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Abstract Background Non-binary identities are increasingly recognized within the spectrum of gender diversity, yet there is a dearth of research exploring the mental health challenges specific to this population. Therefore, this systematic review and meta-analysis aimed to comprehensively assess the mental health outcomes of non-binary youth in comparison to their transgender and cisgender peers. Methods A systematic search was conducted to identify relevant studies across three electronic databases (PubMed, Scopus, Web of Science) covering the period from inception to October 2023. The meta-analysis was performed employing a random-effects model. Inclusion criteria encompassed studies comparing non-binary youth with transgender or cisgender youth, providing data on mental health outcomes such as general mental health, depressive and anxiety symptoms, self-harm and suicidality. Results Twenty-one studies, meeting the inclusion criteria and originating from six different countries, were included in the analysis. The sample encompassed 16,114 non-binary, 11,925 transgender, and 283,278 cisgender youth, with ages ranging from 11 to 25 years. Our meta-analysis revealed that non-binary youth exhibit significantly poorer general mental health compared to both transgender (d = 0.24, 95% CI, 0.05–0.43, p =.013) and cisgender youth (d = 0.48, 95% CI, 0.35–0.61, p

Abstract Background A physician’s empathy level substantially impacts clinical competence, patient relationships, and treatment outcomes. Yet, understanding empathy trends from medical students to resident doctors within a single institution is limited. This study delves into empathy trends within a single-center academic setting and identifies factors associated with low empathy. Methods This cross-sectional study enrolled the second—to sixth-year medical students of Phramongkutklao College of Medicine and the first—to second-year residents at Phramongkutklao Hospital. It utilized a standardized questionnaire covering demographics, family relationships, the Maudsley Personality Inventory (MPI), and the Jefferson Scale of Empathy (JSE). The relationship between variables and JSE scores was analyzed using independent t-test, one-way ANOVA, and Chi-square tests. Multivariable logistic and linear regression analyses examined associated factors and trends across educational levels. A quadratic term was incorporated to evaluate the presence of a nonlinear trend. Results A total of 520 participants, comprising 189 (36.4%) preclinical students, 153 (29.4%) clinical students, and 178 (34.2%) residents, completed the survey. The JSE showed a Cronbach’s alpha of 0.83. The average empathy score was 103.8 ± 15.0, with 27.1% of low empathy levels. Specialty preference and sex-adjusted average empathy scores decreased from 114.5 (95%CI: 112.0–117.0) among second-year medical students to 95.2 (95%CI: 92.2–98.2) among second-year residents (P non−linear

Abstract Background Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals. Methods In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care. Results Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation. Conclusions This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care.

IntroductionLesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) people experience discrimination across many contexts, including healthcare environments. While some research has shown transgender people and non-binary people often endure higher rates of marginalization than cisgender, sexually diverse people, past data are limited.MethodsA sample of LGBTQ+ people (N = 173) in the United States completed an anonymous, online, self-reported survey, which included the Consumer Assessment of Healthcare Providers and Systems and healthcare experience questions. Groups, including people who identified as cisgender, sexually diverse (n = 116), transgender (n = 24), and non-binary (n = 33), were compared using chi-square and multivariate analysis of covariance tests.ResultsCompared to cisgender, sexually diverse people, non-binary people were less likely to report feeling comfortable with a physical exam, having good mental health, respected by providers, that providers had adequate medical information, that providers could care for someone going through gender affirmation, and that hospital staff were comfortable interacting with them. Additionally, non-binary people were more likely to report hospital staff misgendering them.DiscussionThese unique LGBTQ+ subgroup differences may be secondary to identity-specific stigma that non-binary people face. More international studies are needed to elucidate these subgroup-specific healthcare experiences across LGBTQ+ identities.

Abstract Transgender and nonbinary patients face unique healthcare challenges, such as harassment, discrimination, and/or prejudice, at higher rates than their cisgender counterparts. These experiences, or even the fear of these experiences, may push patients to delay or forego medical treatment, thus compounding any existing conditions. Such extraneous issues can be combatted through cultural sensitivity. The authors designed blended education consisting of an online module followed by a live simulation to educate and promote sensitivity. Internal medicine (IM) residents (n = 94) completed the module, which introduced them to transgender community terminology and medical disparities, and ways to incorporate affirming behaviors into their practice. Afterward, they engaged in a simulation with true transgender-simulated patients (SPs) — either trans-masculine, trans-feminine, or non-binary. Residents were expected to conduct a patient interview mirroring an intake appointment. Residents then engaged in a debriefing session with the lead investigator and the SP to reflect on the experience, receive feedback and constructive criticism, and ask questions. After the education, the residents’ knowledge significantly increased, t(66) = 3.69, p ≤ 0.00, d = 0.45, and their attitude toward members of the transgender community also increased significantly, t(62) = 7.57, p ≤ 0.00, d = 0.95. Furthermore, nearly all residents (99%) reported the training allowed them to practice relevant skills and was a worthy investment of their time. Nearly half (45%) of the residents who listed changes they will make to their practice pledged to ask patients for their preferred name and pronouns. Most comments were positive (75%), praising the education’s effectiveness, expressing gratitude, and reporting increased confidence. Results provided evidence that the education was effective in increasing IM residents’ knowledge and attitudes. Further research is needed to investigate the longitudinal effects of this education and to extend the education to a broader audience. The investigators plan to adapt and expand the research to other specialties such as gynecology and emergency medicine.

Non-Binary gender identity is slowly growing in visibility across the globe. In at least seven Member States of the Council of Europe, some judicial, administrative or legislative bodies have already started organising a form of legal recognition for gender identities outside of the binary through the creation of ”third” gender categories and “X” gender markers. This trend is growing fast and the European Court of Human Rights should pronounce itself soon on a potential positive obligation to organize such recognition in the case of Y v. France (pending). In this context, this research reflects on the foundations and flaws of the organisation of gender registration in the Council of Europe Member States. The main focus in this sense is put on the human rights law framework of the Council of Europe and specifically the right to respect for private life (Article 8 of the European Convention on Human Rights (E.C.H.R.)), the prohibition of inhuman and degrading treatment (Article 3 E.C.H.R.) and the freedom of expression (Article 10 E.C.H.R.) in light of the prohibition of discrimination (Article 14 E.C.H.R.). Furthermore, it reflects critically on the recent legal developments that led to the use of “X” gender markers to highlight their inadequacy. In doing so, it points towards the possible abolition of gender registration – or at the very least its suppression from identity documents.

