151
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Meagher T, Filzmaier K. The Medical Underwriting of Transgender Individuals. J Insur Med 2017; 47:43-49. [PMID: 28836906 DOI: 10.17849/insm-47-01-43-49.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As more transgender individuals apply for life insurance, it is important to understand the many health issues that are particular to this population. This article reviews the pathophysiology, diagnosis and treatment of gender dysphoria- the dominant medical problem of transgender individuals. It also reviews the frequent co-morbidities in the transgender population and finishes with a review of the small number of studies that have examined long-term mortality.
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Affiliation(s)
- Timothy Meagher
- Meagher- Vice-President and Medical Director, Munich Re, Montréal; Associate Professor of Medicine, McGill University, Montréal, Québec; Filzmaier- Head of Center of Competence Medical Research & Consulting, Munich Re, Munich, Germany
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152
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Statement on gender-affirmative approach to care from the pediatric endocrine society special interest group on transgender health. Curr Opin Pediatr 2017; 29:475-480. [PMID: 28562420 DOI: 10.1097/mop.0000000000000516] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth. RECENT FINDINGS Transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. SUMMARY The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.
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153
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Abstract
BACKGROUND Risk behaviors and hormone use place transgender individuals (TIs) in jeopardy for osteoporosis. PURPOSE The purpose of this study was to expand the science about the knowledge, health beliefs, and osteoporosis (OP) preventing behaviors of TIs. METHODS This was a mixed-methods pilot study of a convenience sample of 31 TIs 30 years and older. Participants completed an online Osteoporosis Bone Health Survey. Fifteen participants were randomly selected for an interview to describe their perceptions of bone health. RESULTS Transgender individuals performed poorly on the knowledge measure. There were no significant findings for osteoporosis health beliefs. Participants' daily dietary dairy calcium intake was 800 mg and daily walking activity was 17 minutes. Perceptions of bone health revealed two essential elements, knowing and doing. CONCLUSION Determining TIs' bone health perception is important because of their unique healthcare issues. Healthcare providers need to be aware of TIs' bone health needs to help enhance TIs' OP knowledge, health beliefs, and preventing behaviors.
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154
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Mahan RJ, Bailey TA, Bibb TJ, Fenney M, Williams T. Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults. J Am Geriatr Soc 2017; 64:2554-2559. [PMID: 27996106 DOI: 10.1111/jgs.14350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons.
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Affiliation(s)
- Rebecca J Mahan
- Division of Geriatrics, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Trista Askins Bailey
- Division of Geriatrics, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Teryn J Bibb
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Megan Fenney
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Tara Williams
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, Texas
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155
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Velho I, Fighera TM, Ziegelmann PK, Spritzer PM. Effects of testosterone therapy on BMI, blood pressure, and laboratory profile of transgender men: a systematic review. Andrology 2017; 5:881-888. [DOI: 10.1111/andr.12382] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/05/2017] [Accepted: 04/20/2017] [Indexed: 01/08/2023]
Affiliation(s)
- I. Velho
- Gynecological Endocrinology Unit; Division of Endocrinology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Gender Identity Program; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - T. M. Fighera
- Gynecological Endocrinology Unit; Division of Endocrinology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Gender Identity Program; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - P. K. Ziegelmann
- Department of Statistics; Institute of Mathematics; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - P. M. Spritzer
- Gynecological Endocrinology Unit; Division of Endocrinology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Gender Identity Program; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
- Department of Physiology; Federal University of Rio Grande do Sul; Porto Alegre Brazil
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156
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Goldstein Z, Corneil TA, Greene DN. When Gender Identity Doesn't Equal Sex Recorded at Birth: The Role of the Laboratory in Providing Effective Healthcare to the Transgender Community. Clin Chem 2017; 63:1342-1352. [PMID: 28679645 DOI: 10.1373/clinchem.2016.258780] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transgender is an umbrella term used to describe individuals who identify with a gender incongruent to or variant from their sex recorded at birth. Affirming gender identity through a variety of social, medical, and surgical interventions is critical to the mental health of transgender individuals. In recent years, awareness surrounding transgender identities has increased, which has highlighted the health disparities that parallel this demographic. These disparities are reflected in the experience of transgender patients and their providers when seeking clinical laboratory services. CONTENT Little is known about the effect of gender-affirming hormone therapy and surgery on optimal laboratory test interpretation. Efforts to diminish health disparities encountered by transgender individuals and their providers can be accomplished by increasing social and clinical awareness regarding sex/gender incongruence and gaining insight into the physiological manifestations and laboratory interpretations of gender-affirming strategies. This review summarizes knowledge required to understand transgender healthcare including current clinical interventions for gender dysphoria. Particular attention is paid to the subsequent impact of these interventions on laboratory test utilization and interpretation. Common nomenclature and system barriers are also discussed. SUMMARY Understanding gender incongruence, the clinical changes associated with gender transition, and systemic barriers that maintain a gender/sex binary are key to providing adequate healthcare to transgender community. Transgender appropriate reference interval studies are virtually absent within the medical literature and should be explored. The laboratory has an important role in improving the physiological understanding, electronic medical system recognition, and overall social awareness of the transgender community.
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Affiliation(s)
- Zil Goldstein
- Department of Medical Education, Icahn School of Medicine, New York, NY
| | - Trevor A Corneil
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada;
| | - Dina N Greene
- Department of Laboratory Medicine. University of Washington, Seattle, WA.
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157
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Abstract
Purpose: The “transgender tipping point” has brought transgender social and health issues to the forefront of American culture. However, medical professionals have been lagging in academic research with a transgender-specific focus resulting in significant knowledge gaps in dealing with the care of our transgender patients. The aim of this article is to analyze all published Medline-available transgender-specific articles, identify these knowledge gaps, and direct future research to where it is most needed. Methods: We surveyed all Medline-available articles up to June 2016 using a combination of medical subject headings and keywords in titles and abstracts. Articles meeting inclusion criteria were reviewed, categorized, and analyzed for content and study design. Results: In our review of the literature, we identified 2405 articles published from January 1950 to June 2016 that focused on transgender health, primarily in the fields of surgery, mental health, and endocrinology. Conclusion: Significant knowledge gaps were found across the subspecialties, and there was a lack of prospective robust research and representation of transgender-specific data in the core medical journals. More data and research are needed to bridge the knowledge gaps that currently exist and improve the care of the transgender community.
