• 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)
    • 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
    • Transforming the paradigm of nonbinary transgender health: A field in transition

      Bouman, Walter P. (2019)
      This is an editorial in the International Journal of Transgenderism
    • Transgender and anxiety: A comparative study between transgender people and the general population

      Bouman, Walter P.; Brewin, Nicola; Arcelus, Jon (2017)
      Background: Anxiety disorders pose serious public health problems. The data available on anxiety disorders in the transgender population is limited by the small numbers, the lack of a matched controlled population and the selection of a nonhomogenous group of transgender people. Aims: The aims of the study were (1) to determine anxiety symptomatology (based on the HADS) in a nontreated transgender population and to compare it to a general population sample matched by age and gender; (2) to investigate the predictive role of specific variables, including experienced gender, self-esteem, victimization, social support, interpersonal functioning, and cross-sex hormone use regarding levels of anxiety symptomatology; and (3) to investigate differences in anxiety symptomatology between transgender people on cross-sex hormone treatment and not on hormone treatment. Methods: A total of 913 individuals who self-identified as transgender attending a transgender health service during a 3-year period agreed to participate. For the first aim of the study, 592 transgender people not on treatment were matched by age and gender, with 3,816 people from the general population. For the second and third aim, the whole transgender population was included. Measurements: Sociodemographic variables and measures of depression and anxiety (HADS), self-esteem (RSE), victimization (ETS), social support (MSPSS), and interpersonal functioning (IIP-32).Results: Compared with the general population transgender people had a nearly threefold increased risk of probable anxiety disorder (all p < .05). Low self-esteem and interpersonal functioning were found to be significant predictors of anxiety symptoms. Trans women on treatment with cross-sex hormones were found to have lower levels of anxiety disorder symptomatology. Conclusions: Transgender people (particularly trans males) have higher levels of anxiety symptoms suggestive of possible anxiety disorders compared to the general population. The findings that self-esteem, interpersonal functioning, and hormone treatment are associated with lower levels of anxiety symptoms indicate the need for clinical interventions targeting self-esteem and interpersonal difficulties and highlight the importance of quick access to transgender health services. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: journal abstract)
    • 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)
    • Understanding factors that affect wellbeing in trans people "later" in transition: a qualitative study

      Aldridge, Zoe; Thorne, Nat; Marshall, Ellen; English, Cara; Yip, Andrew K. T.; Nixon, Elena; Bouman, Walter P.; Arcelus, Jon (2022)
      PURPOSEAlthough cross-sectional studies have demonstrated that trans people present with lower quality of life and wellbeing than the general population, few studies have explored the factors associated with this, particularly in those who have medically transitioned some time ago. This paper aims to fill the gap in the literature on what factors are associated with wellbeing in trans people who initiated medical transition some time ago.METHODSThis study used semi-structured one-to-one interviews with 23 participants to investigate the factors that impact upon the wellbeing of trans people who had initiated Gender Affirming Medical Treatment five or more years ago. The content of the interviews were analysed with an inductive, grounded theory approach to identify common themes within them.RESULTSThe four themes identified include some consistencies with cisgender populations (while being viewed through the lens of trans experience), as well as those more specific to the trans experience. Together these themes were: Interactions with healthcare services; Seeking societal acceptance; Quality of social support; The 'double-edged sword' of media and social media. Each of the themes identifies a factor that participants highlighted as impacting, either positively or negatively, on their wellbeing.CONCLUSIONSThe results highlight the importance of social support, protective legislations, awareness of trans issues in the general public, and the need of improving the knowledge held by non-specialist healthcare providers.
    • Video gaming and gaming addiction in transgender people: An exploratory study

      Arcelus, Jon; Bouman, Walter P.; Jones, Bethany A.; Richards, Christina (2017)
      Background: There is anecdotal clinical evidence that transgender people use the online world - such as forums and online video gaming - for the purpose of experiencing their gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. Aims: To describe gaming behavior, degree of problematic gaming behavior and associated factors with problematic gaming in a comparatively large group of transgender people accessing transgender health services. Methods: Every individual referred to a national transgender health service in the United Kingdom during a 12-month period was invited to complete a series of questionnaires to measure gaming behavior, interpersonal functioning, severity of autistic features, and anxiety and depressive symptoms. Results: A total of 245 people agreed to participate in the study with 154 (62.9%) describing themselves as current gamers. Gaming behavior in the transgender population attending transgender health services was prevalent, but less than 1% of them presented with clinical scores for Internet Gaming Disorder, with no differences according to gender. Problematic gaming behavior was associated with general interpersonal problems, depression, and young age. Discussion and conclusions: Transgender people who engage in problematic gaming behavior are younger, and present with high interpersonal problems, and depression, which can affect a successful transition. In view of the high levels of gaming activity in this population games that are designed to address these psychological problems may be well received by transgender people. © 2017 The Author(s).
    • Video gaming and gender dysphoria

      Arcelus, Jon; Bouman, Walter P. (2016)
      Video gaming has become an established area of research over the last two decades. Relatively little research has been carried out in the area of in-game gender swapping. The aim of this study is to review the available literature looking at gender dysphoria and gender swapping in video games. And to use clinical cases to investigate the role of video games among the trans population.
    • Video gaming and gender dysphoria: Some case study evidence

      Bouman, Walter P.; Arcelus, Jon (2016)
      During the last two decades, videogames have been occupying an established field of psychological research. In recent years there has been an increase in online gender research, showing that for many groups or individuals this may have psychological benefits (for example, as a way of exploring the functions and gender boundaries in one safe environment). To date, no research has examined the online gender change in individuals with gender dysfunction - people with gender identity problems. Using four case studies, this exploratory study examined the role of gambling in the lives of individuals seeking treatment for gender dysphoria. The main goals were to use exemplary case studies to show that playing games online can be - in some circumstances - a functional way to deal with degenerate identity problems, and that gender change in games can help these individuals to improve gender dysphoria We discuss the limitations of the data collected and suggest recommendations for future research.
    • 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.
    • 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.
    • 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.