Compared to the general population, transpersons are exposed to higher levels of discrimination and violence. The stigmatization of transpersons can lead to physical and psychological problems. In particular, transindividuals exhibit a higher prevalence of depression compared to the cispopulation. The gender minority stress model (GMSM) provides a comprehensive theoretical basis to interpret these biopsychosocial interactions. Using the GMSM, this study aimed to identify associations between experience of stigmatization and the mental health of transitioned transpersons using correlational analyses and multiple regression models. In total, 143 transpersons were recruited. Multivariate analyses identified three variables (i.e., unemployment, nonaffirmation of gender identity, and internalized transphobia) to explain variance of depressive symptoms. Furthermore, a mediation of the proximal factors between distal factors and depressive symptoms was found. However, the moderating effect of resilience factors was not demonstrated. The results confirmed the importance of distal and proximal minority stressors for the mental health of transpersons. At the same time, the protective influence of resilience factors seemed to be surprisingly minor. In the treatment of transpersons, practitioners should not only focus on somatic aspects, but also consider the person's previous experiences of stigmatization.

Background Medical gender-affirming interventions (GAI) are important in the transition process of many trans persons. The aim of this study was to examine the associations between GAI and quality of life (QoL) of transitioned trans individuals. Methods 143 trans persons were recruited from a multicenter outpatient Swiss population as well as a web-based survey. The QoL was assessed using the Short Form (36) Health Survey questionnaire (SF-36). Depressive symptoms were examined using the Short Form of the Center for Epidemiologic Studies-Depression Scale (ADS-K). Multiple interferential analyses and a regression analysis were performed. Results Both transfeminine and transmasculine individuals reported a lower QoL compared to the general population. Within the trans group, nonbinary individuals showed the lowest QoL scores and significantly more depressive symptoms. A detailed analysis identified sociodemographic and transition-specific influencing factors. Conclusions Medical GAI are associated with better mental wellbeing but even after successful medical transition, trans people remain a population at risk for low QoL and mental health, and the nonbinary group shows the greatest vulnerability.

Some people have a profound dissatisfaction with what is considered an able-bodied state by most others. These individuals desire to be disabled, by conventional standards. In this Review, we integrate research findings about the desire for a major limb amputation or paralysis (xenomelia). Neuropsychological and neuroimaging explorations of xenomelia show functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological cause, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of disability. Irrespective of cause, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and we suggest that they should be considered a mental disorder. SummaryThere are persons who suffer from a profound dissatisfaction with what is considered an ablebodied state by most others. They desire to be "dis-abled" by conventional standards. We integrate recent research findings on the desire for a major limb amputation or paralysis ("xenomelia"). Neuropsychological and neuroimaging explorations of xenomelia revealed functional and structural abnormalities in predominantly right hemisphere cortical circuits of higher-order bodily representation, including affective and sexual aspects of corporeal awareness. These neural underpinnings of xenomelia do not necessarily imply a neurological etiology, and a full understanding of the condition requires consideration of the interface between neural and social contributions to the bodily self and the concept of (dis)ability. Irrespective of etiology, disability desires are accompanied by a disabling bodily dysphoria, in many respects similar to gender dysphoria, and deserve to be considered a mental disorder.3 IntroductionThis review integrates recent research findings concerning a condition that is not yet recognized as a mental disorder, which is still in search of a generally accepted medical label and whose conceptual basis is still "under construction". The condition involves a person's dissatisfaction with an able-bodied state. It is referred to as "body integrity identity disorder" (BIID) in the psychiatric literature, "xenomelia" in neurologically oriented studies, and "transability" ("transableism") in approaches to disability from a primarily sociological perspective (table 1, appendix and figure 1, appendix, for the terminology). In this review we use the term "disability desires" to remain descriptive and avoid controversial concepts of identity and too narrow notions of focal brain damage. Although deafness, blindness or the status of a eunuch can be the target of disability desires, the focus of our review is on the desire for limb amputation or paraplegia. These forms of profound bodily modification are the...