Abstract Objective This study was conducted to fill a gap in the literature with regard to unique challenges and assets faced within the relationships of transgender and nonbinary (TNB) individuals with cisgender partners. Background TNB individuals with cisgender partners encounter a variety of stressors and buffers to stress related to the effects of stigma on their relationships. There is a need for the present study to better characterize the unique challenges, assets, and potential phases faced by these couples. Method A total of 19 TNB participants were selected from a larger qualitative study focused on their description of their relationship experiences with a cisgender partner. Grounded theory methodology was used for data analysis. Results Results from the grounded theory analysis of the data are provided in a preliminary model and set of associated themes. The emergent model and themes include a process of acceptance of TNB identities by cisgender partners (such as phases of knowledge burial , partial or split acceptance , self‐suppression , and mutual acceptance ). The themes also include a number of relationship maintenance strategies used by both TNB and cisgender partners in the relationships. Conclusions Couples with mixed cisgender and TNB partners in which the TNB partners disclose their gender identities and/or transition after the start of the relationship experience a number of challenges to relationship survival and use various specific strategies to attain positive outcomes for the couples and individuals. Implications Our results can illuminate clinical practice for couples and family therapy, inform future research designed to explore the experiences of these couples, and improve knowledge as to how their relationships thrive.

Introduction: The Transgender Awareness Webinar was designed to educate the general public about transgender individuals and reduce stigmatizing attitudes toward transgender and gender diverse people.Methods: The present study involved the development of an update of the webinar to be more inclusive of non-binary gender identities and to evaluate the revised webinar using a pilot randomized control trial (RCT) design. The study included 203 participants (n = 102 treatment group; n = 101 control group). Each participant completed a pre-test and post-test of the Transphobia Scale before and after participation in the webinar.Results: Results indicated that transphobia scores went down from pre-to-posttest among participants in the high baseline transphobia category. In addition, several demographic groups had significantly higher levels of mean transphobia scores (higher income, male gender, traditional religious groups).Conclusions: The results of this study suggest that the updated Transgender Awareness Webinar holds promise for reducing transphobia among members of the general public who have high levels of baseline transphobia. Other findings and implications are presented with regard to the development of an anti-stigma webinar.

BackgroundTransgender and nonbinary (TNB) individuals have faced problems with clinical bias in the mental health world. TNB individuals appear to be assigned pathologizing diagnoses like personality disorders at disproportionate rates from their cisgender counterparts, which can result from transphobia and lack of trans-affirmative training.AimsThe following study aims to examine potential diagnostic bias and factors which may lead to the misdiagnosis of BPD in TNB populations.MethodsThis study included a clinical vignette of an adolescent client presenting to the emergency room with several symptoms which met criteria for gender dysphoria. This vignette was presented via email to currently practicing mental health clinicians (N = 178) who were then asked to select a diagnosis from a list provided and report the degree to which each symptom or diagnostic feature impacted their diagnostic decision-making. In addition, practitioners provided demographic information as well as their level of training working with TNB clients, their level of comfort working with TNB clients, and their perceived personal knowledge or competence in TNB-affirmative care. Practitioners also completed a measure to assess levels of endorsement of transphobic attitudes or beliefs.ResultsFindings indicated that borderline personality disorder was the third most selected diagnosis (n = 12), with gender dysphoria (n = 82) and major depressive disorder (n = 75) being the two most assigned diagnoses. Additionally, findings suggested personal knowledge of trans affirmative care, rather than formal training, was more likely to predict diagnostic outcomes in this case. Specifically, individuals who diagnosed gender dysphoria had higher transphobia scores compared to those who chose another diagnosis.DiscussionClinical implications and suggestions for future research are discussed.

Research has presented a dual-sided reality of the positive and negative influences of religion in the lives of transgender and gender expansive (TGE) individuals. This qualitative study utilises a phenomenological approach to explore how positive experiences in faith communities impact TGE individuals. Using inductive, thematic analysis of interviews with nine TGE participants, we look at why participants entered into faith communities and what factors lead them to stay. TGE participants described four main factors that influenced them to seek out a faith community: interpersonal relationships, LGBTQ + visibility, importance of community in personal meaning-making, and connection with God. TGE participants chose to stay in their faith communities because of acceptance and affirmation, major anchoring events, and opportunities for participation. This research provides mental health clinicians with information about the positive religious experiences of TGE individuals and suggestions to support clients at the intersection of religious and TGE identities.

ABSTARCT Background: Literature has recognized deficient knowledge of transgender or gender diverse (TGD) patient needs that can negatively affect health care. Prior research on education has shown little progress responsive to TGD health care needs from nursing. Findings from this demonstrate some improvement, however slight. This study examined the education of family nurse practitioners (FNPs) providing care to TGD patients. Purpose: The purposes of this study were to describe the relationship between location of practice and TGD patient care and to identify emerging themes related to the care of TGD individuals. Methods: Surveys were sent to 3,500 FNPs. Surveys were completed by 356. Results: No significant results were found between location of practice and TGD patient care or between location of education and TGD curricular inclusion. Statistical significance was found between inclusion of TGD content and participants' year of graduation. Those graduating in or after 2011 were more likely to report receiving content. Themes emerged in four areas related to practice area, role, location, and education. This study highlights inadequacy of curricular inclusion of TGD health needs. Findings underscored ways FNPs sourced best practices to provide health care to TGD people. Implications for Clinical Practice: These findings provide additional support for the need to educate FNPs to reduce barriers for TGD persons in accessing affirming health care.

