"Am I Doing the Right Thing?": Pathways to Parenting a Gender Variant Child.

Gender variant (GV) children have a subjective sense of gender identity and/or preferences regarding clothing, activities, and/or playmates that are different from what is culturally normative for their biological sex. Despite increases in rates of GV children and their families presenting at clinics, there is little research on how raising a GV child affects the family as a whole or how families make decisions regarding their care. This study took an ecological-transactional framework to explore the question, "what is the experience of parents who raise a GV or transgender child?" Eight mothers and three fathers of GV male and female children (ages 5-13) referred through a GV support group participated in interviews. Transcripts were analyzed using an adaptation of grounded theory analysis. These parents attempted to pave the way to a nonstigmatized childhood for their GV child, typically through two pathways: rescuing the child from fear of stigma and hurt or accepting GV and advocating for a more tolerant world. Many participants used both pathways to different degrees or shifted paths over time, and the paths selected were related to parents' own understanding of GV and their experiences and backgrounds as well as characteristics of the children they were parenting and the communities they inhabited. Limitations, clinical implications, and future directions are discussed.

[Sociodemographic comparative between the periods 2007-2009 and 2015-2019 of the Gender Identity Treatment Unit of Asturias]. / Estudio sociodemográfico comparativo de los períodos 2007-2009 y 2015-2019 de la Unidad de Tratamiento de Identidad de Género del Principado de Asturias.

BACKGROUND AND OBJECTIVE: The high demand of assistance made by trans people in recent years has directed the focus of research towards the study of their clinical and sociodemographic aspects. The objective of this work was to compare and analyze some sociodemographic variables in trans people in two periods: the period when the unit began to operate and the most recent period. MATERIALS AND METHOD: A sample of 131 users who attended the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) between 2015-2019 was compared with a sample of 33 who attended between 2007-2009. Data were extracted from medical records. RESULTS: Regarding 2007-2009, in 2015-2019 the ratio is inverted in favor of Trans Men (TM). Users of both genders request consultation at an earlier age (specially TM), come less from abroad, achieve higher educational and work qualifications, are less unemployed and request more name changes. And, although Trans Women (TW) continue to be those who are mostly engaged in prostitution and self-administration of hormones, in the most recent period they report it less and, furthermore, they live more accompanied tan in the past. CONCLUSIONS: Changes are observed in the sociodemographic variables of UTIGPA users between 2007-2009 and 2015-2019, in the direction of a greater inclusion. However, the sociodemographic conditions of the TW are still at a disadvantage in comparison to those of the TM.

[Gender dysphoria in trans minors: Ecological niche]. / La disforia de género en menores trans: nicho ecológico.

BACKGROUND AND OBJECTIVE: The objective of the present study is to investigate the contextual characteristics of the onset of gender dysphoria (GD) in trans minors. MATERIALS AND METHOD: All minors who requested consultation in the Gender Identity Treatment Unit from March 2007 to June 2019 participated. Clinical histories were reviewed to obtain the information. Confidentiality was guaranteed. RESULTS: Sixty-four minors required care, 39.1% were trans women (TW) and 60.9% trans men (TM). The age range was between 6-17 years, with a mean of 14.98. Seventy-five percent of the trans minors located the onset of DG in childhood and 25% in adolescence. Parental reaction was suspicious in 55.6% of cases and surprise in 36.5%; 55.6% presented significant psychological distress before going to the unit. Family support was present in 57.1%. The role of social networks and the Internet was relevant for 39.7% of the sample. Of the minors, 44.4% had membership or contact with peer groups or LGTBIQ associations. Results were analysed according to sense of gender. CONCLUSIONS: Minors continue to require care in the units, especially TW. Although GD onset in both groups is mainly in childhood, in adolescence it is more frequent in TM. Trans minors are born, develop and build their identity in a specific context, which is in interaction.

Clinical practice guidelines for transsexual, transgender and gender diverse minors.

Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social-familial environment, in an individualized and flexible way during the gender affirmation path. This service model also includes hormonal treatments tailored as much as possible to the individual's needs, beyond the dichotomic goals of a traditional binary model. This guide addresses the general aspects of professional care of trans* minors and presents the current evidence-based protocol of hormonal treatments for trans* and non-binary adolescents. In addition, it details key aspects related to expected body changes and their possible side effects, as well as prior counselling about fertility preservation.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

[Preservation of fertility in transgender people]. / Preservação da fertilidade em indivíduos transgénero.

