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Prince JCJ, Safer JD. Endocrine treatment of transgender individuals: current guidelines and strategies. Expert Rev Endocrinol Metab 2020; 15:395-403. [PMID: 32990485 DOI: 10.1080/17446651.2020.1825075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This review summarizes gender affirming medical and surgical care available to transgender individuals, along with proposals to improve medically and culturally appropriate care. AREAS COVERED Transgender individuals are those whose gender identity differs from that recorded at birth (usually based on visualization of external sexual anatomy). In order to align the body with the patient's gender identity, clinicians can provide hormone therapy (HT) to bring sex hormone levels to the range associated with the patient's gender identity. At steady state, monitoring for maintenance of levels, as well as for known risks and complications, is required. Treating clinicians should have knowledge of trans assessment criteria, hormone therapy, surgical options, primary care, and mental health needs of transgender patients. A narrative literature review was conducted using Pubmed and EMBASE with articles then selected for relevance. The initial search terms were: androgen suppression, antiandrogen, breast development, chest reconstruction, cisgender, estrogen, fertility preservation, gender-affirming surgery, gender identity, gender incongruence, genital reconstruction, hormone replacement, hyperlipidemia, orchiectomy, prolactin, prostate atrophy, spermatogenesis, spironolactone, testosterone, thrombogenesis, transgender, and virilization. EXPERT OPINION Although guidelines exist and examples of training are available, systematic formal training must be implemented to truly mainstream high-quality gender-affirming health care .
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Affiliation(s)
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai , New York, NY, USA
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102
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Resende SDS, Kussumoto VH, Arima FHC, Krul PC, Rodovalho NCM, Sampaio MRDJ, Alves MM. A transgender man, a cisgender woman, and assisted reproductive technologies: a Brazilian case report. JBRA Assist Reprod 2020; 24:513-516. [PMID: 32469193 PMCID: PMC7558884 DOI: 10.5935/1518-0557.20200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transgender men are individuals who identify as men but were assigned female at birth. Gender-affirming medications include testosterone hormone therapy, known for its diverse effects throughout the body, which include endometrial atrophy and the induction of amenorrhea by suppressing ovulation, without however affecting the ovarian follicle pool. This paper reports the first case in Brazil involving a transgender man and a cisgender woman attempting to form a family. A 34-year-old transgender man and a 28-year-old woman came to our assisted reproduction service. He had been on testosterone for two years. At their initial consultation, testosterone therapy was discontinued. Controlled ovarian stimulation for the transgender man was achieved using a combination of recombinant gonadotropins FSH and LH. Pituitary blockage was performed using a GnRH antagonist protocol. Twenty follicles were aspirated and 16 oocytes were retrieved, 12 of which mature. They were inseminated with donor semen. On the fifth day of development, one high quality blastocyst was transferred to the cisgender woman, resulting in an ongoing pregnancy. Five supernumerary embryos were cryopreserved. Controlled ovarian stimulation with high quality oocytes, high quality embryos, and clinical pregnancy are possible for transgender men, even with a history of testosterone use.
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Affiliation(s)
| | - Vitor Hugo Kussumoto
- Dra Suely Resende - Centro de Reprodução Humana Assistida - Campo Grande, MS, Brazil
| | | | | | | | | | - Mayara Muneishi Alves
- Dra Suely Resende - Centro de Reprodução Humana Assistida - Campo Grande, MS, Brazil
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103
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Testosterone administration increases leukocyte-endothelium interactions and inflammation in transgender men. Fertil Steril 2020; 115:483-489. [PMID: 33032814 DOI: 10.1016/j.fertnstert.2020.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effect of testosterone treatment on metabolic and inflammation parameters and leukocyte-endothelium interactions in transgender men (TGM). DESIGN Prospective observational study. SETTING University hospital. PATIENT(S) One hundred fifty-seven TGM. INTERVENTION(S) Administration of testosterone undecanoate (1,000 mg, intramuscular) every 12 weeks. MAIN OUTCOME MEASURE(S) Endocrine parameters, adhesion molecules (vascular cell adhesion molecule-1, intercellular cell adhesion molecule-1, and E-selectin), proinflammatory cytokines interleukin-6, and tumor necrosis factor alpha were evaluated in serum before and after treatment using Luminex's xMAP technology. In addition, interactions between human umbilical vein endothelial cells and polymorphonuclear leukocytes were assessed by flow chamber microscopy. RESULT(S) Testosterone treatment led to an increase in leukocyte-endothelium interactions due to an increase in polymorphonuclear leukocytes rolling and adhesion and decreased rolling velocity. It also boosted levels of vascular cell adhesion molecule-1, E-selectin, interleukin-6, and tumor necrosis factor alpha. As expected, testosterone also produced a significant increase in free androgenic index, androstenedione, total testosterone, and atherogenic index of plasma and a decrease in sex hormone-binding globulin and high-density lipoprotein cholesterol. CONCLUSION(S) Treatment of TGM with testosterone induces an increase in leukocyte-endothelium interactions and adhesion molecules and proinflammatory cytokines. These effects are a reason to monitor cardiovascular risk in these patients.
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Sex and the serotonergic underpinnings of depression and migraine. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:117-140. [PMID: 33008520 DOI: 10.1016/b978-0-444-64123-6.00009-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most psychiatric disorders demonstrate sex differences in their prevalence and symptomatology, and in their response to treatment. These differences are particularly pronounced in mood disorders. Differences in sex hormone levels are among the most overt distinctions between males and females and are thus an intuitive underpinning for these clinical observations. In fact, treatment with estrogen and testosterone was shown to exert antidepressant effects, which underscores this link. Changes to monoaminergic signaling in general, and serotonergic transmission in particular, are understood as central components of depressive pathophysiology. Thus, modulation of the serotonin system may serve as a mechanism via which sex hormones exert their clinical effects in mental health disorders. Over the past 20 years, various experimental approaches have been applied to identify modes of influence of sex and sex hormones on the serotonin system. This chapter provides an overview of different molecular components of the serotonin system, followed by a review of studies performed in animals and in humans with the purpose of elucidating sex hormone effects. Particular emphasis will be placed on studies performed with positron emission tomography, a method that allows for human in vivo molecular imaging and, therefore, assessment of effects in a clinically representative context. The studies addressed in this chapter provide a wealth of information on the interaction between sex, sex hormones, and serotonin in the brain. In general, they offer evidence for the concept that the influence of sex hormones on various components of the serotonin system may serve as an underpinning for the clinical effects these hormones demonstrate.
