Have you had gender-affirming genital surgery? you can improve patient outcomes today!

Gender COS

Have you ever wondered how researchers, providers, and patients figure out how to measure success?

In some organizations, this requires researching what’s already been pulled together, like conducting a review of published research and journal articles.

Even if they do that, some groups also come together to create what’s known as a Core Outcome Set or COS.

A group is working to come up with a COS for genital surgery. It is vital that transgender and gender diverse folks are a part of this research —otherwise, it won’t encompass the right outcomes.

Interested? You can participate if:

  • You are transgender and/or gender diverse and have undergone genital gender surgery at least 3 months ago & you can read and understand English, Spanish or Dutch AND you are of legal age to undergo genital gender surgery in country of received surgery
  • You are a surgeon specialized in genital gender surgery (plastic surgeons, general surgeons, urologists, gynecologists)
  • You are another type of professional in gender healthcare, related to gender surgery (such as psychologists, endocrinologists, physiotherapists, sexologists, physician assistants, nurses, psychiatrists)
  • OR/AND Authors who have published at least 5 articles on research into genital gender surgery and who have also worked in gender care.

Learn more here

Please note that I am not affiliated with this group. I’ve worked on several COS for other research groups, such as OMERACT, though. So, if you have questions about the general COS process, I’m happy to chat!

Photo used courtesy of Gender Spectrum

Experiences of Conversion Practice by Race, Ethnicity, and Gender

The following is a press release issued by The Pride Study on Wednesday, March 13, 2024:

Official Title

Inequities in Conversion Practice Exposure at the Intersection of Ethnoracial and Gender Identities

Community Title

Experiences of Conversion Practice by Race, Ethnicity, and Gender

What Did We Do?

Conversion practices refer to organized attempts to change the sexual orientation and/or gender identity of people who are LGBTQIA+. Some examples include religious rituals and therapy intended to cause a person to associate negative thoughts with being LGBTQIA+. We looked at experiences of conversion practice in The PRIDE Study’s Lifetime Health and Experiences Questionnaire from 2019-2021 among LGTBQIA+ people. We asked participants if they had any conversion practice experiences in their lifetime, the age when they first experienced conversion practice, and the age when they last experienced conversion practice. We then looked at how experiences of conversion practice differed by race, ethnicity, and gender.

What Was New, Innovative, or Notable? 

This is one of the first studies that looked at how experiences of conversion practice differ by race, ethnicity, and gender. We considered how different identities experience power and oppression and how this may have shaped the experiences of conversion practice for different LGBTQIA+ groups.

What Did We Learn? 

There were 9,274 LGBTQIA+ participants in the study. Of them, 5.7% of LGBTQIA+ participants reported any experiences with conversion practice in their life. On average, participants were 18 years old when they first experienced conversion practice and 21 years old when they last experienced it. This resulted in an average of 3 years between their first and last experience with conversion practice. A higher percentage of transgender and nonbinary participants reported conversion practice experiences, especially participants who are American Indian or Alaska Native and/or Middle Eastern or North African.

What Does This Mean for Our Communities? 

Systems of power and oppression may likely shape differences in conversion practice experiences across LGTBQIA+ groups. This may be important for creating federal and local policies that ban conversion practice to protect LGBTQIA+ groups and reduce the harmful effects of such practices, especially for communities who may be affected the most.

What’s Next? 

We plan to look at how different experiences of conversion practice affect mental health. This involves understanding how practices targeting sexual orientation, gender identity, or both can impact mental health differently for LGBTQIA+ individuals.

Citation

Tran NK, Lett E, Flentje A, Ingram S, Lubensky ME, Dastur Z, Obedin-Maliver J, Lunn MR. Inequities in Conversion Practice Exposure at the Intersection of Ethnoracial and Gender Identities. Am J Public Health. 2024, March 13; 114 (4): 424-434. doi: https://doi.org/10.2105/AJPH.2024.307580

Gov. DeWine: Please Veto HB 68

Gov. DeWine: Please Veto HB 68

According to a 2022 survey, transgender adults make up just 0.51% of Ohioans. That’s roughly 46,000 adults. As of 2021, there were 11.78 million people in the state. There were approximately 8500 trans folks between the ages of 13-17 and another 12,200 aged 18-24. HB 68 would prevent the under-18 group from accessing puberty blockers (which pause puberty and are harmless), hormone replacement therapy (HRT), some types of mental healthcare, or other gender affirming healthcare. Health care professionals who provide these kinds of care could lose their licenses and be sued.