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Affiliation(s)
- Jonathon W Wanta
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Cecile A Unger
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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158
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Wiepjes CM, Vlot MC, Klaver M, Nota NM, de Blok CJ, de Jongh RT, Lips P, Heijboer AC, Fisher AD, Schreiner T, T'Sjoen G, den Heijer M. Bone Mineral Density Increases in Trans Persons After 1 Year of Hormonal Treatment: A Multicenter Prospective Observational Study. J Bone Miner Res 2017; 32:1252-1260. [PMID: 28370342 DOI: 10.1002/jbmr.3102] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/07/2022]
Abstract
Sex steroids are important determinants of bone acquisition and bone homeostasis. Cross-sex hormonal treatment (CHT) in transgender persons can affect bone mineral density (BMD). The aim of this study was to investigate in a prospective observational multicenter study the first-year effects of CHT on BMD in transgender persons. A total of 231 transwomen and 199 transmen were included who completed the first year of CHT. Transwomen were treated with cyproterone acetate and oral or transdermal estradiol; transmen received transdermal or intramuscular testosterone. A dual-energy X-ray absorptiometry (DXA) was performed to measure lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD before and after 1 year of CHT. In transwomen, an increase in LS (+3.67%, 95% confidence interval [CI] 3.20 to 4.13%, p < 0.001), TH (+0.97%, 95% CI 0.62 to 1.31%, p < 0.001), and FN (+1.86%, 95% CI 1.41 to 2.31%, p < 0.001) BMD was found. In transmen, TH BMD increased after 1 year of CHT (+1.04%, 95% CI 0.64 to 1.44%, p < 0.001). No changes were observed in FN BMD (-0.46%, 95% CI -1.07 to 0.16%, p = 0.144). The increase in LS BMD was larger in transmen aged ≥50 years (+4.32%, 95% CI 2.28 to 6.36%, p = 0.001) compared with transmen aged <50 years (+0.68%, 95% CI 0.19 to 1.17%, p = 0.007). In conclusion, BMD increased in transgender persons after 1 year of CHT. In transmen of postmenopausal age, the LS BMD increased more than in younger transmen, which may lead to the hypothesis that the increase in BMD in transmen is the result of the aromatization of testosterone to estradiol. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Chantal M Wiepjes
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Mariska C Vlot
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands.,Department of Clinical Chemistry, VU University Medical Center, Amsterdam, the Netherlands
| | - Maartje Klaver
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Nienke M Nota
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Christel Jm de Blok
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Lips
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, the Netherlands
| | - Alessandra D Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy
| | - Thomas Schreiner
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Guy T'Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Martin den Heijer
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
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159
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Hysterectomy for the Transgender Man. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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160
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161
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Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol 2017; 5:291-300. [PMID: 27916515 PMCID: PMC5366074 DOI: 10.1016/s2213-8587(16)30319-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 01/03/2023]
Abstract
Transgender women experience lifelong gender dysphoria due to a gender assignment at birth that is incongruent with their gender identity. They often seek hormone therapy, with or without surgery, to improve their gender dysphoria and to better align their physical and psychological features with a more feminine gender role. Some of the desired physical changes from oestrogen and anti-androgen therapy include decreased body and facial hair, decreased muscle mass, breast growth, and redistribution of fat. Overall the risks of treatment are low, but include thromboembolism, the risk of which depends on the dose and route of oestrogen administration. Other associated conditions commonly seen in transgender women include increased risks of depression and osteoporosis. The risk of hormone-sensitive cancer seems to be low in transgender women, with no increased risk of breast cancer compared with women and no increase in prostate cancer when compared with men. The evidence base for the care of transgender women is limited by the paucity of high-quality research, and long-term longitudinal studies are needed to inform future guidelines.
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Affiliation(s)
- Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, USA.
| | - Martin den Heijer
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, Netherlands
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162
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Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol 2017; 5:301-311. [PMID: 27084565 DOI: 10.1016/s2213-8587(16)00036-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/02/2016] [Accepted: 01/18/2016] [Indexed: 01/03/2023]
Abstract
Testosterone therapy is a cornerstone of medical treatment for transgender men who choose to undergo it. The goal of testosterone therapy is usually to achieve serum testosterone concentrations in the male reference range. Testosterone has several desired effects as well as undesired and unknown effects. The desired effects include increased facial and body hair, increased lean mass and strength, decreased fat mass, deepening of the voice, increased sexual desire, cessation of menstruation, clitoral enlargement, and reductions in gender dysphoria, perceived stress, anxiety, and depression. Achievement of these goals comes with potential undesired effects and risks including acne, alopecia, reduced HDL cholesterol, increased triglycerides, and a possible increase in systolic blood pressure. An additional benefit of testosterone therapy (with or without mastectomy) is a reduced risk of breast cancer. Most of the effects of testosterone start to develop within several months of starting therapy, although facial hair and alopecia continue to develop after 1 year. A major limitation in the study of testosterone therapy for transgender men is a paucity of high-quality data due to a shortage of randomised controlled trials (partly because of ethical issues), few prospective and long-term studies, the use of suboptimum control groups, loss to follow-up, and difficulties in recruitment of representative samples of transgender populations.
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Affiliation(s)
- Michael S Irwig
- Center for Andrology and Division of Endocrinology, George Washington University, Washington, DC, USA.