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Risque sénologique chez les patients transgenres : à propos des recommandations américaines sur le dépistage des néoplasies mammaires. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bonnington A, Dianat S, Kerns J, Hastings J, Hawkins M, De Haan G, Obedin-Maliver J. Society of Family Planning clinical recommendations: Contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth. Contraception 2020; 102:70-82. [PMID: 32304766 DOI: 10.1016/j.contraception.2020.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/24/2022]
Abstract
Everyone of reproductive potential, no matter sex or gender, may have contraceptive needs. However, with no professional society guidelines and scant data on contraceptive use for transgender and gender-diverse (TGD) populations, clinicians' abilities to counsel patients on use, safety, side effects, and efficacy is severely limited. We know very little about how estrogen- and progestin-containing contraceptive methods interact with gender-affirming testosterone therapy. Consequently, providers must extrapolate from data on use of hormonal contraceptive methods in presumed cisgender women and rely on clinical expertise. Based on available literature and expert opinion, there are important considerations for each method that can help guide contraceptive counseling with TGD patients. Specific considerations include differential experience of side-effects in TGD patients, barriers to access, and potential misconceptions regarding menstruation and reproductive capacity. When counseling a TGD person about their contraception options, providers should engage in shared decision-making, acknowledging the spectrum of identities and experiences within these communities. In order to support gender-affirming patient-centered care, providers should also create a space that is welcoming, use language that promotes inclusivity, and perform physical exams that consider the potential physical and emotional discomforts specific to these patients. Given the lack of population-specific data and guidelines, we encourage providers to integrate what is known about contraceptive use in cisgender women with the unique needs of TGD persons to apply a shared decision-making contraceptive counseling approach with members of these communities.
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Affiliation(s)
- Adam Bonnington
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 550 16th Street, San Francisco, CA 94158, USA.
| | - Shokoufeh Dianat
- Department of Family & Community Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences. Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Jennifer Kerns
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 550 16th Street, San Francisco, CA 94158, USA.
| | - Jen Hastings
- Department of Family and Community Medicine. University of California, San Francisco, 995 Potrero Ave, San Francisco, CA 94110, USA.
| | - Mitzi Hawkins
- San Francisco Veteran Affairs Medical Center, 2356 Sutter St, J-140, San Francisco, CA 94115, USA.
| | - Gene De Haan
- Department of Obstetrics and Gynecology, Kaiser Permanente, East Interstate Medical Office. 3550 N. Interstate Ave, Portland, OR 97227, USA.
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine. HG332, 300 Pasteur Drive, Stanford, CA 94305-5317, USA.
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Investigating Validity and Reliability of the Turkish Version of Transsexual Voice Questionnaire (Male to Female). J Voice 2020; 36:434.e25-434.e35. [PMID: 32712079 DOI: 10.1016/j.jvoice.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The problems faced by trans women with regard to their voice may affect their quality of life. For the evaluation of trans women's voice, tools assessing their self-perception are very important, with the Transsexual Voice Questionnaire (TVQMtF ) being one of the most frequently used. The purpose of this study was to investigate the validity and reliability of the Turkish version of the TVQMtF (TVQMtF -TR), which was previously translated into 12 languages. STUDY DESIGN Cross-sectional study. METHOD A total of 41 trans women participated in this study. The participants filled out the TVQMtF -TR, the self-perceptions of voice femininity questionnaire, and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF-TR). Additionally, 58.5% of the participants filled out the TVQMtF -TR again two weeks after the first interview. RESULTS The total Cronbach's-α value of the TVQMtF -TR was 0.972, and the item-total correlation values were found to be between 0.323 and 0.876. The intraclass correlation coefficient value was 0.931. There was a strong negative correlation between TVQMtF -TR and self-perceptions of voice femininity. There was a significant negative correlation between TVQMtF -TR and the psychological and environmental domains of WHOQOL-BREF-TR. However, there was no significant relationship found between the social and physical domains. CONCLUSION According to the results of the study, the Turkish version of TVQMtF -TR was considered a valid and reliable tool.
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Klein A, Golub SA. Enhancing Gender-Affirming Provider Communication to Increase Health Care Access and Utilization Among Transgender Men and Trans-Masculine Non-Binary Individuals. LGBT Health 2020; 7:292-304. [PMID: 32493100 DOI: 10.1089/lgbt.2019.0294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study was designed to enhance health care providers' abilities to engage transgender men and trans-masculine non-binary individuals (TMNBI) in sexual and reproductive health care conversations by identifying preferences for provider communication and terminology related to sexual and reproductive anatomy and associated examinations. Methods: From May to July 2017, we conducted a cross-sectional online survey with a convenience sample of TMNBI (N = 1788) in the United States. We examined participants' provider communication experiences and preferences related to sexual and reproductive anatomy, and preferred terminology for sexual and reproductive anatomy and associated examinations. Communication experiences/preferences and preferred terminology were assessed by gender identity and gender-affirming medical interventions (hormones and/or surgery). Results: Most participants had regular access to health care (81.3%); of those, 83% received care from a provider knowledgeable in transgender health. Only 26.9% of participants reported that a provider had ever asked about preferred language for their genitalia/anatomy. The majority of the sample (77.7%) wanted a provider to ask directly for preferred language and 65% wanted a provider to use medical terminology, rather than slang when talking about their body. Participants provided varied responses for their preferred terminology related to sexual and reproductive anatomy and associated examinations. Conclusions: These data underscore the importance of medical providers asking for and then using TMNBI' preferred language during sexual and reproductive health conversations and examinations, rather than assuming that all TMNBI use the same language. Asking for and using TMNBI' preferred language may improve gender-affirming sexual and reproductive health care and increase patient engagement and retention among these individuals.
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Affiliation(s)
- Augustus Klein
- Hunter Alliance for Research and Translation, Hunter College of the City University of New York (CUNY), New York, New York, USA.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA
| | - Sarit A Golub
- Hunter Alliance for Research and Translation, Hunter College of the City University of New York (CUNY), New York, New York, USA.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, New York, USA.,The Graduate Center of the City University of New York (CUNY), New York, New York, USA
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Boskey ER, Jolly D, Tabaac AR, Ganor O. Behavioral Health Concerns and Eligibility Factors Among Adolescents and Young Adults Seeking Gender-Affirming Masculinizing Top Surgery. LGBT Health 2020; 7:182-189. [DOI: 10.1089/lgbt.2019.0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Divya Jolly
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ariella R. Tabaac
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Androgenetic alopecia (AGA) is the most common hair loss disorder in men and women. The characteristic and reproducible balding pattern in AGA negatively affects self-image and the external perceptions of the balding patient. The phenotypical changes are driven by dihydrotestosterone (DHT) and its precursor testosterone. DHT induces follicle miniaturization and hair cycle changes until resulting hairs no longer extrude through the skin surface. AGA is inherited in a polygenetic pattern and is susceptible to epigenetic and environmental factors. Currently, minoxidil, finasteride, and photolaser therapy are the only Food and Drug Administration-approved medical treatments for AGA.
