Cisgender has nothing to do with an individual’s sexual orientation. Therefore how do sex and gender differ and where does cisgender fall within the spectrum of gender identities?
Cisgender
Cisgender is a segment of the larger spectrum of gender identities. Also referred to as “cis,” it describes an individual whose gender identity corresponds to the sex they were assigned at birth. Therefore if an individual assigned sex at birth is female and identifies as a girl or a woman they are a cisgender woman.
The term describes how a person sees themselves and helps others communicate more accurately and respectfully.
Although many individuals may identify as cisgender, a cisgender person is not typical nor has qualities or characteristics that inherently differentiate them from a person of other gender identities.
Cisgender women commonly use the pronouns she and her.
A common mistake is using the term cis-gendered.
The proper usage of the term is cisgender.
Sex and Gender Differences
The terms sex and gender are often used interchangeably, however, they are not the same.
Sex is a biological and physiological designation based on an individual’s sex chromosomes and sexual organs.
This includes an individual’s genitals and sex organs.
It also encompasses secondary characteristics – like body size, bone structure, breast size, and facial hair – that are regarded as female or male.
Differences
Gender is a social construct that refers to roles and behaviors that society assigns as being masculine or feminine. The construct infers behaviors that are accepted or appropriate based on how an individual behaves, speaks, dresses, sits, etc.
Gender titles include sir, ma’am, mister, or miss.
Pronouns include him, she, he, and her.
Roles include actress, actor, prince, and princess.
Many of these suggest a power hierarchy of who has it and who does not.
Cisgender women often fall victim to these dynamics.
Sex
Refers to an individual’s chromosomes and the way that their genes are expressed.
Typically described in terms of male and female characteristics or the sex assigned at birth.
Gender
A social construct.
Refers to the social roles, behaviors, and expectations considered and/or deemed appropriate for men and women.
Historically defined as masculine and feminine, however, definitions can change as society changes.
Gender Identities Glossary
Today, gender is viewed as a spectrum where an individual might identify as one gender, more than one gender, or no gender. The definitions are often subtle and can often overlap, co-exist, and/or change. Gender identities include:
Cisgender
An individual whose gender identity matches their assigned sex at birth.
Transgender
An individual whose gender identity does not align with their assigned sex at birth.
Non-binary
An individual who feels their gender identity cannot be defined.
Demigender
An individual who experiences a partial, but not full/complete connection to a particular gender.
Agender
An individual who feels neither male nor female.
Genderqueer
Similar to non-binary but infers refusal of societal expectations.
Gender-neutral
Non-binary similarities but focuses on abandoning gender labels.
Gender fluid
An individual who experiences multiple genders or shifts between genders.
Polygender
An individual who experiences or expresses more than one gender.
Pangender
An individual who identifies with all genders.
Third gender
Third gender is a concept in which individuals are categorized, either by themselves or by society, as neither male nor female, not transitioning.
They are a different gender altogether.
Twin gender
A Native American term describing someone who is male and female or of two spirits simultaneously.
Cis Woman Identity
The terms cis woman or cis female are used to describe individuals who were assigned female at birth and identify as a woman or female. For cisgender woman, this means their gender identity aligns with their primary sex organs and secondary sex traits that include:
Higher pitch voice.
Wider pelvis.
Broadening of hips.
Breast development
It can also involve cisnormativity – a concept that everyone identifies as the gender they were assigned at birth. This could inform how a cis woman is expected to dress and act. An even more extreme concept is gender essentialism – this is the belief that gender differences are rooted purely in biology and cannot be changed. However, even cisnormativity beauty standards can influence the perceptions of transgender women that end up reinforcing gender stereotypes. (Monteiro D, Poulakis M. 2019)
Cisgender Privilege
Cisgender privilege is the concept that individuals who are cisgender receive added benefits compared to individuals who don’t conform to the gender binary norm. This includes cisgender women and men. Privilege happens when a cisgender individual assumes they are the norm and consciously or unconsciously takes action against those who are outside the definition of masculine and feminine. Examples of cisgender privilege include:
Not being denied work and social opportunities because of not fitting into the boy’s or girl’s club.
Not having to have sexual orientation questioned.
Not being denied healthcare due to provider discomfort.
Not fearing that civil rights or legal protections will be taken.
Not worrying about being bullied.
Not having to worry about attracting questioning looks in public.
Not being challenged or questioned about the clothes being worn.
Not being demeaned or mocked because of pronoun use.
Gender identity and sexual orientation are not the same.
A cisgender individual can be heterosexual, homosexual, bisexual, or asexual and so can a transgender individual.
Being cisgender has no correlation to an individual’s sexual orientation.
Chiropractic Care After Accidents and Injuries
References
Clayton, J. A., & Tannenbaum, C. (2016). Reporting Sex, Gender, or Both in Clinical Research? JAMA, 316(18), 1863–1864. doi.org/10.1001/jama.2016.16405
Monteiro, Delmira and Poulakis, Mixalis (2019) “Effects of Cisnormative Beauty Standards on Transgender Women’s Perceptions and Expressions of Beauty,” Midwest Social Sciences Journal: Vol. 22: Iss. 1, Article 10. DOI: doi.org/10.22543/2766-0796.1009 Available at: scholar.valpo.edu/mssj/vol22/iss1/10
Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6, 1511. doi.org/10.3389/fpsyg.2015.01511
Can the effects of vertebral decompression relieve individuals with herniated discs and reduce intradiscal pressure on the spine?
Introduction
The spine’s main job is to maintain the vertical pressure of the body without feeling pain or discomfort, especially when a person is in motion. The spinal discs are between the spinal joints, which are shock absorbers when pressure is implemented when a person is carrying a heavy object. The spinal column also has the spinal cord and nerve roots that are spread out from each section and have nerve root signals to be transmitted back and forth from the muscles to the brain to carry out its function. However, as the body ages, so does the spine, as many individuals are constantly adding unwanted pressure on their spines by doing normal factors and developing musculoskeletal disorders. At the same time, the spinal discs are also being affected as the unwanted pressure compresses them constantly, causing them to crack and herniate out of their position. To that point, the herniated disc aggravates the spinal nerve roots, leading to pain-like symptoms affecting the upper and lower body extremities. When this happens, many people will begin to experience musculoskeletal pain and cause overlapping risk profiles that cause their bodies to be misaligned. However, non-surgical treatments can be implemented as part of a daily routine for individuals dealing with herniated discs to reduce intradiscal pressure off the affected muscles in the upper and lower body extremities and restore functionality to the body. Today’s article focuses on why herniated disc affects many people and how vertebral traction can reduce intradiscal pressure off the spine while relieving the musculoskeletal system. Additionally, we work hand-in-hand with certified medical providers who incorporate our patient’s information to reduce intradiscal stress correlating with herniated discs. We also inform them that vertebral traction therapy (spinal decompression) can help mitigate the pain-like symptoms associated with herniated discs and provide relief to the body. We encourage our patients to ask profound questions while seeking education from our associated medical providers about their pain-like issues. Dr. Alex Jimenez, D.C., incorporates this information as an educational service. Disclaimer
Why Does Herniated Disc Affect People?