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163
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Fung R, Hellstern-Layefsky M, Lega I. Is a lower dose of cyproterone acetate as effective at testosterone suppression in transgender women as higher doses? Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1290566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Raymond Fung
- Division of Endocrinology, Michael Garron Hospital, University of Toronto, Toronto, Canada
| | | | - Iliana Lega
- Division of Endocrinology, Women's College Hospital, University of Toronto, Toronto, Canada
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164
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Mackenzie S, Wilkinson C. Morphological and morphometric changes in the faces of female-to-male (FtM) transsexual people. INT J TRANSGENDERISM 2017. [DOI: 10.1080/15532739.2017.1279581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stenton Mackenzie
- CAHID, School of Science and Engineering, University of Dundee, Dundee, UK
- Face Lab, Liverpool John Moores University, Faculty of Art Professional and Social Studies, Liverpool, UK
| | - Caroline Wilkinson
- School of Art & Design, Liverpool John Moores University Faculty of Arts Professional and Social Studies, Liverpool, UK
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165
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Winkler-Crepaz K, Müller A, Böttcher B, Wildt L. Hormonbehandlung bei Transgenderpatienten. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-016-0116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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166
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Shatzel JJ, Connelly KJ, DeLoughery TG. Thrombotic issues in transgender medicine: A review. Am J Hematol 2017; 92:204-208. [PMID: 27779767 DOI: 10.1002/ajh.24593] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/15/2016] [Accepted: 10/23/2016] [Indexed: 01/14/2023]
Abstract
Clinicians, including hematologists, are more frequently encountering transgender individuals in practice; however, most lack training on the management and complications of transgender medicine. Hormonal therapy forms the backbone of medical interventions for patients undergoing gender transition. While supplementing an individual's intrinsic sex hormone is associated with a variety of hematologic complications including increased rates of venous thrombosis, cardiovascular events, erthyrocytosis, and malignancy, the risks of supplementing with opposing sex hormones are not well understood. Data on the hematologic complications of these therapies are accumulating but remain limited, and clinicians have little experience with their management. This review highlights the current interventions available in transgender medicine and related potential hematologic complications, and it suggests simple, evidence-based management going forward. Am. J. Hematol. 92:204-208, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph J. Shatzel
- Division of Hematology/Medical Oncology; Knight Cancer Institute; Portland Oregon
| | - Kara J. Connelly
- Department of Pediatrics; Oregon Health & Science University; Portland Oregon
| | - Thomas G. DeLoughery
- Division of Hematology/Medical Oncology; Knight Cancer Institute; Portland Oregon
- Department of Pediatrics; Oregon Health & Science University; Portland Oregon
- Department of Pathology; Oregon Health & Science University; Portland Oregon
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167
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Majumder A, Sanyal D. Outcome and preferences in male-to-female subjects with gender dysphoria: Experience from Eastern India. Indian J Endocrinol Metab 2017; 21:21-25. [PMID: 28217493 PMCID: PMC5240066 DOI: 10.4103/2230-8210.196000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Gender dysphoria (GD) is an increasingly recognized medical condition in India, and little scientific data on treatment outcomes are available. AIMS Our objective is to study the therapeutic options including psychotherapy, hormone, and surgical treatments used for alleviating GD in male-to-female (MTF) transgender subjects in Eastern India. SUBJECTS AND METHODS This is a retrospective study of treatment preferences and outcome in 55 MTF transgender subjects who were presented to the endocrine clinic. STATISTICAL ANALYSIS USED Descriptive statistical analysis is carried out in the present study, and Microsoft Word and Excel are used to generate graphs and tables. RESULTS The mean follow-up was 1.9 years and 14 subjects (25.5%) were lost to follow-up after a single or 2-3 contact sessions. Rest 41 subjects (74.5%) desiring treatment had regular counseling and medical monitoring. All 41 subjects were dressing to present herself as female and all of them were receiving cross-sex hormone therapy either estrogen only (68%), or drospirenone in combination with estrogen (12%) or gonadotropin-releasing hormone agonist (GnRH) in combination with estrogens (19.5%). Most of the subjects preferred estrogen therapy as it was most affordable and only a small number of subjects preferred drospirenone or GnRH agonist because of cost and availability. 23.6% subjects underwent esthetic breast augmentation surgery and 25.5% underwent orchiectomy and/or vaginoplasty. Three subjects presented with prior breast augmentation surgery and nine subjects presented with prior orchiectomy without vaginoplasty, depicting a high prevalence of poorly supervised surgeries. CONCLUSIONS Standards of care documents provide clinical guidance for health professionals about the optimal management of transsexual people. The lack of information among health professionals about proper and protocolwise management leads to suboptimal physical, social, and sexual results.
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Affiliation(s)
- Anirban Majumder
- Department of Medicine, Endocrinology Unit, K P C Medical College, West Bengal University of Health Sciences, Kolkata, West Bengal, India
| | - Debmalya Sanyal
- Department of Medicine, Endocrinology Unit, K P C Medical College, West Bengal University of Health Sciences, Kolkata, West Bengal, India
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168
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Aitken S. The primary health care of transgender adults. Sex Health 2017; 14:477-483. [DOI: 10.1071/sh17048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.
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169
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Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev 2017; 39:93-107. [PMID: 28486701 PMCID: PMC5868281 DOI: 10.1093/epirev/mxw003] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022] Open
Abstract
Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.
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Affiliation(s)
- Hayley Braun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Janice Brockman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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170
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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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171
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Mueller SC, Wierckx K, Jackson K, T'Sjoen G. Circulating androgens correlate with resting-state MRI in transgender men. Psychoneuroendocrinology 2016; 73:91-98. [PMID: 27479654 DOI: 10.1016/j.psyneuen.2016.07.212] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 12/29/2022]
Abstract
Despite mounting evidence regarding the underlying neurobiology in transgender persons, information regarding resting-state activity, particularly after hormonal treatment, is lacking. The present study examined differences between transgender persons on long-term cross-sex hormone therapy and comparisons on two measures of local functional connectivity, intensity of spontaneous resting-state activity (low frequency fluctuations, LFF) and local synchronization of specific brain areas (regional homogeneity, ReHo). Nineteen transgender women (TW, male-to-female), 19 transgender men (TM, female-to-male), 21 non-transgender men (NTM) and 20 non-transgender women (NTW) underwent a resting-state MRI scan. The results showed differences between transgender persons and non-transgender comparisons on both LFF and ReHo measures in the frontal cortex, medial temporal lobe, and cerebellum. More interestingly, circulating androgens correlated for TM in the cerebellum and regions of the frontal cortex, an effect that was associated with treatment duration in the cerebellum. By comparison, no associations were found for TW with estrogens. These data provide first evidence for a potential masculinization of local functional connectivity in hormonally-treated transgender men.
