The Year in Review

The aim of this Year in Review on mental health is to provide a synoptic review of notable recent literature on mental health in transgender care, with a particular focus on studies relevant to healthcare decision-making. A systematic search was conducted in PubMed covering the period from January 2023 to August 2025, using keywords related to mental health in transgender and gender diverse populations. A total of 1,264 articles were screened at the title and abstract level. Selected articles were reviewed in full and categorized into the following themes: Mental health disparities, Mental health outcomes associated with gender-affirming treatments, Outcome measures, Healthcare systems and access to care, Psychological interventions, and Detransition and regret. Seminal articles from each theme will be briefly presented. 

Mental Health in Adolescents with Gender Incongruence 

There is a growing body of evidence about mental health impairments in transgender youth and about the course of mental health problems in adolescents recieving gender affirming care. Cross sectional studies from many countries indicate high rates of depression, suicidal ideation and self harm as well as anxiety disorders and eating disorder symptoms in transgender youths. The majority of the studies show higher rates of mental health impairments in trans adolescents assigned male at birth compared to those assigned female at birth. Recent studies including the examination of non-binary identities show a particularly high rate of psychopathological symptoms in this group. In addition, studies with adolescents seeking gender affirming care as well as samples from autism consultations report a high coincidence rate of autism and gender incongruence. However, there seems to be a subgroup of trans youths that do not show accompanying mental health impairments. Protective factors derived from studies inculde support from family members and peers, and – with limited evidence – social transition and medical gender affiming care. 

Longitudinal studies examining the course of mental health impairments and well-being in trans youths recieving medical gender affirming care suggest that mental health impairments appear to improve over time, but evidence is still scarce. Recent reviews show moderate evidence for the positive effects of treatment with gender affirming hormones on psychopathological impairment in minors. The effects of puberty blocking on mental health aim at stablizing the young person in a difficult time of the decision-making process, although the evidence to date is limited. The ongoing debate about the level of evidence and mixed cloncusions drawn from the available literature emphasize the need for further long-term longitudinal studies of this vulnerable population. 

Background:
Gender affirming surgery is a desirable option for many people with gender incongruence. In recent years, the demand for and number of operations performed has steadily increased, as has the number of publications and techniques developed to provide those seeking treatment with the best possible options. Recently, however, changes in the political mood have led to a decline in social acceptance and treatment options in many places. It can be assumed that this makes it more difficult for patients to access surgical treatment options. 

Aim:
Review and evaluation of the literature in terms of innovation and accessibility for patients. 

Methods:
A literature search was carried out in the Pub Med database. Publication dates were set between February 2023 and June 2025. The main search terms were transgender and surgery. All original papers and reviews as well as case reports were included in the results, whereby only full-text papers in English language were accepted. 

Results:
A total of 1144 hits were obtained using the search function. Of these, 253 were (systematic) reviews, but only 9 were clinical studies. A total of 70 case reports were found.
The abstracts were screened and weighted and categorised according to their relevance to the research question. Irrelevant hits were removed.
The presentation will summarise the results and place them in context, both qualitatively and quantitatively. 

The social and political sciences have perhaps never been more relevant to transgender healthcare as today in the context of growing societal polarization and increasing political interference in medicine across countries. This difficult situation is reflected in the title of a recent special issue of Social Science & Medicine (2024), ‘Unequal care: Trans medicine and health in dangerous times.’ Combining topics derived from this special issue alongside systematic searches of academic databases (Scopus, PsycINFO, Google Scholar) for articles published within the last two years (2023-2025), I identify key themes in research on transgender healthcare within the social and political sciences related to, for example: (gender) minority stress, structural stigma, anti-trans legislation, regional variations, mis/disinformation, community knowledge, biases in (education in) medicine, social support/affirmation, and intersectionality. As evidenced by these themes, healthcare practitioners and medical researchers need to work more closely with social and political scientists in these ‘dangerous times’ in order to better understand the influence of societal attitudes and broader social structures on healthcare access and outcomes for trans and gender diverse people. 

