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Using chosen names reduces odds of depression, suicide in trans youths

When trans youths are allowed to use their chosen name, their risk of depression and suicide drops.

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Respecting self-identification matters.

When trans youths are allowed to use their chosen name, their risk of depression and suicide drops.

This is according to a study – authored by Stephen T. Russell, Amanda M. Pollitt, Gu Li and Arnold H. Grossman – that appeared in the Journal of Adolescent Health.

“Many kids who are transgender have chosen a name that is different than the one that they were given at birth,” author Russell was quoted as saying. “We showed that the more contexts or settings where they were able to use their preferred name, the stronger their mental health was.”

For this study, 129 youths were interviewed in three US cities, one each in the Northeast, the Southwest and the West Coast. These transgender youths, aged 15 to 21, were asked whether young people could use their chosen name at school, home, work and with friends.

Compared with peers who could not use their chosen name in any context, young people who could use their name in all four areas experienced 71% fewer symptoms of severe depression; this is 34% lower than reported thoughts of suicide and 65% lower than those who committed suicidal attempts.

“It’s practical to support young people in using the name that they choose. It’s respectful and developmentally appropriate,” Russell ended.

The research was funded by a grant from the National Institute of Mental Health and supported by the UT Population Research Center and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Health & Wellness

No NELL2, no sperm motility; novel protein is essential for male fertility

Male infertility may arise from lack of communication between the testis and the epididymis and new research has uncovered a mechanism of this communication.

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Photo by Dainis Graveris from Unsplash.com

Newly produced spermatozoa within the testis are not fully functional until they mature in the epididymis, a duct that helps to transport and store sperm. Male infertility may arise from lack of communication between the testis and the epididymis and new research has uncovered a mechanism of this communication.

In a study published in Science, Dr. Martin Matzuk at Baylor College of Medicine, Dr. Masahito Ikawa with Osaka University and their colleagues have discovered a novel testicular luminal protein, NELL2, that triggers in the epididymis a chain of events that matures the sperm and enables each one to be motile in females.

Sperm production

Sperm are produced in the seminiferous tubules of the testis and move through the epididymis, a long, convoluted tube linked to the vas deferens, the duct that moves sperm from the testicle to the urethra. When the sperm enter the epididymis, they are not motile and are incapable of fertilization. However, in their passage through the epididymis, the sperm are provided an appropriate environment for maturation and storage pending ejaculation.

It has been hypothesized that proteins released by the testis earlier in this process could act on the epididymis to mature the sperm as they arrive in the epididymis.

“Until now the proteins working through the lumicrine system of signaling have remained elusive. While it was known that the orphan receptor tyrosine kinase ROS1 expressed in the initial segment of the epididymis is necessary for its differentiation, neither the testicular factors that regulate initial segment differentiation nor the process of sperm maturation had been fully understood,” said Matzuk, professor and director of the Center for Drug Discovery at Baylor.

Photo by Dainis Graveris from Unsplash.com

Identifying NELL2

The researchers zeroed in on NELL2, a protein factor secreted by testicular germ cells, as a possible lumicrine regulator of fertility. “Using innovative genome editing technology, we generated knockout mice lacking the NELL2 gene and showed that these knockout males are sterile due to a defect in sperm motility,” explains lead author Dr. Daiji Kiyozum. “Moreover, their infertility could be rescued with a germ-cell-specific transgene, thus excluding other sites of expression. We also illustrated lumicrine signaling by demonstrating tagged NELL2 in the epididymal lumen.”

The research team observed that spermatogenesis proceeds normally in NELL2 knockout mouse testes but their epididymis was poorly differentiated, similar to Ros1 knockout mice. Following mating, neither NELL2 knockout nor Ros1 knockout spermatozoa can enter the uterine tubes or fertilize an egg. Further investigation showed that the Nell2 knockout epididymis is incapable of processing a specific sperm surface protein essential for male fertility.

Implications for male fertility?

Elaborating on their study, Ikawa and Matzuk, both senior authors, said: “We discovered a complicated cascade of events in which disruption of any point in this lumicrine pathway causes a male to be infertile. Our findings have important translational implications for diagnostic and therapeutic research in male infertility and male contraceptive development. This unique transluminal communication pathway between tissues and organs likely functions elsewhere in our bodies.”

Others who contributed to the work include Taichi Noda, Ryo Yamaguchi, Tomohiro Tobita, Takafumi Matsumura, Kentaro Shimada, Mayo Kodani, Takashi Kohda, Yoshitaka Fujihara, Manabu Ozawa, Zhifeng Yu, Gabriella Miklossy, Kurt M. Bohren, Masato Horie and Masaru Okabe.

