Acoustic outcomes and voice-related quality of life in male-to-female transsexuals undergoing Wendler glottoplasty: a single-centre experience.

INTRODUCTION: Many transsexual women seek to feminise their voice through pitch elevation surgeries so that it becomes congruent with their gender identity. This study aims to determine the safety and effectiveness of Wendler glottoplasty (WG) in vocal feminisation through the assessment of acoustic and aerodynamic parameters of the voice, as well as voice-related quality of life (QoL) in male-to-female transsexuals. MATERIAL AND METHODS: We retrospectively reviewed the medical records of transsexual women who underwent WG for voice feminisation at our institution between 2016 and 2023. All acoustic and aerodynamic analyses, a voice self-assessment, and a videolaryngostroboscopic evaluation were performed in the immediate preoperative period and at the follow-up visit 6 weeks after the procedure. RESULTS: A total of 11 patients with a mean age of 32.73 years were included. After WG, there was a significant fundamental frequency and speaking fundamental frequency increase of 109.64 Hz and 83.48 Hz, respectively (p < 0.001), representing an average rise by 9.71 semitones and 8.36 semitones (STs), respectively. No significant differences were found between the mean pre- and postoperative values of fundamental frequencies, frequency range, upper limit of the frequency range of spoken voice, and maximum phonation time. Contrarily, the mean lower limit of frequency range rose by 75.56 Hz (p < 0.001), representing an average increase of 10.56 STs. None of the assessed spirometric parameters changed significantly after WG (p > 0.05). The mean overall Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) scores significantly improved after the surgery, decreasing by 24.54 points (p = 0.008) and 11.5 points (p = 0.001), respectively. A significant improvement was observed in the functional and emotional domains of VHI. Additionally, significantly fewer patients considered the overall quality of their voice to be "poor" after WG. CONCLUSIONS: WG constitutes an effective method of surgical voice feminisation in male-to-female transsexuals with concurrent improvement in their voice-related QoL. Furthermore, it remains a safe procedure without persistent complications and negative influence on the acoustic-aerodynamic measures of the voice.

Back to the Future: Is GnRHa Treatment in Transgender and Gender Diverse Adolescents Only an Extended Evaluation Phase?

CONTEXT: The role of body modifications induced by gonadal suppression in transgender and gender diverse adolescents on psychological functioning has not yet been evaluated. OBJECTIVE: The main aim of the present study was to explore several hormone, physical and psychological functioning changes during gonadotropin-releasing hormone analog (GnRHa) treatment in transgender and gender diverse adolescents (TGDAs). The potential relationship between the physical and hormone effects of GnRHa and psychological well-being, along with its magnitude, was assessed for the first time. METHODS: This prospective multidisciplinary study included 36 TGDA (22 assigned female at birth, and 14 assigned male at birth) who received psychological assessment followed by triptorelin prescription after referring to the Florence Gender Clinic. This study consisted of 3 time points: first referral (T0), psychological assessment (T1); and treatment with intramuscular injections of triptorelin for 3 up to 12 months (T2). Psychometric questionnaires were administered at each time point, and clinical and biochemical evaluations were performed at T1 and T2. RESULTS: The following results were found: (1) GnRHa showed efficacy in inhibiting puberty progression in TGDAs; (2) an increase in psychopathology was observed before starting GnRHa (T1) compared with baseline levels; (3) during GnRHa treatment (T2), a significant improvement in psychological functioning, as well as decrease in suicidality, body uneasiness, depression, and anxiety levels were observed; (4) hormone and physical changes (in terms of gonadotropin and sex steroid levels, height and body mass index percentiles, waist-hip ratio, and acne severity) observed during triptorelin treatment significantly correlated with a reduction in suicidal ideation, anxiety, and body image concerns. CONCLUSION: Psychological improvement in TGDA on GnRHa seems to be related to the objective body changes induced by a GnRHa. Therefore, the rationale for treatment with a GnRHa may not only be considered an extension of the evaluation phase, but also the start of a medical (even if reversible) gender-affirming path, especially in TGDAs whose puberty has already progressed.

Long-term Outcomes After Gender-Affirming Surgery: 40-Year Follow-up Study.

