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Liaw A, Ziaullah A, Wang M. Long-term outcomes of gender assigned at birth in differences of sex development. J Sex Med 2023; 20:709-711. [PMID: 37255299 DOI: 10.1093/jsxmed/qdad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Aron Liaw
- Department of Urology, Wayne State University, Detroit, MI 48201, United States
| | - Abubakr Ziaullah
- School of Medicine, Wayne State University, Detroit, MI 48201, United States
| | - Michael Wang
- Department of Urology, Wayne State University, Detroit, MI 48201, United States
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52
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Kantor LZ, Tordoff DM, Haley SG, Crouch JM, Ahrens KR. Gender and Sexual Health-Related Knowledge Gaps and Educational Needs of Parents of Transgender and Non-Binary Youth. Arch Sex Behav 2023:10.1007/s10508-023-02611-9. [PMID: 37233838 DOI: 10.1007/s10508-023-02611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/26/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
Parents can have a substantial impact on adolescent sexual decision-making, but few studies have explored the role of parents in providing sexual health information to transgender and non-binary (TNB) youth, a population that experiences significant sexual and mental health disparities and lower levels of perceived family support compared with other youth. This study aimed to elucidate existing knowledge gaps and content deemed important for a sexual health curriculum and educational materials for parents of TNB youth. We conducted 21 qualitative interviews with five parents of TNB youth, 11 TNB youth aged 18+, and five healthcare affiliates to identify parents' educational needs. We analyzed the data using theoretical thematic analysis and consensus coding. Parents self-reported multiple knowledge deficits regarding gender/sexual health for TNB individuals and were primarily concerned with long-term impacts of medical interventions. Youth goals for parents included greater understanding of gender/sexuality and sufficient knowledge to support youth through social transition to their affirmed gender identity. Content areas suggested for a future curriculum for parents of TNB youth included: basics of gender/sexuality, diverse narratives of TNB experiences/identities, gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, and resources for peer support. Parents desired access to accurate information and wanted to feel equipped to facilitate affirming conversations with their child, something that could combat health disparities among TNB youth. An educational curriculum for parents has the potential to provide a trusted information source, expose parents to positive representations of TNB individuals, and help parents support their TNB child through decisions about potential gender-affirming interventions.
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Affiliation(s)
- Lane Z Kantor
- David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA, 90095, USA.
| | - Diana M Tordoff
- Department of Epidemiology, Stanford University School of Medicine Palo Alto, Stanford, CA, USA
| | | | - Julia M Crouch
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kym R Ahrens
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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53
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Murawsky S. The struggle with transnormativity: Non-binary identity work, embodiment desires, and experience with gender dysphoria. Soc Sci Med 2023; 327:115953. [PMID: 37156019 DOI: 10.1016/j.socscimed.2023.115953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
I examine how non-binary people who have considered, or accessed, gender-affirming health care experience accountability to transnormativity using 12 in-depth interviews conducted between 2018 and 2019 in a midwestern American city. I detail how non-binary people who want to embody genders that are still largely culturally unintelligible think about identity, embodiment, and gender dysphoria. Using grounded theory methodology, I find that non-binary identity work around medicalization differs from that of transgender men and women in three primary ways: 1) regarding how they understand and operationalize gender dysphoria, 2) in relation to their embodiment goals, and 3) concerning how they experience pressure to medically transition. Non-binary people describe increased ontological uncertainty about their gender identities when researching gender dysphoria that is contextualized by an internalized sense of accountability to the transnormative expectation for medicalization. They additionally anticipate a potential medicalization paradox, where accessing gender-affirming care leads to a different type of binary misgendering and risks making their gender identities less, rather than more, culturally intelligible to others. Non-binary people also experience external accountability to transnormativity as pressure from trans and medical communities to think about dysphoria as inherently binaristic, embodied, and medically treatable. These findings indicate that non-binary people experience accountability to transnormativity differently than trans men and women. Since non-binary people and their body projects often disrupt the transnormative tropes that are the framework for trans medicine, they find trans therapeutics, and the diagnostic experience of gender dysphoria, uniquely problematic. Non-binary experiences of accountability to transnormativity indicate the need to re-center trans medicine to better accommodate non-normative embodiment desires and focus future diagnostic revisions of gender dysphoria to emphasize the social aspects of trans and non-binary experience.
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Affiliation(s)
- Stef Murawsky
- Department of Sociology, University of Cincinnati, Crosley Tower ML 0378, 301 Clifton Court, Cincinnati, OH, 45219, USA.
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54
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Conflitti AC, Spaziani M, Pallotti F, Tarsitano MG, Di Nisio A, Paoli D, Lombardo F. Update on bioethical, medical and fertility issues in gender incongruence during transition age. J Endocrinol Invest 2023:10.1007/s40618-023-02077-5. [PMID: 37071372 PMCID: PMC10371879 DOI: 10.1007/s40618-023-02077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the treatment of these patients to provide a practical approach for clinicians. METHODS A comprehensive literature search within PubMed was performed to provide updates of available evidence regarding the impact on bioethical, medical and fertility issues in gender incongruence during transition age. RESULTS Gender Affirming Hormone Treatment (GAHT) and Gender Affirming Surgery (GAS) can induce unsatisfaction with change, future regrets, and the risk of infertility. This raises ethical issues especially in the management of pubertal patients that remain unresolved. Therapy with GnRH analogues (GnRHa) is intended to delay puberty, so as to give the adolescent a longer period of time to decide whether to continue with the treatments. At the level of physical changes, this therapy may have an effect on bone mineralization and body composition; however, long-term longitudinal data are not yet available. An important feature related to the use of GnRHa is the risk of fertility. Gamete cryopreservation is the most established method of fertility preservation (FP) and should be counselled to transgender adolescents. However, these patients are not always interested in having biological children. CONCLUSION Based on the current evidence, there is a need to conduct further research to clarify certain issues and to standardize clinical practice and improve counselling in transgender adolescent decision making and avoid regrets in the future.
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Affiliation(s)
- A C Conflitti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Science, University Magna Graecia, Catanzaro, Italy
| | - A Di Nisio
- Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Padua, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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55
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Guzman-Parra J, Sánchez-Álvarez N, Guzik J, Bergero-Miguel T, de Diego-Otero Y, Pérez-Costillas L. The Impact of Stressful Life Events on Suicidal Ideation in Gender Dysphoria: A Moderator Effect of Perceived Social Support. Arch Sex Behav 2023:10.1007/s10508-023-02594-7. [PMID: 37069467 DOI: 10.1007/s10508-023-02594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
Factors associated with suicidal ideation in the gender dysphoria population are not completely understood. This high-risk population is more likely to suffer stressful events such as assault or employment discrimination. This study aimed to determine the association of stressful events and social support on suicidal ideation in gender dysphoria and to analyze the moderator effect of social support in relation to stressful events and suicidal ideation. A cross-sectional design was used in a clinical sample attending a public gender identity unit in Spain that consisted of 204 individuals (51.7% birth-assigned males and 48.3% birth-assigned females), aged between 13 and 59 (M = 27.95 years, SD = 9.58). A Structured Clinical Interview, a list of 16 stressful events, and a functional social support questionnaire (Duke-UNC-11) were used during the initial visits to the unit. The data were collected between 2011 and 2012. A total of 50.1% of the sample have had suicidal ideation. The following stressful events were associated with suicidal ideation: homelessness, eviction from home, and having suffered from physical or verbal aggression. Also, there was an inverse relation between perceived social support and suicidal ideation. There was a statistically significant interaction between a specific stressful event (eviction) and perceived social support. The study suggests that the promotion of safer environments could be related to lower suicidal ideation and that networks that provide social support could buffer the association between specific stressful events and suicidal ideation.
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Affiliation(s)
- Jose Guzman-Parra
- Biomedical Research Institute of Málaga (IBIMA). Mental Health Clinical Unit, University Regional Hospital of Málaga, Plaza Hospital Civil S/N, Hospital Civil. 1a Planta. Pabellón 4, 29009, Málaga, Spain
- Transsexual and Gender Identity Unit, University Regional Hospital of Málaga, Málaga, Spain
- Faculty of Psychology, University of Málaga, Málaga, Spain
- Grupo Andaluz de Investigación Psicosocial, Málaga, Spain
| | - Nicolás Sánchez-Álvarez
- Biomedical Research Institute of Málaga (IBIMA). Mental Health Clinical Unit, University Regional Hospital of Málaga, Plaza Hospital Civil S/N, Hospital Civil. 1a Planta. Pabellón 4, 29009, Málaga, Spain
- Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Justyna Guzik
- Faculty of Psychology, Adam Mickiewicz University, Poznań, Poland
| | - Trinidad Bergero-Miguel
- Biomedical Research Institute of Málaga (IBIMA). Mental Health Clinical Unit, University Regional Hospital of Málaga, Plaza Hospital Civil S/N, Hospital Civil. 1a Planta. Pabellón 4, 29009, Málaga, Spain
- Transsexual and Gender Identity Unit, University Regional Hospital of Málaga, Málaga, Spain
| | - Yolanda de Diego-Otero
- Biomedical Research Institute of Málaga (IBIMA). Mental Health Clinical Unit, University Regional Hospital of Málaga, Plaza Hospital Civil S/N, Hospital Civil. 1a Planta. Pabellón 4, 29009, Málaga, Spain.
