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D’Angelo A, Portaluri A, Caprini F, Sofia C, Ferrara F, Condorelli E, Iaccarino L, Catanzariti F, Mancino M, Trombadori CML, Belli P, Marino MA. Male Breast: A Review of the Literature and Current State of the Art of Diagnostic Imaging Work-Up. Diagnostics (Basel) 2023; 13:3620. [PMID: 38132204 PMCID: PMC10743117 DOI: 10.3390/diagnostics13243620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Pathological conditions affecting the male breast (MB) share some similarities with those found in women, while others are specific to men. The first part of this review provides an overview of MB disorders, exploring the most common types of MB diseases. The second part then emphasizes the state-of-the-art approaches proposed in the literature for screening and follow-up with MB cancer patients, which highlights the importance of tailored strategies for diagnosis, follow-up, and identifying high-risk populations. Considering the increasing attention in recent years on the topic, transgender individuals are also included in this review. Together with the MB, it is an understudied category thus far. This review aims to raise awareness among radiologists that MBs should be approached differently from female breasts, contributing to the advancement of medical knowledge, improving patient outcomes, and promoting early detection of MB disorders. The review also provides an update on breast cancer and screening in the transgender population.
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Affiliation(s)
- Anna D’Angelo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Antonio Portaluri
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Flavia Caprini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Francesca Ferrara
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Elvira Condorelli
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Ludovica Iaccarino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Francesca Catanzariti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Matteo Mancino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Charlotte M. L. Trombadori
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Paolo Belli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
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Diagnosis, Treatment, and Prevention of Stroke in Transgender Adults. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose of Review
To identify the current state of science on stroke in transgender adults and highlight gaps in need of further research. We will review current research on cerebrovascular risk and disease, hormone therapy, and stroke in transgender individuals. Finally, we will provide a framework for healthcare providers to prevent and reduce disparities through inclusive care practices.
Recent Findings
Transgender people experience unique stroke risk factors, secondary to both psychosocial stress and health-related behaviors. These include higher rates of HIV, tobacco use, stimulant use, and hepatitis C. The use of gender-affirming hormone therapy may lead to an increased risk for ischemic stroke, but the data are limited and require further research.
Summary
Recent research has highlighted the numerous healthcare disparities faced by transgender individuals. Regarding stroke disparities, these are multifactorial and include contributions from health-related behaviors, inadequate access to care, the use of hormonal therapy, and minority stress. Further research is needed to increase access to care and reduce the substantial gap in outcomes for these individuals.
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Domogauer J, Cantor T, Quinn G, Stasenko M. Disparities in cancer screenings for sexual and gender minorities. Curr Probl Cancer 2022; 46:100858. [DOI: 10.1016/j.currproblcancer.2022.100858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 12/22/2022]
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Patel H, Samaha Y, Ives G, Lee TY, Cui X, Ray E. Chest Feminization in Male-to-Female Transgender Patients: A Review of Options. Transgend Health 2022; 6:244-255. [PMID: 34993297 DOI: 10.1089/trgh.2020.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Management of a transgender (TG) woman's gender dysphoria is individualized to address the sources of her distress. This typically involves some combination of psychological therapy, hormone modulation, and surgical intervention. Breast enhancement is the most commonly pursued physical modification in this population. Because hormone manipulation provides disappointing results for most TG women, surgical treatment is frequently required to achieve the goal of a feminine chest. Creating a female breast from natal male chest anatomy poses significant challenges; the sexual dimorphism requires a different approach than that used in cisgender breast augmentation. The options and techniques used continue to evolve as experience in this field grows.
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Affiliation(s)
- Harsh Patel
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Yasmina Samaha
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Graham Ives
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Tian-Yu Lee
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Xiaojiang Cui
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Edward Ray
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
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Tijerina AN, Srivastava AV, Patel VR, Osterberg EC. Current use of testosterone therapy in LGBTQ populations. Int J Impot Res 2021; 34:642-648. [PMID: 34815551 DOI: 10.1038/s41443-021-00490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/23/2023]
Abstract
Testosterone therapy (TT) is a type of gender-affirming hormone therapy (GAHT) in lesbian, gay, bisexual, transgender, and genderqueer (LGBTQ) populations for gender dysphoria (GD), body uneasiness, and sexual dysfunction. The physical and physiological effects of TT vary widely depending on the dosing regimen and duration of treatment. An individualized approach prioritizing patient-specific desired effects in the context of pre-existing characteristics and health history is strongly recommended. Although TT is an effective treatment for many patients, there has been an increase in the illegitimate acquisition of TT in recent years. Non-judicious prescribing and lack of physician surveillance increases the risk of unintended side effects and potential serious health consequences.
