Sissies, Mama's Boys, and Tomboys: Is Children's Gender Nonconformity More Acceptable When Nonconforming Traits Are Positive?

The evaluation of gender nonconformity in children was examined in two studies. In Study 1, 48 young adults evaluated the positivity of culturally popular labels for gender nonconformity, including "tomboy," "sissy," and two new labels generated in a pilot study, "mama's boy" and "brat." The "mama's boy" was described as a boy who has positive feminine traits (gentle and well-mannered) as opposed to the "sissy" who was described as having negative feminine traits (crying and easily frightened). 

In Study 2, 161 young adults read descriptions of gender-typical and nonconforming children, evaluating them in several domains. The label "mama's boy" was considered negative in Study 1 but an unlabeled positive nonconforming boy was rated as likable and competent in Study 2. However, participants worried about nonconforming boys, saying they would encourage them to behave differently and describing such children with derogatory sexual orientation slurs. "Tomboy" was generally considered a positive label in Study 1. 

In Study 2, gender nonconforming girls were considered neither likable nor dislikeable, and neither competent nor incompetent, reflecting ambivalence about girls' nonconformity. It may be that we use gender nonconformity labels as indicators of sexual orientation, even in young children. Therefore, even when an individual displays objectively positive traits, the stigma associated with homosexuality taints judgments about their nonconforming behavior.

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By:  Coyle EF1, Fulcher M2, Trübutschek D3,4,5.

• 1Department of Psychology, Beloit College, 700 College Street, Beloit, WI, 53511, USA. emilyfcoyle@gmail.com.
• 2Department of Psychology, Washington and Lee University, Lexington, VA, USA.
• 3Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Saclay, NeuroSpin Center, Gif/Yvette, France.
• 4Ecole des Neurosciences de Paris Ile-de-France, Paris, France.
• 5Université Pierre et Marie Curie, Paris, France.
• Arch Sex Behav. 2016 Mar 7. 

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Transgender Men and Pregnancy

Transgender people have experienced significant advances in societal acceptance despite experiencing continued stigma and discrimination. While it can still be difficult to access quality health care, and there is a great deal to be done to create affirming health care organizations, there is growing interest around the United States in advancing transgender health. 

The focus of this commentary is to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy. Terms transgender and gender nonconforming specifically refer to those whose gender identity (e.g., being a man) differs from their female sex assigned at birth. Many, if not most transgender men retain their female reproductive organs and retain the capacity to have children. 

Review of their experience demonstrates the need for preconception counseling that includes discussion of stopping testosterone while trying to conceive and during pregnancy, and anticipating increasing experiences of gender dysphoria during and after pregnancy. The clinical aspects of delivery itself fall within the realm of routine obstetrical care, although further research is needed into how mode and environment of delivery may affect gender dysphoria. Postpartum considerations include discussion of options for chest (breast) feeding, and how and when to reinitiate testosterone. 

A positive perinatal experience begins from the moment transgender men first present for care and depends on comprehensive affirmation of gender diversity.

Full article at:   http://goo.gl/Fo1LMb

By:  Juno Obedin-Maliver1,2 and Harvey J Makadon3,4

¹Department of Medicine, University of California San Francisco, San Francisco, CA, USA

²Department of Gynecology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

³National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA

⁴Harvard Medical School, Boston, MA, USA

Harvey J Makadon, National LGBT Health Education Center, The Fenway Institute, 1340 Boylston Street, Boston, MA, USA

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Body Satisfaction and Physical Appearance in Gender Dysphoria

Gender dysphoria (GD) is often accompanied by dissatisfaction with physical appearance and body image problems. The aim of this study was to compare body satisfaction with perceived appearance by others in various GD subgroups. 

Data collection was part of the European Network for the Investigation of Gender Incongruence. Between 2007 and 2012, 660 adults who fulfilled the criteria of the DSM-IV gender identity disorder diagnosis (1.31:1 male-to-female [MtF]:female-to-male [FtM] ratio) were included into the study. Data were collected before the start of clinical gender-confirming interventions. Sexual orientation was measured via a semi-structured interview whereas onset age was based on clinician report. Body satisfaction was assessed using the Body Image Scale. Congruence of appearance with the experienced gender was measured by means of a clinician rating. 

Overall, FtMs had a more positive body image than MtFs. Besides genital dissatisfaction, problem areas for MtFs included posture, face, and hair, whereas FtMs were mainly dissatisfied with hip and chest regions. Clinicians evaluated the physical appearance to be more congruent with the experienced gender in FtMs than in MtFs. Within the MtF group, those with early onset GD and an androphilic sexual orientation had appearances more in line with their gender identity. In conclusion, body image problems in GD go beyond sex characteristics only. 

An incongruent physical appearance may result in more difficult psychological adaptation and in more exposure to discrimination and stigmatization.