It would also affect the ability of specifically trans women and feminine people to play sports in Kindergarten through college. Earlier this spring, the Ohio Cap Journal reported that there were only six trans girls playing sports in Ohio who would be affected.

That’s right — six.

This is clearly transmisogyny, a particular form of both sexism and transphobia that work together to harm trans girls, women, and feminine folks.

Considering the six, it’s wild how much time, energy, and taxpayer money has been spent on this bill over the last couple of years. An iteration of this bill was introduced last legislative session, too, by the same person even.

DeWine previously said in 2021 that he was against sports bans, stating,

This issue is best addressed outside of government, through individual sports leagues and athletic associations, including the Ohio High School Athletic Association, who can tailor policies to meet the needs of their member athletes and member institutions.

I am (perhaps misguidedly) hopeful that he sees the absurdity in these bills. I highly encourage you to reach out, especially if you’re in Ohio, have a connection to Ohio (waves), and/or are a part of or an ally to the transgender community.

What follows is a letter I sent to Ohio Gov. Mike DeWine Thursday, December 14, 2023, in response to the state legislative bodies passing HB 68 on Wednesday. Gov. DeWine has 10 days from Wednesday to sign HB 68 into law OR veto it.

 

My Letter

I am writing to you as a concerned citizen to urgently request that you veto House Bill 68, which prevents transgender youth from receiving gender-affirming health care and participating in school sports consistent with their gender identity. This is a dangerous bill that would harm the safety and well-being of LGBTQ+ youth, not to mention healthcare providers and those in the athletic community.

I urge you to please veto this bill.

I write to you as an internationally renowned sex educator and researcher, someone who works with groups ranging from Harvard Medical School and the American College of Rheumatology to local movements and governments across the nation. I create educational content, helping people to learn about minoritized groups, which has improved how Fortune 500 companies learn about the world and how to act within it in better ways. From my time living in Wisconsin to my time here in Ohio, I have worked internationally to improve understanding of accessibility, healthcare, and the patient experience – including working with the Centers for Disease Control (CDC) to lessen the rates of preventable chronic diseases.

Above all else, I write to you as a transgender man, as someone who is wildly negatively affected both personally and professionally by transphobia. I can tell you that HB 68 will worsen the viewpoints of Ohio as a state worth moving to or attending college in.

It will increase the amount of hate a very small minority of people receive. For it to specifically target children is abhorrent.

 

A Word on Trans Youth in Sports

The anti-trans sports ban (which we saw in the last general assembly as SB 132 and HB 151) is an example of extreme government overreach and intervention. The Ohio High School Athletic Association and NCAA already have scientifically supported policies in place to ensure that sports are fair and accessible to all. These are experts who have studied this topic in-depth, connected with true experts, and deeply understand these issues.

Legislators can be experts on many things, but those introducing and supporting this bill are not experts on this topic. They have not done unbiased or true research into this; instead, many representatives and others uneducated on this topic are relying on harmful, biased, and skewed viewpoints on this matter.

All Ohio youth that want to take part in athletics belong in sports. Participation in sports is an invaluable part of students’ physical, social, and emotional well-being. Playing sports can provide student athletes with important lessons about leadership, self discipline, teamwork, success, and failure—as well as the joy and shared excitement of being part of a team. It can also positively impact their academics, making Ohio’s students competitive while also giving them strong roots in our state. Instead of celebrating and encouraging this amazing phenomenon, the anti-trans sports ban seeks to single out transgender young people for increased bullying and harassment by needlessly preventing them from participating in the sports they love.

I grew up not playing sports, as I was critically ill for much of my youth. By the time I was physically well enough to play a sport, I was an adult and really had no connections to sport itself. Living in Wisconsin at the time, I encountered a local hockey association that welcomed beginners and was heavily focused on making the space LGBTQ+ friendly. I learned more about myself and my ability to grow – both physically and emotionally – in the six months I played than I had in years prior.