Young transgender people increasingly seek medical help to assist them in their gender transition with hormone therapy and/or sex reassignment surgery. However, these treatments limit fertility and may make them irreversibly infertile. Studies show that the transgender population wishes to have biological children and, to help them achieve this desire for parenthood, there are techniques for preserving fertility, such as cryopreservation of gametes, embryos and ovarian or testicular tissue. However, alongside these techniques, there are ethical issues and several challenges before, during and after these procedures, that may lead young transgender people to reject these methods of preserving fertility. In conclusion, health professionals should be informed about all these dynamics between gender transition therapies and their impact on fertility, in order to better guide these individuals in their decision.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. / Antecedentes de comportamientos autolesivos y autolíticos en población adolescente y adulta joven transexual, atendida en una unidad especializada en identidad de género en España.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

[Sex/gender ratio of adolescents with gender dysphoria of the Gender Identity Treatment Unit of Asturias]. / Ratio sexo/género de los adolescentes con disforia de género de la Unidad de Tratamiento de Identidad de Género de Asturias.

BACKGROUND AND OBJECTIVE: Demand from minors with complaints of gender dysphoria has increased in recent years. This increase has been more pronounced in adolescent trans men in some international research studies. The first objective of this research study was to determine the sex/gender ratio of minors requesting a consultation in the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) and presenting complaints of gender dysphoria. The second objective was to analyse the relationship of the sex/gender ratio with the age variable at which they requested the first consultation and the year in which they requested it. MATERIALS AND METHOD: The sample consisted of 42 children under 18, attended between January 2016 and January 2019. The medical records were then reviewed to obtain information. Descriptive statistics were analysed with the collected data. RESULTS: The sex / gender ratio over the period was 2/1 in favour of trans men. The average age at the request for consultation was 15.02 years (SD=1.84), with a range of 6 to 17 years. A higher percentage of applications was recorded (35.7%) in 2018, mostly made by trans men (93.3%). CONCLUSIONS: There was an inversion of the sex/gender ratio, a favour of trans men, over the last 3years, and an increase in the number of applications by adolescent trans men, coinciding with several international investigations.

Gender detransition: a case study.

Within the last decade, there has been a sharp global rise in the number of young people identifying as transgender. More recently, there appears to be an increase in the numbers of young people detransitioning or returning to identifying with their natal sex after pursuing medical transition. A case is presented of a young woman who pursued a gender transition and returned to identifying as female after almost two years on testosterone. The author considers and critiques the affirmative model of care for gender dysphoric youth in light of this case.

Dans les dix dernières années, on a vu un accroissement considérable du nombre de jeunes personnes qui s'identifient transgenre. Plus récemment, il semble qu'il y ait un accroissement du nombre de jeunes personnes qui reviennent en arrière par une détransition, ou qui reviennent à s'identifier à leur sexe de naissance après avoir souhaité une transition médicale. L'article présente le cas d'une jeune femme qui est entrée dans le processus de transition de genre et qui est ensuite revenue à une identification en tant femme, après presque deux années sous testostérone. A la lumière de ce cas, l'auteur examine et critique le modèle de soin qui va dans le sens d'affirmer la dysphorie de genre chez de jeunes personnes.

En la última década, ha habido un crecimiento global agudo de jóvenes que se han identificado como transgénero. Más recientemente, pareciera haber un incremento en el número de jóvenes de-transicionando o retornando a la identificación con su género natal luego de haber realizado una transición médica. Se presenta el caso de una joven mujer quien prosiguió una transición de género y retornó a identificarse como de género femenino, casi dos años después de haber tomado testosterona. La autora considera y critica, a la luz de este caso, el modelo afirmativo de cuidado para la disforia de género en las y los jóvenes.

[Psychosocial assessment in transgender adolescents]. / Evaluación psicosocial en adolescentes transgénero.