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Affiliation(s)
- A N Tijerina
- University of Texas Dell Medical School, Austin, TX, 78712, USA.
| | - A V Srivastava
- University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - V R Patel
- University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - E C Osterberg
- University of Texas Dell Medical School, Austin, TX, 78712, USA.,Dell Medical School Department of Surgery and Perioperative Care and Ascension Seton Hospital Network, Austin, TX, 78712, USA
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Foster Skewis L, Bretherton I, Leemaqz SY, Zajac JD, Cheung AS. Short-Term Effects of Gender-Affirming Hormone Therapy on Dysphoria and Quality of Life in Transgender Individuals: A Prospective Controlled Study. Front Endocrinol (Lausanne) 2021; 12:717766. [PMID: 34394009 PMCID: PMC8358932 DOI: 10.3389/fendo.2021.717766] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023] Open
Abstract
Background Gender affirming hormone therapy (GAHT), whilst considered the standard of care in clinical guidelines for the treatment of many transgender (trans) people is supported by low quality evidence. In this prospective longitudinal controlled study, we aimed to examine the effect of newly commencing GAHT on gender dysphoria and quality of life (QoL) over a 6 month period. Methods Adult trans (including those with binary and/or non-binary identities) people newly commencing standard full-doses of masculinising (n = 42; 35 = trans masculine, 7 = non-binary) or feminising (n = 35; 33 = trans feminine, 2 = non-binary) GAHT and cisgender participants (n=53 male, n=50 female) were recruited to participate in this longitudinal prospective study. This analysis of gender dysphoria measured by the Gender Preoccupation and Stability Questionnaire and QoL measured by the RAND Short-Form 36 Health survey at baseline, 3 and 6 months after commencement of GAHT was a prespecified secondary outcome. Dysphoria and QoL over time in those starting GAHT compared to cisgender comparison group matched for their presumed sex at birth is reported as the mean difference (95% confidence interval) adjusted for age. Results In trans people initiating masculinising GAHT, there was a decrease in gender dysphoria with adjusted mean difference -6.80 (-8.68, -4.91), p < 0.001, and a clinically significant improvement in emotional well-being [adjusted mean difference 7.48 (1.32, 13.64), p = 0.018] and social functioning [adjusted mean difference 12.50 (2.84, 22.15), p = 0.011] aspects of QoL over the first 6 months of treatment relative to the cisgender female comparison group. No significant differences were observed in other QoL domains. In trans people initiating feminising GAHT, there was a decrease in gender dysphoria [adjusted mean difference -4.22 (-6.21, -2.24), p < 0.001] but no differences in any aspects of QoL were observed. Conclusions In the short-term, our findings support the benefit of initiating masculinising or feminising GAHT for gender dysphoria. Masculinising GAHT improves emotional well-being and social functioning within 6 months of treatment. Multidisciplinary input with speech pathology and surgery to support trans people seeking feminisation is likely needed. Further longitudinal studies controlled for other confounders (such as the presence of social supports) contributing to QoL are needed.
