• What services are available for the treatment of transsexuals in Great Britain?

      Murjan, Sarah; Ferguson, Brian G. (2002)
      Aims and method: We conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care. Results: Eighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment. Clinical implications: There are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.
    • World Professional Association for Transgender Health consensus statement on considerations of the role of distress (Criterion D) in the DSM diagnosis of gender identity disorder

      Bouman, Walter P.; Richards, Christina (2010)
      This article explains the report from the work group of WPATH charged to consider whether a diagnosis for gender identity disorder should be included in the revised DSM; whether distress is inherent, a result of social stigma, or both; and what the implications of this are for the diagnosis in the revised DSM. Suggestions are made to remove gender identity disorder from the next revision of DSM and to find a place in the nonmental disorder section of the ICD, using the more broadly defined and less stigmatizing term gender dysphoria. Alternative suggestions are also put forward to incorporate distress within Criterion A of a diagnosis of Gender Dysphoria (formerly Gender Identity Disorder) in the revised DSM, which will make the condition correspond more closely to its description in the ICD.
    • Diagnostic and treatment issues for people with gender dysphoria in the United Kingdom

      Bouman, Walter P.; Richards, Christina (2013)
      This editorial is focused on the diagnostic and treatment issues for people with gender dysphoria in the United Kingdom. Terminology and diagnosis are important elements in the provision of clinical care which can offer a mutual language and framework, both clinical and bureaucratic, within which we can expediently work together for the benefit of our clients. The DSM-5 claims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than which they were assigned at birth. It makes several important clarifications in the criteria, chief of which is arguably the replacement of the diagnostic name Gender Identity Disorder with Gender Dysphoria. Clinicians from all disciplines within the United Kingdom, whether psychology, psychiatry, endocrinology, surgery, etc., are increasingly questioning the veracity of mental health diagnoses for trans people and, fortunately the World Health Organization (WHO) holds a similar view. The practice guideline in this issue is a shorter and more practical document than the Standards of Care (SoC), although its content remains analogous to, and in the spirit of, the UK SoC. As adherence to the legislative and existing clinical frameworks causes severe stress and anxiety in some patients, clinicians can be positioned such that they are unable to follow the bioethical principle of non-maleficence; this alone supports the argument that these frameworks ought to be critically appraised, further developed, and amended as evidence and clinical experience evolve. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Patient satisfaction with gender identity clinic services in the United Kingdom

      Bouman, Walter P.; Richards, Christina; Baker, Karen; Murjan, Sarah; Mepham, Nick; Robbins-Cherry, Sally (2013)
      Measuring patient satisfaction is important in assessing healthcare outcomes due to the growing emphasis on greater partnership between providers and consumers. National Health Service (NHS) commissioning bodies in the United Kingdom increasingly expect patient satisfaction to be included as a service performance indicator as it is regarded as part of the definition of quality of care. The aim of this survey is to better understand levels of satisfaction with current gender identity clinic services (GICs) provision and to identify areas for improvement. A Patient Satisfaction Questionnaire (PSQ-GD) was developed specifically for use in GICs in the United Kingdom, which was given to all patients during one month. PSQ-GD covers clinical care, administrative and procedural issues as well as patient experience of local service provision from their General Practitioner, local psychiatric services and speech therapy. A total of 330 PSQ-GD were given with a response rate of 85%. Ninety-four percent would recommend the services if a friend or relative had a gender-related problem. Twenty percent were dissatisfied with the level of support for others close to the patient. Thirty-one percent were dissatisfied with local psychiatric services. Twenty-seven percent were dissatisfied with the wait for the first appointment. Administration scored high on satisfaction. A total of 222 positive and 131 negative comments were made. The PSQ-GD offers an opportunity to understand levels of satisfaction with current gender service provision and identifies areas for improvement, most notably the interface between GICs and local psychiatric services. Findings from this study put individual complaints in perspective and show that despite the challenges inherent in providing transgender care good satisfaction can be achieved. We encourage gender care providers to implement quality assurance and improvement procedures to give people with gender dysphoria the opportunity to provide feedback and have a voice in shaping their own health care. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Gender dysphoria services: A guide for general practitioners and other healthcare staff

