Emory University, School of Medicine, Atlanta, GA, USA.
Emory University, Rollins School of Public Health, Atlanta GA, USA.
J Sex Med. 2020 Oct;17(10):2084-2092. doi: 10.1016/j.jsxm.2020.07.019. Epub 2020 Aug 15.
Visual conformity with affirmed gender (VCAG) or "passing" is thought to be an important, but poorly understood, determinant of well-being in transgender people. VCAG is a subjective measure that is different from having an inner sense of being congruent with one's gender identity.
We examined the frequency and determinants of VCAG and explored its association with mental health outcomes in a cohort of transgender adults.
The "Study of Transition, Outcomes & Gender (STRONG)" is a cohort of transgender individuals recruited from 3 Kaiser Permanente health plans located in Georgia, Northern California and Southern California. A subset of cohort members completed a survey between 2015 and 2017. VCAG was assessed as the difference between 2 scales: scale 1 reflecting the person's sense of how they are perceived by others, and scale 2 reflecting the person's desire to be perceived. Participants were considered to have achieved VCAG when their scale 1 scores were equal to or exceeded their scale 2 scores. The frequency of VCAG and their independent associations with anxiety and depression symptoms were explored using data from 620 survey respondents including 309 transwomen and 311 transmen. Based on self-described gender identity, none of the participants identified as nonbinary or gender fluid.
VCAG, depression, and anxiety.
VCAG was achieved in 28% of transwomen and 62% of transmen and was more common in persons who reported greater sense of acceptance and pride in their gender identity as measured on the Transgender Congruence Scale. Another factor associated with greater likelihood of VCAG was receipt of gender-affirming surgery, but the association was only evident among transmen. Participants who achieved VCAG had a lower likelihood of depression and anxiety with prevalence ratios (95% confidence intervals) of 0.79 (0.65, 0.96) and 0.67 (0.46, 0.98), respectively.
VCAG may serve as an important outcome measure after gender-affirming therapy.
Strengths of this study include a well-defined sampling frame and use of a novel patient-centered outcome of interest. Cross-sectional design and uncertain generalizability of results are the limitations.
These results, once confirmed by prospective studies, may help better characterize the determinants of well-being in the transgender community, facilitating the design of interventions to improve the well-being and quality of life of this vulnerable population. To M, Zhang Q, Bradlyn A, et al. Visual Conformity With Affirmed Gender or "Passing": Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People. J Sex Med 2020;17:2084-2092.
视觉上与被认可的性别相符（VCAG）或“变装”被认为是跨性别者幸福感的一个重要但理解甚少的决定因素。VCAG 是一种主观的衡量标准，与内在的性别认同感不同。
我们检查了跨性别成年人队列中 VCAG 的频率和决定因素，并探讨了它与心理健康结果的关系。
“性别过渡、结果和研究（STRONG）”是一个跨性别者队列，招募自佐治亚州、北加利福尼亚州和南加利福尼亚州的 3 个凯撒永久医疗计划。队列的一部分成员在 2015 年至 2017 年期间完成了一项调查。VCAG 通过两个量表的差异来评估：量表 1 反映了一个人对自己被他人感知的感觉，量表 2 反映了一个人希望被他人感知的感觉。当参与者的量表 1 得分等于或超过量表 2 得分时，他们被认为达到了 VCAG。使用包括 309 名跨女和 311 名跨男在内的 620 名调查受访者的数据，探讨了 VCAG 的频率及其与焦虑和抑郁症状的独立关联。基于自我描述的性别认同，没有参与者被认定为非二元性别或性别流动。
VCAG 在 28%的跨女和 62%的跨男中实现，在自我报告的性别认同接受感和自豪感更强的人中更为常见，这在跨性别认同量表上有所体现。另一个与 VCAG 更有可能相关的因素是接受性别肯定手术，但这种关联仅在跨男中存在。实现 VCAG 的参与者患抑郁和焦虑的可能性较低，患病比值（95%置信区间）分别为 0.79（0.65，0.96）和 0.67（0.46，0.98）。
VCAG 可能是性别肯定治疗后的一个重要结果衡量标准。
本研究的优势包括明确的抽样框架和使用新颖的以患者为中心的研究兴趣结果。局限性是横断面设计和结果不确定的通用性。
这些结果，如果能通过前瞻性研究得到证实，可能有助于更好地描述跨性别群体幸福感的决定因素，从而促进设计干预措施来改善这一弱势群体的幸福感和生活质量。