Have you or your loved ones been dealing with muscle aches or strains in their back, neck, or shoulders after carrying/lifting a heavy object? Do you feel a numbing or tingling sensation in your hands, legs, or feet after a long day after work? Or have you been constantly dealing with muscle and joint stiffness after a long workday? At some point in their lives, everyone has dealt with pain affecting their upper and lower extremities, leading to herniated discs in the spine’s upper, middle, or lower portions. As stated earlier, the body and the spine age naturally, leading to the development of herniated discs in the spine. Disc herniation occurs when the nucleus pulposus (inner disc layer) starts to break through the weaker annulus fibrosus (outer disc layer) and compress the surrounding nerve root, leading to an overlapping risk profile to the upper and lower body portions. (Ge et al., 2019) Disc herniation is developed when the spine goes through a natural degeneration, which causes them to be more susceptible to microtears. When individuals start to do normal activities like lifting or carrying heavy objects, it can enhance the progression further, leading to musculoskeletal disorders. Additionally, the spinal degeneration associated with disc herniation can cause inflammatory responses when the protruding disc is compressing the nerve roots, which then causes symptoms of pain and numbness to the upper and lower extremities. (Cunha et al., 2018)
Why do herniated discs cause inflammatory responses to the compressed nerve roots that cause pain-like symptoms to the upper and lower body extremities? Well, when many individuals are experiencing pain associated with herniated discs, they believe they are dealing with upper or lower pain, depending on where the herniated disc is located. This causes referred pain symptoms where the pain is being perceived in one location than the site where the pain is originating. Coincidentally, when individuals are doing repetitive motions associated with herniated discs can cause the adjacent nerve root to be compressed, which then causes the surrounding muscles, ligaments, and soft tissues to be in pain. (Blamoutier, 2019) Pain developing from herniated discs can reduce a person’s quality of life and make them miss out on important life events.
Disc Herniation Overview-Video
Many factors associated with a herniated disc can lead to its development and range from mild to severe depending on where the disc is herniated. Since the spine and spinal disc do degenerate over time naturally, it can cause the disc to crack and dehydrate. This leads to restricted movement, the development of neck, back, and shoulder pain, a decrease in muscle strength in the extremities, and numbness. (Jin et al., 2023) These are some results when herniated discs are not being treated right away. Luckily there are non-surgical treatments to alleviate the pain-like symptoms associated with herniated discs and help reduce intradiscal pressure in the spine while restoring spinal mobility and muscle strength. Spinal decompression, chiropractic care, massage therapy, and physical therapy are some non-surgical treatments that can help alleviate herniated discs and its associated symptoms. Non-surgical treatments can help pull the herniated disc off the compressed nerve root through manual and mechanical manipulation and return it to its original position. Additionally, non-surgical treatments can be part of a daily health and wellness routine combined with other therapies to reduce pain-like symptoms associated with herniated discs and help restore the spine’s mobility. The video above explains the causes, factors, and symptoms associated with herniated discs and how these treatments can alleviate the pain.
The Effects Of Vertebral Traction On Disc Herniation
Non-surgical treatments like vertebral decompression can provide a positive outlook when reducing the effects of herniated discs. Vertical or spinal decompression can help reduce the underlying problem associated with herniated discs by relieving the pain and intradiscal pressure off the vital structures of the spine. (Ramos & Martin, 1994) Additionally, vertebral decompression uses gentle traction to relieve nerve pain associated with herniated discs. It helps reduce the compression force on the affected spinal discs, reducing nerve compression by expanding the disc height in the spine. (Wang et al., 2022)
With spinal decompression being incorporated to reduce the effects of herniated discs, individuals are strapped into a traction machine in a supine position. They will feel a mechanical pull to their spines as the herniated disc returns to its original position and the height of the spinal disc increases. (Oh et al., 2019) This allows the negative pressure from the traction to increase the body’s blood flow for the nutrients and fluids to rehydrate the discs while allowing the body’s natural healing process to kick into full gear. (Choi et al., 2022) After a few consecutive sessions with spinal decompression, many individuals will notice that the pain in their neck, back, and shoulders has decreased and that they can return to their daily activities. Spinal decompression allows the individual to regain their health and well-being while also reminding them to be more mindful of what certain factors can cause the pain to return to the spine. By being more aware of what is affecting a person’s body, they have the tools to continue their health and wellness journey.
References
Blamoutier, A. (2019). Nerve root compression by lumbar disc herniation: A french discovery? Orthop Traumatol Surg Res, 105(2), 335-338. doi.org/10.1016/j.otsr.2018.10.025
Choi, E., Gil, H. Y., Ju, J., Han, W. K., Nahm, F. S., & Lee, P. B. (2022). Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc. International Journal of Clinical Practice, 2022, 6343837. doi.org/10.1155/2022/6343837
Cunha, C., Silva, A. J., Pereira, P., Vaz, R., Goncalves, R. M., & Barbosa, M. A. (2018). The inflammatory response in the regression of lumbar disc herniation. Arthritis Res Ther, 20(1), 251. doi.org/10.1186/s13075-018-1743-4
Ge, C. Y., Hao, D. J., Yan, L., Shan, L. Q., Zhao, Q. P., He, B. R., & Hui, H. (2019). Intradural Lumbar Disc Herniation: A Case Report and Literature Review. Clin Interv Aging, 14, 2295-2299. doi.org/10.2147/CIA.S228717
Jin, Y. Z., Zhao, B., Zhao, X. F., Lu, X. D., Fan, Z. F., Wang, C. J., Qi, D. T., Wang, X. N., Zhou, R. T., & Zhao, Y. B. (2023). Lumbar Intradural Disc Herniation Caused by Injury: A Case Report and Literature Review. Orthopaedic Surgery, 15(6), 1694-1701. doi.org/10.1111/os.13723
Oh, H., Choi, S., Lee, S., Choi, J., & Lee, K. (2019). Effects of the flexion-distraction technique and drop technique on straight leg raising angle and intervertebral disc height of patients with an intervertebral disc herniation. Journal of Physical Therapy Science, 31(8), 666-669. doi.org/10.1589/jpts.31.666
Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg, 81(3), 350-353. doi.org/10.3171/jns.1994.81.3.0350
Wang, W., Long, F., Wu, X., Li, S., & Lin, J. (2022). Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis. Comput Math Methods Med, 2022, 5670303. doi.org/10.1155/2022/5670303
While a healthy, sustainable lifestyle for one individual may not be the best option for another, can experts point out signs of a healthy life?
