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Miramontes S, Pereda Serras C, Woldemariam SR, Khan U, Li Y, Tang AS, Tsoy E, Oskotsky TT, Sirota M. Alzheimer's disease as a women's health challenge: a call for action on integrative precision medicine approaches. NPJ WOMEN'S HEALTH 2024; 2:17. [PMID: 38778871 PMCID: PMC11106001 DOI: 10.1038/s44294-024-00021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
Alzheimer's Disease (AD) is marked by pronounced sex differences in pathophysiology and progression. However, the field has yet to fully recognize AD as a women's health issue, delaying the development of targeted preventative strategies and treatments. This perspective explores the elements impacting AD in women, identifying sex specificity in risk factors, highlighting new diagnostic approaches with electronic health records, and reviewing key molecular studies to underscore the need for integrative precision medicine approaches. Established AD risk factors such as advancing age, the apolipoprotein E4 allele, and poorer cardiovascular health affect women differently. We also shed light on sociocultural risk factors, focusing on the gender disparities that may play a role in AD development. From a biological perspective, sex differences in AD are apparent in biomarkers and transcriptomics, further emphasizing the need for targeted diagnostics and treatments. The convergence of novel multiomics data and cutting-edge computational tools provides a unique opportunity to study the molecular underpinnings behind sex dimorphism in AD. Thus, precision medicine emerges as a promising framework for understanding AD pathogenesis through the integration of genetics, sex, environment, and lifestyle. By characterizing AD as a women's health challenge, we can catalyze a transformative shift in AD research and care, marked by improved diagnostic accuracy, targeted interventions, and ultimately, enhanced clinical outcomes.
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Affiliation(s)
- S. Miramontes
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - C. Pereda Serras
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - S. R. Woldemariam
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - U. Khan
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - Y. Li
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - A. S. Tang
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - E. Tsoy
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA USA
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA USA
| | - T. T. Oskotsky
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
| | - M. Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
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2
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Draper L, Vikas A, Das S, Yadav S, Walker F, Bandilovska I. Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature. Case Rep Psychiatry 2024; 2024:5552781. [PMID: 38746078 PMCID: PMC11093682 DOI: 10.1155/2024/5552781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review. Materials and Methods Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline. Results The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies. Conclusion There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.
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Affiliation(s)
- Lachlan Draper
- North West Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Ashis Vikas
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Subhash Das
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Suresh Yadav
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Frances Walker
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
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3
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Geraci F, Passiatore R, Penzel N, Laudani S, Bertolino A, Blasi G, Graziano ACE, Kikidis GC, Mazza C, Parihar M, Rampino A, Sportelli L, Trevisan N, Drago F, Papaleo F, Sambataro F, Pergola G, Leggio GM. Sex dimorphism controls dysbindin-related cognitive dysfunctions in mice and humans with the contribution of COMT. Mol Psychiatry 2024:10.1038/s41380-024-02527-3. [PMID: 38532008 DOI: 10.1038/s41380-024-02527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
Cognitive dysfunctions are core-enduring symptoms of schizophrenia, with important sex-related differences. Genetic variants of the DTBPN1 gene associated with reduced dysbindin-1 protein (Dys) expression negatively impact cognitive functions in schizophrenia through a functional epistatic interaction with Catechol-O-methyltransferase (COMT). Dys is involved in the trafficking of dopaminergic receptors, crucial for prefrontal cortex (PFC) signaling regulation. Moreover, dopamine signaling is modulated by estrogens via inhibition of COMT expression. We hypothesized a sex dimorphism in Dys-related cognitive functions dependent on COMT and estrogen levels. Our multidisciplinary approach combined behavioral-molecular findings on genetically modified mice, human postmortem Dys expression data, and in vivo fMRI during a working memory task performance. We found cognitive impairments in male mice related to genetic variants characterized by reduced Dys protein expression (pBonferroni = 0.0001), as well as in male humans through a COMT/Dys functional epistatic interaction involving PFC brain activity during working memory (t(23) = -3.21; pFDR = 0.004). Dorsolateral PFC activity was associated with lower working memory performance in males only (p = 0.04). Also, male humans showed decreased Dys expression in dorsolateral PFC during adulthood (pFDR = 0.05). Female Dys mice showed preserved cognitive performances with deficits only with a lack of estrogen tested in an ovariectomy model (pBonferroni = 0.0001), suggesting that genetic variants reducing Dys protein expression could probably become functional in females when the protective effect of estrogens is attenuated, i.e., during menopause. Overall, our results show the differential impact of functional variants of the DTBPN1 gene interacting with COMT on cognitive functions across sexes in mice and humans, underlying the importance of considering sex as a target for patient stratification and precision medicine in schizophrenia.
