• Identifying coping strategies used by patients at a transgender health clinic through analysis of free‐text autobiographical narratives

      Bouman, Walter P.; Arcelus, Jon (2021)
      Background This paper presents an analysis of 32 narratives written by patients waiting for assessment at a transgender health clinic (THC) in England. Narratives are autobiographical free texts, designed to allow patients to describe in their own words their experiences of their gender identity and/or transition prior to a clinic appointment, as part of the assessment process. Objective Narratives were analysed to identify actions prospective patients had taken to manage their (usually lengthy) waiting times, so that these ‘coping strategies’ could be shared with future patients. Design Corpus linguistic methodology was utilized to identify common patterns across the whole corpus of text‐based data, augmented with more detailed sociolinguistic analysis of individual narratives. Results There are broad commonalities in the way the transition experience is described across the corpus in terms of presentation of key experiences and feelings. There are specific descriptions of a number of recurring coping strategies, both positive and negative. Conclusion The empowerment value of writing these narratives may be limited; the existence of recurring key features suggests that patients may feel they have to present their experiences in certain ways to be accepted for treatment. However, dissemination of some positive coping strategies may help future clients of THCs to better cope with waiting times, as well as assisting practitioners in THCs in supporting their patients during this wait. Patient/Public Contribution The clinic's Service Users’ Research Advisory Group contributed to formulating the objective and design of the study. Results were presented at the clinic's annual PPI conference. (PsycInfo Database Record (c) 2021 APA, all rights reserved) (Source: journal abstract)
    • 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.
    • Introduction

      Richards, Christina (2015)
    • Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process?

      Jones, Bethany A.; Brewin, Nicola; Richards, Christina; Van Eijk, Marnix; Stephenson-Allen, Alex; Arcelus, Jon (2017)
      Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services. Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service. Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process. Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n = 176) of the cases. Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed. © 2017 Taylor & Francis Group, LLC
    • Language and terminology

      Arcelus, Jon; Bouman, Walter P. (2017)
      This chapter gives an overview of the terminology in the field of transgender healthcare. The word transgender is often used to describe anyone whose gender identity, expression or behaviour is different from the assigned gender at birth based on the sexual characteristics. The chapter describes a brief historical development of the concept of gender and gender role, and provides a list of terms related to transgender explaining what each term means in order to guide the reader throughout the book.
    • Language and trans health

      Bouman, Walter P. (2017)
    • The levels and predictors of physical activity engagement within the treatment seeking transgender population: A matched control study

      Jones, Bethany A.; Bouman, Walter P.; Arcelus, Jon (2017)
      BACKGROUND Physical activity has been found to alleviate mental health problems and could be beneficial for at-risk populations, such as transgender people. This study had three aims. First, to explore the amount of physical activity that treatment seeking transgender people engage in, and to compare this to matched cisgender people. Second, to determine whether there was a difference in physical activity depending on cross-sex hormone use. Third, to determine factors which predict physical activity among treatment seeking transgender people.METHODTransgender (n=360) and cisgender people (n=314) were recruited from the UK. Participants were asked to complete questionnaires about physical activity, symptoms of anxiety and depression, self-esteem, body satisfaction and transphobia.RESULTSTransgender people engaged in less physical activity than cisgender people. Transgender people who were on cross-sex hormones engaged in more physical activity than transgender people who were not. In transgender people on cross-sex hormones, high body satisfaction was the best statistical predictor of physical activity while high self-esteem was the best statistical predictor in people who were not.CONCLUSIONTransgender people are less active than cisgender people. Cross-sex hormone treatment appears to be able to indirectly increase physical activity within this population, which may be beneficial for mental well-being.
    • Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services

      Bouman, Walter P.; Brewin, Nicola; Arcelus, Jon (2018)
      BACKGROUNDDepression is a serious disorder which significantly impacts wellbeing and quality of life. Studies exploring mental wellbeing in the transgender population are mostly limited by small, non-homogenous samples and lack of matched controls. This study aimed to address these limitations and explore depression rates in a large sample of transgender people, compared with matched controls from the general population, as well as factors predicting depression in those taking cross-sex hormone treatment (CHT) compared to those not.METHODSTransgender individuals (n = 913) completed a measure of depression, measures which predict psychopathology (self-esteem, victimization, social support, interpersonal problems), and information regarding CHT use. Participants were matched by age and experienced gender with adults from the general population who had completed the measure of depression.RESULTSIndividuals were categorized as having no, possible or probable depressive disorder. Transgender individuals not on CHT had a nearly four-fold increased risk of probable depressive disorder, compared to controls. Older age, lower self-esteem, poorer interpersonal function and less social support predicted depressive disorder. Use of CHT was associated with less depression.LIMITATIONSParticipants were attending a national gender identity service and therefore represent only a sub-group of transgender people. Due to the cross-sectional design, longitudinal research is required to fully confirm the finding that CHT use reduces depression.CONCLUSIONThis study confirms that non-treated transgender individuals have an increased risk of a depressive disorder. Interventions offered alongside gender affirming treatment to develop interpersonal skills, increase self-esteem and improve social support may reduce depression and prepare individuals for a more successful transition.
    • Long term effect of gender affirming hormone treatment on depression and anxiety symptoms in transgender people: A prospective cohort study