BACKGROUND: Gender dysphoria is a condition that often leads to significant patient morbidity and mortality. Although gender-affirming surgery (GAS) has been offered for more than half a century with clear significant short-term improvement in patient well-being, few studies have evaluated the long-term durability of these outcomes. METHODS: Chart review identified 97 patients who were seen for gender dysphoria at a tertiary care center from 1970 to 1990 with comprehensive preoperative evaluations. These evaluations were used to generate a matched follow-up survey regarding their GAS, appearance, and mental/social health for standardized outcome measures. Of 97 patients, 15 agreed to participate in the phone interview and survey. Preoperative and postoperative body congruency score, mental health status, surgical outcomes, and patient satisfaction were compared. RESULTS: Both transmasculine and transfeminine groups were more satisfied with their body postoperatively with significantly less dysphoria. Body congruency score for chest, body hair, and voice improved significantly in 40 years' postoperative settings, with average scores ranging from 84.2 to 96.2. Body congruency scores for genitals ranged from 67.5 to 79 with free flap phalloplasty showing highest scores. Long-term overall body congruency score was 89.6. Improved mental health outcomes persisted following surgery with significantly reduced suicidal ideation and reported resolution of any mental health comorbidity secondary to gender dysphoria. CONCLUSION: Gender-affirming surgery is a durable treatment that improves overall patient well-being. High patient satisfaction, improved dysphoria, and reduced mental health comorbidities persist decades after GAS without any reported patient regret.

Desire for Genital Surgery in Trans Masculine Individuals: The Role of Internalized Transphobia, Transnormativity and Trans Positive Identity.

Some trans people experience gender dysphoria, which refers to psychological distress that results from an incongruence between one's gender assigned at birth and one's gender identity. People who are trans masculine or nonbinary assigned-female-at-birth may pursue multiple domains of gender affirmation, including surgical affirmation (e.g., masculine chest reconstruction, penile reconstruction, etc.). The present study aimed to investigate the possible factors involved in trans people's desire to undergo gender-affirming genital surgery. Trans masculine and nonbinary participants (N = 127; mean age = 26.90) were recruited through a web-based survey and completed self-report instruments (i.e., the Internalized Transphobia subscale of the Gender Minority Stress and Resilience Measure, the Trans Positive Identity Measure, the Gender Congruence and Life Satisfaction Scale, an ad hoc scale on transnormativity, and a single-item on desire to undergo genital affirmation surgery). A path analysis showed that higher levels of internalized transphobia led to more significant genital discomfort via a dual parallel mediation of transnormativity and positive identity. Moreover, this genital discomfort fueling pattern was the most significant predictor of the desire to undergo genital surgery as the effect of internalized transphobia was fully mediated by increased genital discomfort. Findings are discussed in the light of the recent strand of research on gender dysphoria as a multifaceted construct, with social components.

Gender-affirming hormone therapy: An updated literature review with an eye on the future.

In line with increasing numbers of transgender (trans) and gender nonbinary people requesting hormone treatment, the body of available research is expanding. More clinical research groups are presenting data, and the numbers of participants in these studies are rising. Many previous review papers have focused on all available data, as these were scarce, but a more recent literature review is timely. Hormonal regimens have changed over time, and older data may be less relevant for today's practice. In recent literature, we have found that even though mental health problems are more prevalent in trans people compared to cisgender people, less psychological difficulties occur, and life satisfaction increases with gender-affirming hormone treatment (GAHT) for those who feel this is a necessity. With GAHT, body composition and contours change towards the affirmed sex. Studies in bone health are reassuring, but special attention is needed for adolescent and adult trans women, aiming at adequate dosage of hormonal supplementation and stimulating therapy compliance. Existing epidemiological data suggest that the use of (certain) estrogens in trans women induces an increased risk of myocardial infarction and stroke, the reason that lifestyle management can be an integral part of trans health care. The observed cancer risk in trans people does not exceed the known cancer-risk differences between men and women. Now it is time to integrate the mostly reassuring data, to leave the overly cautious approach behind, to not copy the same research questions repeatedly, and to focus on longer follow-up data with larger cohorts.

SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people.

PURPOSE: Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS: According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS: In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION: In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.

