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4.
Ann Ital Chir ; 90: 95-99, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31182698

RESUMEN

INTRODUCTION: The access to sex-reassignment surgery is based on the existence of an unequivocal dyscrasia between the morphological sex and the objective evidence that emerges from in-depth analysis of the individual's personality. In Italy, such type of surgical intervention is subject to the authorization of a judge. MATERIAL OF STUDY: Authors examine the recent Italian Constitutional judgement which has addressed the right to change legal sex status without the need for sex-reassignment surgery. DISCUSSION: The Italian approach is in line with scientific evidence that the physical and mental well-being of an individual does not always require the surgical rectification of primary sexual features. Thus, sex reassignment surgery is not to be considered mandatory; rather, it should be aimed at ensuring the transsexual individual's stable psychological and physical good. From an ethical point of view, the Court's decision is very important, since it does not subordinate such fundamental rights as gender identity, healthcare and equality to prior, highly invasive surgery. CONCLUSIONS: The authors point out that critical issues and obstacles to the full implementation of the right to gender identity remain, in that this right is still subject to the authorization of a judge. This approach does not seem to be in line with the recent World Health Organization (WHO) decision to remove the "gender incongruity" from the list of mental and behavioural disorders (as it is in the current International Classification of Diseases-10, so far), to decrease the stigma surrounding such a condition. KEY WORDS: Gender identity, Sex reassignment, Surgery, Stigma, Transsexualism, Transgender.


Asunto(s)
Procedimientos de Reasignación de Sexo/ética , Cirugía de Reasignación de Sexo/legislación & jurisprudencia , Femenino , Humanos , Italia , Masculino , Procedimientos de Reasignación de Sexo/métodos , Cirugía de Reasignación de Sexo/ética
6.
Facial Plast Surg Clin North Am ; 27(2): 179-190, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940383

RESUMEN

Although the acronym LGBTQ is often used as a catchall label for sexual and gender minorities, transgender people have unique and individual health needs and unfortunately experience significant health disparities. This article reviews essential terminology and concepts relevant to discussions of gender and gender identity, practical tips for changes that can be made on the clinical and institutional levels in order to create a welcoming and safe environment for transgender patients, as well as current recommendations for the provision of gender-affirming medical therapy.


Asunto(s)
Competencia Cultural , Identidad de Género , Disparidades en Atención de Salud , Hormonas/uso terapéutico , Procedimientos de Reasignación de Sexo/métodos , Personas Transgénero , Competencia Cultural/educación , Competencia Cultural/organización & administración , Femenino , Hormonas/efectos adversos , Humanos , Masculino , Conducta Sexual , Personas Transgénero/psicología
7.
Facial Plast Surg Clin North Am ; 27(2): 227-232, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940388

RESUMEN

Hair transplantation can play a complementary role in the spectrum of gender transformation procedures sought by transgender patients undergoing gender transformation surgery. The authors' clinic has seen an increase in the demand for hair restoration in transgender patients. Hairline lowering, eyebrow transplantation, and pubic hair transplantation can play roles for male-to-female transgender patients whereas beard hair transplantation and body hair transplantation can play integral roles for female-to-male patients seeking gender transformation surgery. This article delineates an experience in the role hair restoration plays for transgender patients and outlines a surgical approach for these hair restoration procedures.


Asunto(s)
Cabello/trasplante , Procedimientos de Reasignación de Sexo/métodos , Personas Transgénero , Cara/cirugía , Femenino , Humanos , Masculino , Caracteres Sexuales , Trasplante Autólogo/métodos
8.
Facial Plast Surg Clin North Am ; 27(2): 233-242, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940389

RESUMEN

Facial gender-affirming surgery can have significant impact on patient quality of life for some gender-dysphoric patients. Lower jaw contouring can be used to harmonize the face during facial gender-affirming surgery through masculinization or feminization. During feminization, the mandibular angle and body and chin are reduced in width and size. During masculinization, augmentation of the mandibular angle and body and chin are completed with alloplastic implants, fat, or bone. Complications are minimal. Further research is needed on outcomes of these procedures.