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Affiliation(s)
- Federica Geraci
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Roberta Passiatore
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 21205, Baltimore, MD, USA
| | - Nora Penzel
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Samuele Laudani
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Psychiatric Unit - University Hospital, 70124, Bari, Italy
| | - Giuseppe Blasi
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Psychiatric Unit - University Hospital, 70124, Bari, Italy
| | - Adriana C E Graziano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Gianluca C Kikidis
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 21205, Baltimore, MD, USA
| | - Ciro Mazza
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Madhur Parihar
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 21205, Baltimore, MD, USA
| | - Antonio Rampino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Psychiatric Unit - University Hospital, 70124, Bari, Italy
| | - Leonardo Sportelli
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 21205, Baltimore, MD, USA
- Department of Human Genetics, Radboud University Nijmegen, 6525 GD, Nijmegen, The Netherlands
| | - Nicolò Trevisan
- Department of Neuroscience (DNS), University of Padova, 35121, Padova, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy
| | - Francesco Papaleo
- Genetics of Cognition Laboratory, Neuroscience area, Istituto Italiano di Tecnologia, Genova, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, 35121, Padova, Italy
| | - Giulio Pergola
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124, Bari, Italy
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 21205, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 21205, Baltimore, MD, USA
| | - Gian Marco Leggio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy.
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4
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Cartier L, Guérin M, Saulnier F, Cotocea I, Mohammedi A, Moussaoui F, Kheloui S, Juster RP. Sex and gender correlates of sexually polymorphic cognition. Biol Sex Differ 2024; 15:3. [PMID: 38191503 PMCID: PMC10773055 DOI: 10.1186/s13293-023-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Sexually polymorphic cognition (SPC) results from the interaction between biological (birth-assigned sex (BAS), sex hormones) and socio-cultural (gender identity, gender roles, sexual orientation) factors. The literature remains quite mixed regarding the magnitude of the effects of these variables. This project used a battery of classic cognitive tests designed to assess the influence of sex hormones on cognitive performance. At the same time, we aimed to assess the inter-related and respective effects that BAS, sex hormones, and gender-related factors have on SPC. METHODS We recruited 222 adults who completed eight cognitive tasks that assessed a variety of cognitive domains during a 150-min session. Subgroups were separated based on gender identity and sexual orientation and recruited as follows: cisgender heterosexual men (n = 46), cisgender non-heterosexual men (n = 36), cisgender heterosexual women (n = 36), cisgender non-heterosexual women (n = 38), gender diverse (n = 66). Saliva samples were collected before, during, and after the test to assess testosterone, estradiol, progesterone, cortisol, and dehydroepiandrosterone. Psychosocial variables were derived from self-report questionnaires. RESULTS Cognitive performance reflects sex and gender differences that are partially consistent with the literature. Interestingly, biological factors seem to better explain differences in male-typed cognitive tasks (i.e., spatial), while psychosocial factors seem to better explain differences in female-typed cognitive tasks (i.e., verbal). CONCLUSION Our results establish a better comprehension of SPC over and above the effects of BAS as a binary variable. We highlight the importance of treating sex as a biological factor and gender as a socio-cultural factor together since they collectively influence SPC.
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Affiliation(s)
- Louis Cartier
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
| | - Mina Guérin
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Fanny Saulnier
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
| | - Ioana Cotocea
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada
| | - Amine Mohammedi
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Fadila Moussaoui
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Sarah Kheloui
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Robert-Paul Juster
- Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal Mental Health University Institute, 7331, Rue Hochelaga, Montreal, QC, H1N 3V2, Canada.
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada.
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5
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Doyle DM, Lewis TOG, Barreto M. A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people. Nat Hum Behav 2023; 7:1320-1331. [PMID: 37217739 PMCID: PMC10444622 DOI: 10.1038/s41562-023-01605-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/12/2023] [Indexed: 05/24/2023]
Abstract
This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.
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Affiliation(s)
- David Matthew Doyle
- Department of Medical Psychology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands.
| | - Tom O G Lewis
- Department of Psychology, University of Exeter, Exeter, UK
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6
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Iwamoto SJ, Defreyne J, Kaoutzanis C, Davies RD, Moreau KL, Rothman MS. Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults. Ther Adv Endocrinol Metab 2023; 14:20420188231166494. [PMID: 37113210 PMCID: PMC10126651 DOI: 10.1177/20420188231166494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
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.
