RESUMO
Among transgender, non-binary, and/or gender expansive (TNG) persons, interest in medical and/or surgical forms of gender affirmation is heterogenous, as is access to those forms of medically necessary health care. Yet, the literature characterizing TNG persons' interest in medical and/or surgical gender-affirming care, barriers to accessing that care, and how societal narratives and expectations impact TNG individuals' self-image and mental health, as well as their personal choices regarding gender-affirming care remains sparse. Here we present qualitative research exploring TNG participants' interest in gender-affirming care and how such interventions impact identity formation. We conducted loosely structured interviews with a convenience sample of 54 TNG persons in the U.S. and Canada from Facebook pages used to recruit TNG research participants. One-hour interviews were conducted by an openly TNG researcher; participants were compensated. The most frequently sought gender-affirming care was hormone therapy, followed by chest ("top") surgery, genital ("bottom") surgery, electrolysis, breast augmentation, hysterectomy, and voice training. Less commonly desired interventions included fertility preservation, facial feminization/masculinization, and vocal surgery. Participants described four main categories of access barriers: financial (e.g., cost of medical/surgical care, inadequate insurance), logistical (e.g., no local providers, gatekeeping policies around body size and mental health, pandemic-related delays), personal fears about sub-optimal outcomes (e.g., complications, loss of sensation, undesired aesthetic and/or functional results), and societal discrimination (e.g., familial rejection, job loss, safety concerns). Participants reported primarily seeking this healthcare for social legibility, alleviating dysphoria/pursuing euphoria, and/or gender exploration. All who sought gender-affirming care reported improved mental health-including depression, anxiety, dissociation, and eating disorders-and social relationships, though many struggled to find TNG-competent mental health providers. This work provides key insights into how gender-affirming care can contribute to improving mental health for TNG communities, which will assist health providers in optimally treating TNG patients.
RESUMO
OBJECTIVES: The present study aimed at investigating the timing of birth across the day in a rural population of indigenous and nonindigenous women in the province of Formosa, Argentina in order to explore the variation in patterns in a non-Western setting. MATERIALS AND METHODS: This study utilized birth record data transcribed from delivery room records at a rural hospital in the province of Formosa, northern Argentina. The sample included data for Criollo, Wichí, and Toba/Qom women (n = 2421). Statistical analysis was conducted using directional statistics to identify a mean sample direction. Chi-square tests for homogeneity were also used to test for statistical significant differences between hours of the day. RESULTS: The mean sample direction was 81.04°, which equates to 5:24 AM when calculated as time on a 24-hr clock. Chi-squared analyses showed a statistically significant peak in births between 12:00 and 4:00 AM. Birth counts generally declined throughout the day until a statistically significant trough around 5:00 PM. DISCUSSION: This pattern may be associated with the circadian rhythms of hormone release, particularly melatonin, on a proximate level. At the ultimate level, giving birth in the early hours of the morning may have been selected to time births when the mother could benefit from the predator protection and support provided by her social group as well as increased mother-infant bonding from a more peaceful environment.