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The secret to unlocking a better life? Masturbate at least four times per week

TENGA’s 2nd Annual United State(s) of Masturbation survey finds that people who masturbate 4x or more per week live better, healthier lifestyles. And yet talking about masturbation continues to be a topic of embarrassment for many.

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TENGA Co. Ltd. announced results from its second annual United State(s) of Masturbation survey, compiling data from 1,200 Americans age 18-74 on their habits and attitudes toward masturbation, sexuality, general health and wellbeing. The survey found that frequent masturbators, or those who masturbate at least four times per week, visit the doctor less often due to illness, have higher body confidence, are more likely to be employed and have triple the number of orgasms than those who masturbate less frequently (or not at all).

According to the survey, 42% of all respondents masturbate at least once a week, with 20% doing so four or more times per week. The survey assessed key trends and attitudes across gender, generation, sexual orientation and relationship status.

Results also indicated that 89% of respondents who have talked to a significant other about masturbation have had an overall positive experience. And while nearly 50% of people believe openly discussing masturbation would make society better, only 32% have ever had that conversation with a close friend, indicating that a level of embarrassment lingers around the topic. However, 57% of those currently in a committed relationship say they have talked about it with their significant other.

“I’m thrilled to see that so many (people) are taking their sexual wellbeing into their own hands. And even more happy to learn that over half of the survey respondents are comfortable discussing masturbation with their partners,” says Dr. Chris Donaghue, PhD, LCSW, CST and TENGA brand ambassador. “We still have a long way to go to de-stigmatize sexual health education in the United States, but this survey indicates that frequent masturbators may experience a number of positive emotional and physical health benefits.”

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Key findings from the survey about frequent masturbators, those who masturbate at least four times per week, include:

  • Frequent masturbators spend approximately 19 minutes masturbating per session, six minutes longer on average than those who masturbate three times or less per week.
  • Frequent masturbators are 13 percent more likely to have a gym membership, with 41% saying they work out at least four days per week.
  • Those who masturbate four times a week or more are 23 percent more likely to agree that masturbation before exercise or sports helps their athletic performance.
  • Frequent masturbators are eight percent more likely to be employed, either full or part-time, than others.
  • Frequent masturbators are 15% more likely to be comfortable discussing masturbation with partners whom they’re not in a relationship with, and 9% more likely to be comfortable discussing with partners in a committed relationship.

Key findings from the survey about overall respondents include:

  • 47% of all survey respondents who have ever masturbated agree it’s a “good idea” to masturbate before a first date. Frequent masturbators are 16% more likely to masturbate before a job interview and 11% more likely before big family gatherings.
  • 66% of Americans age 18-74 agree that masturbation is “Good for your health,” and 58% of those who masturbate see it as a part of their health and wellness routine.
  • Masturbating with a partner is relatively common: only 39% of Americans age 18-74 say they have never masturbated with a partner.
  • One-third of Americans age 18-74 currently own at least one sex toy, including 24% of men and 41% of women.
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In releasing these results, TENGA encourages people to masturbate frequently for a healthier, more confident life. TENGA also hopes to elevate the conversation around masturbation, prompting people to discuss the topic with loved ones, such as friends and significant others.

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Health & Wellness

COVID-19 linked to cardiac injury, worse outcomes for patients with heart conditions

COVID-19 can have fatal consequences for people with underlying cardiovascular disease and cause cardiac injury even in patients without underlying heart conditions.

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COVID-19 can have fatal consequences for people with underlying cardiovascular disease and cause cardiac injury even in patients without underlying heart conditions, according to a review published today in JAMA Cardiology by experts at The University of Texas Health Science Center at Houston (UTHealth).

Experts have known that viral illnesses such as COVID-19 can cause respiratory infections that may lead to lung damage and even death in severe cases. Less is known about the effects on the cardiovascular system.

“It is likely that even in the absence of previous heart disease, the heart muscle can be affected by coronavirus disease,” said Mohammad Madjid, MD, MS, the study’s lead author and an assistant professor of cardiology at McGovern Medical School at UTHealth. “Overall, injury to heart muscle can happen in any patient with or without heart disease, but the risk is higher in those who already have heart disease.”

