Gnendy Indig, MD

All Publications

• US Laws Restricting Medical Care for Transgender Minors: Statutory Inconsistencies Involving Intersex and Other Individuals. JAMA health forum Mar, S. A., Earp, B. D., Indig, G., McNamara, M., Boskey, E. R., Dalke, K. B., Dietz, E., Carpenter, M., Kraus, C., Lorshbough, E., McLamore, Q., Zieselman, K., Wenger, H. C. 2025; 6 (11): e254157

  Abstract

  Since 2021, there have been growing calls in the US to prohibit gender-affirming medical care (GAMC) for transgender and gender-diverse (TGD) minors (ie, <18 years). Supporters of these bans have argued the restrictions are necessary to protect TGD minors from potentially risky or unproven medical interventions; however, the same bans include exceptions for similar procedures when performed on presumptively non-TGD minors: primarily, infants and children with variations in sex characteristics, or intersex traits.To comprehensively describe US legislation seeking to prohibit GAMC for TGD individuals and determine the extent to which such legislation contains exceptions for similar interventions performed on presumptively non-TGD minors.All US jurisdictions with statutes restricting GAMC across 4 full legislative sessions (January 1, 2021, to December 31, 2024) were searched. For each statute, the authors identified descriptions of sex, gender, and GAMC; restricted health care services; stated purpose(s) for which services are restricted; exceptions to restrictions; and penalties for statutory violations.All US states with legislation restricting voluntarily sought TGD-related health care contain statutory exceptions that allow for physically comparable, but typically nonvoluntary interventions to "normalize" the benign bodily attributes of children with intersex traits. Some statutes also explicitly permit medically unnecessary procedures like penile circumcision on presumptively non-TGD minors.Inconsistent statutory rules appear to be applied to TGD and presumptively non-TGD minors. Furthermore, these findings suggest such rules are shaped by definitions of sex and gender that conflict with current scientific understanding. Sound health policy ought to afford equal access to health care services affecting sexual anatomy, without discrimination based on sex traits or gender.

  View details for DOI 10.1001/jamahealthforum.2025.4157

  View details for PubMedID 41236763

• Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives. Transgender health Stroumsa, D., Maksutova, M., Minadeo, L. A., Indig, G., Neis, R., Ballard, J. Y., Popoff, E. E., Trammell, R., Wu, J. P. 2024; 9 (1): 34-45

  Abstract

  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.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.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.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.

  View details for DOI 10.1089/trgh.2022.0024

  View details for PubMedID 38312454

  View details for PubMedCentralID PMC10835159

• Intersex Surgery Restrictions The SAGE Encyclopedia of LGBTQ+ Studies Indig, G., Grimstad, F. W. edited by Goldberg, A. E. Sage Publication. 2024; 2nd

  View details for DOI 10.4135/9781071891414.n249

• Intersex Inclusion The SAGE Encyclopedia of LGBTQ+ Studies Grimstad, F. W., Indig, G. edited by Goldberg, A. E. Sage Publications. 2024; 2nd

  View details for DOI 10.4135/9781071891414.n247

• The Body Guidelines: A Metacognitive and Harm Reducing Approach to Gender and Sex in Preclinical Medical School Curriculum. Journal of medical education and curricular development Parsa, N., Myers, H., Ravichandran, K., Kus, T., Indig, G. 2023; 10: 23821205231215606

  Abstract

  The incorporation of sex and gender variables in medical education can be made more intuitive and accurate with thoughtful intervention. The authors propose a flowchart to make medical education tools more precise and applicable to patients who would benefit from a nuanced approach to sex and gender. The Body Guidelines can empower educators to consider sex and gender in terms of the etiology and epidemiology of any given pathologic process or disease.

  View details for DOI 10.1177/23821205231215606

  View details for PubMedID 38075445

  View details for PubMedCentralID PMC10702404

• Obstetric, Antenatal, and Postpartum Care for Transgender and Nonbinary People Moravek, M.B., de Haan, G. (eds) Reproduction in Transgender and Nonbinary Individuals Indig, G., Ramos, S., Stroumsa, D. Springer, Cham. 2023

  View details for DOI 10.1007/978-3-031-14933-7_6

• Creation of an Electronic Resource Repository for Differences of Sex Development (DSD): Collaboration Between Advocates and Clinicians in the DSD-Translational Research Network. Sexual development : genetics, molecular biology, evolution, endocrinology, embryology, and pathology of sex determination and differentiation Rutter, M. M., Muscarella, M., Green, J., Indig, G., von Klan, A., Kennedy, K., Weidler, E. M., Barrett, M., Sandberg, D. E., DSD-Translational Research Network 2022: 1-9

