Use of telepsychiatry increased during the COVID-19 pandemic, resulting in greater access and the potential for improved care, although barriers to wider adoption remain. As far back as 1878, telehealth has been used to connect clinicians to patients, with great leaps forward occurring in the late twentieth century, as the US National Aeronautics and Space Administration monitored astronauts’ physiological well-being in space using remote medicine.
Alcohol Use Disorder Treatment in Sexually and Gender Diverse Patients: A Retrospective Cohort Study
While sexually and gender diverse (SGD) people have higher odds of alcohol use disorder (AUD) compared to heterosexual and cisgender people, AUD treatment access and use disparities are not well characterized. The purpose of this study is to assess differences in AUD treatment among SGD versus non-SGD populations.
With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients’ psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.
In “The Context, Science and Practice of Gender-Affirming Care,” commentary authors Alex S. Keuroghlian, JoAnne Keatley, Simran Shaikh and Asa E. Radix, posit that gender-affirming care for transgender and gender diverse (TGD) people should be inclusive, community led and evidence informed to support mental health and wellbeing. This article outlines the evolution of gender-affirming care since the 1930s and emphasizes psychological, social, legal, medical and surgical affirmation within the contexts of culturally responsive healthcare environments, as well as broader policies and laws that support and protect gender diversity locally, nationally and globally.
In “Moving Beyond Psychiatric Gatekeeping for Gender-Affirming Surgery,” commentary authors Drs. Alex S. Keuroghlian and Catherine A. Wu offer a discussion of the phenomenon of clinical gatekeeping in the context of accessing gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS), in contrast to what might be considered reasonable precautions to ensure candidacy. The article details the recent changes in requirement guidance issued by the World Professional Association for Transgender Health (WPATH) “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8” (SOC8), and the way in which this shift reflects a move towards an informed consent model for gender-affirming care. The article authors offer their recommendations for an optimized informed consent approach to GAS to further mitigate the harms of psychiatric gatekeeping.
Article: We Must Set A High Bar For Attributing Psychopathology To Sexual And Gender Minority People
A commentary published July 18, 2022 in the Journal of Clinical Psychiatry cautions clinicians, scientists, and researchers against making assumptions that sexually and gender diverse people have a greater predisposition to psychiatric illness. The commentary was written in response to a newly published study by Oka et al showing that there were no differences in clinical responsiveness to electroconvulsive therapy (ECT) for treatment-resistant psychiatric illness between LGBTQ and non-LGBTQ patients. The authors of the study had hypothesized that LGBTQ patients would be less favorable to ECT because they would be more likely to have clinical conditions less favorable to ECT, such as posttraumatic stress disorder, personality disorders, or substance use disorders.
This new article titled "Association Between Gender-Affirming Hair Removal and Mental Health Outcomes," was recently published in JAMA Dermatology. Authors Michelle Lee, Anthony Almazan, Dr. Vinod Nambudiri and Dr. Alex Keuroghlian discuss how gender-affirming medical care is essential for addressing the mental health burdens of transgender and gender-diverse (TGD) populations and how gender-affirming hair removal (GAHR) procedures, including electrolysis and laser hair removal, are desired by nearly 90% of TGD people. However, such services are covered by only 4.6% of insurance plans, possibly owing in part to limited evidence of their mental health benefits. In this study, they investigate the association between GAHR and mental health outcomes.
Transgender people who have access to gender-affirming surgery report better mental health outcomes, according to a new study. The report, published Wednesday in JAMA Surgery, compared the psychological distress levels, suicide risk and substance use in transgender and gender diverse people who had undergone gender-affirming surgery with those who wanted such procedures but had not yet had them. “This study adds to a growing body of evidence showing affirmation in all forms can be life-saving for trans and gender-diverse people,” said lead author Anthony Almazan, a fourth-year medical student at Harvard Medical School. “Policies that limit access to care can put lives at risk. Our evidence shows we should be expanding gender-affirming care, not limiting it.” You can read the NBC story here.
Paper calls for new psychiatric practices that affirm transgender and gender-diverse patients without pathologizing diagnoses
An editorial published in The British Journal of Psychiatry calls for the development of alternative psychiatric care frameworks that affirm transgender and gender-diverse (TGD) people without pathologizing them through clinical diagnoses. The editorial was authored by researchers at The Fenway Institute and Dartmouth-Hitchcock Medical Center and adds to a growing body of literature demonstrating the need to uncouple gender diversity from the stigma of diagnostic classification.
The National LGBT Health Education Center is excited to announce the following upcoming live webinars in April.
Details and registration information are provided by clicking "Read More." CMEs are available.