Bone health in adult trans persons: an update of the literature.

PURPOSE OF REVIEW: Hormonal treatment in trans persons can affect bone health. In this review, recent studies published on this topic in adults are discussed. RECENT FINDINGS: Before starting hormonal treatment, trans women were found to have lower bone mineral density than cis men, which seems to be related to lower vitamin D concentrations and lower lean body mass, whereas this was not found in trans men. Short-term and long-term studies show that hormonal treatment does not have detrimental effects on bone mineral density in trans women and trans men. Low estradiol concentrations were associated with a decrease in bone mineral density in trans women. SUMMARY: Based on the reassuring findings in these studies, regularly assessing bone mineral density during hormonal treatment does not seem necessary. This confirms the Endocrine Society Guideline stating that bone mineral density should be measured only when risk factors for osteoporosis exist, especially in people who stop hormonal treatment after gonadectomy. The relationship with estradiol concentrations indicate that hormone supplementation should be adequate and therapy compliance should be stimulated. As vitamin D deficiency frequently occurs, vitamin D supplementation should be considered. Future research should focus on fracture risk and long-term changes in bone geometry.

Current Concepts in Masculinizing Gender Surgery.

LEARNING OBJECTIVES: After reading this article and viewing the video, the participant should be able to: 1. Discuss appropriate treatment guidelines, including preoperative mental health and hormonal treatment before gender-affirmation surgery. 2. Name various surgical options for facial, chest, and genital masculinization. 3. Recognize key steps and anatomy during chest-wall contouring and phalloplasty reconstruction. 4. Discuss major risks and complications of chest-wall contouring and phalloplasty reconstruction. SUMMARY: Transgender and gender-nonconforming individuals may experience conflict between their gender identity and their gender assigned at birth. With recent advances in health care and societal support, appropriate treatment has become newly accessible and has generated increased demand for gender-affirming care, which is globally guided by the World Professional Association for Transgender Health. This CME article reviews key terminology and standards of care, and provides an overview of various masculinizing gender-affirming surgical procedures.

The evolution of transgender surgery.

An estimated 1.4% of the population worldwide has been diagnosed with Gender Dysphoria, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Gender reassignment, which holistically encompasses psychotherapy, hormonal therapy and genital and nongenital surgeries, is considered the most effective treatment for transgender nonconforming patients afflicted with gender dysphoria. Little research is currently available identifying the psychosocial needs of the transgender population and their access to preventative and primary care during this transitioning process. This article presents an overview of the evolution and current approaches to genital surgical procedures available for both male-to-female, as well as female-to-male gender-affirmation surgeries. Clin. Anat. 31:878-886, 2018. © 2018 Wiley Periodicals, Inc.

Carne única, nueva carne. Cuerpo y democratización de tecnologías biomédicas de transformación corporal para personas trans en el actual escenario argentino / Unique meat, new meat. Body and democratization of biomedical technologies of corporal transformation for trans people in the current Argentine scenario / Carne única, carne nova. Corpo e democratização das tecnologias biomédicas de transformação corporal para pessoas trans no atual cenário argentino

Resumen Este artículo pretende reflexionar acerca del proceso que va desde la producción de conocimiento biomédico en torno a identidades sexo-genéricas diversas, a las transformaciones en los modos de representar a las personas trans como sujetos de derecho, frente al Estado argentino. La intervención en la escena política de colectivos organizados imprimió una serie de particularidades al dispositivo médico-legal de la transexualidad en Argentina. Así, sujetos-pa(de)cientes nacidos en "cuerpos equivocados" pasaron a organizarse colectivamente y a emponderarse desde ese cuerpo como vehículo, para exigir y negociar otras posibilidades de ser y estar en el mundo. La reciente sanción de la Ley de Identidad de Género introdujo cambios en torno a la democratización del acceso a tecnologías biomédicas de transformación corporal, así como en las dinámicas de atención hospitalaria y sus implicancias en la producción de subjetividades mediadas biotecnológicamente. Finalmente, se introduce un debate en torno a nuevas formas de biosociabilidad y producción de conocimiento que configuran particulares relaciones entre ciencia, tecnología, usuarios, profesionales de la salud e instituciones públicas.

