17α-ethynylestradiol prevents the natural male-to-female sex change in gilthead seabream (Sparus aurata L.).

Exposure to 17α-ethynylestradiol (EE2, 5 µg/g food) impairs some reproductive events in the protandrous gilthead seabream and a short recovery period does not allow full recovery. In this study, spermiating seabream males in the second reproductive cycle (RC) were fed a diet containing 5 or 2.5 µg EE2/g food for 28 days and then a commercial diet without EE2 for the remaining RC. Individuals were sampled at the end of the EE2 treatment and then at the end of the RC and at the beginning of the third RC, 146 and 333 days after the cessation of treatment, respectively. Increased hepatic transcript levels of the gene coding for vitellogenin (vtg) and plasma levels of Vtg indicated both concentrations of EE2 caused endocrine disruption. Modifications in the histological organization of the testis, germ cell proliferation, plasma levels of the sex steroids and pituitary expression levels of the genes coding for the gonadotropin ß-subunits, fshß and lhß were detected. The plasma levels of Vtg and most of the reproductive parameters were restored 146 days after treatments. However, although 50% of the control fish underwent sex reversal as expected at the third RC, male-to female sex change was prevented by both EE2 concentrations.

A social systems analysis of implementation of El Salvador's national HIV combination prevention: a research agenda for evaluating Global Health Initiatives.

BACKGROUND: Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. METHODS: We conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework. RESULTS: El Salvador's national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH. In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions. CONCLUSIONS: Overall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention's potential impact.

Atención psicomédica en la disforia de identidad de género durante la adolescencia / Psychomedical care in gender identity dysphoria during adolescence

Introducción. En la literatura científica, el término disforia de género se utiliza para definir la percepción de rechazo que tiene una persona respecto al hecho de ser hombre o mujer. En niños y adolescentes la disforia de identidad de género es una entidad clínica compleja, que requiere una correcta respuesta a la demanda que expone el paciente, y cuyo resultado es variable e incierto, pues solo unos pocos casos serán transexuales en la vida adulta. Objetivos. - Revisar el estado actual de la etiología y prevalencia, los Protocolos Españoles de Atención Sanitaria, los criterios DSM-V y CIE-10, y los estándares internacionales. - Intervención psicomédica en menores de 18 años. Metodología. - Revisión bibliográfica: bases de datos PubMed y UpToDate. - Exposición de un caso clínico en la adolescencia mujer> hombre. Resultados y conclusiones. - Se ha comprobado el impacto hormonal sobre la etiología de la disforia de identidad de género y la infraestimación de su prevalencia. - Relevancia de los criterios diagnósticos del DSM-V, que incluyen la sustitución del término «trastorno de identidad de género» por «disforia de identidad de género», y con ello, la eliminación parcial de la anterior patologización. - La séptima edición de los estándares internacionales de la World Professional Association for Transgender Health resalta el papel del psicoterapeuta en el asesoramiento durante el camino hacia la transición. - La Guía Española 2012 se distingue por su riqueza en los detalles y explicaciones, con lenguaje dirigido a los diferentes profesionales. - La disforia de identidad de género debe ser atendida por un equipo multidisciplinar en el que el psicoterapeuta debe ser experto en psicopatología del desarrollo y evaluar problemas emocionales y de comportamiento (AU)

Introduction. In the clinical literature, the term gender dysphoria is used to define the perception of rejection that a person has to the fact of being male or female. In children and adolescents, gender identity dysphoria is a complex clinical entity. The result of entity is variable and uncertain, but in the end only a few will be transsexuals in adulthood. Objectives. - To review the current status of the etiology and prevalence, Spanish health care protocols, DSM-V, ICD-10 and international standards. - Psychomedical intervention in under 18 year-olds. Methodology. - A review of PubMed and UpToDate databases. - Presentation of a clinical case in adolescence woman>man. Results and conclusions. - There is evidence of a hormonal impact on the etiology of gender identity dysphoria and an underestimation of its prevalence. - Relevance to DSM-V, including the replacement of the term «gender identity disorder» by «dysphoria gender identity», and thus the partial removal of the previous disease connotation. - The seventh edition of the international standards World Professional Association for Transgender Health highlight the role of the therapist for advice on the way to the transition. - The Spanish 2012 guide stands out for its wealth of details and explanations, with a language targeted at different professionals. - Dysphoria gender identity must be studied by a multidisciplinary team, in which the psychotherapist must be expert in developmental psychopathology and evaluate emotional and behavioral problems (AU)

The voice in transsexuals / La voz en los transexuales

Sex reassignment therapy, i.e. the process of transition in transgender clients, as a rule also includes voice therapy and as such the contribution of a speech language pathologist. Voice therapy in transgender clients is special, however, and is significantly different from what is usually understood by voice therapy in speech language pathology. As transsexualism is becoming more and more accepted in society, more speech language pathologists have a chance of being called upon for helping transsexual clients. The present paper is meant as an introduction to voice therapy in transgender clients. Based on a review of the literature and personal experience various procedures and treatment options are discussed

La terapia de reasignación sexual, es decir, el proceso de transición en clientes transexuales, incluye también como norma la terapia de voz y, por tanto, la mediación de un patólogo del habla y lenguaje. Sin embargo, la terapia de voz en los clientes transexuales es diferente a lo que normalmente entendemos como terapia de voz en la patología del habla y lenguaje. A medida que la sociedad va aceptando más la transexualidad se incrementa la posibilidad de que los patólogos del habla y lenguaje sean requeridos para ayudar a los clientes transexuales. El presente documento constituye una introducción a la terapia de voz en los pacientes transexuales. Basándonos en una revisión de la literatura y la experiencia personal, abordamos diversos procedimientos y opciones de tratamiento

A systems approach to child effeminacy and the prevention of adolescent transsexualism.

This paper describes the treatment of a boy with transsexual behaviour by means of family therapy supplemented by group therapy. It argues that a family systems approach can grasp dimensions of the problems of transsexualism that are missed if an exclusively individual treatment approach is adopted, and concludes that a family systems approach should be part of the assessment and treatment of all children and adolescents presenting with effeminacy or transsexual problems.

Male transsexuals in the homosexual subculture.

The author describes 20 male transsexuals who differ from most discussed in professional studies and from those in media portrayals in that they live in the male homosexual subculture. Furthermore, interviews with these individuals indicated that transsexuals are no more sexually or socially homogeneous than heterosexuals or homosexuals. In general, these men entered the homosexual subculture in their teens; they knew they were not heterosexual and therefore assumed they must be homosexual. As their gender identity crystallized, homosexual activity became repugnant and they rejected and were rejected by male homosexuals. Being unable to attract heterosexual men, they sought bisexual partners in a futile effort to confirm their identity as females. The author suggests that in addition to efforts to help transsexuals shift their gender identity, psychiatrists should emphasize prevention of this psychopathologic symptom.