Background :
The capacity to shape and adapt vocal motor behavior according to individual preferences is at the core of transaffirmative voice care, an emerging interdisciplinary field that integrates
medical, psychological, communicative, and sociocultural perspectives. For transgender and gender-diverse individuals, the voice is a pivotal element in both the perception of their gender by others and their own processes of gender affirmation. The facilitation of a congruent and authentic vocal expression through individualized care is therefore essential. Contemporary approaches to vocal motor behaviour allow for its intentional modulation in accordance with personal preferences. Transaffirmative voice care increasingly strives to accommodate the unique identities of individuals, the evolving array of technical tools, and a
situated understanding of the communicative contexts in which voice is embodied and expressed. This presentation seeks to deliver a comprehensive synthesis of the literature on voice and communication within trans and non-binary populations, covering developments from the 2023 EPATH conference through to 2025.
Methods: This review included peer-reviewed journal articles, written in English and published between 2023 and 2025. Studies were eligible if they focused on the voice and communication of trans and non-binary adults. Three databases – Embase
(www.embase.com), Medline (Ovid), and Scopus (www.scopus.com) – were searched on 20 June 2025, using a combination of three key concepts (voice AND communication AND trans or non-binary people). The results were limited to the publication period covered by this
review. Covidence was used to manage the review process (from eliminating duplicates to extracting data from included studies). An expert in literature review methodology oversaw the process to ensure its rigor, while a subject-matter expert reviewed exclusions for accuracy. The included studies were grouped thematically. Data were presented in a narrative synthesis accompanied by graphic visualizations and tables.
Results: A total of 352 references were found in the three databases and 167 duplicates were removed. Of the 185 references screened based on title and abstract, 59 were excluded. Assessment of the 126 full texts based on eligibility criteria led to the inclusion of 103 journal articles (23 were excluded for the following reasons: non-English language (n = 8), non-peer reviewed journal articles (n = 14), and non-target populations (n = 1)). Eleven thematic areas were identified: autism, voice training, laryngeal surgery, assessment, epistemological reflection, professional training, technologies, general information, database, tobacco, and geographical reality. Nine of these themes included at least two studies and were therefore included in the synthesis, while themes represented by a single study were not synthesized. Recent developments in trans-affirmative vocal care (2023–2025) indicate a significant transformation in the field. Contemporary approaches increasingly prioritize care that is personalized to clients’ vocal goals and gender identity, grounded in rigorous scientific evidence, and enhanced by emerging technologies. As a key marker of identity, social recognition, and emotional well-being, the voice calls for individualized care that moves beyond binary models to embrace androgynous, fluid, or non-gendered vocal expressions. Empirical studies explore the benefits of voice therapy in supporting vocal congruence and
psychosocial well-being. Some studies also describe innovations – such as machine learning based tools, voice-centered apps and immersive virtual reality platforms – as promising avenues for enhancing therapeutic precision and engagement. Emerging frameworks further emphasize client-led goal setting and fluid trajectories over binary vocal norms. Studies also stress the need to raise awareness of vocal health professionals’ roles among both the public and patients, underscoring the importance of collaborative, well-informed care. Cross-cultural perspectives challenge Western-centric models, urging more context-sensitive practices. Moreover, research calls for inclusive, tailored care for trans and autistic individuals, centered on their lived experiences and specific needs, while highlighting the urgent need for clinical and educational frameworks that address both neurodiversity and gender diversity. Finally, it calls for enhanced training of professionals to provide trans-affirmative, reflective, and safe care.
Conclusions. Increasingly, voice therapy and surgery are integrated into holistic care pathways. These developments collectively support a more inclusive, pluralistic, and empowering model of vocal transition. As the field evolves, it underscores the importance of agency, diversity, and ethical responsiveness in trans vocal health.

This presentation will explore both legal research, as well as legislative and case law developments, over the past two years – focusing on the intersections of gender identity, gender expression and law. With a particular interest for the fields of medical law and family law, the presentation will introduce attendees to a selection of monographs, edited collections, journal articles and reports, published since 2023, which address the legal rights and status of trans and non-binary people. In an area of substantial legislative and judicial activity, the presentation will also introduce key national and regional court judgments, and it will highlight a number of actual and proposed legal reforms. The presentation will focus primarily on Europe, but it will also draw from relevant academic resources and legal updates in other parts of the world. Ultimately, the presentation will offer attendees a concise, yet informative, overview of law-focused developments since the last EPATH conference.