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Patel H, Arruarana V, Yao L, Cui X, Ray E. Effects of hormones and hormone therapy on breast tissue in transgender patients: a concise review. Endocrine 2020; 68:6-15. [PMID: 32067157 PMCID: PMC7252590 DOI: 10.1007/s12020-020-02197-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Hormone replacement therapy (HRT) has become a mainstay medical treatment option for management of gender dysphoria in transgender patients of both biologic sexes. Very little is known about the long-term effects of steroid hormone modulation on breast tissue in this population. Most of the data available on the effects of HRT on breast and reproductive tissues come from studies of postmenopausal cisgender women. Therapeutic regimens are often provider-dependent, and there, are no uniform guidelines in place for cancer surveillance in transgender patients. In this review, we present what forms of hormone therapy and hormone modulation are available to transgender patients, what is known about their effects on male and female breast tissue, and what other endogenous and exogenous factors contribute to the macroscopic and cellular changes observed. METHODS A search for the existing literature focusing on therapeutic regimens and the effects of HRT on breast tissue provided the most current information available for this review. Recent evidence-based reports (since the year 2000) and reviews were given priority over anecdotal evidence and expert opinions when conflicting information was encountered. Older resources were considered when primary sources were needed. Given the paucity of available articles on this subject, all resources were given careful consideration. RESULTS Information about the risks associated with HRT in the current literature and in this setting is limited and often conflicting, due to a scarcity of long-term studies tracking breast pathology among transgender men and women. CONCLUSIONS We conclude that the long-term effects of off-label pharmaceutical use for modulation of hormone levels and sexual characteristics in transgender patients have not been well studied. The tendency of steroid hormones to promote the growth of certain cancers also raises questions about the safety of differing doses and drug combinations. Further clinical and laboratory study is needed to better establish safety and dosing guidelines in transgender patients.
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Lindley L, Anzani A, Galupo MP. What Constitutes Sexual Dissatisfaction for Trans Masculine and Nonbinary Individuals: A Qualitative Study. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:612-629. [PMID: 32449493 DOI: 10.1080/0092623x.2020.1765924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The present study is aimed at understanding how trans masculine and nonbinary individuals describe aspects of their sexual dissatisfaction. Previous studies on cisgender sexual dissatisfaction have utilized narrow definitions of dissatisfaction, operationalizing it in opposition to sexual satisfaction. Moreover, the pervasive focus on the outcomes of medical intervention steps in prior sexual dissatisfaction research with trans masculine participants ignored the experiences of individuals who do not desire a medical transition or live outside of the gender binary. Participants in the current study represented a non-clinical sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you dissatisfied with your sex life?" Thematic analysis revealed six overarching themes for participant dissatisfaction: 1) difficulty with orgasm, 2) partner dynamics, 3) trauma, 4) desire for different body parts, 5) gender dysphoria, and 6) medical transition. Discussion focuses on the ways in which clinicians can utilize the current findings to decrease the sexual dissatisfaction of trans masculine and nonbinary individuals.
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Restar AJ. Methodological Critique of Littman's (2018) Parental-Respondents Accounts of "Rapid-Onset Gender Dysphoria". ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:61-66. [PMID: 31011991 PMCID: PMC7012957 DOI: 10.1007/s10508-019-1453-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 05/23/2023]
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Hutchinson A, Midgen M, Spiliadis A. In Support of Research Into Rapid-Onset Gender Dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:79-80. [PMID: 31317286 DOI: 10.1007/s10508-019-01517-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
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Littman L. The Use of Methodologies in Littman (2018) Is Consistent with the Use of Methodologies in Other Studies Contributing to the Field of Gender Dysphoria Research: Response to Restar (2019). ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:67-77. [PMID: 31953699 DOI: 10.1007/s10508-020-01631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
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García-Acosta JM, San Juan-Valdivia RM, Fernández-Martínez AD, Lorenzo-Rocha ND, Castro-Peraza ME. Trans* Pregnancy and Lactation: A Literature Review from a Nursing Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010044. [PMID: 31861638 PMCID: PMC6981677 DOI: 10.3390/ijerph17010044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/16/2022]
Abstract
Pregnancy and lactation involve two aspects that are socially and culturally associated with women. However, there are a few biological differences between male and female breast tissue. Lactation and pregnancy are viable processes that do not depend on sex. Even for the latter, it is only necessary to have an organ capable of gestation. Ways to favor mammogenesis and lactogenesis in trans* women have been established. There are protocols to promote lactation in trans* women, usually used for adoptive mothers or those whose children have been born through gestational surrogacy. Chestfeeding a baby could be the cause of feelings as diverse as gender dysphoria in the case of trans* men, and euphoria and affirmation of femininity in trans* women. This study involves a review of the available scientific literature addressing medical aspects related to pregnancy and lactation in trans* individuals, giving special attention to nursing care during perinatal care. There are scarce studies addressing care and specifically nursing care in trans* pregnancy and lactation. Our study indicates the factors that can be modified and the recommendations for optimizing the care provided to these individuals in order to promote and maintain the lactation period in search of improvement and satisfaction with the whole process.
