• Risk factors for eating disorder psychopathology within the treatment seeking transgender population: The role of cross-sex hormone treatment

      Jones, Bethany A.; Bouman, Walter P.; Arcelus, Jon (2018)
      Many transgender people experience high levels of body dissatisfaction, which is one of the numerous factors known to increase vulnerability to eating disorder symptoms in the cisgender (non-trans) population. Cross-sex hormones can alleviate body dissatisfaction so might also alleviate eating disorder symptoms. This study aimed to explore risk factors for eating disorder symptoms in transgender people and the role of cross-sex hormones. Individuals assessed at a national transgender health service were invited to participate (N = 563). Transgender people not on cross-sex hormones reported higher levels of eating disorder psychopathology than people who were. High body dissatisfaction, perfectionism, anxiety symptoms, and low self-esteem were risk factors for eating psychopathology, but, after controlling for these, significant differences in eating psychopathology between people who were and were not on cross-sex hormones disappeared. Cross-sex hormones may alleviate eating disorder psychopathology. Given the high prevalence of transgender identities, clinicians at eating disorder services should assess for gender identity issues. Copyright (c) 2018 John Wiley & Sons, Ltd and Eating Disorders Association.
    • Risk factors for non-suicidal self-injury among trans youth

      Arcelus, Jon; Marshall, Ellen; Bouman, Walter P. (2016)
      INTRODUCTION: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor.
    • SAT-014 No correlation between serum testosterone levels and aggresion or anger intensity in transgender people: Results from five European centres

      Arcelus, Jon; Bouman, Walter P.; Brewin, Nicola (2019)
      AIM: Anger is a state of emotions ranging from irritation to intense rage. Aggression is the externalization of anger through destructive/punitive behaviour. The World Professional Association for Transgender Health (WPATH) Standards of Care, Edition 7 (SOC7) guidelines warn about aggression in transgender men (TM) on testosterone treatment. We aimed to assess whether aggression and anger intensity increase in TM and decrease in transgender women (TW) after initiation of gender affirming hormone therapy and to identify predictors for anger intensity in transgender people, including levels of sex steroids as well as psychological measurements. METHODS: Prospective changes in aggression were measured at baseline and after one year of gender affirming hormones in 155 transgender persons (64 TM, 91 TW), using the Inventory of Interpersonal Problems (IIP-32) factor ‘too aggressive’. State-level anger intensity was prospectively assessed in 898 participants (440 TM, 468 TW) by the STAXI-2 (State-Trait Anger Expression Inventory-2) State Anger (S-Anger) questionnaire during a three-year follow-up period, starting at the initiation of hormone treatment (testosterone in TM, oestrogens plus anti-androgens in TW). At baseline, psychological questionnaires were administered. Data were analysed cross-sectionally and prospectively. RESULTS: No prospective changes were reported in ‘too aggressive’ scores (after one year of hormone therapy) and S-Anger scores (over 3, 12 and 36 months of hormone therapy) in TM and TW. ‘Too aggressive’ scores were positively correlated to increasing anxiety scores in the entire study population and with lower support from friends in TW. At three, twelve and thirty-six months of gender affirming hormone therapy, anger intensity was not correlated to serum testosterone levels, although there was a correlation with various psychological measures after three and twelve months. TM experiencing menstrual spotting after three months had higher S-Anger scores compared to those without (median 26.5 [18.0 - 29.8] versus 15.0 [15.0 - 17.0], P=0.020). Changes in STAXI-2 S-Anger scores were not correlated to changes in serum testosterone levels after three, twelve and thirty-six months in TM or TW. CONCLUSIONS: Aggression and state-level anger intensity are associated with psychological and/or psychiatric vulnerability or the persistence of menses in TM, but not with exogenous testosterone therapy in TM or serum testosterone levels in both TM and TW.
    • Self-injury among trans individuals and matched controls: Prevalence and associated factors

