While research on intimate partner violence (IPV) has begun to include gay and lesbian relationships, these studies have almost entirely focused on cisgender relationships or victims. To date, little to no research exists on IPV in the transgender community. The current study explored accounts and meanings of IPV victimization as told by 18 transgender-identified survivors. Thirteen in-depth interviews and five open-ended questionnaires were analyzed from a modified grounded theory method through open and focused coding that revealed three broad and salient themes. First, the accounts of violence illustrated the role of transphobic and genderist attacks in the dynamics of abuse. Central to the power dynamics in these abusive relationships was the use of these attacks against trans identities. Second, participants constructed meanings behind their IPV victimization; specifically, they addressed why they felt this happened to them and what motivated abusers. Participants emphasized the meaning behind much of what they experienced as the abuser controlling transition. The survivors described their abusers as wanting to regulate their transition processes and maintain control over their lives. In their discussions, participants attempted to make sense of their experiences and explain why this could’ve happened. Participants felt that they were susceptible to abuse and in a period in their life in which they felt unwanted due to their trans status. This trans vulnerability is how most of the participants explained why they felt they were victimized by their partners. Finally, as all of the participants in the study had left their abusive relationships, their narratives revealed their processing of a victim identity. In these discussions, participants utilized a gendered discourse or a “walking of the gender tightrope” as they distanced themselves from a “typical” feminine and passive victim. Further, participants described navigating genderist resources as they sought help iv for their experiences. This study offers ground-breaking insight into how IPV affects transgender communities and illuminates the distinct realities faced by these survivors.

Within occupational therapy (OT) practice there is a lack of person-centered care regarding lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. This increases LGBTQ patients’ risk for stigma, discrimination, isolation, and a fear of disclosure to healthcare professionals. As a result, LGBTQ patients may not receive appropriate or necessary care, and experience health disparities. The aim of the proposed solution, LGBTQ Voices Heard: A Video Storytelling Approach to Increase Cultural Competence, is to provide occupational therapy practitioners and students with a distinct, meaningful, and effective one-time multimedia educational training. The social penetration theory (SPT), cognitive theory of multimedia learning, and brain-based learning theory guided the program design. The SPT endorses storytelling; multiple, progressively intimate video interviews of LGBTQ patients will be presented in the educational training. The short-term intended outcomes are OT participants’ increased knowledge and confidence when working with LGBTQ patients, and the LGBTQ patients who participated in storytelling feeling that their voices were heard. The long-term outcomes are increased LGBTQ cultural competence for OT practitioners and improved quality of care for LGBTQ patients. This program design is applicable to other healthcare disciplines.

The intent of this thesis is to explore writing during the start of the AIDS epidemic in the U.S. States. This time period encompasses the early 1980s to mid-1990s before Protease Inhibitors were FDA approved which was the medical breakthrough drug that helped turn an HIV diagnosis from a death sentence to a chronic condition. This thesis will be an examination of three themes: “Gay White Cis Male Experience of HIV/AIDS”,” Marginalized Identity Experience of HIV/AIDS” and an exploration of two plays written during the height of the AIDS epidemic that were later turned into HBO productions: The Normal Heart and Angels in America: A Gay Fantasia on National Themes when AIDS was more widely featured in the media. The introductory and concluding paragraphs include details on how my life has been impacted by the those that lived, wrote, fought, and died, during the height of the epidemic.

The side effects of testosterone for transgender men are often overlooked and under-researched. Urinary incontinence in the form of overactive bladder disorder, stress incontinence, and mixed incontinence may arise or be exacerbated by use of testosterone. Using menopause and other similar hormonal transitions such as pregnancy as a reference, the purpose of this thesis is to fully understand the effects of testosterone replacement therapy on transgender people assigned female at birth, and to fully understand the effect of testosterone replacement therapy on the pelvic floor and why there is a potential increased incidence of urinary incontinence. Menopause and pregnancy are used as reference because these are hormonal transitions associated with a decrease in estrogen levels. The decrease in estrogen causes a looseness in the connective tissue structures, which leads to a lack of support in the pelvic floor muscles, causing a urinary incontinence. With a comparison between menopause, pregnancy, and testosterone replacement therapy established, potential solutions to stress urinary incontinence and overactive bladder disorder will be explored.

