Social cure model: testing the link between identity centrality and body appreciation in diverse sexual orientation and gender identity groups.

BACKGROUND: The level of experienced sociocultural pressure to have an idealized body can vary depending on a person's gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health. METHODS: An online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated. RESULTS: Non-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure. CONCLUSIONS: Data in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation.

Support for affirmative actions to increase inclusivity of intersex* persons at an Austrian medical university.

BACKGROUND: Since the ruling handed down by the Austrian Constitutional Court in 2018 intersex variation has been recognized under Austrian law as a "third sex". In order to ensure that people with intersex variation are not discriminated against based on their group membership affirmative actions (i.e., proactive practices to avert discrimination) can be implemented. The current study explored whether students and employees at an Austrian medical university know about intersex variation. Furthermore, the study investigated what affirmative actions are practiced at the medical university to be inclusive for intersex persons and students' and employees' support for such affirmative actions. METHODS: All students and employees of a medical university in Austria were invited by e-mail to participate at the current study that included a self-constructed knowledge test on intersex variation with ten true-false questions. On five-point Likert scales participants reported for each of twelve listed affirmative actions whether they had seen a certain affirmative action at their university and how important they thought the implementation of an affirmative action was. Finally, participants' gender, age, sexual orientation, highest level of education, and nationality was assessed. A cluster analysis was performed to determine groups of people with different degrees of support for affirmative actions for intersex persons. RESULTS: 220 students (62% cisgender women, 38% cisgender men) and 200 employees (72% cisgender women, 28% cisgender men) participated. Participants responded correctly to three out of ten knowledge test questions. The cluster analysis revealed that participants could be clustered as heterosexual cisgender women (Cluster 1; 55%), heterosexual cisgender men (Cluster 2; 30%), or sexual minority cisgender women and men (Cluster 3; 15%). Sexual minority persons knew more about intersex variation than did heterosexual participants. On average, affirmative actions for the inclusivity of intersex people have not been encountered (M = 1.5, SD = 0.4) at the studied university. Participants, especially those in Cluster 3, believed that the listed actions are moderately important. CONCLUSIONS: At the medical university many actions should be taken to increase inclusivity for intersex people. Increasing the knowledge of university staff and students concerning intersex might help increase their support for such actions.

Language analysis of spontaneous descriptions of restless legs syndrome: Gender differences?

Patients with restless legs syndrome (RLS) use various terms when describing their symptoms. Whether gender might influence this has not been investigated so far. The aim of this study was to evaluate possible gender differences in spontaneous descriptions of RLS symptoms. This prospective study, conducted in 100 consecutive German-speaking RLS patients, used a single standardized question. Answers were digitally recorded and transcribed. A content-related linguistic analysis of the transcripts was performed by two independent blinded raters. The lengths of the answers and content-related linguistic features were compared between women and men. Ninety-eight patients were included in the final analysis, 59 women (60.2%) and 39 men (39.8%), with a median age of 62 (23-94) and 63 (31-82) years, respectively (p = 0.602). Demographic and clinical features, including educational level and RLS treatment class, did not differ between genders (p > 0.05). Total word or sentence count showed no gender differences (p = 0.159 and 0.259, respectively), although men used more words per sentence than women (p = 0.018). More men than women described quiescegenic (i.e., triggered by rest or inactivity) symptoms (p = 0.006) and successful attempts at relief (p = 0.039). There was a non-significant trend toward a more frequent use of the first-person perspective in men (median times used = 5 [0-10.5] vs. 3.8 [0-17.5], p = 0.068). The more frequent mention of quiescegenic symptoms and successful attempts at relief in men could indicate differences in phenotypic presentation of RLS between genders, a more precise description of RLS symptoms or a higher experience of self-efficacy in men compared to women.

Links between Virginity Beliefs, Negative Feelings after Virginity Loss and Sexual Performance Anxiety in a Sample of German-Speaking Heterosexual-Identified Women and Men.