The study authors explained that research from previous coronavirus and influenza epidemics suggest that viral infections can cause acute coronary syndromes, arrhythmias, and the development of, or exacerbation of, heart failure.

In a clinical bulletin issued by the American College of Cardiology, it was revealed that the case fatality rate of COVID-19 for patients with cardiovascular disease was 10.5%. Data also points to a greater likelihood that individuals over the age of 65 with coronary heart disease or hypertension can contract the illness, as well experience more severe symptoms that will require critical care.

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According to the study authors, critical cases are those that reported respiratory failure, septic shock, and/or multiple organ dysfunction or failure that resulted in death. “It is reasonable to expect that significant cardiovascular complications linked to COVID-19 will occur in severe symptomatic patients because of the high inflammatory response associated with this illness,” said Madjid, who also sees patients at the UT Physicians Multispecialty – Bayshore clinic.

The novel virus that causes COVID-19 was first identified in January 2020. This novel virus originated in Wuhan, China, and by March 11, 2020, the World Health Organization had declared it a global pandemic. The three most common symptoms of COVID-19 include fever, cough, and shortness of breath. Other less common symptoms are muscle pain, sore throat, nasal congestion, and headache. Symptoms can appear as soon as two days after exposure to the virus to up to14 days after. There is a high viral load in both symptomatic and asymptomatic patients, meaning asymptomatic spread between person to person is likely.

Previously identified coronaviruses known to cause severe illness in humans include Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). SARS-CoV was first identified in southern China in 2002, and by 2003 it had killed over 8,000 individuals in 29 countries. Data suggests that SARS-CoV may have resulted in cardiovascular complications, such as acute coronary syndrome and myocardial infarction. MERS-CoV was first discovered in 2012 in Saudi Arabia. As of 2019, 2,494 cases have been confirmed along with 858 deaths in 26 countries.

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Current COVID-19 treatment options are being researched, and there is a large effort to develop vaccines for prevention and to test antivirals for the treatment of the disease. In the meantime, the study authors encourage all individuals to consult with their health care providers about being vaccinated against influenza and that at-risk patients seek advice on receiving a pneumonia vaccine from their primary care physician. While these vaccines will not provide specific protection against COVID-19, they can help prevent superimposed infections alongside COVID-19.

Study co-authors include Payam Safavi-Naeini, MD, of the Texas Heart Institute; Scott Solomon, MD, of Harvard Medical School; and Orly Vardeny, PharmD, of the University of Minnesota.

It is worth noting that cardiovascular issues greatly affect members of the LGBTQIA community.

A 2018 study in the US, for instance, noted that lesbian, gay and bisexual adults have a “disproportionately high risk” of heart disease and other cardiac problems when compared to heterosexuals.

Another 2018 study noted that trauma, including abuse and neglect, is associated with higher cardiovascular disease risk for lesbian and bi women.


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Health & Wellness

To stay positive, live in the moment – but plan ahead

Mindfulness is when people are centered and living in the moment, rather than dwelling in the past or worrying about the future. Proactive coping is when people engage in planning to reduce the likelihood of future stress.

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A recent study from North Carolina State University finds that people who manage to balance living in the moment with planning for the future are best able to weather daily stress without succumbing to negative moods.

“It’s well established that daily stressors can make us more likely to have negative affect, or bad moods,” says Shevaun Neupert, a professor of psychology at NC State and corresponding author of a paper on the recent work. “Our work here sheds additional light on which variables influence how we respond to daily stress.”

Specifically, the researchers looked at two factors that are thought to influence how we handle stress: mindfulness and proactive coping.

Mindfulness is when people are centered and living in the moment, rather than dwelling in the past or worrying about the future. Proactive coping is when people engage in planning to reduce the likelihood of future stress.

To see how these factors influence responses to stress, the researchers looked at data from 223 study participants. The study included 116 people between the ages of 60 and 90, and 107 people between the ages of 18 and 36. All of the study participants were in the United States.

All of the study participants were asked to complete an initial survey in order to establish their tendency to engage in proactive coping. Participants were then asked to complete questionnaires for eight consecutive days that explored fluctuations in mindfulness. On those eight days, participants were also asked to report daily stressors and the extent to which they experienced negative mood.

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The researchers found that engaging in proactive coping was beneficial at limiting the effect of daily stressors, but that this advantage essentially disappeared on days when a participant reported low mindfulness.

“Our results show that a combination of proactive coping and high mindfulness result in study participants of all ages being more resilient against daily stressors,” Neupert says. “Basically, we found that proactive planning and mindfulness account for about a quarter of the variance in how stressors influenced negative affect.

“Interventions targeting daily fluctuations in mindfulness may be especially helpful for those who are high in proactive coping and may be more inclined to think ahead to the future at the expense of remaining in the present.”

The paper, “Thinking Ahead and Staying in the Present: Implications for Reactivity to Daily Stressors,” is published in the journal Personality and Individual Differences. First author of the paper is Melody Polk, an undergraduate at NC State. The paper was co-authored by Emily Smith and Ling-Rui Zhang, graduate students at NC State. The work was done with support from NC State’s College of Humanities and Social Sciences.

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Health & Wellness

DOH’s Duque says don’t wait for test if you have COVID-19 symptoms; manage it

DOH’s interim guidelines on the management of persons under monitoring (PUMs) suspected with COVID-19 for home quarantine.

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Department of Health (DOH) Secretary Francisco Duque III advised people who have symptoms of COVID-19 to manage their condition as if they really have the disease caused by the new coronavirus instead of waiting to get tested.

As quoted by Inquirer.net from a television interview, Duque said that “if you already know the symptoms, manage it as if it’s COVID-19. If all indications suggest that it’s probably COVID-19, why wait for a test? Manage it as COVID-19 right away. You assume. That’s the way to do it.”

Among the symptoms of COVID-19 are fever, dry cough, cold, shortness of breath, and diarrhea.

Duque, however, did NOT provide the “how to” on managing COVID-19, particularly for those who are not going to get tested, or access medical facilities.

But on February 17, DOH issued Memorandum No. 2020-0090, which contained the interim guidelines on the management of persons under monitoring (PUMs) suspected with COVID-19 for home quarantine.

The guidelines enumerate people who should be home quarantined:

  1. Any person who does not exhibit any sign/symptom, has history of travel to other areas of China and/or history of exposure to a confirmed case of COVID-19 within the past 14 days.
  2. Any person who exhibits fever or any symptom of lower respiratory illness, and has a history of travel to other countries with a confirmed case of COVID-19 but without any history of exposure.
  3. Those undergoing home quarantine shall be prohibited to leave their rooms/hotels where they are quarantined until they have been certified by the local health official to have finished the 14-day requirement for quarantine procedures.

Now how to implement home quarantine?

PUMs should be isolated.

  1. Place the PUM alone in a well-ventilated room, preferably with toilet and bathroom. If this is not possible, maintain a distance of at least one meter from the PUM (for example, sleep in a separate bed).
  2. Assign one person who is of good health as caretaker of the PUM.
  3. Do not allow visitors, family members and even caregivers in the room of the PUM.
  4. Limit the activities of the PUM in his/her room only. If this is not possible, ensure that shared spaces are well-ventilated.
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PUM should use surgical mask.

  1. The PUM should wear a surgical mask fitted tightly to the nose, mouth and chin when in the same room with another household member or when talking to others.
  2. If alone, the PUM is not required to wear mask.
  3. Do not touch mask during use. If the mask gets wet or dirty with secretions (e.g. saliva), change immediately and dispose properly.
  4. After eight hours, throw used mask. Do not reuse or wash masks.
  5. After removal of mask, wash hands with water and soap, or rub hands with 70% alcohol.
The PUM should wear a surgical mask fitted tightly to the nose, mouth and chin when in the same room with another household member or when talking to others.
Photo by @anshu18 from Unsplash.com

Hand hygiene practice for all.