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Affiliation(s)
- Tymon Tai
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of USC, CHP 204M 1540 Alcazar Street, Los Angeles, CA 90033, USA
| | - Amit Kochhar
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of USC, CHP 204M 1540 Alcazar Street, Los Angeles, CA 90033, USA.
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112
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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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Affiliation(s)
- Harsh Patel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Arruarana
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lucille Yao
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xiaojiang Cui
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward Ray
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Sirin S, Polat A. Trans Erkeklerde Uzun Dönem Androjen Tedavisinin Sesle İlişkili Sonuçları. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.649898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Løssl K, Freiesleben NLC, Wissing ML, Birch Petersen K, Holt MD, Mamsen LS, Anderson RA, Andersen CY. Biological and Clinical Rationale for Androgen Priming in Ovarian Stimulation. Front Endocrinol (Lausanne) 2020; 11:627. [PMID: 33013703 PMCID: PMC7498541 DOI: 10.3389/fendo.2020.00627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022] Open
Abstract
Androgen receptors are expressed by all stages of growing follicles, and follicular fluid androgen levels are positively correlated to granulosa cell androgen receptor and follicle-stimulating hormone (FSH) receptor expression. Thus, androgens may promote follicular growth, accumulation and/or responsiveness to gonadotropins. This is explored therapeutically in the concept of androgen priming, to improve the ovarian response to stimulation in assisted reproduction. Androgen effects may be achieved in two different ways, either directly by providing exogenous androgen or by providing luteinizing hormone (LH) activity [i.e., LH or human chorionic gonadotropin (hCG)] to stimulate local ovarian production of androgen. The androgen concentrations in follicular fluid by far exceed the levels in female circulation and it has recently been shown that there was no correlation between serum testosterone levels and follicular fluid androgen levels. There is some evidence that administration of exogenous dehydroepiandrosterone or testosterone increases live birth rates, but an optimal protocol has not been established and such adjuvant treatment should be considered experimental. Furthermore, studies exploring long-term administration of LH activity, achieving LH levels comparable to those seen in women with polycystic ovary syndrome, are awaited. The aim of the present review is to discuss critically the most suitable approach for androgen priming from a biological and clinical standpoint, and to evaluate current approaches and results obtained in clinical trials.
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Affiliation(s)
- Kristine Løssl
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Linn Salto Mamsen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Claus Yding Andersen
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Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL. Breast Imaging in Transgender Patients: What the Radiologist Should Know. Radiographics 2020; 40:13-27. [DOI: 10.1148/rg.2020190044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ujas Parikh
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Elizabeth Mausner
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Chloe M. Chhor
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Ian Karrington
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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116
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Sirin S, Polat A. Association between Subjective and Objective Voice Masculinity in Hormone Naïve Trans Male Individuals. ENT UPDATES 2019. [DOI: 10.32448/entupdates.638475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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117
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Ragmanauskaite L, Kahn B, Ly B, Yeung H. Acne and the Lesbian, Gay, Bisexual, or Transgender Teenager. Dermatol Clin 2019; 38:219-226. [PMID: 32115131 DOI: 10.1016/j.det.2019.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although most teenagers experience acne, for sexual and gender minority teenagers, acne could be more challenging and require specific psychosocial considerations. Acne may be more strongly associated with mental health issues in sexual and gender minority adolescents. Acne development during puberty may trigger gender dysphoria in transgender patients. Transgender and gender nonbinary patients receiving testosterone therapy may experience new or worsening acne. Comprehensive care for moderate to severe acne in sexual and gender minority adolescents should include culturally competent discussions about sexual behaviors, contraception, and/or gender-affirmation treatment plans.
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Affiliation(s)
- Laura Ragmanauskaite
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA
| | - Benjamin Kahn
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA
| | - BaoChau Ly
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA.
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Dutra E, Lee J, Torbati T, Garcia M, Merz CNB, Shufelt C. Cardiovascular implications of gender-affirming hormone treatment in the transgender population. Maturitas 2019; 129:45-49. [PMID: 31547912 PMCID: PMC6761990 DOI: 10.1016/j.maturitas.2019.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 01/25/2023]
Abstract
Transgender men and women represent a growing population in the United States and Europe, with 0.5% of adults and 3% of youth identifying as transgender. Globally, an estimated 0.3-0.5% of the population identify as transgender. Despite the increasing percentage of individuals whose gender identity, gender expression and behavior differ from their assigned sex at birth, health outcomes in transgenders have been understudied. Many transgender people seek treatment with cross-sex hormone therapy starting from a young age and frequently at high doses in order to obtain the secondary sex characteristics of the desired gender. There is a need to understand the potential long-term health consequences of cross-sex hormone therapy, given that cardiovascular disease is the leading disease-specific cause of death in this population. This review discusses the cardiovascular risks of gender-affirming hormone treatments with respect to transgender women and transgender men.
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Affiliation(s)
- Erika Dutra
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Julie Lee
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Tina Torbati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Maurice Garcia
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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Connelly PJ, Marie Freel E, Perry C, Ewan J, Touyz RM, Currie G, Delles C. Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults. Hypertension 2019; 74:1266-1274. [PMID: 31656099 PMCID: PMC6887638 DOI: 10.1161/hypertensionaha.119.13080] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gender-affirming or cross-sex hormone therapy is integral to the management of transgender individuals yet our appreciation of the effects of such hormones on cardiovascular health is limited. Insights into vascular pathophysiology and outcomes in transgender people receiving sex steroids could be fundamental in providing better care for this population through the management of cardiovascular risk and more broadly advance our understanding of the role of sex and gender in vascular health and disease. In addition, there is a need to understand how gender-affirming hormone therapy impacts cardiovascular disease risk and events as transgender individuals age. This review explores the available evidence on the associations between gender-affirming hormones and cardiovascular events such as coronary artery disease, stroke, hypertension, thrombosis, lipid abnormalities, and diabetes mellitus. Current research about vascular outcomes in adults receiving hormonal therapy is limited by the absence of large cohort studies, lack of appropriate control populations, and inadequate data acquisition from gender identity services. Existing epidemiological data suggest that the use of estrogens in transgender females confers an increased risk of myocardial infarction and ischemic stroke. Conversely, transgender males receiving testosterone lack any consistent or convincing evidence of increased risk of cardiovascular or cerebrovascular disease. Further studies are required to confirm whether such risk exists and the mechanisms by which they occur.
