A Comparison of Mental Health,Substance Use,and Sexual Risk Behaviors Between Rural and Non-Rural Transgender Persons

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.     

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina

ABSTRACT

This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.     

Being Transgender: The Experience of Transgender Identity Development

This article is based on a grounded theory analysis of interviews with transgender-identified people from different regions of the United States. Participants held a variety of gender identities under the transgender rubric (e.g., crossdresser, transman, transwoman, butch lesbian). Interviews explored the participants’ experiences in arriving at their gender identity. This article presents three clusters of findings related to the common processes of transgender identity development. This process was made possible by accessibility of transgender narratives that injected hope into what was a childhood replete with criticism and scrutiny. Ultimately, participants came to their identities through balancing a desire for authenticity with demands of necessity—meaning that they weighed their internal gender experience with considerations about their available resources, coping skills, and the consequences of gender transitions. The implications of these findings are considered in terms of their contribution to gender theory, research, and clinical support for transgender clients.     

Resilience to Discrimination and Rejection Among Young Sexual Minority Males and Transgender Females: A Qualitative Study on Coping With Minority Stress

Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection. Semistructured interviews were conducted with 10 sexual minority males and transgender females aged 18–22 years, who currently met criteria for an operationalized definition of resilience to depression and anxiety. Data were analyzed qualitatively, yielding information related to a wide variety of problem-solving, support-seeking, and accommodative coping strategies employed by youth in the face of social stigma. Results are discussed in light of their clinical implications.     

Varieties of Transgender/Transsexual Lives and Their Relationship with Transphobia

The conceptualization of gender variant populations within studies have consisted of imposed labels and a diversity of individual identities that preclude any attempt at examining the variations found among gender variant populations, while at the same time creating artificial distinctions between groups that may not actually exist. Data were collected from 90 transgender/transsexual people using confidential, self-administered questionnaires. Factors like age of transition, being out to others, and participant's race and class were associated with experiences of transphobic life events. Discrimination can have profound impact on transgender/transsexual people's lives, but different factors can influence one's experience of transphobia. Further studies are needed to examine how transphobia manifests, and how gender characteristics impact people's lives.     

Utilization of Health Care Among Female-to-Male Transgender Individuals in the United States

ABSTRACT

Female-To-Male (FTM) transgender individuals were approached at a conference and several peer support groups in the United States and asked to complete a short questionnaire regarding their medical care. Results from the 122 completed questionnaires indicated that a high number of respondents were taking testosterone (n = 106) and had some gender-confirming surgery (n = 68). Seventy percent of respondents rated their overall quality of health care “good” or “excellent.” A surprising finding was the low number (7%) reporting diagnoses of polycystic ovarian syndrome–the incidence of which has been reported elsewhere as high as 50%. Also notable were the high levels of employment, insurance, knowledge of standards of care, and access to providers, contrasting with reports from studies involving predominantly Male-To-Female (MTF) individuals. Finally, FTM's usage of transition-related medical resources can vary, but many within this study are foregoing genital surgery.     

Harassment Patterns and Risk Profile in Spanish Trans Persons

This article describes the harassment patterns and the risk profile in trans people living in Spain. A sample of 212 trans persons, aged 10–62, participated in this cross-sectional study. Results showed a high percentage of harassment (59.9%) and frequency of daily harassment (12.6%), especially verbal attacks (59%) that occurred in public spaces (49.1%) and within educational contexts (46.2%). Harassment is more prevalent in trans women than men. Those who disclose their gender identities at a younger age experience higher percentages and frequency of harassment than those who disclose at an older age. They also suffer more harassment of different types. The risk profile of harassment indicates that older trans women are more likely to suffer harassment than younger ones, and the risk decreases each year they delay their gender identity disclosure. The elimination of transphobic attitudes and the promotion of gender justice should be priority strategies in Spain.     