Healthy Life
Being or living a healthy life is a phrase that can be confusing. Researchers examine some major areas of concern with constant imagery like social media’s role in shaping what behaviors people consider important to reach a physical fitness/health goal. These behaviors prioritize physical appearance and are often linked with negative psychological effects and worsening physical health outcomes. (Binder A, et al., 2021) Studies routinely show that someone’s body shape is not a good indicator of how healthy they really are. (Uhlmann LR, et al., 2018)
Living a healthy life is a multi-faceted endeavor that requires maintaining a balance. New research has shown that “adhering to both quality diet and sufficient physical activity is important for optimally reducing the risk of mortality from all causes, CVD and PDAR cancers.” (Ding D, et al., 2022) Individuals do not need to make extreme changes to these areas of their lifestyle. Studies show that making small adjustments, little by little, prepares the individual to develop long-term sustainable habits. (Adhikari P, Gollub E. 2021)
Nutritional Health
Too much salt, sugar, and saturated fat increases the risk of diseases like diabetes, heart disease, and stroke. (National Institutes of Health, 2017) It can be easy to overlook balanced nutrition and it is not all about what should be restricted and avoided. It is about making sure the body gets the proper amount of nutrient-rich foods essential to overall health. Examples include:
Deficiency of nutrients like magnesium, calcium, and vitamins A, C, D, E, and K are with sleep problems. (Ikonte CJ, et al., 2019)
Not acquiring enough protein can lead to slowed metabolism and weight gain. (Pezeshki A, et al., 2016)
Healthy fats are essential to protect against heart disease and can help maintain high energy levels. (Gammone MA, et al., 2018)
Research has found that depression and nutrition are linked.
Incorporating a diet like the Mediterranean has been associated with a reduced risk of depression symptoms. (Oddo VM, et al., 2022)
Physical Activity
Regular physical activity helps with weight management, reduces the risk of chronic diseases, maintains healthy bones and joints, and contributes to positive mental health and mood.
The Centers for Disease Control and Prevention estimates around 60 percent of the population does not get enough daily physical activity. (Surgeon General Report, CDC. 1999)
According to the research, individuals don’t exercise for consistent reasons that include: not having enough time, no access to resources, and being too tired to work out. (Yen Sin Koh, et al., 2022)
Increasing the heart rate for only 12 minutes a day can protect the cardiovascular system. (Matthew Nayor, et al., 2020)
Signs
A few signs that an individual is healthy.
Stable Energy Levels
Having energy throughout the day is a sign you’re getting high-quality sleep.
Energy levels can also offer clues on nutritional intake, particularly of fats, carbohydrates, and proteins. (Yohannes Adama Melaku, et al., 2019)
The right combination of macronutrients can be different for everyone, especially depending on factors like age, job, medical history, and physical activity.
Paying attention to energy levels at different times of the day can help guide fitness and health goals.
One sign that the mind and body are dealing with stress well is the ability to set boundaries.
Setting boundaries shows recognition and priority for their needs.
This could be boundaries for respect of thoughts and ideas, physical space, emotional needs, the time spent on certain things, sex life, and material possessions.
Fresh Breath
The mouth can show what is going on as far as the health of the body.
Poor oral hygiene can lead to a buildup of bacteria that can spread throughout the respiratory and digestive tracts.
Chronic bad breath is a common sign of poor oral health.
Studies suggest that increased bacteria entering the body can lower immune system response and increase the development of general health problems. (NIH. 2018)
Time to Change
Signs that the mind and body are not healthy include:
Always sick or feel as if you’re coming down with something.
The stomach is constantly feeling like it is bloated, backed up, or dealing with acid reflux or indigestion.
The human body, organs, and tissues are complex structures, and the signals they transmit about underlying issues can be subtle which individuals tend to not notice until the little problems become major ones. It’s important to look at life habits and be honest about changes that may need to be implemented to improve health, lessen the risk of chronic health conditions, and improve quality of life.
Multidisciplinary Evaluations and Treatment
References
Binder, A., Noetzel, S., Spielvogel, I., & Matthes, J. (2021). “Context, Please?” The Effects of Appearance- and Health-Frames and Media Context on Body-Related Outcomes. Frontiers in public health, 9, 637354. doi.org/10.3389/fpubh.2021.637354
Uhlmann, L. R., Donovan, C. L., Zimmer-Gembeck, M. J., Bell, H. S., & Ramme, R. A. (2018). The fit beauty ideal: A healthy alternative to thinness or a wolf in sheep’s clothing? Body image, 25, 23–30. doi.org/10.1016/j.bodyim.2018.01.005
Ding, D., Van Buskirk, J., Nguyen, B., Stamatakis, E., Elbarbary, M., Veronese, N., Clare, P. J., Lee, I. M., Ekelund, U., & Fontana, L. (2022). Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: a prospective study of 346 627 UK Biobank participants. British Journal of sports medicine, bj sports-2021-105195. Advanced online publication. doi.org/10.1136/bjsports-2021-105195
Adhikari, P., & Gollub, E. (2021). Evaluation of the Small Changes, Healthy Habits Pilot Program: Its Influence on Healthy Eating and Physical Activity Behaviors of Adults in Louisiana. European journal of investigation in health, psychology, and education, 11(1), 251–262. doi.org/10.3390/ejihpe11010019
How dietary factors influence disease risk. National Institutes of Health (NIH)
Ikonte, C. J., Mun, J. G., Reider, C. A., Grant, R. W., & Mitmesser, S. H. (2019). Micronutrient Inadequacy in Short Sleep: Analysis of the NHANES 2005-2016. Nutrients, 11(10), 2335. doi.org/10.3390/nu11102335
Pezeshki, A., Zapata, R. C., Singh, A., Yee, N. J., & Chelikani, P. K. (2016). Low protein diets produce divergent effects on energy balance. Scientific reports, 6, 25145. doi.org/10.1038/srep25145
Gammone, M. A., Riccioni, G., Parrinello, G., & D’Orazio, N. (2018). Omega-3 Polyunsaturated Fatty Acids: Benefits and Endpoints in Sport. Nutrients, 11(1), 46. doi.org/10.3390/nu11010046
Oddo, V. M., Welke, L., McLeod, A., Pezley, L., Xia, Y., Maki, P., Koenig, M. D., Kominiarek, M. A., Langenecker, S., & Tussing-Humphreys, L. (2022). Adherence to a Mediterranean Diet Is Associated with Lower Depressive Symptoms among U.S. Adults. Nutrients, 14(2), 278. doi.org/10.3390/nu14020278
Adults, Surgeon General Report, CDC.