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Affiliation(s)
- Paul J Connelly
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Center, University of Glasgow, United Kingdom (P.J.C., E.M.F., C.P., R.M.T., G.C., C.D.)
| | - E Marie Freel
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Center, University of Glasgow, United Kingdom (P.J.C., E.M.F., C.P., R.M.T., G.C., C.D.)
| | - Colin Perry
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Center, University of Glasgow, United Kingdom (P.J.C., E.M.F., C.P., R.M.T., G.C., C.D.)
| | - John Ewan
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom (J.E.)
| | - Rhian M Touyz
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Center, University of Glasgow, United Kingdom (P.J.C., E.M.F., C.P., R.M.T., G.C., C.D.)
| | - Gemma Currie
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Center, University of Glasgow, United Kingdom (P.J.C., E.M.F., C.P., R.M.T., G.C., C.D.)
| | - Christian Delles
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Center, University of Glasgow, United Kingdom (P.J.C., E.M.F., C.P., R.M.T., G.C., C.D.)
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Winston McPherson G, Long T, Salipante SJ, Rongitsch JA, Hoffman NG, Stephens K, Penewit K, Greene DN. The Vaginal Microbiome of Transgender Men. Clin Chem 2019; 65:199-207. [PMID: 30602481 DOI: 10.1373/clinchem.2018.293654] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/16/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hormonal changes influence the composition of vaginal flora, which is directly related to the health of an individual. Transgender men prescribed testosterone experience a vaginal hormone composition that differs from cisgender women. To the author's knowledge, there are no clinical studies evaluating the influence that testosterone administration has on the vaginal microbiome. METHODS Vaginal swabs were self-collected by a cohort of self-identified healthy transgender men prescribed testosterone for at least 1 year (n = 28) and from cisgender women who were used as the comparator (n = 8). Participants completed a questionnaire to indicate the mode and dose of testosterone administration, sexual history, and vaginal health. Serum was collected for hormone analysis. Bacterial community profiles were assessed with broad-range PCR primers targeting the V3-V4 hypervariable region of the 16S bacterial rRNA, next-generation sequencing, and analysis by phylogenetic placement. RESULTS Compared to cisgender women, the vaginal floras of transgender men were less likely to have Lactobacillus as their primary genus. Intravaginal estrogen administration was positively associated with the presence of Lactobacillus in transgender men (P = 0.045). Transgender men had a significantly increased relative abundance of >30 species and a significantly higher α diversity (P = 0.0003). The presence of Lactobacillus was significantly associated with a lower α diversity index (P = 0.017). CONCLUSIONS The vaginal microbiome of transgender men who were assigned a female sex at birth and use testosterone may differ from that of cisgender women. Intravaginal estrogen administration may reduce these differences by promoting colonization with Lactobacillus species and decreasing α diversity.
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Affiliation(s)
| | - Thomas Long
- University of Washington, Department of Laboratory Medicine, Seattle, WA
| | | | | | - Noah G Hoffman
- University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Karen Stephens
- University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Kelsi Penewit
- University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Dina N Greene
- University of Washington, Department of Laboratory Medicine, Seattle, WA;
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Humble RM, Imborek KL, Nisly N, Greene DN, Krasowski MD. Common Hormone Therapies Used to Care for Transgender Patients Influence Laboratory Results. J Appl Lab Med 2019; 3:799-814. [DOI: 10.1373/jalm.2018.027078] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Many laboratory tests are reported and interpreted with sex-specific reference intervals. However, transgender individuals receiving masculinizing or feminizing hormone therapy experience physiological changes predisposing some laboratory tests to shift outside of existing reference intervals. In this study, we review laboratory testing of a large cohort of transgender individuals who were prescribed hormone therapy for at least 6 months at an academic medical center.
Methods
Transgender patients were identified using a search function within the electronic health record with gender identity status verified by chart review. Patients were grouped based on type of hormone therapy administered. All laboratory studies were ordered for medical purposes as part of clinical care; as a result, the exact laboratory tests differed among the patients. Some of the patients had sufficient data for both 6- and 12-month comparisons with baseline laboratory values.
Results
Statistically significant changes were observed at 6- and 12-month comparisons in basic chemistry, endocrine, and hematologic parameters for transgender individuals receiving masculinizing or feminizing hormones. Chart review demonstrated variation in route of administration of hormone therapy and frequency of gender-affirming surgery within the study population.
Conclusions
Transgender individuals receiving hormone therapy experienced significant changes in components of basic chemistry, endocrine, and hematologic parameters following administration of hormone therapy. Variability in hormone dosing and route of administration for gender-affirming treatment warrants further investigation.
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Affiliation(s)
- Robert M Humble
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Nicole Nisly
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Matthew D Krasowski
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Jankowski KS, Fajkowska M, Domaradzka E, Wytykowska A. Chronotype, social jetlag and sleep loss in relation to sex steroids. Psychoneuroendocrinology 2019; 108:87-93. [PMID: 31238173 DOI: 10.1016/j.psyneuen.2019.05.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/26/2023]
Abstract
Chronotype describes preferences for functioning at different times of the day. At the onset of puberty, a sharp shift towards eveningness starts, reaching its peak at the end of adolescence, followed by a steady shift towards morningness as the ageing process occurs. Puberty is also the time when sex differences appear, with men being more inclined to eveningness than women, which diminishes around menopause; the described pattern of changes in chronotype leads to the hypothesis that reproductive hormones may be the driving factor behind this conversion. In the present study, we aimed to verify this hypothesis by analysing participants' testosterone, progesterone and dehydroepiandrosterone (DHEA) levels in the three months, as indicated by assays in 3-cm hair strands from the scalp. Participants (n = 239) of both sexes also completed the Munich Chronotype Questionnaire. The results showed that in men higher testosterone levels were related to eveningness and less sleep loss, whereas greater sleep loss was associated with lower levels of DHEA. In women, no associations between chronotype and levels of the analysed hormones were found. The results support the hypothesis that testosterone levels play a role in shaping eveningness. We further hypothesised that a possible cause of the higher secretion level of testosterone in men with the evening chronotype is a mechanism to offset the negative consequences of sleep loss.
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Affiliation(s)
- Konrad S Jankowski
- Faculty of Psychology, University of Warsaw, Stawki Str. 5/7, 00-183 Warsaw, Poland.
| | | | - Ewa Domaradzka
- Institute of Psychology, Polish Academy of Sciences, Poland
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Abstract
An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.