Background: There are few studies that evaluate patient-reported opioid consumption after discharge from surgery. In addition, there has been a call for "special care in prescribing opioids" for lesbian, gay, bisexual, transgender, questioning patients. Here, we evaluate if patients undergoing gender-affirming mastectomy (GAM) require different amounts of opioids for pain management after discharge compared alongside two surgeries with similar surgical exposure. Materials and methods: From October 2017 to July 2018, patients undergoing oncologic mastectomy without reconstruction, mammoplasty reduction, or gender-affirming mastectomy at a single institution were enrolled in a phone survey study to quantify opioids consumed after discharge from surgery. Patient information was captured from the medical record. A total of 170 patients were called between 14 and 30 d after discharge and were asked to count unused pills from their opioid prescription. Results: A total of 99 patients participated and provided pill counts. There were differences between prescribed and consumed opioids within each surgery. Patients who underwent oncologic mastectomy were prescribed and consumed the lowest amounts of opioids. There were significantly more opioids prescribed to patients with GAM than mammoplasty reduction, but consumption was not statistically different. Patients with oncologic mastectomy, mammoplasty reduction, and GAM consumed a median of 0, 10, and 15 five mg oxycodone equivalent tablets, respectively. Conclusions: Despite similar approaches, surgeries had different opioid prescribing and use profiles. Generally, all patients were overprescribed opioids. Overprescribing may be especially problematic in patients with known higher risk of misuse and substance abuse. Granular data on patient consumption, demographics, and preoperative risk factors for opioid misuse may improve prescribing practices. (C) 2020 Elsevier Inc. All rights reserved.

Transgender and gender-diverse people face multiple barriers to accessing appropriate health care, including denial of service, harassment, and lack of clinician knowledge. This article presents a blueprint for planning and implementing a transgender health program within a primary care practice in order to enhance the capacity of the health care system to meet the medical and mental health needs of this underserved population. The steps described, with emphasis on elements specific to transgender care, include conducting a community needs assessment, gaining commitment from leadership and staff, choosing a service model and treatment protocols, defining staff roles, and creating a welcoming environment.

Transgender and gender diverse (TGD) individuals face economic challenges as a result of the impact of transphobia. The present article includes case narratives from a qualitative study with TGD individuals. An overview of the literature on economic challenges faced by TGD individuals is presented as well as associated clinical implications.

The present two-part study involved the development, dissemination, and pre- and post-assessment of the effectiveness of the Transgender Awareness Webinar to reduce transphobia-stigma towards transgender individuals. The goal of the webinar was to educate undergraduates and mental health providers about transgender individuals and reduce transphobic attitudes. In Study 1, 303 undergraduates at a state university in the Northeastern U.S. completed electronic pretest and posttest measures of the Transphobia Scale before and after participating in the webinar. In Study 2, the Transgender Awareness Webinar was expanded to include mental health content and disseminated to 158 mental health providers. Results from Study 1 and Study 2 revealed that the transphobic attitudes significantly reduced from pretest to posttest test scores on the Transphobia Scale after completing the webinar. Findings suggest that transgender awareness training can be effective for reducing transphobia among various groups, with potential differences in baseline transphobic attitudes depending on demographic variables, prior contact with and prior education about transgender individuals.

Gender and sexuality intersect in different ways for transgender and gender nonconforming individuals. In the present study, intersectionality theory is applied to understand the overlapping levels of stigma and privilege associated with gender and sexual identities among transgender individuals. Pa

Informed consent as a model of care has evolved as an alternative to the standard model of care recommended by the World Professional Association for Transgender Health's Standards of Care, version 7, which emphasizes the importance of mental health professionals' role in diagnosing gender dysphoria and in assessing the appropriateness and readiness for gender-affirming medical treatments. By contrast, the informed consent model for gender-affirming treatment seeks to acknowledge and better support the patient's right to, and capability for, personal autonomy in choosing care options without the required involvement of a mental health professional. Clinicians' use of the informed consent model would enable them both to attain a richer understanding of transgender and gender-nonconforming patients and to deliver better patient care in general.

This report describes the evolution of a Boston community health center's multidisciplinary model of transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for transgender people. Fenway Health's holistic public health efforts recognize the key role of gender affirmation in the care and well-being of transgender people worldwide.

BACKGROUND: There is a dearth of health research about transgender people. OBJECTIVES: This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. DESIGN: A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. RESULTS: Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. CONCLUSIONS: Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.

BACKGROUND: There is a dearth of health research about transgender people. OBJECTIVES: This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. DESIGN: A cross-sectional quantitative needs assessment ( n = 73) and qualitative open-ended input ( n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. RESULTS: Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. CONCLUSIONS: Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.