Asunto(s)
Disforia de Género/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos de Reasignación de Sexo/métodos , Trasplante Óseo , Cefalometría , Mentón/cirugía , Femenino , Humanos , Masculino , Osteotomía , Prótesis e Implantes , Implantación de Prótesis , Caracteres Sexuales , Personas Transgénero
9.
Facial Plast Surg Clin North Am ; 27(2): 243-250, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940390

RESUMEN

Chin reshaping can provide a more identifiable female appearance for transitioning male to female patients undergoing facial feminization. The "sliding" genioplasty has the most potential for dramatically reshaping the chin, while also avoiding many of the issues that may occur with implants. A chin should be evaluated radiologically and by physical examination to determine what changes should be made to any particular chin. When performing osseous genioplasty, the mental nerve can be protected by performing any osteotomies at least 6 mm below the inferior border of the mental nerve canal.


Asunto(s)
Mentón/cirugía , Mentoplastia/métodos , Procedimientos de Reasignación de Sexo/métodos , Cefalometría , Femenino , Mentoplastia/efectos adversos , Humanos , Masculino , Osteotomía , Procedimientos Quirúrgicos Reconstructivos , Caracteres Sexuales , Personas Transgénero
10.
Facial Plast Surg Clin North Am ; 27(2): 251-260, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940391

RESUMEN

Most surgeons who are not routinely treating gender dysphoric patients are more likely to see an isolated rhinoplasty consultation rather than a request for full facial gender confirmation surgery (FGCS). Different from other aspects of FGCS, the surgical basis of rhinoplasty is almost the same as for the cisgender population. Despite technical overlap, the care for patients seeking rhinoplasty for the indication of gender dysphoria vastly differs from that for the cisgender population. This review includes comments on gender norms and outline considerations for the preoperative work-up and operative execution as well as a comprehensive literature review.


Asunto(s)
Disforia de Género/cirugía , Rinoplastia/métodos , Procedimientos de Reasignación de Sexo/métodos , Competencia Cultural , Cara/cirugía , Femenino , Disforia de Género/psicología , Identidad de Género , Humanos , Masculino , Nariz/cirugía , Grupos de Población , Reoperación , Rinoplastia/economía , Rinoplastia/psicología , Caracteres Sexuales , Procedimientos de Reasignación de Sexo/economía , Procedimientos de Reasignación de Sexo/psicología , Personas Transgénero
11.
Facial Plast Surg Clin North Am ; 27(2): 261-266, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940392

RESUMEN

The male upper lip has a distinctly longer cutaneous height from the nasal base to the upper vermilion border than its female counterpart. The subnasal indirect lip lift using the bullhorn technique or its modifications allows for shortening of this height to feminize the lower face, creating a more aesthetically pleasing upper lip secondary to increased vermilion height and lip pout. Patient selection is critical, taking into account lip height, vermilion height, alar base width, skin type, upper incisal show, and maxillary height. Precise measurements, controlled excision of the planned resection, and meticulous reapproximation of skin provide an aesthetic result, while minimizing visible scarring.


Asunto(s)
Disforia de Género/cirugía , Labio/cirugía , Procedimientos de Reasignación de Sexo/métodos , Femenino , Humanos , Labio/anatomía & histología , Masculino , Cuidados Preoperatorios , Caracteres Sexuales
12.
Facial Plast Surg Clin North Am ; 27(2): 267-272, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940393

RESUMEN

Chondrolaryngoplasty, also known as tracheal shave, is a surgical procedure performed for a prominent Adam's apple, usually in transfeminine patients with gender dysphoria to this marker of male sex. Although laryngeal anatomy is complex, knowledge of landmarks and techniques discussed in this article results in a safe procedure with rare complications and improvement in quality of life.


Asunto(s)
Disforia de Género/cirugía , Laringoplastia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos de Reasignación de Sexo/métodos , Cartílago Tiroides/cirugía , Femenino , Humanos , Cartílagos Laríngeos/cirugía , Laringoplastia/efectos adversos , Masculino , Cartílago Tiroides/anatomía & histología , Personas Transgénero
13.
Rev. bras. cir. plást ; 34(1): 65-72, jan.-mar. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-994547

