Background: Transgender health care is a subject of much debate among clinicians, political comme... more Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH's worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.
Objective: This study is a longitudinal evaluation of the effectiveness of gender-affirming hormo... more Objective: This study is a longitudinal evaluation of the effectiveness of gender-affirming hormones for improving psychological well-being and decreasing suicidality among transgender youth referred to a transgender health specialty clinic at a large Midwest children’s hospital. Method: Forty-seven youth (13.73 to 19.04 years; M = 16.59, SD = 1.19) who received gender-affirming hormones were assessed at least 2 times: before the start of treatment and at least 3 months after treatment. Results: After gender-affirming hormones, a significant increase in levels of general well-being and a significant decrease in levels of suicidality were observed. Conclusion: These findings suggest that gender-affirming hormones are a valuable medical intervention with promising psychosocial outcomes for transgender youth.
Clinicians have seen a continually increasing rise in the number of children and adolescents pres... more Clinicians have seen a continually increasing rise in the number of children and adolescents presenting with gender dysphoria. Many are requesting gender-affirming medical interventions before they possess the legal authority to give consent. Since only legal caregivers can provide informed permission for transgender-specific medical treatment for minors, therapists who see these youths need an approach mindful of the distress inherent to the lived experience of transgender minors and respectful of the fear and hesitation most guardians of trans youth experience. Due to the partial or fully irreversible nature of medical treatment for transgender minors, parents tend to be cautious about what they may view as extreme treatments. Sometimes well-meaning parents functionally “filibuster” their adolescent’s transition which can cause a harmful delay in necessary treatment. Utilizing a Bowen family systems framework, this article employs a case study to demonstrate creative strategies clinicians can apply to help families through the transition process. Although, transgender minors may bring the family to initial therapeutic encounter, they are not “holding” family dysfunction. Their distress is due to their dysphoria which is outside their control. At the same time, the family system may experience increased levels of stress resulting from an inability to support a transgender child within a cisnormative world. Successful work with these families will create a new homeostasis. Therapists must earn the trust of both the youth and parents.
Research on transgender and gender diverse individuals has often focused on hardships and experie... more Research on transgender and gender diverse individuals has often focused on hardships and experiences of distress or discrimination. While these studies advance the literature, much less research has focused on positive experiences. In this retrospective study, a phenomenological approach is used to identify and better understand sources of extra-familial support for transgender adolescents. Fifteen participants who self-identified as transgender were interviewed about the sources of extra-familial support they experienced during their adolescence and how these sources were discovered, developed, and accessed. Participants’ ages ranged from 18 to 24 (M = 21). Findings indicate various settings and resources wherein transgender youth have been accepted and received extra-familial support (e.g., extra-curricular activities, teachers, friends, online communities). Clinicians can benefit from understanding where and how transgender adolescents find, and experience, their sources of support.
The purpose of this grounded theory study was to investigate transgender People of Color’s (TPOC’... more The purpose of this grounded theory study was to investigate transgender People of Color’s (TPOC’s) sexual objectification experiences (SOEs). Fifteen TPOC were interviewed about their experiences with sexual objectification. Utilizing intersectionality and objectification theories as our research paradigms, results suggested that participants’ SOEs were shaped by the intersections of cissexism, sexism, and racism, and that participants experienced various levels of privilege and oppression based on their specific identities. Results revealed similarities with previous sexual objectification research as well as unique sexual objectification experiences for TPOC, including racialized sexual objectification, fetishization, genital- and gender transition-based comments, and body policing. Results also suggested that self-objectification may manifest as a desire to affirm one’s gender identity and result in physical safety anxiety. TPOC may engage in body surveillance in order to achieve transgender congruence and reduce potential victimization experiences. Mental health practitioners are encouraged to attend to how intersections of cissexism, sexism, and racism may encourage SOEs, and the ways in which such experiences may impact TPOC.
