Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.     

Bullies,blades, and barricades: Practical considerations for working with adolescents expressing concerns regarding gender and identity

ABSTRACT

Background: Adolescents, by their very nature and need for maturity, struggle with issues of the self and identity, while challenging the very systems that are there to support them. However, gender diverse adolescents may become detached and overwhelmed as a trans identity solidifies during this time. Bullies, blades and barricades describes the challenges, hardship and dispossession that some gender diverse adolescents face from interpersonal and intrapersonal conflicts, societal pressure and hostility.

Method: This paper utilizes the current research on safety and risks affecting trans youth, the authors clinical experience of trans and gender diverse adolescents, and recommendations in the literature for professional care and support of gender diverse adolescents to identify the various ways gender diverse adolescents are negatively affected by their experiences.

Results: Bullying is not limited to school or peer environments and may be present in adolescents' homes, in local communities, in professional services or from sources of information such as the media. The physical dangers gender diverse adolescents face may arise from victimization, violence or rejection, or self-harming behaviors due to negative beliefs, fear or frustration. Barriers preventing disclosure and expression of gender and/or identity may stem from negative experiences, rejection, pubertal changes, imposed limitations, dependence upon school, home or legal environments, or other spheres of influence.

Discussion: Affirmative approaches, individual focus, recognition of family dynamics, inclusion of significant others, advocacy in school and local community environments as well as professional training are the most commonly recommended interventions. This paper provides an inclusive review of the myriad of challenges confronting gender diverse adolescents including often unrecognized forms of pressure, oppression and restrictions. This paper aims to support clinicians by contextualizing the adversity that gender diverse adolescents face and offers strategies for engagement and intervention.     

Characteristics Associated With Individuals’ Caring,Just, and Brave Expressions of the Tendency to Be a Moral Rebel

Extending previous research on the characteristics associated with adolescents’ general tendency to be a moral rebel (Sonnentag & Barnett, 2016), the present study examined the roles of moral identity and (general and situation-specific) moral courage characteristics on 3 (i.e., caring, just, and brave) expressions of the tendency to stand up for one’s beliefs and values despite social pressure not to do so. Results revealed that general and situation-specific moral courage characteristics are important motivators of individuals’ caring, just, and brave expressions of the tendency to be a moral rebel, especially when they possess a relatively strong moral identity.     

“How can you make friends if you don't know who you are?” A qualitative examination of international students' experience informed by the Social Identity Model of Identity Change

This paper explores the contribution of social identity change to international students' health and well‐being. International students typically face a range of challenges from the time they leave their home country, including the need to adapt both to a new culture and norms and to a new educational landscape. Previous research informed by the Social Identity Model of Identity Change (SIMIC) suggests that during such life transitions, an individual's group memberships and associated social identities can provide a buffer against the threats to well‐being that such transitions present. To examine the relevance of SIMIC for the transitions that international students' experience, semistructured interviews were conducted with 15 international students attending an Australian university. Thematic analysis provided support for the relevance of SIMIC's social identity gain and social identity maintenance pathways in the transition and revealed a number of associated factors that acted as either facilitators (e.g., a host family that supported community integration) or barriers (e.g., experiencing culture shock) to social identity change. These findings present the first qualitative support for SIMIC within an international student population and help to flesh out the specific ways in which social identity processes contribute to both positive and negative health and well‐being outcomes.     

“Je suis en terrasse”: Political Violence,Civilizational Politics,and the Everyday Courage to Be

Following the attacks against the Paris offices of the satirical magazine Charlie Hebdo in January 2015 and the subsequent acts of political violence in Paris the following November, a number of memes spread swiftly across social media. Most notable of these were proclamations of “Je suis Charlie,” “Je suis Paris,” “Je suis en terrasse,” and tricolorizing one's Facebook profile page. Although there are various ways by which this phenomenon might be explained, this article argues that, at least for some people, they seem to have operated as key mechanisms by which individuals/society sought to reestablish what Tillich calls “the courage to be,” and which in more contemporary terminology might be labeled a sense of ontological security—the ability to go on in the face of what would otherwise be debilitating anxieties of existential dread. The article argues the memes did this through a number of mechanisms. These included establishing a sense of vicarious identification with the victims; embracing increased levels of danger and seeking to confront the question of mortality head on; reasserting a sense of community and home via the reinstantiation of everyday routines now ascribed with enhanced political and existential significance; and reaffirming a new civilizationally inflected self‐narrative.     

