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Gender affirmation linked with trans, gender nonbinary youth mental health improvement

Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted.

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Enabling transgender and gender nonbinary youth to access gender affirmation processes is good.

This is according to a study – “Gender Affirmation Is Associated with Transgender and Gender Nonbinary Youth Mental Health Improvement” – done by Anna Martha Vaitses Fontanari, Felipe Vilanova, Maiko Abel Schneider, Itala Chinazzo, Bianca Machado Soll, Karine Schwarz, Maria Inês Rodrigues Lobato, and Angelo Brandelli Costa; and which appeared in LGBT Health.

The study aimed to evaluate the impact of each domain of gender affirmation (social, legal, and medical/surgical) on the mental health of transgender and gender nonbinary youth. To do this, 350 transgender boys, transgender girls, and gender nonbinary Brazilian youth, aged from 16 to 24 years old, were asked to answer an online survey.

Among the 350 participants, a total of 149 (42.64%) youth identified as transgender boys, 85 (24.28%) identified as transgender girls, and 116 (33.14%) identified as gender nonbinary youth. The mean age was 18.61 (95% confidence interval 18.34–18.88) years. Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted.

“Enabling transgender and gender nonbinary youth to access gender affirmation processes more easily should be considered as a strategy to reduce depression and anxiety symptoms, as well as to improve gender positivity,” the researchers stated.

Health & Wellness

Mental health disorders and alcohol misuse more common in LGB people

Illicit drug use was highest among bisexual people, at 37%, while for lesbian and gay people it was 25% and heterosexuals, at 10.5%. Alcohol misuse was highest in lesbian and gay people, at 37%, compared with bisexual people at 31%, and heterosexuals, at 24%.

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Lesbian, gay and bisexual (LGB) people are significantly more likely to have mental health conditions and report alcohol and drug misuse than heterosexual people. This is according to a study led by UCL researchers in collaboration with the University of East Anglia and City, University of London, with the findings published in Psychological Medicine.

Given this continued disparity, the report’s authors are calling for government action to ensure equity in health and social care services. They highlight the need for improved awareness among health professionals to the mental health needs of sexual minority groups and are calling for policies that improve societal understanding, starting with encouraging schools to intervene earlier to encourage tolerant attitudes towards sexual minorities across the whole school community.

The research analyzed data from the 2007 and 2014 Adult Psychiatric Morbidity Surveys (APMS), which had a combined sample of 10,433 people in England aged 16-64. The surveys are completed via face-to-face interviews and/or computer self-completion and contain data relating to sexual orientation, common mental disorders (CMD), hazardous alcohol use, and illicit drug use. Further information is collected on experiences of bullying and discrimination, religious identification and childhood sexual abuse.

In this analysis of 2007 and 2014 data, the researchers found there had been no change (i.e. no improvement) between 2007 and 2014, with LGB people remaining at higher risk of poorer mental health when compared to heterosexuals.

The prevalence of depression and anxiety disorders among bisexual people was 40%, and for lesbian and gay people it was 28%, which was significantly higher than that for heterosexuals at 16%. Similarly, illicit drug use was highest among bisexual people, at 37%, while for lesbian and gay people it was 25% and heterosexuals, at 10.5%. Alcohol misuse was highest in lesbian and gay people, at 37%, compared with bisexual people at 31%, and heterosexuals, at 24%.

Researchers found evidence to suggest that exposure to bullying and discrimination may help explain the observed poorer mental health in lesbian women and gay men but not in bisexual people.

No evidence was found to support any apparent contribution of differences in religious affiliation or experiences of adversity such as childhood sexual abuse in the association between sexuality and mental health problems.

Lead author, Dr. Alexandra Pitman (UCL Psychiatry), said: “What this study highlights is the significant and ongoing disparity in mental health between LGB people and heterosexual people, as evidenced by higher levels of mental health problems and alcohol and drug misuse.”

For Pitman, “in order to reduce this persistent inequality in society, we must ensure that health and social care professionals are better trained to identify and care for the wellbeing and mental health needs of sexual minority groups, who are often made to feel invisible within national health systems.”

Pitman said that secondary schools must implement policies and practices that create supportive environments for sexual minority students, including providing (and actively promoting) access to a member of staff who is a designated minorities contact person, who students can talk to in confidence about experiences of discrimination, bullying, or mental health difficulties.

