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1.
Ann Plast Surg ; 88(3 Suppl 3): S148-S151, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35513312

RESUMO

BACKGROUND: Chest masculinization surgeries are one of the most common gender-affirming procedures performed. There is a need for better understanding of the risk of breast cancer and postsurgical screening in female to male (FtM) individuals. This study aimed to evaluate the incidence of high-risk pathologic findings in FtM transgender patients undergoing gender-affirming chest reconstructive surgery. METHODS: Medical records were reviewed from all FtM patients undergoing gender-affirming chest reconstructive surgery from January 2010 to February 2021 by 3 plastic surgeons at the University of Pittsburgh Medical Center. Relative risk of malignant progression was used to stratify pathologic data. Subsequent management of atypical, in situ, and invasive pathology were recorded. RESULTS: A total of 318 patients were included in this study; the average age at surgery was 24.6 ± 8.1 years. Eighty-six patients (27%) had a family history of breast and/or ovarian cancer. Overall, 21 patients (6.6%) had some increased risk of breast cancer: 17 (5.3%) had proliferative lesions, mean age 38.2 ± 12.4 years; 2 had atypical ductal hyperplasia, ages 33.4 and 38.3 years; and 2 had invasive ductal carcinoma, ages 35.4 and 40.6 years. CONCLUSIONS: In this study, we found that 6.6% of FtM transgender patients undergoing top surgery had an elevated risk of breast cancer, with 1.2% of patients having a greater than 2 times risk of breast cancer. These results highlight the importance of appropriate preoperative screening as well as pathological analysis of surgical specimens to help guide clinical care. The authors advocate for a thorough breast cancer risk assessment before surgery for all patients, as well as using pathologic findings to guide postoperative cancer screening and follow-up.


Assuntos
Neoplasias da Mama , Pessoas Transgênero , Transexualidade , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Masculino , Mastectomia/métodos , Pessoa de Meia-Idade
2.
Gynecol Endocrinol ; 38(5): 355-356, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35506459
3.
Lancet ; 399(10335): 1584, 2022 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-35461543
4.
Artigo em Inglês | MEDLINE | ID: mdl-35410053

RESUMO

This article examines the reliability and validity of the adaptation of the Trans Attitudes and Beliefs Scale (TABS), an instrument capable of detecting transphobic positions, to the Spanish context. A total of 829 psychology students participated in the adaptation procedure. A confirmatory factor analysis was performed to study the fit of the new scale to the factor structure of the original scale (interpersonal comfort, gender identity beliefs, and human value). Convergent validity evidence showed significant correlations and predictive levels with different constructs and sociodemographic variables. The internal consistency of the mean scores was adequate at the global level. The study showed that the TABS is a psychometrically sound instrument for the assessment of attitudes toward trans people, particularly in the context of debates over access to rights and the lack of professional training in disciplines such as psychology.


Assuntos
Identidade de Gênero , Transexualidade , Atitude , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
5.
J Sex Med ; 19(5): 864-871, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35379590

