[The problem of the use of hormonal therapy aimed for sex correction by transgender persons on their own initiative]

White Matter Microstructure Among Straight and Gay Cisgender Men, Sao Praphet Song, and Straight Cisgender Women in Thailand

White matter (WM) microstructure is differentiated in relation to sex/gender, psychosexuality, and, among transgender people, gender-affirming hormone (GAH) use. Prior research focused on Western samples, which limits generalizability to other populations. Here, diffusion tensor imaging (DTI) was used to assess WM microstructure in a Thai sample (N = 128) of straight cisgender men, straight cisgender women, gay cisgender men, and sao praphet song (i.e., transfeminine individuals assigned male at birth and sexually attracted to cisgender men). Sao praphet song were further grouped by GAH use. Groups were compared on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) using whole-brain tract-based spatial statistics (TBSS). FA, AD, and RD were further examined via multivariate analysis to assess covariance across WM microstructural indices and participant groups. A significant multivariate pattern differentiated the feminine- from masculine-identifying groups irrespective of sex assigned at birth and suggested WM tissue organization was greater among the latter in the bilateral cingulum, anterior corona radiata, left corpus callosum, and right superior longitudinal fasciculus, forceps minor, and corticospinal tracts. TBSS analyses reinforced that WM differed by gender identity in various regions. Among sao praphet song, GAH use was associated with lower regional FA, suggesting less WM organization bilaterally in the corpus callosum, cingulum, and anterior corona radiata. The findings aligned with prior studies in Western samples, indicating cross-population generalizability of WM microstructural differentiation in relation to sex/gender, psychosexuality, and GAH use.

Access to gender-affirming hormonal therapy in Russia: perspectives of trans people and endocrinologists

Purpose

Worldwide, trans people are known to take hormones without prescription or take higher or lower doses than prescribed. The study's goal was examination of the social context behind provision and receiving of gender-affirming hormonal therapy (GAHT) in Russia, as well as collection of opinions on the organization of healthcare.

Methods

Semi-structured interviews with 20 trans individuals and 6 endocrinologists.

Results

Trans respondents started GAHT between 2004 and 2022. Over that period, the number of trans-competent endocrinologists increased and it became easier to receive the diagnosis F64.0 "transsexualism" (ICD-10), which qualifies one to obtain GAHT. However, the majority still took hormones without supervision. The reasons for self-medication included: the lack of the diagnosis, high cost of appointments and tests, age under 18, and self-perceived understanding of principles of GAHT. Most endocrinologists learnt about GAHT after being approached by a trans patient. They received information from advanced training courses and academic literature. The specialists had diverse opinions on the ideal policy of providing GAHT to trans people, but all claimed that in Russian political realities they found the diagnosis "transsexualism" a necessary prerequisite for initiating GAHT to safeguard both doctors and patients.

Conclusions

The lack of strict law enforcement in the pharmacological sphere in Russia enabled many trans people to initiate GAHT without supervision. Trans-competent endocrinologists were available for those who needed them. Under current political circumstances it is unlikely that the informed consent model (prescription without a psychiatric diagnosis) can be implemented in Russia.

Mental health, minority stress and discrimination against transgender people: a cross-sectional survey in Russia

Mental health needs of transgender people in Russia remain unmet and stigmatised as in many other countries around the globe. The aim of this study was to assess the stressors and perceived need for mental health care among transgender people in Russia. A structured online survey was conducted in November 2019. A total of 588 transgender adults (mean age: 24.0 ± 6.7) was included in the final analysis. An overwhelming majority of respondents (95.1%) reported stress in their lives. Financial burden (73.5%), relationships with relatives (59.4%), and intimate relationships (37.9%) were among the most frequently reported sources of stress. Most of respondents (71.8%) indicated that the psychological distress they perceived interfered with their ability to lead a fulfilling social life. More than half of the respondents (52.4%) had visited a mental health professional prior to their gender transition. Virtually half of them (49%) reported problems related to seeking mental healthcare attributed to stigma. Over one third (37.8%) reported taking non-prescription or off-label medications to improve their well-being or mood. Our study confirmed high rates of psychiatric problems in this vulnerable group and problems in help-seeking. The article also discusses the challenges of providing psychiatric care to transgender people in Russia.