Jack Turban MD MHS is a researcher, medical journalist, and chief fellow in child and adolescent psychiatry at Stanford University School of Medicine. He is co-editor of the book Pediatric Gender Identity: Gender-affirming Care for Transgender and Gender Diverse Youth.
Dr. Turban's research focuses on the determinants of mental health among transgender and gender diverse youth. He led the team that published the first study to link gender identity conversion therapy (attempts to force transgender people to be cisgender) to suicide attempts and the first study to show that access to pubertal suppression during adolescence is associated with lower odds of suicidality among transgender and gender diverse people. His research and perspectives pieces have appeared in The New England Journal of Medicine, JAMA, Annals of Internal Medicine, JAMA Pediatrics, JAMA Psychiatry, Pediatrics, The American Journal of Public Health, and The Journal of the American Academy of Child & Adolescent Psychiatry, among others. His was awarded Best Clinical Perspectives Piece by The Journal of the American Academy of Child & Adolescent Psychiatry in 2017 and 2018. His manuscript on pubertal suppression for transgender youth was awarded best paper in the journal Pediatrics (the official journal of The American Academy of Pediatrics) in 2020. His research has been cited in major court cases regarding the civil rights of transgender people in the U.S., in state legislative debates around the country, and in the United Nations’ independent expert report on conversion therapy.
Dr. Turban is a frequent opinion contributor, and his writing on gender, sexuality, and policy has appeared in The New York Times, The Washington Post, The Los Angeles Times, Vox, Scientific American, The Hill, STAT, and Psychology Today, among others. He is a member of the editorial board of Psychiatric Times.
Dr. Turban is regularly consulted by the media to comment on issues regarding child and adolescent mental health and topics related to LGBTQ health. He and his work have been quoted over 100 times for outlets including NPR’s All Things Considered, The Daily Show with Trevor Noah, ABC’s 20/20 with Diane Sawyer, The New York Times, NBC News, Rolling Stone, The Washington Post, Vox, Reuters, GQ, Vogue, CBC, and Vanity Fair, among others. He has consulted for the U.S. Department of Defense and major tech companies on issues related to LGBTQ mental health. He currently serves on the scientific advisory board for The Upswing Fund, a collaborative fund created by Melinda Gates to support adolescent mental health during the COVID-19 pandemic.
Dr. Turban graduated from Harvard University magna cum laude with a B.A. in neurobiology. He earned his MD and MHS degrees from Yale School of Medicine, where he was an HHMI medical research fellow and graduated with highest honors with an award winning thesis entitled, “Evolving Treatment Paradigms for Transgender Youth.” He completed his adult psychiatry training at MGH/McLean (Harvard Medical School).
He has several active research projects through The Fenway Institute, The McLean Institute for Technology in Psychiatry, and the Harvard T.H. Chan School of Public Health. He is a member of the media committee of The American Academy of Child & Adolescent Psychiatry and the council on communications for The American Psychiatric Association.
- Transgender Health
- Child & Adolescent Psychiatry
Honors & Awards
Best Manuscript of the Year, Pediatrics (2020)
Best Clinical Perspectives Manuscript, Journal of The American Academy of Child & Adolescent Psychiatry (2017)
Best Clinical Perspectives Manuscript, Journal of the American Academy of Child & Adolescent Psychiatry (2018)
Ferris Prize, Yale School of Medicine
Parker Prize, Yale School of Medicine
Pride 30 Innovator, NBC
Excellence in Public Health Award, US Preventative Health Services
Boards, Advisory Committees, Professional Organizations
Media Committee, American Academy of Child & Adolescent Psychiatry (2018 - Present)
Editorial Board, Psychiatric Times (2020 - Present)
Council on Communications, American Psychiatric Association (2019 - Present)
Scientific Advisory Board, Upswing Fund by Melinda Gates & Panorama Global (Adolescent Mental Health during COVID-19) (2020 - Present)
Board Certification, American Board of Psychiatry and Neurology, Psychiatry
General Psychiatry Residency, Massachusetts General Hospital & McLean Hospital (Harvard Medical School)
BA, Harvard University, Neuroscience
MHS, Yale School of Medicine, Health Sciences Research
MD, Yale School of Medicine
Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults.
