Rapidly expanding gender-affirming care based on consensus instead of evidence justifies rigorous governance and transparency.

OBJECTIVE: Public services offering gender-affirming care to minors have rapidly expanded across Australia. Despite limited evidence of safety and efficacy, no public information about these services is routinely available. Data from freedom of information requests sent to Australian public gender services for minors is summarised. Gender service numbers increased rapidly in Queensland (2017:190 - 2022:922) and in Victoria (2019:472 - 2023:1290). Limited transparency prevented strong confidence in the number of patients receiving hormone therapy. Staff FTE employed by gender services jumped after 2020 in NSW (to 16.7 across two sites in 2023), Queensland (to 11.4 in 2023), Victoria (to 9.4 in 2022), and WA (to 10.2 in 2023). CONCLUSIONS: Despite low confidence in their safety and efficacy, the number of patients seen by public gender services has expanded rapidly since 2018. Limited transparency makes it difficult to judge the number of patients seen, treatments provided, and outcomes achieved. Safe, effective care of this vulnerable group requires clear treatment goals, and annual reporting.

Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review.

STUDY OBJECTIVE: This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS: Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS: We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION: The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.

Aproximación a las experiencias de las personas usuarias en una Unidad de Identidad de Género / Approach to the experiences of the users of a Gender Identity Unit

OBJETIVO: Conocer en profundidad las experiencias de las personas usuarias atendidas en la Unidad de Identidad de Género (UIG) del Hospital Clínic de Barcelona. MÉTODOS: Investigación cualitativa socioconstructivista que incluye el papel de las transformaciones de la Unidad y los cambios sociopolíticos en la transidentidad sobre la vivencia de las personas usuarias. Se han realizado ocho entrevistas semiestructuradas y posteriormente un análisis de contenido. RESULTADOS: Del análisis de las entrevistas se definieron cuatro categorías temáticas principales: aspectos sociales, la espera, fuentes de información y UIG frente a Trànsit (actual unidad de referencia). El entorno y el contexto social son fundamentales en la aceptación propia y en las expectativas de cómo debe ser la atención. Muchos de los momentos de espera escapan del control de las personas usuarias generando incertidumbre. Coinciden en la falta de formación de profesionales ajenos a las unidades especializadas y al uso de canales no sanitarios para obtener información. Apuntan a un antagonismo entre la UIG y Trànsit y a la necesidad de colaboración y de cambio en el sistema sanitario para aumentar la autonomía de las personas usuarias. DISCUSIÓN: Los resultados sugieren que para mejorar la experiencia del colectivo trans es fundamental un cambio en los planes de formación sanitaria con perspectiva de género, incluyendo temática trans, un compromiso institucional en favor de la educación, formación e información en este sentido, y que exista colaboración entre la UIG, Trànsit y los centros de Atención Primaria para que todas las entidades avancen

OBJECTIVES: To ascertain the experiences of the users of the Gender Identity Services at Hospital Clínic Barcelona. METHODS: Qualitative research analysed by means of social constructionism which takes into account the role of the transformations in the unit and socio-political changes in the concept of trans identity for users and their experiences. A total of eight semi-structured interviews were held followed by a content analysis. RESULTS: From the analysis of the interviews four main categories were defined. Social aspects, waiting, sources of information and Hospital Services versus Trànsit (the current reference unit). Setting and social context are fundamental for self-acceptance and for expectations about how healthcare should be configured. Most of the waiting time is beyond users' control, which generates uncertainty. They agree on lack of training among healthcare professionals outside specialised services, and on using alternative sources of information other than healthcare providers. They expose the antagonism between hospital services and Trànsit and acknowledge the need for collaboration and change within the health system to ensure the autonomy of users. DISCUSSION: The results suggest that to improve the experience of trans people a change in medical training that includes a gender perspective is required. This must take into account trans issues, an institutional undertaking in favour of education, training and information in this regard, and collaboration with Trànsit and primary care so that all entities can move forward

A saúde das mulheres no SUS em tempos de pandemia: mulheres transgêneras, lésbicas e bissexuais