With the pandemic shutting down my ability to play hockey (I’m immunocompromised), I also know what it’s like to be forced out from a space that I grew to love. It was hard to handle as an adult and, frankly, no child should ever have to go through that – especially when they’re barred from playing because of bigotry. The self-esteem impact that will have on these kids who are at pivotal points in their lives is something we cannot undo.

 

A Word on Gender Affirming Care

The anti-trans gender affirming care ban is another example of extreme government overreach. As has been repeatedly brought up, the bill is based on stigma and bias, not on science nor a genuine regard for the wellbeing of youth in Ohio.

Gender affirming care is safe, effective, and doctor-recommended medical care. This has been studied by health care providers, researchers, and many others for over 100 years, going back to the Institute for the Science of Sexuality (Institut für Sexualwissenschaft) founded in Germany in 1919. This institute helped study and pioneer health care for transgender folks, including hormones and surgery. It operated and served as a beacon internationally for acceptance and care. That is, until the Nazi regime raided the center on May 6, 1933. Soldiers and Nazi youth groups worked together to destroy research within the building, murder staff still located on site, and then burn over 20,000 books and pieces of research. A decent collection of research remained, giving us the ability to continue research and provide affirming care to the transgender community.

The state of Ohio must not penalize healthcare providers for providing good, standard, and necessary care to their patients. Furthermore, legislators with no medical knowledge must not practice medicine by pushing bills like this.

Ohio cannot push transgender healthcare back to the fear instilled in folks by the Nazi regime.

We cannot go backwards.

All Ohioans deserve access to health care, but especially health care that does not tell them they are abominations. That goes double for transgender youth. Most parents affirm their children and want them to feel at-home in their bodies – and in Ohio. These parents should not have to worry about their children’s ability to access care and treatment. They also should not have to worry if their children feel comfortable and welcome in spaces such as school or if their child may suffer a hate crime.

Children should NEVER be a political pawn.

As we’ve seen in other states that have passed similar bills — like Texas and Florida — these families will leave for more welcoming states, and Ohio will suffer for it.

I agree we must protect our children. The best way to do so is to ensure that they have access to best-practice physical and mental health treatment.

Instead, this bill directly puts already vulnerable LGBTQ+ youth at risk of losing access to vital, best-practice healthcare. We know that, without affirming healthcare, children and teens will commit suicide – and that’s not hyperbole.

As a teenager, I was happy. I was (relatively) healthy, too. When my personal hormone makeup changed and more estrogen was introduced because of puberty, I began to struggle. I experienced chronic pain – something I had before, but was definitely worsening – in addition to migraines and struggling with self-esteem and self-image far beyond what the average kid was facing.

The bubbly person who I was went away because of puberty. I became quiet, withdrawn, and experienced suicidal thoughts. I grew up in a home where I was not supported, and this exacerbated these thoughts.

It wasn’t until I started testosterone in January 2020 that I regained the contented feeling I had in my youth. And, no, it didn’t make me better at hockey – that’s a myth. What it did do was to help my chronic pain ease up and give me back my life. Prior to starting intense physical therapy, hockey, and testosterone, I could barely sit up for two hours straight without immense pain — or even passing out. I literally could not work for a few years. But after? I gained a whole new lease on life.

When I think about the years of major depression, relationship issues, suicidal thoughts, and chronic pain I endured because I did not have the option these kids have today, and then think about them getting this taken away from them?

The only word I can think of is monstrous, and it’s not a word Ohio needs to be associated with.

We can protect children and teens and allow them the ability to be who they are. It isn’t hard to do — puberty blockers (which only pause the process) and hormone replacement therapy (HRT) aren’t rocket science. But, what they do is give us a proven way to ensure that transgender children grow into healthy and happy adults.

As someone who is passionate about equity in our world but especially in state legislation, I want to offer to serve as a resource for you. If there is anything that I can do to help share information with you to better enable you to make the most educated decisions possible, please know that I am here and happy to do so.

Sending all my best to you and your family in the holiday season,
A Proud Transgender Man in Athens

Want to get more newsletter-type posts from me? Subscribe to my Substack for free!