- Grupo de Investigación. PAIDI CTS456, Málaga, Spain.
| | - Lucía Pérez-Costillas
- Biomedical Research Institute of Málaga (IBIMA). Mental Health Clinical Unit, University Regional Hospital of Málaga, Plaza Hospital Civil S/N, Hospital Civil. 1a Planta. Pabellón 4, 29009, Málaga, Spain
- Department of Public, Health and Psychiatry, Faculty of Medicine, University of Málaga, Málaga, Spain
- Grupo de Investigación. PAIDI CTS456, Málaga, Spain
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56
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Chao KY, Chou CC, Chen CI, Lee SR, Cheng W. Prevalence and Comorbidity of Gender Dysphoria in Taiwan, 2010-2019. Arch Sex Behav 2023; 52:1009-1017. [PMID: 36692628 PMCID: PMC10102133 DOI: 10.1007/s10508-022-02500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 05/11/2023]
Abstract
Gender dysphoria (GD) is a condition in which a person exhibits marked incongruence between their expressed or experienced gender and their sex assigned at birth. The last survey of individuals with GD in Taiwan was conducted approximately 10 years ago. In this study, we investigated the prevalence of GD in Taiwan within the last 10 years as well as comorbidities. A retrospective medical record review was performed for all patients in the database of the Health and Welfare Data Science Center covered by National Health Insurance in Taiwan from January 2010 until December 2019. The study population of persons with GD was defined as individuals who had been diagnosed with transsexualism (transgender or transsexual) or gender identity disorders. Our review found case numbers and prevalence of GD in 2019 were about twice that of patients in 2010 for both assigned males and assigned females at birth. Case numbers for 2010 versus 2019 were 440 versus 867 for assigned males at birth, and 189 versus 386 for assigned females at birth. The 1-year prevalence for 2010 versus 2019 was 3.8/100,000 versus 7.4/100,000 for assigned males at birth, and 1.6/100,000 versus 3.2/100,000 for assigned females at birth. Comorbidities of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and psychosis were more likely in children with GD younger than 12 years of age; comorbid depression was more likely in adolescents and adults with GD. Improvements in social and mental health support should be provided to help address these comorbidities of ADHD, ASD, and depression among individuals with GD.
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Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Sé, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Shu-Ru Lee
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Wei Cheng
- Department of Pathology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan.
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57
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Morandini JS, Kelly A, de Graaf NM, Malouf P, Guerin E, Dar-Nimrod I, Carmichael P. Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria? Arch Sex Behav 2023; 52:1045-1060. [PMID: 37014582 PMCID: PMC10101898 DOI: 10.1007/s10508-023-02588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
Social gender transition is an increasingly accepted intervention for gender variant children and adolescents. To date, there is scant literature comparing the mental health of children and adolescents diagnosed with gender dysphoria who have socially transitioned versus those who are still living in their birth-assigned gender. We examined the mental health of children and adolescents referred to the Gender Identity Development Service (GIDS), a specialist clinic in London, UK, who had socially transitioned (i.e., were living in their affirmed gender and/or had changed their name) versus those who had not socially transitioned. Referrals to the GIDS were aged 4-17 years. We assessed mental health correlates of living in one's affirmed gender among 288 children and adolescents (208 birth-assigned female; 210 socially transitioned) and of name change in 357 children and adolescents (253 birth-assigned female; 214 name change). The presence or absence of mood and anxiety difficulties and past suicide attempts were clinician rated. Living in role and name change were more prevalent in birth-assigned females versus birth-assigned males. Overall, there were no significant effects of social transition or name change on mental health status. These findings identify the need for more research to understand how social transition influences mental health, including longitudinal studies that allow for more confident inferences to be made regarding the relationship between social transition and mental health in young people with gender dysphoria.
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Affiliation(s)
- James S Morandini
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Aidan Kelly
- Gender Service Organization, Kelly Psychology, London, UK
| | - Nastasja M de Graaf
- Center of Expertise on Gender Dyphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Pia Malouf
- King Street Psychology Clinic, Newtown, Australia
| | - Evan Guerin
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
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58
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Wibowo E, Wong STS, Wassersug RJ, Johnson TW. Choosing Castration: A Thematic Analysis of the Perceived Pros and Cons of Genital Injuries and Ablation by Men Who Voluntarily Sought Castration. Arch Sex Behav 2023; 52:1183-1194. [PMID: 36327012 PMCID: PMC10102058 DOI: 10.1007/s10508-022-02434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Some men elect castration voluntarily without any clear medical reason. Here we aim to document their perception of genital ablation and injuries to better understand their motivations for castration. Participants completed an online survey with open-ended questions related to their perspectives on castration, genital ablation, and genital injuries. Thematic analyses were performed on the responses to these questions. Responses were obtained from 208 male castrated individuals (51.9 ± 16.0 years old). Among these, 154 were physically castrated, 36 chemically castrated, and 18 nullified (had testicles and penis removed). The majority learned about castration from media (55.8%) or animal castration (23.4%). The circumstances when they first wanted to be castrated varied greatly. Most (46.3%) wished to achieve an idealized self motivated by gender dysphoria, body integrity dysphoria, or wanting to be conspicuously non-sexual. The top themes we identified related to the respondents' perceptions of the pros of genital ablation were physical appearance, psychological benefit (i.e., a "eunuch calm"), and being non-sexual. Conversely, themes related to the cons they saw in having no genitals ranged from no disadvantages to loss of sexual/reproductive capability. Some perceived performing genital injury as a step toward ultimate castration or nullification. The respondents similarly varied in whether they saw any loss in having non-functional testicles. Perceptions in this regard appeared to differ depending on whether the respondents were taking supplemental androgens post-castration. Motivations for castration vary greatly between individuals. Clinicians need to understand men's diverse perceptions on castration in order to provide appropriate care for individuals with strong castration desire.
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Affiliation(s)
- Erik Wibowo
- Department of Anatomy, University of Otago, 270 Great King St., Dunedin, 9016, New Zealand.
| | - Samantha T S Wong
- Department of Educational and Counselling Psychology, McGill University, Montreal, PQ, Canada
| | - Richard J Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Thomas W Johnson
- Department of Anthropology (Emeritus), California State University, Chico, CA, USA
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Alaniz VI, Sheeder JL, Whitmore GT, Wilde MD, Hutchens KJ, Nokoff NJ, Reirden DH, Huguelet PS. Menstrual Suppression in Adolescent and Young Adult Transgender Males. J Pediatr Adolesc Gynecol 2023; 36:116-121. [PMID: 37938039 DOI: 10.1016/j.jpag.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe time to cessation of menses in adolescent and young adult transgender males with testosterone and/or other hormonal therapies DESIGN: Retrospective chart review SETTING: Tertiary children's hospital PARTICIPANTS: Patients, aged 10-24, who began gender-affirming hormonal therapy between January 2013 and January 2019 (n = 220) INTERVENTION(S): None MAIN OUTCOME MEASURE(S): Time to cessation of menses RESULTS: Most patients identified as transgender male or transmasculine (211/220, 95.9%), with an average age of 15.8 (±1.9) years. Approximately 53.6% (118/220) of patients reported regular menstrual cycles; 18.2% (40/220) reported irregular cycles. Median time to cessation of menses for all patients was 182 days. Patients treated with testosterone alone (n = 105) reported a median time to cessation of menses of 151 days. Patients who concurrently began testosterone and norethindrone acetate (NETA) (n = 5) had a median time to cessation of menses of 188 days, compared with 168 days for those on testosterone and depot medroxyprogesterone acetate (DMPA, n = 15). In 15 patients who began testosterone, a progestin therapy was later added to induce menstrual suppression, and the median time to cessation of menses was 168 days (+DMPA, n = 4) or 56 days (+NETA, n = 11). Patients treated with NETA (n = 14) or depot leuprolide (n = 11) reported a median time to cessation of menses of 78 days or 77 days, respectively. Considerable variability in prescribing patterns was noted in the remaining 36.4% of patients (n = 80). CONCLUSION Patients used a variety of different hormonal regimens for menstrual suppression. Less than half achieved cessation of menses within 6 months. NETA and depot leuprolide users reported the most rapid cessation of menses.
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Affiliation(s)
- V I Alaniz
- University of Colorado Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO
| | - J L Sheeder
- University of Colorado Department of Obstetrics and Gynecology, Aurora, CO
| | - G T Whitmore
- University of Colorado Department of Obstetrics and Gynecology, Aurora, CO
| | - M D Wilde
- University of Colorado Department of Obstetrics and Gynecology, Aurora, CO
| | - K J Hutchens
- University of Colorado Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO
| | - N J Nokoff
- University of Colorado Department of Pediatrics, Section of Endocrinology, Aurora, CO
| | - D H Reirden
- University of Colorado Department of Pediatrics, Section of Adolescent Medicine, Aurora, CO
| | - P S Huguelet
- University of Colorado Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Aurora, CO.
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60
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Genovese AC, Singh SC, Casubhoy I, Hellings JA. Gender Diverse Autistic Young Adults: A Mental Health Perspective. Arch Sex Behav 2023; 52:1339-1343. [PMID: 36287303 DOI: 10.1007/s10508-022-02443-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 05/11/2023]
Abstract
Gender diverse autistic young adults often face mental health challenges which can increase the challenge of obtaining gender-affirming care. Social and communication differences associated with autism compounds the already complex process of navigating a path toward gender affirmation for individuals with these intersecting identities. In this case series of four gender diverse autistic adults, we demonstrate that success in management of their mental health crises was achieved through enlisting family and social support, obtaining effective mental health treatment, and accessing gender-affirming healthcare. These cases selected from two neuropsychiatric outpatient tertiary referral clinics demonstrate that effective mental health treatment supports ultimate success for these individuals in their journeys toward living as the gender with which they identify. We conclude that healthcare practices and treatment recommendations which incorporate internationally recognized standards of care guidelines for gender diverse individuals improve patient outcomes.