2022; 17 (1): e0261039
To examine associations between recalled access to gender-affirming hormones (GAH) during adolescence and mental health outcomes among transgender adults in the U.S.We conducted a secondary analysis of the 2015 U.S. Transgender Survey, a cross-sectional non-probability sample of 27,715 transgender adults in the U.S. Using multivariable logistic regression adjusting for potential confounders, we examined associations between access to GAH during early adolescence (age 14-15), late adolescence (age 16-17), or adulthood (age ≥18) and adult mental health outcomes, with participants who desired but never accessed GAH as the reference group.21,598 participants (77.9%) reported ever desiring GAH. Of these, 8,860 (41.0%) never accessed GAH, 119 (0.6%) accessed GAH in early adolescence, 362 (1.7%) accessed GAH in late adolescence, and 12,257 (56.8%) accessed GAH in adulthood. After adjusting for potential confounders, accessing GAH during early adolescence (aOR = 0.4, 95% CI = 0.2-0.6, p < .0001), late adolescence (aOR = 0.5, 95% CI = 0.4-0.7, p < .0001), or adulthood (aOR = 0.8, 95% CI = 0.7-0.8, p < .0001) was associated with lower odds of past-year suicidal ideation when compared to desiring but never accessing GAH. In post hoc analyses, access to GAH during adolescence (ages 14-17) was associated with lower odds of past-year suicidal ideation (aOR = 0.7, 95% CI = 0.6-0.9, p = .0007) when compared to accessing GAH during adulthood.Access to GAH during adolescence and adulthood is associated with favorable mental health outcomes compared to desiring but not accessing GAH.
View details for DOI 10.1371/journal.pone.0261039
View details for PubMedID 35020719
- Generalized Anxiety Disorder Symptoms are Higher Among Same- and Both-Sex Attracted Individuals in a Large, International Sample SEXUALITY RESEARCH AND SOCIAL POLICY 2021
Timing of Social Transition for Transgender and Gender Diverse Youth, K-12 Harassment, and Adult Mental Health Outcomes.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
PURPOSE: Many transgender and gender diverse (TGD) youth undergo a social transition in which they change their gender expression to align with their gender identity. Our objective was to examine associations between timing of social transition (during the prepubertal childhood period, adolescence, or adulthood) and adult mental health outcomes.METHODS: We conducted a secondary analysis of the 2015 U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Based on self-reports, participants were categorized as having undergone social transition during childhood (ages 3-9 years), adolescence (ages 10-17 years), or adulthood (ages ≥18 years). Using multivariable logistic regression, we examined associations between timing of social transition and adult mental health outcomes.RESULTS: After adjusting for demographic and potential confounding variables, childhood social transition was associated with lower odds of lifetime marijuana use (adjusted odds ratio .7, 95% confidence interval= .5-.8, p < .0001) when compared with adult social transition. Before adjusting for K-12 harassment based on gender identity, adolescent social transition was associated with adverse mental health outcomes, including greater odds of lifetime suicide attempts when compared with adult social transition (adjusted odds ratio 1.3, 95% confidence interval= 1.1-1.7, p= .004). These associations were no longer significant after further adjusting for K-12 harassment.CONCLUSIONS: Although past research has shown TGD youth who undergo social transition have favorable mental health outcomes in the short term, they may have worse mental health in adulthood if not protected from K-12 harassment based on gender identity. It is the responsibility of clinicians to emphasize the importance of adolescents having safe and affirming social environments.
View details for DOI 10.1016/j.jadohealth.2021.06.001
View details for PubMedID 34272170
- Found in Transition: A Mother's Evolution During Her Child's Gender Change (Book Review) JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY 2021; 60 (6): 784-785
- Legislation to Criminalize Gender-Affirming Medical Care for Transgender Youth. JAMA 2021
The US Supreme Court and the Future of Sexual and Gender Minority Health.
