Jun 262017
 

All lesbian, gay, and bisexual (LGB)* people are not the same. I’ve long been an advocate that it’s not “the LGB community”, it’s “the LGB communities“. Even within just the lesbian “community”, there are subgroups. Everyone has different experiences, needs, and expectations. There is no one universal experience, and no monolithic community.

The easiest example is gender nonconformity. Within lesbian and female bisexual communities, for example, there are women who dress and act more masculine (“butch”) and women who dress and act more feminine (“femme”). The same is true for gay and male bisexual communities. Another example is “coming out”. While it’s a common experience, it’s not universal. I myself never had to “come out” to my family because my family was very accepting.. Bisexual people who date/marry opposite sex partners may also not choose to come out.

Despite differences, we know that there are some generalities about LGB communities. We know that LGB people, as a whole, have higher rates of depression than their straight peers. But we also know that not all LGB people have depression. Could gender nonconformity be the key?

Portrait of a boy, c. 1800. A boy who looked like this might well end up with depression after being teased and bullied.

Portrait of a boy, c. 1800. A boy who looked like this might well end up with depression after being teased and bullied.

Today’s study looked at depression, gender nonconformity, and LGB status among young adults in the United States. They used data from the Add Health study. Add Health was a study that started in schools and continued through until the participants were up to 32. The participants in today’s study were age 18-32. 86.7-93.1% of the sample (women-men range) were heterosexual. The rest were mostly heterosexual, bisexual, mostly lesbian/gay, or lesbian/gay. Depression was measured with a validated scale. Sexual orientation was rated on a Kinsey-type scale. And gender non-conformity was measured with a scale of activities, including team sports, religious activities, video game use, housework, and social activities.

What were the results?

At first, it looked like all the non-heterosexual participants were at higher risk for depression. Bisexuals had more depressive symptoms than lesbian and gay participants. However once they controlled for gender nonconformity, lesbians and gay men did not have more depression symptoms than heterosexuals. Bisexual participants continued to have higher rates of depression and controlling for gender nonconformity.

Who tended to be gender nonconforming? Young men were more nonconforming than young women. Lesbians and gay men were more nonconforming than all the bisexuals (including mostly straight and mostly gay), who were about as nonconforming as straight participants.

And the depression? Young women were more depressed than men. Black, Latino, and Asian participants were also more likely to have it. The same was true for those with low parental education levels and families with financial problems. Participants who were gender nonconforming reported more symptoms of depression than those who were conforming.

Lastly, the researchers looked at whether that depression held over time. Gender nonconformity did not predict depression in the future. Bisexuals, lesbian, and gay young adults were also not at risk for future depression; only depression in the moment. However individuals who identified as mostly heterosexual continued to have higher rates of symptoms. Individuals who are Black, Asian, female, had low parental education levels, or severe family financial problems, continued to have depression symptoms.

What does this really mean?

LGB young adults as a whole continue to be at higher risk for depression. However, that risk appears to mostly be an effect of gender nonconformity as a young adult. Those who are gender nonconforming as young adults are at higher risk for depression as young adults, but six years later that risk goes away. Why? Gender nonconformity is visible, and likely to result in the individual being a target for discrimination, which can result in depression. But then why doesn’t it continue six years later? Either the discrimination reduces (teenagers can be notoriously mean to each other), or the individuals develop coping skills or move into a more accepting community.

Additionally, bisexuals and mostly heterosexuals are at higher risk for depression than lesbians and gay men. Why? Well, it might be because they can “hide” and look heterosexual. That means they don’t need to “come out”. But it also means there’s less acceptance and acknowledgement of their orientation. That could have big effects.

What do we do with this information?

First, we can keep an eye out for the gender nonconforming young adults in our communities, whether they’re straight, bisexual, gay, or somewhere in between. We can support them when they need it. And second, we can create a more accepting environment. The less discrimination and the more acceptance of gender nonconformity, the less depression we are likely to see. We can make the world a positive place to be for everyone.

Want to read the abstract for yourself? The abstract is publicly available.