Abstract This paper looks to reflect on the process ranging from the production of biomedical knowledge around diverse sex-generic identities, to the transformations in the ways of representing trans people, as subjects of law in the Argentine State. The organizations have broken into the political arena, imprinting some characteristics to the medical and legal transsexuality device in Argentine. Thus, subjects-patients/sufferers that have born in "wrong bodies" became collectively organized and empowered from this body as a vehicle to demand and negotiate other possibilities of being in the world. The recent approval of the Gender Indentity Law introduced changes in the democratization of access to biomedical technologies of body transformation, in the hospital care dynamics and its implications on the production of subjectivities biotechnologically mediated. Finally, we introduce the discussion about new ways of biosociabilty and knowledge production, which configure particular relationships between science, technology, users, health professionals and public institutions.

Resumo Este artigo tem como objetivo refletir sobre o processo que vai desde a produção de conhecimento biomédico sobre diversas identidades sexuais genéricas, até mudanças nos modos de representar as pessoas transexuais como sujeitos de direito frente ao governo argentino. A intervenção dos coletivos organizados no cenário político imprimiu uma série de particularidades ao dispositivo médico-legal da transexualidade na Argentina. Assim, sujeitos-pacientes / que padecem, nascidos em "corpos errados", passaram a se organizar coletivamente e empoderar-se a partir daquele corpo como um veículo para exigir e negociar outras possibilidades de ser e estar no mundo. A recente promulgação da Lei de Identidade de Gênero introduziu mudanças na democratização do acesso a tecnologias biomédicas de transformação corporal e dinâmicas de cuidados hospitalares e suas implicações na produção de subjetividades mediadas biotecnologicamente. Por fim, apresenta-se um debate em torno de novas formas de biossociabilidade e produção de conhecimento que formam relações particulares entre ciência, tecnologia, usuários, profissionais de saúde e instituições públicas.

Changing and Unchanging Perspectives regarding Intersex in the Last Half Century: Topics Presented in the Lawson Wilkins Lecture* at the 2015 Pediatric Endocrine Society Meeting.

The understanding, care and treatment of patients born with intersex or disorders of sex development conditions has evolved considerably over the last five decades. Regarding those who require evaluation before gender assignment is made, each "generation" of approach has been based upon and reflects the contemporary biological, social and psychological understanding. The most recent generation needs to consider the dramatically changed societal viewpoints regarding the acceptance and expansion beyond a binary perception of sexuality. This together with advances in genetic etiologies, surgical refinements and psychological support should result in better care and quality of life (QoL) outcomes for patients with these conditions. This paper reviews the successive generations of approach and discusses the multiple challenges facing the multidisciplinary teams caring for these patients today.

[Legal aspects and the treatment procedure of gender dysphoria in Hungary]. / A nemi dysphoria jogi vonatkozásai és a kezelés folyamata Magyarországon.

The legal process of gender transition in Hungary had previously been more developed as in most European countries, as the law enabled transsexual people to change their name and gender before or without a medical treatment, which was unique at the time. Over the years, however, lots of European countries developed legal frameworks and accepted international standards of care for the treatment of gender dysphoria that Hungary did not follow. Currently in Hungary there is no consistent legal framework of gender transition, there is no official regulation or guidelines regarding gender transition process, no institution with the obligation to accommodate the process, and there is no nominated specialist in the state health care system whose remit included dealing with transsexual patients. The information on gender transition options both to the professionals and to the patients is limited and incoherent. This paper reviews the legal aspects and clinical management process of gender dysphoria in Hungary. Some issues regarding the Hungarian practice and possible solutions based on examples from the United Kingdom are addressed within the paper.

Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria.

INTRODUCTION: The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females. AIM: We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria. METHODS: The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006-2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam. RESULTS: Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6,592 adolescents referred for other clinical problems. CONCLUSIONS: Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.

Young adult psychological outcome after puberty suppression and gender reassignment.

BACKGROUND: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach. METHODS: A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated. RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. CONCLUSIONS: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.