RESUMO

BACKGROUND: Self-prescribed gender-affirming hormone therapy (GAHT) is common practice among transgender women, especially in resource-limited countries, yet the effectiveness of each GAHT regimen to achieve female range sex hormone concentrations is not known. AIM: To describe the use and sex hormone concentrations of various GAHT regimens among transgender women who self prescribe in Thailand. METHODS: This was a retrospective study in a community-based setting. Five hundred and 27 records of transgender women taking GAHT who were receiving care at a community health center between January 1, 2018, and December 31, 2020 were included for the analysis. MAIN OUTCOME MEASURES: Blood total testosterone and estradiol concentration after at least a 6-month period of GAHT. RESULTS: Multiple GAHT regimens were identified including oral estradiol valerate (EV), transdermal 17ß-estradiol gel, injectable EV with hydroxyprogesterone caproate, injectable estradiol benzoate with progesterone, oral EV with cyproterone acetate (CPA), and oral contraceptive pills (OCPs). The most common GAHT regimen used by 49.1% of the participants was OCPs that contained 0.035 mg of ethinyl estradiol and 2 mg of CPA. Only 25.2% of this group had female range testosterone concentrations (<50 ng/dL). Oral EV and CPA were used by 23.1% of the participants. Most of them used 12.5 mg of CPA and 47.7% of this group had female range testosterone concentrations. There was no statistical significance between mean testosterone concentrations in CPA 12.5 and 25 mg groups, (P = .086). CLINICAL IMPLICATIONS: The inadequate sex hormone levels found in these commonly self-prescribed GAHT regimens provide information regarding the efficacy and safety of GAHT regimens for health care providers working with transgender women in a community-based setting. STRENGTHS AND LIMITATIONS: This study reflected a real-world situation and provided hormonal profiles among transgender women taking self-prescribed GAHT. However, issues in recall, medical literacy, and adherence to the medication may limit the results. CONCLUSION: Combined hormonal contraceptive pill was a commonly used GAHT regimen in Thai transgender women who self prescribe GAHT. However, this regimen was not effective to decrease testosterone concentrations to the recommended range of less than 50 ng/dL. Overall, self-prescription of GAHT does not appear to be effective in reaching target sex hormone concentrations. Including health care providers in the prescription and monitoring of GAHT may be a more effective approach in the delivery of GAHT. Salakphet T, Mattawanon N, Manojai N, et al. Hormone Concentrations in Transgender Women Who Self-Prescribe Gender Affirming Hormone Therapy: A Retrospective Study. J Sex Med 2022;19:864-871.


Assuntos
Pessoas Transgênero , Transexualidade , Acetato de Ciproterona/uso terapêutico , Estradiol/uso terapêutico , Feminino , Humanos , Estudos Retrospectivos , Testosterona/uso terapêutico
7.
J Sex Med ; 19(5): 846-851, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35288048

RESUMO

BACKGROUND: Despite high rates of online misinformation, transgender and gender diverse (TGD) patients frequently utilize online resources to identify suitable providers of gender-affirming surgical care. AIM: The objective of this study was to analyze the webpages of United States academic plastic surgery programs for the types of gender-affirming surgery (GAS) procedures offered and to determine how this correlates with the presence of an institutional transgender health program and geographic region in order to identify potential gaps for improvement. METHODS: Online institutional webpages of 82 accredited academic plastic surgery programs were analyzed for the presence of the following: GAS services, specification of type of GAS by facial, chest, body and genital surgery, and presence of a concomitant institutional transgender health program. This data was analyzed for correlations with geographic region and assessed for any significant associations. OUTCOMES: Frequencies of GAS services, specification of the type of GAS by facial, chest, body and genital surgery, presence of a concomitant institutional transgender health program, and statistical correlations between these items are the primary outcomes. RESULTS: Overall, 43 of 82 (52%) academic institutions offered GAS. Whether an institution offered GAS varied significantly with the presence of an institutional transgender health program (P < .001) but not with geographic region (P = .329). Whether institutions that offer GAS specified which anatomic category of GAS procedures were offered varied significantly with the presence of an institutional transgender health program (P < .001) but not with geographic region (P = .235). CLINICAL IMPLICATIONS: This identifies gaps for improved transparency in the practice of communication around GAS for both physicians and academic medical institutions. STRENGTHS & LIMITATIONS: This is the first study analyzing the quality, content, and accessibility of online information pertaining to GAS in academic institutions. The primary limitation of this study is the nature and accuracy of online information, as current data may be outdated and not reflect actuality. CONCLUSION: Based on our analysis of online information, many gaps currently exist in information pertaining to GAS in academic settings, and with a clear and expanding need, increased representation and online availability of information regarding all GAS procedure types, as well as coordination with comprehensive transgender healthcare programs, is ideal. Aryanpour Z, Nguyen CT, Blunck CK, et al., Comprehensiveness of Online Information in Gender-Affirming Surgery: Current Trends and Future Directions in Academic Plastic Surgery. J Sex Med 2022;19:846-851.