      Aldridge, Zoe; Patel, Shireen; Guo, Boliang; Nixon, Elena; Bouman, Walter P.; Arcelus, Jon (2020)
      BACKGROUNDCross-sectional studies show that transgender people are more likely than cisgender people to experience depression and anxiety before Gender Affirming Hormone Treatment (GAHT). However, the effect of GAHT on mental health in transgender people, and the role of other factors that may have a predictive effect, is poorly explored.OBJECTIVESUsing a longitudinal methodology, this study investigated the effect of 18 months GAHT on depression and anxiety symptomatology and the predictors on mental health outcomes in a large population of transgender people.MATERIALS AND METHODSParticipants (n=178) completed a socio-demographic questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Scale of Perceived Social Support (MSPSS) and the Autism Spectrum Quotient Short Version (AQ-short) at pre-assessment (T0) and at 18 months after initiation of GAHT (T1).RESULTSFrom T0 to T1, symptomatology was significantly decreased for depression (P <0.001) and non-significantly reduced for anxiety (P=0.37). Scores on the MSPSS predicted reduction in depression, while scores on the AQ-short predicted reduction in anxiety.DISCUSSIONGAHT reduces symptoms of depression which are predicted by having higher levels of social support. Although anxiety symptoms also reduce the changes are not significant and high levels of anxiety still remain post GAHT.CONCLUSIONSThese results highlight the important mental health benefits of GAHT. Support services (professional, third sector or peer-support) aiming at increasing social support for transgender individuals should be made available.
    • Mental health and gender dysphoria: A review of the literature

      Arcelus, Jon (2016)
      Studies investigating the prevalence of psychiatric disorders among trans individuals have identified elevated rates of psychopathology. Research has also provided conflicting psychiatric outcomes following gender-confirming medical interventions. This review identifies 38 cross-sectional and longitudinal studies describing prevalence rates of psychiatric disorders and psychiatric outcomes, pre- and post-gender-confirming medical interventions, for people with gender dysphoria. It indicates that, although the levels of psychopathology and psychiatric disorders in trans people attending services at the time of assessment are higher than in the cis population, they do improve following gender-confirming medical intervention, in many cases reaching normative values. The main Axis I psychiatric disorders were found to be depression and anxiety disorder. Other major psychiatric disorders, such as schizophrenia and bipolar disorder, were rare and were no more prevalent than in the general population. There was conflicting evidence regarding gender differences: some studies found higher psychopathology in trans women, while others found no differences between gender groups. Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population. Copyright © 2016 © 2015 Taylor & Francis.
    • Mental health and quality of life in non-binary transgender adults: A case control study

      Jones, Bethany A.; Bouman, Walter P.; Arcelus, Jon (2019)
      AbstractBackground: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking.Aim: To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth.Method: A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures.Results: Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups.Conclusion: There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.
    • Mental health problems in the transgender population: what is the evidence?

      Arcelus, Jon (2017)
      This chapter discusses the findings from previous studies investigating mental health problems among transgender people. As most of the studies take place among people attending transgender health services the chapter will primarily focus on this group. The chapter will critically review the findings of the studies in order to make sure that they are relevant to the majority of the transgender people attending transgender health services. The chapter will divide the studies in two main categories, 1) those investigating how common mental health problems are in people by comparing them to cisgender groups and 2) studies looking as to how mental health problems change before and after treatment.
    • The need of patient involvement in transgender health care research

      Arcelus, Jon; Bouman, Walter P. (2017)
      In recent years, an unprecedented increase in clinical research in transgender health linked to a substantial increase in the clinical need of transgender people (in the broadest sense, ie, transgender, transsexual, and gender diverse) has been reported. In consequence, new professional networks such as the European Professional Association for Transgender Health (EPATH), the Australian and New Zealand Professional Association for Transgender Health, the Brazilian Professional Association for Transgender Health, and the United States Professional Association for Transgender Health (USPATH); specialist academic journals such as Transgender Studies Quarterly and Transgender Health; and specific sections on transgender health research in established journals such as the Journal of Sexual Medicine have emerged.
    • Non-binary or genderqueer genders

      Richards, Christina; Bouman, Walter P. (2016)
      Some people have a gender which is neither male nor female and may identify as both male and female at one time, as different genders at different times, as no gender at all, or dispute the very idea of only two genders. The umbrella terms for such genders are genderqueer' or non-binary' genders. Such gender identities outside of the binary of female and male are increasingly being recognized in legal, medical and psychological systems and diagnostic classifications in line with the emerging presence and advocacy of these groups of people. Population-based studies show a small percentage - but a sizable proportion in terms of raw numbers - of people who identify as non-binary. While such genders have been extant historically and globally, they remain marginalized, and as such - while not being disorders or pathological in themselves - people with such genders remain at risk of victimization and of minority or marginalization stress as a result of discrimination. This paper therefore reviews the limited literature on this field and considers ways in which (mental) health professionals may assist the people with genderqueer and non-binary gender identities and/or expressions they may see in their practice. Treatment options and associated risks are discussed.