Cargando…
Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations
OBJECTIVE: Gender-affirming hormones (GAH)—the use of sex hormones to induce desired secondary sex characteristics in transgender individuals—is vital healthcare for many transgender people. Among prescribers of GAH, there is debate regarding the value of a universal requirement for an evaluation by...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387802/ https://www.ncbi.nlm.nih.gov/pubmed/35980962 http://dx.doi.org/10.1371/journal.pone.0271785 |
_version_ | 1784770081982513152 |
---|---|
author | Stroumsa, Daphna Minadeo, Leah A. Maksutova, Mariam Moravek, Molly B. Stephenson, Rob Pfeiffer, Paul N. Wu, Justine P. |
author_facet | Stroumsa, Daphna Minadeo, Leah A. Maksutova, Mariam Moravek, Molly B. Stephenson, Rob Pfeiffer, Paul N. Wu, Justine P. |
author_sort | Stroumsa, Daphna |
collection | PubMed |
description | OBJECTIVE: Gender-affirming hormones (GAH)—the use of sex hormones to induce desired secondary sex characteristics in transgender individuals—is vital healthcare for many transgender people. Among prescribers of GAH, there is debate regarding the value of a universal requirement for an evaluation by a mental health provider prior to GAH initiation. The purpose of this qualitative study was to describe the range of attitudes and approaches to mental health evaluation among GAH providers in the United States. We analyzed the providers’ attitudes and base our recommendations on this analysis. METHODS: We conducted semi-structured interviews with 18 healthcare providers who prescribe GAH across the United States. Participants were purposefully recruited using professional networks and snowball sampling to include those who require mental health evaluation and those who do not. We adapted domains from the Theoretical Domains Framework—a framework for understanding influences on health professional behavior—to inform the interviews and analysis. Guided by these domains, we iteratively coded text and identified theoretical relationships among the categories. RESULTS: While some felt a universal requirement for mental health “clearance” was necessary for the identification of appropriate candidates for GAH, others described this requirement as a form of “gatekeeping” that limits access to care. Themes we identified included providers’ ability to ascertain gender identity; concern about mental illness; GAH provider and mental health provider expertise; and provider roles. All providers appreciated the potential advantages of mental health support during GAH treatment. CONCLUSION: Providers in our study practice on a continuum of care rather than adhering to strict rules about the requirement for mental health evaluation prior to GAH treatment. Where they fall on this continuum is influenced primarily by their perceptions of transgender identity and transition, and their interpretation of risk for significant mental illness and its association with transness. Providers who required universal evaluation by a mental health professional tended to hold essentialist, medicalized, and binary ideas of gender and transness. |
format | Online Article Text |
id | pubmed-9387802 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-93878022022-08-19 Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations Stroumsa, Daphna Minadeo, Leah A. Maksutova, Mariam Moravek, Molly B. Stephenson, Rob Pfeiffer, Paul N. Wu, Justine P. PLoS One Research Article OBJECTIVE: Gender-affirming hormones (GAH)—the use of sex hormones to induce desired secondary sex characteristics in transgender individuals—is vital healthcare for many transgender people. Among prescribers of GAH, there is debate regarding the value of a universal requirement for an evaluation by a mental health provider prior to GAH initiation. The purpose of this qualitative study was to describe the range of attitudes and approaches to mental health evaluation among GAH providers in the United States. We analyzed the providers’ attitudes and base our recommendations on this analysis. METHODS: We conducted semi-structured interviews with 18 healthcare providers who prescribe GAH across the United States. Participants were purposefully recruited using professional networks and snowball sampling to include those who require mental health evaluation and those who do not. We adapted domains from the Theoretical Domains Framework—a framework for understanding influences on health professional behavior—to inform the interviews and analysis. Guided by these domains, we iteratively coded text and identified theoretical relationships among the categories. RESULTS: While some felt a universal requirement for mental health “clearance” was necessary for the identification of appropriate candidates for GAH, others described this requirement as a form of “gatekeeping” that limits access to care. Themes we identified included providers’ ability to ascertain gender identity; concern about mental illness; GAH provider and mental health provider expertise; and provider roles. All providers appreciated the potential advantages of mental health support during GAH treatment. CONCLUSION: Providers in our study practice on a continuum of care rather than adhering to strict rules about the requirement for mental health evaluation prior to GAH treatment. Where they fall on this continuum is influenced primarily by their perceptions of transgender identity and transition, and their interpretation of risk for significant mental illness and its association with transness. Providers who required universal evaluation by a mental health professional tended to hold essentialist, medicalized, and binary ideas of gender and transness. Public Library of Science 2022-08-18 /pmc/articles/PMC9387802/ /pubmed/35980962 http://dx.doi.org/10.1371/journal.pone.0271785 Text en © 2022 Stroumsa et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Stroumsa, Daphna Minadeo, Leah A. Maksutova, Mariam Moravek, Molly B. Stephenson, Rob Pfeiffer, Paul N. Wu, Justine P. Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations |
title | Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations |
title_full | Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations |
title_fullStr | Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations |
title_full_unstemmed | Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations |
title_short | Initiating gender-affirming hormones for transgender and non-binary people: A qualitative study of providers’ perspectives on requiring mental health evaluations |
title_sort | initiating gender-affirming hormones for transgender and non-binary people: a qualitative study of providers’ perspectives on requiring mental health evaluations |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387802/ https://www.ncbi.nlm.nih.gov/pubmed/35980962 http://dx.doi.org/10.1371/journal.pone.0271785 |
work_keys_str_mv | AT stroumsadaphna initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations AT minadeoleaha initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations AT maksutovamariam initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations AT moravekmollyb initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations AT stephensonrob initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations AT pfeifferpauln initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations AT wujustinep initiatinggenderaffirminghormonesfortransgenderandnonbinarypeopleaqualitativestudyofprovidersperspectivesonrequiringmentalhealthevaluations |