Impacto psicossocial da pandemia de COVID-19 na saúde mental de pessoas transexuais e travestis: revisão integrativa / Psychosocial impact of COVID-19 pandemic on mental health of transgender and transvestite people: integrative review / Impacto psicosocial de COVID-19 en la salud mental de las personas transgénero y travestis: revisión integrativa

Este estudo objetivou identificar, analisar e integrar resultados de estudos que examinaram o impacto da pandemia de COVID-19 na saúde mental de pessoas transexuais e travestis. Foi realizada uma revisão integrativa da literatura, em conformidade com as diretrizes PRISMA. Conduziu-se uma busca sistemática dos estudos primários publicados em três bases de dados: PubMed/MEDLINE, LILACS e PsycINFO. Foram incluídos oito estudos que atenderam aos critérios de inclusão. A análise temática do material gerou seis categorias temáticas. Os estudos analisados apontaram que a situação de vulnerabilidade social ao qual as pessoas trans encontram-se submetidas no cotidiano foi ampliada durante a pandemia. A necessidade do distanciamento físico resultou no aumento de sintomas de ansiedade e depressão, agravamento das condições econômicas, dificuldades para acessar procedimentos e medicamentos que compõem o processo de afirmação de gênero, além de exacerbar conflitos familiares e manifestações de transfobia. Há necessidade de implementar políticas públicas e uma rede de proteção social para diminuir a vulnerabilidade e sofrimento psicossocial de pessoas trans. (AU)

This study aimed to identify, analyze, and integrate findings from studies that examined the impact of the COVID-19 pandemic on the mental health of transgender and transvestite individuals. An integrative literature review was conducted according to PRISMA guidelines. A systematic search of primary studies was conducted across three databases: PubMed/MEDLINE, LILACS, and PsycINFO. Eight studies that met the inclusion criteria were included. Thematic analysis of the material generated six thematic categories. The studies analyzed pointed out that the situation of social vulnerability faced by trans people in their daily lives intensified during the pandemic. The need for physical distancing led to increased symptoms of anxiety and depression, worsening economic conditions, and difficulties in accessing procedures and medications that make up the gender affirmation process, in addition to exacerbating family conflicts and manifestations of transphobia. Therefore, there is a need to implement public policies and a social protection network to reduce the vulnerability and psychosocial suffering of the transgender and transvestite community. (AU)

El objetivo de este estudio es identificar, analizar e integrar los resultados de los estudios que examinaban el impacto de la pandemia de COVID-19 en la salud mental de las personas transexuales y travestis. Se realizó una revisión integrativa de acuerdo con las directrices PRISMA en tres bases de datos: PubMed/MEDLINE, LILACS y PsycINFO. Se incluyeron ocho estudios que cumplían con los criterios de inclusión. El análisis temático del material generó seis categorías temáticas. Los estudios analizados señalaron que la situación de vulnerabilidad social a la que están sometidas las personas trans en la vida cotidiana se amplió durante la pandemia. La necesidad de distanciamiento físico se tradujo en el aumento de los síntomas de ansiedad y depresión, el agravamiento de las condiciones económicas, las dificultades para acceder a los procedimientos y medicamentos que componen el proceso de afirmación del género, además de exacerbar los conflictos familiares y las manifestaciones de transfobia. Es necesario aplicar políticas públicas y una red de protección social para reducir la vulnerabilidad y el sufrimiento psicosocial de las personas transgénero. (AU)

[Genital gender affirming surgery in trans women: Vulvo-vaginoplasty review]. / Chirurgie génitale d'affirmation de genre pour les femmes trans : revue des vulvo-vaginoplasties.

INTRODUCTION: A trans woman is a woman who was assigned male at birth, and who has a female gender identity. The majority are requesting a gender affirming genital surgery by vulvo-vaginoplasty. The objective is to review this surgery based on its history, then by presenting the different surgical techniques and their success and complication rates. MATERIAL AND METHODS: A narrative review was performed, based on a bibliography search with keywords from 2000 to 2022 on Pubmed. RESULTS: Vulvo-vaginoplasty for trans women began in 1931, and the first case series date from 1969. The procedure includes excision of scrotal skin, orchiectomy, clitoroplasty, urethroplasty, labioplasty, recto-vesico-prostatic dissection and creation of a vaginal cavity (performed by penile skin inversion and graft, intestine, or peritoneum). Vulvo-vaginoplasty by penile skin inversion (VPPI) is today the reference surgical technique. It represents the vast majority of surgeries performed with the longest follow-up. The majority of trans women are satisfied with the procedure aesthetically (90%) and functionally (80%), with an active sexuality. Major complications are rare (< 5%), they correspond to fistulas or vaginal stenosis. CONCLUSION: VPPI is the gold standard technique with satisfactory overall results, but long-term follow-up is requested.

