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.
Mar 162015
 

170px-Rod_of_Asclepius2.svgBeing a gender or sexual minority (GSM) is not only difficulty and tricky for patients — it can also be a challenge for medical providers. Medicine can be a particularly conservative field, depending on location and specialty. Lives are, after all, often at stake.

Despite recent advances it appears that some 40% of lesbian, gay and bisexual medical students are hiding their sexual minority status in medical school. Among transgender medical students, 70% were hiding their identity. All because of fear of discrimination.

That fear has been, and still is, warranted. From medical providers transitioning and losing their practices, to medical students losing their residency slots, to LGBT health student organizations fighting to exist, LGBT providers face similar discrimination as our patients.  Similar happens for other gender and sexual minority health care providers, though we lack statistics. At a meeting of kink-identified mental health care providers, one attendee noted a high level of vulnerability for the clinicians. Being “outed” could lose them their jobs or even trigger legal action.

To some extent, discretion among health care providers is warranted. Most people don’t want to know about their clinician’s (or coworker’s) personal lives. And most GSM providers don’t actually want to share those most intimate details. It’s where the line is that can be distressing — how much information is too much? Can I discuss my wife when other women clinicians are discussing their husbands? How exactly do you notify your fellow clinicians or patients about a change in gender pronouns or name? How can a clinician use information gained from intimate encounters to help patients, without revealing too much? It’s a balance we constantly seek. Sometimes mentors are there and can help. Other times we figure it out as we go along.

Yet we bring a lot to the table, as minorities. Like many racial and ethnic minorities, there are pressures and issues that affect GSM people more than the majorities. We bring that knowledge with us to the research we choose to perform, the communities we participate in, and each and every patient encounter.

We as clinicians and future clinicians need to have the support in order to be appropriately open about our gender and sexual minority status. Our patients and clients must know they can be safe and honest with us so they can receive the most complete and respectful care possible.

Some progress has been made already. There’s an association for LGBT medical professionals. There’s an association for kink psychological research. There’s an association for transgender health. All of which allow student members and provide mentoring. Many other organizations exist too. Some US medical schools are working with their students to provide a safe and welcoming environment where these issues can be explored. The American Association of Medical Colleges recently launched a program to enhance education surrounding LGBT and intersex health care. The American Medical Association also has an LGBT Advisory committee.

I’m proud to say that my medical school has been accepting and supportive of its gender and sexual minority patients, and that clinics in the area of my medical school are seeking to expand their care to be more inclusive of LGBT patients. Support exists for both those seeking medical care, and those seeking to provide that care. It’s only the beginning.

Apr 162014
 

One of the premier medical journals, the New England Journal of Medicine, regularly has perspective/opinion pieces. For a pre-med like me, they can be some of the most valuable pages in the journal — they can be windows into medical practice, public policy and the study and practice of medicine. I read them regularly, since my wife got me a subscription to NEJM. Most aren’t related to gender and sexual minority health, so I haven’t addressed them here much. But in the April 10th edition of NEJM, a treasure! Gilbert Gonzales did a good summary of the intersection between same-sex marriage and health.

Many health journals, including NEJM, tend to live behind a pay wall. This particular article, thankfully, is not. But in the interests of public knowledge and discourse, I wanted to summarize some of the interesting points in this article. A heads up: this is a distinctly United States-focused article.

  • Despite recent advances, roughly 60% of the US population lives in a state that prohibits same-sex marriage
  • There are significant health disparities between LGBT and heterosexual/cisgender people, as shown by the 2011 Institute of Medicine report on LGBT health (which I summarized in 3 parts at the time).
  • Discriminatory environments lead to poorer health outcomes. Example: LGBT people in states that ban same-sex marriage have higher rates of depression, anxiety, and alcohol use than straight/cis people in the same states. By the same token, states where same-sex marriage (e.g., MA and CA) was legalized show a drop in mental health care visits for some GLBT people (e.g., gay men).
  • Legalizing same-sex marriage improves access to health insurance for both same-sex spouses and children of same-sex parents.
  • The Affordable Care Act prohibits insurance companies from denying health insurance coverage because of sexual orientation, transgender identity, or pre-existing conditions like HIV.
  • The recent decision on DOMA (United States v Windsor) means couples in a same-sex marriage get taxed like other married couples. This lowers the tax burden of health care costs and health insurance.
  • Health benefits of same-sex marriage should be included in discussion of marriage equality.

