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Choy DMY, Voon LW, Teoh SCB. UNUSUAL CAUSE OF BRANCH RETINAL ARTERY OCCLUSION: POLYCYTHEMIA IN A TRANSGENDER MAN FROM UNREGULATED TESTOSTERONE USE. Retin Cases Brief Rep 2022; 16:145-148. [PMID: 31464822 DOI: 10.1097/icb.0000000000000924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We report a transgender patient with branch retinal artery occlusion who had secondary polycythemia from unregulated testosterone injections and review the literature on the mechanisms of supraphysiologic and standard doses of testosterone causing a hypercoagulable state. METHODS Case report. RESULTS A 45-year-old Chinese transgender man with no medical history presented with a 1-week history of a scotoma in his left eye vision. Ophthalmologic examination revealed retinal pallor and edema along the superotemporal arteriole in the left eye. Optical coherence tomography showed increased thickness of the inner retinal layers of the superotemporal retina. Fluorescein angiography demonstrated an arm-retina time of 1 minute and 43 seconds, with no vascular sheathing and capillary fallout. A diagnosis of left superotemporal branch retinal artery occlusion was made. Initial blood tests revealed a hemoglobin level of 19.3 g/dL (11.8-14.6 g/dL), hematocrit of 62% (34.3-43.0%), and erythrocytes of 6.56 × 1012/L (3.7-4.8 × 1012/L). He revealed later that he had been on weekly testosterone injections (testosterone enanthate 250-mg depot injection) since 2011. He was also exposed to a moderately high altitude, when his symptoms occurred, raising the possibility of worsening hypercoagulability resulting in his thrombotic event. CONCLUSION To the best of our knowledge, this is the first documented case of a trans man who developed branch retinal artery occlusion after self-administering supraphysiological doses of testosterone. In a young patient with no history of cardiovascular risk factors who develops retinal arterial occlusion, other causes such as hypercoagulable syndromes must be excluded. This case warns of the dangers of unregulated testosterone use, especially at supraphysiologic doses, and the risks of thrombotic events from secondary polycythemia.
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Affiliation(s)
| | | | - Stephen C B Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Eagle Eye Centre, Mt Alvernia Hospital, Singapore
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Abstract
Individuals who identify with a gender not typically associated with their sex assigned at birth are a growing population worldwide. Guidelines to help healthcare providers navigate the care of gender minorities (GMs) are often aimed at primary care providers and may be too general for subspecialists. Pulmonologists may see GM individuals for a variety of reasons, and no reference exists that contains relevant information about GM-specific care, including unique conditions to consider. A systematic review was completed to identify unique characteristics in caring for GM patients with a pulmonary complaint.
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Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy. J Clin Med 2019; 8:jcm8060784. [PMID: 31159456 PMCID: PMC6616494 DOI: 10.3390/jcm8060784] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/16/2022] Open
Abstract
This study seeks to evaluate the long-term effects of pharmacologic therapy on the bone markers and bone mineral density of transgender patients and to provide a basis for understanding its potential implications on therapies involving implant procedures. Following the referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and well-defined PICOT (Problem/Patient/Population, Intervention, Comparison, Outcome, Time) questionnaires, a literature search was completed for articles in English language, with more than a 3 year follow-up reporting the long-term effects of the cross-sex pharmacotherapy on the bones of adult transgender patients. Transgender demographics, time under treatment, and treatment received were recorded. In addition, bone marker levels (calcium, phosphate, alkaline phosphatase, and osteocalcin), bone mineral density (BMD), and bone turnover markers (Serum Procollagen type I N-Terminal pro-peptide (PINP), and Serum Collagen type I crosslinked C-telopeptide (CTX)) before and after the treatment were also recorded. The considerable variability between studies did not allow a meta-analysis. All the studies were completed in European countries. Transwomen (921 men to female) were more frequent than transmen (719 female to male). Transwomen's treatments were based in antiandrogens, estrogens, new drugs, and sex reassignment surgery, meanwhile transmen's surgeries were based in the administration of several forms of testosterone and sex reassignment. Calcium, phosphate, alkaline phosphatase, and osteocalcin levels remained stable. PINP increased in transwomen and transmen meanwhile, CTX showed contradictory values in transwomen and transmen. Finally, reduced BMD was observed in transwomen patients receiving long-term cross-sex pharmacotherapy. Considering the limitations of this systematic review, it was concluded that long-term cross-sex pharmacotherapy for transwomen and transmen transgender patients does not alter the calcium, phosphate, alkaline phosphatase, and osteocalcin levels, and will slightly increase the bone formation in both transwomen and transmen patients. Furthermore, long-term pharmacotherapy reduces the BMD in transwomen patients.