      Arcelus, Jon; Bouman, Walter P. (2015)
      This study aims to determine the prevalence rate of current non-suicidal self-injury (NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and demographic factors. Participants were 97 adults, diagnosed with transsexualism (ICD-10, F64.0), attending a national gender clinic in the United Kingdom, and a matched control group. Clinical participants were all engaged on the treatment pathway. Participants completed the following self-report measures: Self-Injury Questionnaire - Treatment Related (SIQ-TR), Symptom Checklist 90 Revised (SCL-90-R), Rosenberg Self-Esteem Scale (RSE), Hamburg Body Drawing Scale (HBDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The results showed that the trans participants had a significantly higher prevalence of current NSSI behaviour than the non-trans group, with 19% currently engaging in NSSI. Current NSSI was also significantly more prevalent among trans men than trans women. Compared with both trans and non-trans participants with no history of NSSI, trans participants with current NSSI had significantly higher scores on SCL; significantly lower scores on RSE, HBDS and MSPSS; and were younger in age. The study concludes that trans men, specifically, are more at risk of NSSI than trans women and the general population, even when on the treatment pathway. Those who currently self-injure have greater psychopathology, lower body satisfaction, lower self-esteem, lower social support and tend to be younger, than those who do not engage in NSSI. © 2015 John Wiley & Sons Ltd.
    • Sexual orientation of trans adults is not linked to outcome of transition-related health care, but worth asking

      Richards, Christina (2016)
      Since the beginning of contemporary transition-related care at the outset of the 20th century, sexual orientation has ben considered to be closely connected with gender identity and the developmental trajectories of trans people. Specifically, health professionals have regarded the anticipated post-transitional heterosexual behaviour of trans adults as predictive of a good outcome of cross-sex hormones and gender-confirming surgeries. This article reviews the current literature according to the question of whether the sexual orientation of trans people is linked to outcome measures following transition-related interventions. A comprehensive review was undertaken using the Medline database, searching for empirical studies published between 2010 and 2015. Out of a total of 474 studies, only 10 studies reported a follow-up of trans adults and assessed sexual orientation in the study protocol at all. Sexual orientation was predominantly assessed as homosexual versus non-homosexual related to sex assigned at birth. Only one 1 of 10 follow-up studies found a significant association according to the outcome between groups differentiated by sexual orientation. Empirically there is no link between sexual orientation and outcome of transition-related health care for trans adults. In order to provide comprehensive health care, we recommend asking for sexual behaviours, attractions and identities, as well as for gender experiences and expressions; however, this knowledge should not drive, but simply inform, such comprehensive care. 2016 Copyright © 2016 Taylor & Francis.
    • 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)
    • Socio-demographic variables, clinical features and the role of pre-assessment cross-sex hormones in older trans people

      Bouman, Walter P.; Arcelus, Jon (2016)
      As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available.The aim of this study was to investigate the socio-demographic and clinical characteristics of older trans people attending a national service and to investigate the the influence of cross-sex hormones (CHT) on psychopathology.
    • Sociodemographic variables, clinical features, and the role of preassessment cross-sex hormones in older trans people

      Bouman, Walter P.; Marshall, Ellen; Longworth, Julia; Maddox, Victoria; Witcomb, Gemma L.; Arcelus, Jon (2016)
      INTRODUCTION: As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. AIMS: The aim of this study was to investigate the sociodemographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology. METHODS: Individuals over the age of 50 years old referred to a national gender identity clinic during a 30-month period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross-sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology. MAIN OUTCOME MEASURES: Sociodemographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and nonsuicidal self-injury (Self-Injury Questionnaire). RESULTS: The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n = 3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, and divorced and had children. Trans females on CHT who came out as trans and transitioned at an earlier age were significantly less anxious, reported higher levels of self-esteem, and presented with fewer socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem remained. CONCLUSION: The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans people may need to be re-examined.Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
    • Sport and transgender people: A systematic review of the literature relating to sport participation and competitive sport policies