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Affiliation(s)
- Ann C Genovese
- Department of Psychiatry and Behavioral Sciences, University of Kansas Health System, 3901 Rainbow Blvd., MS 4015, Kansas City, KS, 66160, USA.
| | - Saras Chen Singh
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Imaima Casubhoy
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jessica A Hellings
- Department of Psychiatry, University of Missouri-Kansas City, Kansas City, MO, USA
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61
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Diaz S, Bailey JM. Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases. Arch Sex Behav 2023; 52:1031-1043. [PMID: 36991212 PMCID: PMC10102036 DOI: 10.1007/s10508-023-02576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 05/11/2023]
Abstract
During the past decade there has been a dramatic increase in adolescents and young adults (AYA) complaining of gender dysphoria. One influential if controversial explanation is that the increase reflects a socially contagious syndrome: Rapid Onset Gender Dysphoria (ROGD). We report results from a survey of parents who contacted the website ParentsofROGDKids.com because they believed their AYA children had ROGD. Results focused on 1655 AYA children whose gender dysphoria reportedly began between ages 11 and 21 years, inclusive. These youths were disproportionately (75%) natal female. Natal males had later onset (by 1.9 years) than females, and they were much less likely to have taken steps toward social gender transition (65.7% for females versus 28.6% for males). Pre-existing mental health issues were common, and youths with these issues were more likely than those without them to have socially and medically transitioned. Parents reported that they had often felt pressured by clinicians to affirm their AYA child's new gender and support their transition. According to the parents, AYA children's mental health deteriorated considerably after social transition. We discuss potential biases of survey responses from this sample and conclude that there is presently no reason to believe that reports of parents who support gender transition are more accurate than those who oppose transition. To resolve controversies regarding ROGD, it is desirable that future research includes data provided by both pro- and anti-transition parents, as well as their gender dysphoric AYA children.
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Affiliation(s)
| | - J Michael Bailey
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL, 60208, USA.
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62
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Li Y, Zheng L. Validation of Two Measures of Gender Dysphoria/Incongruence in Transgender and Cisgender Populations in China. Arch Sex Behav 2023; 52:1019-1030. [PMID: 36596906 DOI: 10.1007/s10508-022-02517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 05/11/2023]
Abstract
This study examined gender dysphoria (GD) in transgender and cisgender populations in China and aimed to provide validity evidence for two dimensional measures of GD. A total of 293 transgender people (170 transmen, 65 transwomen, and 58 non-binary trans people; mean age, 21.3 years) and 538 cisgender people (296 ciswomen and 242 cismen; mean age, 23.5 years) completed the Utrecht Gender Dysphoria Scale (UGDS), the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), and demographic information online. The UGDS and the GIDYQ-AA had good reliability and validity for the Chinese population. Transgender people reported higher intensity of GD than cisgender people. Cisgender women reported higher intensity of GD than cisgender men. Non-binary transgender people reported lower intensity than binary transgender people. However, transmen reported higher intensity than transwomen for the UGDS but not for the GIDYQ-AA. Transgender people with gender-affirming hormonal treatment experience reported higher intensity of GD than those without treatment. Moreover, transgender people coming out to parents reported higher intensity than those who did not. The cutoff values of the UGDS and the GIDYQ-AA in the original version show high sensitivity for transgender people and specificity for cisgender people. Our findings indicate that the UGDS and the GIDYQ-AA are validated measures of GD in China.
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Affiliation(s)
- Yuqi Li
- Faculty of Psychology, Southwest University, Beibei District, No. 2, Tiansheng Road, Chongqing, 400715, China
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
| | - Lijun Zheng
- Faculty of Psychology, Southwest University, Beibei District, No. 2, Tiansheng Road, Chongqing, 400715, China.
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China.
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63
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Shen WCV, Shen BH. Partial Regret After Gender Affirmation Surgery of a 35-Year-Old Taiwanese Transgender Woman. Arch Sex Behav 2023; 52:1345-1351. [PMID: 36253559 DOI: 10.1007/s10508-022-02442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Gender-affirming surgery (GAS) is often sought after to alleviate the distress of those who suffer from gender dysphoria (GD). While many studies have shown that a significant percentage of people benefit from this procedure, a number of individuals later regret their decision of undergoing surgery. Studies have illustrated what regret depicts, categorizing regret based on intensity, persistency, and sources, in the hopes to prevent an unwanted irreversible intervention. Here, an in-depth interview with a 35-year-old transwoman from Taiwan who underwent feminizing GAS at the age of 31 illustrates her unique cultural upbringing and the course of her regret. Her experience best matches the characteristics of true regret and major regret based on the classifications of Pfäfflin and Wiepjes, respectively, indicating that she expected GAS to be the solution to her personal acceptance issue, but, in retrospect, regretted the diagnosis and treatment as her problems were not solved and worsened to the extent of secondary dysphoria. This case report hopes to shed light on the complexity of GD and regret after GAS, while encouraging the pre-surgical evaluation of psychological comorbidities and post-surgical psychotherapy, and ensuring that patients are informed and give full consent. In addition, more elaborate, long-term, large-scale qualitative research, especially within more conservative cultural settings, is needed.
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Affiliation(s)
- Wei-Chi V Shen
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Bing-Hwei Shen
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei City, 11221, Taiwan.
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64
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Bouzy J, Brunelle J, Cohen D, Condat A. Transidentities and autism spectrum disorder: A systematic review. Psychiatry Res 2023; 323:115176. [PMID: 36996732 DOI: 10.1016/j.psychres.2023.115176] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
Transidentity and autism frequently co-occur. Previous reviews have focused mainly on frequencies. Here, we conducted a systematic review to condense all the studies and themes on this co-occurrence and to offer a global view. We followed the PRISMA method and selected 77 articles (including 59 clinical studies) in April 2022. We found 5 main themes (sex ratio, theories, sexual orientation, clinical and social consequences, and care implications) in addition to frequencies. Many theories have been proposed to explain the co-occurrence. One posits that social difficulties related to autism would lead to less identification with gender norms and less pressure to conform to these norms, allowing for greater gender diversity in people with autism. Given their difficulties with social interactions and communication, the announcement of one's transidentity to one's social group is often discredited, increasing the risk of suffering and delayed care. Many reports reaffirm the importance of providing specialised care for transgender people with autism. Autism is not a contraindication for gender-affirming treatment. However, some cognitive specificities can affect the planning of care, and transgender people with autism are at high risk of discrimination and harassment. We conclude that there is a need to raise awareness about gender and autism.
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Affiliation(s)
- Juliette Bouzy
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Julie Brunelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France.
| | - Agnès Condat
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; UR14 "Santé et droits sexuels et reproductifs", Ined, Paris, France
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65
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Mason A, Crowe E, Haragan B, Smith S, Kyriakou A. Gender Dysphoria in Young People: A Model of Chronic Stress. Horm Res Paediatr 2023; 96:54-65. [PMID: 34673639 DOI: 10.1159/000520361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gender dysphoria (GD) refers to the distress that may accompany gender incongruence, often heightened at the onset of puberty, with the development of secondary sex characteristics. Children and adolescents may be especially vulnerable to severe stressors, including GD, with potentially irreversible effects if these exposures occur during critical periods of development and brain maturation. SUMMARY We describe the evidence for GD as a chronic stressor, drawing parallels to other established models of stress, activating both innate psychological and biological stress responses. As well as being an inherently distressing experience, a person who experiences GD may also experience minority stress. Minority stress has been demonstrated in young people who experience GD with higher rates of social rejection and internalized stigma and shame. The biological stress response in young people with GD is illustrated through the activation of the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and pro-inflammatory response. The number of young people who report experiencing GD has increased exponentially worldwide in the past decade, demanding a change in the clinic infrastructure. Paediatric endocrinologists and specialists in mental health work together to both support psychosocial well-being and offer individualized treatment to align the phenotype with gender identity with the aim of alleviating the distress of GD. Medical interventions may include puberty suppression and gender-affirming hormones. Ongoing monitoring is required prior to initiation and during treatment to ensure that the goals of treatment are being achieved.
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Affiliation(s)
- Avril Mason
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
| | - Eimear Crowe
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Beccy Haragan
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Simon Smith
- Young People's Gender Service, Sandyford Services, Glasgow, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.,Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
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66
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Cohen A, Gomez-Lobo V, Willing L, Call D, Damle LF, D'Angelo LJ, Song A, Strang JF. Shifts in Gender-Related Medical Requests by Transgender and Gender-Diverse Adolescents. J Adolesc Health 2023; 72:428-436. [PMID: 36529618 PMCID: PMC9974924 DOI: 10.1016/j.jadohealth.2022.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/12/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Gender-affirming hormones and/or surgeries seeking to change the body can have potentially lasting effects. Changes in requests for these therapies among gender-diverse youth are not well-understood. The study aim is to characterize factors associated with shifts in gender-related medical requests. METHODS This mixed-methods study used retrospective chart review and qualitative interviews with clinicians. Of 130 youth receiving clinical gender care at Children's National Hospital, 68 met inclusion criteria. Qualitative interview analysis was performed to identify patterns and themes around shifts in gender-related medical requests over time. Statistical analysis employed chi-square and t-tests to compare characteristics in the shift versus no-shift groups and kappa statistics to calculate qualitative coding agreement. RESULTS Of the 68 youth followed over time (mean age 15.11 years, 47% autistic, 22% nonbinary), 20 (29%) reported a shift in request. No significant differences were found by age, autism status, or designated sex at birth. More youth with shifts were nonbinary (p = .012). Six shift profiles were identified from qualitative interviews with excellent reliability (κ = 0.865). Four of the profiles reflect shifts in request prior to starting treatment (85% sample); two involved shifts after commencing treatment (15%). The most common profile reflected a medical request that was made, withdrawn, and re-requested (45%). DISCUSSION Shifts in gender-affirming medical requests by gender-diverse youth may not be uncommon during the adolescent's gender discernment process, and may more likely occur among nonbinary youth. Many individuals who experience shifts away from medical treatment may later resume the request.