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Affiliation(s)
- Sven C Mueller
- Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium.
| | - Katrien Wierckx
- Department of Endocrinology & Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | | | - Guy T'Sjoen
- Department of Endocrinology & Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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172
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Guillamon A, Junque C, Gómez-Gil E. A Review of the Status of Brain Structure Research in Transsexualism. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1615-48. [PMID: 27255307 PMCID: PMC4987404 DOI: 10.1007/s10508-016-0768-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2015] [Accepted: 04/29/2016] [Indexed: 05/22/2023]
Abstract
The present review focuses on the brain structure of male-to-female (MtF) and female-to-male (FtM) homosexual transsexuals before and after cross-sex hormone treatment as shown by in vivo neuroimaging techniques. Cortical thickness and diffusion tensor imaging studies suggest that the brain of MtFs presents complex mixtures of masculine, feminine, and demasculinized regions, while FtMs show feminine, masculine, and defeminized regions. Consequently, the specific brain phenotypes proposed for MtFs and FtMs differ from those of both heterosexual males and females. These phenotypes have theoretical implications for brain intersexuality, asymmetry, and body perception in transsexuals as well as for Blanchard's hypothesis on sexual orientation in homosexual MtFs. Falling within the aegis of the neurohormonal theory of sex differences, we hypothesize that cortical differences between homosexual MtFs and FtMs and male and female controls are due to differently timed cortical thinning in different regions for each group. Cross-sex hormone studies have reported marked effects of the treatment on MtF and FtM brains. Their results are used to discuss the early postmortem histological studies of the MtF brain.
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Affiliation(s)
- Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, c/Juand del Rosal, 10, 28040, Madrid, Spain.
- Academia de Psicología de España, Madrid, Spain.
| | - Carme Junque
- Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | - Esther Gómez-Gil
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Unidad de Identidad de Género, Hospital Clinic, Barcelona, Spain
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174
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Nota NM, Dekker MJHJ, Klaver M, Wiepjes CM, van Trotsenburg MA, Heijboer AC, den Heijer M. Prolactin levels during short- and long-term cross-sex hormone treatment: an observational study in transgender persons. Andrologia 2016; 49. [DOI: 10.1111/and.12666] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- N. M. Nota
- Division of Endocrinology; Department of Internal Medicine; VU University Medical Center; Amsterdam The Netherlands
| | - M. J. H. J. Dekker
- Division of Endocrinology; Department of Internal Medicine; VU University Medical Center; Amsterdam The Netherlands
| | - M. Klaver
- Division of Endocrinology; Department of Internal Medicine; VU University Medical Center; Amsterdam The Netherlands
| | - C. M. Wiepjes
- Division of Endocrinology; Department of Internal Medicine; VU University Medical Center; Amsterdam The Netherlands
| | - M. A. van Trotsenburg
- Department of Obstetrics and Gynaecology; VU University Medical Center; Amsterdam The Netherlands
| | - A. C. Heijboer
- Endocrine Laboratory; Department of Clinical Chemistry; VU University Medical Center; Amsterdam The Netherlands
| | - M. den Heijer
- Division of Endocrinology; Department of Internal Medicine; VU University Medical Center; Amsterdam The Netherlands
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175
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Majumder A, Sanyal D. Outcome and preferences in female-to-male subjects with gender dysphoria: Experience from Eastern India. Indian J Endocrinol Metab 2016; 20:308-311. [PMID: 27186545 PMCID: PMC4855956 DOI: 10.4103/2230-8210.179988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Awareness of gender dysphoria (GD) and its treatment is increasing. There is paucity of scientific data from India regarding the therapeutic options being used for alleviating GD, which includes psychotherapy, hormone, and surgical treatments. AIM To study the therapeutic options including psychotherapy, hormone, and surgical treatments used for alleviating GD. SETTINGS AND DESIGN This is a retrospective study of treatment preferences and outcome in 18 female-to-male (FTM) transgender subjects who presented to the endocrine clinic. RESULTS The mean follow-up was 1.6 years and only one subject was lost to follow-up after a single visit. All subjects desiring treatment had regular counseling and medical monitoring. All FTM subjects were cross-dressing. Seventeen (94.4%) FTM subjects were receiving cross-sex hormone therapy, in the form of testosterone only (61.1%) or gonadotropin-releasing hormone (GnRH) agonist in combination with testosterone (11.1%) or medroxyprogesterone acetate (MPA) depot in combination with testosterone (22.2%). FTM subjects preferred testosterone or testosterone plus MPA; very few could afford GnRH therapy. Testosterone esters injection was preferred by most (72.2%) subjects as it was most affordable while 22.2% chose 3 monthly injections of testosterone undecanoate for convenience and better symptomatic improvement, but it was more expensive. None preferred testosterone gels because of cost and availability concerns. About 33.3% of our subjects underwent mastectomy, 38.9% had hysterectomy with bilateral salpingo-oophorectomy, and only one subject underwent phalloplasty. About 16.7% of FTM subjects presented with prior mastectomy depicting a high prevalence of unsupervised or poorly supervised surgeries not following protocol wise approach. CONCLUSION Notwithstanding of advances in Standards of Care in the Western world, there is lack of awareness and acceptance in the FTM subjects, about proper and timely protocol-wise management options leading to suboptimal physical, social, and sexual results.
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Affiliation(s)
- Anirban Majumder
- Department of Endocrinology, KPC Medical College, Jadavpur, Kolkata, West Bengal, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Jadavpur, Kolkata, West Bengal, India
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176
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Abstract
Transgender individuals experience unique challenges with regards to discrimination and access to health care. Further, their unique health-care needs and challenges lead to greater rates of morbidity. This article seeks to review the unique biology of transgender patients and the effects of cross-sex hormone therapy on ophthalmic and non-ophthalmic pathology. Attention is given to topics in neuro-ophthalmology, oculoplastics, and retinal disease.