American journal of public health
Over the past decade, the United States has made substantial progress in advancing the rights of sexual and gender minority (SGM) people. In 2015, the Supreme Court of the United States (SCOTUS) decision in Obergefell v. Hodges provided same-sex couples the fundamental right to marry across the United States.1 In 2020, the landmark Bostock v. Clayton County decision extended the interpretation of "on the basis of sex" under title VII of the 1964 Civil Rights Act to prohibit workplace discrimination on the basis of sexual orientation and gender identity.2 This sweeping decision sets the precedent that other sex-based antidiscrimination laws should be interpreted to include SGM people. However, explicit and broad protections based on sexual orientation and gender identity are not common features of federal laws, and existing SGM protections remain tenuous, as they rely on judicial interpretation. With recent shifts in the composition of SCOTUS, there is the increasing possibility that the hard-earned protections for SGM people in the United States will be reversed through recently argued and upcoming cases. Based on the available empirical evidence, we are concerned about the possible physical and mental health sequelae. (Am J Public Health. Published online ahead of print May 20, 2021: e1-e3. https://doi.org/10.2105/AJPH.2021.306302).
View details for DOI 10.2105/AJPH.2021.306302
View details for PubMedID 34019455
Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis.
Purpose: There is a paucity of data regarding transgender and gender diverse (TGD) people who "detransition," or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States. Methods: A secondary analysis was performed on data from the U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Participants were asked if they had ever detransitioned and to report driving factors, through multiple-choice options and free-text responses. A mixed-methods approach was used to analyze the data, creating qualitative codes for free-text responses and applying summative content analysis. Results: A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined. Of these, 2242 (13.1%) reported a history of detransition. Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma. History of detransition was associated with male sex assigned at birth, nonbinary gender identity, bisexual sexual orientation, and having a family unsupportive of one's gender identity. A total of 15.9% of respondents reported at least one internal driving factor, including fluctuations in or uncertainty regarding gender identity. Conclusion: Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.
View details for DOI 10.1089/lgbt.2020.0437
View details for PubMedID 33794108
Chronic UV radiation-induced RORγt+ IL-22-producing lymphoid cells are associated with mutant KC clonal expansion.
Proceedings of the National Academy of Sciences of the United States of America
2021; 118 (37)
Chronic ultraviolet (UV) radiation exposure is the greatest risk factor for cutaneous squamous cell carcinoma (cSCC) development, and compromised immunity accelerates this risk. Having previously identified that epidermal Langerhans cells (LC) facilitate the expansion of UV-induced mutant keratinocytes (KC), we sought to more fully elucidate the immune pathways critical to cutaneous carcinogenesis and to identify potential targets of intervention. Herein, we reveal that chronic UV induces and LC enhance a local immune shift toward RORγt+ interleukin (IL)-22/IL-17A-producing cells that occurs in the presence or absence of T cells while identifying a distinct RORγt+ Sca-1+ CD103+ ICOS+ CD2+/- CCR6+ intracellular CD3+ cutaneous innate lymphoid cell type-3 (ILC3) population (uvILC3) that is associated with UV-induced mutant KC growth. We further show that mutant KC clone size is markedly reduced in the absence of RORγt+ lymphocytes or IL-22, both observed in association with expanding KC clones, and find that topical application of a RORγ/γt inhibitor during chronic UV exposure reduces local expression of IL-22 and IL-17A while markedly limiting mutant p53 KC clonal expansion. We implicate upstream Toll-like receptor signaling in driving this immune response to chronic UV exposure, as MyD88/Trif double-deficient mice also show substantially reduced p53 island number and size. These data elucidate key immune components of chronic UV-induced cutaneous carcinogenesis that might represent targets for skin cancer prevention.