There is a lack of research regarding dietary supplement (DS) use among Gay, Bisexual, Transgender, Two-Spirit, Queer (GBT2Q) men and non-binary individuals, despite the higher prevalence of body image issues and societal pressure within this community. This study aimed to investigate patterns and predictors of DS use in this population, including types of DS used, sources of information, and reasons for DS use. A validated and anonymous online questionnaire was completed by 204 participants (52.5% men, 43.1% gay, mean age 29.34 + 6.77 years) across Canada, who were consuming DS at the time of the study. Analyses included descriptive statistics to characterize the sample based on gender, sexuality, age, ethnicity, and other demographic attributes, using Pearson’s chi-square tests and multi-way cross-tabulation analyses. Additionally, regression analyses, including binary and logistic regressions, were employed to identify predictors of DS use. Data analysis concluded that vitamins/minerals (92.2%), proteins (84.3%) and carbohydrates (75.5%) were the most consumed types of supplements. Identifying as certain genders and sexualities was significantly associated with supplement preferences, such that men reported higher use of amino acids (p = 0.033) and non-vitamins/mineral antioxidants compared to individuals identifying as other genders (p = 0.006). Moreover, bisexual participants consumed amino acids (p = 0.043) and carbohydrates (p = 0.026) more frequently when compared to non-bisexual participants. The most listed reason for DS use was to improve immunity (60.3%), with health care professionals being listed as the source of information by most participants (51.0%). Findings from this study can serve as a foundation for further research in this area and can guide the formulation and implementation of adequate policies targeting this underserved population.

Background: Disparities in healthcare for transgender and gender diverse (TGD) people are well-recognized, with pharmacists reporting a lack of knowledge impacting confidence in their interactions with TGD people. Therefore, a training program in TGD healthcare was designed to address this knowledge gap. Objective: To evaluate the impact of the TGD healthcare training program on the awareness, knowledge, and behaviour of pharmacists and pharmacy students in Australia. Method: An online training program was evaluated by pre-and post-test surveys, which assessed the knowledge and awareness of participants, and three-month post-training interviews, which examined the effect of training on pharmacists' practice when providing care to TGD people. Data were analyzed using paired t-tests, content and thematic analysis. Result: Fifty-six pharmacists and twenty-one pharmacy students completed the training and pre-and post-test surveys. Ten pharmacists were interviewed post-training. There was a significant improvement in the awareness (pharmacists, p ≤0.001; students, p = 0.006), knowledge (pharmacists and students, p ≤0.001) and total (pharmacists and students, p ≤0.001) post-test scores for both groups. Interviewed participants found the training program comprehensive and relevant to their practice. Conclusion: This study has demonstrated that educational interventions improve TGD healthcare awareness and knowledge for pharmacists and students with the potential to improve healthcare provision to TGD people and promote inclusivity in society.

Abstract Background Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women. Methods Data were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach’s alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. Results A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q from Grilo et al. (Obes Surg. 23:657–662, 2013), consistently evidenced the best fit across cisgender gay men and lesbian women. The internal consistencies of the three subscales were adequate in both groups, and measurement invariance across the groups was supported. Conclusions Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in cisgender gay men and lesbian women. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse sexual minority samples across race, ethnicity, socioeconomic status, and age ranges.

This exploratory qualitative study aimed to find out more about how the children’s social work system interacts with non-binary parents. It highlights the specific detriment that can be faced by non-binary people hoping to adopt or foster in the United Kingdom. Three key themes emerged: (1) Barriers for non-binary carers, (2) Prejudice in adoption and fostering matching processes and (3) Intersectional disadvantage. The study found that non-binary people experience specific detriment when endeavouring to start or grow their families, examining how cisgenderism operates to privilege some identities over others. Multiple barriers affect the way non-binary people try and navigate how their family lives in a society that is organised around binary gender identities. Cisgenderism can subtly and pervasively exert a devaluing of identities that sit outside of entrenched binary gender norms, influencing how people can understand and express their gender identities within society.

Gender-affirming hormone therapy (GAHT) plays a significant role in the medical care of transgender individuals, helping to align their physical characteristics with their gender identity. While numerous studies have investigated the impact of GAHT on adults, research focusing on its effects on the quality of life (QoL) of transgender youth is limited. In this opinion paper, we aim to address selected challenges associated with gender-affirming medical care, such as (1) the necessity for evidence-based youth gender-affirming medical care, (2) the urge to explore different approaches to gender-affirming medical care diversely in transgender youth research, and (3) understanding the challenges of the detransition process (which refers to stopping or reversing gender-affirming medical or surgical treatments), as well as suggest possible solutions for meaningful progress. Notably, the available evidence underlines a positive impact of GAHT on various aspects of QoL of transgender youth, such as mental health and social functioning, by alleviating gender dysphoria, improving body satisfaction, and facilitating appearance congruence (the degree to which an individual’s physical appearance represents their gender identity). However, challenges related to methodological limitations, as well as ethical considerations, and several sociocultural factors highlight the need for further research to better understand the long-term effects of GAHT on the QoL of transgender youth. Ethical considerations, such as ensuring informed consent and weighing potential benefits against risks, are pivotal in guiding healthcare decisions. Additionally, navigating these ethical responsibilities amid sociocultural contexts is crucial for providing inclusive and respectful care to transgender youth. Addressing these research gaps is, therefore, crucial to developing successful healthcare programmes, raising awareness, and promoting the holistic well-being of transgender youth through comprehensive and affirming care.