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Affiliation(s)
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Robert D. Davies
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- CUMedicine LGBTQ Mental Health Clinic, University of Colorado Hospital, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA
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Bennett-Pierre G, Gunderson EA. Fiber Arts Require Spatial Skills: How a Stereotypically Feminine Practice Can Help Us Understand Spatial Skills and Improve Spatial Learning. SEX ROLES 2022. [DOI: 10.1007/s11199-022-01340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Levin RN, Erickson-Schroth L, Mak K, Edmiston EK. Biological studies of transgender identity: A critical review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2127042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rachel N. Levin
- Departments of Biology and Neuroscience, Pomona College, Claremont, CA, USA
| | | | - Kristie Mak
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - E. Kale Edmiston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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Transwoman Elite Athletes: Their Extra Percentage Relative to Female Physiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159103. [PMID: 35897465 PMCID: PMC9331831 DOI: 10.3390/ijerph19159103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 12/03/2022]
Abstract
There is increasing debate as to whether transwoman athletes should be included in the elite female competition. Most elite sports are divided into male and female divisions because of the greater athletic performance displayed by males. Without the sex division, females would have little chance of winning because males are faster, stronger, and have greater endurance capacity. Male physiology underpins their better athletic performance including increased muscle mass and strength, stronger bones, different skeletal structure, better adapted cardiorespiratory systems, and early developmental effects on brain networks that wires males to be inherently more competitive and aggressive. Testosterone secreted before birth, postnatally, and then after puberty is the major factor that drives these physiological sex differences, and as adults, testosterone levels are ten to fifteen times higher in males than females. The non-overlapping ranges of testosterone between the sexes has led sports regulators, such as the International Olympic Committee, to use 10 nmol/L testosterone as a sole physiological parameter to divide the male and female sporting divisions. Using testosterone levels as a basis for separating female and male elite athletes is arguably flawed. Male physiology cannot be reformatted by estrogen therapy in transwoman athletes because testosterone has driven permanent effects through early life exposure. This descriptive critical review discusses the inherent male physiological advantages that lead to superior athletic performance and then addresses how estrogen therapy fails to create a female-like physiology in the male. Ultimately, the former male physiology of transwoman athletes provides them with a physiological advantage over the cis-female athlete.
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10
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Peragine DE, Gervais NJ, Simeon-Spezzaferro C, Einstein G. A new angle on mental rotation ability in transgender men: Modulation by ovarian milieu. Psychoneuroendocrinology 2022; 141:105751. [PMID: 35398751 DOI: 10.1016/j.psyneuen.2022.105751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Organizational/activational theory posits that transgender individuals should perform in the direction of their gender, not their sex, on cognitive tasks that show sex differences-the largest of which are observed on visuospatial tasks. Yet, tests of this hypothesis have been mixed for transgender men (TM). One possible reason is that performance shifts associated with the hormonal milieu at testing have not been fully considered in TM. Although "activating" influences, like gender-affirming hormone therapy (GAHT), are well-characterized in this population, endogenous ones, like ovarian cycling, have gone unaddressed. To provide a more complete picture of hormonal activation, we explored an influence of ovarian milieu on visuospatial performance of TM, and its potential contributions toward effects of sex and GAHT. We administered two male-favoring mental rotation tests (MRTs), and a sex-neutral control task to 22 TM naïve to GAHT (TM-), 29 TM receiving GAHT (TM+), and cisgender men (CM; n = 24) and women (CW; n = 43), testing cycling men (TM-) and women (CW) in either early follicular phase (Follicular) or midluteal phase (Luteal). On MRTs, performance of TM- varied across the menstrual cycle, and matched that of menstrual phase-matched CW. Additionally, cycling individuals in Follicular performed as strongly as TM+ and CM, all of whom performed above individuals in Luteal. Effects did not extend to a verbal control task, on which TM+ performed below others. Rather than conforming to static categories that suggest sex- or gender-typical organization of cognitive circuits, our findings support dynamic shifts in visuospatial ability of TM, and illustrate the need to consider activating effects of hormones beyond GAHT.
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Affiliation(s)
- Diana E Peragine
- Department of Psychology, University of Toronto, Toronto, M5S 3G3 Canada.
| | - Nicole J Gervais
- Department of Psychology, University of Toronto, Toronto, M5S 3G3 Canada; Rotman Research Institute, Baycrest Hospital, Toronto, M6A 2E1 Canada
| | | | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, M5S 3G3 Canada; Rotman Research Institute, Baycrest Hospital, Toronto, M6A 2E1 Canada; Women's College Research Institute, Women's College Hospital, Toronto, M5G 1N8 Canada; Tema Genus, Linköping University, Linköping SE-581 83, Sweden
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11
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Padilha MI, Caravaca-Morera JA, Gentil AGB, Dal Vesco SNP, Bellaguarda MLDR, Silva A. Transgender people in the nursing discourse: An integrative review. J Adv Nurs 2022; 78:2731-2746. [PMID: 35748098 DOI: 10.1111/jan.15318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 05/15/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To integrate and analyse the literature produced by nurses in terms of care, education and understanding of the reality of transgender (trans) people. DESIGN An integrative review methodology guided by the framework proposed by Whittemore and Knafl. DATA SOURCES The search strategy was applied in the following databases: Medline, Embase, Scopus, Web of Science and CINAHL, as well as in Biblioteca Virtual de Saúde, during February and March 2021, with no time frame. REVIEW METHODS The references found were assessed according to the eligibility criteria established. The information of the articles included was extracted, and a thematic analysis was performed to synthesize the review findings. RESULTS The searches in the databases yielded 2859 articles; 985 after removing duplicates, and 33 articles were included in this review. Three major themes were identified: (1) Understanding the trans universe through the trans perspective; (2) Understanding health and nursing care for trans people; and (3) Trans women as the focus of health and nursing care. The themes evidenced in the lens of nurses and clients the importance of nursing training at all levels to prepare professionals on how to provide culturally competent nursing care for this population and reduce healthcare inequities. CONCLUSION Nurses must work to provide a space for convergence and enhancement of the rights of trans people and cease to be a verticalized care model. To such end, it is necessary to devise places and possibilities to teach and learn, to construct and reconstruct a culturally competent nursing care. IMPACT This review highlighted the current knowledge and identified gaps in the understanding of nurses, health professionals and students about the experience lived by trans people, resulting from the lack of training and continuing education of these professionals.
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12
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Jett S, Malviya N, Schelbaum E, Jang G, Jahan E, Clancy K, Hristov H, Pahlajani S, Niotis K, Loeb-Zeitlin S, Havryliuk Y, Isaacson R, Brinton RD, Mosconi L. Endogenous and Exogenous Estrogen Exposures: How Women's Reproductive Health Can Drive Brain Aging and Inform Alzheimer's Prevention. Front Aging Neurosci 2022; 14:831807. [PMID: 35356299 PMCID: PMC8959926 DOI: 10.3389/fnagi.2022.831807] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 01/14/2023] Open
Abstract
After advanced age, female sex is the major risk factor for late-onset Alzheimer's disease (AD), the most common cause of dementia affecting over 24 million people worldwide. The prevalence of AD is higher in women than in men, with postmenopausal women accounting for over 60% of all those affected. While most research has focused on gender-combined risk, emerging data indicate sex and gender differences in AD pathophysiology, onset, and progression, which may help account for the higher prevalence in women. Notably, AD-related brain changes develop during a 10-20 year prodromal phase originating in midlife, thus proximate with the hormonal transitions of endocrine aging characteristic of the menopause transition in women. Preclinical evidence for neuroprotective effects of gonadal sex steroid hormones, especially 17β-estradiol, strongly argue for associations between female fertility, reproductive history, and AD risk. The level of gonadal hormones to which the female brain is exposed changes considerably across the lifespan, with relevance to AD risk. However, the neurobiological consequences of hormonal fluctuations, as well as that of hormone therapies, are yet to be fully understood. Epidemiological studies have yielded contrasting results of protective, deleterious and null effects of estrogen exposure on dementia risk. In contrast, brain imaging studies provide encouraging evidence for positive associations between greater cumulative lifetime estrogen exposure and lower AD risk in women, whereas estrogen deprivation is associated with negative consequences on brain structure, function, and biochemistry. Herein, we review the existing literature and evaluate the strength of observed associations between female-specific reproductive health factors and AD risk in women, with a focus on the role of endogenous and exogenous estrogen exposures as a key underlying mechanism. Chief among these variables are reproductive lifespan, menopause status, type of menopause (spontaneous vs. induced), number of pregnancies, and exposure to hormonal therapy, including hormonal contraceptives, hormonal therapy for menopause, and anti-estrogen treatment. As aging is the greatest risk factor for AD followed by female sex, understanding sex-specific biological pathways through which reproductive history modulates brain aging is crucial to inform preventative and therapeutic strategies for AD.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Niharika Malviya
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Grace Jang
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Jahan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Katherine Clancy
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Kellyann Niotis
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