View details for DOI 10.1073/pnas.2016963118
View details for PubMedID 34504008
- TRANSGENDER YOUTH: UNDERSTANDING "DETRANSITION," NONLINEAR GENDER TRAJECTORIES, AND DYNAMIC GENDER IDENTITIES ELSEVIER SCIENCE INC. 2021: S3
- ACCESS TO GENDER-AFFIRMING HORMONES DURING ADOLESCENCE AND MENTAL HEALTH OUTCOMES AMONG TRANSGENDER ADULTS ELSEVIER SCIENCE INC. 2021: S227
- GEOSOCIAL "HOOK-UP" APP USE AND THE MENTAL HEALTH OF SEXUAL MINORITY ADOLESCENTS ELSEVIER SCIENCE INC. 2021: S89
- LGBTQ FAMILIES AND THE US SUPREME COURT ELSEVIER SCIENCE INC. 2021: S34-S35
- FACTORS LEADING TO "DETRANSITION" AMONG TRANSGENDER AND GENDER-DIVERSE PEOPLE IN THE UNITED STATES: A THEORETICAL FRAMEWORK AND MIXED-METHODS ANALYSIS ELSEVIER SCIENCE INC. 2021: S3-S4
- Geosocial Networking Application Use Among Sexual Minority Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 2020
Use of Geosocial Networking Applications Is Associated With Compulsive Sexual Behavior Disorder in an Online Sample.
The journal of sexual medicine
2020; 17 (8): 1574–78
Geosocial networking applications (GNAs) are relatively new outlets through which individuals may find partners for sexual encounters. There has been a paucity of research on the associations between use of these platforms and measures of mental health and compulsive sexual behavior disorder (CSBD).To examine associations between use of GNA, anxiety, and CSBD.Using data from a large nontargeted Web-based sample (N = 4,203), we examined demographics associated with the use of GNAs. Using multivariable logistic regression adjusting for demographic differences between users and non-users, we examined associations between GNA use, anxiety, and CSBD.The outcomes are Generalized Anxiety Disorder-7 and a modified Hypersexual Behavior Inventory-19.The percentage of participants that reported they used GNAs was 12.3%. Those who reported using the applications compared with those who did not were more likely to be young, male, and nonheterosexual. After adjusting for demographic variables, GNAs use was associated with CSBD (adjusted odds ratio = 1.62, 95% confidence interval: 1.09-2.37, P = .015) but not anxiety.This study is an initial foray into the relationships between GNA and mental health, establishing a relationship between GNA use and CSBD. Future research is needed to better understand the relationships between GNA use, psychopathology, and CSBD.Strengths of the study include its large sample size and nontargeted recruitment design, which minimizes confirmation bias. Limitations include the cross-sectional nature of this study, which precludes determination of the direction of causation.Use of GNAs was prevalent among our sample and associated with CSBD. GNA use may represent an important platform through which CSBD manifests. Conversely, GNA use may drive CSBD. Turban JL, Passell E, Scheuer L, et al. Use of Geosocial Networking Applications Is Associated With Compulsive Sexual Behavior Disorder in an Online Sample. J Sex Med 2020;17:1574-1578.
View details for DOI 10.1016/j.jsxm.2020.03.020
View details for PubMedID 32402815
View details for PubMedCentralID PMC7390670
- Sexual Health in the SARS-CoV-2 Era. Annals of internal medicine 2020; 173 (5): 387–89
- Gender-congruent government identification is crucial for gender affirmation. The Lancet. Public health 2020; 5 (4): e178–e179
Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation.
2020; 145 (2)
Gonadotropin-releasing hormone analogues are commonly prescribed to suppress endogenous puberty for transgender adolescents. There are limited data regarding the mental health benefits of this treatment. Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes.Using a cross-sectional survey of 20 619 transgender adults aged 18 to 36 years, we examined self-reported history of pubertal suppression during adolescence. Using multivariable logistic regression, we examined associations between access to pubertal suppression and adult mental health outcomes, including multiple measures of suicidality.Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2-0.6).This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.
View details for DOI 10.1542/peds.2019-1725
View details for PubMedID 31974216
View details for PubMedCentralID PMC7073269
Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults.