      Jones, Bethany A.; Arcelus, Jon; Bouman, Walter P. (2016)
      BACKGROUND: Whether transgender people should be able to compete in sport in accordance with their gender identity is a widely contested question within the literature and among sport organisations, fellow competitors and spectators. Owing to concerns surrounding transgender people (especially transgender female individuals) having an athletic advantage, several sport organisations place restrictions on transgender competitors (e.g. must have undergone gender-confirming surgery). In addition, some transgender people who engage in sport, both competitively and for leisure, report discrimination and victimisation. OBJECTIVE: To the authors' knowledge, there has been no systematic review of the literature pertaining to sport participation or competitive sport policies in transgender people. Therefore, this review aimed to address this gap in the literature. METHOD: Eight research articles and 31 sport policies were reviewed. RESULTS: In relation to sport-related physical activity, this review found the lack of inclusive and comfortable environments to be the primary barrier to participation for transgender people. This review also found transgender people had a mostly negative experience in competitive sports because of the restrictions the sport's policy placed on them. The majority of transgender competitive sport policies that were reviewed were not evidence based. CONCLUSION: Currently, there is no direct or consistent research suggesting transgender female individuals (or male individuals) have an athletic advantage at any stage of their transition (e.g. cross-sex hormones, gender-confirming surgery) and, therefore, competitive sport policies that place restrictions on transgender people need to be considered and potentially revised.
    • The stability of autistic traits in transgender adults following cross-sex hormone treatment

      Nobili, Anna; Glazebrook, Cris; Bouman, Walter P.; Arcelus, Jon (2020)
      Background: Recent research has shown that a high percentage of treatment-seeking transgender adults who were assigned female at birth (AFAB) reported scores above the clinical cutoff for autistic traits. It is unclear whether those scores reflect a stable trait or may be inflated by the high levels of anxiety typically associated with transgender people attending clinical services.Aims: This longitudinal study aims to explore the impact of Cross-sex Hormone Treatment (CHT) on levels autistic traits, independent of changes in anxiety.Method: Transgender adults who were assessed at a national transgender health service in the UK, who had not previously received CHT and who had completed the AQ-Short as a measure of autistic traits pre- and one-year post-CHT were included in the study (n = 118). Anxiety was assessed at the same time points using the Hospital Anxiety and Depression Scale.Results: AQ-Short scores remained very stable over time (ICC = 0.7; CIs 0.591-0.779) but anxiety showed little consistency (ICC = 0.386; CIs 0.219 to 0.531). Repeated measures ANOVA found a main effect of assigned sex with AFAB having higher AQ-Short scores. There was no change in AQ-Short scores and no significant interaction between assigned sex and change in AQ-Short scores.Conclusion: This study confirmed that treatment seeking transgender AFAB people have higher levels of autistic traits at follow-up compared to AMAB transgender people and that these traits are stable following one year of CHT regardless of assigned sex. This may have clinical implications regarding the support that transgender people may require following medical transition. (PsycInfo Database Record (c) 2020 APA, all rights reserved) (Source: journal abstract)
    • 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.
    • Taiwanese speech–language therapists’ awareness and experiences of service provision to transgender clients

      Georgiadou, Ioanna (2019)
      AbstractBackground: One of the most influential factors that affect the quality of life of transgender individuals is whether they can be perceived by others to ?pass? in their felt gender. Voice and communication style are two important identifying dimensions of gender and many transgender individuals wish to acquire a voice that matches their gender. Evidence shows that few transgender individuals access voice therapy, and that this is caused by their concerns about stigmatization or negative past experiences within healthcare services. In order to address the negative experiences faced by transgender populations we need a better understanding of healthcare services? current levels of knowledge and LGBT awareness. Some studies of Speech?Language Therapists? (SLTs?) experience and confidence working with transgender individuals have recently been undertaken in the United States (US). However, little research has been carried out in Asia.Aims: To investigate Taiwanese SLTs? knowledge, attitudes and experiences of providing transgender individuals with relevant therapy.Method: A cross-sectional self-administered web-based survey hosted on the Qualtrics platform was delivered to 140 Taiwanese SLTs.Results: Taiwanese SLTs were, (i) more familiar with the terminology used to address ?lesbian, gay, and bisexual groups? than with ?transgender? terminology, (ii) generally positive in their attitudes toward transgender individuals, and (iii) comfortable about providing clinical services to transgender clients. However, the majority of participants did not feel that they were sufficiently skilled in working with transgender individuals, even though most believed that providing them with voice and communication services fell within the SLT scope of practice.Conclusion: It is important for clinicians to both be skilled in transgender voice and communication therapy and to be culturally competent when providing services to transgender individuals. This study recommends that cultural competence relating to gender and sexual minority groups should be addressed in SLTs? university education as well as in their continuing educational programs.
    • The terminology of identities between, outside and beyond the gender binary - a systematic review