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13
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O’Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC. Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents. J Clin Endocrinol Metab 2022; 107:241-257. [PMID: 34476487 PMCID: PMC8684462 DOI: 10.1210/clinem/dgab634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Internationally, increasing numbers of children and adolescents with gender dysphoria are presenting for care. In response, gender-affirming therapeutic interventions that seek to align bodily characteristics with an individual's gender identity are more commonly being used. Depending on a young person's circumstances and goals, hormonal interventions may aim to achieve full pubertal suppression, modulation of endogenous pubertal sex hormone effects, and/or development of secondary sex characteristics congruent with their affirmed gender. This is a relatively novel therapeutic area and, although short-term outcomes are encouraging, longer term data from prospective longitudinal adolescent cohorts are still lacking, which may create clinical and ethical decision-making challenges. Here, we review current treatment options, reported outcomes, and clinical challenges in the pharmacological management of trans and gender-diverse adolescents.
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Affiliation(s)
- Michele A O’Connell
- Department of Endocrinology and Diabetes, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Department of Adolescent Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence: Michele A. O’Connell, FRACP, MD, Department of Endocrinology and Diabetes, The Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Thomas P Nguyen
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital Basel, Basel, Switzerland
| | - S Rachel Skinner
- Speciality of Child and Adolescent Health, Faculty of Medicine and Health, Sydney University, Children’s Hospital Westmead, NSW 2145, Australia
| | - Ken C Pang
- Department of Adolescent Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
- Walter and Eliza Hall Institute for Medical Research, Parkville, VIC 3052, Australia
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14
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Burgund ED. Task-domain and hemisphere-asymmetry effects in cisgender and transmale individuals. PLoS One 2021; 16:e0260542. [PMID: 34874973 PMCID: PMC8651105 DOI: 10.1371/journal.pone.0260542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
The present research examined the extent to which transmale individuals’ functional brain organization resembles that of their assigned sex or gender identity. Cisgender-female, cisgender-male, and transmale participants, who were assigned female sex but did not have a female gender identity, were compared in terms of effects that have been observed in cisgender individuals: task-domain effects, in which males perform better than females on spatial tasks and females perform better than males on verbal tasks; and hemisphere-asymmetry effects, in which males show larger differences between the left and right hemispheres than females. In addition, the present research measured participants’ intelligence in order to control for potential moderating effects. Participants performed spatial (mental rotation) and verbal (lexical decision) tasks presented to each hemisphere using a divided-visual field paradigm, and then completed an intelligence assessment. In the mental-rotation task, cismale and transmale participants performed better than cisfemale participants, however this group difference was explained by intelligence scores, with higher scores predicting better performance. In the lexical-decision task, cismale and transmale participants exhibited a greater left-hemisphere advantage than cisfemales, and this difference was not affected by intelligence scores. Taken together, results do not support task-domain effects when intelligence is accounted for; however, they do demonstrate a hemisphere-asymmetry effect in the verbal domain that is moderated by gender identity and not assigned sex.
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Affiliation(s)
- E. Darcy Burgund
- Department of Psychology, Macalester College, Saint Paul, Minnesota, United States of America
- * E-mail:
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15
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Hamilton BR, Guppy FM, Barrett J, Seal L, Pitsiladis Y. Integrating transwomen athletes into elite competition: The case of elite archery and shooting. Eur J Sport Sci 2021; 21:1500-1509. [PMID: 34077312 DOI: 10.1080/17461391.2021.1938692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The inclusion of transwomen into elite female sport has been brought into question recently with World Rugby banning transwomen from the elite female competition, aiming to prioritise safety over fairness and inclusion, citing the size, force and power-producing advantages conferred to transwomen. The same question is being asked of all Olympic sports including non-contact sports such as archery and shooting. As both these Olympic sports are the polar opposite to the contact sport of rugby in terms of the need to consider the safety of athletes, the IF of both archery and shooting should consider the other elements when deciding the integration of trans individuals in their sports. Studies on non-athletic transwomen have reported muscle mass and strength loss in the range of 5-10% after 1 year of their transition, with these differences no longer apparent after 2 years. Therefore, based on the current scientific literature, it would be justified for meaningful competition and to prioritise fairness, that transwomen be permitted to compete in elite archery after 2 years of GAT. Similarly, it would be justified in terms of shooting to prioritise inclusion and allow transwomen after 1 year of GAT given that the only negligible advantage that transwomen may have is superior visuospatial coordination. The impact of this considered integration of transwomen in elite sports such as archery and shooting could be monitored and lessons learned for other sports, especially where there are no safety concerns from contact with an opponent.
