Pubertal Status at the Time of Fertility Preservation in Transgender Girls.

BACKGROUND: Puberty blockade and gender-affirming hormone therapy can impair fertility. Counseling on fertility preservation is important before initiation of therapy. Our study aimed to assess Tanner staging and the presence of virilizing secondary sex characteristics at the time of sperm collection and correlate the viability of sperm with the Tanner staging and degree of virilization. METHODS: A retrospective chart review of 23 transgender girls referred to pediatric urology at our academic pediatric transgender clinic for fertility preservation counseling was performed. At the initial visit before treatment, pubertal staging along with the assessment of virilizing secondary characteristics was performed. The semen analyses were evaluated for volume, sperm concentration, total sperm count, motility, and total motile count. RESULTS: Of the first 23 transgender girls evaluated and counseled, 8 transgender females successfully produced a sperm sample for cryopreservation. The average testicular volume was 18.5 ml and ranged from 12 ml to 20 ml. The median semen parameters were at or above the 2021 World Health Organization threshold. The 8 transgender females who successfully underwent fertility preservation presented with at least 1 secondary sex characteristic. In 1 subject with Tanner stage 3 pubic hair development and a testicular volume of 12 ml, only voice change was reported. Facial hair and laryngeal prominence were not present on examination. CONCLUSION: More than a third of our patients who accepted a referral to pediatric urology agreed to produce a sperm sample for cryopreservation. All of these patients successfully preserved sperm. With counseling and early referral to pediatric urology, a high percentage of fertility preservation in transgender girls was achieved.

An Intersectional Approach to Therapy with Transgender Adolescents and Their Families.

In recent years, transgender individuals have experienced both greater visibility and increased discrimination, such as direct discriminatory practices and removal of Obama-era protections for transgender students. Minority stress theory suggests that discrimination toward gender identity is related to poor mental health outcomes. This hypothesis is supported by the literature regarding transgender adults and adolescents; notably, familial rejection is highlighted as having a strong association with negative outcomes. The field of psychology has continued to explore best practices in approaches to family therapy with transgender individuals. Gender-affirming techniques have gained momentum, largely due to a recognized need for therapy techniques that aim to cultivate familial support for this vulnerable population. As transgender individuals and their families hold many social identities, including race, ethnicity, socioeconomic status, and gender, affirming family therapy involving transgender individuals must explore ways in which gender identity intersects with and is understood in context of family members' other identities. In particular, we must explore how identities may serve to bolster or impede therapeutic processes targeting acceptance. The current article aims to raise awareness of a need for an intersectional approach with gender-affirming family therapy techniques. We detail ways intersectionality can inform therapy practice and provide case examples from our work with a diverse group of transgender adolescents and their families.

Caregiver and youth agreement regarding youths' trauma histories: implications for youths' functioning after exposure to trauma.

Epidemiological research has demonstrated that youth are exposed to potentially traumatic events at high rates. Caregivers play an important role in youths' successful recovery following exposures to potentially traumatic events. However, past research has documented poor caregiver-youth agreement regarding youths' exposures to potentially traumatic events, indicating a potential lack of support for many youth exposed to such events. This study examined caregiver-youth discrepancies in the reports of youths' lifetime exposures to potentially traumatic events, and the relationship between these reporting discrepancies and youths' post-traumatic stress disorder (PTSD) symptoms, mood symptoms, and functional impairment following disclosures of sexual abuse. Participants included 114 caregiver-youth dyads participating in a family-based intervention at four Child Advocacy Centers in New York City. Standardized measures of trauma history, youth PTSD symptoms, youth mood symptoms, youth functional impairment, and caregiver PTSD symptoms were given in interview format to caregivers and youth at the time of intake into the intervention. The demographic composition of the youth sample was 86.8 % female, 13.2 % male, 32.5 % African American, 54.4 % Latino/a, 2.6 % Caucasian, 0.9 % Asian American, 8.8 % other race/ethnicity. Youth ranged in age from 7 to 16. Results demonstrated poor agreement between youth and caregivers regarding youths' exposure to a range of potentially traumatic events and regarding youths' PTSD symptoms, mood symptoms and functional impairment. Both caregiver-youth discrepancies regarding youths' histories of exposures to potentially traumatic events and caregiver PTSD symptoms were significantly associated with youths' self-reported symptoms and functional impairment. Only caregiver PTSD symptoms were related to caregivers' reports of youths' symptoms and functional impairment. Findings underscore the importance of family support and communication regarding exposures to potentially traumatic events and the detrimental associations of caregiver-youth disagreement about youths' exposures to potentially traumatic events. Recommendations are provided for the assessment and treatment of families presenting in the aftermath of traumatic exposures.

Barriers and opportunities for recruitment for nonintervention studies on HIV risk: perspectives of street drug users.

This study used focus-group discussions in response to a video vignette to examine attitudes toward recruitment for nonintervention research involving HIV testing. Participants were 100 ethnically diverse, economically disadvantaged urban drug users, who were recruited from New York City and Hartford, Connecticut in the spring and summer of 2006. Content analyses revealed themes including (1) fears of stigma and legal trouble balanced by trustworthiness of the recruiter; (2) fears of learning one's HIV status balanced by prospects for health benefits, and (3) the right to receive fair monetary compensation balanced by risks of coercion during periods of cravings. Limitations and implications for recruitment practices have been discussed here.

Informed consent to psychotherapy: protecting the dignity and respecting the autonomy of patients.

Well-implemented informed consent procedures demonstrate psychotherapists' respect for clients' right to self-determination and can initiate meaningful contributions to treatment through enhancing mutual trust, building rapport, and facilitating a sense of ownership. This article details key components of informed consent to psychotherapy by placing them within real-world psychotherapy scenarios. We provide information on client-therapist discussions of the nature and course of therapy, fees and payment policies, the involvement of third parties, confidentiality policies, and new and untested treatments. In addition, this article addresses informed consent procedures for individuals with impaired cognitive capacities and under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations.