We know that access to trans healthcare not only differs within European countries but also between European countries. These differences can lead to some people experiencing more barriers to care than other which is an inequitable approach to care provision. In this paper, we aimed to describe the access to trans specific healthcare across Europe (Including the UK) and to find out which countries operate in a similar manner to each other. In doing this, we hoped to understand what types of care might exist and how they might correspond to important care related factors such as waiting times and the sociopolitical climate.
In this research, we identified 4 clusters of countries. We labelled the first cluster as centralized conservative (E.g., The U.K) and the second as centralized reformist (E.g. Sweden). Both groups of countries mainly deliver care through one central institution and have high treatment supply. However, they differ because countries in cluster one have more stringent regulations to access care such as requiring a diagnosis, and have less policy in place to protect trans rights compared to countries in cluster two. Cluster three is labelled as decentralised marketized (E.g. Austria). In these countries, care is mostly offered by independent and more specialised clinics. However, the care is not well regulated and the standard of care often depends on the demand for treatments and competition between different providers. The fourth cluster of countries was labelled as underdeveloped (E.g., Poland) as in these countries there were low levels of treatment supply and little to no policy in place to protect trans rights in these countries. Waiting times for care were significantly different between groups of countries, with group 1 having longer waiting times than the rest. On the other hand, public support for trans people was lowest in cluster four, echoed by the finding that people felt they had to conceal their gender identity the most in underdeveloped (cluster four) countries.
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Summary: We propose a psychologically-informed concept of social health to join physical and mental components in a more comprehensive assessment of human health. Although there is an extensive literature on the importance of social relationships to health, a theoretical framework is needed to coalesce this work into a codified conceptualisation of social health, defined here as adequate quantity and quality of relationships in a particular context to meet an individual’s need for meaningful human connection. Informing this novel conceptualisation, we outline eight key propositions to guide future research and theory on social health, including five propositions focused on the conceptualisation of social health and three focused on its population patterning. The former five propositions include that social health is an outcome in its own right, that health interventions can have divergent effects on social versus physical and mental aspects of health, that social health has independent effects on quality of life, that it is a dynamic and contextual construct, and that it is embedded and encoded in the human body (and mind). The utility of the social health concept is further revealed in its significance for understanding and addressing population health concerns, such as health inequalities experienced by marginalised groups.
Summary: This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.