Assuntos
Cirurgia de Readequação Sexual , Cirurgia Plástica , Pessoas Transgênero , Transexualidade , Identidade de Gênero , Humanos , Cirurgia de Readequação Sexual/métodos , Transexualidade/cirurgia
8.
PLoS One ; 17(3): e0265043, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35275955

RESUMO

Although 37.5-51% of transgender adults state they would've considered freezing gametes before gender-affirming therapy if offered and 24-25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.


Assuntos
Preservação da Fertilidade , Pessoas Transgênero , Transexualidade , Adolescente , Criança , Criopreservação , Fertilidade , Humanos , Adulto Jovem
10.
LGBT Health ; 9(3): 186-193, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35297673

RESUMO

Purpose: Transgender people face disparities in access to reproductive and sexual health services; however, differences in receipt of contraceptive services have not been quantified. We compare contraceptive patterns between cisgender women and trans masculine people in insurance claims databases. Methods: We analyzed 2014-2018 Truven MarketScan data, using diagnostic and procedural codes to identify sex assigned at birth, and existing coding methodology to identify transgender and nonbinary people. We compared contraceptive patterns between cisgender women and trans masculine people aged 15-49 in Medicaid and commercial databases. Results: We identified 4700 people in the commercial and 1628 people in the Medicaid databases as trans masculine. Trans masculine people were prescribed fewer oral contraceptive pills (Medicaid: 17.44%, commercial: 16.62%) compared to cisgender women (Medicaid: 24.96%, commercial: 27.85%), less long-acting reversible contraception (LARC) use (Medicaid: 7.62%, commercial: 7.49% vs. Medicaid: 12.79%, commercial: 8.51%), had more hysterectomies (Medicaid: 5.77%, commercial: 8.45% vs. Medicaid: 2.15%, commercial: 2.48%), and less evidence of any contraception (Medicaid: 34.21%, commercial: 32.28% vs. Medicaid: 46.80%, commercial: 39.81%). Hysterectomies and LARC use varied by insurance type. Conclusion: We found significant differences in contraceptive patterns between trans masculine people and cisgender women. Data suggest potential differences in hysterectomy occurrences by trans masculine people, and long-acting reversible contraceptive use by cisgender women, in Medicaid versus commercial insurance cohorts. Appropriate counseling, insurance coverage, and removal of structural barriers are needed to ensure adequate access to contraception methods for people of all genders-regardless of whether they are being employed for contraception, menstrual management, or gender affirmation.


Assuntos
Pessoas Transgênero , Transexualidade , Adolescente , Adulto , Anticoncepção , Anticoncepcionais , Feminino , Identidade de Gênero , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
11.
BMJ Open ; 12(3): e052030, 2022 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-35292489

RESUMO

INTRODUCTION: There has been a global increase in demand for gender-specific healthcare services and a recognition that healthcare access is complex and convoluted, even in countries with well-developed healthcare services. Despite evidence in Ireland supporting the improvement in physical and mental health following access to gender care, little is known about the local healthcare navigation challenges. Internationally, research focuses primarily on the experience of service users and omits the perspective of other potential key stakeholders. Youth experiences are a particularly seldom-heard group. METHODS AND ANALYSIS: This study will use a sequential exploratory mixed-methods design with a participatory social justice approach. The qualitative phase will explore factors that help and hinder access to gender care for young people in Ireland. This will be explored from multiple stakeholders' perspectives, namely, young people, caregivers and specialist healthcare providers. Framework analysis will be used to identify priorities for action and the qualitative findings used to build a survey tool for the quantitative phase. The quantitative phase will then measure the burden of the identified factors on healthcare navigation across different age categories and gender identities (transmasculine vs transfeminine vs non-binary). ETHICS AND DISSEMINATION: This study has been approved by St Vincent's Hospital Research Ethics Committee (RS21-019), University College Dublin Ethics Committee (LS-21-14Kearns-OShea) and the Transgender Equality Network Ireland's Internal Ethics Committee (TIECSK). We aim to disseminate the findings through international conferences, peer-review journals and by utilisation of expert panel members and strategic partners.