Full article at:   http://goo.gl/h6yHWx

By:  van de Grift TC1,2, Cohen-Kettenis PT3, Steensma TD3, De Cuypere G4, Richter-Appelt H5, Haraldsen IR6, Dikmans RE7, Cerwenka SC5, Kreukels BP3.

• 1Department of Medical Psychology, Center of Expertise on Gender Dysphoria, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. t.vandegrift@vumc.nl.
• 2Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands. t.vandegrift@vumc.nl.
• 3Department of Medical Psychology, Center of Expertise on Gender Dysphoria, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
• 4Center of Sexology and Gender Problems, Ghent University Hospital, Ghent, Belgium.
• 5Department of Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• 6Department of Neuropsychiatry and Psychosomatic Medicine, Division of Clinical Neuroscience, Rikshospitalet, Oslo, Norway.
• 7Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands. 
• Arch Sex Behav. 2016 Apr;45(3):607-17. doi: 10.1007/s10508-015-0657-3. Epub 2016 Jan 12.

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Johnny Depp, Reconsidered: How Category-Relative Processing Fluency Determines the Appeal of Gender Ambiguity

Individuals that combine features of both genders–gender blends–are sometimes appealing and sometimes not. Heretofore, this difference was explained entirely in terms of sexual selection. 

In contrast, we propose that part of individuals’ preference for gender blends is due to the cognitive effort required to classify them, and that such effort depends on the context in which a blend is judged. In two studies, participants judged the attractiveness of male-female morphs. Participants did so after classifying each face in terms of its gender, which was selectively more effortful for gender blends, or classifying faces on a gender-irrelevant dimension, which was equally effortful for gender blends. In both studies, gender blends were disliked when, and only when, the faces were first classified by gender, despite an overall preference for feminine features in all conditions. Critically, the preferences were mediated by the effort of stimulus classification. 

The results suggest that the variation in attractiveness of gender-ambiguous faces may derive from context-dependent requirements to determine gender membership. More generally, the results show that the difficulty of resolving social category membership–not just attitudes toward a social category–feed into perceivers’ overall evaluations toward category members.

Below:  Examples of stimuli used in Study 1 as a percentage of the female parent

Below:  Examples of face blends used in Study 2

Full article at:   http://goo.gl/RE2YqJ

By:  Helen E. Owen,1 Jamin Halberstadt,1,* Evan W. Carr,2 and Piotr Winkielman2,3,4,*

¹Department of Psychology, University of Otago, Dunedin, New Zealand

²Department of Psychology, University of California San Diego, La Jolla, California, United States of America

³Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom

⁴Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland

Brock University, CANADA

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: HO JH PW. Performed the experiments: HO JH PW. Analyzed the data: HO JH PW EC. Contributed reagents/materials/analysis tools: HO JH PW EC. Wrote the paper: HO JH PW EC.

* E-mail: zn.ca.ogato.ysp@sreblahj; Email: ude.dscu@namleikniwp

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In the Name of Brevity: The Problem with Binary HIV Risk Categories

According to the 'Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations' there are five groups of people at elevated risk of HIV, including 'transgender women or transgender men who have receptive anal sex with men'. Although cost effectiveness strategies and best practice lessons recommend targeting specific populations for HIV prevention, existing risk categories lack specificity, and may in fact cause further confusion. 

Existing categories of risk often perpetuate notions of gender and sexuality that can erroneously exclude, alienate, and stigmatise those who are at the highest risk and thus should be prioritised. 

We review the troubled history of the MSM category and the problematic conflation of trans feminine individuals and MSM in much of the existing HIV literature, and how this practice has stymied progress in slowing the HIV epidemic in the most at-risk groups, including those who do not fit neatly into binary notions of gender and sex. We draw from examples in the field, specifically among trans feminine people in Beirut and San Francisco, to illustrate the lived experiences of individuals whose identities may not fit into Euro-Atlantic constructs of HIV prevention categories.

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By:  Kaplan RL1, Sevelius J2, Ribeiro K3.

• 1 Department of Obstetrics , Bixby Center for Global Reproductive Health, Gynecology, & Reproductive Sciences, University of California , San Francisco , CA , USA.
• 2 Department of Medicine , Center for AIDS Prevention Studies, Center of Excellence for Transgender Health, University of California , San Francisco , CA , USA.
• 3 CRESPPA-LabToP, Université Paris 8 , Villejuif , France.
• Glob Public Health. 2016 Jan 29:1-11. 

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Gender Nonconformity and Butch-Femme Identity among Lesbians in China

Previous studies have indicated that the butch-femme identities of lesbian women are related to gender roles (e.g., instrumentality and expressiveness). 