Série de rodas de conversas com lideranças dos coletivos negros, do campo, indígenas, LGBTs e feministas que representam o segmento das e para as políticas de equidade do Ministério da Saúde. As rodas de conversas, no contexto da pandemia da COVID-19, são promovidas pelo Observatório de Determinantes Sociais em Saúde (DSS) e pela Escola Tocantinense do Sistema Único de Saúde (ETSUS). Participantes: 1. Byanca Marchiori - Presidenta da Associação de Travestis e Transexuais do TO (ATRATO); 2. Danuta Ramos Duarte - Médica, integrante da Rede Nacional de Médicos Populares e da comissão de Diversidade Sexual do IBDFAM, membro do GT de medicina rural da SBMFC; 3. Dhieine Caminski - Lésbica, Psicóloga, militante do SUS e gestora de políticas da Atenção Especializada do Tocantins; 4. Rafaella Mahare - Economista, pós-graduada em Gestão Pública e Gestão de Pessoas. Mediadora: Sâmia Chabo - Enfermeira e bacharel em Direito, especialista em Educação e Sexologia e Administração em Serviços de Saúde

"It's kind of hard to go to the doctor's office if you're hated there." A call for gender-affirming care from transgender and gender diverse adolescents in the United States.

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents' experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender-related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi-structured interviews with 12 TGD-identified adolescents aged 14-17, living in Minnesota, USA in 2017-2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers' concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth.

La perspectiva de despatologización trans: ¿una aportación para enfoques de salud pública y prácticas clínicas en salud mental? Informe SESPAS 2020 / The trans depathologization perspective: a contribution to public health approaches and clinical practices in mental health? SESPAS Report 2020

A lo largo de la última década, la perspectiva teórico-activista de despatologización trans ha contribuido a un cambio en la conceptualización de los procesos de tránsito por los géneros. Partiendo de la observación de una interrelación entre psiquiatrización y violencia transfóbica, grupos activistas por la despatologización trans y personas aliadas demandan la retirada de la clasificación diagnóstica de la transexualidad como trastorno mental. Además, han desarrollado modelos de atención en salud a personas trans y procesos legales de reconocimiento de género basados en perspectivas de despatologización y derechos humanos. Proponen cambiar el papel de les profesionales de salud mental en la atención a personas trans, sustituyendo el rol de evaluación psiquiátrica por tareas de acompañamiento y apoyo psicológico. La perspectiva de despatologización trans se puede relacionar con diferentes enfoques y temas relevantes para la salud pública y la salud mental, entre ellos la sociología del diagnóstico, los enfoques de salud basados en los derechos humanos, la protección de los derechos humanos en salud mental, la cobertura sanitaria universal, la revisión de clasificaciones diagnósticas, perspectivas de interseccionalidad, reflexiones sobre principios bioéticos, modelos de salud integrados y centrados en las personas y enfoques de ética de la investigación. En los últimos años se han desarrollado modelos de decisión informada para la atención en salud a personas trans en algunos países y regiones. Profesionales de la salud, incluyendo a profesionales de salud mental, así como profesionales del ámbito educativo y jurídico-administrativo, pueden tener un papel importante en el abordaje de situaciones de discriminación y violencia transfóbica, contribuyendo a la construcción de una sociedad que respete, reconozca y celebre la diversidad de género

Over the last decade, the academic-activist trans depathologization perspective has contributed to a change in the conceptualization of gender transition processes. Observing an interrelation between psychiatrization and transphobic violence, trans depathologization activist groups and allies demand the removal of the diagnostic classification of transexuality as a mental disorder. Furthermore, they have developed trans health care models and legal gender recognition processes based on depathologization and human rights perspectives. They propose changing the role of mental health professionals in trans health care, substituting the psychiatric assessment role by accompaniment and psychological support tasks. The trans depathologization perspective can be related to various approaches and topics relevant in public health and mental health, among them sociology of diagnosis, human rights based approaches to health, human rights protection in mental health, universal health coverage, review of diagnostic classifications, intersectionality perspectives, reflections on bioethical principles, models of integrated people-centered health services and approaches to research ethics. Over the last few years, informed decision-making models have been developed for trans health care in several countries and world regions. Health professionals, including mental health professionals, as well as professionals from the educational and judicial-administrative sector, can have an important role in addressing situations of discrimination and transphobic violence, contributing to the construction of a society that respects, recognizes and celebrates gender diversity

Health Insurance and Mental Health Care Utilization Among Adults Who Identify as Transgender and Gender Diverse.