Emotional States, Adherence and Prevention Behaviors in Trans Women during the COVID-19 Lockdown / Estados Emocionais e Comportamentos de Aderência e Prevenção em Mulheres Trans Durante o Confinamento por COVID-19 / Estados Emocionales y Conductas de Adherencia y Prevención en Mujeres Trans Durante el Confinamiento por COVID-19

Abstract The pandemic generated multiple biopsychosocial challenges that significantly impacted the health of trans women. The aim of this study is to characterize emotional states and resilience in trans women in Colombia and their relationship to COVID-19 adherence behaviors and prevention behaviors during lockdown. The study employed a cross-sectional descriptive correlational design, with an anonymous online questionnaire that was given to 100 trans women in five cities in Colombia. During the pandemic, more than half of trans women experienced negative emotional states such as depression, anxiety and somatization, and some positive ones such as resilience and personal growth. The latter two contribute to reinforcing adherence and prevention behaviors. This study demonstrates a clear need to give priority and recognition to trans women and their health needs, in order to protect their rights, their well-being, and their health.

Resumo A pandemia gerou múltiplos desafios biopsicossociais que impactaram significativamente a saúde das mulheres trans. O objetivo deste estudo é caracterizar estados emocionais e resiliência em mulheres trans da Colômbia e sua relação com os comportamentos de aderência à COVID-19 e os comportamentos de prevenção durante o confinamento. Foi realizado um desenho descritivo, transversal e correlacional, foi administrado um questionário online anônimo a 100 mulheres trans em cinco cidades da Colômbia. Durante a pandemia, mais da metade das mulheres trans experimentaram estados emocionais negativos como depressão, ansiedade e somatização, e alguns positivos como a resiliência e o crescimento pessoal. Estes dois últimos contribuem para reforçar os comportamentos de adesão e de prevenção. Em situações como a pandemia, é prioritário dar reconhecimento às mulheres trans e às suas necessidades de saúde, a fim de proteger os seus direitos e a sua saúde integral.

Resumen La pandemia generó múltiples desafíos biopsicosociales que impactaron significativamente en la salud de las mujeres trans. El objetivo del presente estudio fue caracterizar los estados emocionales y resiliencia en mujeres trans de Colombia y su relación con las conductas de adherencia y prevención a la COVID-19 durante el confinamiento. Se realizó un diseño trasversal correlacional descriptivo, administrando un cuestionario online anónimo a 100 mujeres trans en cinco ciudades de Colombia. Se encontró que más de la mitad de las mujeres trans han experimentado estados emocionales negativos como depresión, ansiedad y somatización y algunos positivos como resiliencia y crecimiento personal. Los dos últimos contribuyen a fortalecer las conductas de adherencia y prevención de la COVID-19. Es prioritario dar reconocimiento a las mujeres trans y a sus necesidades de salud, desde diversos frentes de acción con el fin de proteger sus derechos y su salud integral.

A Single-Center Study Comparison of Two Different Male-to-Female Penile Skin Inversion Vaginoplasty Techniques and Their 3.5-Year Outcomes.

BACKGROUND: Vaginoplasty is a crucial part of genital gender-affirming surgery with the number of trans women undergoing this intervention steadily, however, up to date, there is still no standardized vaginoplasty technique. AIM: This retrospective single-center study compares single-stage vs two-stage penile skin inversion vaginoplasty techniques and their long-term outcomes. METHODS: Medical records of 63 consecutive patients who underwent single-stage vaginoplasty, as described by Dr Preecha Tiewtranon, and 62 consecutive patients who underwent 2-stage vaginoplasty were reviewed. RESULTS: The mean postoperative hospital stay was 7 days for patients who underwent single-stage vaginoplasty vs 16 days for patients who underwent 2-stage vaginoplasty. Neovaginal depth proved constant in patients who underwent single-stage vaginoplasty, whereas a loss of more than 30% was observed in patients who underwent 2-stage vaginoplasty during the first postoperative year. Early complications were more common than late-onset complications in both groups. The most common complication in the single-stage group was wound dehiscence (4.8%). There were significantly more complications in 2-stage collective, among which wound dehiscence (33.9%), unsatisfactory cosmetic outcome (25.8%), and urethral stenosis (14.5%) were the most common. In the single-stage cohort, 4 (6.4%) patients needed one revision surgery, whereas 35 (56.5%) patients in the 2-stage cohort necessitated one or more reoperations with up to 10 quaternary revisions. All patients reported to have sensitivity to neoclitoris in the single-stage group, whereas 3 (4.8%) patients in the 2-stage group were deprived of it because of neoclitoral necrosis. CLINICAL IMPLICATIONS: Optimizing a vaginoplasty surgical technique and its postoperative protocol. STRENGTHS & LIMITATIONS: The present retrospective study with a mean follow-up of more than 3.5 years offers the first ever comparison of 2 different PSI vaginoplasty surgical techniques performed in the same center. CONCLUSION: Significantly lower complication and revision rates, shorter recovery time, and superior esthetic and functional outcomes were observed in the single-stage than in the two-stage penile skin inversion vaginoplasty surgical technique. Fakin RM, Giovanoli P. A Single-Center Study Comparison of Two Different Male-to-Female Penile Skin Inversion Vaginoplasty Techniques and Their 3.5-Year Outcomes. J Sex Med 2021;18:391-399.