Gender norms can influence women and men adopting different beliefs toward their own virginity. The current online cross-sectional questionnaire study was applied in a sample of German-speaking heterosexual-identified women (n = 536) and men (n = 181; Mage = 23.6, SD = 3.7). In men negative virginity loss experiences and sexual performance anxiety were especially prevalent when virginity loss occurred at an age that was inconsistent with men's virginity beliefs. In women age at virginity loss was not linked to virginity loss experiences or sexual performance anxiety, but the holding of virginity beliefs that deviated from gender norms was associated with those variables.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1958963 .

Associations Between Pornography Consumption, Sexual Flexibility, and Sexual Functioning Among Austrian Adults.

To date, only a few studies have examined the associations between pornography consumption and sexual functioning. The Acquisition, Activation, Application Model (3AM) indicates that the frequency of pornography consumption and the perceived realism of pornography may influence whether sexual scripts are acquired from viewed pornography. Having sexual scripts that are alternative to their preferred sexual behaviors may help people switch to alternative sexual behavior when sexual problems arise. The current study analyzed whether frequent pornography consumption was associated with greater sexual flexibility and greater sexual functioning. Additionally, the perceived realism of pornography consumption was tested as a moderator of those associations. At an Austrian medical university, an online cross-sectional questionnaire study was conducted among 644 medical students (54% women and 46% men; Mage = 24.1 years, SD = 3.8). The participants were asked about their pornography consumption, partnered sexual activity, sexual flexibility, perceived realism of pornography, and sexual functioning. Manifest path analyses revealed direct and indirect associations between frequent pornography consumption and greater sexual functioning through greater sexual flexibility in women but not in men. Perceived realism did not moderate those associations. In conclusion, our study was in line with previous studies that found no significant associations between men's pornography consumption and sexual functioning in men. However, some women may expand their sexual scripts and learn new sexual behaviors from pornography consumption, which may help with their sexual functioning.

Female sexual dysfunction in multiple system atrophy: a prospective cohort study.

PURPOSE: The diagnosis of probable multiple system atrophy relies on the presence of severe cardiovascular or urogenital autonomic failure. Erectile dysfunction is required to fulfil the latter criterion in men, whereas no corresponding item is established for women. In this study, we aimed to investigate sexual dysfunction in women with multiple system atrophy. METHODS: We administered the Female Sexual Function Index questionnaire and interviewed women with multiple system atrophy and age-matched controls regarding the presence of "genital hyposensitivity." RESULTS: We recruited 25 women with multiple system atrophy and 42 controls. Female Sexual Function Index scores in sexually active women with multiple system atrophy were significantly lower (multiple system atrophy = 10; 15.4, 95% CI [10.1, 22.1], controls = 37; 26.1 [24.1, 28.1], p = 0.0004). The lowest scores concerned the domains of desire, arousal and lubrication. Genital hyposensitivity was reported by 56% of the patients with multiple system atrophy and 9% controls (p < 0.0001). CONCLUSIONS: Sexual dysfunction is highly prevalent in women with multiple system atrophy. Screening for disturbances in specific sexual domains should be implemented in the clinical evaluation of women with suggestive motor symptoms.

Gender differences in clinical, laboratory and polysomnographic features of restless legs syndrome.

Restless legs syndrome is a common neurological disorder with a clear female predominance. This study aims to evaluate gender differences in clinical, laboratory and polysomnographic features in patients with restless legs syndrome. For this retrospective analysis, 42 women and 42 men from the Innsbruck RLS database matched by age and therapy were included. Demographic data as well as different severity scales (IRLS, RLS-6 and CGI) were evaluated. Laboratory parameters included several indicators of serum iron status. In all patients, polysomnography was performed according to the AASM guidelines, and periodic leg movements during sleep were scored according to the AASM criteria. IRLS, RLS-6 and CGI revealed more severe symptoms in women (IRLS median [range]: 17.5 [0-35] versus 13.5 [0-32], p = 0.028; RLS-6 median [range]: 18 [0-39] versus 12 [1-42], p = 0.014). Women had lower serum ferritin levels than men (median [range] in µg L-1 : 74 [9-346] versus 167 [15-389], p < 0.001). Twenty-two women and eight men (53.7% versus 22.2%, p = 0.003) had ferritin values below 75 µg L-1 . Periodic leg movements during sleep indices were significantly lower in women than in men (median [range] in number per hr: 11.4 [0-62.5] versus 40 [0-154], p = 0.004, and 12.6 [0-58.5] versus 40 [0.5-208], p = 0.002, for night I and night II, respectively). Restless legs syndrome severity as measured by validated scales was worse in women, while periodic leg movements during sleep indices were higher in men. These results suggest a possible gender difference in phenotypical presentation of restless legs syndrome, manifesting with predominantly sensory symptoms in women and predominantly motor symptoms in men.

