This study of LGBTQ+ college students highlights and amplifies the experiences of their healthy intimate relationships. College represents a pivotal time for personal and relationship development for many students, and seeing the positive ways students with historically minoritized gender and sexual identities navigate relationships has value for understanding how sexuality manifests within the current culture. Using a critical constructivist perspective and photo elicitation methods, the study includes students\' narratives and visual presentations of their lived experiences thriving in healthy intimate relationships. The findings included three specific areas that supported students\' thriving: self-work and self-awareness, fluidity and flexibility, and communication. These findings, and students\' relationship images highlight the ways that they thrive through continual affirmative consent and responsibility to themselves and their relationships. Together, these findings provide possibility models to support imagining and educating about LGBTQ+ students\' healthy intimate relationships. Findings have potential for informing trainings and resources for LGBTQ+ students, enhancing relationship education by challenging oppressive norms that influence all students, and for questioning the ways university regulations inhibit participants\' agency for celebrating their intimacy.

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: There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia.
METHODS: Using data from a national survey of Australian trans young people (N = 859, Mage = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach.
RESULTS: Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one\'s life, and harm reduction.
CONCLUSIONS: While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care.

BACKGROUND: Gender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people).
OBJECTIVE: This study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems.
METHODS: Using hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes, and the general healthcare system) were investigated.
CONCLUSIONS: The cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality.
CONCLUSIONS: The study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations.

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.

UNASSIGNED: The present study explores how coming out to parents - in terms of both status (being out vs. not) and, if out, experience (continuum from rejection to acceptance) - affects trans people\'s mental health.
UNASSIGNED: Participants were 509 young adult trans individuals from Germany (community-based sample; 50% gender binary, 50% nonbinary; 16-35 years). The cross-sectional online study used standardized measures of coming out response, social support, and mental health.
UNASSIGNED: More participants were out to their mother than their father, but mothers did not respond with more acceptance. At the bivariate level, coming out experience, but not coming out status, was positively related to mental health. At the multivariate level, parental support mediated the association between both coming out variables and mental health. That is, trans people who were out to their parents and, if out, had a positive coming out experience received more parental support, which, in turn, was conducive to their mental health. There were no substantial differences between maternal and paternal effects, and effect sizes were equal for coming out status and experience.
UNASSIGNED: This study confirmed the crucial role that parents play when it comes to their child\'s coming out as trans - by accepting their child\'s gender identity early on and providing them with support.

BACKGROUND: PIK3CA mutations are implicated in various cancers, but the implications of multiple concurrent mutations and their orientations within the gene have not been fully explored.
METHODS: In this study, we analyzed multi-PIK3CA mutations across a diverse pan-cancer cohort comprising 3564 tumors.
RESULTS: Multi-PIK3CA mutations were present in 10.3% of all PIK3CA-mutant tumors, predominantly occurring in breast and gynecological cancers. Notably, mutations within the helical domain (E542:E545) exclusively occurred in the trans-orientation, contrasting with mutations in the kinase ABD and C2 domains, which mainly appeared in the cis orientation.
CONCLUSIONS: The distinct pattern of mutation orientations in PIK3CA suggests variable oncogenic potential, with helical domain mutations in the trans-orientation potentially being less oncogenic. These findings highlight the importance of mutation orientation in the PIK3CA gene as potential biomarkers for targeted therapy. This understanding is crucial for designing clinical trials that leverage PI3K inhibitors, aiming for more effective and precise cancer treatment.

BACKGROUND: Understanding how HIV self-testing (HIVST) can meet the testing needs of gay, bisexual and other men who have sex with men (GBMSM) and trans people whose social networks vary is key to upscaling HIVST implementation. We aim to develop a contextual understanding of social networks and HIV testing needs among GBMSM (cis and transgender) and trans women in SELPHI (An HIV Self-testing Public Health Intervention), the UK\'s largest randomised trial on HIVST.
METHODS: This study re-analysed qualitative interviews conducted from 2015 to 2020. Forty-three in-person interviews were thematically analysed using the Framework Method. Our analytic matrix inductively categorised participants based on the unmet needs for HIV testing and the extent of social network support. The role of social networks on HIVST behaviour was explored based on individuals\' testing trajectories.
RESULTS: Four distinct groups were identified based on their unmet testing needs and perceived support from social networks. Optimisation advocates (people with high unmet needs and with high network support, n = 17) strived to tackle their remaining barriers to HIV testing through timely support and empowerment from social networks. Privacy seekers (people with high unmet needs and with low network support, n = 6) prioritised privacy because of perceived stigma. Opportunistic adopters (people with low unmet needs and with high network support, n = 16) appreciated social network support and acknowledged socially privileged lives. Resilient testers (people with low unmet needs and with low network support, n = 4) might hold potentially disproportionate confidence in managing HIV risks without sustainable coping strategies for potential seroconversion. Supportive social networks can facilitate users\' uptake of HIVST by: (1) increasing awareness and positive attitudes towards HIVST, (2) facilitating users\' initiation into HIVST with timely support and (3) affording participants an inclusive space to share and discuss testing strategies.
CONCLUSIONS: Our proposed categorisation may facilitate the development of differentiated person-centred HIVST programmes. HIVST implementers should carefully consider individuals\' unmet testing needs and perceived levels of social support, and design context-specific HIVST strategies that link people lacking supportive social networks to comprehensive HIV care.

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.

Trans people are at significantly elevated risk of suicide death, suicide attempts, and suicidal ideation than their cisgender peers. Suicide prevention efforts are needed that address the most important issues to the trans community. In this qualitative study conducted in the United States in 2021, we aimed to broadly explore trans community member perspectives on suicidality and suicide prevention needs. We conducted four virtual focus groups-including one exclusively for trans people of color. We also solicited additional online responses to the same focus group questions. A total of 56 trans individuals with a history of suicidality participated. We utilized reflexive thematic analysis to develop themes to inform suicide prevention efforts for the trans community. The themes were multicontextual, representing needs across healthcare, legal and political arenas, workplaces, community groups, and interpersonal relationships. The central organizing theme identified as crucial for suicide prevention was \'Having (Real) Rights and Respect.\' Supporting themes were \'Being in Control of Our Own Bodies,\' \'Being Safe as Ourselves,\' and \'Feeling Support and Acceptance,\' which also included a subtheme of \'Embracing Diversity within the Trans Community.\' We provide suggestions and directions for suicide prevention, which build on these themes.