Densidad mineral ósea y composición corporal en mujeres transgénero previamente al tratamiento hormonal cruzado: ¿hay diferencias con hombres cisgénero? / Bone mineral density and body composition in transgender females prior to cross-sex hormone treatment: is there any difference with cisgender males?

Se denomina transgénero mujer (TM) a un varón biológico con identidad de género femenina. El tratamiento hormonal cruzado (THC) es una de las opciones para lograr caracteres sexuales del género autopercibido. Realizamos un estudio de diseño transversal, observacional y analítico para evaluar la densidad mineral ósea, composición corporal y fuerza muscular antes de iniciar la hormonización. Un total de 26 TM en condiciones de ingresar en el estudio fueron comparadas con hombres cisgénero de similar edad (mediana 23,5 vs. 25,5 años). Basalmente, las TM presentaron menor densidad ósea en columna lumbar (1,040 vs. 1,280 g/cm2; p=0,01), cadera total (0,970 vs. 1,070 g/cm2; p=0,01) y cuerpo entero (1,080 vs. 1,220 g/cm2; p<0,01). Observamos, además, menor masa muscular en brazos (5,033 vs. 6,212 kg; p<0,01) y piernas (16,343 vs. 18,404 kg; p=0,02), acompañada de menor fuerza muscular de puño (p<0,01). Concluimos que las TM presentaron características diferentes de la biología masculina aun sin haber iniciado el THC. Sugerimos incluir la evaluación de la densidad mineral ósea en la evaluación inicial de esta población, dados los hallazgos identificados. (AU)

A trans-woman (TW) is a biologically male person with female gender identity. Cisgender denotes a person whose sense of personal identity and gender corresponds with its birth sex. Cross-sex hormone therapy (CSHT) is one of the options to achieve secondary characteristics of the self-perceived gender. We performed a cross-sectional study. Bone mineral density (BMD), body composition, and muscle strength before starting CSHT were assessed. Twenty-six TW (median age 23.5 years) and cisgender males (median age 25.5 years) were matched for age. TW had less BMD at the lumbar spine (1.040 vs 1.280 g/cm2; p=0.01), total hip (0.970 vs 1.070 g/cm2; p=0.01), and total body (1.080 vs 1.220 g/cm2; p<0.01). They also had less skeletal muscle mass in the arms (5.033 vs 6.212 kg; p<0.01) and legs (16.343 vs 18.404 kg; p=0.02), associated with lower grip strength (p<0.01). It appears that bone and muscle characteristics of TW before starting CSHT differ from cisgender men. Taking these findings into account, we suggest the inclusion of BMD in the initial evaluation of TW. (AU)

Essa Boneca Tem Manual: práticas de si, discursos e legitimidades entre travestis iniciantes / This Doll Has a Handbook: practices of oneself among trans women / Esa Muñeca Tiene Manual: prácticas de sí mismo entre mujeres trans

Este artigo discute os modos pelos quais os corpos se produzem como campo de saber e de práticas de si na experiência de travestis iniciantes. Por meio de pesquisa etnográfica são analisadas as atuais formas usadas pelas jovens para acessar informações, aprender técnicas, comprovar práticas e compartilhar saberes sobre as múltiplas possibilidades de experienciar as travestilidades. Os passos seguidos pelas novatas que desejam tornar-se travesti são problematizados pela perspectiva de análise discursiva proposta por Michel Foucault, trazendo ao debate as formas com que reiteram normas com o uso de hormônios e na idealização da feminilidade; e também subvertem práticas atribuindo à internet a função de aliada nas transformações. Neste estudo, são discutidas as estratégias de resistência reinventadas pelas iniciantes diante das violências exercidas pelas travestis mais experientes, assim como a persistência com que buscam produzirem-se como sujeitos legítimos das travestilidades.