Testosterone, Sexual Health, and Pain During Sex among Transgender Men, Nonbinary, and Gender Diverse People | photo of a nonbinary person injection testosterone into their thigh (from gender spectrum)

Testosterone, Sexual Health, and Pain During Sex among Transgender Men, Nonbinary, and Gender Diverse People

The following is research that came out earlier this month (September, 2023) from the Pride Study:

What Did We Do?

We looked at sexual health experiences data from The PRIDE Study’s Annual Questionnaires from 2019-2021 provided by transgender men, nonbinary, and gender diverse people who were assigned female sex at birth (AFAB). We also looked at how these sexual health experiences were different or similar among people who were currently using testosterone and those who were not.

What Was New, Innovative, or Notable? 

Our study is one of the largest to look at the relationship between testosterone use, sexual health, and experiences of genital pain during sex among transgender men, nonbinary, and gender expansive people AFAB.

What Did We Learn? 

There were 1,219 participants in this study. 49% of participants were using testosterone and 42% had never used testosterone. Many (65%) reported having any genital pain during sex in the past 30 days (from when they completed the survey). Compared to people who never used testosterone, individuals who were using testosterone had a higher interest in sexual activity and a higher ability to orgasm. People who were using testosterone were also more likely to report genital pain during sex. We did not see a relationship between current testosterone use and satisfaction with sex life, ability for genitals to produce their own lubrication, or orgasm pleasure.

What Does This Mean for Our Communities? 

Testosterone usage for the purpose of affirming one’s gender can be associated with both positive and negative sexual health experiences. Testosterone likely impacts sexual health experiences in complex ways. For example, testosterone may play a role in genital pain during sex for some individuals. At the same time, testosterone may play a role in increased gender affirmation and improved mental health that may be related to more positive sexual experiences.

It is important that a high percentage of participants reported experiencing genital pain during sex because it can have an impact on their well-being and quality of life. However, there are not any treatments for genital pain during sex that have been evaluated specifically for transgender men or nonbinary and gender diverse people AFAB.

What’s Next? 

Our long-term goal is to identify effective and acceptable ways to treat or prevent genital pain during sex among transgender, nonbinary, and gender diverse people and to make treatments accessible. Future studies will focus on: learning more about people’s preferences for potential treatments, the ways that people using testosterone address genital pain symptoms, and what they find to be most effective. Lastly, we plan to look at how genital pain during sex impacts the overall quality of life, well-being, and relationships for transgender men, nonbinary, and gender diverse people AFAB.

Action Steps: 

See http://www.pridestudy.org/study for more information and to share this study with your friends and family.

If you are interested in conducting research related to LGBTQIA+ health, please learn more about collaborating with The PRIDE Study at http://pridestudy.org/collaborate.

Citation:

Tordoff DM, Lunn MR, Chen B, Flentje A, Dastur Z, Lubensky ME, Capriotti M, Obedin-Maliver J. Testosterone Use and Sexual Function among Transgender Men and Gender Diverse People Assigned Female at Birth. American Journal of Obstetrics & Gynecology. 2023 September 9; doi: https://doi.org/10.1016/j.ajog.2023.08.035 (article will be live in the near future)

View the full PDF at: https://escholarship.org/uc/item/6bz2x0j6

Disabled & Deaf Trans People’s Survey (DTPS)

Disabled & Deaf Trans People’s Survey (DTPS)

The following is from the Transgender Law Center’s Disability Justice Project:

The Disability Project with floral decorations

Ableism is woven into our everyday systems yet the knowledge of disabled and Deaf trans people has often been overlooked in research, leadership development, and philanthropy. Collecting stories and data will create opportunities for our leadership and momentum to tell our collective story and fight for our rights and needs.

The DTPS is a survey created by and for disabled and Deaf trans people. This survey gives disabled and Deaf trans people a tool to advocate for ourselves, to organize, and to transform movement spaces.

Please participate in the survey by visiting the survey website!

Society’s attitudes and negative healthcare experiences among transgender, nonbinary, and gender diverse people

Society’s attitudes and negative healthcare experiences among transgender, nonbinary, and gender diverse people

The following is research from The Pride Study published August 24, 2023.

What Did We Do?

We looked at reports that rated a state or area on their environment for LGBTQIA+ people, which we used to represent their local society’s attitudes. We then looked to see if those attitudes were related to any negative healthcare experiences of transgender, nonbinary, and gender diverse people that were reported in The PRIDE Study 2019 Annual Questionnaire.