Koh, Y. S., Asharani, P. V., Devi, F., Roystonn, K., Wang, P., Vaingankar, J. A., Abdin, E., Sum, C. F., Lee, E. S., Müller-Riemenschneider, F., Chong, S. A., & Subramaniam, M. (2022). A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behavior. BMC public health, 22(1), 1051. doi.org/10.1186/s12889-022-13431-2
Saint-Maurice, P. F., Graubard, B. I., Troiano, R. P., Berrigan, D., Galuska, D. A., Fulton, J. E., & Matthews, C. E. (2022). Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults. JAMA internal medicine, 182(3), 349–352. doi.org/10.1001/jamainternmed.2021.7755
Nayor, M., Shah, R. V., Miller, P. E., Blodgett, J. B., Tanguay, M., Pico, A. R., Murthy, V. L., Malhotra, R., Houstis, N. E., Deik, A., Pierce, K. A., Bullock, K., Dailey, L., Velagaleti, R. S., Moore, S. A., Ho, J. E., Baggish, A. L., Clish, C. B., Larson, M. G., Vasan, R. S., … Lewis, G. D. (2020). Metabolic Architecture of Acute Exercise Response in Middle-Aged Adults in the Community. Circulation, 142(20), 1905–1924. doi.org/10.1161/CIRCULATIONAHA.120.050281
Melaku, Y. A., Reynolds, A. C., Gill, T. K., Appleton, S., & Adams, R. (2019). Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study. Nutrients, 11(10), 2374. doi.org/10.3390/nu11102374
Jamieson, J. P., Black, A. E., Pelaia, L. E., Gravelding, H., Gordils, J., & Reis, H. T. (2022). Reappraising stress arousal improves affective, neuroendocrine, and academic performance outcomes in community college classrooms. Journal of experimental psychology. General, 151(1), 197–212. doi.org/10.1037/xge0000893
Vernia, F., Di Ruscio, M., Ciccone, A., Viscido, A., Frieri, G., Stefanelli, G., & Latella, G. (2021). Sleep disorders related to nutrition and digestive diseases: a neglected clinical condition. International journal of medical sciences, 18(3), 593–603. doi.org/10.7150/ijms.45512
Can spinal decompression treatments be incorporated for individuals with lumbosacral pain and improve posture?
Introduction
Many individuals only realize they have poor posture once they perform a movement that causes pain in the lumbosacral region of their body. Have you or your loved ones experienced muscle aches or strains after relaxing in a weird position? Or do you begin to notice that you are hunched over when walking from one location to another? Many of these scenarios correspond to how we present ourselves with our posture. Our posture helps support the upper body’s weight while stabilizing the lower body through the spine and ensuring that our body is in an upright position when we are in motion. However, as we age, so do our bodies and spine, which then causes us to be in a hunched position, causing our posture to degenerate. This causes lumbosacral pain to develop along the body’s lower extremities, leading to overlapping risk profiles that cause mobility issues, poor posture, and disability if not treated right away. When this happens, the surrounding muscles, ligaments, and tissues around the lumbar spine will begin to develop pain-like symptoms and can make a person’s life miserable. Luckily there are various techniques and treatments to improve poor posture and reduce lumbosacral pain affecting many individuals. Today’s article looks at how lumbosacral pain affects a person’s posture and how spinal decompression and MET therapy can reduce lumbosacral pain and restore good posture. Additionally, we work hand-in-hand with certified medical providers who incorporate our patient’s information to treat and minimize lumbosacral pain associated with poor posture. We also inform them that spinal decompression combined with MET therapy can help with lumbosacral pain while improving good posture back to the body. We encourage our patients to ask profound questions while seeking education from our associated medical providers about their pain-like issues. Dr. Alex Jimenez, D.C., incorporates this information as an educational service. Disclaimer
Lumbosacral Pain Affects Posture
Have you noticed you are constantly slouching or being in a hunched position, only to feel muscle aches and strains in your lumbar-sacral region? Do you feel symptoms of tingling and numbness in your hips and buttock region after sitting down excessively? Or do you feel referred pain in one location and have to shift your weight to compensate for the pain? These pain-like symptoms and scenarios correspond to lumbosacral pain affecting your posture. The lumbosacral spine region has a natural curve that functions as a shock absorber to mitigate the body’s mechanical weight and stress when in motion. (Adams & Hutton, 1985) At the same time, it is susceptible to being constantly injured as the spinal disc is being compressed and can be herniated or damaged over time, manifesting into lumbosacral pain. So how does lumbosacral pain associate with poor posture? When individuals are dealing with low back problems associated with lumbosacral pain, the spinal disc in the lumbosacral region starts to have balancing issues when in motion. (Huang, Jaw, & Young, 2022) When people are dealing with difficulties balancing their gait cycle, it can cause their walking performance and postural control to be dysfunctional and cause the body to be misaligned, thus causing musculoskeletal issues to arise and affecting the lower body and its extremities. The surrounding muscles surrounding the lumbosacral region will begin to experience stiffness in the trunk region, which can cause musculoskeletal changes to the surrounding muscles when individuals start to be in an upright position. (Creze et al., 2019) When poor posture affects the trunk muscles, the surrounding accessory muscles start acting to compensate for the pain. To that point, lumbosacral pain associated with poor posture could lead to abdominal, low back, hip, and pelvic pain. However, many individuals can find various therapies and relieving techniques to improve posture, strengthen the surrounding muscles, and reduce pain-like symptoms.
