LAUSR

Transgender is a term that “encompasses individuals whose gender identity differs from the sex originally assigned to them at birth [and/] or whose gender expression varies significantly fromwhat is traditionally associated with or typical for that sex... as well as other individuals who vary from or reject traditional cultural conceptualizations of gender in terms of the male–female dichotomy [1].” For example, individuals may identify strongly with another gender or with a variance that falls outside of traditional gender constructs, such as identifying with both genders or identifying with neither gender. As background terminology, cisgender refers to a person whose gender identity corresponds with their birth sex. An individual’s gender identity (internal sense of self) and gender expression (outward expression of gender) may be fluid and evolving over time [2]. Healthcare providers, including psychiatrists and psychiatry residents, are increasingly providing assessment and treatment of transgender individuals given the changing demographics in the USA. Of note, the 2016 percentage of adults who identified as transgender in the USA was double the estimate from 2011 [3]. Explanations for this increase include an increase in visibility, more sophisticated data collection over time, and social acceptance of transgender people that may relate to comfort in identifying as transgender on a survey [3]. Reports from 2016 cited that an estimated 1.4 million adults in the USA identified as transgender, based on data from the CDC’s Behavioral Risk Factor Surveillance System [3]. States varied in their demographics, with high percentages of adult residents identifying as transgender in the District of Columbia (2.8% of its population, or 14,550 individuals) and Hawaii (0.8% of its population, or 8450 individuals). Massachusetts was noted at that time to have 29,900 individuals, 0.57% of its population, who identified as transgender. Overall, the age group of 18to 24-year-olds was noted to have a higher percentage (0.66%) of its population identifying as transgender (205,850 individuals) than older age groups. However, given the larger population size of age 25–64, the 0.58% percentage of individuals identifying as transgender in that population represented 967,100 individuals in the USA. Both the variation in transgender presentation and the growing size of this population highlight the need for healthcare professionals to approach gender identity with fewer assumptions and an open perspective regarding patient needs [4]. However, in both the general population and in medical healthcare, stigma continues to exist against transgender individuals. In the general USA population, a 2013 sample of over 2000 heterosexual adults noted significantly less favorable self-reported attitudes towards transgender people than attitudes towards gay men, lesbians, and bisexuals [4]. Although public awareness of transgender individuals may be increasing due to popular culture transgender individuals and political discussions, the ability of transgender individuals to integrate in society at large, such as navigating bathroom laws or serving in the US military, remains a topic fraught with contemporary controversy [2].