Health Care Experiences of Patients with Nonbinary Gender Identities

Bindman, Jay; Ngo, Azze; Zamudio-Haas, Sophia; Sevelius, Jae

doi:10.1089/trgh.2021.0029

Cited by 21 publications

(17 citation statements)

References 15 publications

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“…The PRs’ recommendations support the literature calling for client-centered gender-affirming care that promotes the comprehensive health and wellbeing of patients [ 1 , 28 , 35 , 38 , 73 , 74 ], while providing strategies for achieving these goals. Medical professionals have been explicitly identified as needing training about affirming nonbinary and gender nonconforming patients [ 28 , 74 , 77 , 78 , 79 ], and for that training to be intersectional in recognizing the complexity and interrelatedness of the various components of clients’ identities [ 73 ]. Not only is there a need for gender-affirming training to exist, but physicians also need to be interested in pursuing such training [ 80 ].…”

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

“…This study built upon the existing call for trans-inclusive healthcare with nonbinary-specific care [ 73 , 74 , 75 , 76 ], providing community member experiences accessing healthcare and recommendations for improving gender-affirming care specific to those with expansive gender identities and expression. The PRs’ recommendations support the literature calling for client-centered gender-affirming care that promotes the comprehensive health and wellbeing of patients [ 1 , 28 , 35 , 38 , 73 , 74 ], while providing strategies for achieving these goals. Medical professionals have been explicitly identified as needing training about affirming nonbinary and gender nonconforming patients [ 28 , 74 , 77 , 78 , 79 ], and for that training to be intersectional in recognizing the complexity and interrelatedness of the various components of clients’ identities [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the current healthcare system, many nonbinary people face discrimination and microaggressions that contribute to the avoidance of care [ 73 ], and that has an adverse impact on their health and wellbeing [ 3 ]. However, potential improvement in patient-provider relationships can lead to a more empowering connection through gender-affirmation care [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

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

Kinney

Cosgrove

2022

IJERPH

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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.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Kinney

Cosgrove

2022

IJERPH

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“…Transgender and gender diverse (TGD) individuals experience significant health disparities due to multifactorial causes. The discrimination, social marginalization and minority stress experienced by TGD individuals is widespread and persists within healthcare spaces [1,2]. In a large survey of transgender individuals in the United States, almost half reported encountering discrimination while seeking healthcare services [3].…”

Section: Introductionmentioning

confidence: 99%

Care across the gender spectrum: A transgender health curriculum in the Obstetrics and Gynecology clerkship

et al. 2022

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Background A lack of undergraduate medical curricula on providing healthcare to transgender and gender diverse (TGD) patients has contributed to significant health disparities for TGD communities. To address this gap, we designed and evaluated a novel curriculum to train Obstetrics and Gynecology (OB/GYN) clerkship students in caring for TGD patients. Methods Following Kern’s 6-step method for curriculum development, we created a two-part curriculum on TGD healthcare topics – an online module on gender-affirming care, followed by a series of interactive cases on TGD-specific health topics. Undergraduate medical students completing their core OB/GYN clerkships at a university academic medical center (January-December 2021) were invited to complete this curriculum. Participants completed pre/post assessment surveys to assess their experience caring for TGD patients, as well as a scored knowledge assessment before and after completing the curriculum. Results Sixty-five students participated in this curricular assessment. Prior to completing the module, 45% agreed that they had received adequate TGD health training. Following module completion, students reported increased comfort in caring for transgender patients (49.2% vs. 81.5%; p < .001) and endorsed an improved fund of knowledge of both healthcare maintenance for TGD patients (61.5% vs. 100%; p < .001) and gender affirming medical therapies (60.0% vs. 96.9%; p < .001). Knowledge scores increased from a mean of 9.65 (1.81) to 12.5 (2.20) out of 15 (p < .001). In post-assessment surveys, 95% of participants agreed that the module was helpful for their learning. Qualitatively, students suggested longitudinal integration of TGD-topics into the pre-clinical curriculum, and expanded opportunities to practice patient counseling. Conclusion The findings of this study support the need for student education on TGD health. Integration of interactive, case-based TGD-care curricula into clinical training may increase medical students’ knowledge and comfort in caring for TGD patients. Ongoing efforts to integrate TGD health training into undergraduate medical student curricula are necessary.

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Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

Bruce,

Khouri,

Bolze

et al. 2023

JAMA Surg

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ImportanceThere has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments.ObjectiveTo evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy.Design, Setting, and ParticipantsFor this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020.ExposureDecisional regret and satisfaction with decision to undergo gender-affirming mastectomy.Main Outcomes and MeasuresLong-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders.ResultsA total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P &lt; .001) and anxiety (42 [44%] vs 97 [70%]; P &lt; .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses.Conclusions and RelevanceIn this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.

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Health Care Experiences of Patients with Nonbinary Gender Identities

Cited by 21 publications

References 15 publications

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

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

Care across the gender spectrum: A transgender health curriculum in the Obstetrics and Gynecology clerkship

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

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