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1.
Pediatr Ann ; 50(9): e366-e370, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34542341

RESUMO

The coronavirus disease 2019 pandemic has put strains on transgender and gender expansive (TGE) children and youth, with increased rates of anxiety and depression, lower access to medical and mental health services, and greater exposure to unaccepting home environments. At the same time, for some of these young people, particularly those with supportive living situations, sheltering in place and online schooling has afforded them the opportunity to freely explore and consolidate their gender, protected from the strains of socially induced anxieties, and anticipated or experienced negative, hostile messages from their surrounding environment (ie, school or public meeting places). Culling from emerging data on the psychosocial effects of the pandemic on TGE children and youth, an argument is made for an understanding of these young people's experiences as both stress-inducing and resilience-building, each existing in dialectic tension with the other. Providers are called on to hold both in mind to fortify the biopsychosocial well-being of transgender and gender expansive children and youth. [Pediatr Ann. 2021;50(9):e366-e370.].


Assuntos
COVID-19 , Distanciamento Físico , Pessoas Transgênero/psicologia , Transexualidade/psicologia , Adolescente , Criança , Identidade de Gênero , Humanos , SARS-CoV-2
2.
Am J Epidemiol ; 190(9): 1928-1934, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34467408

RESUMO

We sought to operationalize and validate data-driven approaches for identifying transgender individuals in the Veterans Health Administration (VHA) of the US Department of Veterans Affairs (VA) through a retrospective analysis using VA administrative data from 2006-2018. Besides diagnoses of gender identity disorder (GID), a combination of non-GID data elements was used to identify potentially transgender veterans, including 1) an International Classification of Diseases (Ninth or Tenth Revision) code of endocrine disorder, unspecified or not otherwise specified; 2) receipt of sex hormones not associated with the sex documented in the veteran's records (gender-affirming hormone therapy); and 3) a change in the veteran's administratively recorded sex. Both GID and non-GID data elements were applied to a sample of 13,233,529 veterans utilizing the VHA of the VA between January 2006 and December 2018. We identified 10,769 potentially transgender veterans. Based on a high positive predictive value for GID-coded veterans (83%, 95% confidence interval: 77, 89) versus non-GID-coded veterans (2%, 95% confidence interval: 1, 11) from chart review validation, the final analytical sample comprised only veterans with a GID diagnosis code (n = 9,608). In the absence of self-identified gender identity, findings suggest that relying entirely on GID diagnosis codes is the most reliable approach for identifying transgender individuals in the VHA of the VA.


Assuntos
Disforia de Gênero/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Transexualidade/epidemiologia , Saúde dos Veteranos/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adulto , Idoso , Feminino , Disforia de Gênero/diagnóstico , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos de Readequação Sexual/estatística & dados numéricos , Transexualidade/diagnóstico , Estados Unidos/epidemiologia
6.
AMA J Ethics ; 23(7): E557-562, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34351266

RESUMO

Tension between naming gender dysphoria to render an important kind of suffering among transgender people more visible and avoiding pathologizing experiences of transgender people in a gender-binary world can be keenly felt among patients seeking gender-affirming services. This article suggests why clinical "verification" of a patient's need for gender-affirming care is likely less important than clinicians' expressions of empathy and respect for patients' autonomy. This article also suggests that fostering transgender patients' sense of agency should be prioritized.


Assuntos
Disforia de Gênero , Pessoas Transgênero , Transexualidade , Emoções , Identidade de Gênero , Humanos
7.
Khirurgiia (Mosk) ; (8): 63-68, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363447

