoria (APA, 2008, Coleman et al, 2012), and has been linked to improved mental health outcomes (e.g., reduced depression and anxiety) and quality of life (White Hughto and Reisner, 2016, Murad et al, 2010). Given that transgender women may require a variety of health services while incarcerated, access to supportive medical providers, who are knowledgeable about transgender individuals and their healthcare needs, is essential to ensuring the health of incarcerated transgender women.…”

Section: Introductionmentioning

confidence: 99%

Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women’s healthcare experiences in sex-segregated jails and prisons

Hughto

Clark

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et al. 2018

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Purpose Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. Design/methodology/approach In 2015, 20 transgender women who had been incarcerated in the United States within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated. Findings Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g., sex-segregated prisons, biased culture) or interpersonal factors (e.g., biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated. Research implications Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare. Originality/value This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.

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A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals

Cited by 321 publications

References 17 publications

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women’s healthcare experiences in sex-segregated jails and prisons

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