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Chabbert-Buffet N, Sermondade N, Moreau E, Cristofari S, Johnson N, Mathieu d'Argent E, Levy R, Dupont C. [Transition, fertility and options for preservation of fertility]. ANN CHIR PLAST ESTH 2023; 68:484-490. [PMID: 37423825 DOI: 10.1016/j.anplas.2023.06.005] [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] [Indexed: 07/11/2023]
Abstract
Oftentimes ignored or infrequently expressed, some transgender persons harbor a desire for parenthood. Given the evolution of medical techniques and the enacting of legislative reforms, it is henceforth possible to propose fertility preservation strategies in the overall context of gender transidentity. During the "female to male" (FtM) transition pathway, androgen therapy has an impact on gonadic function, generally inducing blockage of the ovarian function, with amenorrhea. Even though these events may be reversed on cessation of treatment, the possible long-term effects on future fertility and on the health of children yet to be born are little known. Moreover, transition surgeries definitively compromise the possibility of pregnancy insofar as they involve bilateral adnexectomy and/or hysterectomy. Options for fertility preservation in the framework of FtM transition are premised on cryopreservation of oocytes and/or ovarian tissue. In a comparable manner, even though relevant documentation is lacking, hormonal treatments for persons transitioning from male to female (MtF) can have an impact on future fertility. In the event of surgery involving bilateral orchidectomy in which spermatozoid cryopreservation has not been carried out, fertility is definitively impossible. In both cases and under present-day legislation, numerous legal and regulatory barriers render highly problematic the reutilization of cryopreserved gametes. Given these different constraints, it is indispensable to closely supervise these types of treatment by proposing psychological support.
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Affiliation(s)
- N Chabbert-Buffet
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France.
| | - N Sermondade
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | - E Moreau
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | - S Cristofari
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | - N Johnson
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | - E Mathieu d'Argent
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | - R Levy
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
| | - C Dupont
- Centre de fertilité Tenon, hôpital Tenon, Sorbonne université, AP-HP, Paris, France
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2
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Chartier R, Herlin C, Sinna R. [Thoracic reassignment surgeries]. ANN CHIR PLAST ESTH 2023; 68:436-445. [PMID: 37596145 DOI: 10.1016/j.anplas.2023.07.008] [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: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
Thoracic reassignment surgeries are the most common gender reassignment surgeries. They represent the first and sometimes the only step in the reassignment process for transgender patients. Surgical techniques for thoracic reassignment derive from those used for the cisgender population and are accessible to plastic surgeons who do not usually treat transgender patients. On the other hand, there are some anatomical differences between men and women that they should understand, for instance, the positioning of the neo-NAC, the neo-inframammary fold and the scars. It is therefore important to understand these anatomical differences in order to optimize the cosmetic results of these surgeries so that they correspond to the expectations of these patients. In addition, the plastic surgeon will also have to be careful to adapt his approach to the relational level, with these patients, such as avoiding misgendering or using the "dead name". Finally, even if these operations are theoretically covered at 100% by the French health insurance, a request for prior agreement may be required in certain cases.
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Affiliation(s)
- R Chartier
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord, CHU Amiens Picardie, 80054 Amiens cedex 1, France
| | - C Herlin
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Lapeyronie, CHRU de Montpellier, 34295 Montpellier, France
| | - R Sinna
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord, CHU Amiens Picardie, 80054 Amiens cedex 1, France.
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Abstract
Our consultations are saturated by an influx of requests from young people - and very often from their parents - for whom the binarity of the boy/girl classification has been shattered, and whose only watchword is: "I choose my gender, my sexuality, my body, my way of being, of moving and representing myself, I want to become what I am". For them, anatomy is no longer a fatality: hormones, mutilating and restorative surgeries, increasingly sophisticated aesthetic techniques make it possible to adapt their body and their gender to their intimate aspirations. Psychological support must help these patients to explore their gender identity, and allow them to live it as well as possible in their social and family environment.
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Affiliation(s)
- Serge Hefez
- Service de psychiatrie de l'enfant et de l'adolescent, Hôpital de la Pitié Salpétrière, ESPAS, GHU Psychiatrie et Neurosciences, Paris, France.
