{Reference Type}: Journal Article
{Title}: Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives.
{Author}: Stroumsa D;Maksutova M;Minadeo LA;Indig G;Neis R;Ballard JY;Popoff EE;Trammell R;Wu JP;
{Journal}: Transgend Health
{Volume}: 9
{Issue}: 1
{Year}: 2024 Feb
{Factor}: 4.427
{DOI}: 10.1089/trgh.2022.0024
{Abstract}: <B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.