2020; 77 (1): 68–76
Gender identity conversion efforts (GICE) have been widely debated as potentially damaging treatment approaches for transgender persons. The association of GICE with mental health outcomes, however, remains largely unknown.To evaluate associations between recalled exposure to GICE (by a secular or religious professional) and adult mental health outcomes.In this cross-sectional study, a survey was distributed through community-based outreach to transgender adults residing in the United States, with representation from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and US military bases overseas. Data collection occurred during 34 days between August 19 and September 21, 2015. Data analysis was performed from June 8, 2018, to January 2, 2019.Recalled exposure to GICE.Severe psychological distress during the previous month, measured by the Kessler Psychological Distress Scale (defined as a score ≥13). Measures of suicidality during the previous year and lifetime, including ideation, attempts, and attempts requiring inpatient hospitalization.Of 27 715 transgender survey respondents (mean [SD] age, 31.2 [13.5] years), 11 857 (42.8%) were assigned male sex at birth. Among the 19 741 (71.3%) who had ever spoken to a professional about their gender identity, 3869 (19.6%; 95% CI, 18.7%-20.5%) reported exposure to GICE in their lifetime. Recalled lifetime exposure was associated with severe psychological distress during the previous month (adjusted odds ratio [aOR], 1.56; 95% CI, 1.09-2.24; P < .001) compared with non-GICE therapy. Associations were found between recalled lifetime exposure and higher odds of lifetime suicide attempts (aOR, 2.27; 95% CI, 1.60-3.24; P < .001) and recalled exposure before the age of 10 years and increased odds of lifetime suicide attempts (aOR, 4.15; 95% CI, 2.44-7.69; P < .001). No significant differences were found when comparing exposure to GICE by secular professionals vs religious advisors.The findings suggest that lifetime and childhood exposure to GICE are associated with adverse mental health outcomes in adulthood. These results support policy statements from several professional organizations that have discouraged this practice.
View details for DOI 10.1001/jamapsychiatry.2019.2285
View details for PubMedID 31509158
View details for PubMedCentralID PMC6739904
Posting Sexually Explicit Images or Videos of Oneself Online Is Associated With Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans.
The journal of sexual medicine
2020; 17 (1): 163–67
Sending sexually explicit text messages ("sexting") is prevalent among US adults; however, the mental health correlates of this behavior among adults have not been studied adequately. Furthermore, there are few studies examining the related but distinct behavior of posting sexually explicit photos or videos of oneself online (posting sexual images [PSI]) and the mental health correlates of this behavior.To examine associations between sexting, PSI, impulsivity, hypersexuality, and measures of psychopathology.Using a national convenience sample of 283 US post-deployment, post-9/11 military veterans, we evaluated the prevalence of 2 behaviors: sexting and PSI and the associations of these behaviors with psychopathology, suicidal ideation, sexual behaviors, hypersexuality, sexually transmitted infections, trauma history, and measures of impulsivity.Measures of psychopathology including depression, anxiety, post-traumatic stress disorder, insomnia, substance dependence, hypersexuality, and suicidal ideation, as well as measures of impulsivity, sexual behavior, and trauma.Sexting was found to be common among post-9/11 veterans (68.9%). A smaller number of veterans engaged in PSI (16.3%). PSI veterans were more likely to be younger, male, less educated, and unemployed. After adjusting for covariates, no associations were detected between PSI or sexting and the examined measures of psychopathology. However, PSI was associated with higher levels of impulsivity and hypersexuality, whereas sexting was not associated with these measures.Results from this study suggest that not all digital sexual behaviors are associated with psychopathology. However, PSI was associated with hypersexuality and impulsivity. Those who engage with PSI may benefit from guidance on how to manage their impulsivity to prevent ego-dystonic sexual behaviors.The strengths of this study include differentiating PSI from sexting broadly, highlighting that digital sexual behaviors are heterogeneous. Limitations include the study's cross-sectional design, which limits causal interpretations. More research is also needed in civilian populations.PSI was less prevalent than sexting in our sample. This behavior was associated with impulsivity and hypersexuality but not with elevated levels of psychopathology. Sexting was not associated with any of these measures. Turban JL, Shirk SD, Potenza MN, et al. Posting Sexually Explicit Images or Videos of Oneself Online Is Associated with Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans. J Sex Med 2020;17:163-167.