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Affiliation(s)
- Blair R Hamilton
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK.,The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Fergus M Guppy
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK
| | - James Barrett
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Leighton Seal
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Yannis Pitsiladis
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK.,University of Rome "Foro Italico", Rome, Italy.,Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy.,European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
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16
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Kheloui S, Rossi M, Jacmin-Park S, Larocque O, Vallée M, Kerr P, Bourdon O, Juster RP. Psychoneuroendocrine protocol to comprehensively study sexually dimorphic cognition. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 6:100050. [PMID: 35757359 PMCID: PMC9216706 DOI: 10.1016/j.cpnec.2021.100050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background A large body of research provides evidence for sex differences in cognitive abilities. These sex differences stem from the interplay between biological sex (e.g., birth-assigned sex, sex hormones) and psychosocial gender (e.g., gender identity, gender-roles, sexual orientation). Literature remains rather mixed with regards to the magnitude of sex and gender effects on cognitive abilities and mental health. Growing evidence shows that sex hormone assessment combined with measures of psychosocial gender may be fundamental to comprehensively understand individual differences in sexually dimorphic cognitive abilities. Objectives This study protocol describes a sexually dimorphic cognitive battery to assess the influence of sex hormones on performance. In parallel, we aim to assess the inter-related effects that biological sex and psychosocial gender-based factors exert on cognition and mental health. Methods Our projected sample includes 180 adult participants who are at least 18 years old. Sub-groups will be recruited based on birth-assigned sex, gender identity, and sexual orientation. Biological measures will be collected via salivary samples throughout testing to include sex hormones (testosterone, estradiol and progesterone) and stress hormones (cortisol). Demographic and psychosocial variables will be measured through self-report questionnaires. Participants will be required to complete eight classic cognitive tasks that assess a variety of cognitive domains in a 2-h testing session. Results and future directions Results from this study provides unique insights into the correlates of cognitive sex differences and gender diversity. This will give us solid ground to further investigate these influences in clinical populations in which sex hormones and cognitive functioning are often altered. Cognition is modulated by multiple sex and gender factors. Cognitive abilities will be assessed among 180 adults representing diverse sexual orientations and gender identities. This protocol aims to nuance the effects of sex hormones in contrast to those of socio-cultural gender.
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Affiliation(s)
- Sarah Kheloui
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Mathias Rossi
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Silke Jacmin-Park
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Ophélie Larocque
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Morgan Vallée
- Department of Sociology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Philippe Kerr
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Olivier Bourdon
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Canada
- Center on Sex∗Gender, Allostasis and Resilience, Canada
- Corresponding author. Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal Centre de recherche de l’Institut universitaire en santé mentale de Montréal 7331 Hochelaga Street, H1N 3V2, Montreal, Quebec, Canada.
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17
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Hamilton BR, Lima G, Barrett J, Seal L, Kolliari-Turner A, Wang G, Karanikolou A, Bigard X, Löllgen H, Zupet P, Ionescu A, Debruyne A, Jones N, Vonbank K, Fagnani F, Fossati C, Casasco M, Constantinou D, Wolfarth B, Niederseer D, Bosch A, Muniz-Pardos B, Casajus JA, Schneider C, Loland S, Verroken M, Marqueta PM, Arroyo F, Pedrinelli A, Natsis K, Verhagen E, Roberts WO, Lazzoli JK, Friedman R, Erdogan A, Cintron AV, Yung SHP, Janse van Rensburg DC, Ramagole DA, Rozenstoka S, Drummond F, Papadopoulou T, Kumi PYO, Twycross-Lewis R, Harper J, Skiadas V, Shurlock J, Tanisawa K, Seto J, North K, Angadi SS, Martinez-Patiño MJ, Borjesson M, Di Luigi L, Dohi M, Swart J, Bilzon JLJ, Badtieva V, Zelenkova I, Steinacker JM, Bachl N, Pigozzi F, Geistlinger M, Goulis DG, Guppy F, Webborn N, Yildiz BO, Miller M, Singleton P, Pitsiladis YP. Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement. Sports Med 2021; 51:1401-1415. [PMID: 33761127 PMCID: PMC7988249 DOI: 10.1007/s40279-021-01451-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.