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INTRODUCTION: Transgender individuals experience distress due to the persistent feeling that their gender identity is incongruent with their assigned sex. This distress is associated with depression, a high suicide rate, and increased mortality. The best solution for transgender patients is cross-sex hormone therapy, a treatment that changes the physical sex of the patient to be more congruent with their gender identity. This treatment has been proven to reduce depression and suicide rates, as well as increase overall quality of life. Unfortunately transgender patients face unacceptable barriers to accessing this treatment, due in most part to the lack of willing and knowledgeable transgender care providers. Many physicians share the misconceptions that gender identity is malleable, making transgender identity a psychiatric problem, and that cross-sex hormone therapy may not be effective and carries too great a risk. However, the literature supports the notion that gender identity is a rigid biological phenomenon and that cross-sex hormone therapy is safe and effective. Studies reporting failed attempts to assign female sex to XY patients with disorders of sexual development provide evidence that gender identity is not malleable. Other studies reporting elevated gender identity disorder rates in XX individuals with excess prenatal androgen suggest that gender identity is a biological phenomenon influenced by hormones during prenatal development. Neuroanatomical studies of transgender cadavers report that some sexually dimorphic areas of the transgender brain are more similar to the opposite sex than the natal sex, suggesting that gender identity is a rigid biological phenomenon originating in the structure of the brain. A review of the side effects and risks associated with cross-sex hormone therapy concluded that treatment is safe provided the physician is familiar with the recommended treatment and monitoring regimens. The lack of transgender care providers is perpetuated by the fact that transgender medicine is not a standard part of the medical school curriculum. Few physicians, therefore, have experience or training in transgender medicine, which is why, to combat this problem, this study has focused on the medical school education system. Previous studies have demonstrated that the addition of transgender medicine to the medical school curriculum increases student comfort and willingness to provide transgender care. Building upon these findings the present study aims to demonstrate that the addition of transgender medicine to the medical school curriculum is an effective means to increase knowledge and change attitudes towards transgender medicine. METHODS: A single lecture on gender identity and transgender medicine was added to the mandatory first-year biochemistry course and the mandatory second-year pathophysiology course at Boston University School of Medicine. An audience response survey was conducted immediately before and after the first- year lecture to assess the change in students opinions regarding of the etiology of gender identity. An elective online survey consisting of two exam style questions was also sent to the first-year students prior to exposure to the curricular content. The same questions were also added to the first-year biochemistry and second-year pathophysiology exams following exposure to the content. The exam-style questions were designed to assess student knowledge of the rigidity of gender identity and transgender medicine. Results: Following exposure to the curricular content there was an increase in the number of students who believe that the origin of gender identity is in the neuroanatomical structure of the brain (p<0.001). The relative number of correct responses to the exam-style questions significantly improved between the online survey and the first-year exam (p<0.001). On one of the exam questions there was no significant difference between the relative number of correct responses given first-year students the second-year students. On the other exam question the second-year students performed significantly worse (p<0.001). CONCLUSION: Here we demonstrate that the addition of transgender medicine to a medical school curriculum can increase students' knowledge and change their attitudes towards transgender medicine. Following the curricular content students were convinced that gender identity is a rigid biological phenomenon and that cross-sex hormone therapy is a medically justified treatment. These findings suggest that a simple curricular content change is an effective means of training knowledgeable physicians who are willing to provide transgender care.

BACKGROUND: Transgender women suffer a great deal of self-reported anxiety and concern about their facial appearance as they may readily be identified by observers as "trans" when they would prefer to be interpreted solely as women. Little is known about the psychological distress that transgender individuals experience in their decision to undergo major aesthetic plastic surgery as a result of their appearance concern. As such, it remains unknown whether transgender individuals experience improved appearance anxiety and a greater quality of life following facial feminization surgery. AIMS: The objective of this study is to determine, using the Derriford Appearance Scale 24, whether any improvement can be seen among transgender patients in their level of appearance anxiety following facial feminization surgery. We also aim to look at whether additional improvements can be seen in the quality of life of transgender patients. METHODS: A prospective study was conducted on patients undergoing facial feminization surgery. The outcome measure used was the Derriford Appearance Scale 24. The Derriford Appearance Scale 24 was given to transgender patients to fill out at the end of their pre-operative visit before their schedule facial feminization surgery. The scale was then also administered three weeks following surgery and three months following surgery, via the Internet. RESULTS: Twenty-four patients were enrolled. Of these, fourteen patients completed at least one of the surveys, post-operatively; twelve patients completed all three surveys. Of those patients who completed at least two out of the three surveys, scores revealed that 85% of transgender patients displayed higher levels of psychological distress when completing the first survey, preoperatively, than in subsequent post-operative surveys. CONCLUSIONS: Transgender individuals enrolled in the study showed decreased levels of distress both three weeks after surgery and three months after surgery. These results were promising in displaying amelioration of appearance anxiety following facial feminization surgery. Though results show increased quality of life, the degree of impact that gender confirming facial features may have on quality of life for transgender patients has yet to be assessed.

Using qualitative interviews, this study explored public school support of transgender students using questions concerning their knowledge, ideas of what inclusion looks like, level of preparation for teaching transgender students, and openness to learning new information concerning best practices. This study aims to fill gaps in the existing research concerning experiences of transgender public school students, examining teacher support for the sake of helping determine policy steps and education that would best help transgender students looking for inclusive education. Emerging themes included generalized acceptance, fear of teaching outside curriculum, emphasis placed on student needs, and teachers' desires to learn more. These results are explored with consideration to their implications for policy, training, and resource compilation.

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