For transgender individuals, gender-affirming surgery can lead to long-term mental health benefits, according to new research published in the American Journal of Psychiatry. The study found that among transgender individuals with gender incongruence, undergoing gender-affirming surgery was significantly associated with a decrease in mental health treatment over time.

Researchers Richard Branstrom, Ph.D., and John E. Pachankis, Ph.D., with the Yale School of Public Health, New Haven, Connecticut, used the Swedish Total Population Register to identify more than 2.500 individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015. Among individuals with gender incongruence, just more than 70% had received hormone treatment and nearly half (48%) had undergone gender-affirming surgical treatment during the 10-year follow-up period. Nearly all (97%) of those who had undergone surgery also received hormone treatment. Less than one-third had received neither treatment.

They analyzed mental health treatment in 2015 in relation to the length of time since gender-affirming hormone and surgical treatment, including distinguishing the potentially interrelated effects of the two treatments. The mental health measures included health care visits for mood and anxiety disorder, antidepressant and anti-anxiety prescriptions, and hospitalization after a suicide attempt.

Increased time since last gender-affirming surgery was associated with reduced likelihood of use of mental health treatment. The study found the odds of receiving mental health treatment were reduced by 8% for every year since receiving gender-affirming surgery over the 10-year follow-up period. They did not find the same association for hormone treatment.

The study also found that compared with the general population, transgender individuals with a gender incongruence were

• about six times as likely to have had a mood or anxiety disorder health care visit;
• more than three times as likely to have received prescriptions for antidepressants and anti-anxiety medication; and
• more than six times as likely to have been hospitalized after a suicide attempt.

Despite the reduced mental health treatment use after gender-affirming surgery, treatment use among transgender individuals continued to exceed that of the general population.

The authors conclude that “in this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.”

Polyamorous families experience marginalization during pregnancy and birth, but with open, nonjudgmental attitudes from health care providers and changes to hospital policies, this can be reduced. This is according to new research – “The Polyamorous Childbearing and Birth Experiences Study (POLYBABES): a qualitative study of the health care experiences of polyamorous families during pregnancy and birth” – published in CMAJ (Canadian Medical Association Journal).

As it is, in the US alone, an estimated one in five single Americans have engaged in consensual polyamory, or consensual nonmonogamy, and interest in these types of relationships seems to be increasing. People who identify as gay, lesbian or bisexual are more likely to be in consensual nonmonogamous relationships.

Few studies exist on the experiences of polyamorous families in health care, and it appears there are none on experiences during pregnancy and birth.

“[G]iven the high proportion of polyamorous individuals who are of child-bearing age and the substantial potential for stigma, it is important to investigate polyamorous individuals’ experiences with reproductive care providers to better inform practice,” writes Dr. Elizabeth Darling, a study author and assistant dean, midwifery, and an associate professor, Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, with coauthors.

Several themes emerged in this qualitative study of 24 participants, including 11 women who gave birth within the last five years and 13 partners.

Key points:

• Participants deliberately planned families, choosing health care providers who they thought would be less discriminatory because of relationship status.
• More partners means more support, although some partners were not able to fully share this support because of discomfort in disclosing polyamorous relationships.
• People in polyamorous relationships often chose to disclose their status when it was medically relevant, and they received both positive and negative reactions from health care providers.
• Navigating the health system presented challenges, including administrative barriers, in which forms did not have enough space for additional partners, or newborn identification bracelets that could be issued for only two parents

To improve health care experiences for polyamorous families, the study participants suggested health care providers should acknowledge the partners’ presence and roles, be open and nonjudgmental, adapt administrative forms and procedures, and advocate for patients and their families.

“Our findings align with recent reports that individuals engaging in consensual nonmonogamy face stigma with respect to accessing health care,” write the authors. “Our results also suggest that polyamorous individuals face concerns similar to those of other gender and sexual minorities regarding administrative barriers and challenges with disclosure to health care providers.”

The authors state that substantial work needs to be done to remove marginalization experienced by these families in the health care system.

“[R]educing providers’ implicit biases toward sexual minority groups, and patients in consensually nonmonogamous relationships in particular, is vital to addressing health disparities,” writes Dr. Sharon Flicker, Department of Psychology, California State University, Sacramento, California, in a related commentary.

“Health care providers have an opportunity to mitigate this stress by providing inclusive environments and sensitive health care.”

Divisive partisan climates can cause an increase in homophobic bullying. This is according research Dr. Yishan Shen, an assistant professor in the School of Family and Consumer Sciences at Texas State University at Austin.

According to Shen – whose research group was headed by Stephen Russell, chair of the Department of Human Development and Family Sciences at the University of Texas – being a teenager is hard enough, but Dr. Yishan Shen, an assistant professor in the School of Family and Consumer Sciences at Texas State University, has uncovered additional challenges for youths between 10 and 19 who are targets of bullying during contentious political campaigns.

