Visual Conformity With Affirmed Gender or "Passing": Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People.
Affirmation
Mental Health
Passing
Transgender
Journal
The journal of sexual medicine
ISSN: 1743-6109
Titre abrégé: J Sex Med
Pays: Netherlands
ID NLM: 101230693
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
17
03
2020
revised:
12
06
2020
accepted:
19
07
2020
pubmed:
19
8
2020
medline:
22
12
2020
entrez:
19
8
2020
Statut:
ppublish
Résumé
Visual conformity with affirmed gender (VCAG) or "passing" is thought to be an important, but poorly understood, determinant of well-being in transgender people. VCAG is a subjective measure that is different from having an inner sense of being congruent with one's gender identity. We examined the frequency and determinants of VCAG and explored its association with mental health outcomes in a cohort of transgender adults. The "Study of Transition, Outcomes & Gender (STRONG)" is a cohort of transgender individuals recruited from 3 Kaiser Permanente health plans located in Georgia, Northern California and Southern California. A subset of cohort members completed a survey between 2015 and 2017. VCAG was assessed as the difference between 2 scales: scale 1 reflecting the person's sense of how they are perceived by others, and scale 2 reflecting the person's desire to be perceived. Participants were considered to have achieved VCAG when their scale 1 scores were equal to or exceeded their scale 2 scores. The frequency of VCAG and their independent associations with anxiety and depression symptoms were explored using data from 620 survey respondents including 309 transwomen and 311 transmen. Based on self-described gender identity, none of the participants identified as nonbinary or gender fluid. VCAG, depression, and anxiety. VCAG was achieved in 28% of transwomen and 62% of transmen and was more common in persons who reported greater sense of acceptance and pride in their gender identity as measured on the Transgender Congruence Scale. Another factor associated with greater likelihood of VCAG was receipt of gender-affirming surgery, but the association was only evident among transmen. Participants who achieved VCAG had a lower likelihood of depression and anxiety with prevalence ratios (95% confidence intervals) of 0.79 (0.65, 0.96) and 0.67 (0.46, 0.98), respectively. VCAG may serve as an important outcome measure after gender-affirming therapy. Strengths of this study include a well-defined sampling frame and use of a novel patient-centered outcome of interest. Cross-sectional design and uncertain generalizability of results are the limitations. These results, once confirmed by prospective studies, may help better characterize the determinants of well-being in the transgender community, facilitating the design of interventions to improve the well-being and quality of life of this vulnerable population. To M, Zhang Q, Bradlyn A, et al. Visual Conformity With Affirmed Gender or "Passing": Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People. J Sex Med 2020;17:2084-2092.
Sections du résumé
BACKGROUND
Visual conformity with affirmed gender (VCAG) or "passing" is thought to be an important, but poorly understood, determinant of well-being in transgender people. VCAG is a subjective measure that is different from having an inner sense of being congruent with one's gender identity.
AIM
We examined the frequency and determinants of VCAG and explored its association with mental health outcomes in a cohort of transgender adults.
METHODS
The "Study of Transition, Outcomes & Gender (STRONG)" is a cohort of transgender individuals recruited from 3 Kaiser Permanente health plans located in Georgia, Northern California and Southern California. A subset of cohort members completed a survey between 2015 and 2017. VCAG was assessed as the difference between 2 scales: scale 1 reflecting the person's sense of how they are perceived by others, and scale 2 reflecting the person's desire to be perceived. Participants were considered to have achieved VCAG when their scale 1 scores were equal to or exceeded their scale 2 scores. The frequency of VCAG and their independent associations with anxiety and depression symptoms were explored using data from 620 survey respondents including 309 transwomen and 311 transmen. Based on self-described gender identity, none of the participants identified as nonbinary or gender fluid.
OUTCOMES
VCAG, depression, and anxiety.