Building A Stronger Body- Video
Many individuals can seek out various non-invasive therapies to alleviate the issue when it comes to improving posture and reducing lumbosacral pain. These therapies are cost-effective and personalized to the person’s pain. Treatments like chiropractic care and decompression can help restore good posture while realigning the body out of subluxation and help stretch the affected muscles. Coincidentally, non-surgical therapies can be combined with other treatments like physical therapy to strengthen the trunk muscles surrounding the lumbosacral region, thus reducing the load on the lumbosacral spine. (Callaghan, Gunning, & McGill, 1998) When people focus on their health and well-being, non-surgical therapies can provide a positive and safe experience with a team that can help reduce the pain the person has been dealing with their entire lives. The video above explains how these treatments work together to help you build a stronger body while revitalizing your energy and enhancing your health and wellness.
Spinal Decompression Reducing Lumbosacral Pain
When it comes to reducing lumbosacral pain associated with poor posture, many individuals can incorporate non-surgical treatments like spinal decompression and combine them with a personalized treatment plan to reduce the pain-like symptoms. What spinal decompression does to lumbosacral pain is that it helps mitigate intra-disc pressure while increasing disc space within the lumbosacral spinal region. (Amjad et al., 2022) Spinal decompression can help improve leg mobility and stretch out the affected muscles to kick-start the body’s natural healing process. Spinal decompression can even combine with physical therapy to help strengthen the lumbosacral region’s abdominal muscles and enable many individuals with poor posture to be mindful of how they present themselves.(Mielenz et al., 1997)
MET Therapy & Spinal Decompression Restoring Posture
When pain specialists like chiropractors and massage therapists incorporate spinal decompression treatment to reduce lumbosacral pain, they also utilize various techniques to strengthen the lumbosacral muscles to restore proper posture to the body. Many pain specialists use MET (muscle energy techniques) therapy to maintain while stretching the muscles and fascia in the affected areas. MET therapy combined with spinal decompression can help improve muscle shortness in the lumbar fascial tissue, improve posture, and even increase the lumbar and pelvic range of motion. (Tamartash & Bahrpeyma, 2022) These two non-surgical treatments can help many people by addressing their posture and movement dysfunction while strengthening their core stabilized muscles to reduce pain. (Norris & Matthews, 2008) Many individuals who want to regain their health and wellness can make small changes in their routine to improve their posture and be more mindful of their bodies to reduce the chances of lumbosacral pain returning.
References
Adams, M. A., & Hutton, W. C. (1985). The effect of posture on the lumbar spine. J Bone Joint Surg Br, 67(4), 625-629. doi.org/10.1302/0301-620X.67B4.4030863
Amjad, F., Mohseni-Bandpei, M. A., Gilani, S. A., Ahmad, A., & Hanif, A. (2022). Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord, 23(1), 255. doi.org/10.1186/s12891-022-05196-x
Callaghan, J. P., Gunning, J. L., & McGill, S. M. (1998). The relationship between lumbar spine load and muscle activity during extensor exercises. Phys Ther, 78(1), 8-18. doi.org/10.1093/ptj/78.1.8
Creze, M., Bedretdinova, D., Soubeyrand, M., Rocher, L., Gennisson, J. L., Gagey, O., Maitre, X., & Bellin, M. F. (2019). Posture-related stiffness mapping of paraspinal muscles. J Anat, 234(6), 787-799. doi.org/10.1111/joa.12978
Huang, C. C., Jaw, F. S., & Young, Y. H. (2022). Radiological and functional assessment in patients with lumbar spinal stenosis. BMC Musculoskelet Disord, 23(1), 137. doi.org/10.1186/s12891-022-05053-x
Mielenz, T. J., Carey, T. S., Dyrek, D. A., Harris, B. A., Garrett, J. M., & Darter, J. D. (1997). Physical therapy utilization by patients with acute low back pain. Phys Ther, 77(10), 1040-1051. doi.org/10.1093/ptj/77.10.1040
Norris, C., & Matthews, M. (2008). The role of an integrated back stability program in patients with chronic low back pain. Complement Ther Clin Pract, 14(4), 255-263. doi.org/10.1016/j.ctcp.2008.06.001
Tamartash, H., & Bahrpeyma, F. (2022). Evaluation of Lumbar Myofascial Release Effects on Lumbar Flexion Angle and Pelvic Inclination Angle in Patients with Non-Specific Low Back Pain. Int J Ther Massage Bodywork, 15(1), 15-22. doi.org/10.3822/ijtmb.v15i1.709
Can adding calisthenics resistance training to a fitness routine provide health benefits like flexibility, balance, and coordination?
Calisthenics Resistance Training
Calisthenics resistance training requires no equipment, they can be done with minimal space, and are a great way to get a quick burn.
They are a form of resistance training using your own body weight that is low-impact, which makes it accessible to individuals of all ages and fitness levels.
They effectively help build agility, and cardiovascular health, and improve balance, coordination, and flexibility.
Benefits
Muscle Strength
Because calisthenics are easily adaptable to any fitness level, require minimal or no equipment, and are great for beginners and experienced exercise enthusiasts it is a fantastic full-body workout and an excellent way to build strength and muscle. Research supports that calisthenics resistance training can improve muscle strength in various ways.
One study found that eight weeks of calisthenics not only improved posture and body mass index/BMI but can impact strength, even with exercises not routinely performed. (Thomas E, et al., 2017)
During the study, one group did calisthenics and the other maintained regular training routines.
The researchers discovered that the group that did calisthenics increased their repetitions of exercises that were not included.
The group who continued with their regular training routines did not improve on what they could do before the eight-week study. (Thomas E, et al., 2017)
Cardiovascular Fitness
Regular participation in calisthenic resistance training can lead to improved cardiovascular health, including increased endurance and a healthier heart.
Certain calisthenic exercises, like burpees and mountain climbers, are high-intensity movements that can increase heart rate and blood circulation just from the movements.
Gradually performing these exercises at a faster pace, research indicates could potentially experience the same cardiovascular benefits from interval or treadmill running. (Bellissimo GF, et al., 2022) – (Lavie CJ, et al., 2015)
Balance, Coordination, and Flexibility
The movements require a full range of motion that stretches and strengthens the muscles, tendons, and ligaments.