This study examined the association between butch and femme lesbian identities and gender nonconformity in both childhood (Study 1: 434 lesbian women and 230 heterosexual women) and adulthood (Study 2: 207 lesbian women and 342 heterosexual women) among women in China. In Study 1 (97 femmes, 76 androgynous women, and 264 butches), butches recalled more childhood gender nonconformity (CGN) than did femmes, androgynous, and heterosexual women, and androgynous women recalled more CGN than did heterosexual women. 

In Study 2 (43 femmes, 44 androgynous women, and 120 butches), butches reported more adulthood gender nonconformity (AGN) based on a "people-thing" dimension of interests than did femmes and heterosexual women, and androgynous women reported preferring more masculine hobbies than did femmes or heterosexual women. There was no significant difference in CGN and AGN between femmes and heterosexual women. 

These results indicate that femmes are quite similar to heterosexual women with regard to CGN and AGN, thus providing an important extension of previous studies based on a Chinese sample.

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By:  Zheng L1,2, Zheng Y1,2.

• 1 Key Laboratory of Cognition and Personality, Southwest University , Ministry of Education , Chongqing , China.
• 2 Faculty of Psychology , Southwest University , Chongqing , China.
• J Sex Res. 2016 Feb;53(2):186-93. doi: 10.1080/00224499.2015.1058890. Epub 2015 Oct 12. 

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Gender Identity, Healthcare Access & Risk Reduction among Malaysia's Mak Nyah Community

Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). 

In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. 

Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. 

These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW.

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By:  Gibson BA1, Brown SE1, Rutledge R1, Wickersham JA1,2, Kamarulzaman A2, Altice FL1,2,3.

• 1 Department of Internal Medicine, Section of Infectious Diseases, AIDS Program , Yale School of Medicine , New Haven , CT , USA.
• 2 Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.
• 3 Division of Epidemiology of Microbial Diseases , Yale School of Public Health , New Haven , CT , USA.
• Glob Public Health. 2016 Jan 29:1-16 

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Sexual Orientation, Gender Identity and Perceived Source of Infection among Men Who Have Sex with Men and Transgender Women (TW) Recently Diagnosed with HIV and/or STI in Lima, Peru

Risk perception and health behaviors result from individual-level factors influenced by specific partnership contexts. 

We explored individual- and partner-level factors associated with partner-specific perceptions of HIV/STI risk among 372 HIV/STI-positive MSM and transgender women (TW) in Lima, Peru. 

Generalized estimating equations explored participants' perception of their three most recent partner(s) as a likely source of their HIV/STI diagnosis. Homosexual/gay (PR = 2.07; 95 % CI 1.19-3.61) or transgender (PR = 2.84; 95 % CI 1.48-5.44) partners were more likely to be considered a source of infection than heterosexual partners. 

Compared to heterosexual respondents, gay and TW respondents were less likely to associate their partner with HIV/STI infection, suggesting a cultural link between gay or TW identity and perceived HIV/STI risk. 

Our findings demonstrate a need for health promotion messages tailored to high-risk MSM partnerships addressing how perceived HIV/STI risk aligns or conflicts with actual transmission risks in sexual partnerships and networks.

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By:  Blair CS1, Segura ER2, Perez-Brumer AG2,3, Sanchez J4, Lama JR4, Clark JL2.

• 1Division of Infectious Diseases and Program in Global Health, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA. cherieblair@mednet.ucla.edu.
• 2Division of Infectious Diseases and Program in Global Health, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
• 3Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
• 4Asociación Civil Impacta Salud y Educación, Lima, Peru. 
• AIDS Behav. 2016 Jan 14.

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Non-Binary or Genderqueer Genders

Some people have a gender which is neither male nor female and may identify as both male and female at one time, as different genders at different times, as no gender at all, or dispute the very idea of only two genders. 

The umbrella terms for such genders are 'genderqueer' or 'non-binary' genders. Such gender identities outside of the binary of female and male are increasingly being recognized in legal, medical and psychological systems and diagnostic classifications in line with the emerging presence and advocacy of these groups of people. 

Population-based studies show a small percentage - but a sizable proportion in terms of raw numbers - of people who identify as non-binary. While such genders have been extant historically and globally, they remain marginalized, and as such - while not being disorders or pathological in themselves - people with such genders remain at risk of victimization and of minority or marginalization stress as a result of discrimination. 

This paper therefore reviews the limited literature on this field and considers ways in which (mental) health professionals may assist the people with genderqueer and non-binary gender identities and/or expressions they may see in their practice. Treatment options and associated risks are discussed.

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By:  Richards C1,2, Bouman WP1, Seal L2, Barker MJ3, Nieder TO4, T'Sjoen G5.