Voice And Gender Incongruence: Relationship Between Vocal Self-Perception And Mental Health Of Trans Women.

OBJECTIVE: To verify the association between vocal perception and Common Mental Disorders (CMD) suspicion in trans women. METHODS: Cross-sectional observational study including 24 adult trans women with a minimum time of presentation as a woman of six months. The sampling of the subjects was supported by the "Snowball" technique. Three questionnaires were applied for data collection: sociodemographic and health data, Self-Reporting Questionnaire (SRQ-20) and Trans Woman Voice Questionnaire (TWVQ). The sociodemographic and health data collected were: age, marital status, education, smoking habits, speech therapy, use of hormones, and whether they had undergone Sex Reassignment Surgery (SRG). SRQ-20 was used for suspicion of CMD evaluation, such as depressive and anxiety symptoms. TWVQ is a vocal self-report questionnaire for trans women living the full-time gender role in which they self-identify. TWVQ has a minimum score of 30 points and a maximum of 120 points. Higher scores are associated with perceptions of a higher frequency of voice-related difficulties and psychosocial impacts. For statistical analysis, data were analyzed descriptively and statistically using Fisher's and Mann-Whitney's exact tests, both with a significance level of 5%. RESULTS: The average participants' age in this study was 28.2 years old (SD = 6.5 / minimum = 21 and maximum = 48); 83.3% were single; most (41.7%) were high school graduates; and most (95.83%) had not undergone Sex Reassignment Surgery. All subjects reported using hormones; 37.5% were smokers; 4.2% had undergone speech therapy; and the average number of years of experience in the female role was 8.8 years (SD = 7.2). The average TWVQ score was 55.4 points (SD = 4.3). Through SRQ-20, it was verified the prevalence of suspected CMD in 58.3% of the participants. The study results indicated that communicative dissatisfaction in trans women due to inconsistent voice with the recognized gender is associated with probable CMD such as depression and anxiety (P= 0.001). CONCLUSION: Trans women who reported greater difficulties and voice-related effects in their lives had more symptoms of anxiety and depression. Although more research is needed, results indicate the need for inter-professional preventive and therapeutic actions directed towards assisting trans women. This fact encourages reflection on the care of this population and the role of health professionals, enhancing scientific production, clinical practice and the inclusion of the "transsexuality" theme in Speech Language and Hearing Sciences.

Scientific evidence on experiences of pregnant transsexual men / Evidencia científica sobre las experiencias de los hombres transexuales en el embarazo / Evidência científicas sobre experiências de homens transexuais grávidos

ABSTRACT Objective: to analyze the scientific evidence about the experiences of pregnant transsexual men. Method: a descriptive, integrative literature review study without a defined time cut, carried out in January 2021 in the following Databases: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO and BDENF, in Portuguese, English and Spanish; using the DECs and MeSH descriptors: "Transgender People", "Pregnancy", "Reproduction", "Fertilization", "Insemination", "Prenatal Care", "Postpartum Period", "Lactation", "Mispontaneous Abortion" , "Habitual abortion", "Reproductive health" and "Health Care" and their respective synonyms. The elaboration of the guiding question was conducted by the PICo Strategy: (Population): transgender men; I (Interest): experiences during the puerperal pregnancy cycle; Co (Context): reproductive health and health services. The final sample was submitted to the Thematic Analysis Technique. Results: a total of 1,011 studies were identified, 10 of which composed this review after the selection process and peer review. The analysis resulted in two thematic categories: "Pregnancy-puerperal cycle: challenges and experiences" and "Pregnant bodies: perceptions and social relationships". Conclusion: the experiences of pregnant transsexual men are marked by concerns related to pregnancy, childbirth, birth and the puerperium, causing unexpected psychological and/or emotional impacts, evidencing cisheteronormativity and transphobia as structuring aspects which add an additional part to fear of childbirth and violations of rights.