RESUMO

OBJECTIVE: To develop the method of masculinizing mammoplasty with nipple grafting female-to-male transsexuals with BMI >30 kg/m2, large breast volume and severe ptosis. MATERIAL AND METHODS: There were 114 mastectomies in 57 patients with nipple grafting technique. The methods of areola grafting and scar design were modified to improve aesthetic results. Inclusion criteria were BMI >30 kg/m2, breast size B+ and severe ptosis (Regnault grade ≥2). Anonymous survey for evaluation of aesthetic outcome and quality of life was performed a year after surgery. RESULTS: Postoperative complications included hematoma (5.2%), seroma (7.9%), tangential graft necrosis (9.6%), wound dehiscence (0.8%), ligature-induced inflammation (1.7%), scar hypertrophy (12.2%). Three patients (5.2%) developed nipple hypersensivity in long-term postoperative period. Three patients (5.2%) required redo urgent surgery for hematoma. Additional surgical correction of scar hypertrophy was performed in 4 patients (7%). In a year after surgery, patients rated aesthetic postoperative result as 4.45 out of 5 scores. CONCLUSION: Masculinizing mammoplasty with areola autotransplantation is preferable for FtM transsexuals with large breast volume and severe ptosis. This surgery ensures a good aesthetic result with minimal secondary corrections and complication rate.


Assuntos
Neoplasias da Mama , Mamoplastia , Transexualidade , Feminino , Humanos , Masculino , Mastectomia , Mamilos/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Transplante Autólogo , Transexualidade/cirurgia
8.
J Law Med ; 28(3): 734-744, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34369127

RESUMO

The informed consent model of care for people who identify as transgender is predicated on the idea that a careful mental health assessment and a formal diagnosis of gender dysphoria are not necessary preconditions before starting a person on cross-sex hormones. This article considers the legality of the informed consent model in relation to adolescents under 18 in Australia in the light of the decisions of the Family Court in Re Kelvin (2017) 327 FLR 15; [2017] FamCAFC 258 (Re Kelvin) and Re Imogen (No 6) (2020) 61 Fam LR 344; [2020] FamCA 761. The approach taken by the Family Court is predicated on the treatment being a response to a clinically diagnosed disorder, diagnosed after proper assessment. Re Kelvin indicates that assessment and treatment should be conducted by a multidisciplinary team in accordance with internationally recognised standards and guidelines. For these reasons, practising under an informed consent model of care without a mental health assessment or working within a multidisciplinary team, is unlawful.


Assuntos
Disforia de Gênero , Pessoas Transgênero , Transexualidade , Adolescente , Austrália , Disforia de Gênero/diagnóstico , Disforia de Gênero/terapia , Identidade de Gênero , Humanos , Consentimento Livre e Esclarecido
9.
Artigo em Inglês | MEDLINE | ID: mdl-34360237

RESUMO

Transgender and gender nonbinary (TGNB) individuals often report higher levels of depression compared to cisgender individuals. Higher levels of depression in TGNB populations may be partially attributed to a lack of family support, which may be particularly salient for younger individuals. However, two possible protective factors that may mitigate depressive symptoms are self-compassion, defined as an attitude of kindness and understanding towards one's own imperfections, and perceived support, especially from family. The present study aimed to explore whether self-compassion was negatively associated with self-reported depressive symptoms, and whether perceived family support moderated this association, especially for younger individuals. Participants who were (1) at least 18 years of age, (2) identified as TGNB, and (3) experienced gender dysphoria were eligible for this study. Cross-sectional data from 148 individuals were collected online during May 2020. In support of the hypotheses, self-compassion was negatively associated with depressive symptoms, and perceived family support furthered this association. Additionally, results showed that younger participants (ages 18-24) with lower family support reported the highest levels of depressive symptoms. Taken together, these results suggest that self-compassion and perceived family support may be significant protective factors against depressive symptoms for TGNB individuals, although longitudinal research is needed. Taking a strengths-based perspective, mental health clinicians working with TGNB individuals may consider interventions geared toward increasing self-compassion in daily life and working with clients' families to increase support.


Assuntos
Pessoas Transgênero , Transexualidade , Adolescente , Adulto , Estudos Transversais , Depressão/epidemiologia , Empatia , Humanos , Adulto Jovem
10.
Eur J Endocrinol ; 185(4): 539-552, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34342596