RESUMEN

Introdução: A cirurgia de adequação genital tem se mostrado uma opção segura e confiável, com redução drástica na disforia e melhora da qualidade de vida das pessoas transgênero. A técnica mais estudada e utilizada é a inversão peniana com suas modificações, com aparência estética e funcionalidade adequadas, porém sem padronização da técnica cirúrgica. Índices de até 38% de satisfação parcial e 15% de insatisfação podem levar até 66% dos casos a realizar procedimentos adicionais. O objetivo é sugerir refinamentos estéticos na aparência da vulva e comparar com algumas das técnicas descritas, buscando aumentar a satisfação estética e funcional pós-operatória. Métodos: Estudo retrospectivo com 7 pacientes submetidas à cirurgia de readequação sexual entre agosto de 2017 e fevereiro de 2018. O clitóris é feito com a glande em formato de tridente, utilizando a coroa para construir os corpos cavernosos do clitóris e aumentar a área de sensação erógena. Faixa de prepúcio é usada para aumentar a cobertura do clitóris e cobrir a face interna dos pequenos lábios, que são definidos com o uso de suturas. Resultados: Sensibilidade adequada e satisfação com o resultado e capacidade de orgasmo em todas as pacientes observadas. Não houve estenose, fístula ou necrose do clitóris com essa técnica. Somente 1 caso precisou de procedimento adicional para melhor definição estética. Conclusão: A técnica apresentada tem alta satisfação das pacientes e sensibilidade erógena, com algumas vantagens em relação a outras técnicas. Porém, estudos prospectivos com número maior de pacientes são necessários para definir a técnica cirúrgica mais efetiva.


Introduction: Sex reassignment surgery is a reliable and safe option, which has drastically reduced dysphoria and improved the quality of life of transgender individuals. The most studied and used technique is penile inversion with modifications, which results in appropriate esthetic appearance and functionality, but the surgical technique has not been standardized. Partial satisfaction rates up to 38% and dissatisfaction rates of 15% may cause up to 66% of cases to undergo additional procedures. The objective is to suggest esthetic refinements to the appearance of the vulva and compare some of the techniques described, seeking to increase the postoperative esthetic and functional satisfaction. Methods: A retrospective study with 7 patients undergoing sex reassignment surgery between August 2017 and February 2018 was conducted. The clitoris is constructed with the glans in the form of a trident, using the corona to build the corpus cavernosa of the clitoris and increase the area of erogenous sensation. A section of the prepuce is used to increase the coverage of the clitoris and cover the inner surface of the labia minora, which are defined with the use of sutures. Results: Adequate sensitivity and satisfaction with the result and capacity of orgasm in all patients were observed. There was no stenosis, fistula, or necrosis of the clitoris with this technique. Only 1 case needed an additional procedure for better esthetic definition. Conclusion: The technique presented leads to high patient satisfaction and erogenous sensitivity, with some advantages compared to other techniques. However, prospective studies with larger numbers of patients are needed to define a more effective surgical technique.


Asunto(s)
Humanos , Transexualismo/cirugía , Vulva/cirugía , Vulva/fisiopatología , Procedimientos Quirúrgicos Reconstructivos/métodos , Estética , Procedimientos de Reasignación de Sexo/efectos adversos , Procedimientos de Reasignación de Sexo/métodos , Cirugía de Reasignación de Sexo/efectos adversos , Cirugía de Reasignación de Sexo/métodos , Cirugía de Reasignación de Sexo/rehabilitación , Personas Transgénero
14.
Endocrinol Diabetes Nutr ; 66(6): 385-392, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30704917

RESUMEN

PURPOSE: Gender affirming hormone therapy (HT) in transgender men both improves and impairs several surrogate cardiovascular risk markers. However, few prospective works with long follow-up and control group are available. In this context, this work aimed to assess the changes in the metabolic and cardiovascular risk pattern after 12 months of HT in transgender men. Furthermore, we aimed to investigate early effects on target tissues that may reflect an initial vascular damage. METHODS: Prospective observational study, including 20 transgender men, attended in the Gender Identity Unit (UIG) of the Hospital Clinic from July 2013 to November 2015. Anthropometric and body composition by dual-energy X-ray absorptiometry (DXA), hormonal, metabolic and coagulation parameters, endothelial dysfunction by flow-mediated dilation (FMD) and intima-media thickness (IMT) by carotid ultrasound, were assessed at baseline, at 6 and 12 months of HT. RESULTS: We observed an impairment of lipid profile, and increase of homocysteine and leucocytes count, as well as changes in body composition with increased total lean mass together with decreased total fat mass. In addition, higher mean-maximum common IMT was observed after 12 months of HT. CONCLUSION: Our work shows changes in metabolic and inflammatory parameters after HT after short-medium follow-up, which could increase cardiovascular risk in this setting, together with initial evidence of vascular changes.


Asunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/epidemiología , Hormonas Esteroides Gonadales/efectos adversos , Enfermedades Metabólicas/inducido químicamente , Enfermedades Metabólicas/epidemiología , Procedimientos de Reasignación de Sexo/métodos , Adolescente , Adulto , Hormonas Esteroides Gonadales/uso terapéutico , Humanos , Masculino , Estudios Prospectivos , Medición de Riesgo , Factores de Tiempo , Adulto Joven
15.
Endocr Rev ; 40(1): 97-117, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30307546

RESUMEN

Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population.


Asunto(s)
Endocrinología , Disforia de Género/tratamiento farmacológico , Hormonas Esteroides Gonadales , Procedimientos de Reasignación de Sexo , Personas Transgénero , Transexualismo/tratamiento farmacológico , Adolescente , Adulto , Endocrinología/métodos , Endocrinología/normas , Femenino , Hormonas Esteroides Gonadales/administración & dosificación , Hormonas Esteroides Gonadales/efectos adversos , Hormonas Esteroides Gonadales/antagonistas & inhibidores , Humanos , Masculino , Procedimientos de Reasignación de Sexo/efectos adversos , Procedimientos de Reasignación de Sexo/métodos , Procedimientos de Reasignación de Sexo/normas
17.
Folia Phoniatr Logop ; 71(1): 24-28, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30541011

RESUMEN

PURPOSE: To investigate the formant frequency (FF) features of transgender females' (TFs) voice after Wendler's glottoplasty surgery and compare these levels with age-matched healthy males and females. STUDY DESIGN: Controlled prospective. METHODS: 20 TFs and 20 genetically male and female age-matched healthy controls were enrolled in the study. The fundamental frequency (F0) and FFs F1-F4 were obtained from TF speakers 6 months after surgery. These levels were compared with those of healthy controls. RESULTS: Statistical analysis showed that the median F0 values were similar between TFs and females. The median F1 levels of TFs were different from females but similar to males. The F2 levels of TFs were similar to females but different from males. The F3 and F4 levels were significantly different from both male and female controls. CONCLUSION: Wendler's glottoplasty technique is an effective method to increase F0 levels among TF patients; however, these individuals report their voice does not sufficiently project femininity. The results obtained with regard to FF levels may be the reason for this problem. Voice therapy is recommended as a possible approach to assist TF patients achieve a satisfactory feminine voice.


Asunto(s)
Glotis/cirugía , Procedimientos de Reasignación de Sexo/métodos , Personas Transgénero , Adulto , Femenino , Glotis/fisiología , Humanos , Masculino , Percepción del Tono , Estudios Prospectivos , Acústica del Lenguaje , Estroboscopía , Calidad de la Voz , Adulto Joven
18.
BMJ Open ; 8(12): e022425, 2018 12 22.
Artículo en Inglés | MEDLINE | ID: mdl-30580262

RESUMEN

OBJECTIVES: Conversion is a term for treatments that seek to suppress or change a person's sexual orientation or gender. Our review focuses on transgender and gender-diverse (TGD) people. Our aims were to (1) describe the frequency, nature and structure of conversion practices; (2) document difficulties in accessing transition-related healthcare and (3) evaluate the mental health consequences of such practices and access barriers. METHOD: Systematic review and narrative synthesis using the Critical Appraisals Skills Programme and Joanne Briggs Institute critical appraisal tools. Data sources include Embase, MEDLINE, PsychINFO, PsychARTICLES and Web of Science between 1990 and June 2017. PARTICIPANTS: Studies were included that (1) document use of conversion therapies or access barriers to transition-related healthcare; and/or (2) describe how such therapeutic practices and access barriers have been applied and/or (3) evaluate the mental health impacts of such therapies and difficulties accessing transition-related healthcare. Two reviewers screened papers for eligibility. Data were then grouped according to the objectives. Narratives and themes were presented per study. RESULTS: Seven studies met inclusion criteria. Four reports were on 'realignment', involving case studies or case series. Two involved psychoanalysis, one self-exposure therapy and one open-ended play psychotherapy. All four studies concerning 'realignment' were of poor methodological quality. The other three studies explored access barriers from the view point of TGD youth, their parents and healthcare providers. All papers reported access barriers, such as inability to access puberty-delaying medications. The papers concerning barriers to access were of good methodological quality. CONCLUSION: We found limited published evidence on use, nature, structure and/or health consequences of conversion therapies and access barriers to transition in TGD people. However, reports of restriction to access may indicate a more widespread problem. Research is needed into TGD people's experiences of conversion therapy and access barriers to transition-related healthcare TRIAL REGISTRATION NUMBER: CRD42017062149.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Narración , Procedimientos de Reasignación de Sexo/métodos , Conducta Sexual/psicología , Personas Transgénero/psicología , Adaptación Fisiológica , Adaptación Psicológica , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Transferencia de Pacientes/organización & administración , Medición de Riesgo , Educación Sexual/métodos , Adulto Joven
19.
Plast Reconstr Surg ; 142(6): 1600-1608, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30204682