RESUMEN Objetivo: analizar la evidencia científica sobre las experiencias de los hombres transexuales embarazados. Método: estudio descriptivo, tipo revisión bibliográfica integradora, sin corte temporal, realizado en enero de 2021 en las siguientes bases de datos: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO y BDENF, en los idiomas portugués, inglés y español; utilizando los descriptores DeCS y MeSH: "Personas Transgénero", "Embarazo", "Reproducción", "Fertilización", "Inseminación", "Atención Prenatal", "Período Posparto", "Lactancia", "Aborto Espontáneo", "Aborto Habitual", "Salud Reproductiva" y "Atención a la Salud" y sus respectivos sinónimos. La elaboración de la pregunta guía fue realizada por la estrategia PICo: hombres transgénero (P - Población); experiencias durante el ciclo gravídico-puerperal (I - Interés); salud reproductiva y servicios de salud (Co - Contexto). La muestra final se sometió a la técnica de análisis temático. Resultados: se identificaron 1.011 estudios. Después del proceso de selección y la revisión por pares, 10 compusieron esta revisión. El análisis se ha centrado en dos categorías temáticas: "Ciclo gravídico-puerperal: desafíos y experiencias" y "Cuerpos embarazados: percepciones y relaciones sociales". Conclusión: l as experiencias de hombres transexuales embarazados están marcadas por inquietudes relacionadas a la gestación, el parto, el nacimiento y el puerperio, ocasionando impactos psicológicos y/o emocionales inesperados, evidenciando la cisheteronormatividad y la transfobia como aspectos estructurales que incorporan una parcela adicional al miedo del parto y violaciones de derechos.

RESUMO Objetivo: analisar as evidências científicas sobre experiências de homens transexuais grávidos. Método: estudo descritivo, tipo revisão integrativa de literatura, sem recorte de tempo, realizada em janeiro de 2021 nas seguintes Bases de Dados: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO e BDENF, nos idiomas português, inglês e espanhol; usando os descritores DECs e MeSH: "Pessoas Transgênero", "Gravidez", "Reprodução", "Fertilização", "Inseminação", "Cuidado Pré-Natal", "Período Pós-Parto", "Lactação", "Aborto Espontâneo", "Aborto habitual", "Saúde reprodutiva" e "Assistência à Saúde" e respectivos sinônimos. A elaboração da questão norteadora foi conduzida pela Estratégia PICo: (População): homens transexuais; I (Interesse): experiências durante o ciclo gravídico puerperal; Co (Contexto): saúde reprodutiva e serviços de saúde. A amostra final foi submetida à Técnica de Análise Temática. Resultados: foram identificados 1.011 estudos. Após o processo de seleção e avaliação por pares, 10 compuseram esta revisão. A análise resultou em duas categorias temáticas: "Ciclo gravídico-puerperal: desafios e experiências" e "Corpos grávidos: percepções e relações sociais". Conclusão: as experiências de homens transexuais grávidos são marcadas por inquietações relacionadas à gestação, ao parto, ao nascimento e ao puerpério, ocasionando impactos psicológicos e/ou emocionais inesperados, evidenciando a cisheteronormatividade e a transfobia como aspectos estruturantes que acrescentam uma parcela adicional ao medo do parto e violações de direitos.

Psicanálise, precariedade e identidade na atualidade / Psicoanálisis, precariedad e identidad em la actualidad / Psychoanalysis, precariousness and identity in current times

RESUMO. Baseado nas teorias de Foucault e de Butler sobre poder, norma e sujeito, este artigo pretende problematizar o recurso dos sujeitos à identidade na atualidade e os seus desdobramentos para a clínica psicanalítica. Defenderemos que, por um lado, a identidade representa uma sujeição às normas e tem um efeito encarcerador e mascarador de desejos, mas, por outro, pode ser importante enquanto proteção contra o desamparo. Diferenciaremos, a partir de Butler, precariedade (condição universal, compartilhada) de precarização (condição produzida pela distribuição social diferencial da condição de precariedade) e apresentaremos a hipótese de que, quanto maior o grau de precarização de um sujeito, mais importantes o apego e o reconhecimento identitários. Abordaremos especificamente o tema das identidades trans, por sua radicalidade no que diz respeito à condição precária e à busca de reconhecimento. Por fim, recorreremos ao conceito de feminilidade do final da obra de Freud enquanto dispositivo de escuta clínica que permita a transformação de cristalizações identitárias no sentido do novo, do singular e das múltiplas identificações.