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Affiliation(s)
- Lucas Foster Skewis
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | - Ingrid Bretherton
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, VIC, Australia
| | - Shalem Y. Leemaqz
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey D. Zajac
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, VIC, Australia
| | - Ada S. Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, VIC, Australia
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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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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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García-Acosta JM, San Juan-Valdivia RM, Fernández-Martínez AD, Lorenzo-Rocha ND, Castro-Peraza ME. Trans* Pregnancy and Lactation: A Literature Review from a Nursing Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010044. [PMID: 31861638 PMCID: PMC6981677 DOI: 10.3390/ijerph17010044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/16/2022]
Abstract
Pregnancy and lactation involve two aspects that are socially and culturally associated with women. However, there are a few biological differences between male and female breast tissue. Lactation and pregnancy are viable processes that do not depend on sex. Even for the latter, it is only necessary to have an organ capable of gestation. Ways to favor mammogenesis and lactogenesis in trans* women have been established. There are protocols to promote lactation in trans* women, usually used for adoptive mothers or those whose children have been born through gestational surrogacy. Chestfeeding a baby could be the cause of feelings as diverse as gender dysphoria in the case of trans* men, and euphoria and affirmation of femininity in trans* women. This study involves a review of the available scientific literature addressing medical aspects related to pregnancy and lactation in trans* individuals, giving special attention to nursing care during perinatal care. There are scarce studies addressing care and specifically nursing care in trans* pregnancy and lactation. Our study indicates the factors that can be modified and the recommendations for optimizing the care provided to these individuals in order to promote and maintain the lactation period in search of improvement and satisfaction with the whole process.
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Affiliation(s)
- Jesús Manuel García-Acosta
- Faculty of Nursing, University of La Laguna, Canary Islands Public Health Service, 38010 Tenerife, Canary Islands, Spain
- Correspondence: ; Tel.: +34-6-8700-7510
| | | | - Alfredo David Fernández-Martínez
- Department of Education Counseling Universities, Culture and Sports, Government of the Canary Islands, 38010 Tenerife, Canary Islands, Spain;
| | - Nieves Doria Lorenzo-Rocha
- The Faculty of Nursing Nª Sª de La Candelaria, University of La Laguna, Canary Islands Public Health Service, 38010 Tenerife, Canary Islands, Spain; (N.D.L.-R.); (M.E.C.-P.)
| | - Maria Elisa Castro-Peraza
- The Faculty of Nursing Nª Sª de La Candelaria, University of La Laguna, Canary Islands Public Health Service, 38010 Tenerife, Canary Islands, Spain; (N.D.L.-R.); (M.E.C.-P.)
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Awareness, Willingness, and PrEP Eligibility Among Transgender Women in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr 2019; 79:445-452. [PMID: 30142140 DOI: 10.1097/qai.0000000000001839] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV epidemics disproportionately affect transwomen worldwide. Trans-specific guidance, outreach, and interventions to increase pre-exposure prophylaxis (PrEP) use among transwomen are scarce. SETTING Rio de Janeiro, Brazil. METHODS We measured awareness and willingness to use PrEP and examined factors associated with those outcomes among transwomen in Rio de Janeiro and estimated how many transwomen would be eligible for PrEP. Data originate from Transcender study, a respondent-driven sampling survey conducted from August 2015 to January 2016. We performed regression models for PrEP awareness and willingness. RESULTS One hundred thirty-one (38.0%) of 345 participants had heard of PrEP. Among transwomen who self-reported as HIV-negative, 162 (76.4%, N = 212 with available data) reported willingness to use it and 163 (66.8%, N = 244) met PrEP behavioral eligibility criteria. Transwomen with health access in the previous 6 months who reported HIV-infected sexual partner and with 8+ years of schooling had increased odds of PrEP awareness. Lower PrEP awareness was associated with condomless anal intercourse and newly diagnosed HIV infection. Younger age and perceiving themselves at risk of HIV infection increased the odds of PrEP willingness. Lower odds of PrEP willingness were associated with concerns about long-term effects of PrEP and with difficulties in getting access to health care due to transphobia. CONCLUSION Combination of low awareness, high willingness, and substantial PrEP eligibility corroborates transwomen as a key population for HIV prevention. PrEP is a promising and empowering strategy for HIV prevention among transwomen, but trans-specific recommendations are needed to effectively implement PrEP in this population.
