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1.
Womens Health (Lond) ; 20: 17455057241265081, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39051650

RESUMO

BACKGROUND: Danazol is a synthetic progestin with androgenic effects that is approved by the Food and Drug Administration for treatment of endometriosis, benign fibrocystic breast disease, and hereditary angioedema. In recent years, increasing numbers of transgender and nonbinary individuals seeking menstrual suppression have been offered danazol due to its potential to both induce amenorrhea and cause reversible androgenic side effects including pigmentation of vellus hairs and voice changes, which may be desirable in this population. There are currently no studies assessing use of danazol within the transgender population for menstrual suppression. OBJECTIVE: This study's primary aim was to evaluate the use of danazol as a menstrual suppression agent in transgender patients. DESIGN: This was a retrospective multisite cohort study of all individuals who had been on danazol at two tertiary care centers between 2000 and 2022. METHODS: All patients prescribed danazol were identified using a search of the electronic medical records. For demographic purposes, comparisons were made between those who did and did not use danazol for the purpose of menstrual suppression. A detailed chart review was then performed to analyze the experiences of menstrual suppression in transgender and nonbinary patients. RESULTS: Most transgender and nonbinary patients on danazol for menstrual suppression remained on it at their most recent follow-up visit, and many charts noted improvements in gender dysphoria, pelvic pain, dysmenorrhea, endometriosis, and heavy menstrual bleeding. Most transgender patients achieved amenorrhea. CONCLUSION: Danazol may be a reasonable option for menstrual suppression in transgender and nonbinary patients. Our findings show its potential to not only induce amenorrhea but cause desired androgenic symptoms and improve gender dysphoria, pelvic pain, dysmenorrhea, endometriosis, and heavy bleeding. While the androgenic effects of danazol are less desirable in cisgender populations, it is an attractive option for menstrual suppression in transgender and nonbinary patients.


Using danazol to stop periods in transgender individualsDanazol has previously been used to help treat pain and bleeding related to endometriosis. However, danazol can have certain androgenic side effects (acne, deepening of the voice) that cisgender women (individuals who were assigned female at birth and identify with the female gender) often find undesirable, but that could be desirable in transgender patients seeking to affirm their gender by stopping periods. Our study looked at danazol use for period suppression, as well as for other reasons. We found that most transgender patients using danazol for period suppression found it to be successful and remained on it at follow-up appointments, and that many transgender patients saw improved gender dysphoria, pelvic pain, pain during periods, endometriosis, and heavy period bleeding. These findings suggest that danazol may be a good option for menstrual suppression in transgender individuals as any experienced androgenic effects may help with gender dysphoria, whether individuals are not yet ready to start testosterone or do not desire testosterone therapy at all.


Assuntos
Danazol , Pessoas Transgênero , Humanos , Danazol/uso terapêutico , Danazol/efeitos adversos , Feminino , Estudos Retrospectivos , Adulto , Masculino , Antagonistas de Estrogênios/uso terapêutico , Antagonistas de Estrogênios/efeitos adversos , Estudos de Coortes , Amenorreia/induzido quimicamente , Pessoa de Meia-Idade , Adulto Jovem , Menstruação/efeitos dos fármacos
2.
Pediatrics ; 153(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38115796

RESUMO

OBJECTIVES: With this study, we aim to describe transgender and nonbinary adolescents and young adults' stated gender treatment goals at the time of initial presentation to medical care. METHODS: This is a retrospective chart review of transgender and nonbinary patients aged 10 to 24 seeking specific gender-affirming health care. Charts were reviewed for specifically stated goals of future hormonal or surgical care for gender and analyzed by the experienced or asserted gender (man, woman, nonbinary, eclectic) of participants. RESULTS: In total, 176 patient encounters were reviewed. Of these, 71% were assigned female at birth. Most participants experienced a masculine gender (46.6%), identified as white (65.3%), and had private health insurance (73.3%). Most patients had a goal of initiating hormone therapy (97.4%) and eventual surgery (87.1%). Of those who had a surgical goal, most (87.5%) desired surgery of the chest or breast, and a minority (29.3%) desired eventual genital surgery. The second-largest gender group was patients who either declined to state an asserted gender or felt unable to describe their gender experience (eclectic, 23.3%), and this group's treatment goals did not mirror any other group's goals. CONCLUSIONS: At the time of initial presentation to medical care for gender-specific needs, many adolescents are capable of asserting specific treatment goals. Most do not desire genital surgery. A large minority of patients decline to state an asserted gender or feel unable to assert a specific gender, and this population appears distinct from more traditional genders in terms of treatment goals.


