Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States.

The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19-70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

Association Between Body Mass Index and Clinical Outcomes of Gender-Affirming Masculinizing Chest Reconstruction.

INTRODUCTION: Body mass index (BMI) is often used in surgical settings to determine patients' risk of complications. In the context of gender-affirming care, BMI requirements for surgery can limit access to necessary care for larger-bodied people. There is a critical need to understand the association between BMI and postoperative outcomes for this population. METHODS: A retrospective chart review was conducted using the first 250 consecutive gender-affirming masculinizing chest reconstructions performed between 2017 and 2021 at a large academic medical institution. The relationships between BMI, preoperative factors, and common postsurgical outcomes were assessed. RESULTS: Average BMI at surgery was 27.5 ± 6.7 kg/m2. Increases in BMI were associated with longer drain stays, larger volume of tissue resected, higher likelihood of nipple grafts, and lower likelihood of periareolar surgery (all P < 0.0001). Simple logistic regression revealed that BMI increases were significantly related to the likelihood of experiencing dog ears in the intermediate term (P = 0.002). Multivariate logistic regression adjusted for common covariates (age, ethnicity, smoking status, asthma, autoimmune disorders, cardiovascular conditions, and mental health disorders) did not reveal any significant relationships between BMI and the likelihood of experiencing complications at any study point. CONCLUSIONS: Masculinizing chest reconstruction is safe and satisfactory for young adult patients across the range of BMI, with significant differences in outcomes found only for esthetic complications (i.e., dog ears). Surgeons should inform patients with higher BMIs about what outcomes to expect but higher BMI should not preclude surgery access.