IntroductionTransgender and gender non-binary (TGNB) individuals are disproportionally affected by HIV and face high rates of discrimination and stigmatization, resulting in limited access to HIV prevention services. Pre-exposure prophylaxis (PrEP) is highly efficacious for reducing the risk of HIV transmission. However, little research is available regarding PrEP awareness and utilization among TGNB adolescents and young adults (AYA).MethodsTGNB AYA ages 15–24 years old were recruited between December 2021 and November 2022 for participation in a one-time, anonymous online survey study to assess PrEP awareness and perceptions, as well as barriers to its use. Participants were recruited from seven academic centers offering gender-affirming care to TGNB AYA across the United States.ResultsOf the 156 TGNB AYA individuals who completed the survey, most (67%) were aware of PrEP; however, few (7%) had been prescribed PrEP. Many (60%) had not spoken to a medical provider and, even if the medication was free and obtained confidentially, most participants did not plan to take PrEP due to low perceived HIV risk, lack of PrEP knowledge, and concern about interactions between their hormone therapy and PrEP.DiscussionThese findings underscore the need for broad PrEP educational efforts for both TGNB AYA and their providers to improve knowledge, identify potential PrEP candidates among TGNB AYA and improve access by addressing identified barriers.

AbstractThis study examines the presence of discriminatory discourses and symbolic violence in the digital realm within the context of Indonesia. The objective of this research is to identify the discriminatory strategies towards non-heteronormative gender identity within the comment section of an Instagram post published by VICE Indonesia and to comprehend how these strategies function as mechanisms of symbolic violence. The study was conducted qualitatively by analyzing notable comments in the primary data source, which is an Instagram post addressing the issue of non-binary gender in the Indonesian context. To ensure a comprehensive analysis of the comments, only representative comments were included. The data was categorized based on four discriminatory discursive strategies, and subsequently interpreted through the lens of symbolic violence. The results show that the utilization of discriminatory discursive strategies includes the negative portrayal of the other, which involves labeling the out-group using words such as penyimpangan and gangguan jiwa, scare tactics, which are used to stir worries, blaming the victim, by justifying discrimination towards the out-group by emphasizing their negative qualities, and delegitimation, by highlighting the illegitimate status of the out-group. Additionally, the employment of these strategies is argued to transmit symbolic violence as a way to maintain doxa. Furthermore, the transmission of symbolic violence is discussed further and related to the sociocultural context of Indonesia.

Christina Jung,1 Adam Hunter,1 Mona Saleh,2 Gwendolyn P Quinn,1 Siripanth Nippita1 1Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA; 2Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USACorrespondence: Gwendolyn P Quinn, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1st Ave NBV N91-F, New York, NY, 10016, USA, Tel +1-646-501-6878, Email Gwendolyn.quinn@nyulangone.orgAbstract: The gender binary has historically defined the study and practice of reproductive and sexual healthcare. However, the male and female binary categorization of sex does not adequately define patients seeking reproductive and sexual health. Comprehensive sexual healthcare should consider diverse gender identity and non-heteronormative sexual practices, family planning, sexually transmitted infections, cancer prevention, and sexual function. Recent research suggests clinicians do not feel prepared to provide care for sexual and gender minority (SGM) patients. In this narrative review, we focus on reproductive and sexual health within the scope of obstetric and gynecologic (OB/GYN) clinical practice. We used traditional medical subject headings to summarize data from publications in peer-reviewed journals published in the last 10 years and identified barriers, facilitators and best practices for de-gendering reproductive healthcare. Following a roughly chronological care path across the lifespan, we categorized findings into the following topics: Early Care for SGM, Sexual Health, Family Planning, and Care Later in Life for SGM. We include recommendations for creating a welcoming environment, SGM inclusive training for clinicians and staff, and best practices for individualized counseling. We review suggested practices related to service delivery and clinical considerations in the provision of sexual and reproductive health care for gender and sexual minority patients.Keywords: gender, reproductive health, clinician, sexual and gender minorities, transgender, non-binary, LGBTQ+

Abstract Background Intimate partner violence and abuse (IPVA) includes controlling behaviours, psychological, physical, sexual and financial abuse. Globally, surveys and emergency services have recorded an increase in IPVA since restrictions were imposed to limit COVID-19 transmission. Most studies have only included heterosexual women. Methods Data from the Global Drug Survey (an annual, anonymous, online survey collecting data on drug use) Special Edition were analysed to explore the impact of COVID-19 on people’s lives, including their intimate relationships. Five relationship groupings were created using respondents’ lived gender identity: women partnered with men (46.9%), women partnered with women (2.1%), men partnered with men (2.9%), men partnered with women (47.2%), and partnerships where one or both partners were non-binary (1%). Self-reported experience and perpetration of IPVA in the past 30 days before (February) and during COVID-19 restrictions (May or June) in 2020 (N = 35,854) was described and compared for different relationship groupings using Fishers Exact Tests. Changes in IPVA during restrictions were assessed using multivariable logistic regression. Results During restrictions, 17.8 and 16.6% of respondents had experienced or perpetrated IPVA respectively; 38.2% of survivors and 37.6% of perpetrators reported this had increased during restrictions. Greater proportions of non-binary respondents or respondents with a non-binary partner reported experiencing or perpetrating IPVA (p

This videowork is a joint effort of two artists living in different cultural geopolitical and social landscapes. Their choice to live openly nonbinary existences as transpersons in public space form both their creative approach and artistic practice. In the online video meeting, they opened the theme of communication in form of dialogue of gestures to express distinctive qualities of living “in between” normalized binary genders and at the criss cross of mental and bodily discourse within prescribed patriarchal dichotomies. The video presented here is an excerpt of Talking to You, Anna Daučíková, 2021, Two-channel HD video, color, sound, 33 min. The art work is based on an online performance by Anchan and Tamarra, Yogyakarta-Prague, 24.09.2021. The video excerpt is presented together with sign language interpretations in DGS and IS by Dana Cermane, produced for a workshop facilitated by Antkek Engel during the membra(I)nes conference (15 June, 2023, HGB Leipzig/Germany). Sign language interpretation is funded by Aktion Mensch.

The aim of this paper is a theoretical and academic analysis on the importance of devictimizing and depathologizing trans and non-binary persons and identities in school, and towards opening the platform for such research in Serbia. Since school is recognized as the key site of materialization of gender agency which often causes discrimination of gender minorities and even violence, it is of utter importance to work on the implementation of recommendations and examples of good practice in schools, especially in the processes of education and knowledge transference. This paper analyses the available research results and concludes by mapping the ideas for future theoretical, academic and practical research routes of this kind in the local context.