RESUMO

Objective: Sex steroid hormones like estrogens have a key role in the regulation of energy homeostasis and metabolism. In transwomen, gender-affirming hormone therapy like estradiol (in combination with antiandrogenic compounds) could affect metabolism as well. Given that the underlying pathophysiological mechanisms are not fully understood, this study assessed circulating estradiol-driven microRNAs (miRs) in transwomen and their regulation of genes involved in metabolism in mice. Methods: Following plasma miR-sequencing (seq) in a transwomen discovery (n = 20) and validation cohort (n = 30), we identified miR-224 and miR-452. Subsequent systemic silencing of these miRs in male C57Bl/6 J mice (n = 10) was followed by RNA-seq-based gene expression analysis of brown and white adipose tissue in conjunction with mechanistic studies in cultured adipocytes. Results: Estradiol in transwomen lowered plasma miR-224 and -452 carried in extracellular vesicles (EVs) while their systemic silencing in mice and cultured adipocytes increased lipogenesis (white adipose) but reduced glucose uptake and mitochondrial respiration (brown adipose). In white and brown adipose tissue, differentially expressed (miR target) genes are associated with lipogenesis (white adipose) and mitochondrial respiration and glucose uptake (brown adipose). Conclusion: This study identified an estradiol-drive post-transcriptional network that could potentially offer a mechanistic understanding of metabolism following gender-affirming estradiol therapy.


Assuntos
Micropartículas Derivadas de Células/genética , Estradiol/fisiologia , MicroRNAs/genética , Transexualidade , Adipócitos/efeitos dos fármacos , Adipócitos/fisiologia , Adipogenia/efeitos dos fármacos , Adipogenia/genética , Adulto , Animais , Micropartículas Derivadas de Células/efeitos dos fármacos , Micropartículas Derivadas de Células/metabolismo , Estudos de Coortes , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/genética , Metabolismo Energético/efeitos dos fármacos , Metabolismo Energético/genética , Estradiol/sangue , Estradiol/farmacologia , Vesículas Extracelulares/genética , Vesículas Extracelulares/metabolismo , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Homeostase/efeitos dos fármacos , Terapia de Reposição Hormonal , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , MicroRNAs/metabolismo , Pessoa de Meia-Idade , Interferência de RNA/efeitos dos fármacos , Pessoas Transgênero , Transexualidade/genética , Transexualidade/metabolismo , Adulto Jovem
14.
Handb Clin Neurol ; 181: 427-443, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34238476

RESUMO

Gender identity (an individual's perception of being male or female) and sexual orientation (heterosexuality, homosexuality, or bisexuality) are programmed into our brain during early development. During the intrauterine period in the second half of pregnancy, a testosterone surge masculinizes the fetal male brain. If such a testosterone surge does not occur, this will result in a feminine brain. As sexual differentiation of the brain takes place at a much later stage in development than sexual differentiation of the genitals, these two processes can be influenced independently of each other and can result in gender dysphoria. Nature produces a great variability for all aspects of sexual differentiation of the brain. Mechanisms involved in sexual differentiation of the brain include hormones, genetics, epigenetics, endocrine disruptors, immune response, and self-organization. Furthermore, structural and functional differences in the hypothalamus relating to gender dysphoria and sexual orientation are described in this review. All the genetic, postmortem, and in vivo scanning observations support the neurobiological theory about the origin of gender dysphoria, i.e., it is the sizes of brain structures, the neuron numbers, the molecular composition, functions, and connectivity of brain structures that determine our gender identity or sexual orientation. There is no evidence that one's postnatal social environment plays a crucial role in the development of gender identity or sexual orientation.


Assuntos
Identidade de Gênero , Transexualidade , Feminino , Humanos , Hipotálamo , Masculino , Gravidez , Diferenciação Sexual , Comportamento Sexual
15.
BMJ Case Rep ; 14(7)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261631

RESUMO

We present a 69-year-old transgender woman who underwent gender-affirming surgery in 1998 and gender-affirming hormone therapy (cyproterone acetate (CPA) and estradiol) since this time. Following an MRI scan to investigate tremor in 2013, an incidental left anterior clinoid and right petrous meningioma were identified. Subtotal surgical resection was achieved for the anterior clinoid meningioma (WHO grade 1, meningothelial subtype). At follow-up in 2016, an olfactory groove meningioma and left greater wing of sphenoid meningioma were identified. By 2017, both tumours, along with the petrous meningioma, demonstrated significant growth. In 2018, clinical decline was evident and MRI demonstrated further tumour growth. Surgery was scheduled and the olfactory groove meningioma was completely resected (WHO grade 2, chordoid subtype). Hormones were stopped, after which regression of the petrous meningioma was observed. This case demonstrates an association between high-dose CPA and estradiol and the development, growth and regression of meningiomas in a transgender woman.


