Minimizing Venous Thromboembolism in Feminizing Hormone Therapy: Applying Lessons From Cisgender Women and Previous Data

Multidisciplinary management of sexual and gender minorities with bladder cancer

Bladder cancer, a common urologic malignancy, has poor morbidity and mortality in sexual and gender minority (SGM) individuals, stemming from higher risk, poor access to care and lack of quality cancer care. To begin addressing this disparity, this review offers key considerations for evaluation, diagnosis and treatment of SGM individuals with bladder cancer. In addition to thorough medical and surgical history, initial evaluation should include discussion of patient goals for sexual function and organ preservation, as well as an evaluation of sexual function. Prior gender affirming surgery and patient specific sexual function goals will impact diagnosis and treatment approaches, including surgical and radiation therapy. Throughout care for SGM individuals with bladder cancer, it is critical to acknowledge the systemic discrimination that may be experienced by these individuals and approach conversations with sensitivity and humility and incorporate mental and social support as appropriate.

A Call for Updates to Hormone Therapy Guidelines for Gender-Diverse Adults Assigned Male at Birth

Gender-affirming hormone therapy for assigned male at birth (AMAB) individuals with gender incongruence typically consists of estradiol with or without an anti-androgen to achieve physical changes and psychological benefits. However, prescribed hormone regimens vary considerably, and high-quality research in this area is extremely limited. Additional evidence-based research evaluating patient-reported outcome measures (PROMs) is needed to fill current knowledge gaps and create a personalized therapeutic approach for AMAB individuals. This editorial provides a critical description of current treatment options, discusses their variability, reviews some discrepancies in guideline-based dosing recommendations, and recommends areas for further study.

Facial Feminization: Middle Third of the Face

Facial feminization surgery (FFS) as applied to the midfacial region targets modifications to the nasal and malar esthetic complexes. Although a global assessment is paramount in achieving desired functional results, most patients benefit from malar feminization in the form of bony and soft tissue augmentation, and nasal feminization in the form of reductive rhinoplasty. For patients with signs of aging, additional interventions in the form of rhytidectomy are powerful adjuncts to feminization. As with FFS techniques directed toward the upper and lower thirds, the overarching goal is to obtain complementary outcomes that enhance facial harmony and beauty.

Approach to the Patient: Hormonal Therapy in Transgender Adults With Complex Medical Histories

While endocrinologists continue to initiate gender-affirming hormone therapy (GAHT) in healthy transgender and gender diverse (TGD) patients, they may also encounter more TGD patients in their clinics with complex medical histories that influence the patient-provider shared decision-making process for initiating or continuing GAHT. The purpose of this Approach to the Patient article is to describe management considerations in 2 adults with thromboembolic disease and 2 adults with low bone mineral density in the setting of feminizing and masculinizing GAHT.

A Urologist's Guide to Caring for Transgender and Gender Diverse Patients

Urologists are experts in the fields of genital and pelvic anatomy, sexual health and reproductive medicine. As such, a working understanding of urologic conditions relevant to transgender and gender diverse patients should be expected within their scope of practice. Herein, we describe an introductory framework for general urologists to grow their knowledge of the appropriate terminology, anatomy, and basic tenets of gender-affirming care to better manage the urologic needs of transgender and gender diverse patients.

Update in Adult Transgender Medicine

Transgender people often face barriers in health care due to lack of access to care, lack of knowledgeable healthcare professionals, discrimination, and gaps in medical and mental health research. Existing research on transgender health has focused heavily on mental health, HIV/AIDS, sexually transmitted diseases/infections, and substance abuse. Gender-affirming hormone therapy and/or surgery allows for some alignment of biology and gender identity. Gender-affirming care may offer quality-of-life benefits, which may outweigh modest concerns related to exogenous hormone therapy. The Endocrine Society treatment guidelines were revised in 2017, and this article reviews recent data that might inform a future guideline revision. Future longitudinal research is needed to close the gap in knowledge in the field of transgender medicine.

Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults

As the transgender and gender diverse (TGD) population ages, more transfeminine and transmasculine individuals present to clinic to initiate or continue their gender-affirming care at older ages. Currently available guidelines on gender-affirming care are excellent resources for the provision of gender-affirming hormone therapy (GAHT), primary care, surgery, and mental health care but are limited in their scope as to whether recommendations require tailoring to older TGD adults. Data that inform guideline-recommended management considerations, while informative and increasingly evidence-based, mainly come from studies of younger TGD populations. Whether results from these studies, and therefore recommendations, can or should be extrapolated to aging TGD adults remains to be determined. In this perspective review, we acknowledge the lack of data in older TGD adults and discuss considerations for evaluating cardiovascular disease, hormone-sensitive cancers, bone health and cognitive health, gender-affirming surgery, and mental health in the older TGD population on GAHT.

Gender-Affirming Hormone Therapy: What the Head and Neck Surgeon Should Know

The use of gender-affirming hormone therapy is found almost universally in transgendered and nonbinary patients presenting for gender-affirming surgical procedures of the face, neck, and voice. Surgeons caring for this population need to be aware of the effects, reasonable expectations, and limitations as well as potential perioperative risks of both continuation and discontinuation of hormone therapy.

An introduction to gender-affirming hormone therapy for transgender and gender-nonbinary patients

ABSTRACT

Transgender and gender-nonbinary patients may present to primary care providers seeking gender-affirming hormone therapy. Patients who meet criteria for diagnosis of gender incongruence may start or continue hormone therapy after providing informed consent. Prescribing and monitoring of masculinizing and feminizing hormone therapy can be managed in primary care settings.