OBJECTIVES: To evaluate the psychosocial status of the patients who attend a paediatric endocrinology clinic due to gender incongruity (GI), and to establish the impact on this after one-year of cross hormonal therapy (CHT). MATERIAL AND METHODS: An analytical and prospective study conducted on adolescents between 14 and 18 years old with GI, and who attended the Endocrinology clinic during 2018-2019. The sample included 23 transgender cases (16 male and 7 female cases) and 30 cisgender controls. Study variables were collected at T0 (pre-treatment) and T1 (after one year of CHT) and included sociodemographic data, Utrecht test, SDQ-Cas test, family APGAR test, STAI scale-anxiety Grade, and BDI-II depression assessment test. RESULTS: A significant improvement (P<.05) was found between T0 and T1 in the transgender group in terms of emotional symptoms, behaviour problems, hyperactivity symptoms, pro-social conduct, as well as in the degree of anxiety and depression measured by the SDQ-Cas test, the STAI and the BDI-II scale. There were significant differences in these scales between the transgender group and the controls at T0, however, the scores equalised at T1. The families in this sample of transgender patients provided a very favourable environment according to the scores obtained on the family APGAR scale. CONCLUSIONS: The rates of anxiety, emotional and behaviour distress, depressive symptomatology, as well as the feeling of gender dysphoria of these transgender patients were similar to those of non-transsexual population of the same age after one year of CHT initiated at ages between 14-18 years old.

Adult Gender Dysphoria with Coronary Disease. Case Report and Literature Review. / Disforia de género en el adulto con enfermedad coronaria. Reporte de caso y revisión de la literatura.

INTRODUCTION: Gender dysphoria (GD) refers to a marked incongruity between gender identity and biological sex. GD generates a significant clinical discomfort for at least six months. METHODS: Case report and non-systematic literature review. Case presentation A 56-year-old male-to-female patient, who had a history of coronary disease and a second thromboembolic event after hormone therapy (self-medicated). Once she had received acute management for the cardiovascular disease, she consulted for her GD. DISCUSSION: GD requires multidisciplinary management. Cross-sex hormonal therapy is considered the main treatment. It has been documented that oral oestrogen preparations may increase the risk of thromboembolic events in patients over the age of 40, especially when they have cardiovascular risk factors. CONCLUSIONS: Comprehensive treatment should be offered to everyone who has GD, to relieve psychological distress, decrease psychiatric comorbidity and improve quality of life. To date, there is little scientific evidence regarding cross-sex hormonal therapy in transgender women over the age of 40; we therefore recommend multidisciplinary, close and rigorous monitoring, in particular when they have cardiovascular risk.

Transgender medicalization and the attempt to evade psychological distress.

In this paper the author argues that trans-identification and its associated medical treatment can constitute an attempt to evade experiences of psychological distress. This occurs on three levels. Firstly, the trans person themselves may seek to evade dysregulated affects associated with such experiences as attachment trauma, childhood abuse, and ego-alien sexual feelings. Secondly, therapists may attempt to evade feelings, such as fear and hatred, evoked by engaging with these dysregulated affects. Thirdly, we, as a society, may wish to evade acknowledging the reality of such trauma, abuse and sexual distress by hypothesizing that trans-identification is a biological issue, best treated medically. The author argues that the quality of evidence supporting the biomedical approach is extremely poor. This puts young trans people at risk of receiving potentially damaging medical treatment they may later seek to reverse or come to regret, while their underlying psychological issues remain unaddressed.

Dans cet article l'auteur soutient que l'indentification trans et son traitement médical associé peuvent constituer une tentative pour échapper à des expériences de détresse psychologique. Ceci se produit à trois niveaux. Premièrement, la personne trans elle-même peut chercher à éviter les affects dérégulés associés aux expériences telles que le traumatisme de l'attachement, l'abus sexuel dans l'enfance, les ressentis sexuels qui semblent incompatibles avec l'égo. Deuxièmement, les thérapeutes peuvent tenter d'échapper à des émotions, telles que la peur et la haine, évoquées par l'implication avec ces affects dérégulés. Troisièmement, nous, en tant que société, pouvons être animés par le souhait d'échapper à la réalité de tels traumatismes, abus et détresse sexuels en nourrissant l'hypothèse que l'identification trans est une question biologique, qu'il vaut mieux soigner de manière médicale. L'auteur soutient que la qualité des preuves en faveur de l'approche biomédicale est extrêmement pauvre. Ceci expose les jeunes personnes trans au risque de recevoir des traitements médicaux qui les endommagent, traitements qu'elles peuvent plus tard chercher à inverser, ou qu'elles regrettent, pendant que les questions psychologiques fondamentales restent sans attention.