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van Dijk D, Dekker MJ, Conemans EB, Wiepjes CM, de Goeij EG, Overbeek KA, Fisher AD, den Heijer M, T’Sjoen G. Explorative Prospective Evaluation of Short-Term Subjective Effects of Hormonal Treatment in Trans People—Results from the European Network for the Investigation of Gender Incongruence. J Sex Med 2019; 16:1297-1309. [DOI: 10.1016/j.jsxm.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
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125
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Effect of testosterone on chests and abdomens of transgender men. J Am Acad Dermatol 2019; 81:634-636. [DOI: 10.1016/j.jaad.2019.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/11/2018] [Accepted: 01/17/2019] [Indexed: 11/22/2022]
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126
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Sullivan P, Trinidad J, Hamann D. Issues in transgender dermatology: A systematic review of the literature. J Am Acad Dermatol 2019; 81:438-447. [DOI: 10.1016/j.jaad.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
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127
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Approaches to Vaginal Bleeding and Contraceptive Counseling in Transgender and Gender Nonbinary Patients. Obstet Gynecol 2019; 134:81-90. [DOI: 10.1097/aog.0000000000003308] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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128
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Mahfouda S, Moore JK, Siafarikas A, Hewitt T, Ganti U, Lin A, Zepf FD. Gender-affirming hormones and surgery in transgender children and adolescents. Lancet Diabetes Endocrinol 2019; 7:484-498. [PMID: 30528161 DOI: 10.1016/s2213-8587(18)30305-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
The Endocrine Society Clinical Practice Guidelines on the treatment of gender incongruent people recommend the use of gender-affirming cross-sex hormone (CSH) interventions in transgender children and adolescents who request this treatment, who have undergone psychiatric assessment, and have maintained a persistent transgender identity. The intervention can help to affirm gender identity by inducing masculine or feminine physical characteristics that are congruent with an individual's gender expression, while aiming to improve mental health and quality-of-life outcomes. Some transgender individuals might also wish to access gender-affirming surgeries during adolescence; however, research to inform best clinical practice for surgeons and other medical professionals is scarce. This Review explores the available published evidence on gender-affirming CSH and surgical interventions in transgender children and adolescents, amalgamating findings on mental health outcomes, cognitive and physical effects, side-effects, and safety variables. The small amount of available data suggest that when clearly indicated in accordance with international guidelines, gender-affirming CSHs and chest wall masculinisation in transgender males are associated with improvements in mental health and quality of life. Evidence regarding surgical vaginoplasty in transgender females younger than age 18 years remains extremely scarce and conclusions cannot yet be drawn regarding its risks and benefits in this age group. Further research on an international scale is urgently warranted to clarify long-term outcomes on psychological functioning and safety.
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Affiliation(s)
- Simone Mahfouda
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; School of Psychological Sciences, Faculty of Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Julia K Moore
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, WA, Australia
| | - Aris Siafarikas
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Perth, WA, Australia
| | - Uma Ganti
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
| | - Florian Daniel Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Germany.
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129
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Abstract
There are an estimated 1.4 million transgender adults in the United States, and lack of providers knowledgeable in transgender care is a barrier to health care. Obstetricians and Gynecologists can help increase access in part by becoming competent in gender-affirming hormone therapy. For transgender men, testosterone protocols can be extrapolated from those used for hypogonadal cisgender men. Unfortunately, there are not any high-quality, long-term prospective studies on the effectiveness and safety of different testosterone regimens specifically in transgender men, but the available data suggest that gender-affirming testosterone therapy is safe and effective with proper screening and monitoring.
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Abstract
BACKGROUND Transgender individuals experience common and unique dermatologic concerns from severe acne associated with testosterone therapy in transmen to complications due to illicit silicone injections in transwomen. Currently, 2 survey studies and 4 reviews have addressed the dermatologic care of transgender individuals. However, none of them provide a focus on the dermatologic surgeon. OBJECTIVE To assess the dermatologic considerations in transgender individuals and the role of dermatologic surgeon in their care. METHODS The PubMed and MEDLINE databases were reviewed in June 2018 using keywords, such as transgender, procedures, hair removal, laser, and hormone therapy. RESULTS In total, 48 relevant publications addressing dermatologic care in transgender patients were reviewed. According to the literature, there are several critical dermatologic considerations in transgender patients, including hair growth and removal, acne vulgaris, facial procedures to masculinize and feminize the face, scar removal, and sexually transmitted infections. CONCLUSION As dermatologic surgeons have the privilege to improve the health care of transgender patients, they must understand the common and unique concerns of transgender individuals. Given the considerable spectrum of physical goals expressed by transmen and transwomen, individual patient preference must ultimately guide his/her/their dermatologic care.
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131
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Kidd JD, Dolezal C, Bockting WO. The Relationship Between Tobacco Use and Legal Document Gender-Marker Change, Hormone Use, and Gender-Affirming Surgery in a United States Sample of Trans-Feminine and Trans-Masculine Individuals: Implications for Cardiovascular Health. LGBT Health 2019; 5:401-411. [PMID: 30334686 DOI: 10.1089/lgbt.2018.0103] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Transgender individuals smoke tobacco at disproportionately higher rates than the general U.S. population, and concurrent use of gender-affirming hormones (estrogen or testosterone) and tobacco confers greater cardiovascular (CV) risk. This study examines the relationship between tobacco use and legal document gender-marker change, and medical/surgical interventions for gender transition. METHODS Data came from an Internet-based survey of U.S. trans-feminine (n = 631) and trans-masculine (n = 473) individuals. We used multivariable logistic regression to investigate the relationship between past 3-month tobacco use and legal document gender-marker change, hormone use, and gender-affirming surgery controlling for demographic covariates and enacted and felt stigma. RESULTS Compared to trans-feminine participants, trans-masculine individuals reported significantly higher rates of lifetime (74.4% vs. 63.5%) and past 3-month tobacco use (47.8% vs. 36.1%), and began smoking at an earlier age (14.5 vs. 15.5 years). Trans-feminine smokers reported significantly more frequent and heavier use. Adjusting for demographic covariates and enacted and felt stigma, legal document gender-marker change was associated with lower tobacco-use odds among trans-feminine individuals, whereas gender-affirming surgery predicted lower smoking odds among trans-masculine individuals. There were no significant differences in tobacco use by hormone use status. CONCLUSION In this study, trans-masculine individuals were more likely to smoke and trans-feminine individuals reported heavier use. It is concerning that individuals receiving hormones did not report lower smoking rates, given the elevated CV risk of this combination. This is a missed opportunity to intervene on a major public health issue and highlights the need for smoking cessation interventions in this population.