Attachment-related anxiety is associated with poor genital satisfaction and sexual problems in women.

BACKGROUND: Genital satisfaction has been found to influence women's sexual experience. We tested the Relational Bodily Experiences Theory (RBET) that predicts associations between women's genital satisfaction, attachment models, and sexual desire. We extended the model by additionally considering sexual arousal, orgasmic sensation, or the experience of pain during sexual activity as outcome variables. According to the RBET, women's attachment models are associated with their genital satisfaction and linked to women's sexual experience. METHODS: A cross-sectional online questionnaire study was conducted at an Austrian medical university. In total 294 women (Mage = 23.7, SD = 3.4) provided full responses. Women were asked about genital satisfaction and experiences of distressing sexual problems. Attachment-related anxiety and avoidance were assessed with the Experiences in Close Relationships-Relationship Structures Questionnaire. RESULTS: Results partially support the RBET. Attachment-related anxiety was associated with genital satisfaction which, in turn, was linked to experiences of frequent and/or distressing diminished sexual arousal, diminished sexual desire, or pain during sexual activity. CONCLUSIONS: These results suggest that clinicians should assess genital satisfaction when treating female sexual problems. Women with attachment-related anxiety may especially be prone to having poor genital satisfaction and may profit from body image interventions in order to improve their sexual experience.

Austrian male patients' gender role conflict is associated with their wish for interpersonal violence to be addressed during patient-physician conversations: a questionnaire study.

BACKGROUND: Experiencing interpersonal violence and disclosing this experience to physicians can be associated with fear, shame, denial or emotional turmoil. Expressions of such feelings additionally conflict with masculine gender role ideologies and may be experienced as masculine gender role conflict. Masculine gender role conflict is often associated with men's unwillingness to seek professional help. The current study analyzed the association between masculine gender role conflict and men's wish for patient-physician conversations to include questions about interpersonal violence they might have experienced. METHODS: In structured closed-ended interviews conducted at an Austrian hospital 129 male patients (Mage = 59.4, SD = 14.7) were asked what forms of interpersonal violence they had experienced. Additionally, a study-specific questionnaire was used to find out whether male patients wanted future physician-patient conversations to include questions about interpersonal violence they might have experienced. Men's gender role conflict was assessed with the Gender Role Conflict Scale-Short Form. RESULTS: Half of the male patients (50%) reported having experienced at least one form of interpersonal violence. Nearly half of the men (48%) wanted their physician to ask them in future about any violence they might have experienced. One pattern of gender role conflict was positively associated with men's wish to be asked in patient-physician conversations about potential interpersonal violence. Namely, men who reported conflicts between work and family relations were more likely to state that they wanted such conversations (OR = 1.6, 95%CI = 1.1-2.4) than were men who did not often experience this pattern of gender role conflict. CONCLUSIONS: Experiences of interpersonal violence should be an important part of physician-patient conversations with male patients. Overall, male patients would welcome their physician initiating a potential conversation about violence. Using an approach that takes consideration of masculine gender role ideologies may further increase some men's willingness to approach the topic of interpersonal violence. Men who adhere to the norm of being preoccupied with work may be more willing to talk about this subject if healthcare situations are framed in a way that men perceive the possibility to uphold masculine gender role ideologies of self-sufficiency or of being in control.

Parenthood does not explain the gender difference in clinical position in academic medicine among Swedish, Dutch and Austrian physicians.