What Was New, Innovative, or Notable? 

This study was among the first to test how existing research measures may reflect society’s attitudes about transgender, nonbinary, and gender diverse people and how they are related to experiences in healthcare.

What Did We Learn? 

We did not find a relationship between these existing research measures of society’s attitudes about transgender, nonbinary, and gender expansive people and negative healthcare experiences. However, we found that 18% of transgender, nonbinary, and gender diverse people reported a negative experience in healthcare during the past year and 12.5% had a negative experience in mental healthcare. This is important because mental healthcare experiences are not usually looked at separately from the rest of healthcare experiences.

What Does This Mean for Our Communities? 

Transgender, nonbinary, and gender diverse people had negative experiences in both mental healthcare settings and in general healthcare settings. However, society’s attitudes, as measured in our study, were not related to these experiences.

What’s Next? 

Society’s attitudes about transgender, nonbinary, and gender expansive people are not well measured in research. Understanding how the community experiences those attitudes is important. Until this improves, other factors that may affect experiences in healthcare should be looked at to improve the experiences of transgender, nonbinary, and gender diverse people.

Action Steps

See http://www.pridestudy.org/study for more information and to share this study with your friends and family.

If you are interested in conducting research related to LGBTQIA+ health, please learn more about collaborating with The PRIDE Study at http://pridestudy.org/collaborate.

Citation

Clark KD, Lunn MR, Bosse JD, Sevelius JM, Dawson-Rose C, Weiss SJ, Lubensky ME, Obedin-Maliver J, & Flentje A. Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study. Int J Equity Health. 2023 Aug, 24; 22(1):162. doi: https://doi.org/10.1186/s12939-023-01975-7

"The 2023 Gender Census is Open" next to illustrations of happy and thriving transgender and nonbinary people

Gender Census 2023 Now Open!

The 10th annual international gender census, collecting information about the language we use to refer to ourselves and each other, is now open until 9th May 2023. This is a short and easy survey.

What is the Gender Census?

The Gender Census is an annual survey that collects information about the language used by people whose genders are not adequately described, expressed or encompassed by the restrictive gender binary. It has taken place every year since 2015.

The language we ask about includes identity words, honorific titles, and pronouns.

Who can take this survey?

The gender binary is a societal model that classifies all humans into one of two categories:

  • Woman/girl – always, solely and completely
  • Man/boy – always, solely and completely

If you feel like that doesn’t fit your experience of yourself and your own gender in some way, you are invited to participate. This includes, but is definitely not limited to:

  • people whose genders change over time.
  • people whose genders fluctuate in intensity.
  • people who experience more than one gender at a time.
  • people who don’t experience gender at all.
  • people whose gender is neither male/man nor female/woman.

We also welcome anyone who:

  • rejects gender altogether.
  • feels like they’re outside of gender.
  • feels like they transcend or move beyond gender or the gender binary.
  • doesn’t really understand gender as it applies to them.
  • is questioning whether their flavour of trans might be binary or nonbinary.

It’s completely up to you whether you feel you fit any of these. This survey leans on the side of inclusive.

You can find data from previous years’ here. This is research from within our community and responses are anonymous.

How do I participate?

Click here to take the survey. It will close on or around May 9th.

Note: language in this post is taken from the Gender Census site.

"no body criminalized" against flowers with the logos of both the transgender law center and the repro legal defense fund

Announcing the Trans Health Legal Fund

The following press release was issued on Monday, March 7, 2023:

In the face of widespread attacks on transgender people’s bodily autonomy, Transgender Law Center and If/When/How’s Repro Legal Defense Fund are coming together to launch the Trans Health Legal Fund.

This fund provides economic resources and support for people facing investigation, arrest, or prosecution for seeking gender-affirming healthcare. This fund is a vital tool to protect our communities from pervasive attacks on their access to healthcare from extremist policymakers, police, and prosecutors.

“Trans and nonbinary people deserve the right to access the medical care and resources that align with their needs,” said Shelby Chestnut, Executive Director of Transgender Law Center. “The increasing threats of legislators attempting to ban and criminalize gender affirming care and abortion have highlighted even more the need for a collective response. We’re proud to partner with If/When/How’s Repro Legal Defense Fund to create a pathway to liberation and bodily autonomy for all people.”