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Affiliation(s)
- Matthew W Hollar
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Matthew M Zhang
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Louise A Mawn
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Neurological Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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Feldman J, Brown GR, Deutsch MB, Hembree W, Meyer W, Meyer-Bahlburg HF, Tangpricha V, T’Sjoen G, Safer JD. Priorities for transgender medical and healthcare research. Curr Opin Endocrinol Diabetes Obes 2016; 23:180-7. [PMID: 26825469 PMCID: PMC4821501 DOI: 10.1097/med.0000000000000231] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Transgender individuals experience unique health disparities but are the subject of little focused health research. This manuscript reviews current literature on transgender medical and mental health outcomes and proposes research priorities to address knowledge gaps. RECENT FINDINGS Published research in transgender healthcare consists primarily of case reports, retrospective and cross-sectional studies, involving largely European settings. Challenges to US-based transgender health research include a diverse population where no single center has sufficient patient base to conduct clinical research with statistical rigor. Treatment regimens are heterogeneous and warrant study for best practices. Current research suggests increased mortality and depression in transgender individuals not receiving optimal care, and possibly a modest increase in cardiovascular risk related to hormone therapy. Current evidence does not support concerns for hormone-related malignancy risk. SUMMARY The priorities for transgender medical outcomes research should be to determine health disparities and comorbid health conditions over the life span, along with the effects of mental health, medical, and surgical interventions on morbidity and mortality. Specific outcomes of interest based on frequency in the literature, potential severity of outcome, and patient-centered interest, include affective disorders, cardiovascular disease, malignancies, fertility, and time dose-related responses of specific interventions.
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Affiliation(s)
- Jamie Feldman
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - George R. Brown
- Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Mountain Home VAMC, Johnson City, TN
| | - Madeline B. Deutsch
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Wylie Hembree
- Program of Developmental Psychoendocrinology, Division of Gender, Sexuality, and Health, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY and NYS Psychiatric Institute, New York, NY
| | - Walter Meyer
- Department of Psychiatry, University of Texas, Medical Branch, Galveston, TX
| | - Heino F.L. Meyer-Bahlburg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, GA
| | - Guy T’Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Joshua D. Safer
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA
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178
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Risk of hormonotherapy in transgender people: Literature review and data from the French Database of Pharmacovigilance. ANNALES D'ENDOCRINOLOGIE 2016; 77:14-21. [PMID: 26830952 DOI: 10.1016/j.ando.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE After the diagnosis of transsexualism, hormone therapy is an established stage of gender identity disorder treatment for inducing secondary sex characteristic development of the target gender while reducing that of the birth sex. The aim of this study was to review existing data about the risk of hormone therapy in transsexual people. METHODS A PubMed search was done to identify relevant data about adverse drug reactions (ADRs) and mortality associated to hormones exposure. Furthermore, case reports of hormonal therapy-induced ADRs were identified in the French Pharmacovigilance DataBase (FPDB). RESULTS Review of currently available data showed an increase of thromboembolic effects and hyperprolactinemia with oestrogens. Both oestrogens and testosterone derivatives could induce hepatic effects. Currently, there is no significant association between hormone exposure and cancer or mortality in transsexual people. Five ADRs were found in FPDB, and two of them were related to misuse (voluntary overdose and prescription error). CONCLUSION Potential for under-reporting and under-identification in the FPDB of hormonal therapy-induced ADRs in transsexual people should be underlined. Technical improvement of the FPDB could facilitate further identification of reports concerning the risk associated with hormonal therapy in transsexual subjects.
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179
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Abstract
Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.
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Affiliation(s)
- Kenneth J Zucker
- Gender Identity Clinic, Child, Youth, and Family Services, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada;
| | - Anne A Lawrence
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, VU University Medical Center and EMGO Institute for Health and Care Research, Amsterdam 1081 HV, The Netherlands
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180
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Fernandez JD, Tannock LR. METABOLIC EFFECTS OF HORMONE THERAPY IN TRANSGENDER PATIENTS. ENDOCRINE PRACTICE : OFFICIAL JOURNAL OF THE AMERICAN COLLEGE OF ENDOCRINOLOGY AND THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS 2015. [PMID: 26574790 DOI: 10.4158/ep15950.or.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Transgender patients may seek hormone therapy to induce physical changes to simulate their expressed or experienced gender. However, many providers are uncomfortable prescribing transgender hormones due to fears over safety. The goal of this study was to determine if transgender hormone therapy with estrogen and spironolactone for male-to-female (MtF) patients or with testosterone for female-to-male (FtM) patients had adverse anthropomorphic or metabolic effects. METHODS This retrospective chart review study analyzed changes over time for 33 MtF and 19 FtM endocrine clinic patients at an academic endocrine practice with follow-up for up to 18 months after hormone initiation. RESULTS Compared to baseline labs obtained prior to the initiation of hormone therapy, significant changes for the MtF cohort included an increase in high-density lipoprotein (HDL) and decrease in creatinine; however, triglycerides did not show a statistically significant change. In the FtM cohort, there were significant increases in body mass index, creatinine, hemoglobin, and hematocrit. Although statistically significant, these changes were minimal for both cohorts. CONCLUSION In our practice, hormone therapy was found to be safe in this retrospective study.
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181
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Abstract
OBJECTIVE Transgender patients may seek hormone therapy to induce physical changes to simulate their expressed or experienced gender. However, many providers are uncomfortable prescribing transgender hormones due to fears over safety. The goal of this study was to determine if transgender hormone therapy with estrogen and spironolactone for male-to-female (MtF) patients or with testosterone for female-to-male (FtM) patients had adverse anthropomorphic or metabolic effects. METHODS This retrospective chart review study analyzed changes over time for 33 MtF and 19 FtM endocrine clinic patients at an academic endocrine practice with follow-up for up to 18 months after hormone initiation. RESULTS Compared to baseline labs obtained prior to the initiation of hormone therapy, significant changes for the MtF cohort included an increase in high-density lipoprotein (HDL) and decrease in creatinine; however, triglycerides did not show a statistically significant change. In the FtM cohort, there were significant increases in body mass index, creatinine, hemoglobin, and hematocrit. Although statistically significant, these changes were minimal for both cohorts. CONCLUSION In our practice, hormone therapy was found to be safe in this retrospective study.