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Affiliation(s)
- Blair R Hamilton
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Giscard Lima
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - James Barrett
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Leighton Seal
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Guan Wang
- Sport and Exercise Science and Sports Medicine Research and Enterprise Group, University of Brighton, Brighton, UK
| | - Antonia Karanikolou
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
| | - Xavier Bigard
- Union Cycliste Internationale (UCI), Aigle, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Petra Zupet
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Andre Debruyne
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Nigel Jones
- British Association Sport and Exercise Medicine, Doncaster, UK
- British Cycling and University of Liverpool, Liverpool, UK
| | - Karin Vonbank
- Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic (KIMII), University of Vienna, Vienna, Austria
| | - Federica Fagnani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Maurizio Casasco
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Italian Federation of Sports Medicine (FMSI), Rome, Italy
| | - Demitri Constantinou
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Centre for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Centre, University of Zurich, Zurich, Switzerland
| | - Andrew Bosch
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Borja Muniz-Pardos
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - José Antonio Casajus
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Christian Schneider
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Orthopaedic Center Theresie, Munich, Germany
| | - Sigmund Loland
- Department of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - Michele Verroken
- Centre of Research and Innovation for Sport, Technology and Law (CRISTAL), De Montfort University, Leicester, UK
- Sporting Integrity Ltd, Stoke Mandeville, UK
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, San Antonio Catholic University of Murcia, Murcia, Spain
| | - Francisco Arroyo
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaborating Center of Sports Medicine, Guadalajara, Mexico
| | - André Pedrinelli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Orthopaedics, University of São Paulo Medical School, São Paulo, Brazil
| | - Konstantinos Natsis
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Interbalkan Medical Center, FIMS Collaborating Center of Sports Medicine, Thessaloniki, Greece
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - William O Roberts
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - José Kawazoe Lazzoli
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Biomedical Institute, Fluminense Federal University Medical School, Niterói, Brazil
| | - Rogerio Friedman
- Universidade Federal do Rio Grande do Sul, Endocrine Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Ali Erdogan
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Gloria Sports Arena, FIMS Collaborating Centre of Sports Medicine, Antalya, Turkey
| | - Ana V Cintron
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Puerto Rico Sports Medicine Federation, San Juan, Puerto Rico
| | - Shu-Hang Patrick Yung
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Asian Federation of Sports Medicine (AFSM), Hong Kong Center of Sports Medicine and Sports Science, Hong Kong, China
| | | | - Dimakatso A Ramagole
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sandra Rozenstoka
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaboration Centre of Sports Medicine, Sports laboratory, Riga, Latvia
| | - Felix Drummond
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- FIMS Collaboration Centre of Sports Medicine, Instituto de Medicina do Esporte, Porto Alegre, Brazil
| | - Theodora Papadopoulou
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
| | - Paulette Y O Kumi
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Joanna Harper
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | | | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Jane Seto
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kathryn North
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Siddhartha S Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | | | - Mats Borjesson
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Center for Health and Performance, Goteborg University, Göteborg, Sweden
- Sahlgrenska University Hospital/Ostra, Region of Western Sweden, Göteborg, Sweden
| | - Luigi Di Luigi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michiko Dohi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | - James Lee John Bilzon
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department for Health, University of Bath, Bath, UK
| | - Victoriya Badtieva
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
- Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Irina Zelenkova
- GENUD Research Group, FIMS Collaborating Center of Sports Medicine, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Juergen M Steinacker
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Norbert Bachl
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Michael Geistlinger
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fergus Guppy
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Nick Webborn
- School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mike Miller
- World Olympian Association, Lausanne, Switzerland
| | | | - Yannis P Pitsiladis
- Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy.
- Centre for Stress and Age-Related Disease, University of Brighton, Brighton, UK.
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.