  1. Everyone should perform hand hygiene following contact with PUM, or if in contact with immediate environment.
  2. Perform hand hygiene by washing hands with water and soap. If hands are not visibly dirty, use 70% alcohol.
  3. When using soap and water, dry hands using disposable paper towels. If not available, use dedicated cloth towels and replace when wet.
  4. Hand hygiene should be performed before and after preparing food, before eating, after using toilet, and when hand is dirty.

Respiratory hygiene and precaution for all.

  1. Cover mouth and nose when coughing or sneezing by using surgical mask, tissues, flexed elbows, sleeves of clothes or inside the neckline of shirts. Follow this up with hand hygiene.
  2. Avoid direct contact with body fluids, particularly oral and respiratory secretions, and feces.
  3. Avoid sharing toothbrushes, cigarettes, towels, bed linen, etc.
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Food handling for PUM under home quarantine.

  1. The assigned caretaker should serve the plates/tray only up to the room door (where the PUM is staying).
  2. After eating, pick plates/tray using gloves. Perform hand hygiene afterwards.
  3. Utensils should be cleaned thoroughly with water and soap. Reused as needed.
  4. Do not share utensils with PUMs.
Gloves, tissues and masks used by PUM should be placed in separate container before disposing with other household waste.
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Disposal of used gloves, tissue papers and masks.

  1. Immediately throw materials used to cover mouth or nose.
  2. If reusable items are used (e.g. handkerchief), immediately wash after use with water and detergent soap.
  3. Gloves, tissues and masks used by PUM should be placed in separate container before disposing with other household waste.

Cleaning and disinfection of quarantine venues.

  1. Frequently clean/disinfect frequently touched surfaces (e.g. bedside tables, door knobs, bed frames, etc). Use household disinfectant; or diluted bleach solution (i.e. 1 part bleach and 99 parts water).
  2. Clean/disinfect bathroom/toilet at least once a day.
  3. Regularly clean clothes, bed linens, towels, etc. of PUMs.

Now, this is important.

PUMs who develop symptoms should be immediately transported to the nearest health facility. In the same way, all household members of PUMs should seek immediate medical care when signs/symptoms develop.

Frequently clean/disinfect frequently touched surfaces.
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Because the DOH is not at all considering mass testing (yet) in the Philippines, these tips may offer temporary comfort as the country continues to come to grips with COVID-19 with the country’s health department’s weaknesses in offering quality healthcare for all now highlighted.

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Health & Wellness

WHO releases guidance for mental health in the age of coronavirus

To start, the UN body stated that people should “be empathetic to all those who are affected, in and from any country” as it warned “against stigmatizing anyone who has or had the virus.”

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As WHO and health authorities all over the world act to contain the Covid-19 outbreak, advice on safeguarding mental health was developed by the UN health agency’s Department of Mental Health and Substance Use.

WHO’s guidance targets the general population; healthcare workers; health facility managers; childcare providers; older adults, care providers and people with underlying health conditions; and those who are living in isolation to try and contain the spread of the pandemic.

To start, the UN body stated that people should “be empathetic to all those who are affected, in and from any country” as it warned “against stigmatizing anyone who has or had the virus.” 

It also recommended that people seek information updates only from trusted sources. “The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried”, said WHO. “Get the facts; not the rumors and misinformation”. 

It recommended that people seek information updates only from trusted sources.
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The UN health agency also pointed out the benefits of helping others, including phoning neighbors or community members who may need some extra assistance. This is because “working together as one community can help to create solidarity in addressing COVID-19”.

Others tips were segregated to target specific populations.

Those who help others

  1. People should honor caretakers and healthcare workers… for the role they play to save lives and keep loved ones safe, WHO stated.
  2. The feeling of being “under pressure” by healthworkers is normal while emphasizing that stress is “by no means a reflection that you cannot do your job or that you are weak”. 
  3. Healthworkers should rest sufficiently, eat healthy foods, get physical activity and stay in contact with family and friends.
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“This is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses,” said WHO, with the reminder that “this is not a sprint, it’s a marathon”. 