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182
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Taylor ET, Bryson MK. Cancer's Margins: Trans* and Gender Nonconforming People's Access to Knowledge, Experiences of Cancer Health, and Decision-Making. LGBT Health 2015; 3:79-89. [PMID: 26789402 PMCID: PMC4770847 DOI: 10.1089/lgbt.2015.0096] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Research in Canada and the United States indicates that minority gender and sexuality status are consistently associated with health disparities and poor health outcomes, including cancer health. This article investigates experiences of cancer health and care, and access to knowledge for trans* and gender nonconforming people diagnosed with and treated for breast and/or gynecologic cancer. Our study contributes new understandings about gender minority populations that will advance knowledge concerning the provision of culturally appropriate care. This is the first study we are aware of that focuses on trans* and gender nonconforming peoples' experiences of cancer care and treatment, support networks, and access to and mobilization of knowledge. METHODS This article analyzes trans* and gender nonconforming patient interviews from the Cancer's Margins project ( www.lgbtcancer.ca ): Canada's first nationally-funded project that investigates the complex intersections of sexual and/or gender marginality, cancer knowledge, treatment experiences, and modes of the organization of support networks. RESULTS Our analysis documents how different bodies of knowledge relative to cancer treatment and gendered embodiment are understood, accessed, and mobilized by trans* and gender nonconforming patients. Findings reported here suggest that one's knowledge of a felt sense of gender is closely interwoven with knowledge concerning cancer treatment practices; a dynamic which organizes knowledge mobilities in cancer treatment. CONCLUSIONS The findings support the assertion that cisgender models concerning changes to the body that occur as a result of biomedical treatment for breast and/or gynecologic cancer are wholly inadequate in order to account for trans* and gender nonconforming peoples' experiences of cancer treatments, and access to and mobilization of related knowledge.
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Affiliation(s)
- Evan T Taylor
- Department of Language and Literacy Education, Faculty of Education, University of British Columbia , Canada
| | - Mary K Bryson
- Department of Language and Literacy Education, Faculty of Education, University of British Columbia , Canada
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183
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Meriggiola MC, Gava G. Endocrine care of transpeople part II. A review of cross-sex hormonal treatments, outcomes and adverse effects in transwomen. Clin Endocrinol (Oxf) 2015; 83:607-15. [PMID: 25692882 DOI: 10.1111/cen.12754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/03/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
The treatment of transwomen relies on the combined administration of anti-androgens or GnRH analogues to suppress androgen production and thereby reduce male phenotypic characteristics together with oestrogens to develop female characteristics. In transwomen, synthetic oestrogens such as ethinyl oestradiol, as well as conjugated equine oestrogens (CEE), should be avoided to minimize thromboembolic risks especially in older transwomen and in those with risk factors. Currently, available short- and long-term safety studies suggest that cross-sex hormonal therapy (CHT) can be considered safe in transwomen improving the well-being and quality of life of these individuals. Long-term monitoring should aim to decrease cardiovascular risks and should include prostate and breast cancer screenings.
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Affiliation(s)
- Maria Cristina Meriggiola
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Gava
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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184
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Aguayo-Romero RA, Reisen CA, Zea MC, Bianchi FT, Poppen PJ. Gender Affirmation and Body Modification Among Transgender Persons in Bogotá, Colombia. Int J Transgend 2015; 16:103-115. [PMID: 26839525 DOI: 10.1080/15532739.2015.1075930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This paper examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N=14) and a focus group (N=11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data, as well as quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections, but also in carrying out procedures-sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.
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Affiliation(s)
| | - Carol A Reisen
- Department of Psychology, The George Washington University, Washington, DC
| | - Maria Cecilia Zea
- Department of Psychology, The George Washington University, Washington, DC
| | - Fernanda T Bianchi
- Department of Psychology, The George Washington University, Washington, DC
| | - Paul J Poppen
- Department of Psychology, The George Washington University, Washington, DC
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185
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Weinand JD, Safer JD. Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol 2015; 2:55-60. [PMID: 28090436 PMCID: PMC5226129 DOI: 10.1016/j.jcte.2015.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Some providers report concern for the safety of transgender hormone therapy (HT). METHODS This is a systematic literature review of HT safety for transgender adults. RESULTS Current literature suggests HT is safe when followed carefully for certain risks. The greatest health concern for HT in transgender women is venous thromboembolism. HT among transgender men appears to cause polycythemia. Both groups experienced elevated fasting glucose. There is no increase in cancer prevalence or mortality due to transgender HT. CONCLUSION Although current data support the safety of transgender HT with physician supervision, larger, long-term studies are needed in transgender medicine.
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Affiliation(s)
| | - Joshua D. Safer
- Transgender Medicine Research Group, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA
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186
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Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: a 2 year follow-up study. J Psychosom Res 2015; 78:399-406. [PMID: 25691225 DOI: 10.1016/j.jpsychores.2015.02.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 02/04/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Several studies indicate increased prevalence of metabolic syndrome (MetS) among patients with psychiatric disorders as well as among individuals with gender dysphoria (GD) treated by cross-sex hormonal treatment. However, the MetS prevalence among hormone treated GD individuals suffering from psychiatric problems has not been detected. METHODS From a sample of 146 GD patients we selected 122 metabolically healthy individuals in order to investigate the prevalence of MetS after the beginning of the cross-sex hormonal treatment in a 2 year follow-up assessment. Furthermore, we assessed differences in MetS prevalence between hormone treated GD patients with and without concomitant psychiatric problems. RESULTS When treated with hormone therapy, GD patients reported changes in several parameters which are clustered in MetS, with statistically significant differences compared to baseline. Glyco-insulinemic alterations were more pronounced in male to female patients (MtFs). However, weight gain, waist circumference increases, blood pressure increases, and lipid alterations were similar in MtFs and female to male patients (FtMs). 14.8% of the sample at year 1 and 17.2% at year 2 developed MetS. Among patients with concomitant psychiatric problems, 50% at year 1 and 55% at year 2 developed MetS against 8% at year 1 and 10% at year 2 of patients without concomitant psychiatric problems. CONCLUSION This study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.
