PURPOSE: The purpose of this study was to investigate the impact of head position on unfamiliar listeners’ perception of vocal masculinity. METHOD: Twelve cisgender women were recruited as speaking participants in this study. Participants were recorded reciting two voiced sentences at eight time points with varying head positions including baseline, flexed, and extended. Voice samples were cropped and fundamental frequency (fo) was resynthesized to control for any changes in fo across conditions. Twelve cisgender adults were recruited as listening participants. Listeners were presented with 144 paired comparisons of speaker samples and were prompted to select the sample that sounded more masculine in each presented pairing. Ratings of masculinity were analyzed using Thurstone’s law of comparative judgment. A repeated measures one-way analysis of variance (ANOVA) was used to assess the effect of head positioning and repetition, followed by Dunnett’s post hoc tests for significant factors. RESULTS: The ANOVA showed a statistically significant effect of head position on listener perceptions of masculinity. Dunnett’s post hoc tests revealed a statistically significant effect of the flexed position and no statistically significant effect of the extended compared to the neutral condition. CONCLUSION: Speakers’ voices in the flexed head position were perceived as most masculine by unfamiliar listeners. Overall, the results of this study support the use of head posture manipulation to achieve increased vocal masculinity, which adds to the limited research related to voice masculinization strategies for those seeking gender-affirming voice care.

No description available.

Recent years have seen an unprecedented paradigm shift wherein pathologizing approaches to caring for trans children have been contested by efforts to accept and affirm trans children as their self-determined gender. This has resulted in a mainstreaming of gender affirming and de-pathologizing approaches to caring for trans children. While gender affirming care undoubtedly benefits many trans children, this research analyzes the ways in which practices and delivery of gender affirming care can be exclusionary of children who do not fit within a normative, binary, medicalized, white, and middle-class conceptualization of trans childhood. Applying critical social citizenship as a theoretical framework, this research argues that care for trans children is shaped through a complex interweaving of normative liberal citizenship regimes, professional and social care practices, and relational care practices that seek to recognize and create space for children to belong as their self-determined gender. Using a community-based research methodology to engage with trans youth and supportive parent caregivers around their experiences of care, this study sought to a) better understand how the contested landscape of care impacts the lives of trans children and b) offer possibilities for transforming care for trans children. Centring the voices and experiences of trans youth and parents, this research argues that trans children face exclusions and barriers when accessing care. This research then discusses what relational care practices, as shared in participant narratives, offer for envisioning care possibilities that centre trans children’s agency and gender self-determination. The outcome of this research is a vision of care for trans children that is rearticulated through a critical theorization of trans children’s citizenship. / Graduate

No description available.

INTRODUCTION: Neovaginoplasty, is a gender affirming surgery provides a way for transfeminine persons to remove masculine appearing genitalia and replace with a more gender congruent appearance. As of 2019 “bottom” surgery was reported in transgender and non-binary persons at a rate of 4-13% with prevalence increasing rapidly (Nolan et al., 2019). The benefits of combined general and epidural anesthesia for neovaginoplasty has been well described (Salgado et al., 2019). In this study we examined dosing strategies for epidural infusions at our institution for patients undergoing neovaginoplasty. METHODS: This study was approved by the Institutional Review Board at our institution. Non-experimental retrospective chart reviews were conducted and all trans-gender patients who underwent neovaginoplasty procedures between 2014-2019 and were over the age of 18 at the time of chart review were included. Patient demographics including age, ethnicity, BMI were collected as well as comorbidities, history of hormone use, DVT, and nausea. Lumbar Epidurals were placed preoperatively and dosed after incision. Epidural start and stop times were collected along with pain scores measured on a visual analogue scale, and blood loss was recorded. RESULTS: The final cohort consisted of 154 cases that matched the eligibility criteria of this study. About half of these patients, 49.3%, spent 2-4 hours in the PACU after their procedures. The most common ASA status was 2. As expected, an overwhelming number of patients, 141 of 154 (91.6%) reported using hormone therapy. Epidural infusion duration prior to first pain score assessment was 0 to 701 minutes. Median epidural infusion duration was 285 minutes. Patients whose epidural was begun early had an average pain score of 5.06/10 (+2.11). Epidurals which were started late had an average pain score of 5.16/10 (+3.04). Maximum EBL noted for all cases was 450 mls. CONCLUSION: Overall, pain score was not significantly impacted by epidural start time post incision. Average initial pain scores were high in both cohorts, despite good pain relief on postoperative day 1. Observed EBL for these procedures was low at our institution, with no patients requiring blood transfusion. Central sensitization may play a large role in the initial pain scores and PACU length of stays for neovaginoplasty patients. Our future protocols will move towards dosing epidurals prior to incision for these procedures.