“More can also be also be done to implement anti-discrimination strategies and policies in health care institutions. This might include: the use of positive images of LGB people in health service marketing material; ensuring that equal opportunities statements include grounds of sexual orientation; taking a LGB-affirmative stance in psychotherapy (with implications for training of therapists); and training all professionals not to assume heterosexuality,” Pitman said.

Senior author, Professor Michael King (UCL Psychiatry), said: “Our research shows that stigma and social exclusion on the basis of sexual orientation may be more subtle and enduring than we imagine. Despite greater public acceptance and legal changes to ensure equality, the lived experience of a proportion of LGB people remains negative. We would emphasise however that these data also show that the majority of LGB people have robust mental health and lead happy lives.”

Co-author, Dr Joanna Semlyen (The University of East Anglia), said: “We know that sexual minorities are at increased risk of poor mental health than the heterosexual population. What this paper shows is that those inequalities did not change between the two study collection points of 2007 and 2014. This is really important because it shows that, despite some changes in societal attitudes, people who are lesbian, gay and bisexual continue to experience poor mental health.”

For Semlyen, “what we need to do now is not only continue to monitor health in sexual minority populations as standard but also to design studies to understand what causes these inequalities and develop interventions to reduce them.”

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Health & Wellness

COVID-19 exacerbated ongoing mental health disparities for trans, gender nonbinary people

The pandemic exacerbated ongoing mental health disparities for TGNB individuals. Furthermore, reduced LGBTQ/TGNB support was associated with increased psychological distress during the pandemic.

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COVID-19 exacerbated the ongoing mental health disparities for transgender and gender nonbinary people.

This is according to a study – “Understanding the Impact of the COVID-19 Pandemic on the Mental Health of Transgender and Gender Nonbinary Individuals Engaged in a Longitudinal Cohort Study” by Jeremy D. Kidd, MD, MPHORCID; Kasey B. Jackman, PhD, RN; Renato Barucco, MS; Jordan D. Dworkin, PhD; Curtis Dolezal, PhD; Theresa V. Navalta, BS; Joseph Belloir, MS; and Walter O. Bockting, PhD – that appeared in the Journal of Homosexuality.

For the researchers, “TGNB individuals have unique health needs, including gender-affirming hormonal and surgical interventions that many TGNB people need to align their bodies with their gender identity.”

These same interventions may also help other people perceive a TGNB person’s gender as they experience it, thus facilitating gender-affirming social interactions.

For this study, 208 TNGB individuals were surveyed between March-June 2020. The researchers then used multivariable linear regression to examine reduced LGBTQ/TGNB community support and disruptions in gender-affirming health care as predictors of psychological distress during the pandemic.

The researchers found that “the pandemic exacerbated ongoing mental health disparities for TGNB individuals. Furthermore, reduced LGBTQ/TGNB support was associated with increased psychological distress during the pandemic.”

Among the 208 participants, access to LGBTQ-specific and TGNB-specific support services was reduced for 113 individuals (54.3%) and 91 individuals (43.8%), respectively. Out of 208 TGNB individuals, 23 participants (11.1%) reported having a previously scheduled gender-affirming surgery canceled or postponed; 68 participants (32.7%) experienced an interruption in receiving (n = 55) or a delay in starting (n = 13) gender-affirming hormones.

Regarding psychological distress, the study found that “a significantly higher percentage of respondents met criteria for ‘clinically significant psychological distress’ during the pandemic, compared to pre-pandemic ratings.”

The researchers recommended for special attention to be given “to address the unique ways in which TGNB individuals were affected by the COVID-19 pandemic. This includes increasing access to LGBTQ/TGNB community support and addressing long-standing health disparities.”

They added: “Policy-makers tasked with developing programs to assist individuals during and after the pandemic should pay special attention to meeting the unique needs of TGNB individuals while also addressing the long-standing disparities that impact the health and wellbeing of TGNB individuals.”

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Health & Wellness

Trans adults experience elevated levels of substance use disorder diagnoses compared to cisgender peers

Transgender adults experience elevated levels of substance use disorder diagnoses (SUDD) relative to their cisgender peers, which suggests that effective, culturally tailored SUDD treatment interventions are warranted.

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Transgender adults experience elevated levels of substance use disorder diagnoses (SUDD) relative to their cisgender peers, which suggests that effective, culturally tailored SUDD treatment interventions are warranted.

This is according to a study – “Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults” by Jaclyn M. W. Hughto, PhD, MPH; Emily K. Quinn, MA; Michael S. Dunbar, PhD; et al – that appeared in JAMA Network Open.