      Bouman, Walter P.; Murjan, Sarah; Richards, Christina (2013)
      This guide reflects current practice of National Health Service (NHS) gender clinic services in the United Kingdom (UK). The NHS offers healthcare free at the point of access. The guide describes how and when people with gender dysphoria should be referred; and what people with gender dysphoria can expect in terms of assessment, treatment, care and support from gender clinic services. This guide has been written by clinicians of the four largest gender clinic services in England. An early draft of this guide was shared with all UK gender clinic services for their input, following which trans people and other relevant stakeholders were consulted and given an extensive opportunity to comment on the draft guide. This guide is intended to inform primary care physicians, known in the UK as general practitioners, as well as all other relevant gender-related healthcare and psychotherapy service providers, both NHS and privately, commissioning bodies, and people with gender dysphoria. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Who watches the watchmen? A critical perspective on the theorization of trans people and clinicians

      Richards, Christina (2014)
      This paper, made from an explicitly academic-practitioner stance, aims to highlight some of the problematic ways in which academic writing on trans people, and on the clinicians working in trans healthcare, has been presented in recent years. We argue that much work theorizes trans people and clinicians whilst failing to recognise the full and complex humanity of the people concerned. Also, such work frequently universalises a small number of accounts as if they were representative of 'the trans person' or 'the medical/psy profession' as a whole. We call upon future writers and researchers to pay more attention to the multiplicity and diversity of accounts, and to consider the potential damage of perpetuating certain accounts as fixed or universal.
    • Yes and yes again: Are standards of care which require two referrals for genital reconstructive surgery ethical?

      Bouman, Walter P.; Richards, Christina; Arcelus, Jon (2014)
      The commonly used Standards of Care for people with gender dysphoria, including those of the World Professional Association for Transgender Health and The Royal College of Psychiatrists in the United Kingdom, as well as those standards used in many other countries, usually require that two signatures of approval from qualified mental health professionals be provided before genital reconstructive surgery (GRS)—sometimes called sexual reassignment surgery or gender confirmation surgery—is undertaken. This is different from surgeries which are similarly irreversible and remove reproductive capacity carried out on cisgender people. This paper explores the trans-specific issues from a standpoint of medical ethics and argues that, provided sufficient safeguards are in place, including assessment within a multidisciplinary team, a nuanced approach utilising a single signature may instead be appropriate. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: journal abstract)
    • Good practice guidelines for the assessment and treatment of adults with gender dysphoria

      Bouman, Walter P. (2014)
      The Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria is a publication of the Intercollegiate Committee of the Royal College of Psychiatrists. The overall goal of the Good Practice Guidelines is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynaecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counselling, psychotherapy), and hormonal and surgical treatments. The Good Practice Guidelines are based on the best available science and expert professional consensus. The Good Practice Guidelines articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, the Good Practice Guidelines recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the Good Practice Guidelines to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • The good practice guidelines for the assessment and treatment of adults with gender dysphoria in the United Kingdom

      Bouman, Walter P. (2014)
      The Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria (Wylie et al., 2013) published in this issue of Sexual and Relationship Therapy are the Standards of Care for transgender people receiving support and medical care in the UK. These Guidelines provide clinicians with a framework to practice within and provide clients and patients with information as to what to expect from clinical services. The guide for general practitioners and other healthcare staff published last year reflected the care pathway patients and clients were receiving. The Good Practice Guidelines take one step further. This document sets out standards of care to adhere to with the aim to improve the quality of services for people with gender dysphoria as well as to strive towards a certain standardisation of care so that all clients and patients within a certain large geographical region receive a similar service. This must be seen as another positive development. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • People with gender dysphoria who self-prescribe cross-sex hormones: Prevalence, sources, and side effects knowledge