• 1 Nottingham Centre for Gender Dysphoria (http://www.nottinghamshirehealthcare.nhs.uk/nottingham-centre-for-gender-dysphoria), Nottingham , UK ;
• 2 Charing Cross Gender Identity Clinic , London , UK ;
• 3 Department of Psychology in Social Sciences (http://www.wlmht.nhs.uk/gi/gender-identity-clinic/), Open University , Milton Keynes , UK ;
• 4 Interdisciplinary Transgender Health Care Centre Hamburg, Department for Sex Research and Forensic Psychiatry , University Medical Centre Hamburg-Eppendorf (UKE) , Germany ;
• 5 Centre for Sexology and Gender, Department of Endocrinology , Ghent University , Belgium.

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'The Darkest Times Of My Life': Recollections of Child Abuse among Forced Migrants Persecuted Because of Their Sexual Orientation & Gender Identity

Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. 

This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. 

Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. 

Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy.

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By:  Alessi EJ1, Kahn S2, Chatterji S3.

• 1School of Social Work, Rutgers, The State University of New Jersey, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07102, USA.
• 2School of Social Work, McGill University, 3506 University Street, Room 426, Montreal, QC, Canada H3A 2A7.
• 3School of Social Work, Rutgers, The State University of New Jersey, 536 George Street, New Brunswick, NJ 08901, USA. 

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Sexual Orientation & Gender Identity: Review of Concepts, Controversies & Their Relation to Psychopathology Classification Systems

Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity...

...The present paper argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

On the one hand, aligned with a position of “transgression” and/or “deviation from a norm,” people who today are described as LGBT were labeled as mentally ill. Inevitably, classification systems reflect(ed) the existing social attitudes and prejudices, as well as the historical and cultural contexts in which they were developed (Drescher, 2012; Kirschner, 2013). In that, they often failed to differentiate between mental illness and socially non-conforming behavior or fluidity of gender expressions. This position and the historical roots of this discourse are still reflected in the practices of some clinicians, ranging from “conversion” therapies to micro-aggressions in the daily lives of LGBT people, including those experienced in the care by mental health professionals.

On the other hand, lined up with a position of gender variance and fluidity, changes in the diagnostic systems in the last few decades reflect a broader respect and value of the diversity of human sexuality and of gender expressions. This position recognizes that the discourse and practices coming from the (mental) health field may lead to changes in the broader cultural beliefs (Drescher, 2012). As such, it also recognizes the power of medical classifications, health discourses and clinical practices in translating the responsibility of fighting discrimination and promoting LGBT people’s well-being.

In conclusion, it seems crucial to emphasize the role of specific training and supervision in the development of clinical competence in the work with sexual minorities. Several authors (e.g., Pachankis and Goldfried, 2004) have argued for the importance of continuous education and training of practitioners in individual and cultural diversity competences, across professional development. This is in line with APA’s ethical guidelines (American Psychological Association, 2000, 2012), and it is even more relevant when we acknowledge the significant and recent changes in this field. Furthermore, it is founded on the very notion that LGBT competence assumes clinicians ought to be aware of their own personal values, attitudes and beliefs regarding human sexuality and gender diversity in order to provide appropriate care. These ethical concerns, however, have not been translated into training programs in medicine and psychology in a systematic manner in most European countries, and to the mainstreaming of LGBT issues (Goldfried, 2001) in psychopathology.

  

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By: Moleiro C1, Pinto N1.

• 1Instituto Universitário de Lisboa ISCTE-IUL CIS, Lisboa, Portugal.  

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Antiretroviral Therapy & Changing Patterns of HIV Stigmatisation in Entebbe, Uganda

Antiretroviral therapy (ART) has the potential to change processes of HIV stigmatisation. In this article, changing processes of stigmatisation among a group of people living with HIV (PLWH) on ART in Wakiso District, Uganda, are analysed using qualitative data from a study of PLWH's self-management of HIV on ART. 

There were 38 respondents (20 women, 18 men) who had been taking ART for at least 1 year. They were purposefully selected from government and non-government ART providers. Two in-depth interviews were held with each participant. 

Processes of reduced self-stigmatisation were clearly evident, caused by the recovery of their physical appearance and support from health workers. However most participants continued to conceal their status because they anticipated stigma; for example, they feared gossip, rejection and their status being used against them. 

Anticipated stigma was gendered: women expressed greater fear of enacted forms of stigma such as rejection by their partner; in contrast men's fears focused on gossip, loss of dignity and self-stigmatisation. 

The evidence indicates that ART has not reduced underlying structural drivers of stigmatisation, notably gender identities and inequalities, and that interventions are still required to mitigate and tackle stigmatisation, such as counselling, peer-led education and support groups that can help PLWH reconstruct alternative and more positive identities. 

A video abstract of this article, via: https://youtu.be/WtIaZJQ3Y_8

Via:   http://ht.ly/Ss7A5 

By:  Russell S1, Zalwango F2, Namukwaya S2, Katongole J2, Muhumuza R2, Nalugya R2, Seeley J2.

• 1School of International Development, University of East Anglia, Norwich, Norfolk.
• 2Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.