Johanna Olson

Parental Support and Mental Health Among Transgender Adolescents

PURPOSE Family support is protective against health risks in sexual minority individuals. However, few studies have focused specifically on transgender youth, who often experience rejection, marginalization, and victimization that place them at risk for poor mental health. This study investigated the relationships among parental support, quality of life, and depression in transgender adolescents. METHODS A total of 66 transgender youth presenting for care at Childrens Hospital Los Angeles completed a survey assessing parental support (defined as help, advice, and confidante support), quality of life, and depression. Regression analyses assessed the associations between parental support and mental health outcomes. RESULTS Parental support was significantly associated with higher life satisfaction, lower perceived burden of being transgender, and fewer depressive symptoms. CONCLUSIONS Parental support is associated with higher quality of life and is protective against depression in transgender adolescents. Interventions that promote parental support may significantly affect the mental health of transgender youth.

The gender affirmative model: What we know and what we aim to learn

in which he stated: ‘‘Cur-rently experts can’t tell apart kids who outgrow gender dysphoria (desisters) from those who do not (persisters), and how to treat them is controversial’’ [Drescher, 2013, p. 1]. As members of a four-site child gender clinic group, we concur with Dr. Drescher regarding the controversy, but take issue with his assessment of experts and their inability to differentially assess ‘‘persisters’’ and ‘‘desisters’’ in childhood. We would like to take this opportunity to outline the gender affirmative model from which we practice, dispel myths about this model, and briefly outline the state of knowledge in our field regarding facilitators of healthy psychosocial development in gender-nonconforming children. The major premises informing our modes of prac-tice include: (a) gender variations are not disorders; (b) gender presentations are di-verse and varied across cultures, therefore requiring our cultural sensitivity; (c) to the best of our knowledge at present, gender involves an interweaving of biology, devel-opment and socialization, and culture and context, with all three bearing on any in-dividual’s gender self; (d) gender may be fluid, and is not binary, both at a particular time and if and when it changes within an individual across time; (e) if there is pathol-ogy, it more often stems from cultural reactions (e.g., transphobia, homophobia, sex-ism) rather than from within the child.Our goals within this model are to listen to the child and decipher with the help of parents or caregivers what the child is communicating about both gender identity and gender expressions. We define gender identity as the gender the child articulates

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

A pilot randomized clinical trial of youth ages 15-24 nonadherent to antiretroviral therapy (ART) utilizing daily cell phone support was found to have significant improvement in self-reported adherence and HIV RNA. Understanding acceptability and feasibility is critical for future implementation in clinic settings. Exit interviews were obtained from participants and adherence facilitators (AF). Acceptability was assessed from content analysis of exit interviews. Feasibility was assessed via intervention retention and study retention rates. Thirty-seven eligible youth were enrolled with 19 assigned to the intervention. Seven (37%) discontinued the intervention either due to missing over 20% of calls for two consecutive months (N=5) or missing 10 consecutive calls (N=2). Sixteen participants completed exit interviews, 15 reported the call length was just right, 13 reported they would have liked to continue calls after the 24-week intervention, and all participants reported they would recommend the intervention to friends. Scheduling and making calls required less than 1 h per week per participant. Providing cell phone support to youth nonadherent to ART was acceptable and feasible. While the cost is low compared to the price of ART, healthcare systems will need to explore how to cover the cost of providing cell phones (incentive).

The Peripubertal Gender-Dysphoric Child: Puberty Suppression and Treatment Paradigms

Gender-nonconforming youth are emerging at increasingly younger ages, and those experiencing gender dysphoria are seeking medical care at, or sometimes even before, the onset of puberty. Youth with gender dysphoria are at high risk for depression, anxiety, isolation, self-harm, and suicidality at the onset of a puberty that feels wrong. Medical providers would benefit from understanding interventions that help gender-nonconforming children and youth thrive. The use of gonadotropin-releasing hormone (GnRH) agonists to block the onset of an undesired puberty in youth with gender dysphoria is a relatively new practice, particularly in the United States. These medications shut down the hypothalamic-pituitary-gonadal axis (HPG), and the production of either testosterone or estrogen is temporarily halted. Puberty blocking allows a young person to explore gender and participate more fully in the mental health therapy process without being consumed by the fear of an impending developmental process that will result in the acquisition of undesired secondary sexual characteristics. GnRH agonists have been used safely for decades in children with other medical conditions, including central precocious puberty. Potential side effects of GnRH agonists include diminished bone density, injection site problems, emotional instability, and weight gain. Preliminary data have shown GnRH agonists to be very helpful in improving behavioral and overall functioning outcomes. Puberty suppression should ideally begin in the first stages of pubertal development and can be given via intramuscular or subcutaneous injections, or via an implant that is inserted in the upper arm. Monitoring to assure suppression of the HPG axis should occur regularly. Gender-nonconforming youth who remain gender dysphoric can go on to receive cross-sex hormones for phenotypic gender transition when they are older. GnRH agonists have changed the landscape of medical intervention for youth with gender dysphoria and are rapidly becoming the standard of practice.

Young men and the morning after: a missed opportunity for emergency contraception provision?

Objectives Although adolescents and young adults of lower socioeconomic status (SES) are disproportionately affected by unintended pregnancies, research on experiences with emergency contraception (EC) in this population has lagged. Furthermore, it is unclear whether EC-related knowledge and behaviour varies between young men and women. This study investigated knowledge, attitudes and experiences with EC among low SES young men and women aged 18–25 years. Methods One hundred and ninety-eight new enrollees at two Los Angeles primary medical care clinics completed surveys about their knowledge, past use and likelihood of using EC. Chi square (χ2) and regression analyses assessed gender differences in knowledge and attitudes. Results Women were more likely than men to accurately answer questions about EC and its use. Across both sexes, accurate knowledge predicted future willingness to use EC. Only half the women and a third of men knew that EC could be directly dispensed by pharmacists; even fewer knew that the legal access age for EC was 17 years (13%) or that men could access EC from pharmacies for their female partners (24%). Although respondents most commonly reported that friends were their source of current information about EC, both men and women chose health care professionals as their desired source of future information about EC. Conclusions Young men in this sample were significantly less knowledgeable than young women about EC. Educating young men about EC by health care providers during routine visits may be a unique opportunity to increase EC knowledge, access and use among low-income young couples to decrease undesired pregnancies.