These exercises can help decrease the risk of injury and make daily physical activities easier to perform without over-exertion.
Incorporating calisthenics resistance training on a regular basis can help improve posture, balance, and flexibility, depending on which exercises are recommended.
Exercises like stretches, lunges, and squats help to improve flexibility and mobility.
Exercises like single-leg squats and one-arm push-ups can work the balance, coordination, and proprioception of the body.
Mental Health
Exercise, in general, is known to improve mood, reduce stress, and improve overall well-being.
Calisthenic resistance training can have additional impacts on mental well-being.
For example, the discipline and focus required to perform the movements can help concentration and mental clarity.
One study found that calisthenics can reduce cognitive decline and may be useful for dementia prevention. (Osuka Y, et al., 2020)
Another study found that calisthenics helped mental well-being in individuals with diseases like ankylosing spondylitis and multiple sclerosis. (Taspinar O, et al., 2015)
Types
Bodyweight exercises that use an individual’s own body weight as resistance are the foundation. Common examples include push-ups, squats, and lunges. An overview of some of the types of exercises.
Pulling
These exercises focus on training the muscles for pulling movements, which include the back, shoulders, and arms.
Examples include pull-ups, chin-ups, and rows.
Pushing
These exercises focus on training the muscles for pushing movements, like the chest, shoulders, and triceps.
Examples include dips, push-ups, and handstand push-ups.
Core
Core exercises focus on training the abdominal and lower back muscles, which are responsible for maintaining stability and balance.
Examples of core exercises include planks, sit-ups, and leg raises.
Single-Leg
Single-leg exercises focus on training one leg at a time.
These target the muscles of the legs, hips, and core.
Examples of single-leg exercises include single-leg squats, lunges, and step-ups.
Plyometric
Calisthenics resistance training focuses on powerful explosive movements.
Plyometric exercises challenge the muscles to work quickly and forcefully.
Examples include jump squats, clap push-ups, and box jumps.
Getting Started
Start by making sure calisthenics is an appropriate workout option, especially if you are a beginner or have pre-existing medical conditions.
Once cleared to exercise start with familiar movements that can be done with the correct form.
Pushups, bodyweight squats, planks, lunges, and other basic movements are a good place to start.
Make sure to warm up with light and easy motions that mimic the workout movements.
Aim to work each body part during the workout.
Try for at least two workouts a week.
It is recommended to split the movement patterns.
Reps can be counted or set a timer to switch exercises every minute. This is called EMOM-style or every minute on the minute.
Pick four to five exercises that target various areas.
For example, sit-ups can be done for the core, lunges for the glutes and thighs, planks can be done for the shoulders and core, and jumping jacks or jumping rope for cardiovascular.
Calisthenic resistance training is easily modifiable and can be adjusted to individual needs.
Core Strength
References
Thomas, E., Bianco, A., Mancuso, E. P., Patti, A., Tabacchi, G., Paoli, A., … & Palma, A. (2017). The effects of a calisthenics training intervention on posture, strength, and body composition. Isokinetics and exercise science, 25(3), 215-222.
Bellissimo, G. F., Ducharme, J., Mang, Z., Millender, D., Smith, J., Stork, M. J., Little, J. P., Deyhle, M. R., Gibson, A. L., de Castro Magalhaes, F., & Amorim, F. (2022). The Acute Physiological and Perceptual Responses Between Bodyweight and Treadmill Running High-Intensity Interval Exercises. Frontiers in physiology, 13, 824154. doi.org/10.3389/fphys.2022.824154
Osuka, Y., Kojima, N., Sasai, H., Ohara, Y., Watanabe, Y., Hirano, H., & Kim, H. (2020). Exercise Types and the Risk of Developing Cognitive Decline in Older Women: A Prospective Study. Journal of Alzheimer’s disease: JAD, 77(4), 1733–1742. doi.org/10.3233/JAD-200867
Taspinar, O., Aydın, T., Celebi, A., Keskin, Y., Yavuz, S., Guneser, M., Camli, A., Tosun, M., Canbaz, N., & Gok, M. (2015). Psychological effects of calisthenic exercises on neuroinflammatory and rheumatic diseases. Zeitschrift fur Rheumatologie, 74(8), 722–727. doi.org/10.1007/s00393-015-1570-9
Lavie, C. J., Lee, D. C., Sui, X., Arena, R., O’Keefe, J. H., Church, T. S., Milani, R. V., & Blair, S. N. (2015). Effects of Running on Chronic Diseases and Cardiovascular and All-Cause Mortality. Mayo Clinic Proceedings, 90(11), 1541–1552. doi.org/10.1016/j.mayocp.2015.08.001
Can spinal decompression treat individuals with chronic low back pain to reduce joint arthritis and strengthen the surrounding muscles to restore lumbar mobility?