OBJECTIVE: Transgender people are less likely to have health insurance, which has been associated with reduced utilization of health care. In the current study, the authors sought to assess the role of health insurance in mental health care utilization among transgender individuals. METHODS: A total of 4,334 adults who self-identified as transgender or gender diverse (neither male nor female) participated in the 2017 Trans Lifeline Mental Health Survey, which included self-report measures of current insurance type and lifetime history of having seen a therapist or psychiatric provider. Logistic regression analyses assessed the association of insurance status with lifetime utilization of a mental health therapist or psychiatric provider. RESULTS: Although only 8% of the sample were uninsured, these individuals were significantly less likely to have seen a therapist or psychiatric provider in their lifetime compared with those with health insurance, even after the analyses were adjusted for sociodemographic factors. Conversely, those with insurance through the military or the Veterans Health Administration were more than twice as likely as those with employer-provided insurance to have seen a therapist or psychiatric provider. There were no significant differences in mental health care utilization between those with employer-provided insurance versus public or privately purchased insurance. CONCLUSIONS: Rates of being uninsured were lower than in earlier assessments of transgender adults and adults who identify as gender diverse. However, type of health insurance also appeared to be a notable structural factor contributing to disparities in mental health care utilization among transgender individuals.

Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individuals: A Collaborative Multidisciplinary Team Approach.

BACKGROUND: Little is documented about the experiences of pregnancy for transgender and gender-diverse individuals. There is scant clinical guidance for providing prepregnancy, prenatal, intrapartum, and postpartum care to transgender and gender-diverse people who desire pregnancy. CASE: Our team provided perinatal care to a 20-year-old transgender man, which prompted collaborative advocacy for health care systems change to create gender-affirming patient experiences in the perinatal health care setting. CONCLUSION: Systems-level and interpersonal-level interventions were adopted to create gender-affirming and inclusive care in and around pregnancy. Basic practices to mitigate stigma and promote gender-affirming care include staff trainings and query and use of appropriate name and pronouns in patient interactions and medical documentation. Various factors are important to consider regarding testosterone therapy for transgender individuals desiring pregnancy.

Atención sanitaria trans competente, situación actual y retos futuros. Revisión de la literatura / Competent trans health care, current situation and future challenges. A review

Introducción: Conocemos como una persona trans a aquella que no se identifica con el sexo de nacimiento, este hecho aún recogido como patología por el actual manual diagnóstico y estadístico de enfermedades mentales (DSM-V) va a provocar que existan desigualdades y barreras significativas a la hora de la atención sanitaria. Objetivo: Explorar las dificultades para la asistencia sanitaria percibidas por las personas trans y por los profesionales que los atienden en centros sanitarios. Material y método: Revisión de la literatura. Resultados: Tanto los profesionales como las personas trans perciben barreras significativas. Se podrían agrupar en diversos temas: desigualdades en la atención sanitaria percibidas por los pacientes trans, prejuicios y discriminación sentida, riesgos específicos de salud, déficit de conocimientos de los profesionales y déficit de formación en los planes de estudio actuales. Por otro lado, enfermería ante los pacientes trans puede resultar un facilitador. Conclusiones: Existen numerosos factores que pueden ser modificables y que provocan que las personas trans no perciban una asistencia adecuada. La adecuada formación de los profesionales sanitarios es uno de los que adquiere mayor relevancia Los resultados encontrados aportan una información clave para el futuro diseño de intervenciones dirigidas a mejorar la calidad de la asistencia en este colectivo

Introduction: We know as a transgender person who is not identified with the sex of birth, this fact still collected as pathology by the current Diagnostic and Statistical Manual of Mental Illness (DSM-V) will cause inequalities and barriers At the time of health care. Objective: To explore the difficulties for health care perceived by trans people and by the professionals who assist them in health centres. Material and method: Literature review. Results: Both professionals and trans people perceive significant barriers. They could be grouped by diverse topics: healthcare inequalities noticed by trans patients, prejudices and felt discrimination, specific health risks, lack of professional knowledge and deficit of training in current curricula. On the other hand, nursing with trans patients may result in a facilitator. Conclusions: There are multiple factors which can be modified and which produce that trans people do not notice appropriate care. Appropriate training of health professionals is the one which acquires more relevance. The results found provide key information for the future design of interventions aimed at improving the quality of the assistance in this group

Treatment of patients with HIV or hepatitis C by pharmacist clinicians in a patient-centered medical home.

