Aug 312015
 
Psy_II

The Greek letter Psy is often used to symbolize psychology or the APA.

The American Psychological Association has released a 55-page document detailing guidelines for psychologists treating transgender and gender non-conforming individuals. To my knowledge, this is the first such document the APA has published. It’s a huge milestone in trans mental health care.

APA guidelines provide standards for both trainees and practicing psychologists on the expected conduct of psychologists. They’re used in both introductory and continuing education.

In this document, the APA lists out the following guidelines (note that TGNC stands for “transgender/gender non-conforming”):

  1. Psychologists understand that gender is a non‐binary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth.
  2. Psychologists understand that gender identity and sexual orientation are distinct but interrelated constructs.
  3. Psychologists seek to understand how gender identity intersects with the other cultural identities of TGNC people.
  4. Psychologists are aware of how their attitudes about and knowledge of gender identity and gender expression may affect the quality of care they provide to TGNC people and their families.
  5. Psychologists recognize how stigma, prejudice, discrimination, and violence affect the health and well‐being of TGNC people.
  6. Psychologists strive to recognize the influence of institutional barriers on the lives of TGNC people and to assist in developing TGNC‐affirmative environments.
  7. Psychologists understand the need to promote social change that reduces the negative effects of stigma on the health and well‐being of TGNC people.
  8. Psychologists working with gender questioning and TGNC youth understand the different developmental needs of children and adolescents and that not all youth will persist in a TGNC identity into adulthood.
  9. Psychologists strive to understand both the particular challenges that TGNC elders experience and the resilience they can develop.
  10. Psychologists strive to understand how mental health concerns may or may not be related to a TGNC person’s gender identity and the psychological effects of minority stress.
  11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans‐affirmative care.
  12. Psychologists strive to understand the effects that changes in gender identity and gender expression have on the romantic and sexual relationships of TGNC people.
  13. Psychologists seek to understand how parenting and family formation among TGNC people take a variety of forms.
  14. Psychologists recognize the potential benefits of an interdisciplinary approach when providing care to TGNC people and strive to work collaboratively with other providers.
  15. Psychologists respect the welfare and rights of TGNC participants in research and strive to represent results accurately and avoid misuse or misrepresentation of findings.
  16. Psychologists seek to prepare trainees in psychology to work competently with TGNC people.
This is all excellent.
There is a history of psychologists attempting to change gender identity through conversion therapy or other coercive means. The APA’s statement, in effect, states very strongly that attempts to change gender identity should not be attempted. Instead, the APA is embracing the ethical treatment of transgender people and of affirming transgender and gender non-conforming people.
Do these guidelines mean anything for you if you’re receiving therapy? Possibly. Talk with your therapist, whether you’re trans or cis, to make sure they’ve seen the updated guidelines. If you’re receiving therapy that is not within these guidelines, consider talking with your therapist about these guidelines or seeking another therapist.
And spread the word! The document itself is publicly available as a PDF.
Jun 012011
 

For “older” adults, the IOM uses retirement age (around 60) as their starting age. For this group, there are no well-studied areas of health (beyond HIV/AIDS, which I don’t cover here). I’ve decided to leave the conclusion portion for another post – the last in this series.

  • Depression: Definitely more frequent in LGB elders than heterosexual elders. A very significant mental stress for this group is surviving the start of the HIV/AIDS epidemic. One study of elder gay/bisexual men found that 93% of them had known others who were HIV+ or had died of AIDS. There is no empirical data on rates of depression in elder transgender people, but it’s thought to be high.
  • Suicide/suicidal ideation: Empirical data suggest the rates of suicide are higher in LGB elders. No data on transgender elders.
  • Sexual/reproductive health: This is a rarely studied area. PCOS and its related risks may be an issue in some transgender elders. There is some indication that gay/bisexual men may be at the same risk as heterosexual men for prostate cancer. Early research implies that “lesbian bed death” may be a real phenomenon, but it’s a controversial topic. All cis-gendered women (bisexual, heterosexual, or lesbian) appear to have the same rate of hysterectomies. Sexual violence was reported on for transgender elders and it appears to be high. One study found about half of transgender elders had experienced “unwanted touch” in the past fifteen years.
  • Cancers: There are no data on cancers and transgender elders. Elder gay/bisexual men are at a higher risk of developing anal cancer (which is linked to receiving anal sex and HPV). Non-heterosexual women also appear to be at a higher risk for reproductive cancers (due to risk factors like smoking and obesity).
  • Cardiovascular health: Data appear to be conflicted. Transwomen using estrogen may be at a higher risk for venous thromboembolism (this may be because of the specific forms of estrogen used). There’s an association between transgender people getting their hormones from someone other than a doctor and poor health outcomes (e.g., osteoporosis, cardiovascular disease). The relevant transition hormones may cause long-term health problems at high doses, but no studies have really looked at this.

Risk factors include those for the younger age groups. Ageism within the LGBT communities may be an additional challenge for LGBT elders. Elders may also feel they need to hide their orientation if they move into a retirement home. Some retirement homes may also be discriminatory.  Transgender elders especially face very high threats of violence.

Some studies have found that elders felt more prepared for the aging process by being LGBT. Why? They’d already overcome huge difficulties. They’d already done a lot of personal growth. LGBT people are also more likely to have education beyond high school, and education is a well-known protective factor for the negative effects of aging. Conversely, some LGBT elders reported fewer relationship and social opportunities, being afraid of double discrimination, and problems with health care providers.