Introduction
When many individuals are dealing with pain in their lumbar region, more often than not, they believe that it’s the surrounding muscles that protect the spine that is being affected. However, that is only half of the problem. Do you or your loved ones often feel a warm sensation within your lower back, hips, and knees that radiates pain within your joints? Well, joint pain can correlate with low back pain in its chronic state. Since the body and spine can degenerate over time, it can cause the joints to wear and tear while rubbing against each other, causing joint arthritis to develop. When arthritic pain is associated with chronic low back pain, it can lead to overlapping risk profiles that can lead to a life of disability and make the individual miserable. Many pain-like symptoms correlating with chronic low back pain can develop over time and cause mobility and stability problems within the body. Fortunately, many non-surgical treatments can reduce the progression of joint arthritis and alleviate chronic low back pain. Today’s articles examine the correlation between joint arthritis and chronic low back pain while taking a look at how non-invasive treatments like spinal decompression can not only reduce chronic low back pain associated with joint arthritis but also restore lumbar mobility. Additionally, we work hand-in-hand with certified medical providers who incorporate our patient’s information to treat and reduce the progression of joint arthritis associated with low back pain. We also inform them that spinal decompression can help restore lumbar mobility while enhancing muscle strength back to the lumbar region. We encourage our patients to ask profound questions while seeking education from our associated medical providers about their pain-like issues. Dr. Alex Jimenez, D.C., incorporates this information as an educational service. Disclaimer
Joint Arthritis & Chronic Low Back Pain
Do you often experience stiffness in the morning that seems to go away after a few hours? Do you feel aches and pains at work, either at the desk or the requires heavy objects? Or do you feel your joints ache constantly that you are not getting enough sleep at night? These pain-like scenarios are associated with joint arthritis, which can develop into chronic low back pain. Many people know that the lumber spine and the lower extremities will experience high mechanical stress when the body is in an upright position without pain. As the lumbar spine and lower extremities begin to go through repetitive motions over time, that can cause the ligaments and surrounding muscles to have microtrauma tears, resulting in the development of joint arthritis, which can lead to inflammatory effects. (Xiong et al., 2022) Now inflammation in the body is beneficial and harmful depending on the severity within the affected area. Joint arthritis, especially spondylarthritis, is part of inflammatory diseases that affect the joint and the spine and can have various clinical manifestations. (Sharip & Kunz, 2020) The symptoms of joint arthritis include inflammatory pain in the affected area, joint stiffness and swelling, and muscle weakness. When dealing with inflammatory effects associated with joint arthritis, it can cause them to have a decreased quality of life, increase mortality, and become an economic burden. (Walsh & Magrey, 2021)
Now how does joint arthritis be associated with low back pain? When individuals start to make repetitive motions to their lumbar spine, it can lead to abnormal changes to the intervertebral discs. When unwanted pressure begins to compress the intervertebral disc constantly, it can cause wear and tear on the disc, causing them to crack and allowing the annular nociceptors to become over-sensitized. (Weinstein, Claverie, & Gibson, 1988) The affected disc then aggravates the surrounding nerve roots and muscles, causing low back pain. When individuals do their everyday normal, factors that cause degenerative changes to the intervertebral discs can lead to chronic low back pain. (Vernon-Roberts & Pirie, 1977) To that point, chronic low back pain associated with joint arthritis can become a chronic issue if not treated right away.
Arthritis Explained- Video
When reducing the effects of chronic low back pain associated with joint arthritis, many individuals seek treatments to relieve their pain-affected areas with a positive outcome. Non-surgical treatments could be the answer, combined with other therapies to reduce chronic low back pain. (Kizhakkeveettil, Rose, & Kadar, 2014) Non-surgical treatments can be customizable to the individual’s pain while being cost-effective. Many people with arthritic joints can benefit from non-surgical treatments as pain specialists like massage therapists and chiropractors can use various techniques to stretch out the affected muscles, increase the joint’s ROM (range of motions) and realign the body out of misalignment to promote the body’s natural healing process. The video above gives an overview of how arthritis can affect the joints, be associated with low back pain, and how these treatments can alleviate its symptoms through various techniques.
Spinal Decompression & Chronic Low Back Pain
Spinal decompression is a non-surgical therapy treatment that can help many individuals with chronic low back pain. Spinal decompression uses gentle traction on the lumbar spine to pull the spine, allowing the fluids and nutrients to flood back to the affected area and help the body naturally heal itself. When individuals start incorporating spinal decompression for their chronic low back pain, they will feel pressure off their spinal discs. (Ramos, 2004) When individuals begin to feel an improvement in their lumbar region after a few consecutive treatments, they will start to regain their lumbar mobility.
Spinal Decompression Restoring Lumbar Mobility
Spinal decompression can reduce the effects of chronic low back pain and restore lumbar mobility to the spine. Since spinal decompression uses gentle traction on the spine, the intervertebral disc will return to its original position, while the spinal cavity increases disc height. To that point, spinal decompression can cause individuals to improve mobility and cause them to return to their normal daily activities, as it correlates strongly with pain reduction. (Gose, Naguszewski, & Naguszewski, 1998) By incorporating spinal decompression as part of a routine, many individuals can regain their health without dealing with pain-like symptoms.
References
Gose, E. E., Naguszewski, W. K., & Naguszewski, R. K. (1998). Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res, 20(3), 186-190. doi.org/10.1080/01616412.1998.11740504
Kizhakkeveettil, A., Rose, K., & Kadar, G. E. (2014). Integrative therapies for low back pain that include complementary and alternative medicine care: a systematic review. Glob Adv Health Med, 3(5), 49-64. doi.org/10.7453/gahmj.2014.043
Ramos, G. (2004). Efficacy of vertebral axial decompression on chronic low back pain: study of dosage regimen. Neurol Res, 26(3), 320-324. doi.org/10.1179/016164104225014030
Sharip, A., & Kunz, J. (2020). Understanding the Pathogenesis of Spondyloarthritis. Biomolecules, 10(10). doi.org/10.3390/biom10101461
Vernon-Roberts, B., & Pirie, C. J. (1977). Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil, 16(1), 13-21. doi.org/10.1093/rheumatology/16.1.13
Walsh, J. A., & Magrey, M. (2021). Clinical Manifestations and Diagnosis of Axial Spondyloarthritis. J Clin Rheumatol, 27(8), e547-e560. doi.org/10.1097/RHU.0000000000001575
Xiong, Y., Cai, M., Xu, Y., Dong, P., Chen, H., He, W., & Zhang, J. (2022). Joint together: The etiology and pathogenesis of ankylosing spondylitis. Front Immunol, 13, 996103. doi.org/10.3389/fimmu.2022.996103
Gender transitioning is the process of affirming and expressing an individual’s internal sense of gender rather than the one assigned at birth. How can learning the aspects of gender and gender transitioning help support the LGBTQ+ community?
Gender Transitioning
Gender transitioning or gender affirmation is a process through which transgender and gender-nonconforming individuals align their internal gender identity with their external gender expression. It can be described as a binary – male or female – but can also be non-binary, meaning an individual is neither exclusively male nor female.
The process can involve aesthetic appearances, changes in social roles, legal recognitions, and/or physical aspects of the body.
Social affirmation – dressing differently or coming out to friends and family.
Legal affirmation – changing name and gender on legal documents.
Medical affirmation – using hormones and/or surgery to change certain physical aspects of their body.
Transgender individuals can pursue some or all of these.
Barriers
Gender transitioning can be obstructed by various barriers that can include:
Cost
Lack of insurance
Lack of family, friends, or partner support.
Discrimination
Stigma
Addressing All Aspects
The process does not have a specific timeline and is not always linear.
Many transgender and gender-nonconforming individuals prefer gender affirmation to gender transitioning because transitioning is often taken to mean the process of medically transforming the body.