En el presente trabajo, el autor argumenta que la identificación-trans y el tratamiento médico asociado puede constituir una intento de evadir experiencias de angustia psicológica. Esto sucede en tres niveles. Primero, la persona trans puede buscar evadir emociones desreguladas asociadas a experiencias como trauma de apego, abuso infantil, y sentimientos sexuales ego - no alineados. Segundo, los terapeutas pueden intentar evadir sentimientos, tales como miedo y odio, evocados al entrar en contacto con estos afectos desregulados. Tercero, nosotros, como sociedad, podemos desear evadir la realidad de semejante trauma, abuso y angustia sexual, al hipotetizar que la identificación-trans es un tema biológico, y mejor tratarlo medicalmente. El autor da cuenta que la evidencia que fundamenta el abordaje biomédico es extremadamente pobre. Esto supone, para las personas jóvenes trans, el riesgo de recibir tratamiento médico potencialmente dañino, que más tarde pueden buscar revertir, o del que arrepentirse mientras que los temas psicológicos subyacentes permanecen sin ser reconocidos.

Rehabilitación integral de piso pélvico en un paciente con cirugía de reasignación de sexo: a propósito de un caso / Comprehensive pelvic floor rehabilitation in a patient with sex reassignment surgery: Apropos of a case

Objetivo. Presentar el manejo rehabilitador del piso pélvico para la prevención del dolor en un paciente en posoperatorio de cirugía de reasignación de sexo.Caso clínico. Paciente masculino de 23 años con disforia de género que inició la transición de hombre a mujer hace siete años y es llevado a cirugía de reasignación de sexo mediante los procedimientos de orquiectomía, penectomía parcial, vaginoplastia, clitoroplastia y labioplastia, en mayo de 2023.Intervención. El paciente recibió un proceso de rehabilitación intrahospitalaria durante 10 días que incluyó abdominales hipopresivos, reeducación del patrón respiratorio, entrenamiento en activación muscular del core abdominal y esfínteres, movilidad lumbo-pélvica, uso de dilatadores dos veces al día con una duración de dos horas y ejercicios de neurodinamia, retorno venoso y readaptación a la marcha.Resultados. Al cabo de 10 días de hospitalización con atención temprana en rehabilitación pélvica, el paciente informó una mejoría en el síntoma de dolor; adicionalmente se evidenció optimización de la fuerza muscular funcional y de la movilidad del complejo lumbo-pélvico-cadera, así como una adaptación satisfactoria a las terapias dilatadoras. Conclusión. Los pacientes transgéneros sometidos a la cirugía de reasignación de sexo experimentan múltiples cambios en su cuerpo los cuales generan la necesidad de intervención por parte del área de Medicina Física y Rehabilitación para implementar la rehabilitación integral del piso pélvico con el fin de prevenir futuras complicaciones y facilitar el proceso de adaptación a las actividades básicas cotidianas; ello, sumado a la consecución de la satisfacción personal y sexual. Palabras clave. Disforia de género, cirugía de reasignación de sexo, piso pélvico, rehabilitación

Objective. To present the rehabilitation management of the pelvic floor for the prevention of pain in a patient in the postoperative period after sex reassignment surgery. Clinical case. A 23-year-old male patient with gender dysphoria who started the transition from man to woman seven years ago and was taken to sex reassignment surgery through the procedures of orchiectomy, partial penectomy, vaginoplasty, clitoroplasty and labiaplasty in May 2023. Intervention. The patient underwent an in-hospital rehabilitation process for 10 days that included hypopressive abdominal exercises, re-education of the respiratory pattern, training in muscle activation of the abdominal core and sphincters, lumbopelvic mobility, use of dilators twice a day for two hours and exercises of neurodynamics, venous return and gait readaptation. Results. After 10 days of hospitalization with early attention in pelvic rehabilitation, the patient reported an improvement in the symptom of pain; in addition, optimization of functional muscle strength and mobility of the lumbo-pelvic-hip complex was evidenced, as well as a satisfactory adaptation to dilator therapies. Conclusion. Transgender patients who undergo sex reassignment surgery experience multiple changes in their body, which generate the need for intervention by the Physical Medicine and Rehabilitation area to implement comprehensive pelvic floor rehabilitation in order to prevent future complications and facilitate the process of adaptation to basic daily activities; this, added to the achievement of personal and sexual satisfaction

A sexualidade de indivíduos transgêneros: recomendações para profissionais de saúde / The sexuality of individuals transgender: recommendations for healthcare professionals

