Citations

Background: This qualitative study sought to understand factors related to low rates of screening mammography among transgender and gender-diverse (TGD) individuals and how these rates might be improved. Methods: Individuals who self-reported as TGD were recruited from multiple sites and national patient advocates. Consenting participants completed an individual interview using a semistructured guide informed by the Health Belief Model (HBM). Interview data were analyzed using thematic analysis. Results: A total of 44 individuals completed the interview (median age, 44.9 years; range, 19–77 years); 11% were a racial/ethnic minority; and 52%, 20%, and 25%, respectively, self-identified as a transgender woman, transgender man, or nonbinary. Three themes emerged around constructs in the HBM. First, individuals voiced a hope to be treated equally (“I just want to go to work, pay my taxes, love my family, and go along my day and be a good human”) and described how such equitable treatment during screening guarded against gender dysphoria and favored gender affirmation (“it is affirming…being treated as any other woman”). Second, barriers and facilitators related to mammography were identified, including the need to address cost/low cost (“screenings are a luxury”); prior negative/positive experiences (“they would call my name and look at me but dismiss me”); absence/presence of education (“none of the doctors…ever told me what that process looks like”); and perceived low/high cancer risk (“my mom died pretty young from breast cancer”). Finally, practical recommendations were offered, including individual changing/waiting rooms, hiring gender-diverse staff, and engaging clinicians who provide whole-person, trauma-informed care. Conclusions: Mammographic screening among TGD individuals could be improved by proactively creating safe, affirming spaces; working to lower costs; providing educational materials tailored to the TGD community about cancer risk and the practical aspects of screening; and hiring gender-diverse staff. These recommendations from TGD participants merit implementation as well as further study.

ABSTRACT Clinicians tend to overestimate their clients’ progress in treatment. A potential solution of adding formalized assessments into treatment has led to concerns about client paperwork burden. In this mixed‐method study, we explored adult clients’ reactions to one formal assessment, the Outcome Questionnaire‐45 (OQ‐45). We used purposeful sampling to select 17 clients at a university counseling training center who had either improved, showed little change, or who deteriorated according to OQ‐45. Using semi‐structured interviews and grounded theory, we identified two higher order categories, clinical benefits and threats to accuracy, and two axial categories, OQ‐45 likability and perceived accuracy. A crossover mixed analysis showed strong correlations between OQ‐45 outcomes, clinical benefits, and OQ‐45 likability. We proposed a conceptual model showing how client attitudes toward the OQ‐45 depended on how compatible outcomes were to clients’ perceived benefits received in counseling. Counseling implications and future research directions are discussed.

Abstract Paruresis (shy bladder syndrome) is difficulty voiding in public or shared restrooms because of the actual or anticipated presence of others, affecting 2.8% to 6.6% of the general population. Although 59% of transgender persons avoid public restrooms, often for reasons distinct from paruresis, to our knowledge its assessment and treatment in this population remain undocumented. A 53-year-old transgender woman with Klinefelter syndrome (47,XXY) and paruresis since age 5 was referred for treatment. Over the first 14 visits (about 9 months), she received a cognitive-behavioral, schema-informed, and minority-stress-informed protocol integrating psychoeducation, imagery rescripting, cognitive restructuring, breath-holding, and graduated in vivo exposure with paradoxical intention, then supportive psychotherapy. On the Shy Bladder Scale (SBS), she achieved reliable and clinically significant change by Visit 8 (43 to 31, meeting a clinician-defined goal of ≤ 33; RCI = 3.60, p < .05) and her SBS decreased to 8 by Visit 24 in a supportive phase; the reliable-change statistic being defensible only over short intervals, later changes are described by clinical-range and goal status. At 10-year follow-up, the SBS was 18, still below the treatment goal, with minimal depressive and mild anxiety symptoms and improved well-being (PHQ-9 = 4; GAD-7 = 6; WHO-5 = 80%).

Transgender and gender-diverse (TGD) people comprise approximately 0.9% of adults in the United States; among them, 18% to 50% of TGD adults surveyed report being parents. Younger generations of Americans are more likely to identify as TGD, and also more likely to desire children than previous generations of TGD individuals surveyed. Despite this, TGD parents are often underrepresented in literature on parenting experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) parents. TGD parents experience significant mental health, physical health, and socioeconomic disparities due to gender minority stressors, and numerous barriers to reproductive care and affirming mental health care. This article presents an overview of the current literature on TGD parents, psychosocial outcomes for children of TGD parents, common clinical issues that may arise in treatment, and strategies for supporting TGD families to build resilience.

This Viewpoint discusses care denial for transgender youth forced by law and how health systems will need to invest resources to adjust to the expected emergence of mental health concerns, for which psychiatrists can play a key role in developing and implementing such programs locally.