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187
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Goodrum BA. The Effects of Long-Term Testosterone Use on Lipid-Related Cardiovascular Risk Factors Among FtM Patients. Int J Transgend 2015. [DOI: 10.1080/15532739.2014.995261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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188
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Fabris B, Bernardi S, Trombetta C. Cross-sex hormone therapy for gender dysphoria. J Endocrinol Invest 2015; 38:269-82. [PMID: 25403429 DOI: 10.1007/s40618-014-0186-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 10/01/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Gender identity is the sense one has of being male or female. Gender dysphoria (GD) refers to the distress caused by the incongruence between gender identity and biological sex in gender-nonconforming individuals. Cross-sex hormone therapy (CHT) aims at easing GD, improving well-being, and quality of life of gender-nonconforming individuals. This can be achieved by inducing and maintaining the desired-sex characteristics in accordance with the specific aspirations and expectations of each individual. Nevertheless, CHT can be associated with potentially serious long-term complications. METHODS Here, we review when, how, and how long to prescribe CHT to adult transsexuals as well as what to expect and monitor once it has been initiated. RESULTS In recent years, transsexualism has become more and more recognized and depathologized. To manage GD, National and International Standards of Care have been established. Nevertheless, the needs of transgender patients can still be ignored or dismissed. Moreover, some questions remain unanswered because of the lack of specific retrospective or prospective studies on CHT. CONCLUSION Education and culturally sensitive training must be supplied to healthcare professionals to overcome the existing issues on GD management and change the perspectives of transsexual people.
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Affiliation(s)
- B Fabris
- Division of Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - S Bernardi
- Division of Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - C Trombetta
- Division of Urology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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189
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Affiliation(s)
- George R. Brown
- Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
- Mountain Home VAMC, Mountain Home (Johnson City), Tennessee
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190
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Van Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S, Toye K, Lapauw B, Kaufman JM, T'Sjoen G. Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case-controlled study (ENIGI). Eur J Endocrinol 2015; 172:163-71. [PMID: 25550352 DOI: 10.1530/eje-14-0586] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the evolution of body composition and bone metabolism in trans men during the first year of cross-sex hormonal therapy. METHODS In a prospective controlled study, we included 23 trans men (female-to-male trans persons) and 23 age-matched control women. In both groups, we examined grip strength (hand dynamometer), biochemical markers of bone turnover (C-terminal telopeptides of type 1 collagen (CTX) and procollagen 1 aminoterminal propeptide (P1NP)), total body fat and lean mass, and areal bone mineral density (aBMD) by dual-X-ray absorptiometry (DXA) and fat and muscle area at the forearm and calf, bone geometry, and volumetric bone mineral density (vBMD) by peripheral quantitative computed tomography (pQCT), before treatment and after 1 year of treatment with undecanoate (1000 mg i.m./12 weeks). RESULTS Before hormonal treatment, trans men had similar bone and body composition compared with control women. Testosterone treatment induced in trans men a gain in muscle mass (+10.4%) and strength and loss of fat mass (-9.7%) (all P<0.001) and increased the levels of P1NP and CTX (both P<0.01). Areal and volumetric bone parameters remained largely unchanged apart from a small increase in trabecular vBMD at the distal radius and in BMD at the total hip in trans men (P=0.036 and P=0.001 respectively). None of these changes were observed in the control group. CONCLUSIONS Short-term testosterone treatment in trans men increased muscle mass and bone turnover. The latter may rather reflect an anabolic effect of testosterone treatment rather than bone loss.
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Affiliation(s)
- E Van Caenegem
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - K Wierckx
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - Y Taes
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - T Schreiner
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - S Vandewalle
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - K Toye
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - B Lapauw
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - J-M Kaufman
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - G T'Sjoen
- Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium Department of EndocrinologyGhent University Hospital, De Pintelaan 185, 9000 Ghent, BelgiumEuropean Network for the Investigation of Gender Incongruence (ENIGI)Ghent, BelgiumDepartment of EndocrinologyRikshospitalet, Oslo University Hospital, Sognsvannvn 20, Oslo, NorwayCenter for Sexology and Gender ProblemsGhent University Hospital, De Pintelaan 185, Ghent, Belgium
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191
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Morrison SD, Perez MG, Nedelman M, Crane CN. Current State of Female-to-Male Gender Confirming Surgery. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-014-0038-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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192
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Gooren LJ, Kreukels B, Lapauw B, Giltay EJ. (Patho)physiology of cross-sex hormone administration to transsexual people: the potential impact of male-female genetic differences. Andrologia 2014; 47:5-19. [PMID: 25495275 DOI: 10.1111/and.12389] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 12/11/2022] Open
Abstract
There is a limited body of knowledge of desired and undesired effects of cross-sex hormones in transsexual people. Little attention has been given to the fact that chromosomal configurations, 46,XY in male-to-female transsexuals subjects (MtoF) and 46,XX in female-to-male transsexual subjects (FtoM), obviously, remain unchanged. These differences in their genomes cause sex differences in the functions of cells. This study reviews sex differences in metabolism/cardiovascular pathology, immune mechanisms, bone (patho)physiology and brain functions and examines whether they are, maybe partially, determined by genetic mechanisms rather than by (cross-sex) hormones. There do not appear to be major genetic impacts on the changes in bone physiology. Also immune functions are rather unaffected and the evidence for an increase of autoimmune disease in MtoF is preliminary. Brain functions of transsexuals may have differed from controls before cross-sex hormones; they do undergo shifts upon cross-sex hormone treatment, but there is no evidence for changes in sex-specific brain disease. The prevalence of cardiovascular disease is higher in MtoF receiving oestrogens than in FtoM receiving androgens. While type of oestrogen and route of administration might be significant, it is reasonable to speculate that nonhormonal/genetic factors play a role.