Indivíduos transgêneros (ou trans) apresentam diferença entre a sua identidade de gênero e o sexo que lhe foi atribuído ao nascimento, o que provoca sofrimento grave, nomeado como disforia de gênero, estado que apresenta melhora após a transição para o gênero autor-reconhecido. Pessoas transgêneras apresentam os piores marcadores de saúde mental entre os LGBTQIA+. O objetivo deste texto é levantar aspectos psicossociais e sexuais de indivíduos transgêneros e trazer algumas recomendações para profissionais de saúde. Os tratamentos disponibilizados para essa população são os de afirmação de gênero (supressão da puberdade, tratamento hormonal cruzado, cirurgia reconstrutiva torácica e cirurgias genitais afirmativas de gênero). Muitas vezes, as alterações corporais conseguem diminuir os sintomas de disforia, melhorando a qualidade de vida. Porém, para muitos deles, apenas a mudança do papel social de gênero é suficiente. As disfunções sexuais mais frequentes experimentadas por mulheres e homens trans são dificuldades para iniciar e buscar contato sexual (mulheres, 26%, homens, 32%) e para atingir o orgasmo (29% e 15%). A atenção à saúde transgênera deve conter cuidados inter e multidisciplinares holísticos, envolvendo endocrinologia, cirurgia, voz e comunicação, atenção primária, saúde reprodutiva, saúde sexual e mental para acompanhar intervenções de afirmação de gênero, bem como prevenção, cuidado e gerenciamento de doenças crônicas. Indivíduos transgêneros enfrentam, além de todas as questões que afligem a sociedade contemporânea, a invisibilidade reforçada principalmente pela falta de conhecimento e pelos preconceitos. Faz-se necessário um atendimento que seja acolhedor, educativo, não preconceituoso e que respeite a individualidade daqueles que carregam em suas histórias sofrimento e violência.

¿Cómo se está estudiando la co-ocurrencia entre trastorno del espectro autista y disforia de género en la población adolescente? / How is the co-occurrence between autism spectrum disorder and gender dysphoria being studied in the adolescent population?

En los últimos años aumentaron las investigaciones sobre co-ocurrencia de trastorno del espectro autista (TEA) y disforia de género (DG) secundario a la necesidad de una mayor comprensión de este fenómeno clínico emergente. Objetivos: Caracterizar los estudios en torno a la co-ocurrencia entre TEA y DG en adolescentes. Metodología: Se realizó una revisión sistemática bibliográfica. Se seleccionaron los estudios que mencionaron esta correlación e incluyeron población adolescente. Resultados: La búsqueda inicial arrojó un total de 97 publicaciones. Finalmente, de acuerdo a los criterios de elegibilidad, se incluyeron 35 artículos. Existen escasos estudios enfocados sólo en adolescentes, amplios rangos de prevalencia de esta relación y heterogeneidad en los instrumentos utilizados. Conclusiones: Al evaluar individuos con DG se debiese llevar a cabo un screening de TEA, y viceversa, para no pasar por alto esta co-ocurrencia. Cabe destacar que quienes presentan TEA tienen particularidades relacionadas con el pensamiento y planificación a futuro que hay que considerar al momento de realizar cualquier tipo de tratamiento afirmativo irreversible, enmarcado dentro de un proceso terapéutico multidimensional. Palabras claves: Adolescentes, Disforia de género, Trastorno de Espectro Autista (TEA), Condición de Espectro Autista (CEA), Autismo.

Research on co-occurrence of autism spectrum disorder (ASD) and gender dysphoria (GD) increased in recent years driven by the need for greater understanding of this emerging clinical phenomenon. Objective. To characterize studies on the co-occurrence of ASD and GD in adolescents. Methodology. A systematic literature review was conducted. Studies mentioning this correlation and including adolescent population were selected. Results. The initial search showed a total of 97 publications. 35 articles were included in the review that met the eligibility criteria. There are few studies focused only on adolescents, there is a wide range of prevalence of this relationship and heterogeneity in the instruments used. Conclusions. When evaluating individuals with GD, an ASD screening should be conducted,and vice versa, to avoid overlooking this cooccurrence. It is important to note that those with ASD have particularities related to cognitive development that need to be considered when undergoing any type of irreversible affirmative treatment, within a multidimensional therapeutic process. Keywords. Adolescents, Gender dysphoria, Autism Spectrum Disorder (ASD), Autism.