PURPOSE: This report describes an innovative pharmacy practice model assisting in the care of patients living with or at risk of acquiring human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV). SUMMARY: In the state of New Mexico, pharmacists can obtain prescribing privileges through a Pharmacist Clinician (PhC) license. The license allows PhCs to assess patients, order laboratory/diagnostic tests, prescribe medication, and bill select insurances. PhCs have developed a practice model for patients living with or at risk of HIV and/or HCV at a Level 3 National Committee for Quality Assurance Patient-Centered Medical Home in Albuquerque, New Mexico. In 2015, 5 PhCs, employed part time, were involved with 8 different clinics: (1) HIV Adherence and Complex Care, (2) HIV Transitions of Care, (3) HCV Mono- and Co-Infection, (4) HIV Pre-Exposure Prophylaxis (PrEP), (5) HIV Primary Care and Cardiovascular Risk Reduction, (6) Young Adult Clinic, (7) Perinatal HIV, and (8) Pediatric HIV. In 2015, PhCs at the clinic billed for 774 direct patient encounters. CONCLUSION: Pharmacists with the PhC license are able to provide high-quality medical care to patients living with or at risk of HIV and/or HCV infections within an interprofessional medical home model.

La identidad de género, factor de desigualdad olvidado en los sistemas de información de salud de España / Gender identity, a factor of inequality forgotten by Spanish health information systems

El Sistema de Información Sanitaria (SIS) español recoge información sobre la salud. Las personas trans tienen peor estado de salud. El objetivo de este trabajo ha sido valorar la adecuación del SIS para recoger las necesidades de salud de las personas trans. Se revisaron las fuentes de información del SIS disponibles en el Portal Estadístico del Sistema Nacional de Salud con datos sobre la población. Se buscaron las variables «sexo» e «identidad de género». Se incluyeron 19 fuentes. En todas estaba la variable «sexo» y en ninguna la variable «identidad de género». En dos, la variable «sexo» permitía valores de «transexual». El SIS contiene escasa información respecto a la identidad de género. Esto conduce a la invisibilidad de las personas trans en las estadísticas de salud. La obtención de esta información permitiría conocer las barreras de acceso y las necesidades de salud de uno de los colectivos más discriminados de nuestra sociedad (AU)

The Spanish Health Information System (HIS) collects health information. Trans people have poorer health status. This paper aimed to assess the adequacy of the HIS to collect the health data on trans individuals. The HIS sources available in the Statistical Portal of the National Health System were reviewed. The sources containing population health data were selected. The variables "sex" and "gender identity" were searched. Nineteen sources were identified. In all of them the variable "sex" was found, whereas "gender identify" did not appear in any of the 19. In two sources, the variable "sex" allowed values of "transsexual". The SIS contains little information regarding gender identity. This leads to the invisibility of trans people in Spanish health statistics. Obtaining this information would allow for a better understanding of the barriers to health care access, and the health needs of one of the most discriminated groups in our society (AU)

Atención sanitaria a adolescentes con disforia de género / Health care for adolescents with gender disphoria

Fundamentos. El tratamiento de la disforia de género (DG) en adolescentes es reciente. Son reducidos los estudios de adolescentes que han recibido tratamiento con análogos. Para garantizar la calidad asistencial y la seguridad del menor es necesario realizar estudios de seguimiento. El objetivo de la presente investigación fue describir las características del proceso de atención médica y psicológica en adolescentes con DG en la Unidad de Tratamiento de Identidad de Género del Principado de Asturias. Métodos. La muestra se compuso de 20 menores de edad que solicitaron consulta en la UTIGPA desde su apertura en 2007 hasta 2015. Se revisaron de forma retrospectiva las historias clínicas para recoger las variables. Se llevaron a cabo análisis de estadísticos descriptivos. Resultados. El 10% de los adolescentes abandonó en el proceso de acompañamiento psicológico, el 80% empezó a ser valorado por endocrinología y el 10% continuaba exclusivamente en consultas psicológicas. De los tratados médicamente, el 13,3% fue tratado con análogos y el 86,7% recibió directamente tratamiento hormonal cruzado (THC). Los efectos secundarios más prevalentes fueron los problemas dermatológicos (40%), seguidos de mastodinia sin galactorrea (26,7%) y sofocos (20%). El 20% realizó cirugías de confirmación de género. Conclusiones. El perfil del adolescente tratado en la unidad de Asturias es un sujeto que comienza tratamiento hormonal tras acompañamiento psicológico y evaluación endocrinológica. Presenta efectos adversos tras el tratamiento. Una vez instaurado el tratamiento hormonal no abandona el proceso (AU)