RESUMEN

BACKGROUND: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome instrument designed for weight loss and/or body contouring. In this article, the authors describe the development of a new module for masculinizing chest contouring surgery. METHODS: Qualitative methods were used to develop the BODY-Q Chest Module, which was subsequently field-tested in Canada, the United States, The Netherlands, and Denmark between June of 2016 and June of 2017. Participants were aged 16 years or older and seen for gynecomastia, weight loss, or transman chest surgery. Data were collected using either a Web-based application or paper questionnaire. Rasch measurement theory analysis was performed. RESULTS: The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, and 341 gender-affirming). Rasch measurement theory analysis refined a 10-item chest scale and a five-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability [i.e., person separation index and Cronbach alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale), respectively]. Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean scores for the chest and nipple scales were significantly higher (p < 0.001 on independent samples t tests) in participants who were postoperative compared with preoperative. CONCLUSION: This new BODY-Q Chest Module is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes for masculinizing chest contouring surgery.


Asunto(s)
Contorneado Corporal/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Adolescente , Adulto , Anciano , Antropometría , Femenino , Ginecomastia/cirugía , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Procedimientos de Reasignación de Sexo/métodos , Tórax , Pérdida de Peso , Adulto Joven
20.
Plast Reconstr Surg ; 142(5): 1125-1132, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30096122

RESUMEN

BACKGROUND: The effectiveness of gender-confirming surgery is best evaluated on the basis of patient-reported outcomes. This is the first explorative study using the BODY-Q chest module, administered in trans men before and after mastectomy. METHODS: Between October of 2016 and May of 2017, trans men were recruited to participate in a cross-sectional study. Data collection included standardized anamnesis and examination, screening questions on depression/anxiety, and seven BODY-Q scales, including new scales measuring satisfaction of the chest and nipples. Mean scores for preoperative and postoperative participants were compared, and regression analyses were conducted to identify factors associated with BODY-Q scores. RESULTS: In total, 101 persons participated (89 percent; 50 preoperatively and 51 postoperatively). Postoperative participants reported significantly higher (better) scores on the chest (67), nipple (58), body (58) (t tests, all p < 0.001), and psychological (60) (t test, p = 0.05) scales compared with preoperative patients. Postoperative chest and nipple mean scores did not differ significantly from a gynecomastia comparison, whereas scores were less favorable on the psychosocial domains. Preoperatively, chest scores were not associated with objective breast size. Lower postoperative chest scores were associated with planned revision surgery (ß = -0.52) and depressive symptoms (ß = -0.59). CONCLUSIONS: The present findings indicate that chest and nipple satisfaction differences in trans men undergoing mastectomy can be detected using the BODY-Q chest module. Future prospective studies are needed to measure clinical change in satisfaction and how this relates to changes in other aspects of health-related quality of life.


Asunto(s)
Mastectomía Subcutánea/métodos , Satisfacción del Paciente , Procedimientos de Reasignación de Sexo/métodos , Transexualismo/psicología , Transexualismo/cirugía , Adulto , Contorneado Corporal/métodos , Contorneado Corporal/psicología , Imagen Corporal , Estudios Transversales , Femenino , Disforia de Género/psicología , Disforia de Género/cirugía , Indicadores de Salud , Humanos , Relaciones Interpersonales , Masculino , Mastectomía Subcutánea/psicología , Pezones , Medición de Resultados Informados por el Paciente , Calidad de Vida , Procedimientos de Reasignación de Sexo/psicología , Encuestas y Cuestionarios , Tórax
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