In the United States, prohibitionist policies are used as the primary approach to combat the nega... more In the United States, prohibitionist policies are used as the primary approach to combat the negative impact of substance use on society. An extensive academic literature spanning the disciplines of economics, political science, and multiculturalism documents the great social costs of the US’s “War on Drugs” both nationally and internationally. These costs come with at best marginal impact on substance abuse and other crimes linked to the drug trade. In many cases, there is reason to believe that these policies exacerbate the problems they aim to address. This paper explores psychologists’ ethical commitments to social change concerning such drug policy, given the field of psychology’s expanding commitment to social justice. We examine arguments regarding the boundaries between psychologists’ personal and professional ethics with regard to political participation. Using drug prohibition as an exemplar, we suggest that many psychologists’ political actions and professional ethics may be misaligned. Ultimately, we conclude that the endorsement of prohibitionist drug policies is in direct conflict with the guiding ethical principles put forth by the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct.
The purpose of this article was to develop and evaluate evidence for reliability and validity of ... more The purpose of this article was to develop and evaluate evidence for reliability and validity of a multifactor measure of evasive attitudes of sexual orientation across two studies. The Evasive Attitudes of Sexual Orientation Scale (EASOS) was inspired by Neville, Lilly, Duran, Lee, and Browne’s Colorblind Racial Attitudes Scale (2000) and existing literature on contemporary homonegativism. In Study 1, data from 221 heterosexual participants were included in an exploratory factor analysis (EFA) and resulted in a three-factor solution: Institutional Heterosexism, Aversive Heterosexism, and Heterosexual Privilege, with one global factor of Evasive Attitudes of Sexual Orientation. Correlational analyses with the present sample revealed evidence of convergent validity and a lack of response bias. A second sample of 270 heterosexual participants was collected for Study 2. EFA results from Study 2 confirmed the factor structure found in Study 1. Hierarchical regression was used to assess incremental validity of scores in the newly developed measure. Results indicated the EASOS explained participants’ degree of LGBT allyship better than measures of homonegativity and modern heterosexism can alone. The present findings offer initial evidence for the use of the EASOS and may be valuable for future research on contemporary homonegativism.
Background: Transgender health care is a subject of much debate among clinicians, political comme... more Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH's worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.
Objective: This study is a longitudinal evaluation of the effectiveness of gender-affirming hormo... more Objective: This study is a longitudinal evaluation of the effectiveness of gender-affirming hormones for improving psychological well-being and decreasing suicidality among transgender youth referred to a transgender health specialty clinic at a large Midwest children’s hospital. Method: Forty-seven youth (13.73 to 19.04 years; M = 16.59, SD = 1.19) who received gender-affirming hormones were assessed at least 2 times: before the start of treatment and at least 3 months after treatment. Results: After gender-affirming hormones, a significant increase in levels of general well-being and a significant decrease in levels of suicidality were observed. Conclusion: These findings suggest that gender-affirming hormones are a valuable medical intervention with promising psychosocial outcomes for transgender youth.
Clinicians have seen a continually increasing rise in the number of children and adolescents pres... more Clinicians have seen a continually increasing rise in the number of children and adolescents presenting with gender dysphoria. Many are requesting gender-affirming medical interventions before they possess the legal authority to give consent. Since only legal caregivers can provide informed permission for transgender-specific medical treatment for minors, therapists who see these youths need an approach mindful of the distress inherent to the lived experience of transgender minors and respectful of the fear and hesitation most guardians of trans youth experience. Due to the partial or fully irreversible nature of medical treatment for transgender minors, parents tend to be cautious about what they may view as extreme treatments. Sometimes well-meaning parents functionally “filibuster” their adolescent’s transition which can cause a harmful delay in necessary treatment. Utilizing a Bowen family systems framework, this article employs a case study to demonstrate creative strategies clinicians can apply to help families through the transition process. Although, transgender minors may bring the family to initial therapeutic encounter, they are not “holding” family dysfunction. Their distress is due to their dysphoria which is outside their control. At the same time, the family system may experience increased levels of stress resulting from an inability to support a transgender child within a cisnormative world. Successful work with these families will create a new homeostasis. Therapists must earn the trust of both the youth and parents.