      Thorne, Nat; Bouman, Walter P.; Marshall, Ellen; Arcelus, Jon (2019)
      Background: Recently, a multitude of terms have emerged, especially within North America and Western Europe, which describe identities that are not experienced within the culturally accepted binary structure of gender which prevails within those cultures. As yet, there is no clear single umbrella term to describe such identities and a mixture of words have been used in scholarly work to date.Aims: To explore the origins and track the emergence of newer terms and definitions for identities between, outside and beyond the gender binary, to outline current trends in descriptors within scholarly work and to suggest a term which is wide enough to encompass all identities.Methods: A comprehensive systematic review was made, following the PRISMA guidelines. Several relevant key terms were used to search Web of Science, ScienceDirect, PubMed, and the International Journal of Transgenderism. The descriptions each title gives for identities outside of the binary are extracted for analysis.Results: Several terms have been used over the years to describe identities outside of the binary. “Non-binary” and “genderqueer” are currently mostly used as umbrella terms. However, “gender diverse” is emerging as a more suitable wide-ranging inclusive term for non-male and non-female identities.Discussion: Identity outside of “male” and “female” is an emerging concept which currently has several identifiers and little academic agreement on which is the most pertinent. The two leading descriptors are “non-binary” and “genderqueer.” Gender diverse is emerging as a new term which has the aim of including all other terms outside of male and female within it and this article suggests the increase in its use to describe gender identities outside of the binary. (PsycINFO Database Record (c) 2019 APA, all rights reserved) (Source: journal abstract)
    • The prevalence of being transgendered: Estimating the size of the transgender population

      Arcelus, Jon; Bouman, Walter P. (2017)
      This chapter discusses how common it is to identify as transgender. Clinical studies have traditionally shown low prevalence rates of transgender people with more recent studies provide higher prevalence rates of transgender people than older studies. Clinical studies only provide data on transgender people who can and want to access transgender health services. In contrast, population studies have found considerably higher prevalence rates of transgender people than clinical studies. Population studies may be more reliable in facilitating true prevalence rates of transgender people in society. More tolerant societies provide higher prevalence rates of transgender people than less tolerant societies.
    • The transgender handbook: A guide for transgender people, their families and professionals

      Bouman, Walter P.; Arcelus, Jon (2017)
      This handbook is written for transgender people, their families and friends; for professionals who in their day-to-day job may encounter transgender people; and for students, teachers, educators, academics, and members of the public at large with an interest in transgender people. This handbook gives an in-depth overview on a wide spectrum of issues encountered by transgender people, from childhood to later on in life. Key topics addressed include medical and surgical treatments, access to transgender health care, sexuality, mental health issues, fertility, education, and employment. This practical guide is written in a clear and concise manner by more than 40 international specialists in the field of transgender health and well-being. This essential text is extensively referenced and illustrated, and informs the reader on a broad range of important gender-affirming issues.
    • 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)
    • Trans and sexuality: An existentially-informed enquiry with implications for counselling psychology

      Richards, Christina (2018)
      Grounded in cutting-edge qualitative research, Trans and Sexuality explores the sexuality of people who do not identify with the gender that they were assigned at birth. Arguing that whilst splitting members of the trans community into distinct groups might seem like a reasonable theoretical procedure, the pervasive assumption that group membership impacts on the sexuality of trans people has unduly biased opinions in this highly contested, yet dramatically under-researched, area. Moreover, whilst existing literature has taken a purely positivistic standpoint, or relies on methodology that could be seen as exploitative towards trans people, Richards is careful to place the real-life experiences of trans research participants at the heart of the work. Showing that sexuality extends beyond the bedroom, this forward-thinking book touches on topics such as identity, sexuality, and the intersections between the two. Richards takes a cross-disciplinary approach and considers the sexuality of trans people within the contexts of psychiatric and psychological settings, including Gender Identity Clinics, as well as in the broader contexts of cultural and community settings. The implications of the research at hand are also explored with respect to counseling psychology and existentialist philosophy. Trans and Sexuality will appeal to academics, researchers, and postgraduate students in the fields of gender and sexuality, counseling, sociology, psychotherapy, psychology and psychiatry. It will be of particular interest to those seeking an in-depth and up-to-date overview of ethics and methodologies with people from marginalized sexualities and genders. (PsycINFO Database Record (c) 2018 APA, all rights reserved) (Source: jacket)
    • 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)