      Bouman, Walter P.; Mepham, Nick (2014)
      Introduction: There is a scarcity of research into the use of non-physician-sourced cross-sex hormones in the transgender population. However, when medication is not prescribed by health professionals, users' knowledge of such medication may be adversely affected. Aims: This study aims to define the prevalence of Internet-sourced sex hormone use in a population attending for initial assessment at a gender identity clinic, to compare the prevalence between gender-dysphoric men and women, and to compare knowledge of cross-sex hormone side effects between users who source cross-sex hormones from medical doctors and those who source them elsewhere. Methods: In the first part of the study, a cross-sectional design is used to measure the overall prevalence of sex hormone use among individuals referred to a gender clinic. The second part is a questionnaire survey aiming at measuring sex hormone knowledge among individuals referred to this clinic. Main Outcome Measures: Main outcome measures were (i) categorical data on the prevalence and source of cross-sex hormone use and (ii) knowledge of sex hormone side effects in a population referred to a gender clinic. Results: Cross-sex hormone use was present in 23% of gender clinic referrals, of whom 70% sourced the hormones via the Internet. Trans men using testosterone had a sex hormone usage prevalence of 6%; one-third of users sourced it from the Internet. Trans women had a sex hormone usage prevalence of 32%; approximately 70% of users sourced hormones from the Internet. Cross-sex hormone users who sourced their hormones from physicians were more aware of side effects than those who used other sources to access hormones. Conclusion: One in four trans women self-prescribe cross-sex hormones before attending gender clinics, most commonly via the Internet. This practice is currently rare among trans men. Self-prescribing without medical advice leaves individuals without the knowledge required to minimize health risks. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Trans and existential-phenomenological practice

      Richards, Christina (2014)
      Existentialism is concerned with freedom and authenticity—philosophies which permeate the process of transitioning gender. Indeed the recognition of freedom, the eschewing of the comfortable social norms of not transitioning gender, and the attainment of a more personally congruent and authentic gender as well as (in some cases) embodiment, are often the sine qua non of the process of transitioning gender—and consequently any psychological interventions which a trans person may seek as part of this process. Trans then, and the existential project, are fundamentally intertwined. This chapter concerns itself specifically with the matters relating to being trans, which trans people may bring to an existential-phenomenological practitioner (particularly one working from the scientist-practitioner stance such as a psychologist). These issues generally fall roughly into one of three interrelated groups: issues pertaining to whether to transition from one gender to another, issues pertaining to transphobia, whether internalised or from others, and issues pertaining to matters which may impact trans people in particular ways, such as reproduction, ageing, sexuality and such. One issue which is necessarily trans specific is that of transition, so it is to this which we turn first. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • Social support and psychological well-being in gender dysphoria: A comparison of patients with matched controls

      Bouman, Walter P.; Arcelus, Jon (2014)
      Introduction: There is a paucity of research in the area of social support and psychological well-being among people with gender dysphoria. Aims: The present study aimed to investigate levels of social support among individuals with gender dysphoria compared with a matched control group. It also aimed to examine the relationship between social support and psychological well-being. Methods: Participants were 103 individuals diagnosed with gender dysphoria (according to ICD-10 criteria) attending a national gender identity clinic and an age- and gender-matched nonclinical control group recruited via social networking websites. Main Outcome Measures: All participants completed measures of social support (Multidimensional Scale of Perceived Social Support, MSPSS), psychopathology (Symptom Checklist 90 Revised, SCL), quality of life (Short Form 36 version 2, SF), and life satisfaction (Personal Wellbeing Index, PWI). Results: Trans women reported significantly lower MSPSS total and MSPSS family scores compared with control women, although these differences in levels of social support were no longer significant when SCL depression was controlled for. No significant differences were found between trans men and any other group. MSPSS scores did not significantly predict SCL subscales but did predict both SF subscales and PWI total scores. Conclusions: Trans women perceived themselves to be lacking social support. Given that social support is beneficial to quality of life and life satisfaction in those with gender dysphoria, this is of great concern. Though these findings have been derived from correlational results, extended research may highlight the value of clinicians helping trans women to seek out and maintain social support. Additionally, efforts could be made to educate and challenge attitudes of nontrans people towards those with gender dysphoria. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Trans people's reproductive options and outcomes

