UNASSIGNED: Lesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) people experience discrimination across many contexts, including healthcare environments. While some research has shown transgender people and non-binary people often endure higher rates of marginalization than cisgender, sexually diverse people, past data are limited.
UNASSIGNED: A sample of LGBTQ+ people (N = 173) in the United States completed an anonymous, online, self-reported survey, which included the Consumer Assessment of Healthcare Providers and Systems and healthcare experience questions. Groups, including people who identified as cisgender, sexually diverse (n = 116), transgender (n = 24), and non-binary (n = 33), were compared using chi-square and multivariate analysis of covariance tests.
UNASSIGNED: Compared to cisgender, sexually diverse people, non-binary people were less likely to report feeling comfortable with a physical exam, having good mental health, respected by providers, that providers had adequate medical information, that providers could care for someone going through gender affirmation, and that hospital staff were comfortable interacting with them. Additionally, non-binary people were more likely to report hospital staff misgendering them.
UNASSIGNED: These unique LGBTQ+ subgroup differences may be secondary to identity-specific stigma that non-binary people face. More international studies are needed to elucidate these subgroup-specific healthcare experiences across LGBTQ+ identities.

BACKGROUND: Non-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement.
METHODS: We characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18-30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image.
RESULTS: TGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific.
CONCLUSIONS: The OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups.
CONCLUSIONS: Interventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure.

Though significant research highlights higher rates of mental ill-health and substance use among trans, non-binary and gender diverse (henceforth \'trans\') young people, little research has considered patterns, contextual characteristics, and correlates of co-occurring experiences of mental ill-health and substance use among trans young people. Using data from the Trans Pathways study, we used prevalence ratios and age- and gender-adjusted logistic regression models to examine prevalence and differences of co-occurring substance use (past six-month cigarette use, alcohol use, and other drug use) and contextual characteristics of substance use (past six-month solitary alcohol and/or drug use, substance use for coping) by mental ill-health (depression disorder, anxiety disorder, past 12-month self-harm thoughts and behaviours, suicidal thoughts, planning, and attempt/s). Age- and gender-adjusted models assessed associations between co-occurring depressive and anxiety disorders and recent cigarette, alcohol, and other drug use (six co-occurring items total) and 18 interpersonal stressors. Significantly increased odds of smoking or recent use of cannabis or sedatives was observed among trans young people reporting depressive disorder, anxiety disorder (aORs ranging 1.8-3.1). Trans young people who reported recent smoking or use of cannabis, inhalants, or sedatives, had 40% to 80% reduced odds of past 12-month self-harm thoughts, self-harm behaviours, suicidal thoughts, and suicide attempt/s (aORs ranging 0.2-0.6). On the other hand, solitary alcohol and/or other drug use and substance use for coping was significantly associated with increased odds of all mental ill-health outcomes. Issues with school, secure housing, and intimate partner abuse were the most robust correlates of co-occurring mental ill-health and substance use. Trans young people using substances, especially cigarettes, cannabis, and sedatives, often so do with co-occurring experiences of depression and anxiety though limited substance use in more \'social\' contexts may confer benefits for preventing self-harm and suicide thoughts and behaviours. Continued research in partnership with trans young people is warranted to conceptualise more nuanced and precise conceptual parameters of trans-affirming substance use harm reduction approaches.