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Affiliation(s)
- Jeremy D Kidd
- 1 Division on Substance Use Disorders, Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, New York.,2 New York State Psychiatric Institute , New York, New York
| | - Curtis Dolezal
- 2 New York State Psychiatric Institute , New York, New York.,3 Division of Gender, Sexuality, and Health, Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, New York
| | - Walter O Bockting
- 2 New York State Psychiatric Institute , New York, New York.,3 Division of Gender, Sexuality, and Health, Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, New York.,4 Columbia University School of Nursing , New York, New York
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132
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Devanathan AS, Anderson DJ, Cottrell ML, Burgunder EM, Saunders AC, Kashuba AD. Contemporary Drug–Drug Interactions in
HIV
Treatment. Clin Pharmacol Ther 2019; 105:1362-1377. [DOI: 10.1002/cpt.1393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Aaron S. Devanathan
- University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Daijha J.C. Anderson
- University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Mackenzie L. Cottrell
- University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Erin M. Burgunder
- University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Ashley C. Saunders
- University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
| | - Angela D.M. Kashuba
- University of North Carolina Eshelman School of Pharmacy Chapel Hill North Carolina USA
- University of North Carolina School of Medicine Chapel Hill North Carolina USA
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133
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Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, and transgender persons: Epidemiology, screening, and disease prevention. J Am Acad Dermatol 2019; 80:591-602. [PMID: 30744875 PMCID: PMC6375301 DOI: 10.1016/j.jaad.2018.02.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | - Kevin M Luk
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Brian A Ginsberg
- Department of Dermatology, Mount Sinai Hospital, New York, New York
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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134
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Greene DN, McPherson GW, Rongitsch J, Imborek KL, Schmidt RL, Humble RM, Nisly N, Dole NJ, Dane SK, Frerichs J, Krasowski MD. Hematology reference intervals for transgender adults on stable hormone therapy. Clin Chim Acta 2019; 492:84-90. [PMID: 30771301 DOI: 10.1016/j.cca.2019.02.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The complete blood count (CBC) is a cornerstone of patient care. Several of the normal values for the components of the CBC differ by sex and, therefore, male-specific and female-specific reference intervals are required to interpret these laboratory results. Transgender individuals are often prescribed hormone therapy to affirm their gender, with resulting serum hormone concentrations similar to those of cisgender individuals. Gender-specific reference intervals for transgender men and women have not been established for any laboratory measurements, including hematology. We established clinically relevant hematological reference intervals for transgender individuals receiving stable hormone therapy. METHODS Healthy transgender individuals prescribed testosterone (n = 79) or estrogen (n = 93) for ≥12 months were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Concentrations for hemoglobin, hematocrit, MCV, MCHC, and RDWCV, as well as counts for red cells, white cells, and platelets, were evaluated. Results were interpreted in reference to the overall distribution of values and relative to serum estradiol and total testosterone concentrations. Calculated reference intervals were compared to established cisgender reference intervals. RESULTS Regardless of serum hormone concentration, individuals prescribed testosterone or estrogen had hematology parameters that were not clinically different from cisgender males and females, respectively. CONCLUSION The hematology parameters for transgender men and women receiving stable hormone therapy should be evaluated against the cisgender male and cisgender female reference ranges, respectively and does not require concurrent sex hormone analysis. Care providers can utilize this observation to aid in interpretation of hematology laboratory values for transgender people.
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Affiliation(s)
- Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States.
| | | | | | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - Robert M Humble
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Nicole Nisly
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Nancy J Dole
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Susan K Dane
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Janice Frerichs
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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135
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T'Sjoen G, Arcelus J, Gooren L, Klink DT, Tangpricha V. Endocrinology of Transgender Medicine. Endocr Rev 2019; 40:97-117. [PMID: 30307546 DOI: 10.1210/er.2018-00011] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population.
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Affiliation(s)
- Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.,Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Jon Arcelus
- Institute of Mental Health, Jubilee Campus, University of Nottingham, Nottingham, United Kingdom.,Nottingham Centre for Transgender Health, Nottingham, United Kingdom
| | - Louis Gooren
- University Hospital, Vrije Universiteit of Amsterdam, Amsterdam, Netherlands
| | | | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, Georgia
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136
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Motosko CC, Zakhem GA, Pomeranz MK, Hazen A. Acne: a side-effect of masculinizing hormonal therapy in transgender patients. Br J Dermatol 2018; 180:26-30. [PMID: 30101531 DOI: 10.1111/bjd.17083] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Masculinizing hormonal treatment in transgender men has the potential to increase the level of androgens at end organs, including the pilosebaceous unit. Androgen-induced sebocyte growth and differentiation, sebum production and infundibular keratinization may underlie the development of acne vulgaris among patients receiving this therapy. OBJECTIVES The aim of this article is to familiarize dermatologists with the sensitivities and challenges of treating acne in transgender male individuals. METHODS This review article discusses the pathogenesis and treatment of acne in transgender men on testosterone therapy and highlights the unique considerations in treating this underserved patient population. RESULTS Despite the incidence of treatment-related acne and the unique considerations in treating transgender men, studies addressing this topic among this patient population are limited. CONCLUSIONS Generally, the standard guidelines for the treatment of acne can be followed in treating these patients; however, several medical, social and psychological factors should be considered.
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Affiliation(s)
- C C Motosko
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, U.S.A.,Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, U.S.A
| | - G A Zakhem
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, U.S.A.,Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, U.S.A
| | - M K Pomeranz
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, U.S.A
| | - A Hazen
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, U.S.A
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137
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Sousa D, Iriart J. “Viver dignamente”: necessidades e demandas de saúde de homens trans em Salvador, Bahia, Brasil. CAD SAUDE PUBLICA 2018; 34:e00036318. [DOI: 10.1590/0102-311x00036318] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/25/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo: Este artigo discute as necessidades e demandas de saúde de homens trans, tema pouco estudado que, com frequência, interpela a construção de práticas de cuidado em saúde para esta população. Foi realizada uma pesquisa qualitativa composta de observação participante e entrevistas semiestruturadas com dez homens trans residentes em Salvador, Bahia, Brasil, em sua maioria negros, heterossexuais e com idades entre 20 e 43 anos. A análise foi baseada na antropologia interpretativa, articulada às críticas do pressuposto da interseccionalidade e da perspectiva decolonial. As necessidades e demandas de saúde dos homens trans são organizadas em três aspectos: a despatologização, a modificação corporal e os atendimentos ambulatoriais. Esses não são universais entre todos os homens trans e podem ser decorrentes de situações que assinalam conflitos e pressões grupais. A ausência do processo transexualizador no estado e as barreiras no acesso à rede de atenção à saúde intensificam o processo de mercantilização das suas demandas de saúde, em especial, as modificações corporais. Conclui-se que a transfobia estrutural faz disparar uma série de questões de saúde, ao mesmo tempo em que limita as possibilidades de obtenção de cuidado. A despatologização das vivências trans constitui o eixo central com base no qual o cuidado deve ser pensado, relacionando-a a mudanças culturais, políticas e sociais que impliquem a construção de uma sociedade não transfóbica e incidam no bem-estar e reconhecimento dos homens trans.