[Statement by the Spanish Paediatric Association in relation to gender diversity in childhood and adolescence: Ethical and legal view from a multidisciplinary perspective]. / Posicionamiento Técnico de la Asociación Española de Pediatría en relación con la diversidad de género en la infancia y la adolescencia: mirada ética y jurídica desde una perspectiva multidisciplinar.

An ethical and legal view of gender diversity in childhood and adolescence is presented from the perspective of the best interest of the child and the principle of protection against vulnerability. The identification of gender diversity in childhood and adolescence is a process that requires support, coordination and a multidisciplinary team that improves care and helps to obtain evidence that is lacking today. Secure, equitable and comprehensive access to care and health care should be guaranteed when required. It is necessary to promote a changing of social outlook, capable of overcoming the stereotypes that lead to discrimination and increase suffering. Respect for gender diversity in childhood and adolescence is a fundamental Human Right. The recognition of a positive value in diversity is an ethical imperative. All of this, without forgetting that we are talking about minors often in contexts of vulnerability, and currently very uncertain, so prudence is the main rule that should guide decision-making.

Relationship between Smoking and Vocal Self-perception of Trans Women

Objective: To verify the relationship between smoking, age, schooling, and the vocal self-perception of trans women. Methods: Cross-sectional observational quantitative study conducted with 24 trans women over 18 years old, living in their affirmed gender for a minimum of 6 months. Data collection involved selected questions from the translated and authorized Portuguese version of the Trans Woman Voice Questionnaire (TWVQ) and information regarding age, education, occupation, and smoking status. All variables were analyzed descriptively, and the association with smoking was assessed using Pearson's Chi-square, Fisher's Exact, Student's T, and Mann-Whitney tests, with a significance level of 5%. Results: The mean age of trans women was 28.2 +/- 6.5 years (range: 21 - 48). Most participants (41.6%) had completed their high school education and pursued diverse careers. Regarding smoking habits, 58.3% of women were either current smokers or had smoked at least 100 cigarettes in their lifetime. A statistically significant association was found between smoking and age (p = 0.001), with smokers having a lower average age (24.9 years) compared to nonsmokers (32.9 years). However, no statistical significance was observed between smoking, education, and self-perception of vocal femininity. Only 9 (37.5%) trans women perceived their voices as feminine, while 17 (70.7%) desired a more feminine-sounding voice. Limitation: The limited sample size in this study may have constrained the ability to detect significant differences between the analyzed groups using statistical tests. Conclusion: The smoking prevalence was notably high among younger trans women. However, there was no statistically significant difference in vocal self-perception between those who smoked and those who did not. The majority of trans women expressed a desire for their voices to sound more feminine, particularly among smokers.

Objetivo: Verificar la relación entre el tabaquismo, edad, escolaridad y la autopercepción vocal de mujeres trans. Métodos: Estudio observacional transversal cuantitativo realizado con 24 mujeres trans mayores de 18 años, que viven en su género afirmado durante 6 meses. Para la recolección de datos se utilizaron preguntas seleccionadas de la versión portuguesa traducida y autorizada del Trans Woman Voice Questionnaire (TWVQ) y datos sobre edad, educación, ocupación y tabaquismo. Todas las variables se analizaron descriptivamente y la asociación con el tabaquismo se realizó mediante las pruebas Chi-cuadrado de Pearson, Exacta de Fisher, T de Student y Mann Whitney, con un nivel de significación del 5%. Resultados: La edad promedio de las mujeres trans fue de 28,2 +/- 6,5 (rango 21 - 48). La mayoría de las participantes (41,6%) había terminado la escuela secundaria con carreras muy diversas. Respecto al tabaquismo, el 58,3% de las mujeres fuman actualmente o han fumado al menos 100 cigarrillos en su vida. Hubo una asociación estadísticamente significativa entre el tabaquismo y la edad (p = 0,001), en la que la edad promedio entre los fumadores (24,9 años) fue menor que la de los no fumadores (32,9 años). No hubo significación estadística entre el tabaquismo, la educación y la autopercepción vocal. Solo 9 (37,5%) mujeres trans actualmente consideran su voz femenina y 17 (70,7%) dijeron que la voz ideal podría sonar más femenina. Limitación: La pequeña casuística puede haber limitado la identificación de diferencias entre los grupos analizados a través de pruebas estadísticas. Conclusión: El tabaquismo fue alto entre las mujeres trans, especialmente las más jóvenes. La autopercepción vocal no fue estadísticamente diferente entre los grupos de fumadores y no fumadores. La mayoría de las mujeres trans dijeron que sus voces podrían sonar más femeninas, especialmente las fumadoras.