Assuntos
Neoplasias Meníngeas , Meningioma , Pessoas Transgênero , Transexualidade , Idoso , Estradiol , Feminino , Humanos , Neoplasias Meníngeas/induzido quimicamente , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/induzido quimicamente , Meningioma/diagnóstico por imagem , Meningioma/cirurgia
16.
Med Anthropol Q ; 35(3): 402-417, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34291507

RESUMO

This article examines how staff and patients worked to reconcile the rhythms of the body with those of gender-normative health care bureaucracy in a U.S. Midwest gender-affirming health clinic. Drawing from observations of clinical appointments and routine bureaucratic practice, as well as debriefing interviews with transgender and gender-expansive patients, this article applies Laura Bear's theory of "time-maps" and a new materialist approach to bodily agency that recognizes the variability of the body's responses to gender-affirming health care. This evidence demonstrates how health care staff and patients' labor practices structured patients' abilities to embody their plans for medical transition. Anticipating the varied trajectories bodies take during medical transition can interrupt the reproduction of harmful cultural assumptions about sex difference in U.S. health care bureaucracy.


Assuntos
Acesso aos Serviços de Saúde , Pessoas Transgênero , Transexualidade , Instituições de Assistência Ambulatorial , Antropologia Médica , Feminino , Humanos , Masculino , Estados Unidos
18.
J Sex Med ; 18(8): 1434-1443, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34247950

RESUMO

BACKGROUND: Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioning in this population. AIM: We aimed to assess differences in cognitive functioning between transgender women, and non-transgender (cisgender) women and men, and investigated the contribution of cardiovascular risk factors and psychological factors on these differences. METHODS: In this study, 37 transgender women (age range 55 to 69) receiving GHT for at least ten years (range 10.2 to 41.6) were examined, and their cognitive functioning was compared to an age and education level matched cohort consisting of 222 cisgender women and men from the Longitudinal Aging Study Amsterdam. Linear regression analyses were performed. OUTCOMES: Cognitive functioning was assessed by neuropsychological tests including Mini-Mental State Examination (MMSE), Category Fluency animals, Letter Fluency D, 15-Word test (15WT) immediate and delayed recall. Additionally, cardiovascular risk factors and psychological factors such as cardiovascular disease, hypertension, antihypertensive use, statin use, diabetes mellitus, overweight, smoking, alcohol consumption, psychopharmaceutical use, anxiety and depression symptoms were collected. RESULTS: Transgender women had higher MMSE scores compared with cisgender women (+0.9, 95% CI 0.4 to 1.5), and cisgender men (+1.1, 95% CI 0.4 to 1.8). On all other tests transgender women performed similar to cisgender men. Transgender women performed at a lower level than cisgender women on 15WT immediate recall, -5.5, 95% CI -7.6 to -3.4, and 15WT delayed recall, -2.7, 95% CI -3.7 to -1.7, and equal to cisgender women on Fluency animals and Fluency D. Cardiovascular and psychological factors (i.e., cardiovascular disease and depression symptoms) partly explained differences on MMSE score between transgender women and cisgender-control groups. CLINICAL IMPLICATIONS: The results of this study do not indicate a need for tailored hormone treatment strategies for older transgender women, based on cognitive aspects after long-term GHT. STRENGTHS & LIMITATIONS: As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study. CONCLUSION: Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal. van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021;18:1434-1443.


