Gender nonconforming and transgender children/youth: Family, community, and implications for practice.

PURPOSE: The aim of this article is to provide foundational knowledge on gender nonconforming/transgender children/youth. With this knowledge, providers' confidence and ability to address the needs of patients/families can increase. DATA SOURCES: Academic Search Premier, Cinahl, PubMed, World Professional Association for Transgender Health. CONCLUSIONS: The number of gender nonconforming/transgender children/youth presenting to healthcare providers is increasing. The situation presents a myriad of challenges to families. The identity trajectory of gender nonconforming children is variable, and watchful waiting while providing support to the child and family is advised. If gender dysphoria persists as puberty approaches, treatment with puberty blockers is recommended. This provides youth time to further explore their identity, while alleviating the distress of developing unwanted secondary natal sex characteristics. For these individuals, cross-sex hormones may be started at age 16. IMPLICATIONS FOR PRACTICE: The complexities of providing care to gender nonconforming children/youth and their families are best met through an interdisciplinary approach. Consultation with and/or referral to specialists knowledgeable about transgender health care is advised. Beyond a basic understanding of gender nonconformance, of primary importance to patients/families is being heard and supported by their providers. Establishing a safe and welcome environment is paramount. Resources are provided.

"That's who I am: a fat person in a thin body": weight loss, negative self-evaluation, and mitigating strategies following weight loss surgery.

OBJECTIVE: To explore negative self-evaluation following weight loss surgery (WLS). METHODS: In-depth interviews were conducted with 11 women who had WLS. Thematic analysis was conducted through an iterative process, allowing categories and themes to emerge. To ensure rigor, two coders analyzed the data. Data were collected until thematic saturation was achieved. RESULTS: All participants reported health as the motivation for WLS. Overall sentiment regarding WLS was positive. However, negative self-evaluation was reported and includes the following: (a) body-image distortion; (b) body-image dissatisfaction, including excessive skin; and (c) perceived stigma. Mitigating strategies include the following: (a) utilizing markers of progress to increase assimilation of a new identity as a thinner person, and (b) reflecting on the former self as a time of decreased quality of life. IMPLICATIONS FOR PRACTICE: Nurse practitioners and other clinicians treat and counsel patients on obesity and obesity-related morbidity, and may need to discuss WLS with patients who are either contemplating it or have already undergone it. The findings from the present study can provide clinicians insight into the possible psychological effects of WLS-associated weight loss. Bringing possible negative self-evaluative effects into open discussion can help optimize patient care and healthcare results.

Transgender identity and health care: implications for psychosocial and physical evaluation.

PURPOSE: The purpose of this article is to educate nurse practitioners (NPs) regarding: (a) the definition and range of transgenderism, (b) social influences on transgender persons, and (c) health care for transgender persons. DATA SOURCES: Data sources include review of the literature in the areas of gender, gender identity, marginalized populations, and gender transition. Personal communication was also utilized. CONCLUSIONS: Transgender persons remain marginalized and may remain closeted and at risk for negative psychosocial consequences. For those that do come out, other issues present, including the navigation of gender transition and psychosocial and physical changes that may be positive and/or negative. Examples of positive effects may include satisfaction of living authentically and decrease in depression. Negative effects may include social discrimination and loss of relationships. To provide holistic care, NPs need to be aware of transgender lives in social context and of their healthcare needs. IMPLICATIONS FOR PRACTICE: Suggestions for cultivating a supportive healthcare environment include the usage of sensitive language and an appropriate health history and physical examination. Further, to help rectify the knowledge deficit regarding transgender care among healthcare providers, NP educators and preceptors may utilize this article as a resource in their work with students.