Transgender experiences and transphobia in higher education

While categories like “campus climate” highlight variation across institutions, trans people's experiences also vary within an institutional context. By studying trans people's experiences in higher education, however, we can better understand and respond to the differentiated and changing needs of transgender people in other arenas. In this paper, I review key qualitative and quantitative findings along several themes: (a) disclosing trans identities, (b) trans communities, and (c) resources and career‐level support. Specifically, I use the concept of microclimates to explain how trans people encounter various forms of support and discrimination on campus. For example, someone might receive support from particular individuals, such as an advisor, or spaces, like a gender studies classroom, but not others. Researchers also report both similarities and differences between binary and nonbinary trans people, as well as between transgender men and transgender women, suggesting that there is no universal trans experience, nor a one‐size‐fits‐all approach to supporting trans students and faculty members. Challenging interpersonal and systemic transphobia requires context‐specific interventions.     

The role of marriage in explaining racial and ethnic disparities in access to health care for men in the US

Reducing disparities in access to health care is a long-standing objective of the federal government. Building on research showing that marriage can provide important resources for obtaining needed health care, we suggest that racial and ethnic differences in marriage could explain persistent disparities in access. Using data from MEPS and NLSY we investigate the association between marriage and access to health care among men, and estimate the extent to which racial and ethnic differences in both the returns to marriage and marital rates explain differences in access and preventive service use. We find that marriage accounts for up to 24 % of racial and ethnic differences in access and preventive use. The returns to marriage for whites and blacks, however, are greater than that for Hispanics. We suggest that differences in spousal characteristics such as education and income could explain why whites and blacks benefit from marriage more than Hispanics. We find support for this hypothesis: differences in spousal characteristics account for up to 37 % of the gap in access and preventive use among married adults.     

THe Use of Hormone Therapy in the Male-to-Female Transgender Population: Issues for Consideration in Thailand

ABSTRACT

Objectives: Prejudice against transgender people is evident around the world with discrimination in many aspects of life, including access to health care. Even in Thailand, where male-to-female (MTF) transgender people are particularly visible and society is reputedly accepting, barriers to attaining appropriate health care still exist. The vast majority of MTF transgender people in Thailand are reported to be taking hormone therapy; however, most do not seek medical advice regarding these regimens, with the initiation and tailoring of medication often being guided by sympathetic peers instead. The objectives of this review are to consider hormone therapy in the context of the Thai population and provide recommendations regarding ways to improve practice and reduce health risks. Methods: The data analysis in this article represents a comprehensive literature review regarding hormone therapy for MTF transgender people including the guidelines for initiation, prescribing, and monitoring of hormone therapy, risks for serious adverse events and reported hormone use by the MTF transgender population in Thailand. Results: There is a notable lack of published research regarding hormone therapy in the transgender population. Guidelines, whilst relying considerably on expert opinion, do provide clear recommendations on the initiation, maintenance and monitoring of hormone therapy. Comparison of endocrine guidelines with reported practice in Thailand reveals significant opportunities for improvement in MTF transgender hormone therapy. Conclusions: The incautious use of hormone therapy may represent a considerable health risk behavior undoubtedly contributing to the morbidity and mortality in MTF transgender people. Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.     

Stress,Stigma, and Sexual Minority Status: The Intersectional Ecology Model of LGBTQ Health

One of the four overarching goals of Healthy People 2020 is to achieve health equity, eliminate health disparities, and improve the health of all groups, including the health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations. In 2011, the Institute of Medicine (IOM) released a report that drew attention to the unique health disparities experienced by sexual minorities and underscored the need for a comprehensive approach to sexual minority health research. This article proposes a new model of LGBTQ health to help measure, explore, explain, and predict the impact of sexual minority status on health outcomes. The Intersectional Ecology Model of LGBTQ Health (IEM) demonstrates how the relentless hypervigilance of LGBTQ individuals in a heteronormative society impacts health outcomes through the primary vehicles of stigma and chronic, elevated stress. The purpose of the IEM is to guide future research and enhance public health practice for LGBTQ populations.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health

Research suggests that transgender people face high levels of discrimination in society, which may contribute to their disproportionate risk for poor health. However, little is known about whether gender nonconformity, as a visible marker of one's stigmatized status as a transgender individual, heightens trans people's experiences with discrimination and, in turn, their health. Using data from the largest survey of transgender adults in the United States, the National Transgender Discrimination Survey (N = 4,115), we examine the associations among gender nonconformity, transphobic discrimination, and health‐harming behaviors (i.e., attempted suicide, drug/alcohol abuse, and smoking). The results suggest that gender nonconforming trans people face more discrimination and, in turn, are more likely to engage in health‐harming behaviors than trans people who are gender conforming. Our findings highlight the important role of gender nonconformity in the social experiences and well‐being of transgender people.     

Perceptions of transition-related health and mental health services among transgender adults

The opportunity to live authentically is critical for the well-being of transgender individuals. For many this requires accessing transition-related services. Current knowledge of transition-related care is limited. This study aims to elucidate experiences and needs of transgender individuals (N = 65) related to (a) therapeutic support, (b) medical care, and (c) aspects of living authentically in order to inform the development and delivery of trans-affirmative services. Findings reveal challenges accessing health care providers with trans-specific competency; gaps between critical aspects of transition-related care and receipt of services; and heterogeneity of experiences and needs. Recommendations for improving transgender-affirmative services are provided.     

Promoting resilience and emotional well-being of transgender young people: research at the intersections of gender and sexuality

Within lesbian, gay, bisexual and transgender (LGBT) research there is increasing health-related scholarship on trans lives, with a growing awareness of the impact of health inequalities on trans well-being. The aim of the paper is to provide greater understanding of transgender young people’s views of what is needed to promote their emotional well-being and resilience by undertaking specific analysis of data collected as part of wider research with young people (n?=?97). The study utilised participatory qualitative methods with a cross sectional design generating data via a focus group with trans youth (n?=?5), followed by thematic analysis. Findings suggest that both individual and collective capacities or resources enable and sustain resilience and well-being for trans young people. The adversity trans youth face is present in school, the community and in healthcare, but they are able to find places where they feel safe and connected to others. Practitioners, teachers and school nurses are well positioned to facilitate structural change in alliance with trans youth to promote resilience. Research results were utilised to inform health improvement, commissioning and service delivery.     

Missing from the Conversation: Sexual Risk Factors Across Young People by Gender Identity and Sexual Orientation

Abstract

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n?=?15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.     

An Analysis of Health Care Disparities and Subsequent Public Policy Initiatives

Racial and ethnic health disparities are a major clinical, public health, and societal problem in the United States. This article provides a historical analysis of the identification and progression of health disparities between Whites and minorities from 1989 to 2011. Key causes of health disparities are addressed, including the lack of culturally competent care, health insurance, and medical homes. Federal legislation that mandated federal health agencies to implement a plan to eliminate disparities is discussed.     

College students' acceptance of trans women and trans men in gendered spaces: The role of physical appearance

ABSTRACT

Transgender people often face prejudice and discrimination in school, employment, housing, and health care, and this can affect their psychological well-being. Although the literature on prejudice toward transgender people is growing, there is limited research that has examined differences in attitudes toward trans women and trans men separately. Specifically, the current study examined the role of physical appearance in the acceptance of transgender women and men in gendered spaces, including bathrooms, locker rooms, residence halls, and sorority and fraternity organizations. Participants viewed masculine-appearing and feminine-appearing images of a trans woman and trans man. Measurements of overall transacceptance and gendered-space acceptance were assessed. Results indicated that, in general, trans women were less accepted than trans men. The masculine-appearing trans woman was less accepted in the gendered spaces compared to the feminine-appearing trans woman and both images of the trans men. Also, female participants were generally more accepting of transgender people than male participants were. These findings suggest that, compared to trans men, discrimination of trans women is more likely, especially when the trans woman's physical appearance transgresses traditional gender expectations.     