View details for DOI 10.1016/j.jsxm.2019.09.018
View details for PubMedID 31708484
View details for PubMedCentralID PMC7037740
- Medical Training in the Closet. The New England journal of medicine 2019; 381 (14): 1305–7
Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital.
The Psychiatric quarterly
2019; 90 (3): 601–12
Transgender adolescents may require for inpatient psychiatric care, and have unique healthcare needs and can face barriers to quality care. This study sought to address limited understanding of the inpatient experience of transgender adolescents. This study uses qualitative methods to gain insight into the experience of transgender adolescents and psychiatric care providers on an adolescent inpatient psychiatric unit in the northeast United States. Semi-structured interviews were conducted with patients (9 total, ages 13-17) and unit care providers (18 total). These interviews were recorded, transcribed, and analyzed using inductive thematic analysis. Patients and providers generally reported a supportive inpatient environment. Factors that contributed to this environment were efforts by care providers to respect patients regardless of gender identity, to use patient's preferred identifiers, and to acknowledge mistakes in identifier use. Barriers to consistently supportive interactions were also identified, including a lack of consistent identification of a patient's transgender identity in a supportive manner during the admission intake, challenges associated with the presence of birth-assigned name and gender within the care system (e.g. in the electronic medical record, identifying wristbands, attendance rosters), and a lack of formal training of care providers in transgender cultural competency. Interviews also provided insight into how providers grapple with understanding the complexities of gender identity. Findings suggest that gender-affirming approaches by providers are experienced as supportive and respectful by transgender adolescent patients, while also identifying barriers to consistently supportive interactions that can be addressed to optimize care.
View details for DOI 10.1007/s11126-019-09653-0
View details for PubMedID 31209713
View details for PubMedCentralID PMC7045586
Psychological Attempts to Change a Person's Gender Identity From Transgender to Cisgender: Estimated Prevalence Across US States, 2015.
American journal of public health
2019; 109 (10): 1452–54
Objectives. To examine exposure to psychological attempts to change a person's gender identity from transgender to cisgender (PACGI) among transgender people in the United States, lifetime and between the years 2010 and 2015, by US state.Methods. We obtained data from the 2015 US Transgender Survey, a cross-sectional nonprobability sample of 27 716 transgender people in the United States, to estimate the percentage exposed to PACGI in each US state.Results. Overall, 13.5% of the sample indicated lifetime exposure to PACGI, ranging across all US states from 9.4% (South Carolina) to 25.0% (Wyoming). The percentage of transgender adults in the United States reporting exposure to PACGI between 2010 and 2015 was 5% overall, and across all states ranged from 1.2% (Alaska) to 16.3% (South Dakota).Conclusions. Despite major medical organizations identifying PACGI as ineffective and unethical, 13.5% of transgender people in the United States reported lifetime exposure to this practice. Findings suggest that this practice has continued in every US state as recently as the period 2010 to 2015.
View details for DOI 10.2105/AJPH.2019.305237
View details for PubMedID 31415210
View details for PubMedCentralID PMC6727306
Potentially Reversible Social Deficits Among Transgender Youth.
Journal of autism and developmental disorders
2018; 48 (12): 4007–9
Recently, there has been increased attention to a putative relationship between Autism Spectrum Disorder (ASD) and gender dysphoria, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis for those whose gender assigned at birth does not match their gender identity. Studies have shown an over-representation of ASD symptoms among transgender youth. These studies, however, have used scales that are non-specific for ASD. These ASD symptoms may represent social deficits that are secondary to social stress and deprivation, as transgender youth suffer high rates of peer and family rejection. These social deficits may not represent true ASD and may be reversible as patients are affirmed in their gender identities and social stress is reduced.