Assuntos
Pessoas Transgênero , Transexualidade , Idoso , Cognição , Estudos Transversais , Feminino , Hormônios , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Sex Med ; 18(8): 1444-1454, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34247956

RESUMO

OBJECTIVE: Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care. METHOD: This retrospective cohort study used military healthcare data from 2010-2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents. RESULTS: 3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.45, 95% CI [4.77-6.24]), use more mental healthcare services (IRR 2.22; 95% CI [2.00-2.46]), and be prescribed more psychotropic medications (IRR = 2.57; 95% CI [2.36-2.80]) compared to siblings. The most pronounced increases in mental healthcare were for adjustment, anxiety, mood, personality, psychotic disorders, and suicidal ideation/attempted suicide. The most pronounced increased in psychotropic medication were in SNRIs, sleep medications, anti-psychotics and lithium. Among 963 TGD youth (Mage: 18.2) using gender-affirming pharmaceuticals, mental healthcare did not significantly change (IRR = 1.09, 95% CI [0.95-1.25]) and psychotropic medications increased (IRR = 1.67, 95% CI [1.46-1.91]) following gender-affirming pharmaceutical initiation; older age was associated with decreased care and prescriptions. CONCLUSION: Results support clinical mental health screening recommendations for TGD youth. Further research is needed to elucidate the longer-term impact of medical affirmation on mental health, including family and social factors associated with the persistence and discontinuation of mental healthcare needs among TGD youth. Hisle-Gorman E, Schvey NA, Adirim TA, et al. Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment. J Sex Med 2021;18:1444-1454.


Assuntos
Disforia de Gênero , Pessoas Transgênero , Transexualidade , Adolescente , Idoso , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos
20.
J Sex Med ; 18(7): 1271-1279, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34274043

RESUMO

BACKGROUND: Possible options of genital gender affirming surgery in transmasculine are metoidioplasty or phalloplasty. As opposed to phalloplasty, no flapbased neophallic reconstruction is needed in metoidioplasty. Urethral lengthening is needed in metoidioplasty if the patient desires voiding at the tip of the neophallus. This urethral lengthening poses the patient at risk for urethral complications. AIM: Our primary goal was to describe the morbidity and specific the urethral complications related to metoidioplasty. Second, we sought for predictors of these urethral complications. METHODS: Our institutional database was retrospectively analyzed to identify transmasculine who underwent metoidioplasty between 2006 and 2020. This cohort was further evaluated for surgical morbidity, urethral complications and potential predictors for urethral complications. OUTCOMES: The rate of surgical morbidity and urethral complications (temporary/permanent fistula, stricture or fistula and stricture) was calculated. Potential predictors evaluated herein were BMI, concomitant vaginectomy, active smoking and additional urethral lengthening (AUL). They were tested with logistic regression analysis with calculation of Odds Ratio (OR). RESULTS: Seventy-four patients underwent metoidioplasty with a median follow-up of 44 months. Median age was 26 years. AUL was done in 36 (48.6%) patients and established by a transverse preputial skin island and labium minus flap in respectively 34 and 2 patients. Within 30 days after metoidioplasty, 3 (4.1%) high-grade complications were noted. Urethral complications of any kind were noted in 42 (56.8%) patients. All fistulas, permanent fistulas and strictures were seen in resp. 34 (45.9%), 27 (36.5%) and 14 (18.9%) patients. AUL is a significant predictor for all urethral complications (OR 15.5), strictures (OR 24.5), all fistula's (OR 6.07) and permanent fistulas (OR 3.83). In contrast, smoking is only a predictor for all fistulas (OR 6.54) and permanent fistulas (OR 3.76). CLINICAL IMPLICATIONS: Obtaining information about the risk of complications is important in preoperative patient counselling. Patient who desires AUL are at higher risk to develop urethral complications and patients who continue to smoke at the period of metoidioplasty have a higher risk of fistula formation. STRENGTH & LIMITATIONS: Sufficient events to calculate predictors for urethral complications. However, this is a retrospective study with still a small number of patients with a relative short follow-up. CONCLUSION: Urethral complications are frequent after metoidioplasty and approximately 50% needs corrective surgery. AUL is an independent risk factor for fistula and stricture formation, whereas smoking is a risk factor for fistula formation. Waterschoot M, Hoebeke P, Verla W, et al. Urethral Complications After Metoidioplasty for Genital Gender Affirming Surgery. J Sex Med 2021;18:1271-1279.


Assuntos
Cirurgia de Readequação Sexual , Transexualidade , Adulto , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Readequação Sexual/efeitos adversos , Retalhos Cirúrgicos , Transexualidade/cirurgia , Uretra/cirurgia
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