Assuntos
Disforia de Gênero , Pessoas Transgênero , Transexualidade , Recém-Nascido , Humanos , Masculino , Feminino , Adulto Jovem , Adolescente , Disforia de Gênero/cirurgia , Objetivos , Estudos Retrospectivos , Identidade de Gênero
3.
Womens Health (Lond) ; 19: 17455057231197166, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37675891

RESUMO

Access to comprehensive and culturally competent reproductive health care is essential for individuals and communities to realize and achieve health and well-being, as one prefers. The disability community represents a diverse group of individuals with a wide spectrum of functional, physical, sensory, and/or neurodivergent abilities. Existing barriers to reproductive health care are a consequence of environmental and attitudinal barriers, not from the disabilities themselves. People with disabilities are also not frequently centered or included in discussions surrounding reproductive rights. This article reviews the intersection of the Disability Justice Movement and the history of discrimination in the United States against people with disabilities with a particular focus on reproductive oppression. We discuss the mechanisms of inequity and barriers to health care, including financial barriers, inaccessible medical facilities, provider discrimination and competency, and guardianship; as well as the importance of open access to contraception, menstrual health, and abortion for people with disabilities. Finally, we explore the intersection of the Disability Justice Movement and the Reproductive Justice Movement to better promote reproductive autonomy.


Assuntos
Aborto Induzido , Pessoas com Deficiência , Gravidez , Feminino , Humanos , Estados Unidos , Saúde Reprodutiva , Anticoncepção , Direitos Sexuais e Reprodutivos , Acessibilidade aos Serviços de Saúde
5.
J Adolesc Health ; 73(5): 940-945, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37610385

RESUMO

PURPOSE: There is very little information available regarding the health needs of transgender and gender diverse adolescents and young adults with gender dysphoria who reside in rural areas of the United States. This study aims to determine if residing in a rural area is associated with the use of telemedicine services, such as synchronous voice-video appointments, for initial contact for medical interventions for gender-related reasons in adolescents and young adults with gender incongruence. METHODS: This study is a retrospective chart review of patients (N = 176) ages 10-24 years who had an initial medical appointment for gender-related concerns between July 1, 2020 and June 30, 2022. Participants were determined to be rural or not based on address eligibility for rural-related health care services by the Centers for Medicare and Medicaid Services Rural Health Clinics Program or the Federal Office of Rural Health Policy grant programs. The use of telemedicine versus in-person appointments were compared, as were initial medical prescriptions (hormones, psychotropic medications, contraceptives, etc.) and recommendations for medical follow-ups made at this initial appointment. RESULTS: Most participants did not reside in a rural location (N = 130). There was no statistically significant difference in the use of telemedicine versus in-person care in rural patients (22% vs. 78%) as compared to nonrural patients (21% vs. 79%), nor any statistically significant differences in the medical decisions made at the initial appointment with respect to rurality or modality of care. DISCUSSION: Residing in a rural area is not associated with either choice of in-person care versus telemedicine services for initial medical appointments or medical decision-making.