Plain English Summary Gender diverse is a term that includes gender identities such as (but not limited to) transgender, non-binary, and gender fluid. Eating disorders are becoming increasingly recognized among this population. In recent years there has been a better understanding of the risk factors and screening for eating disorders in the outpatient setting for gender diverse adolescents. However, the medical, anthropometric, and psychiatric characteristics of gender diverse adolescents with eating disorders requiring inpatient medical stabilization are poorly understood. This study examines these characteristics in gender diverse adolescents hospitalized for eating disorder-related medical complications from 2012 to 2020. Gender diverse adolescents presented for medical hospitalization with signs of malnutrition, including vital sign instability and laboratory abnormalities, as well as additional psychiatric diagnoses such as depression and anxiety. Understanding the medical, anthropometric, and psychiatric presentation of this population can lead to more tailored and comprehensive care with the potential to reduce the risks of adverse health outcomes.

Non-binary gender is a marginalised queer identity increasingly receiving mainstream media representation, a subject that warrants investigation. Non-binary is an umbrella term under which many experiences of gender fall, a factor that necessitates a nuanced variety of narrative representations to avoid perpetuating or creating static and singular archetypes. This article examines a sample of young adult novels with non-binary protagonists published between 2017 and 2020, exploring the various ways these texts express and explore their central characters’ gender identity. My findings reveal thematic commonalities between these novels, with particular focus on the language used to describe these characters’ felt sense of gender, their experiences with dysphoria/euphoria, their relationships to broader queer communities within their story worlds, and the intersections of queer gender and speculative elements. I argue that this subset we might call ‘non-binary YA’ serves as an emblem of the development of queer YA overall, its rapid expansion through various genres and narrative types providing a microcosm of the growth of the literary field and pointing to its future.

Research shows that transgender and non-binary (TNB) individuals frequently experience discrimination and mistreatment in health care settings. These negative experiences cause TNB people to underutilize health care and, when they do utilize it, may affect communication of health information. Moving from social cognitive theory (SCT) and theory of planned behavior (TPB), this study investigated what factors influence pre-, during, and post physician visit communication between TNB individuals and general practitioners (GPs) in The Netherlands. Between March and May 2022, fifteen TNB individuals and ten GPs participated in semi-structured interviews and focus groups about their experiences with GP-TNB interactions. The findings suggest that GPs addressing TNB people, GP knowledge and education, GP office procedures and environment, and social environment (in)directly facilitate or hamper communication. These findings support previous ideas about the influence of factors such as knowledge and social environment on one's behavior, as previously described in SCT and TPB. They also add and specify how pre-determined and novel factors affect whether TNB people feel welcome and comfortable at GP offices and if GPs feel equipped to provide TNB people with quality care. More specifically, to facilitate appropriate health communication, GPs are advised to ask patients about their pronouns, adjust intake forms, and put up TNB-specific posters or a Pride flag in their offices. TNB people are advised to make an introductory appointment to discuss their gender identity. Lastly, TNB topics should be included in medical curricula and online GP resources.

Background: Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field. This paper presents a protocol for a scoping review to map and synthesise the academic and grey literature on instruments used to assess healthcare navigation and access for transgender and non-binary individuals seeking gender-affirming care. Methods: This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages will be undertaken: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation. The PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation will be utilised and reported. The research team will undertake the study as outlined in this protocol and an expert panel of young transgender and non-binary youth will oversee the project through patient and public involvement. Conclusions: This scoping review has the potential to inform policy, practice, and future research through enhanced understanding of the complex interplay of factors that impact healthcare navigation for transgender and non-binary people seeking gender-affirming care. The results from this study will inform further research into healthcare navigation considerations generally and will inform a research project entitled “Navigating access to gender care in Ireland—a mixed-method study on the experiences of transgender and non-binary youth”.

Abstract Background Emerging international evidence indicates the COVID-19 pandemic has exacerbated socioeconomic and health challenges faced by transgender (trans) and non-binary populations globally. This qualitative study is among the first to characterize impacts of the pandemic on these groups in Canada. Methods Drawing on data from the Trans PULSE Canada survey (N = 820), we used thematic analysis to examine the free-form responses of 697 participants to one open-ended question on impacts of the pandemic. We first organized responses into descriptive themes, and then used this preliminary analytical process to construct more refined, higher order themes that provided a rich account of the pandemic’s impacts. Results Our results are organized into five themes that highlight the pandemic’s impacts on trans and non-binary populations in Canada. These include: (1) reduced access to both gender-affirming and other healthcare, (2) heightened financial, employment, and housing precarity, (3) strained social networks in an era of physical distancing and virtual communication, (4) an intensification of safety concerns, and (5) changes in experiences of gender affirmation. Conclusion Our findings highlight the pandemic’s systemic impacts on the lives of trans and non-binary people in domains such as healthcare, employment, and housing, and on the social networks of these groups, many of which reflect an exacerbation of pre-existing inequities. Based on our analysis, we recommend that public health researchers, policymakers, and practitioners attend to the structural impacts of the pandemic on these groups as primary sites of inquiry and intervention.

Plain English Summary Gender-expansive describes gender identities that do not fit within the binary gender identity system, such as man or woman. We asked gender-expansive participants in The PRIDE Study to fill out a widely used survey about muscle dysmorphia (when someone is worried about not being muscular enough). We found that this issue about muscularity has three parts for gender-expansive people: (1) a desire to be bigger and more muscular, (2) dissatisfaction with the way their body looks, and (3) problems with normal life functions. We find that this survey is appropriate for use in gender-expansive people. These results can help providers and researchers understand the muscle-related problems that gender-expansive people face.

Non-binary people do not identify with the two normative poles of gender, masculine and feminine. In the context of learning FFL, they are confronted with the hypergrammatical and binary functioning of grammatical gender in French, which can be problematic when their first language does not have a grammatical gender, such as Turkish. How, then, can non-binary people be allowed to express themselves and talk about themselves in the FFL classroom? Based on a field survey conducted at Galatasaray University (Istanbul) in 2021-2022, this paper proposes an analysis of the issues related to the learning of non-binary people in FFL didactics, as well as pedagogical approaches.