Assuntos
Pessoas Transgênero , Transexualidade , Adolescente , Identidade de Gênero , Acesso aos Serviços de Saúde , Humanos , Irlanda
12.
Rev Bras Enferm ; 75Suppl 2(Suppl 2): e20210173, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35262561

RESUMO

OBJECTIVES: to identify scientific evidence on gender violence perpetrated against trans women. METHODS: integrative review, carried out in June 2020, without time frame, in the Scopus, MEDLINE, Embase, CINAHL, WoS, PsycInfo and LILACS databases. The controlled descriptors of DeCS, MeSH and their entry terms were used: "Transgender People", "Transgender", "Gender Identity", "Transsexuality", "Gender Violence", "Aggression", "Sexual Offenses", "Rape", "Violence", "Domestic Violence". The presentation and synthesis of the results were presented in the PRISMA-2009 flowchart. RESULTS: the final sample, consisting of 16 articles, identified different types of violence (sexual, physical, verbal, psychological and financial), perpetrated by family members, strangers, police officers, intimate partners, health professionals, acquaintances, or friends. CONCLUSIONS: trans women suffer violence and social exclusion that result from stigma and discrimination due to gender identity and result in unrestricted damage to physical health.


Assuntos
Violência Doméstica , Violência de Gênero , Violência por Parceiro Íntimo , Delitos Sexuais , Transexualidade , Violência Doméstica/psicologia , Feminino , Identidade de Gênero , Humanos , Masculino
13.
Prev Med ; 156: 106988, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35150748

RESUMO

We investigated health, economic, and social disparities among transgender adults (transgender women, men, and nonbinary) aged 18 years and older. Using population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS), we pooled 2016 through 2019 data (n = 47,894). We estimated weighted distributions and prevalence by gender identity for background characteristics, economic, social and health indicators. We performed regressions of these indicators on gender identity, including transgender versus cisgender adults and transgender nonbinary adults compared to cisgender adults, followed by subgroup analyses: transgender women and men compared to each cisgender group and to one another, adjusting for covariates. Compared to cisgender adults, transgender adults overall were significantly younger and lower income with less education; more likely single with fewer children; and had several elevated health risks, including poor physical and mental health, and higher rates of chronic conditions and disability. Alternatively, transgender men and women had higher rates of flu vaccination than cisgender men. Between transgender subgroups, transgender men and transgender nonbinary adults were younger than transgender women; transgender men were significantly less likely married or partnered than transgender women; and, transgender women were more likely to live alone than nonbinary respondents. This is one of the first population-based studies to examine both between and within subgroup disparities among cisgender, transgender binary, and transgender nonbinary adults, revealing patterns of inequities across subgroups. More research understanding the mechanisms of these disparities and the development of targeted interventions is needed to address the unique needs of subgroups of transgender people.


Assuntos
Pessoas Transgênero , Transexualidade , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Criança , Feminino , Identidade de Gênero , Humanos , Masculino , Saúde Mental , Pessoas Transgênero/psicologia
14.
Endocr Pract ; 28(4): 420-424, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35217191

RESUMO

OBJECTIVE: Gender-affirming surgeries are becoming increasingly common in the United States. For many transgender and gender-diverse patients, gender-affirming surgery is a critical aspect of their overall health and wellness and has a significant impact on their social functioning. Although often the role of the primary care provider, endocrinology specialists may also need to counsel their patients and collaborate with surgical teams. METHODS: This narrative review provides an overview of the preoperative assessment and perioperative management for the most common gender-affirming surgeries. RESULTS: Preoperative assessment prior to gender-affirming surgeries can resemble assessment for other surgeries. CONCLUSION: In the absence of data specific to gender-affirming surgeries, risk stratification and amelioration must use surrogate data from other populations.