Transmen's Health Care Experiences: Ethical Social Work Practice Beyond the Binary

Informed by institutional ethnography approaches, this study includes interviews with 3 young transmen (21–29) about their experiences regarding Canadian health care and the work they perform to access care. Semistructured interviews were used to gather data that were then analyzed to identify key aspects of participants’ experiences and perceptions. Findings describe the extra work transmen perform to compensate for a lack of provider competence in transgender health care. Influences of the dominant gender binary ideology as it shapes the health care experiences of transmen are discussed. This article calls for social workers to challenge the gender binary and use practice frameworks informed by transgender theory.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

Institutional contexts and mortality: the case of Peru

Increasingly, attention is being given to institutional contexts to explain differential demographic and health outcomes. Regional inequality in terms of economic development, social institutions, and health services leads to regional disparities in health outcomes, especially infant mortality. The author uses linked data from population and economic censuses, government agencies, and health surveys on 24 Peruvian provinces to explore how differential economic development and institutional contexts influence health outcomes. Regional inequities based on rural population, subsistence activity, women's illiteracy, monthly income, gross domestic product, medical care, and health facilities are compared, with a cluster analysis identifying institutional contexts which have internal similarities. These contexts are able to discriminate differences in infant mortality. The analysis demonstrates that infant mortality in Peru varies systematically with social, economic, and medical contexts. Economic development, income and subsistence levels, women's literacy, and the amount of medical care and public health services influence health outcomes. It is clear that understanding such regional inequities can help explain disparities in health outcomes.     

Sex and Gender Diversity Among Transgender Persons in Ontario,Canada: Results From a Respondent-Driven Sampling Survey

Recent estimates suggest that as many as 1 in 200 adults may be trans (transgender, transsexual, or transitioned). Knowledge about dimensions of sex and gender in trans populations is crucial to development of inclusive policy, practice, and research, but limited data have been available, particularly from probability samples. The Trans PULSE community-based research project surveyed trans Ontarians (n = 433) in 2009–2010 using respondent-driven sampling. Frequencies were weighted by recruitment probability to produce estimates for the networked Ontario trans population. An estimated 30% of trans Ontarians were living their day-to-day lives in their birth gender, and 23% were living in their felt gender with no medical intervention. In all, 42% were using hormones, while 15% of male-to-female spectrum persons had undergone vaginoplasty and 0.4% of female-to-male spectrum persons had had phalloplasty. Of those living in their felt gender, 59% had begun to do so within the past four years. A minority of trans Ontarians reported a linear transition from one sex to another, yet such a trajectory is often assumed to be the norm. Accounting for this observed diversity, we recommend policy and practice changes to increase social inclusion and service access for trans persons, regardless of transition status.     

“Why would we take men? This is an OB/GYN”: Gender,hysterectomy, and the patriarchal dividend

Hysterectomy experiences among transmasculine individuals represent a powerful case to examine gendered dynamics in healthcare, especially given the continued cultural association between the uterus and womanhood. In this paper, I draw on theories from feminist science and technology studies and medical sociology to examine in-depth interviews with 46 trans or nonbinary individuals who have had, want, or are considering an elective premenopausal hysterectomy. I find that trans men and nonbinary patients must negotiate what I call the structural feminization of gynecology which often leads to poor healthcare experiences. This paper also extends theories of a “patriarchal dividend” in medicine by examining reported differences in medical experiences when patients are perceived as cisgender women versus as trans men or nonbinary. I find a double bind inherent in the patriarchal divided in healthcare: masculinity often leads to better care, but the patriarchal dividend is constrained by the stigma introduced by being a trans patient. In the process, I extend social scientific knowledge of a highly common yet understudied procedure while expanding scholarship on medicine, gender, and embodiment.     

The queer youth cultural competency (QYCC) scale: Measuring competency in direct-care behavioral health workers

Sexual and gender minority (SGM) youths are disproportionately represented in behavioral health treatment settings, and face disparities in outcomes when compared to their non-SGM peers. These youths need workers who are culturally competent in addressing their specific needs. This article presents a scale to measure the SGM-related cultural competence of direct care workers. The scale, named the Queer Youth Cultural Competency (QYCC) scale, fills a gap in the measurement literature and enables social workers to more robustly address the cultural competency of service providers as it relates to lesbian, gay, bisexual, transgender, queer, and questioning youths receiving behavioral health treatment.