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Hadj-Moussa M, Ohl DA, Kuzon WM. Evaluation and Treatment of Gender Dysphoria to Prepare for Gender Confirmation Surgery. Sex Med Rev 2018; 6:607-617. [PMID: 29891226 DOI: 10.1016/j.sxmr.2018.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gender dysphoria is the experience of marked distress due to incongruence between genetically determined gender and experienced gender. Treatment of gender dysphoria should be individualized and multidisciplinary, involving a combination of psychotherapy, social gender transition, cross-sex hormone therapy, gender-affirming surgery, and/or ancillary procedures and services. The goal of all treatment modalities is to alleviate distress and affirm the patient's experienced gender identity. This article is the first in a 3-part series focused on the diagnostic assessment and non-operative treatment of gender dysphoria. Parts 2 and 3 focus on operative aspects of gender dysphoria treatment. AIM To summarize the recommendations of the World Professional Association for Transgender Health (WPATH) and the Endocrine Society (ES), as well as review published literature regarding the non-operative treatment of gender dysphoria. METHODS A review of relevant literature through January 2017 was performed via PubMed. OUTCOMES WPATH guidelines regarding diagnosis and non-surgical treatment of gender dysphoria, specifically regimens and risks of cross-sex hormone therapy were reviewed. RESULTS Few physicians have experience with the diagnosis or treatment of gender dysphoria, although the number of patients seeking treatment has risen substantially in recent years. As a result, clinicians have turned to published recommendations from WPATH and ES, both of which promote high-quality, evidence-based care for patients with gender dysphoria. Successful treatment requires an individualized multidisciplinary approach. Non-operative treatment is both safe and effective for the majority of patients with gender dysphoria. CONCLUSIONS Guidelines from WPATH and ES, along with published literature pertaining to the diagnosis and non-operative treatment of gender dysphoria, were reviewed and summarized. Hadj-Moussa M, Ohl DA, Kuzon WM. Evaluation and Treatment of Gender Dysphoria to Prepare for Gender Confirmation Surgery. Sex Med Rev 2018;6:607-617.
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Affiliation(s)
| | - Dana A Ohl
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - William M Kuzon
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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Metastasio A, Negri A, Martinotti G, Corazza O. Transitioning Bodies. The Case of Self-Prescribing Sexual Hormones in Gender Affirmation in Individuals Attending Psychiatric Services. Brain Sci 2018; 8:E88. [PMID: 29757929 PMCID: PMC5977079 DOI: 10.3390/brainsci8050088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/24/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
Self-prescribing of sexual hormones for gender affirmation is a potentially widespread and poorly studied phenomenon that many clinicians are unaware of. The uncontrolled use of hormones poses significant health hazards, which have not been previously reported in the literature. We have collected seven clinical cases in general adult psychiatry settings (both inpatient and outpatients), describing transgender and gender non-conforming individuals' (TGNC) self-prescribing and self-administering hormones bought from the Internet without any medical consultation. Among these cases, two were taking androgens, and the rest were taking oestrogens. The main reason for self-administration of hormones seems to be the lack of access to specialised care due to discrimination and long waiting lists. We advocate for clinicians to be aware of the phenomenon and proactively help TGNC individuals by enquiring about self-prescribing of hormones, providing information and referring to the most appropriate treatment centre as well as encourage a public debate on the discrimination and the stigma that TGNC population suffer from. Overall, there is an urgent need for the implementation of different and innovative health care services for TGNC individuals as well as more targeted prevention strategies on such underreported and highly risky behaviours. Furthermore, it is necessary for every clinician involved in the care for TGNC people to be aware of their special needs and be able to be an allied and an advocate to help in reducing stigma and discrimination that affect the access to care for this often underserved population.
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Affiliation(s)
- Antonio Metastasio
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK.