This article discusses the means through which bodies are produced as a field of knowledge and practices of oneself, based on the experience of beginners trans women. Based on ethnographic research, the contemporaneous ways of accessing information, learning techniques, verifying practices and sharing knowledge about the several possibilities of experiencing travestilities are analyzed. The steps followed by beginners that wish to become trans women are problematized by the perspective of discursive analysis proposed by Michel Foucault, arising the debate about the ways they reiterate guidelines with the use of hormones and the idealization of femininity, as well as subvert practices, attributing to internet the role of ally as regards transformation. This study also discusses strategies of resistance reinvented by beginners against the violence exerted by the most experienced trans women, as well as the persistence through which they try to produce themselves as legitimate subjects of travestilities.

Este artículo discute los modos por los cuales los cuerpos se producen como campo de saber y de prácticas de sí mismo, en la experiencia de mujeres trans recién iniciadas. Por una investigación etnográfica son analizadas las actuales formas usadas por las jóvenes para acceder a información, aprender técnicas, comprobar prácticas y compartir saberes sobre las múltiples posibilidades de experimentar las travestilidades. Los pasos seguidos son problematizados por la perspectiva de análisis discursivo propuesta por Michel Foucault, trayendo a la discusión las formas con que repiten normas con el uso de hormonas y en la idealización de feminidad; y también aparecen prácticas atribuyendo a internet la función de aliada en las transformaciones. En este estudio, también son discutidas las estrategias de resistencia reinventadas por las novatas delante de las violencias, así como la perseverancia con que buscan producirse como sujetos legítimos de las travestilidades.

Correlates of Recent HIV Testing Among Transgender Women in Greater Kuala Lumpur, Malaysia.

PURPOSE: In Malaysia, an estimated 9.7%-12.4% of transgender women (TW) are HIV positive, with higher estimates among those engaged in sex work. According to the 90-90-90 Joint United Nations Programme on HIV/AIDS strategy, HIV testing is the first crucial step in curbing the HIV epidemic. This study examines correlates of recent HIV testing among TW in Greater Kuala Lumpur, Malaysia. METHODS: TW (N = 199) in Greater Kuala Lumpur completed a survey on healthcare access and utilization, including HIV testing history. Bivariate logistic regression and penalized multivariate logistic regression were used to explore correlates of HIV testing in the last 12 months. RESULTS: Overall, 41.7% of TW reported having ever been tested for HIV. Among participants who were HIV negative or not sure of their HIV status (n = 187), only 18.7% (n = 35) had been tested for HIV in the last 12 months. The multivariate analysis indicated that having a primary care provider (PCP), being 26-40 years of age, and having higher mental health functioning were positively associated with recent HIV testing. Active amphetamine use and previous depression diagnosis were also associated with recent HIV testing. CONCLUSION: HIV testing is the first step in linking individuals to prevention and treatment interventions. Our findings suggest that having a PCP can improve engagement in HIV testing. Moreover, PCPs can serve as a valuable link to HIV treatment and prevention services. Current interventions that target social and behavioral risk factors for HIV, on their own, may be insufficient at engaging all HIV-vulnerable TW.

Gender-Affirming Penile Inversion Vaginoplasty.

In recent years, greater acceptance of transgender individuals in society and the inclusion of medical coverage for gender-affirmation surgeries has led to an increasing number of patients seeking gender-affirming vaginoplasty. Since the first descriptions of neovaginal reconstruction for gender affirmation were described in the early and mid-1900s, various techniques and revisions have been introduced. This article provides a brief historical perspective, defines the goals of surgical treatment within a multidisciplinary approach adhering to World Professional Association for Transgender Health standards, and focuses on issues related to what is currently the most common approach to primary neovaginal reconstruction, the penile inversion vaginoplasty.

Hormonal and surgical treatment in trans-women with BRCA1 mutations: a controversial topic.

INTRODUCTION: Male-to-female transgender persons (trans-women) receive livelong cross-sex hormonal treatment in order to induce and maintain secondary female characteristics. One of the concerns of long-term estrogen treatment is the induction of carcinomas of estrogen-sensitive tissues such as the breast. BRCA1 mutations have been shown to account for a large proportion of inherited predispositions to breast cancer. AIM: The aim of this case report is to discuss the hormonal and surgical options in the treatment of trans-women with a genetic predisposition for breast cancer. METHOD: We describe a case of a trans-woman who was found to be a carrier of a BRCA1 mutation. RESULTS: The patient underwent a breast augmentation. She refused a prophylactic mastectomy followed by a primary breast reconstruction. She also underwent a vaginoplasty and a bilateral castration. Androgen blocking treatment was stopped after surgery; estradiol treatment however was continued. CONCLUSIONS: This case points to the importance of routine investigation of family history in trans-women. Trans-women with BRCA mutations should be carefully monitored and if cancers develop, this should be reported. Follow-up should be according to the guidelines for breast cancer screening in biological women, and the guidelines for prostate cancer and colon cancer screening in men.