Background: Globally, with the increased visibility, the number of transgender people accessing healthcare services has risen in the last decade. Although pharmacists are required to provide equitable and respectful care to all patients, their experiences interacting with trans and gender-diverse (TGD) people and attitudes towards the provision of care are largely unknown. Objectives: This study aimed to determine the experiences and attitudes of pharmacists providing care to TGD people in Queensland, Australia. Methods: Within a transformative paradigm, this study used semi-structured interviews conducted in person, over the phone, or through the Zoom app. Data were transcribed and analyzed by applying the constructs of the Theoretical Framework of Accessibility (TFA). Results: A total of 20 participants were interviewed. Analysis revealed all seven constructs across interview data, with affective attitude and self-efficacy being the most frequently coded constructs, followed by burden and perceived effectiveness. The least coded constructs included ethicality, intervention coherence, and opportunity cost. Pharmacists had positive attitudes towards providing care and interacting professionally with TGD people. Prime challenges in delivering care were being unaware of inclusive language and terminology, difficulty building trusted relationships, privacy and confidentiality at the pharmacy, inability to locate appropriate resources, and lack of training in TGD health. Pharmacists felt rewarded when they established rapport and created safe spaces. However, they requested communication training and education to improve their confidence in delivering care to TGD people. Conclusion: Pharmacists demonstrated a clear need for further education on gender-affirming therapies and training in communication with TGD people. Including TGD care in pharmacy curricula and continuous professional development activities is seen as an essential step towards pharmacists improving health outcomes for TGD people.

This paper will show that sporting institutions that police the boundaries of women’s sports do so to keep sportswomen constrained in ways that men’s sports and male athletes are not. This paper explores three methods that sporting establishments have used to police and constrain women’s sports and sportswomen: the exclusion of women and the creation of different rules for men’s and women’s sports, the policing of international sporting administrations of which women can compete in women’s sports by invoking the specter of “gender fraud”, and the exclusion of trans women from sports by relying on conservative Christian notions of a gender binary motivated by a similar strain of homophobia that animated previous efforts to prevent the legalization of same-sex marriage. Taken together, these three threads reveal that gender policing in women’s sports is not and has never been about “fairness” but about preserving heteropatriarchal systems of power that position women as weak and inherently less athletic than men.

Background: Despite the increased visibility of transgender and gender diverse (TGD) people, little is known about their interactions with pharmacists and pharmacy staff while accessing care from the pharmacies. Objectives: The objective of this study was to explore the experiences and expectations of the TGD people regarding their interactions with pharmacists and pharmacy staff in Queensland, Australia. Methods: This study is situated in a transformative paradigm and utilized narrative inquiry to conduct semi-structured interviews with TGD participants. An interview guide based on the relevant literature and the constructs of the Theoretical Framework of Accessibility was developed. Purposive and snowball sampling was used to recruit people who identified as TGD and had previously visited pharmacies to access care. Depending on participants' preferences, interviews were conducted face-to-face or via phone or Zoom application. Interviews were recorded, transcribed, and organized in chronological stories. Data were analyzed to derive themes from the participant stories. Results: A total of 22 participants (transwomen = 11, transmen = 8, non-binary trans masculine = 3) were interviewed. Two major themes were identified, (1) Challenges of accessing care from the pharmacy and (2) Making the most of the interactions between TGD people and pharmacists. Major challenges of accessing care from pharmacies included anticipated anxiety of accessing care, healthcare system constraints, compromised privacy and confidentiality at the pharmacy, and being challenged about their gender. Many avoided interacting with pharmacists and staff or kept their interactions minimal. Participants recognized that pharmacists play a meaningful role in TGD health and provided insights about how pharmacists can improve care provision to TGD people. Conclusion: Cultural and pharmacotherapeutic education in transgender health are crucial for Australian pharmacists and staff to provide inclusive, respectful, and person-centered care to TGD people.

Abstract Background In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights’ fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. Methods A self-administered questionnaire was used to collect data from 1773 young (16–29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission’s definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. Results There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. Conclusions Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.

Abstract Introduction Because transgender individuals experience disproportionately high rates of HIV infection, this population is an increasing focus of epidemiological and implementation science research to combat the epidemic. However, study participants, providers and other advocates have become increasingly concerned about research practices that may alienate, objectify, exploit or even re‐traumatize the communities they are designed to benefit. This commentary explores the common pitfalls of HIV research with transgender communities and provides a potential framework for ethical, community‐engaged research practice. Discussion We review some of the critical challenges to HIV research with transgender and non‐binary communities that limit the potential for such studies to improve practice. For example, scales that measure stigma perceptions/experiences often include activating language, while the consistent focus in research on risk and trauma can often feel judgemental and redundant. Because of limited employment opportunities, some participants may feel undue influence by research stipends; others may perceive their participation as fuelling the larger research economy without providing research jobs to community members. Questions remain regarding optimal strategies for authentic research partnership beyond community advisory boards or focus groups. Transgender and non‐binary researchers are under‐represented and may be tokenized. Many demonstration projects provide much‐needed services that disappear when the research funding is over, and community‐based dissemination efforts are often perceived as “too little, too late” to effect change. Conclusions Based on this review and input from study participants across the United States, we detail six recommendations for ethical HIV research with transgender and non‐binary communities, including (1) equitable budgeting with community‐based programme partners; (2) representation in the development of both research agenda and methods; (3) integration of research activities into the ongoing work of any clinical or service site, so that individuals’ needs as “clients” can continue to be prioritized over their role as “participants;” (4) mindfully considered compensation that values the contributions of community members, but avoids undue influence; (5) transparent, community‐focused and timely communication at every stage of the study, including research purpose, data usage, preliminary findings and full‐scale results; and (6) planning for sustainability of any programme or services beyond the life of the research project.

The deconstruction of the binary sex-gender system that sustains modern western states demands the deconstruction of its dichotomies and their excluding effects on non-normative identities. This demands in turn that gender self-determination be recognised as a right. In Spain this right has been given constitutional status (STC 99/2019), yet it is currently not articulated in legislation. Proposals of a new legal framework have met with resistance and an ensuing need for compromise. Unless it grasps and upholds the full constitutional extent of the right to gender self-determination, however, legislation risks being born both unconstitutional and obsolete, out of pace with social demands.