RESUMEN. Basado en las teorías de Foucault y Butler sobre el poder, la norma y el sujeto, este artículo pretende problematizar el apego de los sujetos a la identidad en la actualidad y sus consecuencias para la clínica psicoanalítica. Argumentaremos que, por un lado, la identidad representa una sujeción a las normas y tiene un efecto de encarcelamiento y enmascaramiento del deseo, pero por otro lado puede ser importante como protección contra el desamparo. Diferenciaremos, a partir de Butler, la precariedad (condición universal, compartida) de la precarización (condición producida por la distribución social diferencial de la condición de precariedad) y presentaremos la hipótesis de que cuanto mayor es el grado de precariedad de un sujeto, más importantes son el apego y el reconocimiento identitarios. Abordaremos específicamente el tema de las identidades trans debido a su radicalidad con respecto a la condición precaria y la búsqueda de reconocimiento. Finalmente, recurriremos al concepto de feminidad del trabajo final de Freud como dispositivo de escucha clínica que permite la transformación de cristalizaciones identitarias en el sentido del nuevo, del singular y de las identificaciones múltiples.

ABSTRACT. Based on Foucault's and Butler's theories about power, norm and subject, this article intended to problematize the subjects' attachment to identity in the current time and its consequences for the psychoanalytic clinics. We argued that, on the one hand, identity represents a subjection to norms and has an incarcerating and masking effect of desires, but on the other hand, it can be important as a protection against helplessness. We distinguished, with Butler, precariousness (a universal, shared condition) from precarity (a condition produced by the differential social allocation of the precarious condition) and hypothesized that the higher the degree of precariousness of a subject, the more important the identity attachment and recognition. We specifically addressed the theme of trans identities, because of its radicality regarding the precarious condition and the search for recognition. Finally, we used the concept of femininity at the end of Freud's work as a clinical listening device that allows the transformation of identity crystallizations towards the new, the singular and the multiple identifications.

El cuerpo trans*: territorio de poder, lugar de resistencia al poder heteronormativo / The trans* body: territory of power, place of resistance to the heteronormative system

Este artículo reflexiona sobre el cuerpo trans* como territorio de poder que hace resistencia al poder hegemónico, cuyo orden busca "normalizar" los cuerpos de acuerdo con lo estipulado socialmente bajo el "deber ser" del género. Para ello se realiza un abordaje teórico sobre el cuerpo, desde posturas como las de Foucault y Butler que lo conciben como entidad que en sí misma es poder. Con base en los referentes teóricos presentados, se expresan los argumentos que permiten entender los cuerpos trans* como territorios de subversión frente al orden establecido sobre estos. Se concluye que las personas trans, si bien se resisten a la heterosexualidad obligatoria, posiblemente no sea de forma estructural y radical, sino desde dentro del orden social, generando ciertas fisuras en sus prácticas y performances que presentan ante el sistema, develando una presencia que excede sus linealidades

This article reflects on the trans* body as a territory of power, which resists the hegemonic power, whose order seeks to "normalize" the bodies according to what is socially stipulated under the "duty to be" of gender. For this, a theoretical approach is made to the body, from positions such as those of Foucault and Butler that conceive it as an entity that in itself is (is) power. Based on the theoretical references presented, the arguments that allow us to understand trans* bodies as territories of subversion against the order established on them are expressed. It is concluded that trans people, although they resist compulsory heterosexuality, may not be structurally and radically, but from within the social order, generating certain fissures in their practices and performances that they present to the system, revealing a presence that exceeds their linearities

Ovarian, breast, and metabolic changes induced by androgen treatment in transgender men.