  Abstract

  INTRODUCTION: People with differences of sex development (DSD) and their families need education about these conditions while receiving emotional and peer support to participate in shared decision-making, reduce social isolation, and optimize physical and psychosocial outcomes. Barriers to education and support include limited knowledge and awareness by healthcare providers, tension among patient and medical communities, varied quality of educational resources, and the sensitive nature of DSD. We aimed to create an electronic repository of vetted quality online resources about DSD.METHODS: The electronic resource repository (e-RR) was a collaboration between affected individuals and advocates and healthcare providers in the DSD-Translational Research Network (DSD-TRN), an NIH-supported consortium of US teams committed to standardizing and optimizing care in DSD. The e-RR development and ongoing growth involved: (1) identification of resources by the project team (3 advocates and 1 physician), (2) evaluation and feedback by DSD-TRN clinical teams, (3) creation of the e-RR, and (4) review and revision. Twitter-like descriptions accompanied each entry; resources were categorized by target age, audience, and condition.RESULTS: Thirty-seven web-based educational, peer and advocacy support, and clinician-oriented resources were reviewed. Eight of 10 DSD-TRN teams responded to a survey regarding resource inclusion. Awareness of individual resources varied widely. Consensus was achieved when opinions differed; 30 resources were included. The e-RR is available online and as a downloadable booklet at http://www.accordalliance.org/resource-guide/.CONCLUSION: The e-RR increases awareness of and access to vetted educational and support resources for those with DSD and healthcare providers. It represents important collaboration between advocates and providers.

  View details for DOI 10.1159/000524629

  View details for PubMedID 35636406

• COVID-19 and medical education in Africa: a cross sectional analysis of the impact on medical students. BMC medical education Bernard, A., Indig, G., Byl, N., Abdu, A. N., Mengesha, D. T., Admasu, B. A., Holman, E. 2021; 21 (1): 605

  Abstract

  The African continent currently experiences 25% of the global burden of disease with only 1.3% of the world's healthcare workers. The COVID-19 pandemic has caused unprecedented disruption to medical education systems, increasing the strain on already-vulnerable regions. Our study examines the impact of COVID-19 on medical students across 33 countries in the African continent.A 39-item anonymous electronic survey was developed and distributed to medical students across Africa through social networks to assess the impact of the COVID-19 pandemic on medical education. The survey assessed the domains of: class structure changes and timing, patient interactions, exam administration, learning environment satisfaction, mental health impacts, and volunteer opportunities/engagement.694 students across 33 countries participated. 80% of respondents had their classes suspended for varied lengths of time during the pandemic, and from these students 59% of them resumed their classes. 83% of students felt they were in a supportive learning environment before the pandemic, which dropped to 32% since the start. The proportion of students taking exams online increased (6-26%, p<0.001) and there was a decrease in the proportion of students seeing patients as a part of their education (72-19%, p<0.001).COVID-19 is harming medical students in Africa and is likely to worsen the shortage of the future's healthcare workforce in the region. Pandemic-related impacts have led to a degradation of the learning environment of medical students. Medical schools have shifted online to differing degrees and direct patient-care in training of students has decreased. This study highlights the urgent need for flexible and innovative approaches to medical education in Africa.

  View details for DOI 10.1186/s12909-021-03038-3

  View details for PubMedID 34879844

  View details for PubMedCentralID PMC8654489

• Clinician Advocacy and Intersex Health: A History of Intersex Health Care and the Role of the Clinician Advocate Past, Present, and Future. Pediatric annals Indig, G., Serrano, M., Dalke, K. B., Ejiogu, N. I., Grimstad, F. 2021; 50 (9): e359-e365

  Abstract

  Throughout the history of Western culture, sex has been reflected as a binary rule, with this binary system affecting self-expression, lifestyle choices, and health outcomes of everyone, but especially those with intersex traits. "Intersex" (or differences of sex development) is an umbrella term used to describe a wide range of natural variations in genitalia, gonads, and chromosome patterns that do not fit typical binary notions of male or female bodies. Currently, people who identify as intersex or as having intersex traits are not provided with the appropriate care needed for their wellbeing. Intersex health care has undergone a great deal of change in the last century, led by intersex leaders and advocates. Clinician advocates have also played a vital role. This article will focus on this history of intersex health care evolution, the role of clinician advocacy, and suggestions for how clinicians can become advocates for improving intersex health care. [Pediatr Ann. 2021;50(9):e359-e365.].

  View details for DOI 10.3928/19382359-20210816-01

  View details for PubMedID 34542337