*: Please note that although today’s article does not use the word “cis” throughout despite the implication. The study in question examined cis individuals. However in my language, I use “men/male” and “women/female” to refer to gender identity, not biologic sex. So the general statements I make are intended to be inclusive of both cis and trans individuals, who can be lesbian/gay, bisexual, or straight.

Oct 052015
 

480px-RGB_LED_Rainbow_from_7th_symmetry_cylindrical_gratingI’ve been saying for years now that the phrase “LGBT community” is insufficient when it comes to health. It’s not one community — it is multiple communities. The social issues and health issues that a gay transgender man faces every day are different from the issues a bisexual cisgender woman faces every day. There are some similarities and grouping the communities together has been politically useful. But it should never be forgotten that L, G, B, and T all face different types of health concerns and have different civil rights battles to face.

A study came out in August that has to be one of my favorites this year. Researchers in Georgia surveyed over three thousand lesbian, gay, bisexual, pansexual, transgender, gender non-conforming, and queer people. They asked about health behaviors of all kinds. And then they did statistical analysis, comparing the various genders (cis male, cis female, trans male, trans female, genderqueer) and sexual orientations (lesbian, gay, bisexual, pansexual, queer, straight). Let’s look at what they found!

  • Diet and exercise: The researchers asked about fatty foods, eating while not hungry, quantity of vegetables and fruits eaten, and about hours and types of exercise. Transgender women had the least healthy diet of all genders. As a group, they were less likely to eat many fruits and vegetables, and more likely to drink sugared drinks and eat when they weren’t hungry. Both cisgender and transgender men were also less likely to eat many vegetables compared with other groups. Genderqueer people and gay cisgender men were most likely to exercise.
  • Substance use: The researchers asked about smoking tobacco and alcohol consumption. Cisgender men were the most likely to drink alcohol, binge drink, and to drink even when they didn’t want to. Participants who identified as queer were also more likely to drink. When it came to tobacco, transgender men and straight participants were the most likely to smoke.
  • Motor vehicle risk: The researchers asked about seatbelt use, speeding, and texting while driving. No clear differences for speeding were noted. Transgender men and straight participants were most likely to drive without a seatbelt. Texting while driving varied considerably; gay and lesbian drivers were most likely to text while driving.
  • Sexual behaviors: The researchers asked about frequency of unprotected sex and sex while intoxicated. Gay men were least likely to have unprotected sex while lesbian women were most likely to have unprotected sex. When it came to sex while intoxicated, only the bisexual participants stood out as being most likely among the groups to have sex while intoxicated.
  • Violence: The researchers asked about self harm and expressing anger at others. Overall rates of interpersonal anger were very low. Transgender men and pansexual people were most likely to self harm.
  • Medical risk taking: The researchers asked about delaying medical care and not following physician advice. Transgender women were least likely to seek care; 1/3 reported that they regularly delayed seeking medical care. Both transgender women and transgender men were more likely to not follow medical advice when it was given. Bisexual people were also more likely to delay seeking medical care compared to lesbian and gay participants.

That’s a mouthful, right? There are a lot of details I left out of this summary and it still threatens to be overwhelming with detail. So how we can break this down even more simply? By talking about the conclusions.

The researchers go into some possible causes for all these different results. Maybe gay men are safer about sex because of HIV risk. Maybe transgender men eat few vegetables because of cultural expectations that “men eat lots of meat and not many vegetables.” Maybe gay and lesbian people text more while driving because of the lack of community-specific messages.

Maybe. And they’re all good thoughts.

I tend to look forward more to what we can do with these data. I’m pretty happy with this study — it’s one of the broadest I’ve seen for inclusion. Few health-oriented pieces of research include pansexual and genderqueer individuals.

It’s important to remember that these results are at the group level. Any individual person who is a gender/sexual minority will have their own health behaviors and risks. They should be evaluated and treated as individuals. From a public health perspective though, this research brings valuable data. Only by knowing what each group faces can prevention, screening, and treatment campaigns be created. Only by knowing, for example, that transgender and bisexual people avoid seeking medical care can we then examine “why?” and act to remove the barriers so that appropriate, respectful medical care is available.