Gender-affirming hormone therapy (GAHT) is often provided to transgender people. In this review of the literature, the current knowledge of ovarian, breast, and metabolic changes (body composition, insulin resistance, bone density, cardiovascular risk factors such as lipids, blood pressure, and hematocrit) observed following GAHT in adult transgender men is discussed. A body of literature concurs to describe that long-term androgen therapy in transgender men exerts atrophic effects on the breast. There is currently no evidence of an increased risk of breast cancer. Long-term testosterone treatment induces ovarian effects that become visible after 6 months of therapy. These changes consist of both macroscopic and microscopic alterations of ovarian morphology that mimic the typical ovarian aspect encountered in women with polycystic ovary syndrome but without an effect on antral follicle count. Metabolic effects of long-term androgen treatment in transgender men put them at par with cisgender men in terms of lipid profile, insulin resistance, and overall mortality. Body composition changes as desired after testosterone administration in most transgender men, and insulin resistance decreases with virilization. There are no detrimental effects on bone mineral density. Cardiometabolic risk and morbidity data are currently reassuring, even if certain studies show conflicting results. An increase in blood pressure and a decrease in high-density lipoprotein cholesterol have been reported as risk factors, whereas polycythemia is rare and treatable. Most available data are observational and based on biochemical markers instead of the more direct measures of cardiovascular damage. An explanation for these observed changes is mostly lacking. Psychological stress and lifestyle factors are often forgotten in a much needed integrated approach.

The uterus in transgender men.

Transgender men experience a disharmony between their birth sex and their intimate sense of gender belonging. Gender-affirming hormone therapy and gender-affirming surgery (GAS) are often inherently part of the gender-affirming process. In this context, we should ask whether it is better to keep or remove the uterus. Keeping the uterus and ovaries avoids a surgical procedure and a pubic scar. Furthermore, it preserves fertility and the possibility of carrying a baby. On the other hand, keeping the uterus is often psychologically unbearable for transgender men and the long-term effects of androgens on the uterus and ovaries remain uncertain. Conversely, hysterectomy and oophorectomy are part of the GAS process. New mini-invasive surgery procedures for hysterectomies decrease the risks and limit the likelihood of scars to a minimum. In practice, the data suggest that very few transgender men carry a pregnancy and/or use their oocytes after gender-reaffirming treatment. Clinicians should counsel their transgender men patients about the definitive infertility consequences of hysterectomy and oophorectomy and discuss all fertility preservation options before undertaking GAS. Individualized approaches must be preferred to systematic procedures regarding the personal decision to keep or not keep the uterus and ovaries.

Transgender men: clinical care and implications in reproductive medicine: introduction.

Gender dysphoria, a discrepancy between gender identity and genetically determined sex, is encountered in approximately 0.5% of people uniformly across the world. In the case of transgender men, formerly called female-to-male transsexuals, the available gender-affirming measures, hormone therapy and possible surgical procedures, are multiple and discussed in detail in this series of articles.

Masculinizing gender-affirming surgery for trans men and non-binary individuals: what you should know.

Gender dysphoria, the discordance between one's gender identity and anatomy, affects nearly 25 million people worldwide, and the prevalence of transgender and non-binary identities is increasing because of greater acceptance and awareness. Because of the improved accessibility to gender-affirming surgery (GAS), many providers will care for patients during and after gender transition. For trans men (female-to-male), GAS represents a combination of procedures rather than a single surgery. The particular combination of masculinizing procedures is chosen on the basis of informed patient-provider discussions regarding the patient's goals and anatomy and implemented through a multidisciplinary team approach. In this review, we describe the common procedures comprising masculinizing GAS to improve delivery of specialized care for this patient population.

Penile inversion vaginoplasty outcomes: Complications and satisfaction.

Penile inversion vaginoplasty helps to alleviate gender dysphoria and improve quality of life in many transgender individuals. Overall, the procedure is associated with high post-operative satisfaction, even when complications occur. Adverse events related to vaginoplasty are commensurate with other genitourinary reconstructive procedures performed for other diagnoses (ie, cancer or congenital issues). Here, we explore the incidence of complications following vaginoplasty, emphasizing the challenges in defining and managing these adverse events. In addition, outcome measures to assess patient satisfaction will be reviewed.

Take the T out, put the T in: Gender-affirming hormones in youth.