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Affiliation(s)
- Ariel Cohen
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland; Department of Surgery, Children's National Hospital, Washington, DC; Department of Pediatric and Adolescent Gynecology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Washington, DC.
| | - Veronica Gomez-Lobo
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland; Department of Surgery, Children's National Hospital, Washington, DC
| | - Laura Willing
- Gender Development Program, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC
| | - David Call
- Gender Development Program, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC
| | - Lauren F Damle
- Department of Surgery, Children's National Hospital, Washington, DC; Department of Women and Infant Services, MedStar Washington Hospital Center, Washington, DC
| | - Lawrence J D'Angelo
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Divisions of Adolescent and Young Adult Medicine, George Washington University School of Medicine, Washington, DC
| | - Amber Song
- Gender Development Program, Children's National Hospital, Washington, DC; Division of Neuropsychology, Center for Autism Spectrum Disorders, Children's National Hospital, Washington, DC; Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC
| | - John F Strang
- Gender Development Program, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC; Division of Neuropsychology, Center for Autism Spectrum Disorders, Children's National Hospital, Washington, DC; Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC
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67
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Jha S, Bouman WP. Introduction to healthcare for transgender and gender-diverse people. Best Pract Res Clin Obstet Gynaecol 2023; 87:102299. [PMID: 36702654 DOI: 10.1016/j.bpobgyn.2022.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
This editorial provides a broad introduction to transgender health for transgender and gender-diverse people. Following a brief description of the history of transgender and gender-diverse people, the development of medical treatment is discussed, together with the use of appropriate terminology and language. The content largely draws attention to the guidance in the Standards of Care for the Health of Transgender and Gender Diverse People Version 8 developed by the World Professional Association for Transgender Health (WPATH) and published in 2022. Further key areas addressed are as follows. • The use of names and pronouns. • Population estimates of transgender and gender diverse people. • Diagnostic classification systems in transgender health. • A wide range of gender-affirming medical interventions, including hormones and surgeries. • Ethical considerations for research with transgender and gender diverse populations.
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Affiliation(s)
- Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Level 4, Jessop Wing, Tree Root Walk, Sheffield. S10 2SF, UK; Honorary Professor School of Medicine, University of Sheffield, UK.
| | - Walter Pierre Bouman
- Nottingham National Centre for Transgender Health, 12 Broad Street, Nottingham NG1 3AL, UK; Honorary Professor School of Medicine, University of Nottingham, UK.
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68
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Stolk THR, Asseler JD, Huirne JAF, van den Boogaard E, van Mello NM. Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 87:102312. [PMID: 36806443 DOI: 10.1016/j.bpobgyn.2023.102312] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The decision to pursue one's desire for children is a basic human right. For transgender and gender-diverse (TGD) people, gender-affirming care may alter the possibilities to fulfill one's desire for children due to the impact of this treatment on their reproductive organs. We systematically included 76 studies of varying quality describing the desire for children and parenthood; fertility counseling and utilization; and fertility preservation options and outcomes in TGD people. The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation. The most utilized fertility preservation strategies include oocyte vitrification and sperm banking through masturbation. Oocyte vitrification showed successful outcomes, even after testosterone cessation. Sperm analyses when banking sperm showed a lower quality compared to cis male samples even prior to gender-affirming hormone treatment and an uncertain recovery of spermatogenesis after discontinuing treatment.
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Affiliation(s)
- T H R Stolk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J D Asseler
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J A F Huirne
- Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - E van den Boogaard
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - N M van Mello
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
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69
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Cipres DT, Shim JY, Grimstad FW. Postoperative Vaginal Bleeding Concerns after Gender-Affirming Hysterectomy in Transgender Adolescents and Young Adults on Testosterone. J Pediatr Adolesc Gynecol 2023; 36:33-38. [PMID: 36089115 DOI: 10.1016/j.jpag.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE This study aimed to characterize the incidence and management of postoperative vaginal bleeding concerns experienced by transgender adolescents and young adults (AYA) on testosterone hormone therapy after gender-affirming hysterectomy (GAH). METHODS This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care children's hospital. The incidence of patient-reported postoperative vaginal bleeding concerns and management of bleeding are described. RESULTS Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or operative characteristics reached statistical significance in association with postoperative bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding without intervention. Among 11 patients who underwent an exam for evaluation of bleeding, findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%). CONCLUSIONS Over half of transgender AYA on testosterone therapy in this cohort reported postoperative vaginal bleeding concerns that were most often secondary to atrophy and granulation tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding could worsen gender dysphoria, these findings support the need for patient counseling on postoperative bleeding expectations and identification of interventions to reduce vaginal bleeding after GAH.
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Affiliation(s)
- Danielle T Cipres
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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70
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van der Sluis WB, Schäfer T, Nijhuis THJ, Bouman MB. Genital gender-affirming surgery for transgender women. Best Pract Res Clin Obstet Gynaecol 2023; 86:102297. [PMID: 36599721 DOI: 10.1016/j.bpobgyn.2022.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Transgender women may opt for genital gender-affirming surgery (gGAS), which comprises bilateral orchiectomy, gender-affirming vulvoplasty, or vaginoplasty. Vaginoplasty is chosen most frequently in this population, penile inversion vaginoplasty being the surgical gold standard. In selected cases, skin graft vaginoplasty, intestinal vaginoplasty, or peritoneal vaginoplasty may be indicated. In this article, we discuss the various types of gGAS for transgender women, (contra)-indications, intraoperative considerations, techniques, surgical outcomes, and postoperative patient-reported outcomes.
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Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Gender Clinic, Bosch en Duin, the Netherlands.
| | - Tim Schäfer
- Gender Clinic, Bosch en Duin, the Netherlands; Department of Plastic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Tim H J Nijhuis
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Gender Clinic, Bosch en Duin, the Netherlands; Amsterdam Public Health (APH) Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
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71
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Timmermans FW, Elfering L, Steensma TD, Bouman MB, van der Sluis WB. Mastectomy is a safe procedure in transgender men with a history of breast reduction. J Plast Surg Hand Surg 2023; 57:483-487. [PMID: 36621980 DOI: 10.1080/2000656x.2022.2164293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Little is known about the safety and surgical outcomes of mastectomy after breast reduction in the trans male population. Several concerns have been voiced that performing mastectomy with prior breast reduction surgery, increases the risk for complications and revision surgery. All transgender men with a history of breast reduction, who underwent a mastectomy at our center between 01-1990 and 01-2021 were identified from our hospital registry. A retrospective chart study was conducted recording surgical characteristics, surgical complications, revision surgery, and clinical follow-up. A total of 1362 subcutaneous mastectomies were performed between 01-1990 and 01-2021. A total of 36 (2.6%) individuals were included (35 bilateral and 1 unilateral breast reduction). The mean age at mastectomy was 37 ± 10 years, and the median time between breast reduction and mastectomy was 6.3 years (range 1.0-31.1). Most individuals underwent a Wise-pattern breast reduction (91%) and a double incision mastectomy with free nipple grafts (86%). Following mastectomy, one acute reoperation was performed because of hemorrhage (3%). Partial pedicled nipple necrosis was seen in 7% and (partial) non-take of nipple grafts in 4%. Scar revisions were performed in 9%, dogear corrections in 20%, and both nipple corrections, and contour corrections in 6%. When comparing the outcomes in literature for surgical complications, scar revision, contour correction or nipple areolar complex revision, no clear disadvantage seems to be present when performing mastectomy after breast reduction. Mastectomy is a safe procedure in transgender men with a history of breast reduction.
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Affiliation(s)
- Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lian Elfering
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Amsterdam Movement Sciences Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
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72
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Tirrell AR, Chang BL, Perez-Alvarez IM, Dekker PK, Kim KG, Fan KL, Del Corral G. Selecting a chest masculinization plastic surgeon: a survey of transgender patients. Eur J Plast Surg 2023; 46:1-9. [PMID: 36624821 PMCID: PMC9813877 DOI: 10.1007/s00238-022-02020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/06/2022] [Indexed: 01/06/2023]
Abstract
Background Chest masculinization is a commonly performed gender-affirming procedure in transmasculine and non-binary patients and has increased in prevalence in recent years despite continued barriers to surgical care. With the expansion of insurance coverage and trained surgeons, patients at times have the opportunity to be selective in choosing their gender-affirming surgeon. This study aimed to investigate factors that transmasculine individuals consider important when selecting their chest masculinization plastic surgeon. Methods All patients who underwent chest masculinization with a single surgeon between January 2018 and December 2021 were surveyed via an online questionnaire to rate 21 factors associated with surgeon selection. Multiple-choice questions and free text space were included to further clarify patient preferences. Results were analyzed to rate factors in order of importance. Results One hundred three individuals completed the survey, generating a response rate of 49.5%. Average patient age at time of surgery was 27.0 years, and 2.0% of patients had prior gender affirmation surgery (GAS). The top five most important factors were surgeon specialization in GAS, insurance coverage, board certification, number of times surgeon has performed procedure, and availability of Before and After photographs. The five least important factors were age of surgeon, medical publications, availability of YouTube videos, location of training, and surgeon presence on social media. Conclusions Transmasculine patients employ distinct criteria when selecting a chest masculinization gender-affirming plastic surgeon. An improved understanding of these factors informs providers of ways to enhance patient access to information and gender-affirming care.Level of evidence: Not gradable.