Background.Dysphoria gender treatment in adolescents is recent. Studies of adolescents treated with analogs are reduced. To ensure the quality of care and safety of the child, follow-up studies are necessary. The aim of the present research was to describe the characteristics of the process of medical and psychological attention in adolescents with the DG in the Gender Identity Treatment Unit of Asturias in the period 2007-2015. Methods. The sample included 20 minors. The clinical history was made to collect the variables. It was made descriptive analysis. Results. 10% of adolescents abandoned in the process of psychological counseling, 80% began to be valued by endocrinology and 10% continued exclusively in psychological consultations. Of the medical treated adolescents, 13.3% were treated with analogues and 86.7% received cross-hormonal treatment (THC) directly. The most prevalent secondary effects were dermatological problems (40%), followed by mastodynia without galactorrhea (26.7%) and hot flashes (20%). 20% performed gender confirmation surgeries. Conclusions. The profile of the adolescent treated in the unit of Asturias is a subject that begins hormonal treatment after psychological accompaniment and endocrinological evaluation. The minor has adverse effects after treatment. Once the hormonal treatment has been established, they do not abandon the process (AU)

Barriers to Care Among Transgender and Gender Nonconforming Adults.

Policy Points: Transgender and gender nonconforming (GNC) adults may experience barriers to care for a variety of reasons, including discrimination and lack of awareness by providers in health care settings. In our analysis of a large, population-based sample, we found transgender and GNC adults were more likely to be uninsured and have unmet health care needs, and were less likely to have routine care, compared to cisgender (nontransgender) women. Our findings varied by gender identity. More research is needed on transgender and GNC populations, including on how public policy and provider awareness affects health care access and health outcomes differentially by gender identity. CONTEXT: Very little population-based research has examined health and access to care among transgender populations. This study compared barriers to care between cisgender, transgender, and gender nonconforming (GNC) adults using data from a large, multistate sample. METHODS: We used data from the 2014-2015 Behavioral Risk Factor Surveillance System to estimate the prevalence of having no health insurance, unmet medical care needs due to cost, no routine checkup, and no usual source of care for cisgender women (n = 183,370), cisgender men (n = 131,080), transgender women (n = 724), transgender men (n = 449), and GNC adults (n = 270). Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for each barrier to care while adjusting for sociodemographic characteristics. FINDINGS: Transgender and GNC adults were more likely to be nonwhite, sexual minority, and socioeconomically disadvantaged compared to cisgender adults. After controlling for sociodemographic characteristics, transgender women were more likely to have no health insurance (OR = 1.60; 95% CI = 1.07-2.40) compared to cisgender women; transgender men were more likely to have no health insurance (OR = 2.02; 95% CI = 1.25-3.25) and no usual source of care (OR = 1.84; 95% CI = 1.18-2.88); and GNC adults were more likely to have unmet medical care needs due to cost (OR = 1.93; 95% CI = 1.02-3.67) and no routine checkup in the prior year (OR = 2.41; 95% CI = 1.41-4.12). CONCLUSIONS: Transgender and GNC adults face barriers to health care that may be due to a variety of reasons, including discrimination in health care, health insurance policies, employment, and public policy or lack of awareness among health care providers on transgender-related health issues.

Supporting the Health and Well-Being of Transgender Students.

Throughout the United States, there has been a rise in public discourse about transgender people and transgender issues. Much of this attention stems from passed and proposed anti-LGBTQ (lesbian, gay, bisexual, transgender, queer or questioning) legislation, including "bathroom bills" that would require transgender people to use public facilities corresponding with the sex designated on their birth certificates. With the recent discussion and legislation impacting school-aged children and adolescents, what does this mean for school nurses and how can they care and advocate for their transgender students? In this article, we aim to empower school nurses to join the discussion, advocate for inclusive and equitable school policies, and deliver gender-affirming care to transgender students. We will explain transgender identities; transgender-related stigma, prejudice, discrimination, and health concerns; gender-affirming approaches in caring for transgender youth; and implications for school nurses. School nurses play a key role in creating a space that is welcoming and affirming where transgender students can thrive.

Características de los menores de edad con disforia de género que acuden a la unidad de tratamiento de identidad de género / Caracteristics of adolescents with gender dysphoria referred to the gender identity treatment unit