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Health & Wellness

Incarceration, police discrimination may worsen psychological, physical health of sexual minority men – study

43% of study participants reported police discrimination within the previous year, which was most frequent among those with a history of incarceration. Respondents who faced high levels of police discrimination within the previous year also tended to show high levels of psychological distress and HIV risk, and a low willingness to take PrEP compared with their peers.

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Incarceration and police discrimination may contribute to HIV, depression and anxiety among gay, bisexual and other sexual minority men, according to a Rutgers led study.

The study, funded by the National Institute of Health (NIH) and published in the journal Social Science & Medicine, examined associations between incarceration, police and law enforcement discrimination and recent arrest particularly with Black sexual minority mens’ psychological distress, risk for HIV and willingness to take pre-exposure prophylaxis (PrEP) for HIV prevention.

“Evidence suggests Black sexual minority men in the US may face some of the highest rates of policing and incarceration in the world,” said lead author, Devin English, assistant professor at the Rutgers School of Public Health. “Despite this, research examining the health impacts of the US carceral system rarely focuses on their experiences.”

The study particularly examined how incarceration and police discrimination, which have roots in enforcing White supremacy and societal heterosexism, are associated with some of the most pressing health crises among Black sexual minority men like depression, anxiety, and HIV.

The researchers surveyed 1,172 Black, gay, bisexual, and other sexual minority men over the age of 16 from across the US who reported behaviors that increased their risk for HIV over the previous six months. Participants reported on their incarceration history, experiences of police and law enforcement discrimination, anxiety and depression, sexual behavior, and willingness to take PrEP.

They found that 43% of study participants reported police discrimination within the previous year, which was most frequent among those with a history of incarceration. Respondents who faced high levels of police discrimination within the previous year also tended to show high levels of psychological distress and HIV risk, and a low willingness to take PrEP compared with their peers. The study also found that respondents who were previously incarcerated or recently arrested had a heightened HIV risk and lower willingness to take PrEP.

“These findings transcend individual-level only explanations to offer structural-level insights about how we think about Black sexual minority men’s HIV risk,” said co-author Lisa Bowleg, professor of psychology at The George Washington University. “The study rightly directs attention to the structural intersectional discrimination that negatively affects Black sexual minority men’s health.”

The findings support the need for anti-racist and anti-heterosexist advocacy and interventions focused on reducing discrimination in societies, and the carceral system specifically.

“Despite experiencing a disproportionate burden of violence and discrimination at the hands of the police, and extremely high carceral rates, Black queer men are largely invisible in discourse on anti-Black policing and incarceration,” said co-author Joseph Carter, doctoral student of health psychology at the City University of New York’s Graduate Center. “Our study provides empirical support for the intersectional health impacts of police and carceral discrimination that have been systemically perpetrated onto Black queer men.”

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Health & Wellness

Covid-19 affects adolescent and young adults sexual and reproductive health

LGBTQ youth have also been impacted. And for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.

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Social distancing and limited access to contraceptive and abortion care during the COVID-19 pandemic is affecting the sexual and reproductive health of adolescents and young adults, according to a new study by researchers at Columbia University Mailman School of Public Health and Rutgers University. The researchers address how these challenges, as well as peer and romantic relationships, are being navigated.

The finding are published in the journal Perspectives on Sexual and Reproductive Health.

Huge changes for adolescents and young adults, include school closures, potentially much more time with family, the interruption of the normal trajectory toward increased independence and, for many, very limited or no physical proximity to sexual and romantic partners.

Even though the pandemic may lead to less opportunities for sex for some young people, disruptions in access to contraception and abortion can be extremely problematic for adolescents and young adults who are still able to be physically close to their partners during the pandemic, note the authors. “The good news is that some services, including obtaining many forms of contraception and receiving testing and treatment for sexually transmitted diseases can be handled through telemedicine,” said Leslie Kantor, a professor and chair of the Rutgers Department of Urban Global Public Health. “If telemedicine remains as widely available as it has been during the coronavirus pandemic, access to sexual and reproductive health care may actually improve for young people.” However, Kantor and colleagues say that lack of privacy and confidentiality, which many adolescents and young adults are experiencing while living at home with family, can also hinder the ability to get necessary sexual and reproductive healthcare.