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Cohen D, Barnes H. Authors' reply to Shaw. BMJ 2019; 367:l6789. [PMID: 31801735 DOI: 10.1136/bmj.l6789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Saad TC, Blackshaw BP, Rodger D. Hormone replacement therapy: informed consent without assessment? JOURNAL OF MEDICAL ETHICS 2019; 45:824-825. [PMID: 31230038 DOI: 10.1136/medethics-2019-105611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy (HRT) is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT.
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Rosenthal SM, Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Safer JD, Tangpricha V, T'Sjoen GG. Response to Letter to the Editor: "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2019; 104:5102-5103. [PMID: 31046093 DOI: 10.1210/jc.2019-00930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 02/13/2023]
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White PC. Letter to the Editor: "Genetic Link Between Gender Dysphoria and Sex Hormone Signaling". J Clin Endocrinol Metab 2019; 104:4418-4419. [PMID: 30942857 DOI: 10.1210/jc.2019-00487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/28/2019] [Indexed: 01/27/2023]
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Foreman M, Vilain E, Harley V. Response to Letter to the Editor: "Genetic Link Between Gender Dysphoria and Sex Hormone Signaling". J Clin Endocrinol Metab 2019; 104:4420. [PMID: 30942840 DOI: 10.1210/jc.2019-00701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/24/2022]
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O'Connor M, Madden B. In the Footsteps of Teiresias: Treatment for Gender Dysphoria in Children and the Role of the Courts. JOURNAL OF LAW AND MEDICINE 2019; 27:149-163. [PMID: 31682347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Family Court of Australia has stepped back from a previously perceived need for involvement in the approval of stage 1 and stage 2 treatments, for children requiring gender transformation. At present those children and their families who are in agreement need not seek authorisation of the Family Court to undertake either Stage 1 (pubarche blockade with gonadotrophin-releasing hormone agonists) or Stage 2 treatment (cross-hormone therapy such as oestrogen for transgender males). Stage 1 treatment to suppress pubarche would nowadays be commenced at Tanner stage 2 which commences as early as 9.96 years in girls and 10.14 years in boys. Suppression of puberty continues until the age of 16 years when cross hormonal treatment commences. This article questions the assertion that suppression of puberty by GnRH analogues either in cases of precocious puberty or gender dysphoria is "safe and reversible" and argues that it warrants ongoing caution, despite the Family Court having broadly accepted that assertion.
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McCartney M, Bewley S, Clifford D, Byng R. Gender incongruence in children, adolescents, and adults: response to Dr White. Br J Gen Pract 2019; 69:379. [PMID: 31345801 PMCID: PMC6650118 DOI: 10.3399/bjgp19x704753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Harris RM, Frader JE. The Case of Seth: To Treat or Not to Treat. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:69-71. [PMID: 31237509 DOI: 10.1080/15265161.2019.1618948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Reirden DH, Glover JJ. Maximizing Resources: Ensuring Standard of Care for a Transgender Child in a Rural Setting. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:66-67. [PMID: 31237502 DOI: 10.1080/15265161.2019.1618944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Fisher CB. Providing Puberty Suppression Treatment for Transgender Youth: What Constitutes Competence? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:68-69. [PMID: 31237500 PMCID: PMC6746416 DOI: 10.1080/15265161.2019.1618949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Bockting W. How Far Has Transgender Health Come Since Stonewall? Am J Public Health 2019; 109:852-853. [PMID: 31067088 PMCID: PMC6508006 DOI: 10.2105/ajph.2019.305095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2019] [Indexed: 11/04/2022]
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Brandelli Costa A. Formal comment on: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One 2019; 14:e0212578. [PMID: 30889187 PMCID: PMC6424477 DOI: 10.1371/journal.pone.0212578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hsu S. Fanon and the New Paraphilias: Towards a Trans of Color Critique of the DSM-V. THE JOURNAL OF MEDICAL HUMANITIES 2019; 40:53-68. [PMID: 30076507 DOI: 10.1007/s10912-018-9531-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This essay places psychiatrist and philosopher Frantz Fanon's anti-colonial, anti-racist message from Peau Noire, Masques Blancs/Black Skin, White Masks (1952; 1967; 2008) in conversation with the new diagnoses of "Gender Dysphoria" and "Transvestic Disorder" in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Specifically, the essay discusses sexologist Ray Blanchard's controversial theory of autogynephilia alongside Fanon's ambivalent rendering of transgender desire and interracial trans phenomenology in a crucial but frequently overlooked passage in Black Skin. Fanon's anti-colonial critique of psychiatry allows us to reconsider how Blanchard's theories on paraphilia engage with the foundational psychoanalytic concepts of identification and desire, as identified by the Freudian and Lacanian models and explored in the writings of Judith Butler, Catherine Millot, Charles Shepherdson, and others. By offering a fresh interpretation of the French text, this essay argues that a "trans of color critique" can benefit from Black Skin's unexpected insight into trans desire: Fanon's "man of color," who simultaneously undergoes a gender transition and a racial transformation, represents the literal embodiment of his critique of colonial racism. Given the role of the new paraphilias in the DSM-V, this essay concludes that a trans of color critique is well positioned to reinforce the anti-colonial message Fanon addressed to the psychiatric and psychoanalytical fields, which have tended to diagnose psychic injury while ignoring its causation, and which continue to neglect the fact that medical access is just as important as material support and security for minority subjects, in particular.