BACKGROUND: A physician\'s empathy level substantially impacts clinical competence, patient relationships, and treatment outcomes. Yet, understanding empathy trends from medical students to resident doctors within a single institution is limited. This study delves into empathy trends within a single-center academic setting and identifies factors associated with low empathy.
METHODS: This cross-sectional study enrolled the second-to sixth-year medical students of Phramongkutklao College of Medicine and the first-to second-year residents at Phramongkutklao Hospital. It utilized a standardized questionnaire covering demographics, family relationships, the Maudsley Personality Inventory (MPI), and the Jefferson Scale of Empathy (JSE). The relationship between variables and JSE scores was analyzed using independent t-test, one-way ANOVA, and Chi-square tests. Multivariable logistic and linear regression analyses examined associated factors and trends across educational levels. A quadratic term was incorporated to evaluate the presence of a nonlinear trend.
RESULTS: A total of 520 participants, comprising 189 (36.4%) preclinical students, 153 (29.4%) clinical students, and 178 (34.2%) residents, completed the survey. The JSE showed a Cronbach\'s alpha of 0.83. The average empathy score was 103.8 ± 15.0, with 27.1% of low empathy levels. Specialty preference and sex-adjusted average empathy scores decreased from 114.5 (95%CI: 112.0-117.0) among second-year medical students to 95.2 (95%CI: 92.2-98.2) among second-year residents (Pnon-linear<0.001). The adjusted proportion of low empathy is highest among sixth-year medical students (54.4%, 95%CI: 34.4-73.2%). Factors associated with low empathy included those preferring procedure-oriented specialties (AOR: 4.16, 95%CI: 1.54-11.18) and a higher parental income (AOR: 2.97, 95%CI: 1.09 to 8.10). Subgroup analysis revealed that residents with a GPAX above 3.5 and those in technology-oriented specialties were also associated with lower empathy (AOR: 3.46, 95%CI: 1.40-8.59 and AOR: 2.93, 95%CI: 1.05-8.12, respectively).
CONCLUSIONS: A declining empathy trend was observed among medical students, which then plateaued among residents. Additionally, residents in technology-oriented specialties may require empathy enhancements due to their ongoing patient consultations. Addressing these issues requires collaborative planning between students and teachers to foster empathy throughout the medical curriculum.

There is a lack of research regarding dietary supplement (DS) use among Gay, Bisexual, Transgender, Two-Spirit, Queer (GBT2Q) men and non-binary individuals, despite the higher prevalence of body image issues and societal pressure within this community. This study aimed to investigate patterns and predictors of DS use in this population, including types of DS used, sources of information, and reasons for DS use. A validated and anonymous online questionnaire was completed by 204 participants (52.5% men, 43.1% gay, mean age 29.34 + 6.77 years) across Canada, who were consuming DS at the time of the study. Analyses included descriptive statistics to characterize the sample based on gender, sexuality, age, ethnicity, and other demographic attributes, using Pearson\'s chi-square tests and multi-way cross-tabulation analyses. Additionally, regression analyses, including binary and logistic regressions, were employed to identify predictors of DS use. Data analysis concluded that vitamins/minerals (92.2%), proteins (84.3%) and carbohydrates (75.5%) were the most consumed types of supplements. Identifying as certain genders and sexualities was significantly associated with supplement preferences, such that men reported higher use of amino acids (p = 0.033) and non-vitamins/mineral antioxidants compared to individuals identifying as other genders (p = 0.006). Moreover, bisexual participants consumed amino acids (p = 0.043) and carbohydrates (p = 0.026) more frequently when compared to non-bisexual participants. The most listed reason for DS use was to improve immunity (60.3%), with health care professionals being listed as the source of information by most participants (51.0%). Findings from this study can serve as a foundation for further research in this area and can guide the formulation and implementation of adequate policies targeting this underserved population.

OBJECTIVE: To discuss the increasing visibility of non-binary individuals and inclusive policies and practices in Assisted Reproductive Technologies (ART).
METHODS: Comparison between traditional ART approach designed for binary genders and propose approach in non-binary individuals.
RESULTS: Traditional ART services, designed for binary genders, must adapt to address the unique fertility needs of non-binary patients. This includes using gender-neutral language, providing comprehensive fertility assessments, and offering hormone therapy and fertility preservation options. Children of non-binary parents benefit from open communication about gender diversity, enhancing psychological well-being. Positive societal attitudes and inclusive environments in schools are crucial for preventing discrimination and promoting mental health. A systemic approach is required to make ART inclusive. This involves training staff, adjusting facilities, updating documentation, and advocating for supportive legislation. Addressing the reproductive needs of non-binary individuals ensures equitable access to care and supports their family-building goals.
CONCLUSIONS: Ensuring the well-being of children in non-binary families requires psychological support, inclusive healthcare, legal recognition, social support, and comprehensive education.