Transgender (trans) and non-binary people experience barriers to culturally competent healthcare and many have reported avoiding care. COVID-19 and related mitigation strategies may have exacerbated avoidance, and poor mental health may be bidirectionally related to avoiding care. This study estimated the prevalence of primary care avoidance during the pandemic in a national sample of trans and non-binary people in Canada with a primary care provider and examined the association between poorer self-rated mental health and avoidance. In Fall 2019, Trans PULSE Canada collected multi-mode survey data from trans and non-binary people. In September to October 2020, 820 participants completed a COVID-19-focused survey. In this cross-sectional analysis, multivariable logistic regression models estimated odds ratios adjusted for confounders and weighted to the 2019 sample. The analysis included 689 individuals with a primary healthcare provider, of whom 61.2% (95% CI: 57.2, 65.2) reported fair or poor mental health and 25.7% (95% CI: 22.3, 29.2) reported care avoidance during the pandemic. The most common reason for avoidance was having a non-urgent health concern (72.7%, 95% CI: 65.9, 79.5). In adjusted analyses, those with fair or poor mental health had higher odds of avoiding primary care as compared to those with good to excellent mental health (adjusted odds ratio [AOR] = 2.37; 95% CI: 1.50, 3.77). This relationship was similar when excluding COVID-related reasons for avoidance (AOR = 2.52; 95% CI: 1.52, 4.17). Expansion of virtual communication may enhance primary care accessibility, and proactively assessing mental health symptoms may facilitate connections to gender-affirming mental health services.

This study explores the experiences of NBGQ youth with microaggressions. It investigates the types of microaggressions they face and their subsequent needs and coping mechanisms and the impacts on their lives. Semi-structured interviews with ten NBGQ youth in Belgium were conducted and analyzed using a thematic approach. The results showed that experiences of microaggressions were centered around denial. The most common ways to cope were finding acceptance from (queer) friends and therapists, engaging in a conversation with the aggressor, and rationalizing and empathizing with the aggressor, leading to self-blame and normalization of the experiences. Microaggressions were experienced as exhausting, which influenced the extent to which the NBGQ individuals wanted to explain themselves to others. Furthermore, the study shows an interaction between microaggressions and gender expression, in which gender expression is seen as a motive for microaggressions and microaggressions have an impact on the gender expression of NBGQ youth.

Introduction: Identities that lie outside of exclusively male and female, such as non-binary and genderqueer, have become increasingly more prevalent and visible within recent years. However, to date, the role of terminology in the development of such gender identities has been under-researched. This study aims to: (1) Examine what role terminology plays in coming to identify as non-binary. (2) Explore the continuing importance of terminology once a non-binary identity is established. Methods: This study uses thematic analysis on data produced from interviews with 16 participants who self-selected for the study and were recruited from several transgender and LGBTQ+ organisations on the basis that they identified outside the gender binary of male and female. Results: The analysis uncovered several key themes and sub-themes relating to terminology choice, encountering new terms and the process of identifying with new terminology, as well as becoming visible and understood by others. Conclusions: This study found that terminology is not only central in coming to identify as something other than exclusively male and female, it also remains an important factor when it comes to making a non-binary identity visible to others.

The paper deals with recent changes occurring in the English language due to the changes in the society itself. Every language is influenced by the changes happening in every aspect of human life, namely, in politics, economics, culture or human relations. The topic of the paper is how the changes in gender relations influence the English grammar, that is, the part of the grammar dealing with English pronouns. Nowadays, many people, transgender or others, refuse to be denoted by singular pronouns "he" or "she" - and choose the singular "they" instead. Although this use of "they" is not such a new thing, because the nonbinary pronoun "they" was voted the Word of the Year 2015 by American Dialect Society and again in 2019 as the Word of the Decade by the same institution, people are still sceptic about its grammatical correctness. But, this use of the pronoun is gaining in popularity, and very soon, the English language might accept these changes.

Abstract Purpose Gender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations. Methods The participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people. Results We present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18–26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18–25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise. Conclusions Gender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.

Resumen: Algunas personas, también las menores de edad, tienen una identidad de género que no se corresponde con el sexo asignado al nacer. Se les conoce como personas trans*, que es el término paraguas que engloba transgénero, transexual y otras identidades no conformes con el género asignado. Las unidades de asistencia sanitaria a menores trans* requieren un trabajo multidisciplinario, realizado por personal experto en identidad de género, que permita, cuando así lo soliciten, intervenciones para el menor y su entorno sociofamiliar, de forma individualizada y flexible durante el camino de afirmación de género. Este modelo de servicio también incluye tratamientos hormonales adaptados en la medida de lo posible a las necesidades del individuo, más allá de los objetivos dicotómicos de un modelo binario tradicional. Esta guía aborda los aspectos generales de la atención profesional de menores trans* y presenta el protocolo actual basado en evidencia de tratamientos hormonales para adolescentes trans* y no binarios. Además, detalla aspectos clave relacionados con los cambios corporales esperados y sus posibles efectos secundarios, así como el asesoramiento previo sobre preservación de la fertilidad. Abstract: Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social–familial environment, in an individualized and flexible way during the gender affirmation path. This service model also includes hormonal treatments tailored as much as possible to the individual's needs, beyond the dichotomic goals of a traditional binary model. This guide addresses the general aspects of professional care of trans* minors and presents the current evidence-based protocol of hormonal treatments for trans* and non-binary adolescents. In addition, it details key aspects related to expected body changes and their possible side effects, as well as prior counselling about fertility preservation.