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Herlin C, Boissière F, Boukhenouna H, Chartier R, Sinna R. [Sociological aspects of transgenrism]. ANN CHIR PLAST ESTH 2023; 68:397-403. [PMID: 37596144 DOI: 10.1016/j.anplas.2023.07.009] [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: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
The surgery of trans people is not apprehended by most of plastic surgeons as a simple surgery for the purpose of morphological transformation. At the same time, the French trans population does not benefit from adequate surgical coverage. Over the past few years, French regulations have simplified the process of reassignment surgeries. In addition, we have witnessed a fairly rapid increase in requests for transition surgery with accelerated and sometimes atypical courses. In recent years, a number of specialists have warned the medical community about the risks of slippage due to a lack of psychological monitoring of certain people beginning a transition process. Quite recently, hybrid transition paths have also appeared which, from a surgical point of view, are no longer limited to ensuring that a native assigned female patient can take on the most masculine appearance possible or the reverse. In this manuscript, we expose the biological, historical and societal place of transidentity and then address the reasons for the warnings of a certain category of the medical population while reassuring the surgical community on the benefits of reassignment surgeries in a controlled context. We end by proposing a few ways to improve the care course of trans people applicable in France.
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Affiliation(s)
- C Herlin
- University hospital Lapeyronie of Montpellier, plastic and reconstructive surgery department, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
| | - F Boissière
- University hospital Lapeyronie of Montpellier, plastic and reconstructive surgery department, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - H Boukhenouna
- University hospital Lapeyronie of Montpellier, plastic and reconstructive surgery department, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - R Chartier
- University hospital Picardie of Amiens, Amiens, France
| | - R Sinna
- University hospital Picardie of Amiens, Amiens, France
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5
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Faucher P, Linet T. [Contraception for transgender men: A case report and review]. Gynecol Obstet Fertil Senol 2023; 51:182-185. [PMID: 36436822 DOI: 10.1016/j.gofs.2022.11.008] [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: 02/24/2022] [Revised: 10/09/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
All methods of contraception used by a cisgender woman can theoretically be used by a transgender man. In practice, some contraceptives can aggravate gender dysphoria and should be discarded. On the other hand, contraceptives which make it possible to consolidate amenorrhea or to accentuate the virilization induced by taking testosterone will be better tolerated.
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Affiliation(s)
- P Faucher
- Service de gynécologique obstétrique, hôpital Trousseau, AP-HP Paris, Paris, France.
| | - T Linet
- 15, rue des cinq Diamants, Paris, France
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6
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Grateau S, Dupont C, Rivet-Danon D, Béranger A, Johnson N, Mathieu d'Argent E, Chabbert-Buffet N, Sermondade N. [Fertility preservation for transmen]. Gynecol Obstet Fertil Senol 2022; 50:797-804. [PMID: 36183988 DOI: 10.1016/j.gofs.2022.09.006] [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: 05/23/2022] [Revised: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
The evolution of medical techniques as well as legislative changes currently allow to propose fertility preservation strategies in the context of transidentity. During "female to male" transition, androgen therapy has an impact on gonadal function since it usually induces a blockage of ovulation with amenorrhea. Although this effect is reversible when treatment is stopped, the possible long-term effects of testosterone treatment on future fertility or health of future children are poorly known. In addition, transitional surgeries definitely compromise fecundity when they include bilateral ovariectomy and/or hysterectomy. Yet, although long ignored or poorly expressed, the desire for parenthood is a reality in transgender men. Fertility preservation options in FtM transition rely on oocyte or ovarian tissue cryopreservation. The purpose of this review is to provide an overview of the literature regarding fertility preservation in transgender men. Although series remain limited, the increase in the number of recently published articles reflects the interest in improving the management of fertility issues in transgender men.
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Affiliation(s)
- S Grateau
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Dupont
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - D Rivet-Danon
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Béranger
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Johnson
- Service de gynécologie-obstétrique-médecine de la reproduction, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - E Mathieu d'Argent
- Service de gynécologie-obstétrique-médecine de la reproduction, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique-médecine de la reproduction, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - N Sermondade
- Service de biologie de la reproduction - CECOS, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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7
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Briet M, Barkatz J, Frontczak S, Ramanah R, Chabbert Buffet N, Cristofari S. [Modalities of gynecological follow-up of transgender patients - Literature review]. Gynecol Obstet Fertil Senol 2022; 50:788-796. [PMID: 36150648 DOI: 10.1016/j.gofs.2022.09.003] [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: 01/24/2022] [Revised: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Transgender patients are at increased risk of cancer, sexually transmitted diseases, short- and long-term postoperative complications in patients with vaginoplasty, but also unwanted pregnancy in non-hysterectomized trans men. However, access to care is often difficult for these patients, who often do not benefit from appropriate gynecological monitoring, especially for fear of judgment or discrimination. In view of the health risks of these patients, it is essential to be able to offer them specific and adapted gynecological follow-up. To date, there are no clear recommendations regarding the gynecological follow-up of transgender patients. We relied on the recommendations of the World Professional Association of Transgender Health (W-PATH) and the Endocrine Society Guideline and performed a literature review. We carried out several searches via pubmed in order to explore one by one the different aspects of gynecological follow-up, in particular of non-hysterectomized transgender men and transgender women with a vaginoplasty. It emerges from this a lack of follow-up of transgender people, with a reluctance to consult a gynecologist, associated with the lack of knowledge and experience of health professionals. Due to the risks identical to those of the general population, added to those specific to transgender people, it is important to be able to offer these patients specialized and personalized gynecological follow-up, and to raise awareness and train health professionals on the importance of and the specificities of the gynecological follow-up of these patients.