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138
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Handelsman DJ, Hirschberg AL, Bermon S. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. Endocr Rev 2018; 39:803-829. [PMID: 30010735 PMCID: PMC6391653 DOI: 10.1210/er.2018-00020] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022]
Abstract
Elite athletic competitions have separate male and female events due to men's physical advantages in strength, speed, and endurance so that a protected female category with objective entry criteria is required. Prior to puberty, there is no sex difference in circulating testosterone concentrations or athletic performance, but from puberty onward a clear sex difference in athletic performance emerges as circulating testosterone concentrations rise in men because testes produce 30 times more testosterone than before puberty with circulating testosterone exceeding 15-fold that of women at any age. There is a wide sex difference in circulating testosterone concentrations and a reproducible dose-response relationship between circulating testosterone and muscle mass and strength as well as circulating hemoglobin in both men and women. These dichotomies largely account for the sex differences in muscle mass and strength and circulating hemoglobin levels that result in at least an 8% to 12% ergogenic advantage in men. Suppression of elevated circulating testosterone of hyperandrogenic athletes results in negative effects on performance, which are reversed when suppression ceases. Based on the nonoverlapping, bimodal distribution of circulating testosterone concentration (measured by liquid chromatography-mass spectrometry)-and making an allowance for women with mild hyperandrogenism, notably women with polycystic ovary syndrome (who are overrepresented in elite athletics)-the appropriate eligibility criterion for female athletic events should be a circulating testosterone of <5.0 nmol/L. This would include all women other than those with untreated hyperandrogenic disorders of sexual development and noncompliant male-to-female transgender as well as testosterone-treated female-to-male transgender or androgen dopers.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord, New South Wales, Australia.,Department of Andrology, Concord Hospital, Sydney, New South Wales, Australia
| | - Angelica L Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stephane Bermon
- Laboratoire Motricité Humaine, Education, Sport, Santé, Université Côte d'Azur, Nice, France.,Health and Science Department, International Association of Athletics Federations, Monaco
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139
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Abstract
High quality empirical data assessing morbidity and mortality and cancer incidence among transgender people are almost non-existent. Sex hormone treatment of conditions in older non-transgender people might as yet be taken as the best available analogy to hormone administration to aging transgender persons. Testosterone administration to transgender men carries little risk with regard to cardiovascular disease and cancer. A dose adaptation may be needed in men with a high hematocrit or cardiac insufficiency. In transgender men, even after breast ablation, breast cancer may occur in residual mammary tissue. Treatment with estrogens (specifically oral ethinylestradiol) of transgender women, particularly in combination with progestins, carries a significant relative risk of developing cardiovascular disease (almost a twofold incidence compared to the general population). The dose of estrogens may have to be reduced with aging. A change from oral to probably safer transdermal estrogens must be considered. Though rare, tumors of the breasts, prostate, meninges and pituitary have been encountered. Based upon the available expertise, initiation of cross-sex hormone treatment in elderly subjects is without disproportionate risks.
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Affiliation(s)
- Louis J Gooren
- Emeritus, Department of Endocrinology, VU Medical Center, PO box 7057, 1007MB, Amsterdam, the Netherlands.
- , Chiang Mai, Thailand.
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender Ghent University Hospital, Corneel Heymanslaan 10 9 K12, 9000, Ghent, IE, Belgium
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140
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Abstract
The landscape of gender dysphoria has changed dramatically in recent years secondary to increased societal acceptance, legislative changes, and medical providers' increased awareness of the associated psychosocial burden associated with the diagnosis. National and global advocacy efforts, in conjunction with expanded third-party insurance coverage, have resulted in new health care opportunities for patients suffering from gender dysphoria. Delivering quality, streamlined health care to these patients requires a complex multidisciplinary approach, involving multiple medical and mental health disciplines, including plastic surgeons. To accommodate the expanding demand for gender-affirmation surgery, academic medical centers specializing in these procedures are gradually emerging. Advancing surgical techniques in the setting of rising patient demand encourage plastic surgeons to increasingly provide high-quality health care to this diverse patient population in an effort to optimize psychosocial functioning and minimize the burden of gender dysphoria. Although the current literature is replete with the evolving surgical and technical approaches to gender-affirming surgery, there remain critical gaps in the plastic surgery literature describing the delivery of comprehensive care to these patients. To address these gaps, the authors establish a framework that plastic surgeons can use to guide their management of patients with gender dysphoria to optimize surgical and psychosocial outcomes. First, the authors describe a timeline of events that have shaped present-day transgender medicine and characterize the current role of the plastic surgeon in the management of gender dysphoria. Subsequently, the authors discuss psychosocial and ethical considerations surrounding gender dysphoria. Finally, the authors discuss the future scope of transgender medicine.
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141
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Abstract
In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
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142
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143
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Savkovic S, Lim S, Jayadev V, Conway A, Turner L, Curtis D, Goebel C, Handelsman DJ. Urine and Serum Sex Steroid Profile in Testosterone-Treated Transgender and Hypogonadal and Healthy Control Men. J Clin Endocrinol Metab 2018; 103:2277-2283. [PMID: 29584875 DOI: 10.1210/jc.2018-00054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of testosterone (T) treatment on antidoping detection tests in female-to-male (F2M) transgender men is unknown. We investigated urine and serum sex steroid and luteinizing hormone (LH) profiles in T-treated F2M men to determine whether and, if so, how they differed from hypogonadal and healthy control men. METHOD Healthy transgender (n = 23) and hypogonadal (n = 24) men aged 18 to 50 years treated with 1000 mg injectable T undecanoate provided trough urine and blood samples and an additional earlier postinjection sample (n = 21). Healthy control men (n = 20) provided a single blood and urine sample. Steroids were measured by mass spectrometry-based methods in urine and serum, LH by immunoassay, and uridine 5'-diphospho-glucuronosyltransferase 2B17 genotype by polymerase chain reaction. RESULTS Urine LH, human chorionic gonadotropin, T, epitestosterone (EpiT), androsterone (A), etiocholanolone (Etio), A/Etio ratio, dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), and 5α,3α- and 5β,3α-androstanediols did not differ between groups or by time since last T injection. Urine T/EpiT ratio was <4 in all controls and 12/68 (18%) samples from T-treated men, but there was no difference between T-treated groups. Serum estradiol, estrone, and DHEA were higher in transgender men, and serum T and DHT were higher in earlier compared with trough blood samples, but serum LH, follicle-stimulating hormone, and 3α- and 3β,5α-diols did not differ between groups. CONCLUSION Urine antidoping detection tests in T-treated transgender men can be interpreted like those of T-treated hypogonadal men and are unaffected by time since last T dose. Serum steroids are more sensitive to detect exogenous T administration early but not later after the last T dose.