Abstract Background Prior research examining autistic traits in gender minority adults has reported mixed findings. Most prior studies did not include non-binary individuals. Little is known about the mechanisms shaping autistic traits in gender minority adults. This study examined autistic traits, as well as constructs related to the extreme male brain theory of autism and the mindblindness theory, in transgender and non-binary adults. Methods An online survey was conducted to assess autism-related traits in 323 gender minority adults, including 74 transgender men (individuals assigned female at birth and identify as a man), 95 transgender women (individuals assigned male at birth and identify as a woman), 104 non-binary AFAB (individuals assigned female at birth and identify as non-binary), and 50 non-binary AMAB (individuals assigned male at birth and identify as non-binary). Autistic traits, systemising, empathising, and Theory of Mind (ToM) were measured using the Autism Spectrum Quotient (AQ), the short forms of the Systemising Quotient (SQ-Short) and the Empathy Quotient (EQ-Short), the 10-item version of the Empathy Quotient (EQ-10) and the Reading the Mind in the Eyes Test (Eyes Test). Participants’ scores on these measures were compared with previously published scores based on large-scale general population samples including thousands of participants. Results On average, compared with control females in the general population samples, both transgender men and non-binary AFAB scored significantly higher on the AQ and the SQ-Short but scored significantly lower on the EQ-Short, the EQ-10, and the Eyes Test. No clear or consistent group differences emerged when transgender women and non-binary AMAB were compared with control males. Limitations The present study does not have a large sample of gender minority adults. It has been argued that the measures employed may not provide a precise assessment of the psychological constructs of interest. The present study has a “non-clinical” sample. However, not all gender minorities have access to or require clinical services, and so a “non-clinical” sample may be more representative of the gender minority community as a whole than samples recruited through clinics. Conclusions The current findings suggest a “masculinised” autism-related profile and reduced ToM in transgender men and in non-binary AFAB. These findings might be interpreted to support the extreme male brain theory of autism and the mindblindness theory. Further research is needed to corroborate these findings.

Abstract Background Social attitudes to transgender persons and other gender minorities vary around the world, and in many cultures, prejudices and social stigma are common. Consequently, transgender persons face challenges related to discrimination and negative attitudes among the public. The purpose of this study was to compare life satisfaction, loneliness, mental health, and suicidal behavior among transgender students with cisgender students’ experiences in a nationwide sample of Norwegian students pursuing higher education. Methods In total,50,054 full-time Norwegian students completed an online questionnaire (response rate 30.8%), of whom 15,399 were cisgender males, 34,437 cisgender females, 28 individuals who reported being binary transgender (12 transwomen and 16 transmen), and 69 individuals non-binary transgender persons. The measures included questions concerning gender identity, life satisfaction (Satisfaction With Life Scale), loneliness (The Three-Item Loneliness Scale), mental health problems (Hopkins Symptoms Check List), mental disorders, and suicidal ideation, suicidal behavior, and self-harm. Chi-square tests, Independent-Samples Kruskal-Wallis tests, and logistic regression analyses were used to examine differences between gender identities. Results Transgender students reported significantly more psychosocial burdens on all measures. There were no significant differences in any of the measures between the binary and non-binary transgender students. Conclusion The findings call for increased awareness about welfare and health for transgender students in Norway. Higher education institutions need to consider measures at various levels to establish a learning environment that is more inclusive for gender minorities.

A pre-setting based sub-radix-2 approximation technique for multi-bit/cycle successive-approximation-register (SAR) analog to digital converters (ADCs) is proposed in this paper. The proposed approximation technique enhances the conversion speed and relieves the power hungry reference voltage buffer. The sub-radix-2 approximation only adjusts the weights of original binary DAC array without introducing additional unit capacitors and leading to reduced silicon area and power consumption. An adder based backend encoding circuit is proposed, with negligible power and silicon area overhead. Furthermore, the non-ideal DNL/INL, which are caused by incomplete DAC settling, are characterized and analysed in this paper. The peak DNL/INL values are symmetrically located at 1/4 and 3/4 of full scale. With the presence of sub-radix-2 approximation, the peak INL/DNL could be significantly reduced. The simulation results show the better performance of sub-radix-2 approximation than binary approximation. Designed in CMOS 40nm technology, it could keep a higher (>9.5-bit) effective number of bits (ENOB) with short settling time of DAC buffer, and boost the sampling rate equivalently.

In this article I suggest that the non-binary identity of Jael (Judg 4–5) has been erased or overlooked due to dominant discourses of heteronormativity and binary gender. This biblical narrative depicts Jael performing roles and behaviours which have been identified as masculine (violent, warrior, killer) and feminine (mother, seductress, nurturing). Moreover, Jael’s name appears in the Hebrew masculine form, alongside Jael’s feminine label of “woman/wife.” Despite such evidence of gender ambiguity, interpretations of Judg 4–5 tend to identify Jael unproblematically as a woman, thereby ignoring this character’s non-binary potential. This article contributes an original reading of Jael by interpreting the text from a non-binary perspective, employing queer methodologies. Inviting the reader to look beyond hetero-binarized expectations, my investigation reveals Jael as a gender ambiguous character.

The Bible is not an obvious source of affirmation for non-binary or agender identities. Commentaries on gender in the Bible focus on narratives in which gender is foregrounded by the text, and queering these narratives requires negotiation around binary categories of gender. This article proposes that biblical narratives which portray God through gender-neutral images may speak especially to non-binary and agender identities. This premise can be demonstrated by applying a genderqueer hermeneutic to two biblical fire theophanies: Moses’ encounter at the burning bush (Exod 3) and the arrival of the Holy Spirit at Pentecost (Acts 2). Exodus 3 and Acts 2 describe encounters with the divine in which divine selfhood is revealed in gender-neutral or ungendered terms. The deeply personal nature of divine self-disclosure within these encounters is underpinned by expressions of selfhood which exist outside binary categories of gender—indeed, beyond gendered categories altogether. Far from being irrelevant to the discussion of gender, gender-neutral images in the Bible offer a method of “re-imaging” divine selfhood in ways which affirm genderqueer expressions of the self.

Abstract Background The Friendship Questionnaire (FQ) is a widely used measure of friendships in autism research and beyond. This study sought to revisit the original paper where the measure was presented, using a larger sample of both autistic and non-autistic participants to examine gender differences in scoring. It also sought to expand upon the original paper by comparing FQ results to those of the Unidimensional Relationship Closeness Scale (URCS), to examine whether there are differences in how autistic people report on their general friendships in contrast to their most significant relationships. Methods Participants were recruited for an online study, and 949 people (532 autistic, 417 non-autistic) aged between 18 and 81 took part. Participants completed a demographic questionnaire, the Autism Quotient-28, the Friendship Questionnaire, and the Unidimensional Relationship Closeness Scale. Results We used robust regressions and Pearson’s correlational analyses, conducted in R. Autistic people scored lower than non-autistic people on the FQ, and similar gender differences in the pattern of FQ scores were seen in both groups. There was a significant negative correlation between AQ and FQ scores in both groups. On the URCS, we took the data from those who rated specific close relationships and found that autistic people scored this relationship more highly than non-autistic adults did. There was a significant negative correlation between AQ and URCS scores in both groups. Also, in both groups, there was a significant positive correlation between FQ and URCS scores. Limitations The data is entirely self-report, and diagnoses could not be verified with a clinician, although AQ scores support self-identification as autistic. Also, the groups were not evenly matched on age and other demographic variables, although this was controlled for in analyses. It is also the case that more autistic than non-autistic people were unable to specify a close relationship to score on the URCS, meaning that a certain set of experiences are not represented in this data. Conclusions We conclude that our data replicates the core finding of the original FQ paper that autistic people score lower on the FQ. In contrast to that paper, however, we found that there were gender differences among the autistic population. Also, our inclusion of the URCS suggests that the intimate romantic relationships and best-friendships of autistic people can be of similar quality to those of non-autistic people, suggesting that there may be important differences in autistic people’s relations with friends in general versus close friends and romantic partners.