- Centre for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
| | - Attilio Negri
- Centre for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
| | - Giovanni Martinotti
- Centre for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
- Department of Neuroscience, Imaging, and Clinical Science, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Ornella Corazza
- Centre for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
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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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Schneider F, Kliesch S, Schlatt S, Neuhaus N. Andrology of male-to-female transsexuals: influence of cross-sex hormone therapy on testicular function. Andrology 2017; 5:873-880. [DOI: 10.1111/andr.12405] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 12/24/2022]
Affiliation(s)
- F. Schneider
- Center of Reproductive Medicine and Andrology; Institute of Reproductive and Regenerative Medicine; Muenster Germany
- Department of Clinical Andrology; Center of Reproductive Medicine and Andrology; Muenster Germany
| | - S. Kliesch
- Department of Clinical Andrology; Center of Reproductive Medicine and Andrology; Muenster Germany
| | - S. Schlatt
- Center of Reproductive Medicine and Andrology; Institute of Reproductive and Regenerative Medicine; Muenster Germany
| | - N. Neuhaus
- Center of Reproductive Medicine and Andrology; Institute of Reproductive and Regenerative Medicine; Muenster Germany
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Lingiardi V, Giovanardi G. Challenges in assessing personality of individuals with Gender Dysphoria with the SWAP-200. J Endocrinol Invest 2017; 40:693-703. [PMID: 28238165 DOI: 10.1007/s40618-017-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/30/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Personality assessment can be useful to better understand the complexity of transgender and transsexual people. In particular, the Shedler Westen Assessment Procedure-200 (SWAP-200) is a measure that provides an accurate dimensional evaluation of personality. When assessing gender non-conforming people, however, clinicians can encounter some difficulties in giving appropriate ratings to all the items. PURPOSE OF THE REVIEW A brief guide to the use of SWAP-200 with transgender patients is provided, taking into account three areas of psychological functioning: identity, relationships and sexuality. The authors review, one by one, the SWAP-200 items related to these areas, and, relying on their clinical experience and on scientific literature on Gender Dysphoria, they propose recommendations for making personality diagnoses meaningful. CONCLUSION This paper facilitates a better clinical understanding of transgender people, and help clinicians to be more knowledgeable in the assessment of this heterogeneous population.
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Affiliation(s)
- V Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - G Giovanardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
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Joseph A, Cliffe C, Hillyard M, Majeed A. Gender identity and the management of the transgender patient: a guide for non-specialists. J R Soc Med 2017; 110:144-152. [PMID: 28382847 PMCID: PMC5407520 DOI: 10.1177/0141076817696054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between a person's natal sex (that assigned to them at birth) and gender identity results in distress, with high associated rates of self-harm, suicidality and functional impairment. We show that gender reassignment can be a safe and effective treatment for gender dysphoria with counselling, exogenous hormones and surgery being the mainstay of treatment. The role of the general practitioner in the management of transgender patients is discussed and we consider whether hormone therapy should be initiated in primary care in the absence of specialist advice, as is suggested by recent General Medical Council guidance.
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Affiliation(s)
- Albert Joseph
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Charlotte Cliffe
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Miriam Hillyard
- North West Thames Foundation School, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Castellano E, Crespi C, Dell'Aquila C, Rosato R, Catalano C, Mineccia V, Motta G, Botto E, Manieri C. Quality of life and hormones after sex reassignment surgery. J Endocrinol Invest 2015; 38:1373-81. [PMID: 26486135 DOI: 10.1007/s40618-015-0398-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Transpeople often look for sex reassignment surgery (SRS) to improve their quality of life (QoL). The hormonal therapy has many positive effects before and after SRS. There are no studies about correlation between hormonal status and QoL after SRS. AIM To gather information on QoL, quality of sexual life and body image in transpeople at least 2 years after SRS,to compare these results with a control group and to evaluate the relations between the chosen items and hormonal status. SUBJECTS AND METHODS Data from 60 transsexuals and from 60 healthy matched controls were collected. Testosterone,estradiol, LH and World Health Organization Quality of Life (WHOQOL-100) self-reported questionnaire were evaluated. Student’s t test was applied to compare transsexuals and controls. Multiple regression model was applied to evaluate WHOQOL’s chosen items and LH. RESULTS The QoL and the quality of body image scores intranspeople were not statistically different from the matched control groups’ ones. In the sexual life subscale,transwomen’s scores were similar to biological women’s ones, whereas transmen’s scores were statistically lower than biological men’s ones (P = 0.003). The quality of sexual life scored statistically lower in transmen than intranswomen (P = 0.048). A significant inverse relationship between LH and body image and between LH and quality of sexual life was found. CONCLUSIONS This study highlights general satisfaction after SRS. In particular, transpeople’s QoL turns out to be similar to Italian matched controls. LH resulted inversely correlated to body image and sexual life scores.
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