Assuntos
Cirurgia de Readequação Sexual , Pessoas Transgênero , Transexualidade , Identidade de Gênero , Humanos , Assistência Perioperatória , Cirurgia de Readequação Sexual/métodos , Transexualidade/cirurgia , Estados Unidos
15.
Curr Opin Obstet Gynecol ; 34(2): 62-68, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35102108

RESUMO

PURPOSE OF REVIEW: The visibility of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities, specifically the transgender and nonbinary (TGNB) communities, continues to grow. However, there is little description, much less guidance toward optimizing, the pregnancy-related care of TGNB people. The overarching goal of this paper is to provide guidance that aids in reimagining obstetrics to include people of all genders. RECENT FINDINGS: This article will review current literature and provide recommendations specific to the hospital birthing environment to help address the lack of knowledge regarding pregnancy-related care of TGNB individuals. This care is further divided into three main times: (1) preconception, antepartum care, and triage, (2) intrapartum, and (3) postpartum. We also discuss considerations for the general medical care of TGNB individuals. SUMMARY: Understanding facilitators and barriers to gender affirming pregnancy-related care of TGNB individuals are first steps toward providing a respectful, affirming, and evidence-based environment for all patients, especially TGNB individuals. Here we provide context, discussion, and resources for providers and TGNB patients navigating pregnancy-related care. Lastly, this review challenges researchers and clinicians with future directions for the care of TGNB individuals in this continually expanding field.


Assuntos
Pessoas Transgênero , Transexualidade , Feminino , Humanos , Masculino , Parto , Gravidez , Cuidado Pré-Natal , Comportamento Sexual
17.
LGBT Health ; 9(3): 194-198, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35119296

RESUMO

Purpose: The prevalence of vulvar pain and dyspareunia has not been studied in trans masculine individuals. The aim of this study was to determine the prevalence of self-reported vulvar pain symptoms and dyspareunia in this population and investigate its relationship to gender-affirming hormone therapy with testosterone. Methods: Trans masculine individuals of ages 18-64 years participated in a voluntary online survey including questions about demographics, hormone therapy, and whether they experienced vulvar pain symptoms. The study was conducted between May 2017 and October 2018. Descriptive statistics were used to analyze the data. Results: A total of 782 trans masculine individuals completed the survey. The mean age was 27 years (standard deviation 8.6). The majority was White (661/778, 85.0%) and had private health insurance (517/781, 66.2%). Testosterone use was reported by 468 of 782 (59.8%) individuals, and 566 of 672 (84.2%) individuals had been sexually active in their lifetime. Unintentional pain with sexual intercourse was experienced by 372 of 605 (61.5%) participants. A total of 236 of 399 (59.1%) individuals utilized testosterone compared with 136 of 206 (66.0%) individuals who did not (p = 0.11). Of survey respondents, 68 of 710 (9.6%) individuals reported vulvar pain symptoms, and 42 of 452 (9.3%) individuals were on testosterone compared with 26 of 258 (10.1%) individuals not on testosterone (p = 0.79). Of all participants experiencing vulvar pain symptoms, 42 of 68 (61.8%) individuals were on testosterone. Conclusion: In this study, trans masculine individuals had a higher prevalence of dyspareunia than the general population, whereas the prevalence of vulvar pain was similar to that reported in cisgender women. The use of testosterone did not appear to increase the risk of developing unintentional pain with intercourse or vulvar pain symptoms.


Assuntos
Dispareunia , Transexualidade , Adolescente , Adulto , Dispareunia/epidemiologia , Dispareunia/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Dor , Prevalência , Inquéritos e Questionários , Adulto Jovem
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