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Affiliation(s)
- Sasha Savkovic
- Andrology Department, Concord Hospital, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - Sarina Lim
- Andrology Department, Concord Hospital, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - Veena Jayadev
- Andrology Department, Concord Hospital, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - Ann Conway
- Andrology Department, Concord Hospital, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - Leo Turner
- Andrology Department, Concord Hospital, ANZAC Research Institute, Sydney, New South Wales, Australia
| | - Douglas Curtis
- Australian Sports Drug Testing Laboratory, National Measurement Institute, Sydney, New South Wales, Australia
| | - Catrin Goebel
- Australian Sports Drug Testing Laboratory, National Measurement Institute, Sydney, New South Wales, Australia
| | - David J Handelsman
- Andrology Department, Concord Hospital, ANZAC Research Institute, Sydney, New South Wales, Australia
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144
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Van Renterghem SMJ, Van Dorpe J, Monstrey SJ, Defreyne J, Claes KEY, Praet M, Verbeke SLJ, T'Sjoen GGR, Van Bockstal MR. Routine histopathological examination after female-to-male gender-confirming mastectomy. Br J Surg 2018; 105:885-892. [DOI: 10.1002/bjs.10794] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/22/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
Abstract
Background
The number of transmen seeking gender-confirming surgery has risen steadily throughout the last decade. Pathologists are increasingly confronted with transmale mastectomy specimens. It is not clear whether routine histopathological examination is useful. This study explored the possible benefit of routine investigation through detailed description of lesions encountered in mastectomy specimens after female-to-male gender-confirming surgery.
Methods
Breast tissue from a cohort of transmen was reviewed. The presence of benign and malignant breast lesions was recorded. The number of terminal duct–lobule units (TDLUs) per ten low-power fields (LPFs) was quantified. Information on hormone therapy and morphometry was retrieved for selected patients.
Results
The cohort included 344 subjects with a mean age of 25·8 (range 16–61) years at the time of surgery; the age at surgery decreased significantly over time. Older individuals presented with a significantly higher number of breast lesions. The number of TDLUs per LPF was lower in heavier breasts, but did not correlate with age. Breast lesions, either benign or malignant, were present in 166 individuals (48·3 per cent). Invasive breast cancer was found in two (0·6 per cent); one tumour was an unexpected finding. The number of breast lesions encountered on histopathological examination increased significantly when more tissue blocks were taken.
Conclusion
The discovery of an unexpected breast cancer in a 31-year-old transman emphasizes the importance of thorough routine histopathological examination of mastectomy specimens. The number of tissue blocks taken should be based on age and breast weight.
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Affiliation(s)
| | - J Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - S J Monstrey
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - J Defreyne
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent, Belgium
| | - K E Y Claes
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - M Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - S L J Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - G G R T'Sjoen
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent, Belgium
| | - M R Van Bockstal
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
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145
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Ziegler A, Henke T, Wiedrick J, Helou LB. Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review. Int J Transgend 2018. [DOI: 10.1080/15532739.2017.1411857] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Aaron Ziegler
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Travis Henke
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jack Wiedrick
- Biostatistics & Design Program, School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Leah B. Helou
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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146
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Abstract
PURPOSE This review will inform radiologists about the evidence base regarding radiographic imaging for transgender individuals and considerations for providing culturally sensitive care for this population. FINDINGS Transgender individuals are increasingly referred for both screening and diagnostic breast imaging. It is important that the clinic environment is welcoming, the medical staff utilize accepted terminology and patients are able to designate their gender and personal history to ensure appropriate care. Hormone and surgical treatments used for transition by many transgender women and men may change the approach to imaging. SUMMARY Although not yet evidence-based, screening mammography is currently suggested for transgender women with risk factors, including those receiving hormone treatment over 5 years. The risk for breast cancer in transgender individuals is still being defined.
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Affiliation(s)
- Emily B. Sonnenblick
- Department of Radiology, Icahn School of Medicine at Mt Sinai, One Gustav Levy Place, New York, NY 10029 USA
| | - Ami D. Shah
- Department of Radiology, Icahn School of Medicine at Mt Sinai, One Gustav Levy Place, New York, NY 10029 USA
| | - Zil Goldstein
- Department of Medicine, Center for Transgender Medicine and Surgery at Mt. Sinai , 275 Seventh Avenue, New York, NY 10011 USA
| | - Tamar Reisman
- Department of Medicine, Icahn School of Medicine at Mt. Sinai, 275 Seventh Avenue, New York, NY 10011 USA
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147
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Frey JD, Poudrier G, Thomson JE, Hazen A. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. J Sex Med 2017; 14:991-1002. [DOI: 10.1016/j.jsxm.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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148
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Moreno-Arrones OM, Becerra A, Vano-Galvan S. Therapeutic experience with oral finasteride for androgenetic alopecia in female-to-male transgender patients. Clin Exp Dermatol 2017; 42:743-748. [DOI: 10.1111/ced.13184] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - A. Becerra
- Dermatology Department; Hospital Universitario Ramon y Cajal; Madrid Spain
| | - S. Vano-Galvan
- Dermatology Department; Hospital Universitario Ramon y Cajal; Madrid Spain
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149
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Abstract
PURPOSE OF REVIEW To explore the medical and surgical clinical dilemmas in the management of trans (transgender) men, a growing population receiving more attention than in the past. RECENT FINDINGS Testosterone therapy is commonly prescribed to trans men for masculinization. Nonetheless, the optimal formulations and doses of testosterone therapy for trans men have not been well established. Testosterone therapy has been associated with increased levels of hemoglobin and triglycerides, as well as diabetes. Periodic monitoring of hemoglobin, cholesterol, and fasting glucose is therefore recommended. As compared to non-transgender women, trans men have lower age-specific rates of breast cancer and cervical cancer which can be attributed, in part, to surgeries such as bilateral mastectomies and hysterectomies. The frequency in which to recommend mammograms and Pap smears (in patients with intact cervices) is uncertain in this population because of a lack of evidence-based data. Many trans men desire and undergo bilateral mastectomies with much fewer undergoing metoidioplasty or phalloplasty. SUMMARY For trans men, most clinicians target serum testosterone concentrations in the normal male reference range. The frequency of screening for breast and cervical cancer should be individualized based upon anatomy, patient age, age of initiation of testosterone therapy, and other factors.
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Affiliation(s)
- Michael S Irwig
- Center for Andrology and Division of Endocrinology, The George Washington University, Washington, DC, USA
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150
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Abstract
Many transgender men and women seek hormone therapy as part of the transition process. Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features. Guidelines exist to help providers choose appropriate candidates for hormone therapy, and act as a framework for choosing treatment regimens and managing surveillance in these patients. Cross-sex hormone therapy has been shown to have positive physical and psychological effects on the transitioning individual and is considered a mainstay treatment for many patients. Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy.
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Affiliation(s)
- Cécile A Unger
- Center for Urogynecology & Pelvic Reconstructive Surgery, Center for LGBT Care, Department of Obstetrics & Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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