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- Title
Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives.
- Authors
Stroumsa, Daphna; Maksutova, Mariam; Minadeo, Leah A.; Indig, Gnendy; Neis, Rafael; Ballard, Jesse Y.; Popoff, Elliot E.; Trammell, Racquelle; Wu, Justine P.
- Abstract
Purpose: Gender-affirming hormones (hormones)—the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals—are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care. Methods: We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively. Results: We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals. Conclusion: A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
- Subjects
COMPETENCY assessment (Law); GENDER affirming care; HORMONE therapy; RESEARCH methodology; PHYSICIAN-patient relations; NONBINARY people; INTERVIEWING; PATIENTS' attitudes; EXPERIENCE; LGBTQ+ people; SOUND recordings; RESEARCH funding; PATIENT care; JUDGMENT sampling; THEMATIC analysis; CISGENDER people
- Publication
Transgender Health, 2024, Vol 9, Issue 1, p34
- ISSN
2688-4887
- Publication type
Article
- DOI
10.1089/trgh.2022.0024