An individual does not have to undergo medical treatment to affirm their identity, and some transgender people avoid hormones or gender-affirming surgery.
Transitioning is a holistic process that addresses all aspects of who a person is inwardly and outwardly.
Certain aspects of transitioning may be more important than others, like changing one’s name and gender on their birth certificate.
Reevaluation and revision of gender identity can be continual rather than a step-by-step, one-way process.
Exploring Gender Identity
Gender transitioning often starts in response to gender dysphoria which describes the constant sense of uneasiness that occurs when the gender an individual was assigned at birth does not match how they experience or express their gender internally.
Some individuals have experienced symptoms of gender dysphoria as early as 3 or 4 years of age. (Selin Gülgöz, et al., 2019)
Gender dysphoria can be largely informed by the culture that surrounds the individual, specifically in cultures where strict codes determine what is masculine/male and feminine/female.
Unease Expressed in Different Ways
Dislike of one’s sexual anatomy.
A preference for clothes typically worn by the other gender.
Not wanting to wear clothes typically worn by their own gender.
A preference for cross-gender roles in fantasy play.
A strong preference for engaging in activities that are typically done by the other gender.
Dysphoria
Gender dysphoria can fully emerge during puberty when awareness about how an individual’s body defines them creates internal distress.
Feelings may be amplified when an individual is described as a tomboy, or a sissy, or is criticized and attacked for acting like a girl or acting like a boy.
During puberty, the physical changes can cause long-standing feelings of not fitting in and may evolve into feelings of not fitting in their own body.
This is when individuals can undergo a process referred to as internal transitioning and begin to change how they see themselves.
Gender transitioning/affirmation becomes the next step. Transitioning is not about changing or recreating oneself but about expressing their authentic self and asserting who they are socially, legally, and/or medically.
Social
Social transitioning involves how a person publicly expresses their gender. The transition can include:
Changing pronouns.
Using chosen name.
Coming out to friends, family, coworkers, etc.
Wearing new clothes.
Cutting or styling hair differently.
Changing mannerisms like moving, sitting, etc.
Changing voice.
Binding – strapping the chest to hide breasts.
Wearing breast and hip prosthetics to accentuate feminine curvature.
Packing – wearing a penile prosthesis to create a penile bulge.
Tucking – tucking the penis to conceal a bulge.
Playing certain sports
Pursuing different lines of work.
Participating in activities that might typically be seen as male or female.
Legal
Legal transitioning involves changing legal documents to reflect the individual’s chosen name, gender, and pronouns. This includes governmental and non-government documents that can include:
Birth certificates
Social Security ID
Driver’s license
Passport
Bank records
Medical and dental records
Voter registration
School ID
Provisions allowing for changes can vary by state.
Some states only allow changes if bottom surgery – genital reconstruction is performed.
Others will allow the changes without any form of gender-affirming surgery.
Medical transitioning typically involves hormone therapy to develop some of the male or female sex characteristics. It can also involve surgery to change certain physical aspects combined with hormone therapy.
Hormone therapy assists individuals to physically look more like the gender they identify as.
They can be used on their own and can also be used before gender-affirming surgery.
Hormone therapy takes two forms:
Transgender Men
Testosterone is taken to help deepen the voice, increase muscle mass, promote body and facial hair, and enlarge the clitoris. (M S Irwig, K Childs, A B Hancock. 2017)
Transgender Women
Estrogen is taken as well as testosterone blockers to redistribute body fat, increase breast size, reduce male-pattern baldness, and reduce testicle size. (Vin Tangpricha 1, Martin den Heijer. 2017)
Surgery
Gender affirmation surgery aligns an individual’s physical appearance to their gender identity. Many hospitals provide gender-affirming surgery through a transgender medicine department. Medical procedures include:
Facial surgery – Facial feminization surgery.
Breast augmentation – Increases breast size with implants.
Chest masculinization – Removes contours of breast tissues.
Tracheal shaving – Reduces the Adam’s apple.
Phalloplasty – Construction of a penis.
Orchiectomy – Removal of the testicles.
Scrotoplasty – Construction of a scrotum.
Vaginoplasty – Construction of a vaginal canal.
Vulvoplasty – Construction of the outer female genitalia.
Roadblocks
Transgender individuals are protected from public and private insurance discrimination under federal and state laws, including Medicare and Medicaid. (National Center for Transgender Equality. 2021)
Medicaid programs in nine states do not cover gender-affirming medical treatments, and only Illinois and Maine offer comprehensive standard care recommended by the World Professional Association for Transgender Health/WPATH. (Kaiser Family Foundation. 2022)
Medicare also has no consistent policy regarding the approval of gender-affirming surgery.
Others report family or partner disapproval as the main reason why they discontinue gender affirmation. (Jack L. Turban, et al., 2021)
If you know someone who is transgender or is considering transitioning, learning about gender and gender transitioning and how to be supportive is a great way to be an ally.
Enhancing Your Lifestyle
References
Gülgöz, S., Glazier, J. J., Enright, E. A., Alonso, D. J., Durwood, L. J., Fast, A. A., Lowe, R., Ji, C., Heer, J., Martin, C. L., & Olson, K. R. (2019). Similarity in transgender and cisgender children’s gender development. Proceedings of the National Academy of Sciences of the United States of America, 116(49), 24480–24485. doi.org/10.1073/pnas.1909367116
Irwig, M. S., Childs, K., & Hancock, A. B. (2017). Effects of testosterone on the transgender male voice. Andrology, 5(1), 107–112. doi.org/10.1111/andr.12278
Tangpricha, V., & den Heijer, M. (2017). Estrogen and anti-androgen therapy for transgender women. The Lancet. Diabetes & endocrinology, 5(4), 291–300. doi.org/10.1016/S2213-8587(16)30319-9
National Center for Transgender Equality. Know Your Rights in Health Care.
Kaiser Family Foundation. Update on Medicaid coverage of gender-affirming health services.
Center of Medicare and Medicaid Services. Gender dysphoria and gender reassignment surgery.
Transgender Legal Defense and Education Fund. Health insurance medical policies.
National Center for Transgender Equality and National Gay and Lesbian Task Force. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.
Turban, J. L., Loo, S. S., Almazan, A. N., & Keuroghlian, A. S. (2021). Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT health, 8(4), 273–280. doi.org/10.1089/lgbt.2020.0437
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