Assuntos
Serviços de Saúde Rural , Telemedicina , Idoso , Adolescente , Adulto Jovem , Humanos , Estados Unidos , Estudos Retrospectivos , Medicare , Atenção à Saúde , Telemedicina/métodos
6.
Ther Adv Reprod Health ; 17: 26334941231158251, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36938373

RESUMO

The newly released World Professional Association for Transgender Health Standards of Care, 8th Edition specify that adolescents should be offered menstrual suppression as part of their treatment plans to suppress menses and alleviate dysphoria, provide contraception, or improve irregular bleeding on testosterone therapy. This is a review of current evidence-based options for reversible interventions for menstrual suppression in adolescents with gender dysphoria or incongruence. Shared decision-making should be used by the clinician at all times, and the clinician should be intentional in prioritizing the patient's stated needs and desires when offering interventions. No method should be withheld due to the experience of gender incongruence alone. Contraceptive options offering menstrual suppression include depot-medroxyprogesterone acetate, levonorgestrel intrauterine systems, progestin-only contraceptive pills, and combined hormonal contraceptives. Non-contraceptive options include norethindrone acetate, oral medroxyprogesterone acetate, gonadotropin-releasing hormone analogues/agonists, and danazol. Certain patients may also benefit from non-pharmacologic interventions, such as specialty menstrual underwear. Plain language summary: Using medicine to stop Menstrual periods in teens with gender incongruence Summary: Newly released recommendations for the care of teens and young adults with gender dysphoria or incongruence specifically recommend using medications to get rid of menstrual periods if desired or medically necessary. Patients may ask for this to help improve dysphoria, as a feature they want in birth control, or simply because they do not want to have periods. Because temporarily getting rid of periods is something that doctors can do for any patient old enough to have periods, patients with gender dysphoria should also be able to have their periods temporarily stopped using medications if requested. Doctors should ensure that they always help the patient make a decision that is right for them instead of prescribing what they think is right without considering the patient's input. Options for temporarily getting rid of periods can include birth control, such as oral contraceptive pills, patches, or rings; intrauterine devices; or shots, and it can also be done with things that are not birth control, such a progesterone pills or puberty blockers. Finally, some patients may only need improved period hygiene with period underwear to feel better in their bodies.

7.
Contemp Clin Trials ; 122: 106937, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36167287

RESUMO

BACKGROUND: This double-blind, placebo-controlled study evaluates the effectiveness of oral naltrexone in adolescents and young adults with eating disorders (EDs) characterized by purging with or without binge-eating behaviors. We hypothesize that participants receiving oral naltrexone will demonstrate greater improvements in body mass index in underweight participants and self-reported ED symptomatology compared to placebo. METHODS: Thirty individuals receiving treatment in a partial hospitalization program for EDs with diagnoses of anorexia nervosa binge-eating/purging type, bulimia nervosa, or purging disorder will receive six weeks of either placebo or oral naltrexone. Participants will complete a battery of self-report measures and laboratory safety monitoring every three weeks in addition to standard of medical care for treatment environment. RESULTS: Analysis will compare outcomes at weeks three and six, and follow-up at nine weeks and six-months across the oral naltrexone and placebo groups. Main effects for time will examine improvements over the course of treatment for all participants, while group × time interactions will examine differences in the rate of change over time between study arms. CONCLUSIONS: We hypothesize that participants receiving oral naltrexone will experience more rapid improvements in symptom severity and weight restoration compared to placebo across study time points. There are very few medications with high-quality data demonstrating both safety and efficacy in the treatment of eating disorders. The authors theorize this study will demonstrate a clinically significant effect of oral naltrexone on impulsive-type EDs and support its use as an effective option for treatment augmentation.


Assuntos
Anorexia Nervosa , Transtorno da Compulsão Alimentar , Bulimia Nervosa , Bulimia , Transtornos da Alimentação e da Ingestão de Alimentos , Adulto Jovem , Adolescente , Humanos , Naltrexona/uso terapêutico , Bulimia Nervosa/tratamento farmacológico , Transtornos da Alimentação e da Ingestão de Alimentos/tratamento farmacológico , Transtorno da Compulsão Alimentar/tratamento farmacológico , Anorexia Nervosa/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
J Pediatr Surg ; 57(1): 104-110, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34670677

