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Iwamoto SJ, Defreyne J, Rothman MS, Van Schuylenbergh J, Van de Bruaene L, Motmans J, T’Sjoen G. Health considerations for transgender women and remaining unknowns: a narrative review. Ther Adv Endocrinol Metab 2019; 10:2042018819871166. [PMID: 31516689 PMCID: PMC6719479 DOI: 10.1177/2042018819871166] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.
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Affiliation(s)
- Sean J. Iwamoto
- University of Colorado School of Medicine, Division of Endocrinology, Metabolism and Diabetes, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Center for Research on Culture and Gender, Ghent University, Ghent, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. J Am Acad Dermatol 2019; 80:1712-1721. [DOI: 10.1016/j.jaad.2018.05.1259] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Transgender individuals experience common and unique dermatologic concerns from severe acne associated with testosterone therapy in transmen to complications due to illicit silicone injections in transwomen. Currently, 2 survey studies and 4 reviews have addressed the dermatologic care of transgender individuals. However, none of them provide a focus on the dermatologic surgeon. OBJECTIVE To assess the dermatologic considerations in transgender individuals and the role of dermatologic surgeon in their care. METHODS The PubMed and MEDLINE databases were reviewed in June 2018 using keywords, such as transgender, procedures, hair removal, laser, and hormone therapy. RESULTS In total, 48 relevant publications addressing dermatologic care in transgender patients were reviewed. According to the literature, there are several critical dermatologic considerations in transgender patients, including hair growth and removal, acne vulgaris, facial procedures to masculinize and feminize the face, scar removal, and sexually transmitted infections. CONCLUSION As dermatologic surgeons have the privilege to improve the health care of transgender patients, they must understand the common and unique concerns of transgender individuals. Given the considerable spectrum of physical goals expressed by transmen and transwomen, individual patient preference must ultimately guide his/her/their dermatologic care.
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Davies A, Bouman WP, Richards C, Barrett J, Ahmad S, Baker K, Lenihan P, Lorimer S, Murjan S, Mepham N, Robbins-Cherry S, Seal LJ, Stradins L. Patient satisfaction with gender identity clinic services in the United Kingdom. SEXUAL AND RELATIONSHIP THERAPY 2013. [DOI: 10.1080/14681994.2013.834321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Klein A, Steinert S, Baeumler W, Landthaler M, Babilas P. Photoepilation with a diode laser vs. intense pulsed light: a randomized, intrapatient left-to-right trial. Br J Dermatol 2013; 168:1287-93. [DOI: 10.1111/bjd.12182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Khodaeyani E, Amirnia M, Babaye-Nazhad S, Alikhah H, Brufeh B. Efficacy of intense pulsed light in hirsutism. Pak J Biol Sci 2010; 13:635-641. [PMID: 21717866 DOI: 10.3923/pjbs.2010.635.641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Unwanted hair growth presents a significant problem for many patients and considerable resources are spent to achieve a hair-free appearance. Our aim of this study was to further evaluate the efficacy of this method in hirsutism in our region. Sixty patients with idiopathic hirsutism presenting to Dermatology Clinics of Tabriz University of Medical Sciences from September 2007 to March 2009 were classified in three groups regarding the site of hirsutism (chine, face, or mustache). All patients underwent IPL-therapy every month for six sessions. The changes in number and diameter of regional hairs were recorded at the end of each session. The patients had the mean age of 25.50+/-3.01 years (18-33 year). The disease was in chin in 26 cases (43.3%), face in 18 patients (30%) and mustache in 16 (26.7%). The skin type was III in 49 (81.7%) or IV in 11 (18.3%) patients. The positive therapeutic response after sixth session in total and in chin, face and mustache were 86.43, 88.66, 86.95 and 82.19%, respectively. The therapeutic response was not statistically significant in different body regions. The hair number in all treated regions was decrease significantly in each session in comparison with the first therapeutic session (p<0.05). Also, the hair diameter at the end of last session was decreased significantly in comparison with the first session in all treated regions (p<0.05). Regarding the high efficacy (86.42%) of IPL in treatment of facial hirsutism and absence of side effect, it is recommended as an effective treatment modality in hirsutism.
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Affiliation(s)
- E Khodaeyani
- Department of Dermatology, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Williamson C. Providing Care to Transgender Persons: A Clinical Approach to Primary Care, Hormones, and HIV Management. J Assoc Nurses AIDS Care 2010; 21:221-9. [DOI: 10.1016/j.jana.2010.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/15/2010] [Indexed: 11/29/2022]
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Holzer G, Nahavandi H, Neumann R, Knobler R. Photoepilation with variable pulsed light in non-facial body areas: evaluation of efficacy and safety. J Eur Acad Dermatol Venereol 2010; 24:518-23. [DOI: 10.1111/j.1468-3083.2009.03450.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sand M, Bechara FG, Sand D, Altmeyer P, Hoffmann K. A Randomized, Controlled, Double-Blind Study Evaluating Melanin-Encapsulated Liposomes as a Chromophore for Laser Hair Removal of Blond, White, and Gray Hair. Ann Plast Surg 2007; 58:551-4. [PMID: 17452842 DOI: 10.1097/01.sap.0000245129.53392.0e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Laser hair removal of blond and white hair is a complicated task with often unsatisfactory results as a result of a lack of laser-absorbing chromophore. In the present study, we investigated if repetitive external application of liposomal melanin (Lipoxome; Dalton Medicare B.V., Zevenbergschen Hoek, The Netherlands) enables removal of blond/white and gray hair with a diode laser. METHODS Forty-two areas of blond, gray, or white facial and body hair of 16 patients were treated with a liposomal melanin spray (Lipoxome) and 3 cycles of 800 nm diode laser at intervals of 8 weeks (28-40 J/cm). A control group of 16 patients applied physiological saline spray before diode laser treatment. Hair regrowth was measured 8 weeks after each cycle and additionally 6 months after the last treatment by counting the number of terminal hairs compared with baseline pretreatment values. Complications and treatment outcomes were documented. RESULTS Mean regrowth in the liposomal melanin group was 83% after 3 treatment cycles. Six months after therapy, average terminal hair count compared with baseline pretreatment showed 14% reduction. Although significant difference was seen compared with the control group showing a 10% reduction of hair growth after 6 months (P < 0.05), the clinical outcome was disappointing. CONCLUSIONS Melanin-encapsulated liposomal spray in combination with diode laser treatment showed significant higher efficacy in the treatment of white and blond hair compared with a control group. However, the clinically observed hair reduction was so weak that additional effort as well as higher costs argues against the application of the tested formulation.
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Affiliation(s)
- Michael Sand
- Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany.
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Fodor L, Menachem M, Ramon Y, Shoshani O, Rissin Y, Eldor L, Egozi D, Peled IJ, Ullmann Y. Hair Removal Using Intense Pulsed Light (EpiLight). Ann Plast Surg 2005; 54:8-14. [PMID: 15613875 DOI: 10.1097/01.sap.0000141940.34379.78] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and 1 case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.
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Affiliation(s)
- Lucian Fodor
- Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Technion University, Haifa, Israel
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