As for elder interactions with the health care system, again there’s a lot in common with younger age groups. One out of four transgender elders report being denied health care solely because they were transgender. Elders in general face problems if they need to enter assisted living homes, as some homes are discriminatory. It’s also worth noting that LGBT elder social structure is different from heterosexual social structure. LGBT elders rely much more on close friends than relatives (and/or adult children). Their chosen families are less likely to be recognized by the medical community, especially without legal paperwork.

So that’s it for what I’ll summarize from the report. Thanks for sticking around for it… this is hefty stuff.

May 012011
 

On March 31, the Institute of Medicine released a report on LGBT (lesbian, gay, bisexual, transgender) health. It’s a fairly important document, but it is almost three hundred pages long… So I’m going to cover it in several posts. There’s a lot of material in it, and I’m not going to cover it all. The bulk of the material I am covering is broken up by age group: childhood/adolescence, early/middle adulthood, and later adulthood.

As a note: when I say LGB in these articles, I really do mean just lesbian, gay and bisexual people. Some of the studies referenced only include sexual orientation, not gender identity.

Health of LGBT Children and Adolescents

In general, studies on LGBT youth health are scarce. Most of the studies that do exist focus on mental health (because chronic disease generally doesn’t affect young people). Most LGB youth are well-adjusted and happy.

What is known? Compared with heterosexual/cisgender youth:

  • LGB youth definitely have a higher rate of suicidal ideation (thinking about committing suicide) and suicide attempts. This is true regardless of age, substance use, sex/gender, and race/ethnicity. Transgender youth may also be at a higher suicide risk.
  • LGB youth seem to have higher rates of binge eating. In addition, young gay and bisexual men seem to have a higher rate of purging.
  • What few studies have looked at LGB youth and pregnancy found that they either had similar or higher rates of teen pregnancy.
  • LGB youth may be heavier than their heterosexual peers

Health risk factors:

  • Harassment, victimization, and violence: LGBT youth report higher levels of these than heterosexual/cisgender youth. The harassment can occur at school or at home. Harassment at school is associated with lower grades, less school involvement and health problems. LGBT youth are also at a higher risk of punishment from school officials, police, or courts than heterosexual youth.
  • Substance use: LGB youth use more drugs (including alcohol and tobacco) younger than heterosexual youth.
  • Homelessness: LGBT youth are at a much higher risk for becoming homeless, and this risk appears to increase with age. 22-35% of all homeless youth are LGB. LGB youth are at a higher risk than heterosexual youth for being victimized or discriminated against while homeless. They are also at significant risk for “risky sexual behavior” (like prostitution).
  • Childhood abuse: LGBT youth are at a higher risk for being sexually or physically abused.

As for protective factors…there aren’t any data yet. They’re working on it, though!

Other findings? It’s pretty well known that young people (adolescents) are uncomfortable talking about sex with their doctors. However, some small preliminary studies have found that doctors generally don’t ask about sexual orientation (or gender identity)! Some doctors feared upsetting their patients. Others weren’t sure how to handle a sexual minority patient. Others had negative impressions of LGBT people. All this makes me rather sad. 🙁

…and that’s it for what’s in the literature. There is, of course, lots more to young LGBT health…but it hasn’t hit the medical and psychiatric literature yet (meaning that there aren’t any studies).

Next time!: Health of LGBT adults

Apr 102011
 

UCLA recently published a report on California LGB (lesbian, gay, or bisexual) elders and their health. This was part of the California Health Interview Survey. They looked specifically at LGB elders, aged 50-70, and how their health compared with straight elders.

Their main findings:

  • In general, the differences between LGB and straight elders were more prominent for men than women.
  • LGB elders are more likely to be living alone than straight elders. About half of all gay or bisexual elders live alone, and only 13.4% of straight elders live alone. For women, about 28% (a little more than 1 in 5) of lesbian or bisexual elders live alone, and about 19% straight elders live alone. Why? The report points to differences in social structures: “The majority [of LGB elders] have spent their early and middle adulthood creating independent and self-sufficient lives. Fewer LGB than heterosexual adults have children, so as they enter a time in life when support from children and biological kin are increasingly important to maintaining independence, these supports are less likely to be there than for heterosexual individuals.”
  • LGB elders are more likely to have certain chronic diseases than straight elders. Specifically, men were more likely to have hypertension, diabetes, psychological distress syndrome, physical disability, or self-report that their health was “poor” or only “fair”. For women, higher rates of psychological distress syndrome, physical disability, and self-reporting. Psychological distress syndrome seems to be referring to a non-specific mental illness, most likely depression or anxiety.
  • LGB elders visit the doctor more frequently than straight elders, and LGB women are more likely to delay seeking medical attention.
  • LGB elders are not more likely than straight elders to have heart disease, delay filling prescriptions, visit the emergency room, or to lack a regular health care provider.

Some other interesting things that they found:

  • about 2.3% of elders were LGB
  • LGB elders were more likely than straight elders to have a graduate degree.

This report did NOT look at:

  • HIV infections. They did summarize other estimates stating that one in five gay men are living with HIV. Their results may be reflecting HIV infection-related health issues.
  • Quality of care. They did state that “Past research has documented that discrimination, homophobia, and a lack of ‘cultural competence’ can affect the quality of health care for lesbian, gay and bisexual adults”.

The statistics on the numbers of elders living alone means that they may need help…whether from the community in general, their local government, or through programs like GLEH and OpenHouse. Also, LGB elders appear have poorer health than their straight counterparts. I want to know why: is it the additional stress from homophobia? Is it from HIV? Is it from poor quality of care? Third, GLB elders appear to be having more money difficulties than straight elders. This may be due to institutionalized homophobia, especially not having same-sex partners recognized by Medicare and Social Security.