Studies have continuously shown that fewer women than men achieve leadership positions in academic medicine. In the current study we explored gender differences in clinical position among academic physicians at three university hospitals, each in a different European country. These countries, Sweden, the Netherlands and Austria, differ in terms of gender equality. We analyzed whether the number of children, working hours or publications could explain gender differences in physicians' clinical position. In this cross-sectional questionnaire study 1333 (54% female) physicians participated. Physicians were asked about their gender, age, number of children, working hours and clinical position. We used structural equation models to explore the influence of gender on the physicians' clinical position in each of the three countries. We explored whether the association between gender and clinical position could be explained by number of children, working hours or publication activity. The analyses revealed that at all three university hospitals gender influenced clinical position. These gender differences in clinical position could be partly explained by gender differences in publication activity. Female physicians as compared to male physicians were likely to publish fewer articles, and in turn these lower publication numbers were associated with lower clinical positions. The number of children or working hours did not explain gender differences in publication activity or clinical position. Therefore, factors other than unequal allocation of household labor, such as the academic working environment, may still disproportionately disadvantage women's progress, even at universities in countries with high rates of gender equality such as Sweden.

The importance of equal treatment: Medical students'opinions on affirmative action, equal treatment and discrimination.

We assessed medical students' opinion of affirmative action programs (AAPs), perception of gender equality and discrimination. 276 medical students (56.2% female) participated. Women considered AAPs to be more important than did men. Most women (62.6%) and men (71.9%) received equal treatment, but significantly more women (22.6%) than men (11.6%) experienced discrimination. It is necessary to convey the importance of gender equality and equal treatment, including discrimination and mistreatment. Thus, we have to raise awareness for gender equality and equal treatment not only in staff, in students or in health care but also among each other.

Promoting gender in medical and allied health professions education: Influence on students' gender awareness.

In this study, we explored whether attendance at lectures on Gender Medicine, students' gender or university affiliation influenced students' gender awareness in medicine. We recruited 483 students (352 women/131 men) of medicine, allied health profession with focus on patient contact and allied health profession students with focus on laboratory work. Students with focus on laboratory work profited the most from Gender Medicine lectures as their gender sensitivity was positively associated with lecture attendance. Men profited more from Gender Medicine lectures than did women. We underline the importance of implementing Gender Medicine lectures in study programs of health care professions.

Gender differences and similarities in medical students' experiences of mistreatment by various groups of perpetrators.

BACKGROUND: Mistreatment of medical students during medical education is a widespread concern. Studies have shown that medical students report the most mistreatment compared to students of other study programs and that the prevalence of mistreatment peaks during clinical training. For this reason, a study was conducted to assess prevalence of mistreatment among medical students committed by various groups of people. The focus was to identify whether gender was associated with the experience of mistreatment. Additionally, students' perception of university climate for reporting sexual harassment was assessed. METHOD: In the study 88 medical students (45 women, 43 men) participated. A modified version of the Questionnaire on Student Abuse was used to assess students' experience of various types of mistreatment and associated distress during medical education. To explore factors that could be associated with this experience the organizational climate for reporting sexual harassment was assessed with the Psychological Climate for Sexual Harassment. RESULT: The most often cited perpetrators of mistreatment were strangers (79.5%), friends (75.0%) and university staff (68.2%). Strangers mostly committed psychological mistreatment and sexual harassment, whereas friends additionally engaged in physical mistreatment of medical students. The most common form of mistreatment conducted by university staff was humiliation of students. These kinds of psychological mistreatment were reported to be distressing (43%). Gender differences were found in the prevalence of mistreatment. Women experienced more sexual harassment and humiliation than did men. On the other hand, men experienced more physical mistreatment than did women. Women reported experiencing more distress from mistreatment experiences than did men and also more often reported being mistreated by university staff than did men. Women perceived a greater risk in reporting sexual harassment to the organization than did men. CONCLUSION: Mistreatment of female and male students should be focused on using a gender perspective because types of mistreatment can differ by gender. Additionally, interventions should include the societal level as there was a high prevalence of mistreatment perpetrated by strangers. Also the issue of trust in the university needs to be addressed and the organization is called on to visibly demonstrate that it represents and protects its students as well as its staff.

Abortion as one aspect of Women's Health.