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18
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Geist C, Greenberg KB, Luikenaar RAC, Mihalopoulos NL. Pediatric Research and Health Care for Transgender and Gender Diverse Adolescents and Young Adults: Improving (Biopsychosocial) Health Outcomes. Acad Pediatr 2021; 21:32-42. [PMID: 32980544 DOI: 10.1016/j.acap.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023]
Abstract
Adolescent and young adult (AYA) transgender health care and research have expanded rapidly in the United States and abroad, but the effects of gender-affirming social, hormonal, or surgical care on overall health remain unclear. Gender diverse identities, also termed nonbinary, have often been neglected in favor of (male/female) binary identities, even in the context of transgender health care and research. No high quality studies have assessed how gender-affirming medical care impact health inequities in transgender and gender diverse (TG/GD) adults, much less in AYAs, despite the fact that that TG/GD adults have higher than average morbidity and mortality across a host of health concerns, from human immunodeficiency virus infection to thromboembolism, and that reported depression with suicidal ideation is >10 times higher in TG/GD adults than in the general population. TG/GD youth have related but different needs from TG/GD adults. TG/GD AYA are embedded in family and schools, where stigma may be difficult to escape; mental health during adolescence has areas of increased risk as well as resilience; and the effects of early hormonal and surgical interventions on long-term health are insufficiently studied. Because of this, an inclusive and proactive approach to addressing the needs of TG/GD AYA by pediatric clinicians, researchers, and educators is particularly crucial. This article focuses on what is known and unknown about clinical practice, research, and education related to TG/GD health. We highlight the role of gender affirmation by clinicians as they care and advocate for TG/GD AYAs; the potential challenges of hormonal treatment for peripubertal youth; and short- and long-term effects on physical and reproductive health of medical or surgical interventions. We also discuss how social context influences knowledge gaps and the health-relevant risks faced by TG/GD AYA. The challenges are formidable, but opportunities await: high priority research questions to explore, educational gaps to be filled, and advocacy that needs the voices of pediatricians to promote policies to facilitate positive health outcomes for TG/GD AYA.
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Affiliation(s)
- Claudia Geist
- Division of Gender Studies, Department of Sociology (C Geist), University of Utah, Salt Lake City, Utah
| | - Katherine B Greenberg
- Departments of Pediatrics and Obstetrics/Gynecology (KB Greenberg), University of Rochester, Rochester, NY
| | | | - Nicole L Mihalopoulos
- Department of Pediatrics (NL Mihalopoulos), University of Utah, Salt Lake City, Utah.
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Montes-Galdeano F, Roman P, Ropero-Padilla C, Romero-López A, Ruiz-González C, Rodriguez-Arrastia M. Improving the care management of trans patients: Focus groups of nursing students' perceptions. J Nurs Manag 2020; 29:75-84. [PMID: 32969544 DOI: 10.1111/jonm.13160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
AIM To know the perspectives of nursing students in trans patients' care and their access to health services and how to improve the quality of care in trans patients, related to the barriers identified by nursing students. BACKGROUND Lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) find barriers related to the health care access, including stigma, discrimination and lack of education. In addition, to the transphobia reported in some health care providers. METHODS A descriptive qualitative study was performed through 12 focus group interviews in nursing students. Data analysis was based on content analysis. RESULTS 124 first-year nursing students participated. The qualitative analysis resulted in three major themes: (a) Exposing an invisible reality, (b) Interprofessional communication: a starting point to arise awareness and (c) Care with pride as a link between individuality and professionalism. CONCLUSIONS Our findings suggest that both LGBTQ+ content and institutional resources are the cornerstone for nursing students and professionals' practice in order to develop and provide a well-informed and high-quality care delivery to these patients. IMPLICATIONS FOR NURSING MANAGEMENT Policymakers, senior charge nurses and other managers should be aware of the structural-level changes identified and ongoing mentoring needed to guarantee trans patients' privacy and safety.
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Affiliation(s)
- Francisco Montes-Galdeano
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, Almeria, Spain.,Torrecardenas University Hospital, Almeria, Spain
| | - Pablo Roman
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, Almeria, Spain.,Health Research Centre, University of Almeria, Almeria, Spain.,Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain
| | - Carmen Ropero-Padilla
- Pre-Department of Nursing, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain.,Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
| | - Agustín Romero-López
- Department of Geography, History and Humanities, Faculty of Humanities, University of Almeria, Almeria, Spain.,Research Group HUM-472 Laboratory of Social and Cultural Anthropology, University of Almeria, Almeria, Spain
| | - Cristofer Ruiz-González
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almeria, Almeria, Spain.,Torrecardenas University Hospital, Almeria, Spain
| | - Miguel Rodriguez-Arrastia
- Pre-Department of Nursing, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain.,Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
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