BACKGROUND: An increasing number of adolescents are seeking gender care at clinics and hospital programs, and requesting gender-affirming hormonal treatment. The interventions can either include suppression of testosterone and introduction of estrogen, or suppression of estrogen and introduction of testosterone. AIMS: This review article focuses on the psychosocial experiences of youth who have completed their endogenous puberty and are now requesting one of these two forms of gender-affirming hormonal treatment. We investigate the comparative profiles of these two subgroups of transgender/gender-expansive youth. MATERIALS AND METHODS: Review of research data, established standards of care and practice guidelines, and clinical observations. RESULTS: Differences and similarities are noted and discussed in several realms: gender-related experiences prior to receiving hormonal treatment; the relationship between the physical changes and psychological experiences that accompany the introduction of testosterone or suppression of testosterone with replacement with estrogen; the intrapersonal and interpersonal implications of the treatment; considerations of fertility preservation for future family building; the role of the family in the decision-making process prior to starting a course of hormone therapy; and the capacity of youth to make informed decisions about these partially irreversible medical interventions. DISCUSSION: Medical providers who offer gender-affirming hormonal care to youth should work with the family and allied professionals to assure that the youth's gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in. CONCLUSION: The cohort of youth who come to medical providers after completing puberty, and request gender-affirming hormones in the form of increases or reductions in T have a great deal in common, and also extensive variation among them.

Sexual health after vaginoplasty: A systematic review.

BACKGROUND: Vaginoplasty is a gender-affirming procedure for transgender and gender diverse (TGD) patients who experience gender incongruence. This procedure reduces mental health concerns and enhances patients' quality of life. A systematic review investigating the sexual health outcomes of vaginoplasty has not been performed. OBJECTIVES: To investigate sexual health after gender-affirming vaginoplasty for TGD patients. DATA SOURCES: MEDLINE/PubMed, Embase, Scopus, and PsycINFO databases were searched, unrestricted by dates or study design. METHODS: We included primary literature that incorporated TGD patients, reported sexual health outcomes after vaginoplasty intervention and were available in English. Outcomes included at least one of these sexual health parameters: sexual desire, arousal, sensation, activity, secretions, satisfaction, pleasure, orgasm, interferences, or aids. RESULTS: Our search yielded 140 studies with 12 different vaginoplasty surgical techniques and 6,953 patients. The majority of these studies were cross-section or retrospective cohort observational studies (66%). 17.4%-100% (median 79.7%) of patients (n = 2,384) were able to orgasm postoperatively regardless of revision or primary vaginoplasty techniques. Female Sexual Function Index was the most used standardized questionnaire (17 studies, ranging from 16.9 to 28.6). 64%-98% (median 81%) of patients were satisfied with their general sexual satisfaction. The most common interference of sexual activity was dyspareunia. CONCLUSIONS: The heterogenous methods of measuring sexual outcomes reflect the difficulty in comparing single-center surgical outcomes, encouraging the need for a standardized and validated metric for reporting sexual health after vaginoplasty for TGD patients. The most common sexual health parameter reported is sexual activity while therapeutic aids and pleasure were the least reported parameters. Future studies are needed to improve and expand methods of measuring sexual health, including prospective studies, validated questionnaires, and inclusive metrics. Systematic review registration number: PROSPERO 01/01/2021: CRD42021224014.

Association Between Gender-Affirming Surgeries and Mental Health Outcomes.

Importance: Requests for gender-affirming surgeries are rapidly increasing among transgender and gender diverse (TGD) people. However, there is limited evidence regarding the mental health benefits of these surgeries. Objective: To evaluate associations between gender-affirming surgeries and mental health outcomes, including psychological distress, substance use, and suicide risk. Design, Setting, and Participants: In this study, we performed a secondary analysis of data from the 2015 US Transgender Survey, the largest existing data set containing comprehensive information on the surgical and mental health experiences of TGD people. The survey was conducted across 50 states, Washington, DC, US territories, and US military bases abroad. A total of 27 715 TGD adults took the US Transgender Survey, which was disseminated by community-based outreach from August 19, 2015, to September 21, 2015. Data were analyzed between November 1, 2020, and January 3, 2021. Exposures: The exposure group included respondents who endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses. The comparison group included respondents who endorsed a desire for 1 or more types of gender-affirming surgery but denied undergoing any gender-affirming surgeries. Main Outcomes and Measures: Endorsement of past-month severe psychological distress (score of ≥13 on Kessler Psychological Distress Scale), past-month binge alcohol use, past-year tobacco smoking, and past-year suicidal ideation or suicide attempt. Results: Of the 27 715 respondents, 3559 (12.8%) endorsed undergoing 1 or more types of gender-affirming surgery at least 2 years prior to submitting survey responses, while 16 401 (59.2%) endorsed a desire to undergo 1 or more types of gender-affirming surgery but denied undergoing any of these. Of the respondents in this study sample, 16 182 (81.1%) were between the ages of 18 and 44 years, 16 386 (82.1%) identified as White, 7751 (38.8%) identified as transgender women, 6489 (32.5%) identified as transgender men, and 5300 (26.6%) identified as nonbinary. After adjustment for sociodemographic factors and exposure to other types of gender-affirming care, undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio [aOR], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001). Conclusions and Relevance: This study demonstrates an association between gender-affirming surgery and improved mental health outcomes. These results contribute new evidence to support the provision of gender-affirming surgical care for TGD people.

