Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience

Determinants of and Barriers to Hormonal and Surgical Treatment Receipt Among Transgender People

Purpose: Medical gender confirmation therapy (GCT) plays an important role in transgender health; however, its prevalence and determinants constitute an area of uncertainty. Methods: Data for this cross-sectional study were obtained from an online survey distributed from October 2012 through the end of 2013 among persons who visited the social media sites of a transgender education and social networking meeting. Eligible respondents (n=280) were persons whose gender identity was different from their sex assigned at birth and who responded to questions about previously received or planned hormonal therapy (HT), chest reconstruction, or genital surgery. Multivariable logistic regression models examined how receipt and plans to receive different GCT types were associated with participants' characteristics and gender identity. Results: The respective percentages of ever and current HT were 58% and 47% for transwomen and 63% and 57% for transmen. Genital surgery was reported by 11 participants; all transwomen. Relative to transmen, transwomen were thrice more likely to report plans to undergo genital surgery. By contrast, transmen were more than 10 times as likely as transwomen to have had or planned chest surgery. Older participants and those who were in a committed relationship were less likely to plan future GCT. Having health insurance was not associated with GCT receipt. Treatment cost was named as the main problem by 23% of transwomen and 29% of transmen. Accessing a qualified healthcare provider for transgender-related care was listed as the primary reason for not receiving surgery by 41% of transmen and 2% of transwomen. Conclusions: Prevalence of GCT differed across subgroups of participants and was lower than corresponding estimates reported elsewhere. The variability of results may reflect differences in recruitment procedures and response rates; however, it is also possible that it may be driven by geographic, socioeconomic, and health-related heterogeneity of the transgender population.

Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results

BACKGROUND AND AIMS

Chest-wall contouring surgery is an important part of the gender reassignment process that contributes to strengthening the self-image and facilitating living in the new gender role. Here, we analyze the surgical techniques used in our clinic and report the results.

MATERIAL AND METHODS

Female-to-male transgender patients (n = 57) undergoing chest-wall contouring surgery at Tampere University Hospital between January 2003 and April 2015 were enrolled in the study. Breast appearance was evaluated and either a concentric circular approach or a transverse incision technique was used for mastectomy. Patient characteristics and data regarding the technique and postoperative results were collected and analyzed retrospectively.

RESULTS

In addition to the transgender diagnosis, 40.4% of the patients had another psychiatric diagnosis. For mastectomy, a concentric circular approach was used in 50.9% and a transverse incision approach in 49.1% of the patients. In the transverse incision group, 21.4% of the patients underwent pedicled mammaplasty and 78.6% mastectomy with a free nipple-areola complex graft. Compared with the transverse incision group, breasts were smaller (p < 0.001) and body mass index value was lower in the concentric circular group (p = 0.001). One-third of the patients had complications (hematoma, infection, seroma, fistula, or partial necrosis of nipple-areola complex) and the reoperation rate was 8.8%. Hematoma was the most frequent reason for reoperation. Corrections were required for the scar in 14.0% of the patients, the contour in 28.0%, the areola in 15.8%, and the nipple in 5.3%. Secondary corrections were needed more often in the concentric circular (55.2%) than in the transverse incision group (25.0%; p = 0.031).

CONCLUSIONS

The larger the breast, poorer the skin quality, and greater the amount of excess skin, the longer the required incision and resulting scar is for mastectomy of female-to-male patients. Hematoma is the most common reason for acute reoperation and secondary corrections are often needed.

Breast care in the transgender individual

INTRODUCTION

Transgender individuals undergo hormone therapy and/or alter their breasts or genitals to facilitate a transition from male to female or female to male. Changes in the breast tissue from hormone therapy, breast binding, mastectomy, or breast augmentation are of specific interest to women's health care providers. To provide competent care, providers must be knowledgeable about unique aspects of breast health in this vulnerable population, including screening guidelines and client education. The purpose of this integrative literature review is to compile the current research on breast health for transgender individuals and to serve as a resource for providers.

METHODS

A search of the literature was performed using CINAHL, Ovid, and PubMed. Results were reviewed for relevant articles, and the reference lists of these were reviewed for additional resources. When available, studies specific to the transgender population are presented; studies of other populations are also included when relevant. Theories of human endocrinology, physiology, and anatomy will provide the foundation for the review and discussion.

RESULTS

Research into breast care for transgender individuals is limited. Often, practitioners must draw conclusions for practice from scattered case studies or research with nontransgender populations. Many of the procedures and practices transgender individuals choose to undergo, such as implantation, injection, binding, and mastectomy, carry serious risks.

DISCUSSION

Transgender individuals should be counseled on all the possible outcomes of their decisions, so they are capable of making informed choices. They must also be followed with careful consideration of these choices. More research in many areas of transgender breast care is necessary.

Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey

STUDY OBJECTIVE

Transgender, transsexual, or transitioned (trans) people have reported avoiding medical care because of negative experiences or fear of such experiences. The extent of trans-specific negative emergency department (ED) experiences, and of ED avoidance, has not been documented.

METHODS

The Trans PULSE Project conducted a survey of trans people in Ontario, Canada (n=433) in 2009 to 2010, using respondent-driven sampling, a tracked network-based method for studying hidden populations. Weighted frequencies and bootstrapped 95% confidence intervals (CIs) were estimated for the trans population in Ontario and for the subgroup (n=167) reporting ED use in their felt gender.

RESULTS

Four hundred eight participants completed the ED experience items. Trans people were young (34% aged 16 to 24 years and only 10% >55 years); approximately half were female-to-male and half male-to-female. Medically supervised hormones were used by 37% (95% CI 30% to 46%), and 27% (95% CI 20% to 35%) had at least 1 transition-related surgery. Past-year ED need was reported by 33% (95% CI 26% to 40%) of trans Ontarians, though only 71% (95% CI 40% to 91%) of those with self-reported need indicated that they were able to obtain care. An estimated 21% (95% CI 14% to 25%) reported ever avoiding ED care because of a perception that their trans status would negatively affect such an encounter. Trans-specific negative ED experiences were reported by 52% (95% CI 34% to 72%) of users presenting in their felt gender.

CONCLUSION

This first exploratory analysis of ED avoidance, utilization, and experiences by trans persons documented ED avoidance and possible unmet need for emergency care among trans Ontarians. Additional research, including validation of measures, is needed.