The number of people with non-binary gender experience seeking gender-affirming treatment is rising in Finland as in other European countries. The treatments vary, and there is no long-term follow-up data on the benefits of the treatments orthe stability of non-binary gender experience. The aim of this study was to evaluate the clinical outcome of empirical gender-affirming treatment among non-binary individuals who were examined in Helsinki University Hospital’s Gender Identity Clinic during the period 2010–2018. 50 individuals were included in the study (43 were natal females and 7 natal males) and were sent a questionnaire which 39 individuals completed forming a follow-up group, i.e. respondents. All the patients’ psychiatric diagnoses were reviewed. It was found that 8% of patients had no other psychiatric diagnosis in addition to gender disorder diagnosis, and 50% had three or more psychiatric diagnoses, most commonly depression (76%) or anxiety disorder (48%). Neuropsychiatric diagnoses were assigned to 20% and eating disorders to 16%. The use of psychiatric services prior to the examination period was high, in line with the prevalence of psychiatric morbidity. Health-related quality of life (HRQoL) was measured by using the 15D. The results were compared with an age- and gender-standardized sample of the general Finnish population. The mean 15D score among the follow-up group was significantly lower than among the general population. There was no statistically significant difference in the mean 15D score at the beginning of the examination period and at follow-up, suggesting that the treatment of gender dysphoria may not have a large effect on overall HRQoL. The respondents experienced the gender-affirming treatment to be beneficial, and the non-binary gender identity had remained stable among 32 (82%) respondents. The results of this study show that among these non-binary individuals, gender-affirming treatment alleviated gender dysphoria. Moreover, the treatments did not cause any concerning disbenefits, such as regret or unacceptable somatic complications. More research is urgently needed on the effectiveness of gender-affirming treatment among non-binary individuals.

No abstract available.

Background: School plays an important role in transgender and non-binary (TNB) youths’ life and well-being. The aim of this study was to gain a better understanding of how the lived experiences, gender affirmation and challenges encountered by TNB youths in the school setting affect their well-being. Method: Our study was a qualitative secondary data analysis, based on the interviews of 12 Canadian TNB youths aged 15–17 years old. Results: We found that TNB students’ well-being was closely related to the acknowledgment of gender identity at school. Several factors, including school socio-cultural environment, teachers’ and peers’ attitudes and behaviours, school physical environments and the respect of confidentiality of gender identity were all found to impact TNB students’ well-being. To face adversity related to some of these factors, TNB youths used several contextually driven strategies such as compromising, educating, and sensitizing others about gender diversity and avoiding certain people or situations. Conclusion: Our results highlight the important influence of school climate and culture, as well as teachers’, school personnel’s and peers’ behaviours and attitudes on TNB youths’ well-being. Our findings can guide future interventions to help schools become more inclusive and supportive of gender diversity.

(1) Background: Fertility preservation allows for trans and non-binary individuals to achieve parenthood using their own gametes. Considering that preservation of gametes can be performed at increasingly earlier ages, it is important to analyze both the attitudes of trans and non-binary youth and their parents towards available family formation options, including fertility preservation. We aimed to explore attitudes toward parenthood and fertility among trans and non-binary youth and parents of trans and non-binary youth. (2) Methods: A questionnaire about fertility attitudes was administered to 33 adolescents and young adults and 27 parents. (3) Results: Trans and non-binary youth showed little interest in resorting to fertility preservation, and both parents and youth mentioned the lack of knowledge about this procedure as the main reason for not performing it. Parents were overall supportive of their children’s decisions, including the choice of different pathways to parenthood other than biological reproduction. (4) Discussion: Health providers should ensure that young trans and non-binary persons and their parents are aware of family formation options, including fertility preservation along with its impact in future genetic parenthood.

An issue being tackled in modern, particularly western, archaeology is the assumption that something intrinsic to a scholar’s own culture is an etic in space and time. While many insist our views of sex and gender in the modern world are changing, there has always been variation from the sex-based binary.This article explores intersex visibility in archaeology, and the potential for contemporary non-binary genders. This is achieved through analysis of the issues that prevent non-binary identities and intersex people from being identified in archaeology. This paper argues that gender cannot be explored accurately out of context, as it is strongly linked to the culture they live in and their life experiences. Additionally, the people who buried them might have had a different view of their gender and its presentation. Thus, this paper focuses on the issues of studying gender in Roman Britain, and in the ancient world.

This paper draws from the findings of research that was initiated as a consequence of previous research activities related to University-LGBT community physical activity projects (2012–2018). Specifically, the research underpinning this paper centers transgender and non-binary experiences of recreational swimming and aquatic activity (2017–2020). To date, the research has received small amounts of funding from four sources and resulted in two public engagement activities (two art exhibitions). The findings that inform the discussion are taken from nine semi-structured interviews, three focus groups including a professionally drawn illustration of two of these focus groups, and sixty-three research participant's “drawings” as well as informal conversations with eight stakeholders. The findings concern transgender and non-binary people's feelings of un/safety in the public spaces of an indoor swimming pool and the accompanying display of their embodied self. These two elements of un/safety—spatiality and embodiment—are critically discussed in relation to physical activity and in/equality. In this way, the work contributes to sustained University-LGBT community links and provides possibility for evidenced-based intervention to address inequality.