View details for DOI 10.1007/s10803-018-3603-0
View details for PubMedID 29752630
- Drs. Turban and van Schalkwyk Reply. Journal of the American Academy of Child and Adolescent Psychiatry 2018; 57 (11): 887–89
- Understanding Pediatric Patients Who Discontinue Gender-Affirming Hormonal Interventions. JAMA pediatrics 2018; 172 (10): 903–4
Dynamic Gender Presentations: Understanding Transition and "De-Transition" Among Transgender Youth.
Journal of the American Academy of Child and Adolescent Psychiatry
2018; 57 (7): 451–53
The following clinical scenarios are composite cases that illustrate clinically important phenomena based on several patients. Jamie is a 19-year-old who was assigned a female gender at birth and had a history of major depressive disorder in remission. She presented to her primary care physician, psychiatrist, and psychotherapist reporting dysphoria related to gender and requesting gender-affirming hormone therapy. Jamie had symptoms for at least 6 months consistent with DSM-5 criteria for gender dysphoria. After full clinical assessment by her therapist, psychiatrist, and primary care physician, her integrated care team initiated gender-affirming hormone therapy and provided close follow-up from her mental health providers. For 13 months, Jamie was treated with testosterone, changed her pronouns to he/him/his, and began wearing traditionally masculine clothing. Throughout this period, she remained engaged in regular care with her psychotherapist, who was experienced in providing gender-affirming care. Eventually, Jamie informed her care team that after the trial of testosterone and much reflection, she had come to understand her identity as a queer woman and wished to discontinue hormone therapy. Jamie reported being pleased about the hormone therapy trial, because this allowed her to clarify her gender identity. She did not regret her social affirmation or any physical changes that occurred during this process, such as fat redistribution and minor facial hair growth, in the context of otherwise being healthy. Lupita is a 23-year-old who was assigned a male gender at birth and had a history of major depressive disorder and panic disorder. At 18 years of age, after a comprehensive evaluation, she initiated gender-affirming hormone therapy with her primary care provider, changed her name to "Lupita," changed her pronouns to she/her/hers, and started wearing more traditionally feminine clothing. That following year, she started attending college and faced continual gender-based harassment from other students as a result of her gender-nonconforming physical appearance. Her college health services were not affirming of her gender and referred to her repeatedly by her birth name and with he-series pronouns. Lupita became demoralized and after 5 months decided to de-transition. She became progressively more depressed and attempted suicide in her sophomore year. Then she transferred colleges, found gender-affirming clinical providers, and resumed estradiol and spironolactone (an antiandrogen) therapy and her social affirmation through name, pronouns, and style of dress. Her mood improved dramatically and she was able to graduate from college. Lupita now presents seeking breast augmentation surgery.
View details for DOI 10.1016/j.jaac.2018.03.016
View details for PubMedID 29960687
- "Gender Dysphoria" and Autism Spectrum Disorder: Is the Link Real? Journal of the American Academy of Child and Adolescent Psychiatry 2018; 57 (1): 8–9.e2
Knowledge and attitudes toward transgender health.
The clinical teacher
2018; 15 (3): 203–7
Hormonal interventions for transgender adolescents have become increasingly common; however, there is a paucity of research on medical student knowledge of, and attitudes toward, these interventions following didactic instruction. Furthermore, no studies have examined whether students can be aware of the literature on the mental health benefits of these treatments yet continue to find them unethical.An anonymous online survey was administered to students, from first to fourth year (n = 407), who had received one or two lectures on the treatment of youths with gender dysphoria (GD).Surveys were completed by 162 respondents (40%). A majority was able to correctly answer questions regarding psychiatric co-morbidities, diagnostic criteria, hormonal interventions, long-term benefits of interventions and terminology. There was some evidence that precision in the use of terminology waned over time. Many were unclear on the role of puberty blockers and the time requirement for a diagnosis of GD. A minority (14%) reported a belief that hormonal therapy is unethical, although these same individuals recognised that these treatments have mental health benefits.Our results have implications for future instruction, including: the need to teach pharmacological and diagnostic issues more deliberately; providing refresher training on terminology; and relying on interactive discussion or patient visits, rather than didactic lectures alone, for ethically charged medical topics. Similar levels of knowledge among students who believe that hormonal therapy is ethical and unethical may indicate that imparting didactic knowledge about therapeutic benefits alone may not be sufficient to affect attitudes regarding endocrine care for transgender youth. Hormonal interventions for transgender adolescents have become increasingly common.