Chest binding and respiratory complaints in transgender men / Uso de binder e queixas respiratórias em homens transexuais

Abstract Introduction: Chest binders are an important resource for building masculinity in transgender men without mastectomy, although they can cause respiratory and thoracic damage if misused. Objective: To analyze the association between chest binding and chest complaints in transgender men. Methods: This was a quantitative cross-sectional study conducted at the Trans Space of the Hospital das Clínicas de Pernambuco and the LGBTQI Patrícia Gomes outpatient clinic of the Lessa de Andrade polyclinic in Recife (Pernambuco State, northeastern Brazil). Sixty transgender men aged >18 years were included, and data on sociodemographics, general health, chest binding, and respiratory complaints in the thoracic region were collected. Descriptive analysis was performed, and prevalence ratios (PR) were estimated with a confidence interval (CI) of 95% to associate between binder use and complaints in the chest region. Results: The average was 27.25 years, of which 81.7% did not undergo mastectomy and 53.3% used chest binders. The use of chest binders was significantly associated with complaints in the chest region (PR = 2.73), difficulty breathing (PR = 2.27), and chest pain (PR = 1.82). Conclusion: This study demonstrated a higher prevalence of complaints in the chest and respiratory region in transgender men who use chest binders. This reinforces the need to broaden the view on the health of this population. Gender construction strategies are essential for the quality of life and mental health of transgender men, and binders are an important ally in this process.

Resumo Introdução: O uso de binder é um importante recurso para a construção da masculinidade nos homens transexuais não mastectomizados, contudo, pode acarretar danos respiratórios e torácicos se usado de forma inadequada. Objetivo: Analisar a associação entre o uso de binder e as queixas torácicas em homens transexuais. Métodos: Estudo transversal quantitativo realizado no Espaço Trans do Hospital das Clínicas de Pernambuco e no ambulatório LGBTQI Patrícia Gomes da Policlínica Lessa de Andrade, em Recife, PE. Foram incluídos 60 homens transexuais, com idade acima de 18 anos, e foram coletadas informações sociodemográficas, de saúde geral, uso de binder e queixas na região torácica. Foi realizada a análise descritiva e estimadas as razões de prevalência (RP) com intervalo de confiança (IC) de 95% para a associação entre o uso de binder e queixas na região do tórax. Resultados: A média foi de 27,25 anos; destes, 81,7% não realizaram mastectomia e 53,3% faziam uso de binder. O uso de binder teve associação significativa com queixas na região do tórax (RP = 2,73), dificuldade para respirar (RP = 2,27) e dor no tórax (RP = 1,82). Conclusão: Este estudo demonstrou que há prevalência maior de queixas na região do tórax e queixas respiratórias nos homens transexuais que fazem uso de binder. Isto reforça a necessidade de ampliar o olhar sobre a saúde dessa população. Estratégias de construção de gênero são essenciais para a qualidade de vida e saúde mental de homens transexuais, sendo o uso de binder um importante aliado neste processo.

Characteristics of a Population with Gender Incongruence Assisted at a Specialized Outpatient Service in the City of Ribeirão Preto / Características de uma população com incongruência de gênero assistida em ambulatório especializado em Ribeirão Preto

Abstract Objective To identify the age when individuals first perceive gender incongruence (GI) and to compare sociodemographic data of female-to-male (FtM) and male-tofemale (MtF) transgender individuals assisted at an outpatient service. Methods The present cross-sectional study was conducted through a review of the medical records of individuals diagnosed with GI at a single specialized outpatient service in the city of Ribeirão Preto, state of São Paulo, Brazil. Results A total of 193 medical records from 2010 to 2018 were evaluated, and 109 (56.5%) patients had GI since childhood. The FtM transgender individuals perceived GI in childhood more often than the MtF transgender individuals (odds ratio [OR]: 2.06, 95% confidence interval [95%CI]: 1.11-3.81) Unattended hormone use was highest among the MtF group (69.6% versus 32.3%; OR: 4.78, 95%CI: 2.53-9.03). All of the individuals who were engaged in prostitution or were diagnosed with a sexuallytransmitted infection, including HIV, were in the MtF group. Conclusion Despite the more prevalent perception of GI in childhood among the FtM group, social issues were more prevalent among the MtF group, which may be the result of social marginalization.