So — can we change the conversation? Instead of talking about “the LGBT community”, let’s talk about “the LGBT communities”. Or, even better, “gender and sexual minority communities” — removing the alphabet soup and expanding the definitions at the same time. This research is only the tip of the iceberg. We have so much more to explore.

The paper is published online ahead of print. The abstract is publicly available.

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.
Jan 182013
 

Book Cover - http://genderborngendermade.com/

Gender Born, Gender Made: Raising Healthy Gender Non-Conforming Children was written by Dr. Diane Ehrensaft and published in 2011. Dr. Ehrensaft is a psychoanalytically trained developmental and clinical psychologist. Her practice includes transgender and gender non-conforming youth, and she works closely with Gender Spectrum, which also works with such youth.

How to summarize the book? It is an exploration. Dr. Ehrensaft pulls strands from her experiences working with children (including her own) to weave a tapestry of stories which she uses to address everything from the varying experiences of gender, psychological theories surrounding gender, to parental and sibling reactions and experiences. Some of the stories are heartwarming; some heartbreaking.

Underlying this is Dr. Ehrensaft’s refreshing philosophy: Let the children explore freely and guide. She also describes the psychoanalytic perspective and Zucker’s reparative perspective as contrast. In all, though, the book is very light on theory and rich with anecdotes, demonstrating helpful and harmful approaches and the varying ways children react to and explore their gender.

Who should read it? I think it was primarily intended for parents of gender non-conforming children. Therapists treating families with gender non-conforming children may find some of the terminology and ideas useful in their own practices. The language is accessible for a lay audience, and Dr. Ehrensaft uses pronouns with respectful grace and skill.

Overall, I recommend it. Besides, look at that adorable child on the cover. How can you resist?

Oct 252012
 

LGBT youth are at elevated risk for suicide. Researchers have been looking into the risk factors for suicide in LGBT youth. Most of the studies so far have been cross-sectional; that means they only studied how things are once, at one point in time. Longitudinal studies, in contrast, measure at multiple points in time. Longitudinal studies are expensive, and risk losing track of participants, but they provide more information.

This year, the first longitudinal study of LGBT youth suicide risk factors was published. The participants were interviewed twice, a year apart. Both times, they were psychiatrically evaluated and asked about suicide attempts. They filled out questionnaires evaluating hopelessness, impulsivity, social support, gender non-conformity, age of same-sex attraction, and LGBT-related victimization.

In this sample, roughly 31.6% of the participants had attempted suicide. This is far higher than the 8% rate reported by the CDC. Seven variables were associated with previous suicide attempts: hopelessness, impulsivity, LGBT-related victimization, low family support, being younger when first feeling same-sex attraction (for LGB youth), and symptoms of either depression or conduct disorder. That is, the more hopeless or impulsive the youth, the more likely it is that they have previously made a suicide attempt. Gender non-conforming behavior and peer support did not seem to affect suicide risk. When it came to predicting future suicide attempts, the best predictor was previous suicide attempts. Youth who had previously attempted suicide had a 10 times greater risk of another attempt compared to those who hadn’t attempted suicide.

As always, these results should be accepted with caution. For example, this study did not find that gender non-conforming behavior was associated with suicidality. This is in contrast to other studies which did find an association. This study’s participants may not be representative of the population. They also had a small (ish) sample: 237 participants; 21 were transgender, and 13 had attempted suicide. Small sample sizes can limit a study’s ability to detect statistical significance. Gender non-conforming behavior may actually be associated with suicidality, but this study may not have had a large enough sample to detect it.

For me, this study brings up the question: How do we prevent suicide attempts in our LGBT youth who have already attempted suicide? They’re the most at risk for future attempts, according to this study. I don’t have a solid answer; neither do the researchers. But they do say that “The current findings underscore the need for increased prevention efforts and specifically point to the value of targeting youth who have made a prior attempt and who acknowledge their same-sex attractions at younger ages.”

Study Abstract – Full Text – Archives of Sexual Behavior