Containment lost: the challenge to child psychotherapists posed by modern CAMHS

The paper is an examination of some emotional challenges facing child psychotherapists working in modern CAMHS following the introduction of the NHS internal market for commissioning and providing services. Its introduction has brought the loss of organisational containment for all CAMHS clinicians. The meaninglessness in work reported by clinicians is a clue to this loss. This loss is especially difficult for child psychotherapists because of their particular investment in the apprehension of meaning in symptoms and other presentations by patients. The paper proposes that meaninglessness is itself a clue to the ascendancy of what Freud called the death instinct, and that this is inherent within the internal market model. Because service design and delivery is predicated upon it, the internal market model structurally determines that clinicians are bound to senior management in a way that leaves child psychotherapists open to professional life-threatening dynamics associated with the death instinct. The ?K (Bion) world of CAMHS is thus deathly, leaving child psychotherapists vulnerable to self-destruction. We have lost a workplace in which our approach flourished conferring on us the identity of a discipline structurally favoured, because of the help we provided through this approach to patient and clinic work. This loss of identity brings the dangers of containment lost. This situation leaves child psychotherapists emotionally vulnerable and is akin to Satan’s loss in Milton’s Paradise Lost.     

Education as hospitality: welcoming foreigners into a common world

ABSTRACT

The present article aims at examining the specific difficulties that the school form – the modern educational institution par excellence – faces in order to attain hospitality as the raison d'être of the educational process. Educational activity is here understood as a form of hospitality which involves caring for the newcomers and for the physical and symbolic place into which they arrive. A cinematographical narrative drawn from Bégaudeau’s Entre les Murs supplements this analysis of some of the challenges we are faced with when dealing with students from different national backgrounds, beliefs and forms of life.     

Good omens? The intricate relations between educational and vocational identity in adolescence

Abstract

This study examines the relation between educational and vocational identity in Romanian adolescents. Access to work-relevant experiences is very limited among Romanian adolescents, and most encounters with career constructs are confined to educational settings. Hence, to gain a better understanding of how identity processes in the educational and vocational domains support or inhibit each other, we aimed at investigating: (a) educational and vocational identity statuses through cluster analysis and (b) associations between identity statuses in these life domains. Participants were 1551 Romanian youth, aged 14–20 (39.3% girls), who completed measures of educational and vocational identity. Results indicated that, in the Romanian context, educational and vocational identities are closely linked, as adolescents draw information for future career development mostly from their educational experiences. Implications for youth policies and for applied interventions sensitive to socioeconomic and cultural realities are discussed.     

The mediating role of identity incompatibility in the relationship between perceived discrimination and acculturation preferences in two generations of the ethnic Russian minority in the North Caucasus

Abstract

The present study tested a model in which the perceived incompatibility of ethnic Russian and regional North Caucasian identities mediates the relationship between perceived discrimination and acculturation strategies in two generations of ethnic Russian minority members living in the Kabardino-Balkar Republic, North Caucasus, Russian Federation. Two identities might be perceived incompatible when they represent conflicting sets of norms and values and the two communities may place competing demands on individual commitment and loyalty. We sampled 105 dyads from ethnic Russian families (youth: M = 18 years, SD = 2.35, 48.6% female; parents: M = 43 years, SD = 6.97, 68.6% female). The questionnaire included measures of perceived discrimination, perceived identity incompatibility, and acculturation strategies. The results of multigroup path analysis showed that the perceived identity incompatibility mediated the relationship between perceived discrimination and two strategies, aimed at culture maintenance (integration and separation) in both generations. Identity incompatibility is regarded as a psychological mechanism that explains the impact of perceived discrimination on minority acculturation preferences in a multicultural region.     

The Multigroup Ethnic Identity Measure – Revised (MEIM-R): Psychometric evaluation with adolescents from diverse ethnocultural groups in Italy

The Multigroup Ethnic Identity Measure – Revised (MEIM-R) is an extensively used questionnaire assessing ethnic identity. However, studies on its measurement characteristics in the European context are lacking. The current study addressed this gap by investigating the MEIM-R psychometric proprieties across multiple ethnocultural groups in Italy. Participants were 1445 adolescents (13–18 years) of Italian, East European, and North African origin. Results showed that the MEIM-R has good internal consistency. Multigroup confirmatory factor analyses revealed configural and metric invariance, i.e., an equal, correlated two-factor structure (ethnic identity exploration and commitment) and equal factor loadings across groups. Scalar invariance, i.e., equal item intercepts, was found only for the commitment scores that showed no group differences in latent factor mean levels. Partial structural invariance was evidenced, with the factor covariances varying across groups. These findings suggest that the MEIM-R is a valuable tool to assess the correlates of ethnic identity, although further research is needed.