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Affiliation(s)
- Abigail R. Tirrell
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, NW 20007 USA
| | - Brian L. Chang
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, NW 20007 USA
| | - Idanis M. Perez-Alvarez
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL USA
| | - Paige K. Dekker
- Division of Plastic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA USA
| | - Kevin G. Kim
- Department of Plastic Surgery, Hansjörg Wyss, New York University Langone Health, New York, NY USA
| | - Kenneth L. Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, NW 20007 USA
| | - Gabriel Del Corral
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, NW 20007 USA
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Lee WG, Butler G, Carmichael P, Rashid T, Yasmin E, Morley R, Barrett J, Christopher N, Sangster P. Urological and Gynaecological Considerations for the Use of Gonadotropin-releasing Hormone Analogues in Transgender and Nonbinary Adolescents: A Narrative Review. Eur Urol Focus 2023; 9:35-41. [PMID: 36396559 DOI: 10.1016/j.euf.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT Gonadotropin-releasing hormone analogues (GnRHAs) delay the progression of puberty in transgender and nonbinary (TGNB) adolescents and reduce the impact of dysphoria due to ongoing physical development. The intervention remains contentious despite growing evidence to support this practice. OBJECTIVE To stimulate discussion on this topical issue in the urological and gynaecological community given potential ramifications for future fertility, physical development, and options for gender affirmation surgery (GAS). EVIDENCE ACQUISITION We conducted searches of the MEDLINE (from 1946) and Embase (from 1974) databases for the benefits and potential challenges of hormone blockade in TGNB adolescents on February 1, 2022. Evidence with a primary focus on clinical issues of interest to urologists and gynaecologists was objectively synthesised and reported. EVIDENCE SYNTHESIS The onset of puberty represents a period of distress for TGNB adolescents as secondary sexual characteristics develop. GnRHAs are prescribed to inhibit sex hormone production, but the decision to treat should be balanced against the known (and unknown) adverse effects. Fertility preservation is more likely to be successful if GnRHA treatment is delayed for as long as possible. Some adolescents may decide to stop GnRHA use to harvest spermatozoa or oocytes before starting gender-affirming hormone treatment. Transfeminine individuals should consider that options for genital GAS may become more limited, as vaginoplasty with penile skin inversion requires an adequate stretched penile length. Transmasculine individuals may no longer require chest reconstruction for breast development. CONCLUSIONS Offers of GnRHA treatment to TGNB adolescents should be balanced by careful preparation and counselling. Urologists and gynaecologists can complement the expertise of specialist psychosocial and adolescent endocrinology teams, and should be involved early in and throughout the treatment pathway to maximise future functional and surgical outcomes. PATIENT SUMMARY Puberty blockers for transgender and nonbinary adolescents have benefits, but timing is important to preserve fertility and surgical options.
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Heng YJ, Zhang KJ, Valero MG, Baker GM, Fein-Zachary VJ, Irwig MS, Wulf GM. Invasive Ductal Carcinoma of the Breast in a Transgender Man: A Case Report. Case Rep Oncol 2023; 16:811-817. [PMID: 37900827 PMCID: PMC10601725 DOI: 10.1159/000529859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 10/31/2023] Open
Abstract
There is limited literature about breast cancer in the transgender population. Very little is known about how gender-affirming hormone therapy affects their breast cancer risk. On the other end, for those diagnosed with breast cancer, there are no clinical guidelines to manage their breast cancer, specifically, how to manage their gender-affirming hormone therapy during breast cancer treatment. Here, we report a 52-year-old transman diagnosed with a grade 2 invasive ductal carcinoma (ER+/PR+/HER2-), and ductal carcinoma in situ (DCIS) of intermediate grade. We discussed his risk factors as well as treatment options.
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Affiliation(s)
- Yujing J. Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kevin J. Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Monica G. Valero
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gabrielle M. Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valerie J. Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael S. Irwig
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerburg M. Wulf
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
There is significant disagreement about how to support trans-identified or gender-dysphoric young people. Different experts and expert bodies make strikingly different recommendations based upon the same (limited) evidence. The US-originating "gender-affirmative" model emphasizes social transition and medical intervention, while some other countries, in response to evidence reviews of medical intervention outcomes, have adopted psychological interventions as the first line of treatment. A proposed model of gender-affirming care, comprising only medical intervention for "eligible" youth, is described in Rosenthal (2021). Determining eligibility for these medical interventions is challenging and engenders considerable disagreement among experts, neither of which is mentioned. The review also claims without support that medical interventions have been shown to clearly benefit mental health, and leaves out significant risks and less invasive alternatives. The unreliability of outcome studies and the corresponding uncertainties as to how gender dysphoria develops and responds to treatment are also unreported.
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Affiliation(s)
- J Cohn
- Society for Evidence-based Gender Medicine (SEGM), Twin Falls, ID, USA
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76
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Hasan S, Khan A. Gender Dysphoria and its associated hurdles in Pakistan. Eur Neuropsychopharmacol 2022; 65:52-3. [PMID: 36343428 DOI: 10.1016/j.euroneuro.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
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Dasaraju S, Klein ME, Murugan P, Farooqui M, Khalifa MA. Microscopic Features of Vaginectomy Specimens from Transgender Patients. Am J Clin Pathol 2022; 158:639-645. [PMID: 36208153 DOI: 10.1093/ajcp/aqac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We aimed to better understand the histologic changes in vaginectomy specimens in transgender and gender-diverse (TGD) individuals after prolonged androgen administration. METHODS After obtaining institutional review board approval, we reviewed clinical records for all TGD individuals who underwent vaginal tissue resection at our institution between January 2002 and July 2020. RESULTS Ten transgender males who underwent vaginectomy for gender affirmation were identified. All patients had been assigned female gender at birth, and the median age at surgery was 41 years (range, 22-74 years). All 10 patients had received androgen for 2 to 10 years preoperatively. The corresponding pathology specimens were examined grossly and microscopically, including with immunohistochemical stains for NKX3.1, prostate-specific antigen (PSA), p501s, and androgen receptor (AR). No gross lesions were identified. Microscopically, prostate-like glands (8/10), urothelial metaplasia (4/10), and vaginal atrophy (8/10) were identified. Seven cases with prostate-like glands showed positive staining with PSA, NKX3.1, p501s, and AR in both squamous and glandular components. CONCLUSIONS Recognition of these androgen-related changes enables pathologist to avoid the overdiagnosis of dysplasia. Long-term follow-up is needed to thoroughly understand any potential future implications of these androgen-related changes.
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Affiliation(s)
- Sandhyarani Dasaraju
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Molly E Klein
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mariya Farooqui
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mahmoud A Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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78
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Karvonen M, Karukivi M, Kronström K, Kaltiala R. The nature of co-morbid psychopathology in adolescents with gender dysphoria. Psychiatry Res 2022; 317:114896. [PMID: 37732850 DOI: 10.1016/j.psychres.2022.114896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 10/31/2022]
Abstract
Gender-referred adolescents (GR) have been reported to present with considerable psychiatric symptomatology compared to their age-peers. There is, however, little research on how they compare to adolescents referred due to mental health problems (MHR). We set out to compare psychopathology in adolescents referred to our specialized gender identity unit (n = 84) and adolescents referred to a general adolescent psychiatric clinic (n = 293) in a university hospital setting in Finland. Of the GR adolescents, 40.9% had not received any psychiatric diagnosis during adolescence. Eating disorders were less common in the GR than in the MHR group, but otherwise the prevalences of disorders did not differ statistically significantly. At the symptom level, the GR adolescents displayed significantly more suicidal ideation and talk and less alcohol abuse and eating disorder symptoms than did the MHR adolescents, but otherwise their symptom profiles were comparable. Additionally, the GR adolescents had significantly fewer total externalizing symptoms than did the MHR adolescents. Adolescents seeking gender affirming treatments present with psychiatric symptoms and disorders comparable to those seen among adolescent psychiatric patients. Medical gender affirming care may not be a sufficient intervention for treating psychiatric comorbidities of adolescents with gender dysphoria.
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Affiliation(s)
- M Karvonen
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland.
| | - M Karukivi
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - K Kronström
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - R Kaltiala
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Vanha Vaasa Hospital, Vaasa, Finland
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79
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Mazzoli F, Cassioli E, Ristori J, Castellini G, Rossi E, Cocchetti C, Romani A, Angotti T, Giovanardi G, Mosconi M, Lingiardi V, Speranza AM, Ricca V, Vignozzi L, Maggi M, Fisher AD. Apparent autistic traits in transgender people: a prospective study of the impact of gender-affirming hormonal treatment. J Endocrinol Invest 2022; 45:2059-2068. [PMID: 35779204 PMCID: PMC9525411 DOI: 10.1007/s40618-022-01835-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated differences in Autism Spectrum Quotient (AQ) scores between a sample of hormone-naïve transgender and cisgender people and the impact of gender-affirming hormonal treatment (GAHT) on AQ scores across time. Furthermore, we assessed alexithymia and social anxiety as possible mediators of changes in AQ scores. METHODS A cross-sectional comparison between cisgender and transgender people before GAHT and a prospective study on the effects of GAHT over time were performed. Transgender and cisgender people completed several psychometric tests. A total sample of 789 persons (n = 229 cismen; n = 172 ciswomen; n = 206 transmen; n = 182 transwomen) referring to the Florence and Rome Gender Clinics between 2018 and 2020 was enrolled. Of these, 62 participants referring to the Florence Gender Clinic were evaluated in a prospective study at baseline and 12 months after GAHT. RESULTS Groups showed significant differences in terms of autistic traits: ciswomen showed lower scores of AQ, while cismen reported higher scores of AQ than all other groups. Transgender individuals showed significant higher levels of Gender Dysphoria (GD), body uneasiness, alexithymia and social anxiety, compared to cisgender ones. No significant differences in general psychopathology were found between groups. Across time, transmen and transwomen showed a significant reduction in AQ scores. The decrease in alexithymia and social anxiety after GAHT did not predict the change in AQ scores. CONCLUSIONS The autistic traits in our sample may represent an epiphenomenon of GD rather than being part of an Autism Spectrum Disorder (ASD) condition, since they significantly decreased after 12 months of GAHT.
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Affiliation(s)
- F Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - E Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - G Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - E Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - A Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - T Angotti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - G Giovanardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - M Mosconi
- Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - V Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A M Speranza
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - V Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence University Hospital, Florence, Italy.
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy.
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80
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Arnoldussen M, Hooijman EC, Kreukels BP, de Vries AL. Association between pre-treatment IQ and educational achievement after gender-affirming treatment including puberty suppression in transgender adolescents. Clin Child Psychol Psychiatry 2022; 27:1069-1076. [PMID: 35638479 PMCID: PMC9574895 DOI: 10.1177/13591045221091652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concerns exist regarding effects of puberty suppression on neurodevelopment. Intelligence is strongly correlated with educational achievement in the general population. This study aimed to examine the association between pre-treatment intelligence and educational achievement after gender-affirming treatment including puberty suppression in transgender adolescents to contribute to the emerging understanding of the effect that gender-affirming treatment including puberty suppression may have on cognitive development. METHODS IQ was measured in 72 adolescents (45 trans boys, 27 trans girls) at clinical entry (mean age 12.78 years), educational achievement was evaluated after gender-affirming treatment (mean age 20.40 years). RESULTS IQ pre-treatment and educational achievement post-treatment were positively associated (Nagelkerke R = 0.71). DISCUSSION The association between IQ pre-treatment and educational achievement post-treatment in transgender adolescents who received gender-affirming medical treatment including puberty suppression appears to be similar to the general population. This may reflect that gender-affirming medical treatment including puberty suppression does not negatively affect the association between IQ and educational achievement.