There is a lack of research on gender diverse people\'s experiences with endometriosis. We explored the experience of 11 transgender and non-binary people with endometriosis using phenomenology. We collected data through multiple interviews and diaries and constructed two themes using hermeneutic analysis: (1) Unhomelikeness of Living with Endometriosis and being Gender Diverse, and (2) Towards a Homelikeness of Living with Endometriosis as a Gender Diverse Individual, which we discussed in relation to Svenaeus Phenomenology of Medicine. Unhomelikeness is an experience of disconnection with our bodies and being-in-the-world as a result of living with a chronic disease. We show how gender diverse people with endometriosis may have additional layers of unhomelikeness due to further diagnostic delays, endometriosis symptoms that may trigger gender dysphoria and experiences with treatment that are not inclusive of their gender identity. We advocate for additional support and awareness for gender diverse people with endometriosis.

This exploratory qualitative study aimed to find out more about how the children\'s social work system interacts with non-binary parents. It highlights the specific detriment that can be faced by non-binary people hoping to adopt or foster in the United Kingdom. Three key themes emerged: (1) Barriers for non-binary carers, (2) Prejudice in adoption and fostering matching processes and (3) Intersectional disadvantage. The study found that non-binary people experience specific detriment when endeavouring to start or grow their families, examining how cisgenderism operates to privilege some identities over others. Multiple barriers affect the way non-binary people try and navigate how their family lives in a society that is organised around binary gender identities. Cisgenderism can subtly and pervasively exert a devaluing of identities that sit outside of entrenched binary gender norms, influencing how people can understand and express their gender identities within society.

This study aimed to understand the experiences that trans, masculine presenting, non-binary and gender diverse (TMNG) people who menstruate have with period product packaging and marketing, and identified opportunities for improvement through an inclusive communication design framework. Semi-structured online interviews were conducted with nine TMNG consumers, allies and advocates. These revealed positive and negative experiences with the current design of period product packaging and marketing throughout the entire \'user journey\', including purchasing, use and disposal. A thematic analysis of the interviews confirmed that problems exist with the lack of representation through imagery and language on period product packaging and marketing. The resulting three themes were engaged with to develop an inclusive communication design framework that included: the need for an improvement in the physical experience of periods; the need for improved mental health and emotional relationship to periods; and the need for the consideration of broader social issues such as sustainability and accessibility in relation to period product packaging and marketing.

Gender-affirming hormone therapy (GAHT) plays a significant role in the medical care of transgender individuals, helping to align their physical characteristics with their gender identity. While numerous studies have investigated the impact of GAHT on adults, research focusing on its effects on the quality of life (QoL) of transgender youth is limited. In this opinion paper, we aim to address selected challenges associated with gender-affirming medical care, such as (1) the necessity for evidence-based youth gender-affirming medical care, (2) the urge to explore different approaches to gender-affirming medical care diversely in transgender youth research, and (3) understanding the challenges of the detransition process (which refers to stopping or reversing gender-affirming medical or surgical treatments), as well as suggest possible solutions for meaningful progress. Notably, the available evidence underlines a positive impact of GAHT on various aspects of QoL of transgender youth, such as mental health and social functioning, by alleviating gender dysphoria, improving body satisfaction, and facilitating appearance congruence (the degree to which an individual\'s physical appearance represents their gender identity). However, challenges related to methodological limitations, as well as ethical considerations, and several sociocultural factors highlight the need for further research to better understand the long-term effects of GAHT on the QoL of transgender youth. Ethical considerations, such as ensuring informed consent and weighing potential benefits against risks, are pivotal in guiding healthcare decisions. Additionally, navigating these ethical responsibilities amid sociocultural contexts is crucial for providing inclusive and respectful care to transgender youth. Addressing these research gaps is, therefore, crucial to developing successful healthcare programmes, raising awareness, and promoting the holistic well-being of transgender youth through comprehensive and affirming care.