RESULTS
VCAG was achieved in 28% of transwomen and 62% of transmen and was more common in persons who reported greater sense of acceptance and pride in their gender identity as measured on the Transgender Congruence Scale. Another factor associated with greater likelihood of VCAG was receipt of gender-affirming surgery, but the association was only evident among transmen. Participants who achieved VCAG had a lower likelihood of depression and anxiety with prevalence ratios (95% confidence intervals) of 0.79 (0.65, 0.96) and 0.67 (0.46, 0.98), respectively.
CLINICAL IMPLICATIONS
VCAG may serve as an important outcome measure after gender-affirming therapy.
STRENGTHS AND LIMITATIONS
Strengths of this study include a well-defined sampling frame and use of a novel patient-centered outcome of interest. Cross-sectional design and uncertain generalizability of results are the limitations.
CONCLUSION
These results, once confirmed by prospective studies, may help better characterize the determinants of well-being in the transgender community, facilitating the design of interventions to improve the well-being and quality of life of this vulnerable population. To M, Zhang Q, Bradlyn A, et al. Visual Conformity With Affirmed Gender or "Passing": Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People. J Sex Med 2020;17:2084-2092.
Identifiants
pubmed: 32807706
pii: S1743-6095(20)30769-4
doi: 10.1016/j.jsxm.2020.07.019
pmc: PMC7529975
mid: NIHMS1616417
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2084-2092Subventions
Organisme : NICHD NIH HHS
ID : R21 HD076387
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Références
J Gen Intern Med. 2006 Dec;21 Suppl 5:S21-7
pubmed: 17083496
J Gay Lesbian Ment Health. 2017;21(1):64-76
pubmed: 29170689
Ann Epidemiol. 2016 Mar;26(3):198-203
pubmed: 26907539
J Homosex. 2001;42(1):89-101
pubmed: 11991568
J Sex Med. 2016 Nov;13(11):1778-1786
pubmed: 27667355
Psychoneuroendocrinology. 2012 May;37(5):662-70
pubmed: 21937168
Am J Public Health. 2015 Oct;105(10):2108-16
pubmed: 26270284
J Sex Med. 2017 May;14(5):721-730
pubmed: 28366591
Am J Bioeth. 2018 Dec;18(12):10-12
pubmed: 31159693
Am J Bioeth. 2018 Dec;18(12):3-9
pubmed: 31159688
J Sex Med. 2018 Apr;15(4):591-600
pubmed: 29463478
J Homosex. 2011;58(1):10-51
pubmed: 21213174
Int J Prison Health. 2018 Jun 11;14(2):69-88
pubmed: 29869582
Qual Life Res. 2010 Sep;19(7):1019-24
pubmed: 20461468
Int Rev Psychiatry. 2016;28(1):44-57
pubmed: 26835611
J Nerv Ment Dis. 2013 Nov;201(11):996-1000
pubmed: 24177489
Perm J. 2012 Summer;16(3):37-41
pubmed: 23012597
Am J Public Health. 2014 Nov;104(11):2191-8
pubmed: 24328655
Soc Sci Med. 2015 Dec;147:222-31
pubmed: 26599625
Arch Sex Behav. 1975 Nov;4(6):639-56
pubmed: 1212093
BMC Public Health. 2015 Jun 02;15:525
pubmed: 26032733
Lancet. 2016 Jul 23;388(10042):412-436
pubmed: 27323919
Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):180-7
pubmed: 26825469
J Consult Clin Psychol. 1988 Dec;56(6):893-7
pubmed: 3204199
N Engl J Med. 2019 Dec 19;381(25):2451-2460
pubmed: 31851801
Eur J Plast Surg. 2017;40(3):223-226
pubmed: 28603386
BMJ Open. 2017 Dec 27;7(12):e018121
pubmed: 29284718
Psychoneuroendocrinology. 2014 Jan;39:65-73
pubmed: 24275005
Clin Endocrinol (Oxf). 2010 Feb;72(2):214-31
pubmed: 19473181
JAMA Surg. 2017 Apr 1;152(4):394-400
pubmed: 28196182