While examining data from the California Healthy Kids Survey gathered before a 2008 referendum known as Proposition 8, Shen found what she described as an “odd peak of homophobic bullying in 2008.”

Shen reported the trend to Russell, whose laboratory she joined as a graduate student at UT in 2015 to expand her scholarship to other minority and marginalized groups. Russell dubbed Shen’s finding as “The Prop 8 Effect”, in a reference to attitudes about a California ballot initiative intended to eliminate the right of same-sex couples to marry. They continued studying the topic, with their findings published as “Proposition 8 and Homophobic Bullying in California“ in the journal Pediatrics.

The researchers determined that secondary school students reported “significantly more” homophobic bullying as the Prop 8 vote was approaching, but less after the Prop 8 vote. 

The researchers tried running different statistical analyses to see if there are other possible explanations, like the economic or ethnic makeup of the schools, but after controlling for each of these variables, the same pattern was observed, thereby leading them to conclude that the increase in rates of bullying was associated with Prop 8.

 One school initiative was found to prevent and combat homophobic bullying in their study – the formation of gay-straight alliance (GSA) clubs. 

Real move for inclusion; or mall-versus-mall PR effort targeting the pink peso?

Months after Araneta Center’s Farmers Plaza in Cubao, Quezon City figured in a much-hyped controversy for refusing to allow a transgender woman to use a toilet befitting her gender identity, SM Supermalls announced that it will begin to install all-gender restrooms in its malls starting this November.

The move will be first done in malls in Metro Manila, including SM Mall of Asia, SM City North EDSA, SM Megamall, SM Aura Premier and The Podium; as well as at SM Seaside City Cebu.

The move, according to a statement released by the giant company, is a “leap towards a more gender-inclusive community”, as SM Supermalls aims to “continue to provide a safe community space that advocates inclusivity, equality, and respect for all regardless of gender expression, identity, or sexual orientation.”

“With inclusivity and innovation at the core of everything we do, we endeavor to create spaces where all shoppers are welcome,” SM Supermalls COO Steven Tan was quoted as saying.

The all-gender restroom will be a new facility in addition to the male, female, and PWD restrooms in these malls.

The effort may be commendable, but SM Supermalls is not always on the side of what’s right. In 2015, for instance, its establishment in Baguio City, SM Baguio, cut 60 trees surrounding the mall for its expansion, including to build additional parking.

SM Supermalls is also infamous for practicing contractualization – i.e. not regularizing its employees, thus failing to give many security of tenure and benefits.

How are adolescent family relationships associated with trajectories of depressive symptoms from adolescence into midlife for women and men?

This was the question asked by a study – “Association of Positive Family Relationships With Mental Health Trajectories From Adolescence To Midlife” by Ping Chen, PhD and Kathleen Mullan Harris, PhD – published by JAMA Pediatrics, with the findings suggesting an association of early intervention in family relationships during adolescence with better mental health into adulthood and midlife.

The study analyzed data from the National Longitudinal Study of Adolescent to Adult Health, which used a multistage, stratified school-based design to select a prospective cohort of 20 745 adolescents in grades 7 to 12 from January 3, 1994, to December 26, 1995 (wave 1). These respondents were followed up during four additional waves from April 14 to September 9, 1996 (wave 2); April 2, 2001, to May 9, 2002 (wave 3); April 3, 2007, to February 1, 2009 (wave 4); and March 3, 2016, to May 8, 2017 (sample 1, wave 5), when the cohort was aged 32 to 42 years.

The study sample of 8,952 male adolescents and 9,233 female adolescents that were analyzed was a US national representation of all population subgroups by sex, race/ethnicity, socioeconomic status, and geography.

Levels of depressive symptoms (Center for Epidemiologic Studies–Depression Scale [CES-D]) from ages 12 to 42 years were then used to estimate propensity score–weighted growth curve models to assess sex differences in trajectories of depression by levels of positive adolescent family relationships.

A total of 18,185 individuals (mean [SD] age at wave 1, 15.42 [0.12] years; 9233 [50.8%] female) participated in the study.

The study found that females and males who experienced positive adolescent family relationships had “significantly lower levels of depressive symptoms from early adolescence to midlife than did those who experienced less positive adolescent family relationships.”

For example, depressive symptoms were lower among those with high levels of family cohesion compared with those with low cohesion between 12 (1.26 lower CES-D score; 95% CI, 1.10-1.42) and 40 (0.78 lower CES-D score; 95% CI, 0.50-1.06) years of age among females and between 12 (0.72 lower CES-D score; 95% CI, 0.57-0.86) and 37 (0.21 lower CES-D score; 95% CI, 0.00-0.41) years of age among males.