      Richards, Christina (2014)
      Trans people are those people whose sex assigned at birth does not align with their gender identity - a condition that can cause marked distress. Consequently, many trans people seek to change their gender, often permanently. Most usually that change is to male or female although sometimes the change is to a non-binary gender form. However, as the last of these is less usual this commentary will consider only trans people who identify as male or female. [PUBLICATION] 10 references
    • Trans is not a disorder – but should still receive funding

      Richards, Christina; Arcelus, Jon; Bouman, Walter P.; Murjan, Sarah (2015)
      This editorial focuses on providing healthcare funding systems among transgender. At present, the healthcare funding systems in many countries are set up in such a way as to make it effectively impossible to assist trans people with hormones and surgeries if they do not have a diagnosis which relates to those interventions. Of course this should not necessarily be the case. We will, of course use diagnosis for pragmatic ends to assist the trans people who see us, but, to help, not to label, and-given the long history of pathologisation, and longer history of diversity-never as a de facto understanding that trans people are disordered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Further sexualities

      Richards, Christina (2015)
      -
    • Interpersonal functioning among treatment‐seeking trans individuals

      Bouman, Walter P.; Arcelus, Jon (2015)
      Objectives: Trans people have been found to have high levels of depression. In view of the association between interpersonal problems and depression and the importance of interpersonal skills to navigate the transition of trans people, this study aims to investigate the levels of interpersonal problems among treatment-seeking trans men and women and the role of depression in this association. Method: A total of 104 patients from a UK gender identity clinic and 104 age- and gender-matched control participants completed self-report measures of interpersonal problems and general psychopathology, including depression. Results: Trans people reported significantly higher scores on global interpersonal problems and on the Inventory of Interpersonal Problems-32 (IIP-32) Hard to be Sociable, Hard to be Supportive, and Hard to be Involved subscales and lower scores on the Too Open subscale. Depression accounted for significant differences on IIP-32 global and the Too Open subscale but not on Hard to be Sociable, Hard to be Supportive, and Hard to be Involved subscales. Conclusions: Trans individuals present with interpersonal problems, which could potentially increase their vulnerability to mental health problems. Therefore, addressing interpersonal problems may help to prevent the development of depressive symptomatology and facilitate transition.
    • Systematic review and meta-analysis of prevalence studies in transsexualism

      Arcelus, Jon; Bouman, Walter P. (2015)
      Background: Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data.; Methods: Databases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed.; Results: The overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years.; Conclusions: The overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.; Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    • Transgender—Living in a gender different from that assigned at birth

      Murjan, Sarah; Bouman, Walter P. (2015)
      This chapter primarily focuses on those trans people who engage with clinical services and seek treatment-such as cross-sex hormones and surgery—to make their body more congruent with their gender identity and who therefore may be diagnosed with 'gender dysphoria' or 'transsexualism'. It is important to recognize that being trans need not be a clinical matter and that trans people self-identify in a variety of ways independently of whether or not they seek, or receive, any diagnosis; have received cross-sex hormone treatment; or have undergone surgery. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)
    • Further genders

      Richards, Christina (2015)
      In this chapter, we cover those gender forms which fall outside the common binary of women and men. However, as we will see, bisecting the world into women and men — or, indeed, women, men, and others — is not necessarily a useful way of conceptualising things. Consequently, we have entitled this chapter ‘Further Genders’ in order to be comprehensible to readers who are unfamiliar with gender forms other than woman or man (whether trans or cisgender1).