In terms of testing for sexually transmitted infections or seeking abortion care, there is not a lot of data specifically on young people. But many states have tried to restrict abortion access by arguing it is not an essential service despite the fact that abortion clearly is essential and needs to be timely. There also have been very concerning declines in vaccinations for all children older than age 2 and the use of the HPV vaccine, which prevents cancer-causing infections and pre-cancers, has plummeted.

Photo by Sharon McCutcheon from Unsplash.com

LGBTQ youth have also been impacted, although fortunately, many LGBTQ centers quickly moved support groups and other services online. And for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.

While social disruption resulting from the pandemic affects young adults’ sense of health and well-being, one positive aspect is that young adults are digital natives familiar with online platforms and social media. “Young people are supposed to be gaining independence at this time in life, so for those who have had to return home after a period of being away, maintaining relationships with friends and romantic partners at a distance may be particularly challenging. Our view that their constant digital connection was negative is now a positive for them at this time,” said David Bell, MD, MPH, Columbia Mailman School of Public Health associate professor of Population and Family Health and Pediatrics.

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Health & Wellness

Study finds gender-affirming health care good on paper; still lacking in practice

Fact: Many trans women, especially those in rural areas, couldn’t find a doctor trained to provide those hormones, and the doctors they could access did not know where to refer them for more specialized care.

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Good in reports; shitty in actual practice.

This is the state of gender-affirming policies and health care for transgender women, with many of pro-LGBTQIA polices actually still not fully realized in practice, according to a study from Oregon State University found.

In the US, the Supreme Court recently barred employment discrimination against LGBTQIA people, which brings national law more in line with laws that have been in place in various states for several years.

Oregon, for instance, has the Oregon Equality Act of 2008 that protects trans people against employment and housing discrimination, while the expansion of Medicaid in 2015 expanded health coverage to include gender-affirming care like hormone-replacement therapy and transition surgery.

However – and this is worth stressing – those legal protections are not enough to address social determinants of health such as financial status and access to housing, or the everyday discrimination still felt by many trans women in Oregon, said Jonathan Garcia, a researcher ins the OSU College of Public Health and Human Sciences said. The cumulative effect of those subtler forms of discrimination takes a significant toll on trans women.

“In spite of ranking so highly in terms of Oregon’s support for gender-affirming care, the impact of social discrimination is so great that it challenges policy implementation and the lived experience of people,” Garcia said. “This is how discrimination sort of gets in between the cracks – it plays out in more complicated and indirect ways so that you can’t really weed it out.”

Garcia’s study, published in the Transgender Health journal, gathered detailed interviews with 25 trans women in Oregon, ages 18 to 39. Of those 25, six had been homeless at some point in the 12 months prior and only 20% had full-time employment, though all had some form of health insurance.

According to the study’s findings, one of the biggest challenges facing trans women is navigating the health care system. At least in Oregon, though the law requires insurance to cover hormone-replacement therapy, many trans women, especially those in rural areas, couldn’t find a doctor trained to provide those hormones, and the doctors they could access did not know where to refer them for more specialized care.

In other cases, trans women had to undergo a psychological evaluation to obtain a diagnosis of gender dysphoria – the distress people feel when the sex they’re assigned at birth doesn’t match the gender with which they identify – before they could begin to access hormone replacement therapy. This route is much more time-consuming and cost-prohibitive than the “informed consent model,” wherein trans patients can attest that they understand the risks and benefits of pursuing gender-affirming medical treatment, without first having to prove psychological distress. For some study participants, the idea of gender dysphoria made them feel like they had a medical problem and invalidated their lived experience.

“All of that is really, really confusing,” Garcia said. “It requires them to become experts in their rights, in the law, in the availability of these services and where they are offered.”

Most trans women who were able to navigate that system credit their success to their social support network of other trans people. In addition to this informal network, Garcia said, the system needs to have trained and properly compensated health workers in place who can act as navigators, and they need to understand not just health care but the intersections with housing and the legal system that affect people’s access to care.

“We need help with navigating these systems and establishing trust, so that people are actually able to claim and enjoy the rights that they have, so that the rights don’t remain on paper,” he said.

The study was limited in that 21 of 25 participants were white women. Despite numerous efforts to recruit Black and Latinx trans women, Garcia said, they were unable to reach them through participant referrals and community center contacts. He attributed this to their extreme marginalization in queer spaces in Oregon.

“But we can tell that whatever this set of women is experiencing, I expect the experience of trans women of color to be far more challenging,” Garcia said. “Specifically because of structural racism and disenfranchisement from queer networks, which were a critical resource for the women who were able to navigate these systems.”