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Affiliation(s)
- Marijn Arnoldussen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Evelien C Hooijman
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Baudewijntje Pc Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdams, Netherlands
| | - Annelou Lc de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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81
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Kauffman RP, Guerra C, Thompson CM, Stark A. Concordance for Gender Dysphoria in Genetic Female Monozygotic (Identical) Triplets. Arch Sex Behav 2022; 51:3647-3651. [PMID: 36044128 DOI: 10.1007/s10508-022-02409-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The biopsychosocial etiology of gender dysphoria is poorly understood, but current thought suggests a complex interaction of genetic, hormonal, environmental, and differences in brain development and physiology. Twin studies have implicated a genetic role in the formation of gender identity. Congruence for gender dysphoria is more common among monozygotic twins compared to dizygotic twins. We present a case of monozygotic (identical) triplets who have each transitioned from female to male under the care of a university transgender health service. Each triplet experienced gender dysphoria from childhood and has undergone transitional endocrine care and various aspects of gender-affirming surgery. Although a pure genetic or biological component cannot be attributed as a cause of their gender dysphoria with absolute certainty since the triplets were raised together, this unusual case of gender dysphoria among a set of monozygotic triplets adds support for a heritable role in gender identity formation.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine, 1400 S. Coulter St., Amarillo, TX, 79106, USA.
| | - Carly Guerra
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, USA
| | | | - Amy Stark
- Department of Psychiatry, Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, USA
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Revuelta Fernández AI, Fernández Rodríguez M, Guerra Mora P, García Vega E. [Sociodemographic comparative between the periods 2007-2009 and 2015-2019 of the Gender Identity Treatment Unit of Asturias]. Rev Int Androl 2022; 20:249-56. [PMID: 35933292 DOI: 10.1016/j.androl.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/30/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The high demand of assistance made by trans people in recent years has directed the focus of research towards the study of their clinical and sociodemographic aspects. The objective of this work was to compare and analyze some sociodemographic variables in trans people in two periods: the period when the unit began to operate and the most recent period. MATERIALS AND METHOD A sample of 131 users who attended the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) between 2015-2019 was compared with a sample of 33 who attended between 2007-2009. Data were extracted from medical records. RESULTS Regarding 2007-2009, in 2015-2019 the ratio is inverted in favor of Trans Men (TM). Users of both genders request consultation at an earlier age (specially TM), come less from abroad, achieve higher educational and work qualifications, are less unemployed and request more name changes. And, although Trans Women (TW) continue to be those who are mostly engaged in prostitution and self-administration of hormones, in the most recent period they report it less and, furthermore, they live more accompanied tan in the past. CONCLUSIONS Changes are observed in the sociodemographic variables of UTIGPA users between 2007-2009 and 2015-2019, in the direction of a greater inclusion. However, the sociodemographic conditions of the TW are still at a disadvantage in comparison to those of the TM.
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83
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Khadr S, Masic U, Clarke V, Lynn RM, Holt V, Carmichael P. Key socio-demographic characteristics of children and adolescents with gender dysphoria: A British Isles surveillance study. Clin Child Psychol Psychiatry 2022; 27:1106-1123. [PMID: 35746847 DOI: 10.1177/13591045221108840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present research used linked surveillance systems (British Paediatric Surveillance Unit; and the Child and Adolescent Psychiatry Surveillance System) over a 19 month period (1 November 2011-31 May 2013) to notify of young people (4-15.9 years) presenting to secondary care (paediatrics or child and adolescent mental health services) or specialist gender services with features of gender dysphoria (GD). A questionnaire about socio-demographic, mental health, and GD features was completed. Presence of GD was then assessed by experts in the field using then-current criteria (DSM-IV-TR). Incidence across the British Isles was 0.41-12.23 per 100,000. 230 confirmed cases of GD were noted; the majority were white (94%), aged ≥12 years (75.3%), and were assigned female at birth (57.8%). Assigned males presented most commonly in pre-adolescence (63.2%), and assigned females in adolescence (64.7%). Median age-of-onset of experiencing GD was 9.5 years (IQR 5-12); the majority reported long-standing features (2-5 years in 36.1%, ≥5 years in 26.5%). Only 82.5% attended mainstream school. Bullying was reported in 47.4%, previous self-harm in 35.2%, neurodiversity in 16%, and 51.5% had ≥1 mental health condition. These findings suggest GD is rare within this age group but that monitoring wellbeing and ensuring support for co-occurring difficulties is vital.
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Affiliation(s)
- Sophie Khadr
- Institute of Child Health, 11700University College London, London, UK
| | - Una Masic
- Gender Identity Development Service, 9705Tavistock and Portman NHS Trust, London, UK
| | - Venetia Clarke
- Institute of Child Health, 11700University College London, London, UK
| | - Richard M Lynn
- Institute of Child Health, 11700University College London, London, UK
| | - Victoria Holt
- Child and Adolescent Mental Health Service, 158987Royal Free Hospital, London, UK
| | - Polly Carmichael
- Gender Identity Development Service, 9705Tavistock and Portman NHS Trust, London, UK
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84
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Anderson D, Wijetunge H, Moore P, Provenzano D, Li N, Hasoon J, Viswanath O, Kaye AD, Urits I. Gender Dysphoria and Its Non-Surgical and Surgical Treatments. Health Psychol Res 2022; 10:38358. [PMID: 36168640 PMCID: PMC9501960 DOI: 10.52965/001c.38358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
Gender dysphoria is defined by severe or persistent distress associated with an incongruence between one's gender identity and biological sex. It is estimated that 1.4 million Americans and 25 million people worldwide identify as transgender and that 0.6% of Americans experience gender dysphoria. The pathophysiology of gender dysphoria is multifactorial and incompletely understood. Genetics, androgen exposure, neuroanatomy, brain connectivity, history of trauma, parents with psychological disorders, and being raised by less than two parents are associated with gender dysphoria. Gender dysphoria most frequently presents in early teenage years but can present earlier or later. Anxiety and depression are the two most common comorbid diagnoses and may be the reason for presentation to medical care. Diagnosis is established through history and or validated questionnaires. Treatment includes psychosocial therapy, pharmacotherapy for underlying depression and/or anxiety, hormonal therapy, non-genital and/or genital feminization or masculinization operations. The frequency and severity of treatment related morbidity increases progressively as treatments go from conservative to more invasive. Gender dysphoria and its treatment is individualized and not completely understood.
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Affiliation(s)
| | - Himasa Wijetunge
- School of Medicine, Louisiana State University Health Sciences Center
| | - Peyton Moore
- School of Medicine, Louisiana State University Health Science Center
| | - Daniel Provenzano
- School of Medicine, Louisiana State University Health Sciences Center
| | - Nathan Li
- Medical School, Medical College of Wisconsin
| | - Jamal Hasoon
- Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- School of Medicine, Louisiana State University Health Sciences Center
| | - Alan D Kaye
- School of Medicine, Louisiana State University Health Sciences Center
| | - Ivan Urits
- School of Medicine, Louisiana State University Health Sciences Center
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Abstract
Medical treatment for adolescents with gender dysphoria has attracted considerable attention in recent years, with continuing court involvement in Australia and recent judicial review proceedings in the UK. In Re Imogen [No 6], the Family Court of Australia held that an application to the Family Court is mandatory if a parent or a medical practitioner of an adolescent diagnosed with gender dysphoria disputes the diagnosis, the adolescent's capacity to consent, or the proposed treatment. In this article, we examine the Family Court's rationale for preserving its welfare jurisdiction in gender dysphoria cases. We analyse case law developments in Australia and more recently in the UK and identify a thread of judicial discomfort in gender dysphoria jurisprudence about adolescents consenting to medical treatment that the court perceives to be 'innovative', 'experimental', 'unique', or 'controversial'. We explore whether treatment for gender dysphoria can be characterised as 'innovative' and identify four factors that appear to be influencing courts in Australia and the UK. We also consider how such a characterisation might impact (if at all) on an adolescent's capacity to consent to gender dysphoria treatment. We critique the ongoing role of courts in these cases and recommend a robust decision-making framework for gender dysphoria treatment to minimise court involvement in the future.
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Affiliation(s)
| | - Georgina Dimopoulos
- Swinburne Law School, Swinburne University of Technology, Hawthorn, Australia
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86
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Clayton A, Malone WJ, Clarke P, Mason J, D'Angelo R. Commentary: The Signal and the Noise-questioning the benefits of puberty blockers for youth with gender dysphoria-a commentary on Rew et al. (2021). Child Adolesc Ment Health 2022; 27:259-262. [PMID: 34936180 DOI: 10.1111/camh.12533] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
This commentary is a critique of a recent systematic review of the evidence for the use of puberty blockers for youth with gender dysphoria (GD) by Rew et al. (2021). In our view, the review suffers from several methodological oversights including the omission of relevant studies and suboptimal analysis of the quality of the included studies. This has resulted in an incomplete and incorrect assessment of the evidence base for the use of puberty blockers. We find that Rew et al.'s conclusions and clinician recommendations are problematic, especially when discussing suicidality. A key message of the review's abstract appears to be that puberty blockers administered in childhood reduce adult suicidality. However, the study used for the basis of this conclusion (Turban et al., 2020) did not make a causal claim between puberty blockers and decreased adult suicidality. Rather, it reported a negative association between using puberty blockers and lifetime suicidal ideation. The study design did not allow for determination of causation. Our commentary concludes by demonstrating how the GD medical literature, as it moves from one publication to the next, can overstate the evidence underpinning clinical practice recommendations for youth with GD.