View details for DOI 10.1111/tct.12738
View details for PubMedID 29178596
Research Review: Gender identity in youth: treatment paradigms and controversies.
Journal of child psychology and psychiatry, and allied disciplines
2018; 59 (12): 1228–43
Pediatric gender identity has gained increased attention over the past several years in the popular media, political arena, and medical literature. This article reviews terminology in this evolving field, traditional models of gender identity development and their limitations, epidemiology and natural history of cross-gender identification among children and adolescents, co-occurring conditions and behaviors, research into the biological and psychosocial determinants of cross-gender identification, and research into the options regarding and benefits of clinical approaches to gender incongruent youth.Based on a critical review of the extant literature, both theoretical and empirical, that addresses the issue of pediatric gender identity, the authors synthesized what is presently known and what is in need of further research in order to elucidate the developmental trajectory and clinical needs of gender diverse youth.The field of pediatric gender identity has evolved substantially over the past several years. New research suggests that cross-gender identification is prevalent (approximately 1% of youth). These youth suffer disproportionately high rates of anxiety, depression, and suicidality. Although research into the etiology of cross-gender identification is limited, emerging data have shown that affirmative treatment protocols may improve the high rates of mental health difficulties seen among these patients.The field of pediatric gender identity has evolved dramatically. Emerging data suggest that these patients' high rates of anxiety, depression, and suicidality appear to be improved with affirmative protocols, although future longitudinal data are needed.
View details for DOI 10.1111/jcpp.12833
View details for PubMedID 29071722
- Ten Things Transgender and Gender Nonconforming Youth Want Their Doctors to Know. Journal of the American Academy of Child and Adolescent Psychiatry 2017; 56 (4): 275–77
- Transgender Youth: The Building Evidence Base for Early Social Transition. Journal of the American Academy of Child and Adolescent Psychiatry 2017; 56 (2): 101–2
Psychiatric disorders, suicidal ideation, and sexually transmitted infections among post-deployment veterans who utilize digital social media for sexual partner seeking.
2017; 66: 96–100
Digital social media platforms represent outlets through which individuals may find partners for sexual encounters. Using a sample of US post-deployment military veterans, the current study evaluated the prevalence of digital sex seeking as well as clinical correlates of psychopathology, suicidal ideation, and sexually transmitted infections (STIs).Using data from a baseline telephone interview and follow-up internet-based survey, we examined the prevalence of sexual partnering via digital social media platforms in a national sample of 283 US combat veterans.Among veterans, 35.5% of men and 8.5% of women reported having used digital social media to meet someone for sex. Individuals who reported having used digital social media to find sexual partners (DSMSP+) as compared to those who did not (DSMSP-) were more likely to be young, male, and in the Marine Corps. After adjusting for sociodemographic variables, DSMSP+ status was associated with post-traumatic stress disorder (OR=2.26, p=0.01), insomnia (OR=1.99, p=0.02), depression (OR=1.95, p=0.03), hypersexuality (OR=6.16, p<0.001), suicidal ideation (OR=3.24, p=0.04), and treatment for an STI (OR=1.98, p=0.04).Among US post-deployment military veterans, DSMSP+ behaviors were prevalent, particularly among men. The association between DSMSP+ behaviors and PTSD, insomnia, depression, hypersexuality, suicidal ideation, and STIs suggest that veterans who engage in DSMSP+ behaviors should be particularly thoroughly screened and evaluated for these psychiatric concerns and counseled on the benefits of safe sexual practices.
View details for DOI 10.1016/j.addbeh.2016.11.015
View details for PubMedID 27902944