Transgender Teachers: The Personal,Pedagogical, and Political

This empirical research study examines the experiences of three male-to-female transgender teachers who transitioned genders, in three different decades (1980s, 1990s, 2000s) while actively teaching within Canadian K–12 public schools. I utilize poststructural storylines to explore how these transgender teachers navigated the personal, pedagogical, and political and the survival and transition strategies they developed to become intelligible within their schools. Their storylines illustrate how they developed counternarratives to challenge traditional discourses of trans invisibility, silence, shame, and fear.     

The Invisible Work of Closeting: A Qualitative Study About Strategies Used by Lesbian and Gay Persons to Conceal Their Sexual Orientation

ABSTRACT

The last decades have offered substantial improvement regarding human rights for lesbian and gay (LG) persons. Yet LG persons are often in the closet, concealing their sexual orientation. We present a qualitative study based on 182 histories submitted from 161 LG individuals to a Web site. The aim was to explore experiences of closeting among LG persons in Norway. A broad range of strategies was used for closeting, even among individuals who generally considered themselves to be out of the closet. Concealment was enacted by blunt denial, clever avoidance, or subtle vagueness. Other strategies included changing or eliminating the pronoun or name of the partner in ongoing conversations. Context-dependent concealment, differentiating between persons, situations, or arenas, was repeatedly applied for security or convenience. We propose a shift from “being in the closet” to “situated concealment of sexual orientation.”     

Experiences of Violence Among Transgender Women in Puerto Rico: An Underestimated Problem

Violence is a public health concern faced on a daily basis by transgender women. Literature has documented how it adversely affects quality of life and health and in some instances leads to homicide. Considering the lack of research documenting the experiences of violence among transgender women, the objective of this article was to explore manifestations of violence among this population in Puerto Rico. The data presented in this article are part of a larger study on transgender/transsexual health in Puerto Rico. For the purpose of this article we focus on the quantitative data analysis. Participants (N = 59 transgender women) were recruited via respondent driven sampling. Implications and specific recommendations are discussed in light of these findings.     

Factors Influencing the Career and Academic Choices of Lesbian,Gay, Bisexual,and Transgender People

This is an empirical study of academic and career choices for 119 lesbian, gay, bisexual, and transgender (LGBT) students using a questionnaire. Respondents who reported that their sexual orientation influenced their choices a great deal indicated that the influences were both positive and negative. This group was most likely to have experienced anti-LGBT discrimination in the past. In comparing lesbian, bisexual people, and gay males, gay males and respondents from visible minorities were the most likely to feel a negative impact, while bisexual respondents were the least likely. There were too few transgender respondents to include in these statistical comparisons; however, frequencies suggest that transgender people may be the most vulnerable of all. Results suggest that counselors need to take sexual orientation issues, particularly past experiences of discrimination, when working with LGBT clients.     

Development and Validation of the Transgender Inclusive Behavior Scale (TIBS)

Transgender-inclusive behaviors are actions and communication supporting transgender individuals. Examples include using language not reinforcing the gender binary, asking for and using correct pronouns, creation of spaces that welcome members of the transgender community, and acknowledging cisgender (non-transgender) privilege. A survey was developed measuring this behavior in individuals to examine the impact of transgender-inclusive behavior and the potential effect of interventions on promoting inclusive behavior. Data were collected utilizing an online survey (N = 1,051). The sample was split in half to run two sets of cases in a principal components analysis. Analysis of the full sample showed Cronbach’s alpha to be .93 (n = 918). Findings suggest that the Transgender Inclusive Behavior Scale (TIBS) may be a useful instrument for identifying behaviors related to being inclusive of transgender individuals, groups, and communities. It may also be used to measure behavior change before and after transgender-specific educational and behavioral interventions.     

The Big Freak Out: Educator Fear in Response to the Presence of Transgender Elementary School Students

Increased visibility of transgender children requires elementary school professionals to take on issues of gender diversity, sex and sexuality, which are considered taboo in elementary school spaces. School professionals who have worked with transgender children were interviewed about their experience with these students, perceptions of their school's success in supporting them, and recommendations for information and resources needed by schools to provide support. Findings indicate that fear and anxiety are common educator responses to the presence of a transgender child and the disruption of the gender binary, and these emotions are limiting the possibilities for schools to affirm transgender identity.     