Women's Health is closely tied to sexuality. In the European context the European Women's Rights Movement fought for women's sexual rights and the right of women to self-determination over a woman's own body. However, there appears to still be an ongoing struggle to have such rights (e.g. abortion) reflected in legislation. In response to the article "Women's Health as an Ideological and Political Issue: Restricting the Right to Abortion, Access to In Vitro Fertilization Procedures and Prenatal Testing in Poland" (Zuk & Zuk, 2017 ), the potential influence of the Catholic Church on abortion legislation is discussed. In this connection Austria is used as example to illustrate differences in the influence of the Catholic Church in predominantly Catholic countries. Additional aspects of women's sexual and reproductive rights are included in this comment, such as access to contraceptives, emergency contraceptives, cost coverage and quality of health care. Given the development of the political situation in Europe, women's rights and Women's Health are in danger of becoming a victim of recent political developments. Thus, a close look at these matters is needed.

Similar Employment of Coercion Strategies by Men and Women: Links Between Conformity to Traditional Masculine Ideologies and Sexual Coercion Following Sexual Rejection.

During hookups some people use coercive tactics to obtain sex from a reluctant partner. The current study explored whether individuals with greater conformity to traditional masculine ideologies (TMIs) are more willing to use coercive and coaxing tactics following sexual rejection than are individuals with less conformity to TMIs. German-speaking participants (N = 771; 50.5% men and 49.5% women; age M = 27.98, SD = 8.04), recruited through Prolific or university-wide mailing lists, were randomly assigned to read one of two hypothetical scenarios depicting a hookup leading to sexual rejection. One scenario included rejection when trying to initiate sexual activity. In the other scenario, rejection followed after some consensual sexual activity had taken place. Participants reported their propensity to use coercive and coaxing tactics. Results showed significant associations between conformity to TMIs and an increased propensity to use coercion and coaxing tactics. Additionally, sexual rejection after sexual activities leads to an increased propensity to use coaxing tactics. During hookups, men and women with greater conformity to TMIs related to sexual interactions, power dynamics and the endorsement of aggressive behaviors may perceive sexual rejection as a loss of control and try to regain dominance and power by using coercive and coaxing tactics.

How do we get gender medicine into medical education?

Gender medicine, which takes a differentiated look at human beings as individuals and aims to provide targeted, gender-specific medical care, is slowly gaining recognition and acceptance. Nevertheless, this medical science that cuts across all medical disciplines has been only marginally incorporated into medical education curricula. The authors will look at the incorporation of gender medicine into the curriculum of Innsbruck Medical University to discuss the factors and the strategy that helped to establish it.

Explorative Questionnaire Study About Education with Regard to the Health of Sexual Minorities at an Austrian Medical University.

Physicians can play a critical role in helping lesbian, gay, and bisexual-identified (LGB) individuals face minority stress. The current questionnaire study among 305 medical students (62.6% women/37.4% men; Mage = 23.4, SD = 3.2) assessed whether medical students learn about LGB-specific concepts at an Austrian medical university. Students reported that their education contained little content about LGB-specific concepts. The majority of students did not hold negative attitudes toward homosexuality and they would like a larger range of courses concerning LGB-specific topics. The barrier most strongly associated with the intention to ask future patients about their sexual orientation was the belief that sexual orientation was irrelevant for clinical practice. Future education programs on LGB-specific topics may not need to focus on reducing negative attitudes toward sexual minorities, but should contain more facts on LGB individuals' specific healthcare needs and explain to students why a patient's sexual orientation is important to healthcare.

Not Always a "Buffer": Self-Compassion as Moderator of the Link Between Masculinity Ideologies and Help-Seeking Intentions After Experiences of Intimate Partner Violence.

Many women and men experience intimate partner violence (IPV) during their lifetime. However, only relatively few people actually seek formal help after such an experience. The current study applied the mediated-moderation model of self-compassion and stigma that has previously been used to explain men's help-seeking behavior for depressive symptoms. The current study analyzed whether conformity to masculinity ideologies (CMI), self-stigma, and self-compassion were related to women's and men's intention to seek formal help after IPV experiences. A cross-sectional online questionnaire study was conducted with 491 German-speaking participants (65.8% women/34.2% men; age: M = 36.1 years; SD = 14.2). Participants read three vignettes about experienced IPV and then indicated how likely they would be to seek medical or psychological help if they were in the main character's situation. Additionally, the Conformity to Masculine Norms Inventory, Self-Stigma of Seeking Help Scale, and Self-Compassion Scale were used. Separate manifest path models for women and men revealed that strong CMI was linked to strong self-stigma in women and men. In turn, strong self-stigma was linked to weak intentions to seek formal help after IPV experiences. In men, strong self-compassion weakened (i.e., "buffered") the link between CMI and self-stigma. However, direct associations between strong CMI and weak intentions to seek formal help remained, especially for those participants with strong self-compassion. The current study adds to the existing literature on associations between CMI, self-compassion, and self-stigma by showing that those links are also relevant in women. However, self-compassion might not always act as a "buffer" and mediators that explain links between strong CMI and weak intentions to seek formal help in people with strong self-compassion need to be found in future studies.