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Affiliation(s)
- M Briet
- Centre d'assistance médicale à la procréation, pôle mère-femme, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Sorbonne université, 75005 Paris, France.
| | - J Barkatz
- Service d'urologie - Transplantation rénale- andrologie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - S Frontczak
- Centre d'assistance médicale à la procréation, pôle mère-femme, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Service de biologie et médecine de la reproduction, cryobiologie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Université de Franche-Comté, UFR Santé, 25000 Besançon, France
| | - R Ramanah
- Pôle mère-femme, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Université de Franche-Comté, UFR Santé, 25000 Besançon, France
| | - N Chabbert Buffet
- Service de gynécologie obstétrique médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne université, 75005 Paris, France
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8
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Brouillet S, Ducrocq B, Mestres S, Guillemain C, Ravel C, Reignier A. [Fertility preservation and access to medically assisted reproduction for Trans people: Guidelines from French Professional Association for Transgender Health]. Gynecol Obstet Fertil Senol 2022; 50:682-688. [PMID: 35750197 DOI: 10.1016/j.gofs.2022.06.005] [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: 02/07/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Many health care professionals are dealing with the issue of transgender people in their medical practice. In the field of reproduction, Trans people can benefit from fertility preservation before the introduction of hormonal treatment or surgery altering their fertility. This article, which is the result of a collaborative work of several reproductive professionals involved in the health of Trans people, provides an overview of the possibilities of fertility preservation and medically assisted reproduction techniques in France for Trans people.
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Affiliation(s)
- S Brouillet
- Inserm 1203 DEFE, département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, Montpellier, France
| | - B Ducrocq
- CECOS, CHU de Lille, institut de biologie de la reproduction, Lille, France
| | - S Mestres
- Assistance médicale à la procréation, CECOS, CHU de Clermont-Ferrand, CHU d'Estaing, Clermont-Ferrand, France
| | - C Guillemain
- Pôle femmes-parents-enfants, centre clinicobiologique d'assistance médicale à la procréation - CECOS, APHM, hôpital La Conception, 13385 Marseille cedex 5, France
| | - C Ravel
- Inserm, service de biologie de la reproduction - CECOS, EHESP, CHU de Rennes, université Rennes, Irset (institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - A Reignier
- Inserm, biologie et médecine de la reproduction et gynécologie médicale, centre de recherche en transplantation et immunologie, UMR 1064, CHU de Nantes, Nantes université, Nantes, France.
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9
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Benaloun E, Sermondade N, Moreau E, Chabbert-Buffet N, Cristofari S, Johnson N, Lévy R, Dupont C. [Fertility preservation for transwomen]. ACTA ACUST UNITED AC 2021; 49:547-552. [PMID: 33434749 DOI: 10.1016/j.gofs.2021.01.007] [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] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/19/2022]
Abstract
The evolution of medical care for transgender people currently makes it possible to propose fertility preservation. Fertility preservation should be initiated before the start of hormonal treatments and/or surgical procedures. The "reproductive" aspect and the desire for parenthood among transgender people have long been ignored. However, these aspects are important to consider and fertility preservation should be discussed before the start of the physical transition. The aim of this review is to assess the literature on fertility preservation for transgender women ("male to female"). Many uncertainties remain regarding the impact of hormonal treatments on the reproductive functions of transgender women and their reversibility. However, the significant increase in the number of recently published articles is evidence of the improvement in the conditions of access to these procedures for women starting a transition process. Nevertheless, there are still a number of barriers that can prevent or delay this process.
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Affiliation(s)
- E Benaloun
- Service de biologie de la reproduction CECOS, AP-HP, hôpital Tenon, Paris, France
| | - N Sermondade
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France
| | - E Moreau
- Service de biologie de la reproduction CECOS, AP-HP, hôpital Tenon, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, AP-HP, hôpital Tenon, Paris, France
| | - S Cristofari
- Service de chirurugie plastique reconstructrice et esthétique, AP-HP, hôpital Tenon, Sorbonne université, Paris, France
| | - N Johnson
- Service de gynécologie-obstétrique et médecine de la reproduction, AP-HP, hôpital Tenon, Paris, France
| | - R Lévy
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France
| | - C Dupont
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France.
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