Research on transgender and gender diverse individuals has often focused on hardships and experie... more Research on transgender and gender diverse individuals has often focused on hardships and experiences of distress or discrimination. While these studies advance the literature, much less research has focused on positive experiences. In this retrospective study, a phenomenological approach is used to identify and better understand sources of extra-familial support for transgender adolescents. Fifteen participants who self-identified as transgender were interviewed about the sources of extra-familial support they experienced during their adolescence and how these sources were discovered, developed, and accessed. Participants’ ages ranged from 18 to 24 (M = 21). Findings indicate various settings and resources wherein transgender youth have been accepted and received extra-familial support (e.g., extra-curricular activities, teachers, friends, online communities). Clinicians can benefit from understanding where and how transgender adolescents find, and experience, their sources of support.
The purpose of this grounded theory study was to investigate transgender People of Color’s (TPOC’... more The purpose of this grounded theory study was to investigate transgender People of Color’s (TPOC’s) sexual objectification experiences (SOEs). Fifteen TPOC were interviewed about their experiences with sexual objectification. Utilizing intersectionality and objectification theories as our research paradigms, results suggested that participants’ SOEs were shaped by the intersections of cissexism, sexism, and racism, and that participants experienced various levels of privilege and oppression based on their specific identities. Results revealed similarities with previous sexual objectification research as well as unique sexual objectification experiences for TPOC, including racialized sexual objectification, fetishization, genital- and gender transition-based comments, and body policing. Results also suggested that self-objectification may manifest as a desire to affirm one’s gender identity and result in physical safety anxiety. TPOC may engage in body surveillance in order to achieve transgender congruence and reduce potential victimization experiences. Mental health practitioners are encouraged to attend to how intersections of cissexism, sexism, and racism may encourage SOEs, and the ways in which such experiences may impact TPOC.
In the United States, prohibitionist policies are used as the primary approach to combat the nega... more In the United States, prohibitionist policies are used as the primary approach to combat the negative impact of substance use on society. An extensive academic literature spanning the disciplines of economics, political science, and multiculturalism documents the great social costs of the US’s “War on Drugs” both nationally and internationally. These costs come with at best marginal impact on substance abuse and other crimes linked to the drug trade. In many cases, there is reason to believe that these policies exacerbate the problems they aim to address. This paper explores psychologists’ ethical commitments to social change concerning such drug policy, given the field of psychology’s expanding commitment to social justice. We examine arguments regarding the boundaries between psychologists’ personal and professional ethics with regard to political participation. Using drug prohibition as an exemplar, we suggest that many psychologists’ political actions and professional ethics may be misaligned. Ultimately, we conclude that the endorsement of prohibitionist drug policies is in direct conflict with the guiding ethical principles put forth by the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct.
The purpose of this article was to develop and evaluate evidence for reliability and validity of ... more The purpose of this article was to develop and evaluate evidence for reliability and validity of a multifactor measure of evasive attitudes of sexual orientation across two studies. The Evasive Attitudes of Sexual Orientation Scale (EASOS) was inspired by Neville, Lilly, Duran, Lee, and Browne’s Colorblind Racial Attitudes Scale (2000) and existing literature on contemporary homonegativism. In Study 1, data from 221 heterosexual participants were included in an exploratory factor analysis (EFA) and resulted in a three-factor solution: Institutional Heterosexism, Aversive Heterosexism, and Heterosexual Privilege, with one global factor of Evasive Attitudes of Sexual Orientation. Correlational analyses with the present sample revealed evidence of convergent validity and a lack of response bias. A second sample of 270 heterosexual participants was collected for Study 2. EFA results from Study 2 confirmed the factor structure found in Study 1. Hierarchical regression was used to assess incremental validity of scores in the newly developed measure. Results indicated the EASOS explained participants’ degree of LGBT allyship better than measures of homonegativity and modern heterosexism can alone. The present findings offer initial evidence for the use of the EASOS and may be valuable for future research on contemporary homonegativism.
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Papers by Luke R Allen