Sexual Orientation- and Gender Identity-Affirming Activities Provided in Primary Care.

Importance: Addressing health disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities has been a significant policy focus for more than a decade. Ensuring access to safe, respectful primary health care from knowledgeable clinicians is crucial for reducing health inequalities.

Objective: To assess the engagement of primary care practices in LGBTQ+ affirming care activities and identify practice characteristics associated with increased engagement.

Misgendering and the health and wellbeing of nonbinary people in Canada.

Misgendering-using the wrong name, pronoun, or gendered language to refer to someone-is known to have negative impacts on the mental health and well-being of trans individuals generally. However, little is known about the effects of misgendering on nonbinary people specifically. As such, our research asked: 1) Among nonbinary people, what factors are associated with frequency of misgendering?; and 2) Do nonbinary people who experience misgendering less often have better health outcomes? We analyzed data from Trans PULSE Canada, a community-based survey of trans and nonbinary people living in Canada, using a subset ( = 1091) who identified as nonbinary and completed questions on misgendering.

Factors associated with primary healthcare provider access among trans and non-binary immigrants, refugees, and newcomers in Canada.

Objective: Trans and non-binary (TNB) immigrants, refugees, and newcomers (IRN) face intersecting challenges and barriers, including stigma and persecution in countries of origin, and others unique to the Canadian resettlement process. The present study aimed to investigate factors that are associated with having a primary healthcare provider among TNB IRN.

Design: Trans PULSE Canada was a community-based, national study of health and wellbeing among 2,873 TNB people residing in Canada, aged 14 and older, who were recruited using a multi-mode convenience sampling approach.

Pre-exposure Prophylaxis Awareness and Use Among Transgender and Nonbinary Individuals in Canada.

Background: Transgender and nonbinary populations are disproportionately affected by HIV and face barriers to accessing HIV-related services. Pre-exposure prophylaxis (PrEP) may benefit those at risk of HIV acquisition. However, PrEP awareness and uptake, along with potential barriers and facilitators, have not been investigated among transgender and nonbinary individuals living in Canada.

Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy.

Background: Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection.

Pathways to Care for Adolescents Attending a First Hormone Appointment at Canadian Gender Affirming Medical Clinics: A Cross-Sectional Analysis From the Trans Youth CAN! Study.

Purpose: Limited research has examined adolescents' pathways to gender-affirming medical care.

Methods: Enrollment in Trans Youth CAN! was at an initial appointment for hormone suppression or gender-affirming hormones, if pubertal or postpubertal, and < 16 years old. Adolescent/parent surveys and clinical records were obtained for 174 adolescents and 160 matched parents at 10 medical clinics across Canada.

Gynecological concerns and vaginal practices and exposures among transfeminine individuals who have undergone vaginoplasty.

Background: Vaginoplasty is a gender-affirming surgery that is medically necessary for some transfeminine individuals. Little research exists describing vaginal health after the initial recovery from surgery, and evidence-based guidelines for vaginal care practices are unavailable.

Aim: The study sought to describe self-reported gynecological concerns and vaginal care practices among transfeminine persons who have undergone vaginoplasty.

Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study.

Purpose: Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada.

Methods: Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada.

Change in Finances, Peer Access, and Mental Health Among Trans and Nonbinary People During the COVID-19 Pandemic.

Due to structural transphobia, trans and nonbinary (TNB) individuals were particularly vulnerable to the negative effects of social isolation and financial instability resulting from COVID-19. The present study examined the effect of change in finances and access to TNB peer gatherings on anxiety and depression during the COVID-19 pandemic. Participants were 18 years and older (mean = 30) and completed prepandemic baseline (Fall 2019) and pandemic follow-up (Fall 2020) surveys.

Gynecological Care Among Brazilian Women Who Have Sex with Women: A Respondent-Driven Sampling Study.

This study aimed to describe the gynecological care provided to Brazilian women who have sex with women (WSW). Respondent-driven sampling was used to recruit Brazilian WSW. The survey questions, concerning gynecological care, were designed in Portuguese by medical professionals, medical students, and LGBTQIA+ community members, including the authors.

Rare exemplars and missed opportunities: Intersectionality within current sexual and gender diversity research and scholarship in psychology.

Using intersectionality as our critical analytical framework, we examined 22 articles on sexual and gender diversity (SGD) published in peer-reviewed psychology journals between January and June 2022 to: (1) identify their engagement with intersectionality's core themes; and (2) highlight key findings and directions for future intersectional SGD research. Our review includes 12 theoretical and empirical articles that addressed a breadth of topics such as intersectional stigma/discrimination, gendered racism, minority stress, and intersectional ableism. This review highlights opportunities within intersectional SGD research in psychology to provide a needed corrective to the discipline's tradition of individualistic, single-axis research focused on predominantly White, cisgender and heterosexual people, and attend to intersectionality's focus on intersecting power relations and commitments to social justice.

Sex and Gender Multidimensionality in Epidemiologic Research.

