How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

Abstract

The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.

Aftercare Needs Following Gender-Affirming Surgeries: Findings From the ENIGI Multicenter European Follow-Up Study

“…Nearly two-third of the participants from all 3 countries expressed the need for additional postoperative care, which is in line with the reported needs in nonclinical studies. 11…”

“…9 Goodquality aftercare is thought to improve the aesthetic and functional outcomes of GAS: adequate wound care promotes healing and lifelong dilation is fundamental in maintaining the opening in the pelvic diaphragm, 10 which both are of importance for satisfaction with surgical results. 5,9,11 Furthermore, routine cancer screening, long-term postoperative monitoring of breast implants after breast augmentation, and evaluation of sexual function are some of many examples of care that could be applied after gender-affirming procedures. 9 Satisfaction with the results of surgery is beneficial for quality of life and in reducing psychological symptoms.…”

“…15 Targets for aftercare could be coping with unfavorable postoperative outcomes alongside attention for mental health challenges. Mental health services are considered to be helpful in the transitioning process by most treatment-seeking transgender (TSTG) individuals 11,16 as they may give support, assist adaptation and promote mental health and self-growth. According to the Standards of Care by the World Professional Association for Transgender Health (WPATH), surgeons ought to ensure direct aftercare and consultation with other health care providers after GAS.…”

“…A majority of TSTG individuals mention the desire for post-GAS aftercare according to recent Dutch and German community sample studies. 11,17 While aftercare is viewed as pivotal to good treatment outcomes, a substantial share of transgender individuals receives limited clinical follow-up, 18 which may be the result of insufficient capacity. Also, little is known about the individual experiences and needs for care in the period after GAS from transgender individuals' perspectives.…”

Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden

“…The use of continuous scales or validated questionnaires may shed further light on the associations in this study. This cross-sectional sub-study only reflects the desires at one point during the evaluation process, whereas a recently published cross-sectional study of a German convenience sample of 415 transgender persons implies that needs and wishes regarding decision-making and supportive interventions may fluctuate during the treatment process (Mayer et al, 2019).…”