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Affiliation(s)
- L J Gooren
- Emeritus VU Medical Center, Amsterdam, The Netherlands; Androconsult, Chiang Mai, Thailand
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193
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Mepham N, Bouman WP, Arcelus J, Hayter M, Wylie KR. People with Gender Dysphoria Who Self‐Prescribe Cross‐Sex Hormones: Prevalence, Sources, and Side Effects Knowledge. J Sex Med 2014; 11:2995-3001. [DOI: 10.1111/jsm.12691] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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194
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Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat 2014; 149:191-8. [DOI: 10.1007/s10549-014-3213-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 12/22/2022]
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195
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Bouman W, Richards C, Addinall R, Arango de Montis I, Arcelus J, Duisin D, Esteva I, Fisher A, Harte F, Khoury B, Lu Z, Marais A, Mattila A, Nayarana Reddy D, Nieder T, Robles Garcia R, Rodrigues O, Roque Guerra A, Tereshkevich D, T’Sjoen G, Wilson D. Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical? SEXUAL AND RELATIONSHIP THERAPY 2014. [DOI: 10.1080/14681994.2014.954993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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196
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Smith KP, Madison CM, Milne NM. Gonadal Suppressive and Cross-Sex Hormone Therapy for Gender Dysphoria in Adolescents and Adults. Pharmacotherapy 2014; 34:1282-97. [DOI: 10.1002/phar.1487] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Christina M. Madison
- Southern Nevada Health District; Roseman University of Health Sciences; Las Vegas Nevada
| | - Nikki M. Milne
- Roseman University of Health Sciences; South Jordan Utah
- Utah Valley Regional Medical Center, Family Medicine Clinic; Provo, Utah; Provo Utah
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197
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Idrus NI, Hymans TD. Balancing benefits and harm: chemical use and bodily transformation among Indonesia's transgender waria. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:789-97. [PMID: 25091633 PMCID: PMC4154068 DOI: 10.1016/j.drugpo.2014.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 12/03/2022]
Abstract
Background Members of Indonesia's diverse male-to-female transgender community often describe themselves as waria. Waria do not equate being feminine with being female. They do not want to be women; they aspire to be like women. It entails cultivating mannerisms and wearing make-up and women's clothes, shaving one's legs and styling one's hair. But some go further in their practices of self-administered, chemically assisted bodily transformation. Methods Field research took place in Makassar, the capital city of South Sulawesi; in a smaller town in the regency of Bulukumba on the south coast of Sulawesi; and in the special region of Yogyakarta in Java. Data were collected through repeated in-depth interviews with ten waria youths aged between 18 and 26 in each site; interviews with pharmacists, drug and cosmetics store clerks; three focus group discussions at each site; and participant observation. Results Our respondents saw their bodies as ‘projects’ they can manipulate with pharmaceutical products and cosmetics. To lighten their skin, they experimented with different brands of exfoliating liquid, whitening cream, powder, foundation, face soap and skin scrub. To grow breasts and reduce muscle mass, they experimented with different brands and dosages of contraceptive pills and injections in order to get faster, better and longer-lasting results. Conclusion Harm reduction programs often neglect chemicals that are not narcotics, not related to sexually transmitted infections, and which are legally and freely available. Safety issues arise when otherwise safe products are used off-label in large quantities. Drug policy-makers are paying insufficient attention to the safety of cosmetics.
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Affiliation(s)
- Nurul Ilmi Idrus
- Department of Anthropology, Faculty of Social and Political Sciences, Hasanuddin University, Makassar, Indonesia; European Research Council Chemical Youth project, University of Amsterdam, The Netherlands.
| | - Takeo David Hymans
- European Research Council Chemical Youth project, University of Amsterdam, The Netherlands.
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198
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Abstract
OBJECTIVE Limited information exists regarding breast health in the transgender population. In this article, we review transgender terminology, barriers faced by transgender patients, current breast care screening recommendations, and normal and abnormal imaging findings in this population. CONCLUSION Health disparities in the transgender population continue. Educating physicians on the breast health care needs of transgender patients is important for improving their care.
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199
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Gooren LJ. Management of female-to-male transgender persons: medical and surgical management, life expectancy. Curr Opin Endocrinol Diabetes Obes 2014; 21:233-8. [PMID: 24755998 DOI: 10.1097/med.0000000000000064] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Hormonal treatment of transgender people is becoming a normal part of medicine, though numbers of subjects remain small because of low prevalence. Information on treatment is scattered and this review brings together the latest information on treatment goals and potential side-effects of androgen treatment of female-to-male transsexual subjects. RECENT FINDINGS Androgen treatment of female-to-male transsexuals is usually uneventful, with a good patient compliance. Goals of hormonal treatment are elimination of secondary sex characteristics of the female sex and induction of those of the male sex. Completion takes approximately 2 years. Hormonal treatment is eventually followed by surgical ablation of breasts and removal of uterus and ovaries. Phalloplasty may be considered. Concerns are the sequelae of hypogonadism following surgery, such as loss of bone mass. Contrary to earlier expectations, there is no increase in cardiovascular disease. (Hormone-related) cancers are rare, but vaginal, cervical, endometrial carcinomas have been reported. Cancers of the breasts are of greater concern and have been found in residual mammary tissue after breast ablation. So far, androgen treatment has not raised major safety concerns. Regrets about changing sex have not been reported. SUMMARY Testosterone treatment of female-to-male transsexuals is effective and well tolerated.
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Affiliation(s)
- Louis J Gooren
- VU University Medical Center, Amsterdam, The Netherlands
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200
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Abstract
Many transgender youth experience significant amounts of emotional distress regarding the incongruence between their internal gender identity and their physical body. Cross-gender hormonal medical treatments, as managed by a multidisciplinary medical/mental health team, assist patients in transitioning to their desired gender by aligning the physical body to match the gender identity. The World Professional Association for Transgender Health Standards of Care and the Endocrine Society's Clinical Practice Guidelines provide a basic road map for practitioners. Expectations of the youth and the concerns of the family must be addressed and the youth psychologically supported during the transition period. Issues around future fertility should be explored as well. The goal of this article is to introduce the general pediatrician to cross-gender hormone treatments, their management, monitoring laboratory tests and clinical effects, and the issues surrounding their use in adolescents.
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