RESUMO

PURPOSE: Creating inclusive LGBTQ+ environments is important in the provision of inclusive care. This cross sectional study assessed whether patient intake forms in pediatric surgery departments were LGBTQ+ inclusive (L-I). METHODS: North American pediatric surgery departments affiliated with pediatric surgery fellowships or general surgery residencies were contacted to retrieve patient intake forms. Forms were assessed for LGBTQ+ inclusivity using a novel L-I scoring system consisting of 6 criteria: preferred name, pronouns, preferred language, gender identity, sex assigned at birth, and l-I guardianship. Institutions without intake forms were invited to comment on their use of l-I intake questions. RESULTS: 59/125 programs responded to our query, 10 of which provided intake forms. Median l-I score was 2/6 points (range 1-4). l-I guardianship was the most common question asked. No intake form asked for pronouns. Of the 49 institutions without forms, 30.5% reported asking l-I questions during initial visits. Narratives from these institutions varied widely. Some institutions supported routine l-I questions while others stated l-I questions were unnecessary, irrelevant, and/or offensive. CONCLUSIONS: Few North American pediatric surgery departments consistently ask l-I questions during the intake process. Comments questioning the appropriateness and necessity of l-I questions highlight the need for LGBTQ+ education. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Cross sectional study.


Assuntos
Minorias Sexuais e de Gênero , Instituições de Assistência Ambulatorial , Criança , Estudos Transversais , Feminino , Identidade de Gênero , Humanos , Recém-Nascido , Masculino , Comportamento Sexual
10.
Lancet Child Adolesc Health ; 4(9): 699-708, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32827491

RESUMO

Sexual and reproductive health is an important aspect of human development, but discussions with adolescents and young adults on this topic are often challenging for health-care providers. As a result, many adolescents and young adults do not receive appropriate, comprehensive sexual education, despite recognition from WHO and the UN that access to this education is a human right. Adolescents and young adults with mild to moderate intellectual or developmental disability, or both, are just as likely to be sexually active as are their peers without disability; however, these individuals are less likely to receive comprehensive sexual education. To ensure adequate comprehensive sexual education for adolescents and young adults with intellectual and developmental disabilities, sexual health educators should facilitate conversations about sexual and reproductive health that are non-judgmental and sexually inclusive. Such initiatives should use an educational framework grounded in universal design for learning, including use of multiple media types with clear, concise language and images.


Assuntos
Educação Sexual/métodos , Comportamento Sexual , Saúde Sexual/educação , Adolescente , Deficiências do Desenvolvimento/psicologia , Deficiências do Desenvolvimento/terapia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Deficiência Intelectual/psicologia , Deficiência Intelectual/terapia , Masculino , Medição de Risco , Adulto Jovem
11.
J Pediatr Rehabil Med ; 12(3): 317-324, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476181

RESUMO

PURPOSE: Assessing provider adherence to preventative sexual and reproductive healthcare guidelines in adolescents and young adults (AYA) patients with physical and intellectual disabilities (PWD). METHODS: Records of PWD (N= 42) age 12-26 receiving health maintenance between 01/01/11-12/31/16 were reviewed for: (1) initiation and completion of human papilloma virus (HPV) vaccination series, (2) initiation and completion of meningococcal vaccination, (3) screening for human immunodeficiency virus (HIV), and documentation of (4) sexual, (5) menstrual, and (6) pregnancy histories. Unaffected age and gender-matched patients provided comparison data (Comparison Cohort, CC). RESULTS: The mean age of both groups was 17.3 years ± 3.8 and 40.5% were female. There was no significant difference between groups regarding the completion of HPV or meningococcal vaccine series. Among those 15+ years of age, 7.1% of PWD and 28.6% of CC were screened for HIV (p= 0.04). Sexual history was documented in 19.0% of PWD versus 73.8% of CC (p< 0.001). Among females, menstrual regularity was recorded in 11.8% of PWD versus 47.1% of CC (p= 0.02) and pregnancy history in 0.0% of PWD versus 29.4% of CC (p= 0.04). CONCLUSIONS: Adherence to sexual health guidelines was suboptimal, and lower among PWD. Vaccination rates did not differ between the two groups.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Serviços de Saúde para Pessoas com Deficiência/normas , Atenção Primária à Saúde/normas , Serviços de Saúde Reprodutiva/normas , Saúde Sexual/normas , Adolescente , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
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