The Impact of Social Connectedness and Internalized Transphobic Stigma on Self-Esteem Among Transgender and Gender Non-Conforming Adults

The transgender and gender non-conforming (TGNC) community continues to represent a notably marginalized population exposed to pervasive discrimination, microaggressions, and victimization. Congruent with the minority stress model, TGNC individuals persistently experience barriers to wellbeing in contemporary society; however, research uncovering resilience-based pathways to health among this population is sparse. This study aimed to explore the impact and interaction between internalized transphobic stigma and a potential buffer against minority stress—social connectedness—on the self-esteem of TGNC identified adults. Data were collected from 65 TGNC identified adults during a national transgender conference. Multiple regression analysis reveals that self-esteem is negatively impacted by internalized transphobia and positively impacted by social connectedness. Social connectedness did not significantly moderate the relationship between internalized transphobia and self-esteem. Micro and macro interventions aimed at increasing social connectedness and decreasing internalized transphobic stigma may be paramount for enhancing resiliency and wellbeing in the TGNC community.     

Coming In: Queer Narratives of Sexual Self-Discovery

Many models of queer sexuality continue to depict a linear narrative of sexual development, beginning in repression/concealment and eventuating in coming out. The present study sought to challenge this by engaging in a hermeneutically informed thematic analysis of interviews with eight queer people living in Western Australia. Four themes were identified: “searching for identity,” “society, stigma, and self,” “sexual self-discovery,” and “coming in.” Interviewees discussed internalized homophobia and its impact on their life; experiences and implications of finding a community and achieving a sense of belonging; the concept of sexual self-discovery being a lifelong process; and sexuality as fluid, dynamic, and situational rather than static. The article concludes by suggesting that the idea of “coming in”—arriving at a place of acceptance of one’s sexuality, regardless of its fluidity or how it is viewed by society—offers considerable analytic leverage for understanding the journeys of sexual self-discovery of queer-identified people.     

Perceived Sibling Relationships of Sexual Minority Youth

The purpose of this study was to examine the relationships of sexual minority youth and their siblings. The participants were 56 lesbian, gay, bisexual, or transgender individuals ranging in age from 18 to 24 years, who reported information about a total of 107 siblings. Respondents completed a demographic data questionnaire as well as adapted versions of the Sibling Closeness Scale (SCS) and the Sibling Approval of Sexual Behavior Scale (SASBS) to describe their relationship with each of their siblings. Analyses examined birth order and gender in relation to outness to siblings as well as sibling closeness and approval. Results provide information about disclosure of LGBT status to siblings, elements of closeness and acceptance in sibling relationships of sexual minority youth, and the significance of gender and birth order in these sibling relationships.     

Sexual Messages in Black and White: A discourse analysis of Essence and Cosmo

The research presented employed critical discourse analysis to examine advice columns on sex and women's sexual freedom as expressed in two popular women's magazines, Essence and Cosmopolitan, over a three-year period. Essence has a Black female audience, Cosmo a predominantly White female audience. Critical discourse analysis is concerned with language as a primary force for the production and reproduction of ideology and belief systems that come to be accepted as common sense. The study asked whether and to what extent sex talk in these two magazines mirrored tenets of sexual liberation as set forth by “second-wave feminism.” Findings showed that while both magazines reinforced women's right to sexual pleasure and to ask for what they wanted, Essence came closest to mirroring the tenets of women's liberation by advocating women's right to say no to men's bad behavior and to be their own persons. By contrast, Cosmo advised women to be innovative in exciting and keeping their men and to be more flexible in managing men's less than desirable behavior.     

HIV Risk Behaviors in the U.S. Transgender Population: Prevalence and Predictors in a Large Internet Sample

To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.     

Barriers to Optimal Care between Physicians and Lesbian,Gay, Bisexual,Transgender, and Questioning Adolescent Patients

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.