Along with age and race, sex has historically been a core stratification and control variable in epidemiologic research. While in recent decades research guidelines and institutionalized requirements have incorporated an approach differentiating biological sex from social gender, neither sex nor gender is itself a unidimensional construct. The conflation of dimensions within and between sex and gender presents a validity issue wherein proxy measures are used for dimensions of interest, often without explicit acknowledgement or evaluation.

The Preferences of Transgender and Nonbinary People for Virtual Health Care After the COVID-19 Pandemic in Canada: Cross-sectional Study.

Background: Virtual health care use has dramatically increased in response to the COVID-19 pandemic, raising the question of its potential role after the pandemic. For transgender (trans) and nonbinary (TNB) people, virtual care is promising because it may expand access to appropriate health care providers. However, emerging research indicates potential disparities in virtual care access related to sociodemographic, health, and social factors.

Impacts of COVID-19 on trans and non-binary people in Canada: a qualitative analysis of responses to a national survey.

Background: Emerging international evidence indicates the COVID-19 pandemic has exacerbated socioeconomic and health challenges faced by transgender (trans) and non-binary populations globally. This qualitative study is among the first to characterize impacts of the pandemic on these groups in Canada.

Methods: Drawing on data from the Trans PULSE Canada survey (N = 820), we used thematic analysis to examine the free-form responses of 697 participants to one open-ended question on impacts of the pandemic.

Methods in HIV-Related Intersectional Stigma Research: Core Elements and Opportunities.

Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we propose a series of core elements for future HIV-related intersectional stigma research.

Avoidance of primary healthcare among transgender and non-binary people in Canada during the COVID-19 pandemic.

Transgender (trans) and non-binary people experience barriers to culturally competent healthcare and many have reported avoiding care. COVID-19 and related mitigation strategies may have exacerbated avoidance, and poor mental health may be bidirectionally related to avoiding care. This study estimated the prevalence of primary care avoidance during the pandemic in a national sample of trans and non-binary people in Canada with a primary care provider and examined the association between poorer self-rated mental health and avoidance.

Experiences and Stressors of Parents of Trans and Gender-Diverse Youth in Clinical Care from Trans Youth CAN!

Parents of trans and gender-diverse youth can experience challenges navigating gender-affirming (GA) care such as stigma, transphobia, and lack of support. There is little information available about stressors, worries, and positive feelings of parents as they try to support their youth accessing GA care. This article presents baseline survey data on experiences and stressors of 160 parents/caregivers in the Trans Youth CAN! cohort study, which examined medical, social, and family outcomes in youth age 16 years or younger considering puberty blockers or GA hormones.

Describing Intersectional Health Outcomes: An Evaluation of Data Analysis Methods.

Background: Intersectionality theoretical frameworks have been increasingly incorporated into quantitative research. A range of methods have been applied to describing outcomes and disparities across large numbers of intersections of social identities or positions, with limited evaluation.

Methods: Using data simulated to reflect plausible epidemiologic data scenarios, we evaluated methods for intercategorical intersectional analysis of continuous outcomes, including cross-classification, regression with interactions, multilevel analysis of individual heterogeneity (MAIHDA), and decision-tree methods (classification and regression trees [CART], conditional inference trees [CTree], random forest).

The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People.

Transgender and gender diverse individuals may seek gender-affirming medical care, such as hormone therapy or surgery, to produce primary and/or secondary sex characteristics that are more congruent with their gender. Gender-affirming medical care for transmasculine individuals can include testosterone therapy, which suppresses circulating estrogen and can lead to changes in the vaginal epithelium that are reminiscent of the post-menopausal period in cisgender females. Among transfeminine individuals, gender-affirming medical care can include vaginoplasty, which is the surgical creation of a vulva and neovaginal canal, commonly using penile and scrotal skin.

Quantitative methods for descriptive intersectional analysis with binary health outcomes.

Intersectionality recognizes that in the context of sociohistorically shaped structural power relations, an individual's multiple social positions or identities (e.g., gender, ethnicity) can interact to affect health-related outcomes.

Health care access among transgender and nonbinary people in Canada, 2019: a cross-sectional survey.

Background: Previous Canadian studies have identified problems regarding health care access for transgender (trans) and nonbinary people, but all-ages national data have been lacking. This study describes access to care among trans and nonbinary people in Canada, and compares health care access across provinces or regions.

Methods: We conducted a bilingual, multimode cross-sectional survey (Trans PULSE Canada) from July 26 to Oct.

Do Clinical Data from Transgender Adolescents Support the Phenomenon of "Rapid Onset Gender Dysphoria"?

Although emergence of gender dysphoria at puberty is long established, a distinct pathway of rapid onset gender dysphoria was recently hypothesized based on parental data. Using adolescent clinical data, we tested a series of associations that would be consistent with this pathway, however, our results did not support the rapid onset gender dysphoria hypothesis.

Latent variable and clustering methods in intersectionality research: systematic review of methods applications.

Purpose: An intersectionality framework has been increasingly incorporated into quantitative study of health inequity, to incorporate social power in meaningful ways. Researchers have identified "person-centered" methods that cluster within-individual characteristics as appropriate to intersectionality. We aimed to review their use and match with theory.