Sex hormones influence survival of patients with metastatic urothelial carcinoma undergoing immune checkpoint therapy.

INTRODUCTION: Clinical trials investigating efficacy of immune checkpoint inhibitors (ICI) revealed sex-specific divergent outcomes in urothelial cancer (UC), suggesting that sex hormones might play an important role in gender-specific dimorphisms of response upon ICI. However, further clinical investigations are still needed to understand the influence of sex hormones in UC. The aim of this study was to get further insights on the prognostic and predictive value of sex hormone levels in patients with metastatic UC (mUC) who underwent ICI. MATERIAL AND METHODS: Sex hormone levels of patients with mUC including luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, prolactin, testosterone and 17ß-estradiol (E2) were evaluated at baseline and during ICI at 6/8 weeks and 12/14 weeks. RESULTS: Twenty-eight patients (10 women, 18 men) with a median age of 70 years were included. Metastatic disease was confirmed in 21 patients (75%) after radical cystectomy while seven patients showed mUC at first diagnosis. Twelve patients (42.8%) received first line and 16 patients second line pembrolizumab. The objective response rate (ORR) was 39% (CR in 7%). The median progression-free survival (PFS) and overall survival (OS) was 5.5 and 20 months. Focusing on changes of sex hormone levels during ICI, a significant increase in FSH levels and decrease of the LH/FSH ratio was noticed in responders (p = 0.035), yet without sex-specific significance. When adjusted for sex and treatment line, a significant increase of FSH levels was confirmed in men during second line pembrolizumab. Focusing on baseline levels, LH/FSH ratio was significantly higher in female responders (p = 0.043) compared to non-responders. In women, increased LH levels and LH/FSH ratio were associated with better PFS (p = 0.014 for LH, p = 0.016 for LH/FSH ratio) and OS (p = 0.026 and p = 0.018). In male patients, increased E2 levels were linked with improved PFS (p < 0.001) and OS (p = 0.039). CONCLUSION: Increased LH and LH/FSH values in women as well as high E2 levels in men were significant predictors of better survival. Elevated LH/FSH ratio was predictive of better response to ICI in women. These results show first clinical evidence of the potential role of sex hormones as prognostic and predictive biomarker in mUC. Further prospective analyses are needed to corroborate our findings.

Urothelial carcinoma (UC) presents as aggressive disease with a greater incidence in men, yet a more aggressive course of disease in women. Patients with metastatic UC receive a chemotherapy regimen as the gold standard, based on an included platin substance. In the case of having contraindications to chemotherapy, checkpoint immunotherapy, priming the immune system to the tumor, is the treatment of choice. Furthermore, immunotherapy is used as second line therapy in progressive disease after chemotherapy and as maintenance therapy in stable tumor conditions after completing the chemotherapy regimen.Evidence shows that sex hormones of the hypothalamus­hypophysis axis influence development and course of UC. The sex hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH) stimulate estrogen (E2) production with a negative feedback function on the LH and FSH secretion. High levels of E2 present with a protective effect against UC. Sex has furthermore shown to predict potential response to immunotherapy. This study therefore focused on monitoring and correlating changes of sex hormone levels in 28 patients during therapy with checkpoint inhibitors.This first study assessing changes in sex hormones and the influence of baseline sex hormone values on survival in UC shows that responders to immunotherapy had significantly increased FSH levels. FSH furthermore increased in male patients receiving second line immunotherapy. High values of LH and a high LH/FSH ratio at baseline correlated with better overall survival in female patients. High E2 levels were indicative of better survival in male patients. The study results represent first suggestive prognostic and predictive results to the response of immunotherapy in UC.