This cross-sectional study used the OptumLabs Data Warehouse to analyze de-identified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017.

The study involved 15,637 transgender adults (4,955 [31.7%] transmasculine/TM) and 46,911 cisgender adults (23,664 [50.4%] men). Most (8,627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years.

Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2,594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs.

Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]).

The researchers concluded that “the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers.”

So for the researchers, there is a “need to ensure access to high-quality SUD treatment for transgender individuals as well as additional research to understand facilitators and barriers to SUD treatment engagement for this population. Such research can inform the development of novel public health interventions to prevent and treat SUD among transgender people.”

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Health & Wellness

LGB adults may be at greater risk from COVID-19 due to higher prevalence of underlying health conditions

CDC researchers found that “sexual minority persons… have higher self-reported prevalences of several underlying health conditions associated with severe outcomes from COVID-19 than do heterosexual persons, both in the overall population and among racial/ethnic minority groups.”

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This illustration is a representation of kindness and camaraderie, showing groceries being delivered to different homes in need. Image created by Joystick Interactive. Submitted for United Nations Global Call Out To Creatives - help stop the spread of COVID-19 in collaboration with Talenthouse.

The odds of contracting a severe case of COVID-19 may be greater for adults who identify as gay, lesbian or bisexual than for heterosexuals.

This is according to a report – “Sexual Orientation Disparities in Risk Factors for Adverse COVID-19–Related Outcomes, by Race/Ethnicity — Behavioral Risk Factor Surveillance System, United States, 2017–2019” by Kevin C. Heslin, PhD and Jeffrey E. Hall, PhD; and appeared in the Morbidity and Mortality Weekly Report – released by the US Centers for Disease Control and Prevention (CDC).

In the report, the researchers found that “sexual minority persons… have higher self-reported prevalences of several underlying health conditions associated with severe outcomes from COVID-19 than do heterosexual persons, both in the overall population and among racial/ethnic minority groups.”

For the report, CDC researchers combined data from three years of health-related telephone surveys (2017-2019) conducted in up to 31 US states that included a question about sexual orientation. There were 643,956 survey participants, and 4.7% identified as gay, lesbian or bisexual.

The report, however, noted that the number of respondents identifying as transgender or nonbinary was too small for reliable estimates.

The report found that there is disparity, and this existed across all the underlying conditions and behaviors for LGBT people, although not equally.

The top 11 in ranked order were:

  • current asthma sufferers
  • chronic obstructive pulmonary disease (COPD)
  • kidney disease, current smokers
  • past asthma sufferers
  • stroke
  • cancer
  • heart disease
  • diabetes
  • obesity
  • hypertension

The report stressed: “Because of their sexual orientation, sexual minority persons experience stigmatization and discrimination that can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being through meaningful work and economic security, routine and critical health care, and relationships in which sexual orientation and gender identity can be openly expressed. Persons who are members of both sexual minority and racial/ethnic minority groups might therefore experience a convergence of distinct social, economic, and environmental disadvantages that increase chronic disease disparities and the risk for adverse COVID-19–related outcomes.”

The researchers recommended the inclusion in discussions of the intersections of sexual orientation and race/ethnicity, deemed “critical to ensuring health equity for all, including subpopulations whose circumstances often remain uncaptured despite acknowledgments of their distinct importance and needs.”

“Because of longstanding social inequities and higher prevalences of several underlying health conditions, sexual minority populations might be vulnerable to COVID-19 acquisition and associated severe outcomes, and this vulnerability might be magnified when coupled with other demographic characteristics such as race/ethnicity,” they added.

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Health & Wellness

LGBTQ2SPIA+ patients face unique cancer risks – study

Over 70 percent of respondents were unfamiliar with all terms associated with LGBTQ2SPIA+, and the same percentage were unsure if specific resources were available for the LGBTQ2SPIA+ population at their cancer center. This uncertainty affects the care given to these patients.

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LGBTQ2SPIA+ patients face unique cancer risks, including fear of discrimination, higher incidence of certain cancer sites, and lower screening rates, resulting in more cancers detected at later stages.

This is according to the Journal of Medical Imaging and Radiation Sciences, published by Elsevier, where undergraduate researchers from the University of Alberta’s Radiation Therapy Program in the Faculty of Medicine and Dentistry describe how the experience of LGBTQ2SPIA+ when dealing with cancer risks are different.