All good things to point out, and good to see in such a mainstream medical journal.

We’re lucky enough that the NEJM has decided to have this article be open access. So if you can, read it to form your own opinions!

And as always…  Stay healthy, stay safe, and have fun!

Aug 062013
 

CC BY-NC 2.0 - flickr user springfieldhomerTime for the monthly summary of the latest gender and sexual minority, and sexuality, related news!

  • The American Heart Association released a consensus that physicians should counsel people about resuming sex after a heart-related illness (e.g., heart attack, stroke, pacemaker installation). Apparently physicians have not be doing that. Oops! More information here.
  • Risk factors for developing PTSD (post-traumatic stress disorder) after exposure to a traumatic event have been further explored in adolescents. 61% of teens in this study were exposed to a potentialy traumatic event, but only 4.7% of the teens in the study actually developed PTSD. Risk factors included: previous diagnosis of a mood or anxiety disorder, being female, and the type of event. Interpersonal traumatic events (e.g., being raped or assaulted by another person) were associated with a higher risk of PTSD. Why bring this study up? Because GSM youth are at high risk for traumatic events! More info.
  • Virginia Johnson passed away due to natural causes. She was one half of the Masters and Johnson team that did pioneering work on sexuality in the 1960s. Condolences to her friends, family and loved ones. More info.
  • The X chromosome may have a role in sperm production. Not at all surprised by this – after all, the idea of the X chromosome as the “female” chromosome and the Y chromosome as the “male” chromosome are based in human perception, not pure biology. More info.
  • Female survivors of childhood sexual abuse may benefit from writing about their experiences. A study found that female survivors who specifically wrote about how the abuse changed the way they thought about sex had improved sex lives. Abstract.
  • PSA, prostate-specific antigen, may be useful as an indicator of testosterone level. While PSA’s usefulness as a screening tool for prostate cancer is still under debate, this other use is an interesting idea. It’s not currently in use for detecting low levels of testosterone, but it might be in the future. Cool! Abstract.
  • The average penis size has been determined. Again. Sorta. This study was internet, self-report based. So who really knows? This study reports that the average erect penis is 14.15 cm (5.57 in) long with a 12.23 cm (4.81) circumference. The racial makeup and age of the sample was not reported in the abstract. Abstract.
  • Sex addiction does not appear to be an addiction, according to a study out of UCLA. Interesting and not altogether surprising. Press release.
May 022013
 

 

CC BY-NC 2.0 - flickr - Jonathan Gill Summary of some of the interesting news bits from April 2013.

  • Researchers in Sweden find that early vaccinations against HPV are more effective than late vaccinations (93% effective before 14 years, 76% after 14 years and before 20 years). Abstract. Open Source Full Text.
  • Despite low risk of side effects and mild side effects, fewer U.S. parents were less likely to vaccinate against HPV in 2010 than in 2008 (43.9% unwilling to vaccinate in 2010 vs 39.8% unwilling in 2008). AbstractOpen Source Full Text.
  • Anal cancer rates have dramatically increased since 1973. Abstract.
  • Roughly 3/4ths of men who show “hypersexual” behavior report being distressed by it or having functional problems. Slightly more than half have relationship problems. Abstract.
  • Attitudes about female circumcisions have been assessed via Facebook in the “Middle East”. Female circumcision is done by doctors about half of the time, and was more common in rural areas than urban areas. Nearly half of the sample indicated that female circumcision was “necessary” or “very necessary.” Abstract.
  • Persistant genital arousal disorder may be caused by a mass, according to a recent case study.
  • In women with menstrual cycles, estrogen may have a delayed positive effect on libido. Progesterone may have a negative effect on libido. News article.
  • The U.S. Department of Justice has issued new guidelines for medical examinations after a rape. These guidelines now emphasize the survivor’s emotional and physical needs over any forensic needs. News articleGuidelines.
  • Recent cases of meningitis in gay men raised concerns that gay men may be at risk. After analysis the cases appear not to have been related. Gay men who have been sexually active in or around New York City since September 1st are still advised to get a meningitis vaccine to be on the safe side. News article.

Why the flower picture? It’s a tongue-in-cheek reference to the “flower of the month.” Besides, it’s pretty!

Did I miss anything? Let me know in the comments.

Hope you all had a lovely month!