The transgender and gender diverse (TGD) patient population consists of a diverse group of people with unique needs who have, unfortunately, been underserved by the medical community. These individuals share a disproportionate burden of discrimination and disease when compared to cisgender persons. However, despite this, they continue to receive inequitable treatment, and transgender health topics still comprise just a small portion of medical education training. While efforts to improve awareness and training regarding transgender health care needs are underway, these take time to gain traction. It also relies heavily on changing medical providers’ own biases. Telemedicine has been proposed as a way to potentially bridge the gap and increase the access and availability of quality, informed medical care to this community. Although telemedicine has demonstrated its ability to do this in other areas of medicine, the existing research on whether it has the capacity to do so for transgender health care delivery is scant. The majority of the existing literature on the topic consists of retrospective qualitative feedback provided during a time where telemedicine was still emerging as a commonplace medium through which medical care is provided. Therefore, this thesis proposes to perform a randomized controlled trial investigating whether instituting a hybrid telemedicine approach has the capability to expand the accessibility of specialty transgender health care services as compared to fully in person medical care while maintaining a high standard of health care quality and patient satisfaction. This study would have the capacity to help inform future health care policy and provide support for continued telemedicine offerings and reimbursement moving forward.

<p dir="ltr">This thesis outlines a comprehensive training program designed to equip mental health professionals with the knowledge, skills, and cultural competency necessary to provide gender-affirming mental health services to transgender veterans. Included in this training is an overview of the literature documenting the severe mental health disparities experienced by this population through a minority stress framework, unique challenges and needs commonly faced by transgender veterans, and barriers to receiving culturally competent and effective mental health services. Guidelines for the provision of gender affirming therapy for transgender veterans are offered, in addition to opportunities for self-of-therapist reflections, discussions, and activities around these topics.</p>

Transgender and nonbinary (TNB) people identify with a gender identity that differs from cultural expectations based on sex assigned at birth. Many TNB people pursue social and/or medical transition with the intent of affirming their gender identity to themselves and the world around them. Medical transition describes the process of utilizing one or more forms of gender-affirming medical care (e.g., hormone therapy, gender confirmation surgery, hair removal, breast augmentation, mastectomy) in order to change the physical body such that it is more congruent with an individual’s affirmed gender identity. Researchers suggest that many TNB individuals currently use or desire to use gender-affirming hormone therapy (GAHT), and that some TNB individuals desire or use nontraditional or non-standardized (e.g., low dose) hormone therapy regimens. Unfortunately, many TNB people encounter barriers in the process of accessing gender-affirming healthcare, especially individuals who are nonbinary and/or desire gender transition steps that are nontraditional or non-standardized (e.g., low-dose hormone therapy). In current research literature, little is currently known about the experiences and healthcare needs of TNB people who currently or desire to take nontraditional GAHT. To address this gap in the research literature, the present study was a qualitative study involving semi-structured interviews with 10 TNB people to explore their experiences connected to nontraditional GAHT. The grounded theory analysis revealed a core category: Nontraditional Gender Affirmation Model. The core category is comprised of five axial level categories: Social Processes, Medical Processes, Barriers to Accessing Medical Transition Care, Facilitators to Accessing Medical Transition Care, and Coping with Distress and Barriers. The five axial level categories are comprised of 30 open-coding level categories and 33 open-coding level subcategories. The grounded theory model developed depicts a framework of various phenomena involved in the process of gender affirmation for transgender and nonbinary individuals with nontraditional gender transition needs, including nontraditional approaches to GAHT. Implications for healthcare providers, psychological practice, and future research are discussed.

Background: Transgender or nonbinary (TNB) individuals in the United States experience higher rates of sexual and reproductive health disparities when compared to their cisgender counterparts, along with lower access to care. TNB people in the south experience higher rates of disparities. Societal, interpersonal, and individual barriers contribute to these disparities in the TNB population. However, there is a paucity of research examining the sexual and reproductive health experiences of TNB people living in Central Appalachia. Methods: An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in central Appalachia regarding their sexual and reproductive health experiences. Transcribed interviews were analyzed repeatedly by the primary investigator and the study equity committee to identify emergent themes which focused on understanding an individual’s lived experiences through interpretation. Results: Twenty participants from eastern Tennessee and western North Carolina from four Appalachian states within three Appalachian sub-regions participated in this study. Four themes were identified: a) perceptions and/or experiences receiving SRH healthcare shaped the individual’s self-agency regarding accessing and receiving SRH care, along with influencing their sense of self regarding their gender; b) heteronormative expectations within the medical field influenced interactions with providers and the care system; c) community is integral to SRH experiences, and d) policy and laws impact willingness and ability to access SRH care. Discussion: TNB individuals living in central Appalachia experience individual, interpersonal, community, and social factors that impact their sexual and reproductive healthcare experiences. By addressing these factors based on recommendations from participants, public health leaders, policy makers, and providers can improve sexual and reproductive healthcare experiences of TNB people living in central Appalachia.

<p dir="ltr">The need for affirming relational therapy is important for clients who identify as transgender and gender nonconforming - particularly during the process of their transition. Because of the conceptual overlap between the two approaches, the Satir Model of experiential therapy can be effectively applied to existing frameworks for affirming couple therapy. The study reflects the efficacy of this proposed model of therapy through a phenomenological case study. The results, their implications, and the application of the model are discussed.</p>