Relation Between Identity Disclosure to Family Members and Mental Health in Japanese Transgender People.

Family members are critical mediators of the experiences of transgender people. We studied whether transgen-der subjects had disclosed their identity to their families and their families' reactions after the disclosure. We also evaluated the subjects' mental state and its association with disclosure status. Transgender people were recruited for this anonymous questionnaire survey in the Okayama University Hospital gender clinic. Subjects disclosed their identity to family members at the following rates: 68.7% to the father, 89.1% to the mother, 59.1% to a brother, 77.8% to a sister, and 47.6% to grandparents. Fathers had the lowest rate (26.7%) of posi-tive reactions, while over 50% of fathers showed an ambiguous response. Approximately 20% of parents showed a negative response. The majority of parents agreed to hormonal treatment and sex-reassignment sur-gery and that the transgender child should live with the gender they wanted to express. However, the rate of subjects with mood and anxiety disorders according to the Kessler 6 scale was significantly higher in those who experienced negative or ambiguous reactions from family members compared to those who experienced posi-tive reactions. Educational and mental health professionals should support the disclosure process of transgen-der people as well as their family members.

Gender Expression among Transgender Women in Japan: Support Is Needed to Improve Social Passing as a Woman.

Gender expression is important for transgender women to improve their social passing as women. Herein, a questionnaire about the status of gender expression and support needs was distributed to 54 transgender women aged 17-71 in Japan. Most of the respondents noted that they had found it relatively difficult to handle physical changes and weight gain due to hormone treatment. They also found it difficult to enact and sustain practices such as a feminine use of voice and to use women-only services, whereas practicing and continuing with routine skin and hair care and feminine mannerisms were relatively easy for them. In the questionnaire regarding the support for gender transitioning, many items showed only a small percentage of the transgender women had received the support that they were looking for, and most of their needs for support were not addressed. Some of the factors that increased the respondents' needs and achievement of gender expression as women included estrogen treatment, sex reassignment surgery, and living as a woman; these aspects met their support needs as well. Gender support professionals need to coordinate and collaborate with specialists in areas such as nutritional guidance and voice training to enable transgender women to improve the extent to which they can socially 'pass' as women.