Resumo Objetivo Identificar o período da vida emque indivíduos indentificaram pela primeira vez sua incongruência de gênero (IG), e comparar os dados sociodemográficos de homens e mulheres transgêneros (trans) atendidos em um ambulatório. Métodos Estudo transversal realizado por meio de revisão dos prontuários de pessoas com IG em ambulatório especializado de Ribeirão Preto, São Paulo, Brasil. Resultados Foram avaliados 193 prontuários de 2010 a 2018, e 109 (56.5%) pacientes apresentavamIG desde a infância. Homens trans perceberam a IG na infância com mais frequência do que as mulheres trans (razão de probabilidades [RP]: 2.06, intervalo de confiança de 95% [IC95%]: 1.11-3.81). O uso de hormônio sem supervisão foi maior entre as mulheres trans (69.6% versus 32.3%; RP: 4.78; IC95%: 2.53-9.03). Todos as pessoas que estavam inseridas na prostituição ou que apresentavam algum diagnóstico de infecção sexualmente transmissível, incluindo o HIV, eram mulherestrans. Conclusão Apesar da percepção mais prevalente da IG na infância entre homens trans, os agravos sociais foram mais prevalentes entre as mulheres trans, o que pode ser resultado da marginalização social.

Consideraciones en población transgénero respecto a la infección por VIH, terapia antiretroviral, profilaxis preexposición (PreP) e interacción con tratamiento de reafirmación de género / Considerations in the transgender population regarding HIV infection, antiretroviral therapy, pre-exposure prophylaxis (PreP) and interaction with gender reaffirmation treatment

Resumen La infección por VIH es una epidemia global (prevalencia de 0,8%). En Latinoamérica, Chile, Brasil y Uruguay son los países con mayores índices. Entre las más afectadas están la población transgénero (OR 48,8 respecto a la población general). Múltiples factores bio-psico-sociales explican estas cifras. Bajo uso del preservativo, la idea de reafirmación de género, el temor a ser reemplazadas(os) por personas cisgéneros, presencia de comercio sexual, entre otros, influyen en las mayores tasas de infección. Se han implementado medidas de prevención del VIH, pero pocas dirigidas en específico a personas transgénero. La profilaxis preexposición (PreP) parece ser una nueva alternativa de prevención en este grupo, y la integración de las unidades de apoyo en la reafirmación de género con las unidades que entregan PreP, podrían aumentar su adherencia y cobertura. En las personas transgénero con infección por VIH existe baja adherencia a terapia antirretroviral (TARV), en parte por priorización del tratamiento hormonal y miedo a que la TARV altere su proceso de hormonización. Los pocos datos existentes muestran que la hormonización no se afecta con la mayoría de la TARV, pero algunos tratamientos hormonales podrían disminuir las concentraciones plasmáticas y tisulares de ciertos antirretrovirales. Faltan estudios que evalúen la interacción entre antirretrovirales y tratamiento hormonal de reafirmación de género.

Abstract HIV infection is a global epidemic, with a prevalence of 0.8%. In Latin America, Chile, Brazil and Uruguay are the countries with the highest rates. The transgender population is the most affected (OR of 48.8 compared to the general population). Multiple bio-psycho-social factors explain these issues. The low use of condoms for pressure from the partner, the idea of reaffirmation of gender, the fear to be replaced by a cisgender person, the presence of commercial sex, among others, influence the highest rates of infection. HIV prevention measures have been implemented, but few specifically targeted at transgender people. Pre-exposure prophylaxis (PreP) seems to be a new prevention alternative in this group, and the integration of support units in gender reaffirmation with units that deliver PreP could increase their adherence and coverage. In HIV (+) transgender people there is low adherence to antiretroviral therapy (ART), in part due to the prioritization of hormonal treatment and the fear that ART will alter their hormonalization process. The few data that exist show that hormonalization is not affected by ART, but that some hormonal treatments could lower the levels of certain antiretrovirals. More studies must be done to evaluate the interaction between antiretrovirals and gender affirming hormone therapy.