Male-to-female transgenders demonstrated unique perspectives on perceived facial attractiveness and orthognathic surgery need

PURPOSE

The esthetic preference and decision concerning undergoing orthognathic surgery in the transgender population have not been reported. The aims of this study were to examine the influence of the sagittal mandibular position on the esthetic perception and perceived surgery need in male-to-female transgenders (MTFTs) compared with male and female laypeople.

MATERIALS AND METHODS

A questionnaire study was performed by male-to-female transgender, male and female laypeople. Three-dimensional black & white male and female facial images with facial contour angle (FCA) of 3°, 1°, 5°, 9°,13°, 17°, and 21° were shown to the participants. The participants scored the images' perceived facial attractiveness using visual analog scales (VAS) and indicated whether orthognathic surgery was needed.

RESULTS

The participants included 85 MTFTs, 85 males, and 85 females. The results revealed that there were significant differences in the VAS scores between the MTFT and male participants. The MTFTs rated the male images with prognathism of 1° and -3°FCA in significantly lower scores compared with the males (P = 0.033, P = 0.010). Female images with prognathism 1°FCA was rated by the MTFTs in significantly lower scores compared with the males (P = 0.041). A significantly higher number of surgery needs was found in the MTFTs compared with the other groups.

CONCLUSIONS

Gender influences esthetic perception and the decision to undergo orthognathic surgery. MTFTs have a unique perspective on facial esthetics, being more desirous of surgery than males and females. Clinicians should be aware of the ideal expectation in facial esthetics in MTFTs.

F-Chin/Feminizing the Chin: A Genioplasty Technique with Virtual Planning for Male-to-Female Transgender Patients

The chin is an essential structure in facial harmony and an important gender marker. Advancing a receding chin is fundamental to improve the facial appearance, particularly in male-to-female transgender patients. However, in patients with microgenia and/or retrognathia, desiring a more feminine appearance, a chin advancement can result in a wider, square shape; an undesirable effect. Genioplasty is a versatile procedure used in facial feminization surgery that allows modifying the natural anatomy of the chin in all three spatial dimensions. The technique herein described proposes a simple genioplasty procedure for feminizing the chin (F-chin genioplasty) in transgender patients where anteroposterior advance is required. Virtual planning was used to establish the landmarks for an anteroposterior advancement with transverse reduction in the chin. A perpendicular line to the Frankfurt plane passing through the incisal edge of the upper central incisor was used to plan the anteroposterior movement, and two vertical lines on the outer wall of the nasal cavity  for the chin transverse measurement. The authors present three case reports with the F-chin genioplasty transgender technique with satisfactory results, ensuring a more feminine facial appearance.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Raising the alarm: Mental health status of the transgender community in Pakistan

In Pakistan, the transgender community faces many challenges. Transgender identity is considered taboo and people tend to distance themselves from them without knowing their issues. They face difficulties seeking education, jobs, and even basic human rights. They also face violence and social exploitation. Due to the lack of support from their family members, they're more prone to develop psychological problems and suicidality. Trans rights are human rights - the purpose of our paper is to expose the dire state of mental health of the transgender community in Pakistan on an international platform. We aim to bring a global concern to this problem because we hope that it will spur the relevant authorities to take steps to mitigate the current situation. Special attention should be paid to the protection and education of transgender individuals. If they're suffering from any psychiatric disorder, healthcare professionals should be there to help them.

Assessment of oral health status and treatment needs of HIV positive transgenders in Odisha - a cross-sectional study

Introduction

Human Immunodeficiency virus (HIV) causes the human immunodeficiency infection which is a major global health problem. Oral health status of people infected by HIV is also compromised. There is limited literature on oral health status of HIV/AIDS transgenders in Odisha.

Aim

This study was conducted to assess the oral health status of HIV-positive transgenders.

Methodology

A cross-sectional study was conducted among the HIV positive transgenders in Odisha. Snowball sampling technique was employed to reach the population. Oral health was recorded using modified WHO 2013 proforma. Clinical examination using disposable mouth mirror and explorer. Chi square statistics was used for finding the association between the socio-demographic variables and DMFT, CPI, and LOA scores.

Results

The study included 153 participants out of which seventy participants belonged to the age group 18-30 years. Majority of the participants were unemployed and most of them had spent around 6-10 years in school. Majority of the participants used toothbrush for cleaning their teeth and the average duration of cleaning tooth was less than two minutes. Toothpick was the most common method used for cleaning interdental areas and none of the participants used dental floss or interdental brushes. The mean DMFT score which was recorded to be 1.424. Around 28.10% (43) inmates had pockets of depth 4 mm to 5 mm. Loss of attachment of 6 mm to 8 mm was found in majority (57, 37.25%) of the participants. Most of the participants did not require any prosthesis both in the upper and lower arches. Around 32 participants (20.91%) had very mild fluorosis, 29 participants (18.95%) exhibited signs of moderate fluorosis. Age was found to be significantly associated with loss of attachment score (p = 0.023). Occupation had an association with the DMFT score (p = 0.002) while years in school was found to be significantly associated with CPI score (p = 0.045).

Conclusion

The oral health status of transgenders is poor and needs immediate attention.

