Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Perspective on equitable translational studies and clinical support for an unbiased inclusion of the LGBTQIA2S+community

Abstract

Research regarding the mental health of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, 2 Spirit (LGBTQIA2S+) community has been historically biased by individual and structural homophobia, biphobia, and transphobia, resulting in research that does not represent the best quality science. Furthermore, much of this research does not serve the best interests or priorities of LGBTQIA2S + communities, despite significant mental health disparities and great need for quality mental health research and treatments in these populations. Here, we will highlight how bias has resulted in missed opportunities for advancing understanding of mental health within LGBTQIA2S + communities. We cite up-to-date research on mental health disparities facing the LGBTQIA2S + community and targeted treatment strategies, as well as guidance from health care professionals. Importantly, research is discussed from both preclinical and clinical perspectives, providing common language and research priorities from a translational perspective. Given the rising tide of anti-transgender sentiment among certain political factions, we further emphasize and discuss the impact of historical and present day ciscentrism and structural transphobia in transgender mental health research, from both clinical and translational perspectives, with suggestions for future directions to improve the quality of this field. Finally, we address current best practices for treatment of mental health issues in this community. This approach provides an opportunity to dispel myths regarding the LGBTQIA2S + community as well as inform the scientific community of best practices to work with this community in an equitable manner. Thus, our approach ties preclinical and clinical research within the LGBTQIA2S + community.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Association AP (1994). Diagnostic and statistical manual of mental disorders. 4th Edition.

  2. Association AP (2013). Diagnostic and statistical manual of mental disorders. 5th Edition.

  3. Rodriguez A, Agardh A, Asamoah BO. Self-reported discrimination in health-care settings based on recognizability as transgender: a cross-sectional study among transgender U.S. citizens. Arch Sex Behav. 2018;47:973–85.

    Article  PubMed  Google Scholar 

  4. Shim RS. Dismantling structural racism in psychiatry: a path to mental health equity. Am J Psychiatry. 2021;178:592–8.

    Article  PubMed  Google Scholar 

  5. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123:346–52.

    Article  PubMed  Google Scholar 

  6. Obedin-Maliver J, Goldsmith ES, Stewart L, White W, Tran E, Brenman S, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306:971–7.

    Article  CAS  PubMed  Google Scholar 

  7. Stubbe DE. Interest in identity: improving LGBTQ psychiatric care. Focus (Am Psychiatr Publ). 2020;18:300–3.

    PubMed  Google Scholar 

  8. Papadatou-Pastou M, Ntolka E, Schmitz J, Martin M, Munafo MR, Ocklenburg S, et al. Human handedness: A meta-analysis. Psychol Bull. 2020;146:481–524.

    Article  PubMed  Google Scholar 

  9. Gilbert AN, Wysocki CJ. Hand preference and age in the United States. Neuropsychologia. 1992;30:601–8.

    Article  CAS  PubMed  Google Scholar 

  10. Green AE, DeChants JP, Price MN, Davis CK. Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. J Adolesc Health. 2022;70:643–9.

    Article  PubMed  Google Scholar 

  11. Sequeira GM, Kidd KM, Rankine J, Miller E, Ray KN, Fortenberry JD, et al. Gender-diverse youth’s experiences and satisfaction with telemedicine for gender-affirming care during the COVID-19 pandemic. Transgend Health. 2022;7:127–34.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Park BC, Das RK, Drolet BC. Political issues surrounding gender-affirming care for transgender youth-reply. JAMA Pediatr. 2022;176:323.

    Article  PubMed  Google Scholar 

  13. Becker JB, Prendergast BJ, Liang JW. Female rats are not more variable than male rats: a meta-analysis of neuroscience studies. Biol Sex Differ. 2016;7:34.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Goetz TG, Mamillapalli R, Devlin MJ, Robbins AE, Majidi-Zolbin M, Taylor HS. Cross-sex testosterone therapy in ovariectomized mice: addition of low-dose estrogen preserves bone architecture. Am J Physiol Endocrinol Metab. 2017;313:E540–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23:S1–S259.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Redcay A, Bergquist K, Luquet W. On the basis of gender: a medical-legal review of barriers to healthcare for transgender and gender-expansive patients. Soc Work Public Health. 2021;36:615–27.

    Article  PubMed  Google Scholar 

  17. Aghi K, Goetz TG, Pfau DR, Sun SED, Roepke TA, Guthman EM. Centering the needs of transgender, nonbinary, and gender-diverse populations in neuroendocrine models of gender-affirming hormone therapy. Biol Psychiatry Cogn Neurosci Neuroimaging. 2022;7:1268–79.

    PubMed  Google Scholar 

  18. Hughto JMW, Pachankis JE, Reisner SL. Healthcare mistreatment and avoidance in trans masculine adults: the mediating role of rejection sensitivity. Psychol Sex Orientat Gend Divers. 2018;5:471–81.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014;140:921–48.

    Article  PubMed  Google Scholar 

  20. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Puckett JA, Matsuno E, Dyar C, Mustanski B, Newcomb ME. Mental health and resilience in transgender individuals: What type of support makes a difference? J Fam Psychol. 2019;33:954–64.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bauer GR, Lawson ML, Metzger DL, Trans Youth CANRT. Do clinical data from transgender adolescents support the phenomenon of “rapid onset gender dysphoria”? J Pediatr. 2022;243:224–227.e222.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Drs. E. Kale Edmiston, E. Mae Guthman and William Carlezon for their support and encouragement, as well as the American College of Neuropsychopharmacology for the opportunity to bring together these researchers, providing a platform to discuss such important topics. We also would like to thank funding sources R25MH119043 and R13MH126604.

Author information

Authors and Affiliations

Authors

Contributions

TG: Substantial Contributions to the work design, drafting the work, and final approval. KA: Substantial Contributions to the work design, drafting the work, and final approval. CA: Substantial Contributions to the work design, drafting the work, and final approval. DE: Substantial Contributions to the work design, drafting the work, and final approval. NE: Substantial Contributions to the work design, drafting the work, and final approval. JM: Instigating the work, contributing to its design, drafting, and final approval. JY: Instigating the work, contributing to its design, drafting, and final approval. TR: Instigating the work, contributing to its design, drafting, and final approval.

Corresponding author

Correspondence to Jared W. Young.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goetz, T.G., Aghi, K., Anacker, C. et al. Perspective on equitable translational studies and clinical support for an unbiased inclusion of the LGBTQIA2S+community. Neuropsychopharmacol. 48, 852–856 (2023). https://doi.org/10.1038/s41386-023-01558-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41386-023-01558-8

This article is cited by

Search

Quick links