{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:04:09Z","timestamp":1793714649512,"version":"4.6.1"},"reference-count":39,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Transgender Health"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Gender-affirming hormones (hormones)\u2014the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals\u2014are 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =12) and were not (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/trgh.2022.0024","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T16:08:50Z","timestamp":1667405330000},"page":"34-45","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives"],"prefix":"10.1177","volume":"9","author":[{"given":"Daphna","family":"Stroumsa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA."},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Maksutova","sequence":"additional","affiliation":[{"name":"Medical School, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah A.","family":"Minadeo","sequence":"additional","affiliation":[{"name":"School of Information Sciences, Wayne State University, Detroit, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gnendy","family":"Indig","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Services, University of Vermont, Burlington, Vermont, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Neis","sequence":"additional","affiliation":[{"name":"Department of History, University of Michigan, Ann Arbor, Michigan, USA."},{"name":"Frankel Center for Judaic Studies, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse Y.","family":"Ballard","sequence":"additional","affiliation":[{"name":"Independent Researcher and Community Activist, Detroit, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliot E.","family":"Popoff","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Racquelle","family":"Trammell","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine P.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA."},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA."},{"name":"Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823ed1c1"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-012-9975-x"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-2162"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-01658"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0261039"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/trgh.2015.0008"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-020-01655-5"},{"key":"e_1_3_6_9_2","unstructured":"World Professional Association for Transgender Health. 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