Fundamentos. La demanda de atención a menores con disforia de género se ha incrementado en los últimos años. El objetivo de la presente investigación fue describir el perfil de adolescentes que solicitaron consulta en la Unidad de Tratamiento de la Identidad de Género del Principado de Asturias (UTIGPA) por presentar quejas de disforia de género.Método. La muestra se compuso de 20 menores de 18 años que fueron atendidos entre marzo de 2007 y diciembre de 2015. Se hizo uso de la historia clínica para recoger la información. Se llevaron a cabo análisis de estadísticos descriptivos y se utilizó la razón sexo/género. Resultados. Los 20 adolescentes representaron el 14,6% de la muestra total (137 personas). Tuvieron una media de edad de 15,20 (DT=1,473) y un rango entre 12 y 17. La razón sexo/género fue de 1/1 (10 pertenecieron al grupo de hombre a mujer y 10 al grupo de mujer a hombre). Cuando llegaron a la unidad el 100% convivía con su familia nuclear o extensa y en el 60% sus padres estuvieron separados. El 70% fue derivado desde salud mental. El 10% no presentó antecedentes asistenciales y al 35% se le prescribió tratamiento psicofarmacológico. El 95% no realizó autotratamiento hormonal. El 100% se definió como heterosexual. El 25% realizó una demanda exclusiva de intervenciones psicológicas y el 75% de tratamientos médicos. Conclusiones. El perfil del menor es un adolescente aproximadamente de 15 años derivado mayoritariamente desde salud mental. La razón sexo/género es la misma para ambos sexos. Presentan antecedentes asistenciales y realiza una demanda prioritaria de tratamientos médicos, tanto hormonales como quirúrgicos (AU)

Background. The demand for treatment among people with gender dysphoria has increased during the last years. The aim of the present research was to carry out an analysis of the demand of the teenagers that requested consultation at the UTIGPA (Gender Identity Treatment Unit of Principality of Asturias) as they presented complains of gender dysphoria. Method. The sample included 20 minors that were treated between March 2007 and December 2015. The clinical history was made to collect information. It was made descriptive analysis and the reason sex/gender was used. Results. The 20 teenagers represented the 14,6% of the whole sample (of 137 demands). The age average was 15,20 years (SD=1,473) and the range of years was between 12-17. The reason sex/gender was 1/1 (10 into the man to woman group and 10 into the woman to man group). At the arrival at the Treatment Unit, 100% of the individuals lived with their nuclear or extended family and in the 60% of the cases, their parents were separated. 70% of the cases were referred from mental health services. 10% hadn ́t got any past medical history and 35% had never received any prescription for a psychopharmacological treatment. 95% hadn’t done any hormonal self-treatment. 100% defined themselves as heterosexual. 25% requested exclusively for psychological interventions and 75% asked for medical treatments. Conclusions. The profile of the minor was a teenager of approximately 15 years old that was referred from mental health services. Contrary to the findings of other national and international researches, the rate sex/gender was equated in our research. The minor had got a past medical history and their priority request was for medical treatments, both hormonal and surgical therapies (AU)

What the Primary Care Pediatrician Needs to Know About Gender Incongruence and Gender Dysphoria in Children and Adolescents.

The recognition and acknowledgment that gender identity and birth-assigned sex may be incongruent in children and adolescents have evolved in recent decades. Transgender care for children and adolescents has developed and is now more widely available. Controversies exist, however, around clinical management of gender dysphoria and gender incongruence in children and adolescents. Clinical guidelines are consensus based and research evidence is limited. Puberty suppression as part of clinical management has become a valuable element of adolescent transgender care, but long-term evidence of success is limited. These uncertainties should be weighed against the risk of harming a transgender adolescent when medical intervention is denied.

Addressing Health Disparities via Coordination of Care and Interprofessional Education: Lesbian, Gay, Bisexual, and Transgender Health and Oral Health Care.

Lesbian, gay, bisexual, and transgender (LGBT) persons are a diverse group, but they share a common need for competent, accessible health care, dispensed without intolerance and with an understanding of their unique health needs. Dental practitioners need to understanding that LGBT persons have distinctive health (and oral health) needs. This article reviews the literature on oral and overall health of LGBT persons in the United States, and discusses ways in which dentists can improve the health care they provide to this vulnerable population, including how interprofessional education and collaborative practice may help to reduce oral health disparities within this group.

Education Creates Welcoming Environment for Transgender Patients.

The ED often is the access point of choice for transgender patients who may be reluctant to interact with providers. Experts say there is a need for training and education of how to present a gender-affirming healthcare environment. Recommended steps include a review of policies, along with corresponding changes to electronic and paper intake forms to ensure that the language used is inclusive of all genders. While blanket discrimination may be declining, experts note that some providers are uncertain about how to interact with a transgender patient. It's always best to ask patients for their preferred name and pronoun and to repeat this exercise every three to six months for return patients, as gender identify can be fluid. To ease anxiety for transgender patients, consider developing a navigator program that will pair any transgender patient who requests the service with a trained advocate who can support and guide the patient through the system.