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4
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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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Lood Y, Aardal-Eriksson E, Webe C, Ahlner J, Ekman B, Wahlberg J. Relationship between testosterone in serum, saliva and urine during treatment with intramuscular testosterone undecanoate in gender dysphoria and male hypogonadism. Andrology 2017; 6:86-93. [DOI: 10.1111/andr.12435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 09/08/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Lood
- National Board of Forensic Medicine; Department of Forensic Genetics and Forensic Toxicology; Linköping Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - E. Aardal-Eriksson
- Division of Clinical Chemistry; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - C. Webe
- Department of Endocrinology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Ahlner
- National Board of Forensic Medicine; Department of Forensic Genetics and Forensic Toxicology; Linköping Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - B. Ekman
- Department of Endocrinology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Wahlberg
- Department of Endocrinology; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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6
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Affiliation(s)
- Wesley Chan
- Department of Opthalmology and Visual Sciences (Chan), Queen Elizabeth II Health Sciences Centre, Halifax, NS; Stettler Medical Clinic (Drummond), Stettler, Alta.; Department of Family Medicine (Kelly); University of Calgary Cumming School of Medicine, Calgary, Alta
| | - Alasdair Drummond
- Department of Opthalmology and Visual Sciences (Chan), Queen Elizabeth II Health Sciences Centre, Halifax, NS; Stettler Medical Clinic (Drummond), Stettler, Alta.; Department of Family Medicine (Kelly); University of Calgary Cumming School of Medicine, Calgary, Alta
| | - Martina Kelly
- Department of Opthalmology and Visual Sciences (Chan), Queen Elizabeth II Health Sciences Centre, Halifax, NS; Stettler Medical Clinic (Drummond), Stettler, Alta.; Department of Family Medicine (Kelly); University of Calgary Cumming School of Medicine, Calgary, Alta.
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7
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The transgender patient in primary care: practical advice for a 10-minute consultation. BJGP Open 2017; 1:bjgpopen17X101001. [PMID: 30564674 PMCID: PMC6169934 DOI: 10.3399/bjgpopen17x101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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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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Abstract
Studies of tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC)-based preexposure prophylaxis (PrEP) have not focused on transgendered women who are at disproportionate risk of HIV acquisition. Concerns exist for drug interactions between cross-sex therapy (estradiol, progestins, and spironolactone) with tenofovir disoproxil fumarate-emtricitabine. This review assessed the experimental and theoretical risk for such drug interactions. It was found that none of these medications are implicated as major perpetrators of drug interactions, and the classes use different metabolic pathways for clearance, suggesting a low likelihood for interactions in either direction. Subanalyses of transgender women in Preexposure Prophylaxis Initiative suggested PrEP efficacy if adherence was high. Nevertheless, several research gaps were identified, particularly the need for controlled interaction studies in transgendered women, including effects on renal clearance, intracellular tenofovir diphosphate and emtricitabine triphosphate in target cells, as well as hormone effects on HIV susceptibility and immunity. PrEP should continue to be offered to transgender women while additional research is planned or pending.
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Statement on gender-affirmative approach to care from the pediatric endocrine society special interest group on transgender health. Curr Opin Pediatr 2017; 29:475-480. [PMID: 28562420 DOI: 10.1097/mop.0000000000000516] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth. RECENT FINDINGS Transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. SUMMARY The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.
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Mahan RJ, Bailey TA, Bibb TJ, Fenney M, Williams T. Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults. J Am Geriatr Soc 2017; 64:2554-2559. [PMID: 27996106 DOI: 10.1111/jgs.14350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons.
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Affiliation(s)
- Rebecca J Mahan
- Division of Geriatrics, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Trista Askins Bailey
- Division of Geriatrics, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Teryn J Bibb
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Megan Fenney
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Tara Williams
- School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, Texas
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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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13
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Aitken S. The primary health care of transgender adults. Sex Health 2017; 14:477-483. [DOI: 10.1071/sh17048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.
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Moffitt O, Findley JC. A case of first-onset psychosis and repeated relapses secondary to discontinuation of non-prescription estrogen replacement therapy in a transgendered female. Gynecol Endocrinol 2016; 32:796-798. [PMID: 27426632 DOI: 10.1080/09513590.2016.1202230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The estrogen hypothesis of psychosis states that estrogens contribute a protective effect against the development of psychotic disorders. Conversely, hypoestrogenic states have been shown to be associated with the occurrence of psychotic disorders in women. We present the case of a 24-year-old transgendered female who experienced a first-onset psychosis and subsequent relapses associated with discontinuation of non-prescription estrogen replacement therapy.
