The Gender Congruence and Life Satisfaction Scale (GCLS): Development and validation of a scale to measure outcomes from transgender health services

Background: It is vital that the treatment offered at transgender health services can be evaluated to ensure a high quality of care. However, the tools currently used to evaluate treatment at transgender health services are limited by mainly focusing on mental health or because they have been developed for binary transgender people only. This study therefore aimed to develop and validate a tool that addresses these limitations. The Gender Congruence and Life Satisfaction Scale (GCLS) was developed through reviewing the literature, conducting interviews with transgender people, and holding discussions with experts working in transgender healthcare. An initial pool of items was developed and feedback on these was obtained. The tool was then validated.

Method: For the validation of the tool, a total of 789 participants (451 transgender [171 transgender females, 147 transgender males, 133 people identifying as non-binary], and 338 cisgender [254 females, 84 males]) were recruited from the United Kingdom to test the factor structure and validity of the GCLS.

Results: Exploratory factor analysis retained 38 items which formed seven subscales (psychological functioning; genitalia; social gender role recognition; physical and emotional intimacy; chest; other secondary sex characteristics; and life satisfaction). These seven subscales were found to have good internal consistency and convergent validity. The GCLS was also found to be capable of discriminating between groups (e.g., people who have and have not undergone gender affirming medical interventions). Transgender and cisgender subscale norms are provided for the GCLS.

Conclusion: The GCLS is a suitable tool to use with the transgender population to measure health-related outcomes for both clinical and research purposes.     

The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

Abstract

Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate.

Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions.

Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17?years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery.

Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions.

Discussion: The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.     

Prenatal Paranoia: An Analysis of the Bumpy Landscape for the Pregnant Athlete

ABSTRACT

I analyze the case of pregnant athletes, and argue that sexism surrounds pregnant athlete’s participation in sport. I claim that we stigmatize the pregnant body in action. Participating in sport while pregnant is often considered socially irresponsible behaviour because of unfounded fear of harming the fetus. Many believe that elite sport is in conflict with reproductive ability. However, this belief is not rooted in scientific findings, and rather is reinforced by traditional sexist views of the woman’s athletic body and its capabilities. Analyzing the various degrees of sexism like sexual objectification and unjust discrimination that surround the pregnant athlete is a relevant and necessary exercise in order to challenge traditional sexist views and increase agency for the pregnant athlete.     

The cost of treating substance use disorders: individual versus family therapy

This study examined the cost of substance use disorders treatment in a large healthcare organization. A survival analysis demonstrated that family therapy utilised the least number of sessions (M = 2.41) when treating substance use disorders followed by individual therapy (M = 3.38) and mixed therapy (M = 6.40). Family therapy was the least costly of the three types, at $124.55 per episode of care for a client, with individual therapy costing $170.22 and mixed therapy $319.55. The ratio of family therapists utilising family therapy was more than three to one compared to other licensed professionals. The percentages of clients coming back for more than one episode of care are fewest for family therapy (8.9%) followed by mixed therapy (9.5%) and individual therapy (12.0%).     

Racism,stress, and sense of personal control among Aboriginal Australian pregnant women

Objectives

To characterise racism experiences in the past year and to investigate a causal association between racism, stress, and sense of personal control in a sample of pregnant South Australian Aboriginal women.

Methods

Data was from the baseline sample of 369 Aboriginal women participating in a randomised controlled trial to prevent early caries in children. Data on demographics, racism experiences, stress, sense of personal control, and health behaviours were collected through interview-guided questionnaires. Linear regression modelling was used to test the association between racism and stress and sense of personal control in separate models. The final models presented were adjusted for confounding.

Results

Participant mean age was 24.7 years (SD ±0.30; Min–Max: 14–43 years). Almost two-thirds (64.7%) resided in rural and regional areas and the highest educational attainment for almost three-quarters (73.7%) was high school or less. Nearly half (48.3%) reported at least one experience of racism in the previous year and almost one third (31.8%) reported racism occurring in a public setting. The adjusted regression coefficients for the effect of racism on stress and sense of personal control were respectively 0.61 (95% confidence interval [CI] 0.28, 0.93) and −0.36 (95% CI −0.68, −0.04).

Conclusions

Our findings contribute with evidence that racism is one of the psychosocial causes of poor mental health among Aboriginal Australians. Culturally sensitive and safe mental health interventions may be beneficial in buffering racism effects during pregnancy. Societal-level policies aimed at both naming and reducing institutionalised racism against Aboriginal Australian Aboriginals are necessary.