To discover the knowledge, attitudes, and practice behaviors of the healthcare professionals treating these patients, the authors surveyed Radiation Therapists (RTs)–key members of the cancer treatment team who are responsible for planning and delivering radiation therapy. In addition to the highly technical aspects of the job, RTs explain procedures, answer questions, comfort patients, and provide emotional support during the treatment journey, making these professionals a natural point of education and support for LGBTQ2SPIA+ patients.

Results suggest there are knowledge gaps and inconsistencies when caring for this patient population. Over 70 percent of respondents were unfamiliar with all terms associated with LGBTQ2SPIA+, and the same percentage were unsure if specific resources were available for the LGBTQ2SPIA+ population at their cancer center. This uncertainty affects the care given to these patients, either limiting RT’s interactions with this community or being unable to provide specific side effect management education, a crucial part of the RT role.

Despite clear evidence of the RT community desiring LGBTQ2SPIA+-specific care, a significant portion of respondents stated that all patients should be treated equally, and therefore no practice adaptation is required. Most respondents reported being comfortable caring for the LGBTQ2SPIA+ community, despite the majority also asserting that they have had inadequate education in this area.

However, the survey found an overall willingness to improve practice behaviors, with 86.9 percent of total respondents interested in receiving more education on this topic. As one respondent stated:

“I can’t really think of ‘how’ I am actively creating a safe environment for disclosing their sexual orientation, nor do I know how to properly create that environment….I can definitely say that I am non-judgmental of their life choices if it comes up in conversation, etc., but I really don’t know what more I should be doing, admittedly. Further training or information on how to better create a safe environment for patients would be beneficial.”

The authors conclude that future research should examine the experiences of LGBTQ2SPIA+ patients from their perspective. To provide truly patient-centered care, LGBTQ2SPIA+-targeted resources for both patients and radiation therapists need to be considered a priority.

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Health & Wellness

Osteoporosis risk may be greater in gay men – study

As it is, sexual minorities already have greater risks of several adverse health outcomes. This may be due to a greater prevalence of unhealthy lifestyle factors, including smoking; as well as the significant stresses they experience related to the stigma associated with their sexuality.

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Non-heterosexual minority men have a greater risk of poor bone health than heterosexual men. This is according to a study published in the American Journal of Human Biology, which also noted that this risk appears to be independent of lifestyle and psychosocial factors.

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Surprisingly, the study – “Sexual orientation‐based disparities in bone health: Evidence of reduced bone mineral density and mineral content among sexual minority men but not women in multiple NHANES waves” by James K. Gobb and Eric C. Shattuck – did not find that non-heterosexual minority women were more likely to experience poor bone health.

As it is, sexual minorities already have greater risks of several adverse health outcomes. This may be due to a greater prevalence of unhealthy lifestyle factors, including smoking; as well as the significant stresses they experience related to the stigma associated with their sexuality.

But according to the people behind this study, there has been little research looking at whether sexuality has any impact on bone health using assessments of bone mineral density measures or fracture risk.

To examine the association between bone health and sexuality, these researchers combined data on 3,243 adults from the 2007 to 2008, 2009 to 2010, and 2013 to 2014 cycles of US National Health and Nutrition Examination Survey. The data included dual-energy X-ray absorptiometry (DXA) assessments. With an average age of 36 years, the participants included 253 sexual minority people (53 lesbian/gay, 97 bisexual, and 103 same-sex experienced) and 2,990 heterosexuals.

Sexual orientation-based comparisons were made for a number of bone health indicators, including z-scored bone mineral density in the lumbar spine (L1-4 vertebrae) and proximal femur (femoral head, greater trochanter, and intertrochanteric line), bone mineral content in the femur and spine, and osteoporosis risk.

Photo by @akwice from Pexels.com

The study reported sexual orientation‐based disparities in bone mass across all anatomical sites. This effect was due to differences between heterosexual and gay men and persisted in linear regressions after adjusting for risk factors.

Differences were also found in femoral and femoral neck BMC in heterosexual and gay men (P = .02) and in femoral, femoral neck and spinal BMC between heterosexual and bisexual women (P = .05). Sexual orientation remained significant in BMC regressions.

“Our findings suggest that sexual minority men but not women are at greater risk for poor bone health relative to heterosexuals and this disparity is independent of the lifestyle and psychosocial risks included in our models,” the researchers stressed.

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