TRANScending the Bounds of Reproductive Psychiatry

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Salon West

CE: 1.5 CME

Lead Speaker(s)

Fíona Fonseca, MBBChBAO, MS (they/them/theirs)

Consultation-Liaison Psychiatry Fellow
Mayo Clinic
Rochester, Minnesota

Speaker(s)

Nona A. Nichols, MD (she/her/hers)

Consultation-Liaison Psychiatry
Cleveland Clinic
Lakewood, OH
Isabella Kratzer, MD

Resident Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Morgan Faeder, MD, PhD

Assistant Professor of Psychiatry and Neurology
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania

Abstract: Even within consultation-liaison (CL) psychiatry, reproductive psychiatry is considered a subspecialty of women’s mental health. Similarly, in discussions about transgender mental health, discourse is often restricted to dysphoria, trauma, and the role of the psychiatrist as gatekeeper for gender affirming interventions. There is a notable gap in the literature on the CL psychiatrist’s role in addressing the reproductive needs of transgender patients in a way that is affirming.

Our presentation will address reproductive health issues for transgender individuals including the impact of hormonal and surgical interventions on reproductive and mental health. We will share insights into what counseling transgender patients through the process of decision-making about preservation of fertility might look like. We will discuss ways for the CL psychiatrist to support transgender individuals navigating pregnancy. We will also demonstrate the role CL psychiatrists can play in supporting the wellbeing of transgender patients by counseling about preventative screening for reproductive health.

As we discuss ways to expand the definition of both reproductive psychiatry and lesbian, gay, bisexual, and transgender (LGBT) mental health, we will share examples of programs at institutions that have access to LGBT mental health and transgender health clinics in addition to “women’s mental health” clinics. Following this, we will discuss ways to integrate concepts from such programs at your institution, challenge barriers faced by your transgender patients, and help advocate for them.

Our presentation will provide an immersive learning experience through an interactive case study of a non-binary patient treated with brexanolone for postpartum depression. Through the use of polls and multiple-choice questions, we will create an engaging learning environment. This presentation is an inter-institutional collaborative effort by psychiatrists across the continuum of resident-fellow-attending, including colleague representation from both the binary and non-binary transgender communities. Through our presentation, and in an era where there is a newfound focus on diversity, equity, and inclusion, we challenge CL psychiatry to address the reproductive needs of not just women but all individuals.

References:

Agénor, M., Murchison, G. R., Najarro, J., Grimshaw, A., Cottrill, A. A., Janiak, E., ... & Charlton, B. M. (2021). Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review. Sexual and Reproductive Health Matters, 29(1), 1886395.

Payne, J. L. (2019). Reproductive psychiatry: giving birth to a new subspecialty. International Review of Psychiatry, 31(3), 207-209.

Rodriguez-Wallberg, K., Obedin-Maliver, J., Taylor, B., Van Mello, N., Tilleman, K., & Nahata, L. (2022). Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines. International Journal of Transgender Health, 1-19.
Learning Objectives:
Participants will be able to describe the gap in psychiatric knowledge as regards supporting transgender individuals beyond issues of dysphoria, trauma, and gatekeeping for gender affirming interventions
Participants will inspect current data within reproductive and transgender psychiatry, including as these areas overlap Participants will integrate knowledge learned in this presentation into a broader understanding of reproductive psychiatry
Participants will formulate ways to approach reproductive health for transgender patients at both the individual as well as institutional level