Those in charge

  1. Protect staff from chronic stress and poor mental health to provide them with the capacities they need to perform their duties. 
  2. Focus on the longer term rather than short-term crisis responses.
  3. Team leaders or health facility managers are encouraged to deliver quality communication and accurate information updates to all staff. 
  4. Consider the benefits of rotating workers from higher- to lower-stress functions, and in partnering inexperienced workers with those who are more experienced, to provide reassurance.
  5. Maintain the buddy system to “provide support, monitor stress and reinforce safety procedures,” WHO stated, advocating for outreach personnel to work in pairs and to “initiate, encourage and monitor work breaks”.

Those with children

  1. Help children find positive ways to express feelings, such as fear and sadness. “Children feel relieved if they can express and communicate their feelings in a safe and supportive environment,” the UN health agency maintained, encouraging that if safe, they be kept close to their parents and family. 
  2. Regular contact with parents should be maintained, such as twice-daily scheduled phone or video calls.

Caring for the vulnerable

  1. Relay clear instructions in a concise, respectful and patient way (pictures may be utilized) when dealing with older adults and people with underlying health conditions who are vulnerable, as they may become more anxious, agitated and withdrawn during the outbreak.
  2. Engage their family and other support networks to provide information and help them practice prevention measures, including handwashing.
  3. When in isolation, stay connected and maintain daily routines, as much as possible. 
  4. Keep things in perspective starting with avoid listening to or following rumors.
“This is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses.”
Photo by @geraltyichen from Unsplash.com

Pregnant, breastfeeding women 

  1. Additionally, the UN Population Fund (UNFPA) recommended that breastfeeding women who become ill should not be separated from their newborns.
  2. While there is no evidence that the illness can be transmitted through breastmilk, UNFPA urged mothers who are infected to wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces.
  3. If a mother is too ill to breastfeed, she should be encouraged to express milk for the baby, while taking all necessary precautions.
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In the end, “mental health and psychosocial support should be made available to affected individuals and their families”.

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Health & Wellness

Anxious about COVID-19? Stress can have lasting impacts on sperm and future offspring

Prolonged fear and anxiety brought on by major stressors, like the coronavirus pandemic, can not only take a toll on a person’s mental health, but may also have a lasting impact on a man’s sperm composition that could affect his future offspring.

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Prolonged fear and anxiety brought on by major stressors, like the coronavirus pandemic, can not only take a toll on a person’s mental health, but may also have a lasting impact on a man’s sperm composition that could affect his future offspring. That is the finding of study published in the journal Nature Communications by researchers at the University of Maryland School of Medicine.

The research outlines a biological mechanism for how a father’s experience with stress can influence fetal brain development in the womb. The effects of paternal stress can be transferred to offspring through changes in the extracellular vesicles that then interact with maturing sperm. Extracellular vesicles are small membrane-bound particles that transport proteins, lipids, and nucleic acids between cells. They are produced in large amounts in the reproductive tract and play an integral role in sperm maturation.

“There are so many reasons that reducing stress is beneficial especially now when our stress levels are chronically elevated and will remain so for the next few months,” said study corresponding author Tracy Bale, PhD, Professor of Pharmacology and Director of the Center for Epigenetic Research in Child Health & Brain Development at the University of Maryland School of Medicine. “Properly managing stress can not only improve mental health and other stress-related ailments, but it can also help reduce the potential lasting impact on the reproductive system that could impact future generations.”

She and her colleagues did not specifically study those who were under stress due to the coronavirus pandemic.

To examine a novel biological role for extracellular vesicles in transferring dad’s stress to sperm, the researchers examined extracellular vesicles from mice following treatment with the stress hormone corticosterone. After treatment, the extracellular vesicles showed dramatic changes in their overall size as well as their protein and small RNA content.