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Laidlaw MK, Van Meter QL, Hruz PW, Van Mol A, Malone WJ. Letter to the Editor: "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2019; 104:686-687. [PMID: 30476120 DOI: 10.1210/jc.2018-01925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/20/2018] [Indexed: 02/13/2023]
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Strang JF, Janssen A, Tishelman A, Leibowitz SF, Kenworthy L, McGuire JK, Edwards-Leeper L, Mazefsky CA, Rofey D, Bascom J, Caplan R, Gomez-Lobo V, Berg D, Zaks Z, Wallace GL, Wimms H, Pine-Twaddell E, Shumer D, Register-Brown K, Sadikova E, Anthony LG. Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. J Am Acad Child Adolesc Psychiatry 2018; 57:885-887. [PMID: 30392631 DOI: 10.1016/j.jaac.2018.04.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/31/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022]
Abstract
Turban and van Schalkwyk assert in their Translations article, "'Gender Dysphoria' and Autism Spectrum Disorder: Is the Link Real?" that an over-representation of autism spectrum disorder (ASD) in gender dysphoria is unsupported based on current evidence. Turban and van Schalkwyk discuss 7 of the currently 19 available empirical studies (excluding reviews and case reports) of the over-occurrence of ASD and/or autism traits with gender dysphoria/diversity. They are correct to note that some ASD screeners may lack specificity; that is, a clinical-range total score could indicate non-ASD-related mental health conditions or other developmental difference. However, they do not account for the 7 available studies which specifically report rates of clinical diagnoses of ASD among unselected gender-diverse samples. We suggest also that many of the studies that assess ASD-symptoms in gender-diverse groups are more convincing than suggested by Turban and van Schalkwyk because they employ measures assessing the multi-dimensionality of ASD symptoms and report significant elevations not only for socially-related symptoms but also for the various components of restricted and repetitive behaviors and interests (RRBI) core to ASD. We come together to write this response as gender clinicians and researchers, autism clinicians and researchers, and key stakeholders, including autistic and autistic transgender self-advocates. We work and live with the co-occurrence of autism and gender diversity on a daily basis, and we are concerned that perpetuating misunderstanding about the co-occurrence places individuals at risk.
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Tagliotti P. [About a case of gender dysphoria]. VERTEX (BUENOS AIRES, ARGENTINA) 2018; XXIX:263-266. [PMID: 30785968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The concept of gender dysphoria is used to designate the dissatisfaction resulting from the conflict between gender identity and gender assigned at birth (genetic, gonadal, genital and morphological). The most frequently encountered psychopathologies include depressive disorders, anxiety, substance abuse, disorders of the personality, and they present a suicide attempt rate of 19 to 25%. Being a manifestation of low prevalence, this report aims to describe the case of a patient with gender dysphoria and comment on the experience of the therapeutic approach.
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Sudo T, Yamamoto K, Yoshikawa R. Qualitative Study on the Psychological Experiences of Trans-man and Trans-woman. THE TOKAI JOURNAL OF EXPERIMENTAL AND CLINICAL MEDICINE 2018; 43:45-49. [PMID: 29961931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/06/2018] [Indexed: 06/08/2023]
Abstract
Transsexuals have problems associated with self and gender identities, as well as with their relationships with specialists such as doctor and counsellors. On the basis of the principle of interpretative phenomenological analysis, an exploratory research was carried out on self by studying the psychological experiences of participants and their relationships with specialists. Consequently the following needs of the transsexuals were identified: (1) understanding and alleviation of grief, conflict, and anxiety associated with gender dysphoria; (2) recovery and improvement of self-esteem; (3) support in real-life experiences and measures related to social and legal issues, such as coming out; and (4) necessity of information provision at medical institutions and among peers. To meet these needs, it was suggested that the specialists should (1) help recover their self-esteem through the exploration of their sexual identities and maintain and improve their quality of life and (2) provide comprehensive support to alleviate the grief caused by gender dysphoria. Such support will facilitate affirmative psychological experiences of transsexuals, which will require further attention in the form of clinical intervention.
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