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Affiliation(s)
| | - William J Malone
- Department of Medicine, Idaho College of Osteopathic Medicine, Boise, ID, USA
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Rew L, Young CC, Monge M, Bogucka R. Response: "The Signal and the Noise"-a response to Clayton et al. (2021). Child Adolesc Ment Health 2022; 27:263-264. [PMID: 34927341 DOI: 10.1111/camh.12534] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
The purpose of this response is to clarify points about the steps we took in a systematic review of the literature and to reaffirm our findings.
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Affiliation(s)
- Lynn Rew
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Cara C Young
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Maria Monge
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Roxanne Bogucka
- Life Science Library, The University of Texas at Austin, Austin, TX, USA
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88
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Schwartz BI, Effron A, Bear B, Short VL, Eisenberg J, Felleman S, Kazak AE. Experiences with Menses in Transgender and Gender Nonbinary Adolescents. J Pediatr Adolesc Gynecol 2022; 35:450-456. [PMID: 35123055 DOI: 10.1016/j.jpag.2022.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/19/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To describe menstrual history, associated dysphoria, and desire for menstrual management in transgender male and gender diverse adolescents who were assigned female at birth DESIGN: Retrospective chart review SETTING: Tertiary care children's hospital PARTICIPANTS: All patients seen in a multidisciplinary pediatric gender program from March 2015 through December 2020 who were assigned female at birth, identified as transgender male or gender nonbinary, and had achieved menarche INTERVENTION: None MAIN OUTCOME MEASURES: Patient demographics, menstrual history, interest in and prior experiences with menstrual management, parental support, and concerns about menstrual management RESULTS: Of the 129 included patients, 116 (90%) identified as transgender male and 13 (10%) as gender nonbinary, with an average age of 15 (SD 1.6) years. Almost all (93%) patients reported menstrual-related dysphoria. Most (88%) were interested in menstrual suppression. The most common reasons for desiring suppression were achievement of amenorrhea (97%) and improvement of menstrual-related dysphoria (63%). CONCLUSIONS Most gender diverse patients assigned female at birth reported dysphoria associated with menses and desired menstrual suppression. This information can encourage physicians to raise this topic and offer menstrual management for gender diverse patients who experience distress related to menses, especially for those who are not ready for or do not desire gender-affirming hormonal treatment. Future research is needed to better understand patients' experiences with menses and to determine the optimal menstrual management methods. This could be an important intervention to improve outcomes for this vulnerable population.
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Affiliation(s)
- Beth I Schwartz
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Hospital, Wilmington, Delaware.
| | - Arielle Effron
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin Bear
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware
| | - Vanessa L Short
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julia Eisenberg
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah Felleman
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware; Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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89
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Westwater JJ, Riley EA, Peterson GM. A nationwide survey of individual family member experiences of youth gender dysphoria and diversity in Australia. Int J Transgend Health 2022; 24:447-460. [PMID: 37901059 PMCID: PMC10601499 DOI: 10.1080/26895269.2022.2104417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background Previous research has highlighted that youth gender dysphoria (GD) and gender diversity (GDI) are experienced in unique ways by different family members, with youth outcomes significantly influenced by family support and understanding. Few studies on a national level have explored individual family member experiences, specifically family, social and healthcare experiences, involving young people, parent/carers and siblings. Aims Using an online survey incorporating circular questioning, this study sought to discover individual family member experiences of youth GD/GDI in Australia, within a family, healthcare, and social context. Methods Young people experiencing GD/GDI, parents/carers and siblings were recruited through Facebook advertising and completed an online survey, exploring positive and negative experiences of youth GD/GDI, within and outside of the family. Survey questions predominantly used Likert scales, with free-text fields, enabling both quantitative and qualitative data analysis. Results Six hundred and sixty young people aged 12-17 years experiencing GD/GDI, 158 parents/carers ranging in age from under 30 years to more than 60 years (most common age band was 40-49 years; 62%), and 40 siblings aged 12-17 years completed at least part of the online survey. Participants reported mixed experiences of youth GD/GDI with varying levels of understanding and support provided by family members and others. Parents and siblings generally felt it important for healthcare professionals to ask everyone's experience in the family, although only one-third of young people felt this was important. Most parents and young people also highlighted the importance of sibling support. Conclusion The majority of young people felt misunderstood by other family members. Most family members, particularly young people, reported different viewpoints within families and primarily negative experiences. The research findings support sibling inclusion in healthcare appointments in certain circumstances, depending on context, and a whole of family approach overall, if agreeable to the family and unlikely to cause harm.
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Mahmoud R, Arbel S, Shuster A, Ianculovici C, Peleg O, Kleinman S. Intraoperative blood loss and the need for preoperative blood preparations in transgender women undergoing facial feminization surgeries: implications for surgeons. Int J Oral Maxillofac Surg 2022; 52:72-78. [PMID: 35717281 DOI: 10.1016/j.ijom.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
The aim of this retrospective study was to assess blood loss during facial feminization surgeries and to evaluate blood transfusion requirements. Data from the medical records of all male-to-female transgender patients (transwomen) treated with gender affirming hormones and undergoing facial feminization surgeries were analysed. The total blood loss was calculated based on the haemoglobin balanced method. Twenty transwomen (average age of 25.9 years) were enrolled. Group 1 included 10 transwomen who underwent cranioplasty, genioplasty, and mandibular angles refining, group 2 included six transwomen who underwent cranioplasty and genioplasty, and group 3 included four transwomen who underwent mandibular angles refining and genioplasty. The median calculated blood loss for groups 1, 2, and 3 was 1159.7 ml, 828.5 ml, and 546.2 ml, respectively. The group differences in surgical time, intraoperative fluid amounts, and calculated blood loss volumes were significant. None of the patients required an intraoperative blood transfusion and the hormonal treatment had no effect on the amount of calculated blood loss. Hence, blood loss during facial feminization surgeries is well controlled and does not lead to life-threatening events, precluding the possibility of providing generalized recommendations for preoperative blood transfusion preparations.
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Affiliation(s)
- R Mahmoud
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - S Arbel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Ianculovici
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Peleg
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Kleinman
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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91
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Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM. Is It Autism? A Critical Commentary on the Co-Occurrence of Gender Dysphoria and Autism Spectrum Disorder. J Homosex 2022; 69:1204-1221. [PMID: 33852376 DOI: 10.1080/00918369.2021.1905385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An increasing amount of literature revealed a link between GD and ASD. Both GD and ASD are complex and heterogeneous conditions characterized by a large variety of presentations. Studies have reported that individuals with GD tend to have higher prevalence rates of autistic traits in comparison to the general population. The purpose of this commentary is to provide, through the description of a clinical case, our reading and a possible interpretation of the correlation of these two conditions in light of the several methodological limitations found in literature. We hypothesize that the traits often classified as autistic could be more accurately related to the distress and discomfort evoked by GD. The autistic traits of individuals with GD as forms of psychological defenses and coping mechanisms aimed at dealing with socio-relational and identity problems are discussed.
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Affiliation(s)
- Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Guido Giovanardi
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Eleonora Innocenzi
- Department of Letters and Philosophy, "Tor Vergata," University of Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Giorgio Caviglia
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
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92
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Grimstad F, Moyer Q, Williams CR, Kremen J. A Body-Neutral and Gender-Neutral Modified Ferriman-Gallwey Diagram. J Pediatr Adolesc Gynecol 2022; 35:375-378. [PMID: 34748917 DOI: 10.1016/j.jpag.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The modified Ferriman-Gallwey (mFG) diagram for scoring hirsutism uses images with traditionally Eurocentric feminine features. No reports have documented its utility in patients with other gender identities. CASE A 16-year-old nonbinary masculine patient, assigned female sex at birth, was seen for hyperandrogenism and irregular menses. They declined an exam, citing body dysphoria, and declined self-documenting on the mFG diagram, expressing anxiety with gendered images. We subsequently developed a novel, gender-inclusive mFG diagram, which the patient was then comfortable using to document their hair pattern. SUMMARY AND CONCLUSION This case documents how the binary gendered characteristics of the mFG diagram can impact the care of patients. As gender expression is highly individual, we created the first gender-inclusive version of the mFG diagram to enhance care for all patients.
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Affiliation(s)
- Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | | | - Coleen R Williams
- Department of Psychology, Harvard Medical School, Boston, Massachusetts; Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Jessica Kremen
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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93
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Milionis C, Ilias I, Koukkou E. Progesterone in gender-affirming therapy of trans women. World J Biol Chem 2022; 13:66-71. [PMID: 35721880 PMCID: PMC10558402 DOI: 10.4331/wjbc.v13.i3.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Progesterone is an endogenous steroid hormone with an important role for the physiology of the female reproductive system and the mammary gland. It has additional significant actions in other tissues, such as the cardiovascular system, the central nervous system, and bones. The present article explores potential clinical implications from the addition of bioidentical progesterone to gender-affirming treatment of trans women. For this purpose, it provides an overview of the physiological action of progesterone in target tissues and speculates on possible benefits for gender transitioning. Progesterone is expected to exert moderate anti-androgen action through suppression of the hypothalamic-pituitary-gonadal axis and inhibition of the conversion of testosterone to dihydrotestosterone. It may also contribute to breast maturation. In the long-term, progesterone could prevent bone loss and protect cardiovascular health. The potential benefits are mainly inferred by extrapolating evidence from biological actions in cisgender women and medical assumptions and hence, clinicians need to be cautious when applying these data into practice. Further research is needed to ascertain the efficacy and safety of progesterone in current hormonal regimens.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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94
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Kallitsounaki A, Williams DM. Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis. J Autism Dev Disord 2022:10.1007/s10803-022-05517-y. [PMID: 35596023 DOI: 10.1007/s10803-022-05517-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
The suggested overlap between autism spectrum disorder (ASD) and gender dysphoria/incongruence (GD/GI) has been much disputed. This review showed a relationship between ASD traits and GD feelings in the general population and a high prevalence of GD/GI in ASD. Our meta-analyses revealed that the pooled estimate of the prevalence of ASD diagnoses in GD/GI people was 11% (p < .001) and the overall effect size of the difference in ASD traits between GD/GI and control people was significant (g = 0.67, p < .001). Heterogeneity was high in both meta-analyses. We demonstrated that the chances that there is not a link between ASD and GD/GI are negligible, yet the size of it needs further investigation.