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When sperm were incubated with these previously “stressed” extracellular vesicles prior to fertilizing an egg, the resulting mouse pups showed significant changes in patterns of early brain development, and as adults these mice were also significantly different than controls for how they responded to stress themselves.

To see if similar differences occurred in human sperm, the researchers recruited students from the University of Pennsylvania to donate sperm each month for six months, and complete questionnaires about their perceived stress state in the preceding month. They found that students who had experienced elevated stress in months prior showed significant changes in the small RNA content of their sperm, while those who had no change in stress levels experienced little or no change. These data confirm a very similar pattern found in the mouse study.

“Our study shows that the baby’s brain develops differently if the father experienced a chronic period of stress before conception, but we still do not know the implications of these differences,” said Dr. Bale. “Could this prolonged higher level of stress raise the risk for mental health issues in future offspring, or could experiencing stress and managing it well help to promote stress resilience? We don’t really know at this point, but our data highlight why further studies are necessary.”

The research team did find that stress-induced changes in the male reproductive system take place at least a month after the stress is attenuated and life has resumed its normal patterns. “It appears the body’s adaptation to stress is to return to a new baseline,” Dr. Bale said, “a post-stress physiological state – termed allostasis.”

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This research was funded by the National Institute of Mental Health and included co-authors from the Institute for Genome Sciences at the University of Maryland School of Medicine and the Department of Pharmaceutical Science at the University of Maryland School of Pharmacy, as well as the University of Pennsylvania.

“This research represents a critical step in understanding important mechanisms that underlie the field of intergenerational epigenetics,” said UMSOM Dean E. Albert Reece, MD, PhD, MBA, who is also the Executive Vice President for Medical Affairs, University of Maryland, and the John Z. and Akiko K. Bowers Distinguished Professor. “Such knowledge is crucial to identify early interventions to improve reproduction and early childhood development down the road.”

While the study did not test stress management interventions to determine what effects they might have on attenuating the changes in sperm composition, Dr. Bale, who goes for regular runs to reduce the stress of the current COVID-19 pandemic, contends that any lifestyle habits that are good for the brain are likely good for the reproductive system.

“It is important to realize that social distancing does not have to mean social isolation, especially with modern technologies available to many of us,” said Joshua Gordon, Director of the National Institute of Mental Health in his web message about coping with coronavirus. “Connecting with our friends and loved ones, whether by high tech means or through simple phone calls, can help us maintain ties during stressful days ahead and will give us strength to weather this difficult passage.”

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It is worth noting that stress adversely affects more LGBTQIA people. In February 2019, for instance, a study found that increased exposure to negative messages about same-sex marriage was associated with greater psychological distress for lesbian, gay and bisexual people.

The bad effects of stress among members of the LGBTQIA community was also already noted by earlier studies. In 2018, a study involving 94,250 women across the US found that lesbian and bi women were more likely than heterosexual women to develop type 2 diabetes during the course of the 24-year study follow up.

The Centers for Disease Control and Prevention (CDC) has tips on “stress and coping” page on their COVID-19 site that recommends the following to “support yourself”:

  • Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.

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Health & Wellness

Access to identification documents reflecting gender identity may improve trans mental health

A study finds that possessing gender-concordant IDs is associated with reduced psychological distress, and a lower prevalence of suicidal thoughts and suicide planning.

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A study finds that possessing gender-concordant IDs is associated with reduced psychological distress, and a lower prevalence of suicidal thoughts and suicide planning. And the authors suggest policy changes to increase access to gender-concordant IDs. For example, by reducing fees, administrative hurdles and eligibility requirements, and also by either expanding gender options beyond male or female, or by removing gender markers entirely.

Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The authors note that the survey only questioned respondents at one time point, making it difficult to confirm whether lack of gender-affirming IDs caused psychological distress or the other way around. It is possible that trans people suffering from psychological distress might find it harder to obtain IDs. However, a previous Canadian study found that having at least one document showing a trans person’s preferred gender marker was associated with fewer suicidal thoughts and suicide attempts, and previous research has found that mental health risks in transgender adolescents are reduced when their preferred name is used socially.