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Affiliation(s)
- Olivia Moffitt
- a Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Jonathan Chase Findley
- a Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston , Houston , TX , USA
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Aguayo-Romero RA, Reisen CA, Zea MC, Bianchi FT, Poppen PJ. Gender Affirmation and Body Modification Among Transgender Persons in Bogotá, Colombia. Int J Transgend 2015; 16:103-115. [PMID: 26839525 DOI: 10.1080/15532739.2015.1075930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This paper examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N=14) and a focus group (N=11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data, as well as quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections, but also in carrying out procedures-sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.
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Affiliation(s)
| | - Carol A Reisen
- Department of Psychology, The George Washington University, Washington, DC
| | - Maria Cecilia Zea
- Department of Psychology, The George Washington University, Washington, DC
| | - Fernanda T Bianchi
- Department of Psychology, The George Washington University, Washington, DC
| | - Paul J Poppen
- Department of Psychology, The George Washington University, Washington, DC
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Fabris B, Bernardi S, Trombetta C. Cross-sex hormone therapy for gender dysphoria. J Endocrinol Invest 2015; 38:269-82. [PMID: 25403429 DOI: 10.1007/s40618-014-0186-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 10/01/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Gender identity is the sense one has of being male or female. Gender dysphoria (GD) refers to the distress caused by the incongruence between gender identity and biological sex in gender-nonconforming individuals. Cross-sex hormone therapy (CHT) aims at easing GD, improving well-being, and quality of life of gender-nonconforming individuals. This can be achieved by inducing and maintaining the desired-sex characteristics in accordance with the specific aspirations and expectations of each individual. Nevertheless, CHT can be associated with potentially serious long-term complications. METHODS Here, we review when, how, and how long to prescribe CHT to adult transsexuals as well as what to expect and monitor once it has been initiated. RESULTS In recent years, transsexualism has become more and more recognized and depathologized. To manage GD, National and International Standards of Care have been established. Nevertheless, the needs of transgender patients can still be ignored or dismissed. Moreover, some questions remain unanswered because of the lack of specific retrospective or prospective studies on CHT. CONCLUSION Education and culturally sensitive training must be supplied to healthcare professionals to overcome the existing issues on GD management and change the perspectives of transsexual people.
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Affiliation(s)
- B Fabris
- Division of Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - S Bernardi
- Division of Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - C Trombetta
- Division of Urology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, Battista G, Venturoli S, Meriggiola MC. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med 2014; 11:3002-11. [PMID: 25250780 DOI: 10.1111/jsm.12698] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Gender dysphoria is characterized by a strong discomfort with the gender assigned at birth and the urge to live as a member of the opposite gender. The acquisition of phenotypic features of the desired gender requires the use of cross-sex hormones. Female-to-male (FtM) transsexual persons are treated with testosterone to induce virilization. AIM The aim of the study was to assess the effects of three different testosterone formulations on body weight and composition and metabolic and bone parameters. METHODS Forty-five FtM transsexuals were randomly assigned to receive testoviron depot (i.m.: 100 mg/10 days; n = 15), testosterone gel (50 mg/die; n = 15), and testosterone undecanoate (i.m.: 1,000 mg every 6 weeks for the first 6 weeks and then every 12 weeks, n = 15). FtM individuals were studied before, at week 30, and at week 54 of testosterone treatment. MAIN OUTCOME MEASURES Anthropometric, metabolic, bone, hematological, and biochemical parameters were evaluated at baseline and after 12 months of treatment. RESULTS Lean body mass significantly increased and fat mass decreased in all groups. No modifications were reported in fasting insulin and insulin sensitivity index. High-density plasma lipoprotein levels declined significantly and low-density lipoprotein concentrations increased significantly in the three groups. The activated partial thromboplastin time and factor I did not change while prothrombin time significantly increased in all groups. At week 54, all subjects were amenorrheic and time to amenorrhea did not differ between the three groups. Current general life satisfaction was increased in all subjects after 1 year of treatment. CONCLUSIONS One-year testosterone administration in FtM transsexuals appears to be very safe with no differences among the testosterone formulations used. Our study is preliminary, and the detection of subtle or long-term differences in the effects of the three formulations may require further larger and longer term studies in this and other populations.
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Affiliation(s)
- Carla Pelusi
- Division of Endocrinology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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