ONGOING WORK WITH SARAH: A 13‐YEAR‐OLD GIRL SUFFERING FROM ANOREXIA NERVOSA

The following is a reflection upon the challenges presented to an in‐patient nursing team in their care of Sarah. The intention is to illustrate the value of application of psychoanalytic theory to this case in order to increase nurses' understanding of the internal world of our young patient, thereby improving nursing care, supervision and minimizing potential adverse impact of such a damaged young person upon the quality of care on the unit as a whole. All names have been changed and some background details have been altered or omitted to protect identities.     

Putting the Burden of Proof in Its Place: When Are Differential Allocations Legitimate?

It is widely assumed that legitimate differential allocations of the burden of proof are ubiquitous: that in all cases in which opposing views are being debated, one side has the responsibility of proving their claim and if they fail, the opposing view wins by default. We argue that the cases in which one party has the burden of proof are exceptions. In general, participants in reasoned discourse are all required to provide reasons for the claims they make. We distinguish between truth‐directed and non‐truth‐directed discourse, argue that the paradigm contexts in which there are legitimate differential allocations of the burden of proof (law and formal debate) are non‐truth‐directed, and suggest that in truth‐directed contexts, except in certain special cases, differential allocation of the burden of proof is not warranted.     

A Study of the Use and Interpretation of Standardized Suicide Risk Assessment: Measures within a Psychiatrically Hospitalized Correctional Population

The reliability, validity, and utility of the Adult Suicidal Ideation Questionnaire (ASIQ), Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSS), and Reasons for Attempting Suicide Questionnaire (RASQ) with correctional mental health populations was evaluated. Evidence was found indicating good to excellent reliability for all measures. Each of the measures significantly differentiated multiple attempters from single attempters and nonattempters, providing evidence of convergent and divergent validity. Logistic regression and receiver operating characteristic analyses revealed strong associations between multiple attempts and the ASIQ, BSS, and RASQ, but not the BHS. Implications for suicide risk assessment processes in correctional settings are discussed.     

Parental desire and fertility preservation in assigned male at birth transgender people living in Belgium

Abstract

Introduction: Transgender people who chose to proceed with gender affirming hormonal and/or surgical therapy, may face reduced options for fulfilling their parental desire in the future. The ideas and concerns of adult transgender people regarding fertility preservation and parental desire have never been reported in a large, non-clinical sample of assigned male at birth (AMAB) transgender people.

Methods: A web-based survey on fertility and parenthood in (binary and non-binary) transgender people was conducted in Belgium. AMAB people were selected for this analysis.

Results: We included 254 AMAB persons, of which 196 (77.2%) self-identified as transgender women (TW), 14 (5.5%) as cross-dressers and 44 (17.3%) as gender non-binary (GNB) people. Fifty-five (21.6%) respondents had a current/future parental desire, parental desire was already fulfilled in 81 (31.9%) and not present in 57 people (22.4%) (other: 19.2%). TW were more likely to express a parental desire, compared to GNB people and cross-dressers (P?=?0.004). In total, 196 AMAB people previously sought medical assistance, of which 30 (15.3%) considered the loss of fertility due to the transitioning process undesirable. The majority (68.2%) did not want fertility preservation (FP). Fourteen people (9.8%) had proceeded with FP. The main reasons not to proceed with FP included not feeling the need (70; 68.0%), not desiring a genetic link with (future) child(ren) (20; 19.4%) and having to postpone hormone treatment (15; 14.6%). TW were more likely to have a parental desire and to have cryopreserved or to consider cryopreserving gametes, compared to GNB people.

Conclusion: Parental desire and FP use were lower in the current non-clinical sample than in previous research on clinical samples. This can possibly be explained by the barriers transgender people face when considering fertility options, including postponing hormone therapy. Also, GNB persons have different needs for gender affirming treatment and FP.     

Organizing the voice questionnaire for transgender persons

Abstract

Background: The validated Transsexual Voice Questionnaire Male to Female (TVQ^MtF) and the adapted TVQ Female to Male (FtM) (TVQ^FtM) are both 30-item-long questionnaires used to evaluate self-perception of voice in transgender persons. They are part of a series of questionnaires completed by transgender persons during follow-up of cross-sex hormone therapy (CSHT).

Aim: The aim of this study was to examine if these questionnaires can be organized.

Methods: The TVQ^MtF or the TVQ^FtM was filled out at the start of CSHT, by 145 trans women and 83 trans men. Data were analyzed by factor analyses on both the questionnaires.

Results: The factor analyses resulted in a three-factor solution for both the TVQ^MtF and the TVQ^FtM. The three factors were labeled as anxiety and avoidance, vocal identity, and vocal function.

Conclusion: Both the questionnaires can be organized into three factors. This could contribute to making shorter versions of the questionnaires. Shorter versions would be useful to hormone prescribing physicians to track down more quickly voice problems in trans people undergoing virilizing or feminizing hormone treatment.     

Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: A prospective cohort study (ENIGI)

Abstract

Background: Previous studies have cross-sectionally described amenorrhea in cohorts of transgender men on intramuscular or subcutaneous testosterone injections. It remains uncertain which testosterone preparations most effectively suppress vaginal bleeding and when amenorrhea occurs after testosterone initiation.

Aim:To investigate the clinical effects of various testosterone preparations on vaginal bleeding and spotting in transgender men.

Methods: This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Data on the persistence and intensity of vaginal bleeding and spotting, serum sex steroid levels and body composition were prospectively and cross-sectionally assessed in 267 transgender men during a three-year follow-up period, starting at the initiation of various testosterone preparations.

Results: After three months of testosterone, 17.9% of transgender men reported persistent vaginal bleeding and 26.8% reported spotting. The percentages reporting vaginal bleeding and spotting decreased over the first year of testosterone (bleeding 4.7% and spotting 6.9% at 12?months, respectively), with no participants reporting vaginal bleeding or spotting after 18?months of testosterone. Factors associated with vaginal bleeding or spotting included lower serum testosterone levels and being on testosterone gel as compared to injections (e.g., esters or undecanoate preparations). If vaginal bleeding persisted, starting progestogens at three months resulted in a decrease in the intensity of vaginal bleeding and spotting.

Discussion: Transgender men and hormone-prescribing providers can be reassured that vaginal bleeding and spotting usually stop within three months after testosterone initiation. If not, serum testosterone levels should be measured and testosterone dose adjusted to achieve serum testosterone levels in the physiologic male range. Adding a progestin can be considered after three to six months if bleeding persists. Providers should be aware that cessation of bleeding can be more difficult to achieve in transgender men with lower serum testosterone levels or those on testosterone gel.