“Our results suggest that governments and administrative bodies can play an important role in helping to reduce psychological distress for trans people, simply by making it easier to access identity documents that reflect their identity,” says Dr Ayden Scheim from Drexel University, USA.

Of the 1.4 million Americans who identify as transgender, over half are estimated to have clinical depression, compared to around 30% over a lifetime in the general US population, while 31% to 41% attempt suicide at some point during their lives, compared to less than 9% generally in the US. These mental health disparities can be attributed in part to a lack of recognition and acceptance of trans people’s identified gender. Lack of gender-concordant official documents can prevent access to services such as healthcare, education, and employment, and increase exposure to verbal harassment and violence.

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The authors suggest that at the moment, the ID change process can be difficult to impossible. For example, in most US states updating a name on government-issued ID first requires a court-ordered name change, which can cost several hundred dollars. Most states require medical letters or affidavits to validate reclassification requests, and some may require gender transition surgery. In most jurisdictions, gender markers reflecting non-binary gender identity (such as an ‘X’ marker) are not yet available.

To explore the impact of access to IDs on psychological distress, suicidal thoughts and suicide attempts, researchers analysed data from 22,286 trans people, who were surveyed in 2015. Respondents were asked whether all, some or none of their IDs – including birth certificates, passports and driving licences – listed their preferred name and gender marker. Psychological distress was measured using a validated scale with a score between 0 and 24, with 13 or greater indicating serious psychological distress. To assess respondents’ suicide risk, they were asked whether they had seriously considered suicide in the previous 12 months, whether they had made any plans to kill themselves and whether they had attempted suicide.

To ensure that the analysis was able to pick up any association between mental health and access to updated IDs, the authors of the current study adjusted the results to account for other variables that could contribute to psychological distress and suicidal thoughts – such as age, ethnicity, medical transition status and years living full-time in the identified gender.

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The results found that 45.1% of respondents (10,288 out of 22,286) had no IDs with their preferred name and gender marker, 44.2% (9,666/22,286) had some ID that matched their name and/or gender, and only 10.7% (2,332/22,286) had their preferred name and gender on all their documents. The authors weighted the sample to reflect the age and ethnicity of the US population, although they note that trans demographics may not mirror broader US population demographics.

The reasons for not changing gender markers included a lack of suitable gender options (in the group with no concordant ID, people with non-binary identities were over-represented), cost, and perceived ineligibility (for example, believing that additional medical treatment was required). The authors also identified geographic variation in the results, with participants in western states more likely to have gender-concordant ID, while those in the Midwest were less likely.

Those with all gender-concordant IDs had a 32% lower prevalence of serious psychological distress than those with no updated documents. They were also 22% less likely to have had suicidal thoughts in the past year and 25% less likely to have made plans to kill themselves. Those with some updated IDs had smaller reductions in distress and suicidal thoughts (e.g., 12% reduction in distress). The results did not indicate an association between access to IDs and suicide attempts, once the authors had adjusted for other influences on mental health.

“When a trans person changes their gender on their official documents, it can be a critical step towards gaining social acceptance and legal recognition, and our findings suggest that policy changes to support trans people with taking this step should be considered, in order to help improve their wellbeing, reduce their exposure to discrimination and reduce suicidal thoughts,” says Professor Greta Bauer from Western University, Canada.

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The authors note that other variables not covered in the study may mediate psychological distress, for example access to social support.

Writing in a linked comment, lead author Dr Monica Malta (who was not involved in the study) from the University of Toronto says: “The cross-sectional study design prohibits causal interpretation of the identified relationships, and reverse causation is plausible–those with better mental health might be better able to navigate the difficult bureaucratic requirements to obtain gender congruent IDs. Even with those limitations, the large dataset and careful inclusion of potential confounders strengthen the study design. Thus, the authors’ findings support the need to increase the availability of and streamline the processes to obtain gender congruent IDs. Gaining gender-congruent IDs should be easy, affordable, and quickly completed by adequately trained officials at TGD-friendly environments.”

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