Low feasibility of in vitro matured oocytes originating from cumulus complexes found during ovarian tissue preparation at the moment of gender confirmation surgery and during testosterone treatment for fertility preservation in transgender men.

OBJECTIVE: To study the feasibility of in vitro maturation of ovarian tissue oocytes for fertility preservation in transgender men on testosterone treatment. DESIGN: Cross-sectional study SETTING: University hospital PATIENT(S): Eighty-three transgender men enrolled from November 2015 to January 2019 INTERVENTION(S): In vitro maturation of cumulus-oocyte complexes (COCs) harvested at the time of gender confirmation surgery, and fertilization through intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S): In vitro maturation, fertilization, and blastulation rates; comparison of morphokinetics with vitrified-warmed oocytes; and analysis of the genetic profiles of embryos. SECONDARY OUTCOMES: association between serum hormone levels; COCs' morphologic characteristics, and vitrification rate. RESULT(S): All participants were on testosterone treatment for a median of 83 (64[Quartile 1]; 113.2[Quartile 2]) weeks. A total of 1,903 COCs (mean per participant, 23 ± 15.8) were collected. The in vitro maturation rate was 23.8%, vitrification rate was 21.5%, and survival rate after warming was 72.6% (n = 151). Intracytoplasmic sperm injection was performed in 139 oocytes. The rate of normal fertilized oocytes was 34.5%, and 25 (52.1%) embryos reached day 3. One blastocyst was achieved on day 5. Aberrant cleavage patterns and early embryo arrest were observed in 22 (45.8%) and 44 (91.7%) zygotes, respectively. Compared with vitrified-warmed donor oocytes, a delay was observed in pronuclei disappearance, t2 (time to reach 2 cell stage) timings, and CC1 (the duration of the 1st cell cycle) and SS3 (synchronization of cleavage pattern (calculated as t8-t5) time intervals. A normal genetic pattern was seen in 42% embryos. The proportion of vitrified oocytes was negatively associated with progesterone (odds ratio, 0.76) and positively associated with antimüllerian hormone serum levels (odds ratio, 1.23). The highest vitrification rate was achieved by the morphologic characteristic 344 at day 0 and by 433 at day 2. CONCLUSION(S): Ovarian tissue oocytes matured in vitro show low developmental capacity in transgender men, when collected under testosterone treatment.

A Longitudinal Study of Features Associated with Autism Spectrum in Clinic Referred, Gender Diverse Adolescents Accessing Puberty Suppression Treatment.

Literature has documented inflated rates of features associated with autism spectrum (AS) in clinic referred, gender diverse young people. This study examined scores on the Social Responsiveness Scale, Second Edition (SRS-2) over time in a group of clinic referred, gender diverse adolescents accessing gonadotropin-releasing hormone analogues (GnRHa) to supress puberty. Primary caregivers of 95 adolescents presenting to the Gender Identity Development Service (GIDS) completed the SRS-2 prior to receiving endocrine input (mean age: 13.6 ± SEM: 0.11) and after approximately one year of accessing GnRHa (mean age: 14.6 ± SEM: 0.13). No significant differences in SRS-2 scores over time and between birth assigned sex were found. No interactions between time and birth assigned sex were established for SRS-2 subscales or total scores.