Stroke in Male-to-Female Transgenders: A Systematic Review and Meta-Analysis

BACKGROUND

The effect of hormonal therapy has been extensively studied in women. However, similar data on male-to-female (MTF) transgenders, another important population that receives hormonal therapy is lacking. Existing studies in MTF transgenders are skewed toward mental health and health-harming behaviors while few have focused on chronic health conditions. Our study aims to review the existing data on stroke in MTF transgenders and perform a quantitative analysis on the frequency of this condition in this special population.

METHODS

PubMed, Cochrane, Scopus, Embase, ClinicalTrials.gov, and Web of Science were systematically searched for studies that reported data on the occurrence of cerebrovascular diseases in MTF transgenders. We reported the hormonal regimens, clinical characteristics, and outcomes of stroke in MTF transgenders. A meta-analysis of proportions was performed by the random-effects model to compute for the frequency of cerebrovascular events in MTF transgenders.

RESULTS

Fourteen studies were included in the qualitative analysis while five studies were included in the quantitative analysis. A total of 109 MTF transgenders (Mean 14; range 1-53) suffered a cerebrovascular event. Random-effect modeling analysis showed an overall estimated frequency of 2% for cerebrovascular events in transgenders with a moderate degree of heterogeneity (I2 = 62%).

CONCLUSION

Hormonal therapy in MTF transgenders may confer cardiovascular risks in this population. However, more population-based studies that include clinical characteristics and outcomes of chronic health diseases in MTF transgenders are warranted. Such studies may be crucial in directing future guidelines on the health care and management of MTF transgenders.

Influence of Sexual Genotype and Gender Self-Perception on Sociosexuality and Self-Esteem among Transgender People

Empirical data from studies with both heterosexual and homosexual individuals have consistently indicated different tendencies in mating behavior. However, transgenders' data are often overlooked. This exploratory study compared levels of sociosexuality and self-esteem between transgenders and non-transgender (cisgender) individuals. The aim was to verify whether either sexual genotype or gender self-perception had more influence on the examined variables in transgenders. Correlations between self-esteem and sociosexuality levels were also investigated. The sample consisted of 120 Brazilian individuals (51 transgenders) from both sexes. Sociosexuality scores indicated mostly sex-typical patterns for transgenders of both sexes across the construct's three dimensions (behavior, attitude, and desire), except for female-to-male transgenders' behavioral sociosexuality. Unique associations between the dimensions of sociosexuality were found for transgender participants. No differences in self-esteem were observed and no correlations between self-esteem and sociosexuality were found. The results suggest that transgenders' sociosexuality is largely influenced by their sexual genotype despite their incongruent gender self-perception and that the relationships between behavior, attitude, and sociosexual desire are different from those observed in cisgenders.

High levels of non-communicable diseases risk factors among transgenders in Puducherry, South India

Context:

Identification and documentation of risk factors for non-communicable diseases (NCDs) among an 'invisible community' like the transgenders (TGs) will throw light on the prevailing health status of one of the most marginalized populations in India, thereby paving way for initiating measures that would cater to their healthcare needs.

Aims:

To estimate prevalence of risk factors for NCDs among TGs registered in a community-based organization in Puducherry.

Settings and Design:

A cross-sectional descriptive study among adult (≥18 years) TGs in a community-based organization in Puducherry.

Methods and Material:

Data on sociodemographic details, selected risk factors of NCDs—alcohol use, tobacco use, physical inactivity, obesity, unhealthy diet, hypertension, and self-reported diabetes mellitus (DM) were collected using a pre-tested structured questionnaire. Dependence levels on tobacco and/or alcohol were obtained using “Fagerstrom Addiction Scale” and “Alcohol Use Disorder Identification Test” scales, respectively.

Statistical Analysis Used:

Data were single entered using EpiData and analyzed using EpiData Analysis.

Results:

Of the 200 TGs included in the study, mean (SD) age was 30 (8.8) years. Around 47% belonged to upper-lower socioeconomic class. About 90% of the participants had unhealthy dietary practice, 84% were physically inactive, 41% had high waist hip ratio, 36% were obese, 16% had high blood pressure, and 8% had self-reported DM. Prevalence of tobacco use was 43.5% with high nicotine dependence noted in 29% (23/79) of smokeless tobacco users and 12% (2/17) of smokers. Alcohol use was reported among 64.5% of which one fifth had possible dependence.

Conclusion:

Prevalence of selected risk factors for NCDs was high among TGs when compared to general population in Puducherry, which warrants targeted health interventions and priority in policy planning.

Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices

PURPOSE

Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities.

METHODS

We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps.

RESULTS

Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents.

CONCLUSIONS

This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented.

A false sense of security: lesbian, gay, bisexual, and transgender (LGBT) surrogate health care decision-making rights

This article addresses the timely and ethically problematic issue of surrogate decision-making rights for lesbian, gay, bisexual, and transgender (LGBT) patients and their families in the American health care system. Despite multiple pro-LGBT recommendations that have been released in recent years by the Obama administration, the Institute of Medicine, and the US Department of Health and Human Services, such initiatives, while laudable, also have unfortunately occasioned a "false sense of security" for many LGBT patients, their families, and their caregivers. In particular, new regulations on surrogate decision making merely invoke a sense of universal patient rights rather than actually generating them. Therefore, it is imperative that primary care physicians urge all LGBT patients to take proactive steps to protect themselves and their loved ones by naming proxy decision makers well before the crises that would necessitate such decisions.