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Affiliation(s)
- Aimilia Kallitsounaki
- School of Psychology, University of Kent, Keynes College, CT2 7NP, Canterbury, Kent, United Kingdom.
| | - David M Williams
- School of Psychology, University of Kent, Keynes College, CT2 7NP, Canterbury, Kent, United Kingdom
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95
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Regnerus M, Vermurlen B. Attitudes in the U.S. Toward Hormonal and/or Surgical Interventions for Adolescents Experiencing Gender Dysphoria. Arch Sex Behav 2022; 51:1891-1902. [PMID: 35089461 DOI: 10.1007/s10508-021-02214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 06/14/2023]
Abstract
In order to align with their inner sense of gender identity, adolescents suffering from gender dysphoria are increasingly being treated with cross-sex hormones and irreversible surgeries to alter their bodies. The present study is the first to examine attitudes about these recently emergent medical practices in a national population. We used data from the 2018 Post-Midterm Election Study, a survey representative of adults in the USA ages 20 to 65 years (N = 5285), to examine the social factors associated with approval or disapproval of hormonal and/or surgical interventions for adolescents seeking medical treatment for gender dysphoria. Higher fertility, race/ethnicity (in this case, black), sex (male), and heterosexual self-identity were each robustly associated with disapproval. Nested regression models revealed that a range of religion measures were statistically significant (toward disapproval). However, all but evangelical self-identification were no longer significant after accounting for support for abortion rights, the spectrum of political self-identification, and voting behavior. These findings, prompted by a high percentage of variance explained, led us to consider perspectives on medical transitions for adolescents as fitting the "culture war" framework, largely polarized between a "progressive" worldview of bodily autonomy and an "orthodox" worldview of bodily integrity.
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Affiliation(s)
- Mark Regnerus
- Department of Sociology, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Brad Vermurlen
- Department of Sociology, The University of Texas at Austin, Austin, TX, 78712, USA.
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96
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Schaeff C. Assigned-Female-at-Birth Trans Masculine and Non-Binary Individuals Differ in Their Body Satisfaction and Desire for Gender Affirming Treatments. Arch Sex Behav 2022; 51:2037-2047. [PMID: 35099654 DOI: 10.1007/s10508-021-02178-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/20/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Abstract
Many non-binary individuals physically affirm their gender, but the binary/non-binary component of gender identity is rarely reported, and when it is, assigned-male- and assigned-female-at-birth individuals are often grouped together. We compared the experience of assigned-female-at-birth trans masculine and non-binary individuals via an anonymous online survey and found that patterns of overall body satisfaction and strength of intention to modify the body support the idea that the lower engagement in physical affirmation by non-binary individuals reflects less need to undergo body modifications. Trans masculine and non-binary participants who had had at least one gender affirming treatment (GAT) mostly identified as trans and expressed a similar ranking of GAT preferences. In contrast, non-physically affirmed cohorts differed in strength of intention to modify their body, desired GAT and the proportion who identified as trans, with more than a third of non-physically affirmed non-binary individuals not wanting any GAT and a third wanting GAT without testosterone. Several participants who did not want testosterone used female-based identifiers suggesting that some non-binary individuals use GAT to defeminize rather than masculinize their bodies. Individuals' orientation to the binary/non-binary and trans/non-trans dimensions of identity appears connected to their strength of motivation to physically affirm and their preferred outcomes but there is ambiguity in the usage of the terms. We need to explore what these terms mean to a given individual if we are to support them as they make decisions about whether and how to modify their body to affirm their gender.
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Affiliation(s)
- Catherine Schaeff
- Department of Biology, Hall of Science, American University, 4400 Mass. Ave. N.W, Washington, DC, 20016, USA.
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97
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Talaei A, Hedjazi A, Badieyan Moosavi N, Dadgarmoghaddam M, Lotfinejad N, Khorashad BS. The Epidemiology of Gender Dysphoria in Iran: The First Nationwide Study. Arch Sex Behav 2022; 51:1881-1889. [PMID: 35511409 DOI: 10.1007/s10508-021-02250-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
Gender dysphoria (GD) is defined as a persistent and distressful incongruence between one's gender identity and one's at-birth-assigned sex. Sex reassignment has been religiously accepted for transgender individuals in postrevolutionary Iran since 1987; however, very little is known about how many individuals seek and receive such treatment annually. This study provides the first nationwide effort to assess the prevalence of GD in Iran as a function of diagnosis. The medical records of all transgender individuals referred to the Iranian Legal Medicine Organization between March 2012 and March 2017 were reviewed. All individuals diagnosed with GD were contacted. A total of 839 medical records meeting study criteria were received and evaluated. The prevalence of transgender individuals was estimated to be 1.46 per 100,000 Iranians with a transwoman (TW)/ transman (TM) ratio of 1:2. The mean age of individuals with GD at the time of referral was 25.22 (SD = 6.25) years for TW and 25.51 (SD = 5.66) years for TM. The findings are twofold. First, gender dysphoria is less prevalent in Iran than has been reported in Western countries. Second, the sex ratio is skewed toward at-birth-assigned females, which differs from what has been reported in Western countries. These findings have been interpreted in light of Iran's legal system, which is based on Islamic penal codes. These findings are of utmost importance for both health providers and legislators, as it can illustrate a more accurate picture of the transgender population in Iran.
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Affiliation(s)
- Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arya Hedjazi
- Legal Medicine Research Center, Legal Medicine Organization, Sanabad Street, Mashhad, 91386-15916, Iran
| | - Nazilla Badieyan Moosavi
- Legal Medicine Research Center, Legal Medicine Organization, Sanabad Street, Mashhad, 91386-15916, Iran.
| | - Maliheh Dadgarmoghaddam
- Community Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasim Lotfinejad
- Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad S Khorashad
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Division of Pediatric Psychology and Child Health Evaluation and Research Center, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
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98
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Lindley L, Anzani A, Galupo MP. Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals. Arch Sex Behav 2022; 51:2049-2063. [PMID: 35449364 DOI: 10.1007/s10508-021-02242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.
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Affiliation(s)
- Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Annalisa Anzani
- Department of Psychology, University of Milano, Bicocca, Italy
| | - M Paz Galupo
- Department of Psychology, Towson University, 8000 York Road, Towson, MD, 21252, USA.
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99
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Abstract
OBJECTIVE Gender dysphoria (GD) is characterized by distress due to inconsistency between gender identity and biological sex. Individuals with GD often desire to be the other gender, which is called transgender. Although altered brain volumes in transgender people, particularly transgender women, have been reported, the particular brain regions have been inconsistent among studies. This study aimed to investigate neuroanatomical differences in transgender men without physical interventions. METHOD T1-weighted magnetic resonance images (MRIs) were acquired in 21 transgender men and 21 cisgender women matched for biological sex and age. Whole-brain comparisons using voxel-based morphometry (VBM) were performed to identify gray matter volume (GMV) differences between transgender men and cisgender women. RESULTS Transgender men showed greater GMV in the right posterior cingulate gyrus (PFWE-corr = 3.06×10-6) and the left occipital pole (PFWE-corr = 0.017) and lower GMV in the left middle temporal gyrus (PFWE-corr = 0.017) than cisgender women. Even after including serum sex hormone levels as covariates, the posterior cingulate gyrus was still significant (PFWE-corr < 0.05). In contrast, the occipital pole and the middle temporal gyrus were not significant after controlling for the sex hormone levels (PFWE-corr > 0.05), especially affected by testosterone but not estradiol. CONCLUSION These findings suggest that transgender men have altered brain structure. We suggest that larger posterior midline structures may contribute to sensitivity to self-referential processing through altered visual perception in transgender people.
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Affiliation(s)
- Taku Fukao
- Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazutaka Ohi
- Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshiki Shioiri
- Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Gifu, Japan
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Gavazzi G, Fisher AD, Orsolini S, Bianchi A, Romani A, Giganti F, Giovannelli F, Ristori J, Mazzoli F, Maggi M, Viggiano MP, Mascalchi M. The fMRI correlates of visuo-spatial abilities: sex differences and gender dysphoria. Brain Imaging Behav 2022; 16:955-964. [PMID: 35384549 PMCID: PMC9010387 DOI: 10.1007/s11682-022-00638-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
The contribution of brain regions to visuospatial abilities according to sex differences and gender identity is inconsistently described. One potential explaining factor may be the different tasks employed requiring a variable load of working memory and other cognitive resources. Here we asked to 20 cis and 20 transgender participants to undergo functional Magnetic Resonance Imaging during performance of a judgement line of orientation test that was adapted to explore the basic visuospatial processing while minimizing the working memory load. We show that V1 activation may be viewed as a brain area with enhanced activation in males, regardless of participants’ gender identity. On its turn, gender identity exclusively influences the visuospatial processing of extrastriate visual areas (V5) in women with gender dysphoria. They showed enhanced V5 activation and an increased functional connectivity between V5 and V1. Overall our neuroimaging results suggest that the basic visuospatial abilities are associated with different activations pattern of cortical visual areas depending on the sex assigned at birth and gender identity.
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Affiliation(s)
| | - Alessandra Daphne Fisher
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Stefano Orsolini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Andrea Bianchi
- Neuroradiology Unit, "Careggi" University Hospital, Florence, Italy
| | - Alessia Romani
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Fiorenza Giganti
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Via San Salvi, 12, 50135, Florence, Italy
| | - Fabio Giovannelli
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Via San Salvi, 12, 50135, Florence, Italy
| | - Jiska Ristori
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesca Mazzoli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Maria Pia Viggiano
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Via San Salvi, 12, 50135, Florence, Italy.
| | - Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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