The study also found that the reduction in depressive symptoms associated with positive adolescent family relationships was greater for females than males during the adolescent and early adulthood years (ie, early 20s) (eg, low-high cohesion difference in mean CES-D score, −1.26 [95% CI, −1.42 to −1.10] for females and −0.72 [95% CI, −0.86 to −0.57] for males at 12 years of age; low-high cohesion difference in mean CES-D score, −0.61 [95% CI, −0.69 to −0.53] for females and −0.40 [95% CI, −0.48 to −0.31] for males at 20 years of age), after which females and males benefited equally from positive adolescent relationships throughout young adulthood to midlife.

As per the authors, “The findings suggest that positive adolescent family relationships are associated with better mental health among females and males from early adolescence to midlife. Interventions in early family life to foster healthy mental development throughout the life course appear to be important.”

This is noteworthy for the LGBTQIA community because other studies highlight the relevance of family support to LGBTQIA people. An earlier study released in July, for instance, showed “that derisive parenting fosters dysregulated anger in adolescent children. Dysregulated anger is indicative of difficulties regulating emotion, which typically result in negative emotions, verbal and physical aggression, and hostility. Increases in dysregulated anger, in turn, place adolescents at greater risk for bullying and victimization, and for becoming bully-victims (bullies who also are victimized by other bullies).”

WASHINGTON, DC – The US Supreme Court heard oral arguments on a major civil rights question: Are gay and transgender people covered by the law barring employment discrimination on the basis of sex?

As FYI: Legal developments in many countries – including the Philippines – are affected by those in the US. For instance, when the Philippines’ Supreme Court heard oral arguments on marriage equality in the country, the civil rights movement in the US was mentioned, along with other international laws/statutes pushing for LGBTQIA human rights.

At the SCOTUS, three cases are being heard.

Two of those cases, Altitude Express Inc. v. Zarda and Bostock v. Clayton County, ask whether a worker can be fired for their sexual orientation. The third, R.G. & G.R. Harris Funeral Homes v. EEOC, asks whether a worker can be fired because of their gender identity.

US currently has a federal civil rights law that somewhat touches on this – Title VII of the Civil Rights Act of 1964, which forbids employers from discriminating against employees on the basis of sex as well as gender, race, color, national origin and religion.

However, the text of the law bans only “sex” discrimination, not specifically stating discrimination based on a worker’s “sexual orientation” or “gender identity”.

It is worth noting, therefore, that in the US, 29 states still do not have a law protecting the rights of LGBTQIA workers from being fired solely because of their SOGIE.

The cases now at SCOTUS, therefore, ask whether concepts like sexual orientation and gender identity – both tightly bound to the concept of sex (meaning gender, not sexual intercourse) – should also be included under its grasp.

Thus far, the members of SCOTUS are divided.

The top court’s liberal members are expected to vote with the plaintiffs and the argument that LGBTQIA workers should be covered by Title VII of the Civil Rights Act.

Associate Justice Sonia Sotomayor was among those who already noted that firing LGBTQIA people not because they under-performed but because of who they are may fall under the statutory ban on sex discrimination. “We can’t deny that homosexuals are being fired merely for being who they are and not because of religious reasons, not because they are performing their jobs poorly,” Sotomayor said, calling it “invidious behavior.”

For Associate Justice Elena Kagan, Title VII prohibits employment discrimination that occurs “because of (an employee’s) race, color, religion, sex, or national origin.” The language used here is broad and it suggests that a simple test should apply in sex discrimination cases. A plaintiff in such a case should prevail unless they would have experienced the exact same treatment if they “were a different sex.”

For Associate Justice Ruth Bader Ginsburg, interpretations of Title Vii had changed in the past. Since this law was enacted, the SCOTUS has held that it applied to discrimination based on sex stereotypes, as well as same-sex harassment. And though these areas were presumably not on the minds of the legislators who voted for it, “no one ever thought sexual harassment was encompassed by discrimination on the basis of sex back in 1964. It wasn’t until a book was written in the middle 1970s bringing that out,” Ginsburg said. “And now we say, ’Of course, harassing someone, subjecting her to terms and conditions of employment she would not encounter if she were a male, that is sex discrimination. But it wasn’t recognized.”

But conservative justices – including those appointed by US Pres. Donald Trump, who may continuously claim to be pro-LGBTQIA but has been attacking LGBTQIA human rights in the country by implementing policies not beneficial to the LGBTQIA community (such as banning transgender people from serving in the military) – are concerned of “massive social upheaval” if the court will rule in favor of LGBTQIA workers, instead of allowing Congress to legislate on the subject.

Decisions from the nine justices of America’s highest court are due by next June. – WITH SUZETTE MAGALLANES-PADOR