Garcia’s co-author was Richard Crosby at the University of Kentucky.

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Health & Wellness

Suicide rate for people with schizophrenia spectrum disorders 170 times higher

The authors suggest increasing the age limit for admission to first episode psychosis programs (most are closed to people over 30) and increasing the length of clinical follow-up care after a first episode of psychosis.

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The suicide rate for people with schizophrenia spectrum disorders (SSD) is 170 times higher than the general population, according a study just published in the journal Schizophrenia Research, a figure the authors call “tragically high.”

The study of 20-years of population data, believed to be the largest of its kind ever done, examined statistics on over 75,000 patients who received a first diagnosis of SSD. On average, each patient was followed for almost ten years. The study found several key factors that were predictors of suicide including:

  • During the first five years after an individual has been diagnosed with SSD
  • If there was evidence of a mood disorder or hospitalization prior to diagnosis
  • If the individual was diagnosed with SSD at a later age

“What this study teaches is us that although people with SSD are at higher risk for suicide, we can target those at the highest risk with changes in policy and treatment,” said lead author Dr. Juveria Zaheer, Clinician Scientist at the CAMH Institute for Mental Health Policy Research.

“In the past clinicians have focused on treating the psychosis itself when it first appears,” said senior author Dr. Paul Kurdyak, Director, Health Outcomes and Performance Evaluation, CAMH Institute for Mental Health Policy Research and Clinician Scientist at ICES. “This study shows that treatment has to include suicide prevention safety planning as well from the very beginning.”

The authors suggest increasing the age limit for admission to first episode psychosis programs (most are closed to people over 30) and increasing the length of clinical follow-up care after a first episode of psychosis.

“Now that we know what is happening, we need to better understand why,” said Dr. Zaheer. “Our next step will be to study the lived experience of people with SSD who have had suicidal ideation.”

Suicide – by itself – is a big issue in the LGBTQIA community.

In 2018, for instance, a study found that almost 14% of adolescents reported a previous suicide attempt, with disparities by gender identity in suicide attempts. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%).

Still in 2018, another study found that 50.8% of transmasculine adolescents between the ages of 11 and 19 have attempted suicide at least once, while 41.8% of nonbinary adolescents – those who don’t identify as exclusively male or exclusively female – have attempted suicide.

And in June 2020, yet another study noted that death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers.

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Health & Wellness

Physical activity in all of its forms may help maintain muscle mass in midlife

Hormonal changes during menopause decrease muscle mass, but physical activity might slow the decrement.

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Photo by Oleg Ivanov from Unsplash.com

A large study of middle-aged women shows that age-related changes in skeletal muscle are part of everyday life for women in their fifties. During this time, women transition from perimenopause to postmenopause and the production of estrogen ceases. Loss of estrogen has an effect on muscles and leads to a decline in muscle mass. Physical activity in all of its forms may help maintain muscle mass in midlife.

“We already knew that estrogen has a role in the regulation of muscle properties,” says doctoral student Hanna-Kaarina Juppi. “By following the hormonal status, measuring many aspects of muscles and by taking into consideration the simultaneous chronological aging of women going through menopausal transition, we were able to show that the decrease of muscle mass takes place already in early postmenopause.”

In the current study, muscle size was measured in the perimenopausal state and right after entering postmenopause, when menstruation had permanently stopped. Women were on average 51-and-a-half years old at the beginning of the study and 53 years old at the final measurements, so the average duration of menopausal transition was one-and-a-half years. The time it takes a woman to go through menopause is unique: in this study it varied from less than six months to more than three years. During this time, the decrease in muscle mass was on average one percent.

Juppi continues: “The observed change does not seem like much, but what is meaningful is that the decline happens in a short period of time and can have an impact on metabolism, as muscles are important regulators of whole-body metabolism.”

Physical activity was found to be positively associated with the maintenance of muscle mass during the menopausal transition. Women who were more active had higher muscle mass before and after menopause compared to the less active women. It seems that even though menopause alone decreases muscle mass, staying physically active throughout middle age can help women to slow the change.

The current study was conducted in the Gerontology Research Center and Faculty of Sport and Health Sciences, and is part of a larger study, Estrogenic Regulation of Muscle Apoptosis (ERMA), led by Academy Research Fellow Eija Laakkonen. More than a thousand women between the ages of 47 and 55 from the Jyväskylä region participated in the ERMA study. At the beginning of the study, 381 of them were perimenopausal, while 234 reached early postmenopause during the study. The research was funded by the Academy of Finland and the European Commission.

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