“Our fights for reproductive justice and trans liberation are deeply intertwined. As our movements face continuous waves of attacks on our bodily autonomy, it’s essential that we show up together to support the needs of our communities,” said Rafa Kidvai, Director of If/When/How’s Repro Legal Defense Fund. “Criminalization creates a harmful, life-long domino effect on someone’s life, whether they face jail, arrest, or surveillance. Together with the Transgender Law Center, we will work to minimize the harms of the criminal legal system and fight to ensure our communities can live safely and authentically.”

The Trans Health Legal Fund will curtail the deep and lasting harm of facing criminalization by providing financial support that’s for the whole human – from bail to commissary to therapy. Transgender people who are facing criminalization for seeking healthcare can apply to the fund at www.transgenderlawcenter.org.

Transgender Law Center (TLC) is the largest national trans-led organization advocating for a world in which all people are free to define themselves and their futures. Grounded in legal expertise and committed to racial justice, TLC employs a variety of community-driven strategies to keep transgender and gender nonconforming people alive, thriving, and fighting for liberation.

The Repro Legal Defense Fund (RLDF) is a program of If/When/How: Lawyering for Reproductive Justice that works to prevent, defend against, and put a permanent stop to the criminalization of people’s bodies. The RLDF provides bail and strong defenses for anyone criminalized for something that happens during pregnancy, and the folks who directly support them.

The U.S. Trans Survey is now open! [closed]

The following is from an email sent out by the U.S. Trans Survey Team @ National Center for Transgender Equality yesterday (10-19):

take the us trans survey

We’re proud to announce that the U.S. Trans Survey is now open and ready for you to take! Whether you pledged to take the survey or not, you can take the survey today!!

As trans people, we know that we’ve accomplished incredible things together as a community. Join thousands of other people folks around the country in sharing your experience to create a clear picture of what it’s like to be trans in the United States.

If you are trans and plan to take the survey, here’s what you need to know:

  • The survey is open to people of all trans identities (binary and nonbinary), ages 16 and older, living in the United States and U.S. territories, regardless of citizenship status.
  • If you pledged to take the survey, you are not obligated to take the survey. Participation is voluntary. When you click on the link to start the survey, you will be asked to consent to take the survey.
  • The U.S. Trans Survey is an anonymous survey. Your response will be kept confidential and will not be used to identify you.
  • The time required to take the survey may vary, but make sure to set aside at least 60 minutes to take the survey.
  • The survey will be available in both English and Spanish.
  • Please let your trans friends and siblings know about the survey too!

The U.S. Trans Survey is being conducted by the National Center for Transgender Equality in partnership with the National Black Trans Advocacy Coalition, TransLatin@ Coalition, and National Queer Asian Pacific Islander Alliance.

If you have any questions, please reach out at ustranssurvey@transequality.org.

Again, thank you so much for being part of this important survey. We’re excited to see the results!

Click here to take the survey now!

With love and solidarity,

The U.S. Trans Survey Team

Pledge to Take the 2022 US Trans Survey

a graphic featuring black, brown, white, pink, and blue hands - pledge to take the us trans survey

The U.S. Trans Survey (USTS) is the largest survey of trans people in the United States. The USTS documents the lives and experiences of trans people in the U.S. and U.S. territories. The last time data was collected was back in 2015. That year, nearly 28,000 people took the survey!

The USTS is the main source of data about trans people for the media, educators, policymakers, and the general public, covering health, employment, income, the criminal justice system, etc.  USTS reports have been a vital resource, including the reports on the experiences of people of color and reports by state.

It is vital that we ensure that this survey includes data about historically and continually forcibly marginalized groups, including Black and Brown folks, those in rural areas, disabled folks, and more.

So, if you are ages 16+ and are transgender, nonbinary, etc., please consider pledging to take the survey when it’s out later this year.

Pledge here

Note: By submitting this pledge form, you’ll receive email updates from the National Center for Transgender Equality (NCTE) about the survey. Pledging to take the survey does not obligate you to take the survey. Participation is voluntary. You will be asked to consent to take the survey later when the survey enrollment begins.