Experiences of surgery readiness assessments in British Columbia.

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard. Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate. Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia. Results: We developed three main themes to capture participants' narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps. Discussion: These narratives demonstrate how much variation exists among people's experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.

"It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns.

BACKGROUND AND PURPOSE: The World Health Organization has developed standards for youth-friendly health services to support adolescents and encourage health care utilization among youth. Necessary building blocks for youth-friendly care include strong interpersonal relationships between youth and health care providers. Nurse practitioners (NPs) may be particularly well positioned to form these relationships. This study explored a core aspect for building youth-provider relationships. The study examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents discussed use of personal pronouns (e.g., he, she, they, ze) in relation to transgender and gender diverse (TGD) people. METHODS: A secondary qualitative analysis of 66 in-depth interviews with LGBTQ youth from across Minnesota, Massachusetts, and British Columbia, Canada was conducted. Results were sorted into four main themes describing different aspects of personal pronoun use as related to TGD individuals. CONCLUSIONS: Stories and experiences shared by participants illustrate how to assess which pronouns to use for a given person, how to use pronouns in different contexts, why respecting pronouns is important to TGD people, and flexibility as an integral component of the learning process when it comes to appropriate pronoun use. IMPLICATIONS FOR PRACTICE: Understanding how youth discuss personal pronouns could improve practice with TGD youth. Each of the four themes can be applied to clinical encounters to ensure culturally sensitive care. Practice recommendations include asking adolescents what pronouns they prefer clinic staff to use on intake forms and having NPs and clinic staff provide their own pronouns to patients in introductions.

"I would have preferred more options": accounting for non-binary youth in health research.

As a research team focused on vulnerable youth, we increasingly need to find ways to acknowledge non-binary genders in health research. Youth have become more vocal about expanding notions of gender beyond traditional categories of boy/man and girl/woman. Integrating non-binary identities into established research processes is a complex undertaking in a culture that often assumes gender is a binary variable. In this article, we present the challenges at every stage of the research process and questions we have asked ourselves to consider non-binary genders in our work. As researchers, how do we interrogate the assumptions that have made non-binary lives invisible? What challenges arise when attempting to transform research practices to incorporate non-binary genders? Why is it crucial that researchers consider these questions at each step of the research process? We draw on our own research experiences to highlight points of tensions and possibilities for change. Improving access to inclusive health-care for non-binary people, and non-binary youth in particular, is part of creating a more equitable healthcare system. We argue that increased and improved access to inclusive health-care can be supported by research that acknowledges and includes people of all genders.

"Let's Talk about the Institution": Same-Sex Common-Law Partners Negotiating Marriage Equality and Relationship Legitimacy.

The 2005 Canada-wide legalization of same-sex marriage provided same-sex couples with access to an institution they had previous been excluded from. Yet not all couples choose to marry. In this paper, we examine why this is the case, considering the role of personal, political, and historical factors. We draw on 22 interviews with people in common-law same-sex relationships in Toronto to examine how they understand their relationship within the new context of marriage equality. We find that participants feel they are held accountable to marriage as a default relationship legitimacy norm, indicating that this new institutional access is accompanied by a set of social expectations. Despite their awareness of the need to navigate a social context favoring marriage, participants individualize their relationship decisions as personal rather than political. Participants often contradict themselves as they articulate what marriage means to them, suggesting that, in this period of legal and social transition, people are negotiating multiple meanings, societal messages, and traditions when it comes to making sense of their relationship. We discuss the implications of these findings for LGBQ activism and the framing of sexuality-based inequalities in Canadian society.