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Solanki P, Colon-Cabrera D, Barton C, Locke P, Cheung AS, Spanos C, Grace J, Erasmus J, Lane R. Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care. Transgend Health 2023; 8:137-148. [PMID: 37013095 PMCID: PMC10066762 DOI: 10.1089/trgh.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Purpose Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments. Methods Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, n=212) or a primary care clinic (IC model, n=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression. Results WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=0.016). Conclusion WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.
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Affiliation(s)
- Pravik Solanki
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - David Colon-Cabrera
- Department of Anthropology, School of Social Sciences, Monash University, Clayton, Australia
- Monash Health Gender Clinic, Hampton East, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Peter Locke
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Cassandra Spanos
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Julian Grace
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Jaco Erasmus
- Monash Health Gender Clinic, Hampton East, Australia
| | - Riki Lane
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- Monash Health Gender Clinic, Hampton East, Australia
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Oshima Y, Matsumoto Y, Terada S, Yamada N. Prevalence of Gender Dysphoria by Gender and Age in Japan: A Population-Based Internet Survey Using the Utrecht Gender Dysphoria Scale. J Sex Med 2022; 19:1185-1195. [PMID: 35431150 DOI: 10.1016/j.jsxm.2022.03.605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Several studies have attempted to estimate the prevalence of gender dysphoria (GD) from a general population sample. However, no previous studies used reliable questionnaires. AIM To estimate the prevalence of GD in Japan by gender and age using the Utrecht Gender Dysphoria Scale (UGDS). METHODS A cross-sectional observational study was conducted with 20,000 respondents between the ages of 20 and 69 who were registered with an internet research company. The study consisted of two phases. First, the participants were asked to self-identify their gender on two 5-point Likert scales. Second, the screened participants completed the UGDS. OUTCOMES Self-identified gender and GD were defined as follows: ambivalent gender (equally feeling like the birth gender and another gender), incongruent gender (a stronger sense of the latter vs the former), narrow GD (incongruent gender + UGDS score ≥ 41), and broad GD (ambivalent or incongruent gender + UGDS score ≥ 41). RESULTS Among the eligible participants, the age-adjusted proportions of those classified as male (n = 7827) and female (n = 8903) at birth were 6.0% and 5.9%, respectively, for ambivalent gender, and 0.93% and 1.0%, respectively, for incongruent gender. The age-adjusted prevalence of GD was 0.27% (95% confidence interval, 0.18-0.42) and 0.35% (95% confidence interval, 0.25-0.50) for narrow GD and 0.87% (95% confidence interval, 0.69-1.1) and 1.1% (95% confidence interval, 0.86-1.3) for broad GD, respectively. No significant gender differences were found within the age groups, except for broad GD in respondents in their 50s (P = .016). However, for both genders, significant differences were found between age groups such that GD was more prevalent in younger vs older respondents, except for broad GD in respondents classified as female at birth (P = .063). CLINICAL IMPLICATIONS Clinicians should be aware that the prevalence of GD is not negligible and that it varies with age. GD should be assessed in detail from various perspectives in addition to self-identified gender. STRENGTHS & LIMITATIONS This study used a reliable questionnaire to examine the prevalence of GD in a large population. However, the participants did not represent the general population because this was an internet survey. CONCLUSION The prevalence of GD was much higher than previously estimated by clinic-based studies, and was more frequently associated with participant age vs gender. Oshima Y, Matsumoto Y, Terada S, et al. Prevalence of Gender Dysphoria by Gender and Age in Japan: A Population-based Internet Survey Using the Utrecht Gender Dysphoria Scale. J Sex Med 2022;19:1185-1195.
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Affiliation(s)
- Yoshitaka Oshima
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Yosuke Matsumoto
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Baba T, Endo T, Ikeda U, Ikeda H, Ichihara K, Masumori N, Saito T. Self-administration of gender-affirming hormones and supratherapeutic dosing are relatively common in Japanese transgender women. J Obstet Gynaecol Res 2022; 48:2208-2213. [PMID: 35304797 DOI: 10.1111/jog.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/15/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
AIM This study was performed to determine the proportion of transgender women with self-adjusted hormone administration and excess dosing. METHODS The medical records of 87 transgender women who visited our gender clinic from 2010 through 2019 were reviewed. The complete blood count and serum concentrations of D-dimer, gonadotropins, and sex steroids were compared between transgender women who were self-administering gender-affirming hormones and women not using such hormones. RESULTS Fifty-eight of 87 (66.7%) transgender women had contravened the guideline and self-adjusted their hormone administration. The hormonal data of one woman with hypopituitarism were eliminated from the analyses. The serum gonadotropin and testosterone levels were significantly lower in the self-administration group than in the hormone-naïve group. Gonadotropin levels below the lower limit of normal were found in 32/86 (37.2%) transgender women. The testosterone levels in six transgender women were not analyzed because these women had undergone sex reassignment surgery before visiting our hospital. Testosterone levels below the lower limit of normal men were found in 36/80 (45.0%) transgender women. Unexpectedly, 29/36 (80.6%) transgender women who were classified as having suppressed serum testosterone levels had testosterone levels of <0.6 ng/mL, which corresponds to the levels in cisgender women. The white blood cell count and hemoglobin concentration were significantly different between the groups. CONCLUSION Self-initiated hormonal treatments seem to affect the serum concentrations of gonadotropin and sex steroids and the complete blood count. The prevalence of transgender women with self-adjusted use of gender-affirming hormones is high, and an excess dose of hormones occasionally occurs.
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Affiliation(s)
- Tsuyoshi Baba
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Utako Ikeda
- Department of Gynecology, Tonan Hospital, Sapporo, Japan
| | | | - Koji Ichihara
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
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Van de Cauter J, Van Schoorisse H, Van de Velde D, Motmans J, Braeckman L. Return to work of transgender people: A systematic review through the blender of occupational health. PLoS One 2021; 16:e0259206. [PMID: 34723993 PMCID: PMC8559954 DOI: 10.1371/journal.pone.0259206] [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: 04/14/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Return to work (RTW) or work resumption after a work absence due to psychosocial or medical reasons benefits the well-being of a person, including transgender people, and is nowadays a major research domain. The objective is to examine, through an occupational lens, the literature reporting objective RTW outcomes and experiences in transgender people to (a) synthesize what is known about return to work (full-time, part-time, or self-employed) and (b) describe which gaps persist. METHODS & SAMPLE Several databases and the gray literature were explored systematically. Studies between November 1, 2006 and March 1, 2021 revealing RTW quantitative and qualitative data of adult transgender people were eligible. This review was registered on PROSPERO (CRD42019128395) on April 30, 2019. RESULTS Among the 14,592 articles initially identified, 97 fulfilled the inclusion criteria which resulted in 20 being analyzed. Objective RTW outcomes, such as number of RTW attempts, time to RTW or number of sick days, were lacking; thus, other relevant work outcomes were reported. Compared to the general population, lower employment rates and more economic distress were observed, with trans women in particular saying that their work situation had deteriorated. Research on positive RTW experiences was highlighted by the importance of disclosure, the support from especially managers and coworkers who acted as mediators, personal coping, and a transition plan along with work accommodations. Negative work experiences, such as demotion, lay-offs, and discrimination were often prominent together with a lack of knowledge of trans issues among all stakeholders, including occupational health professionals. CONCLUSION & RECOMMENDATIONS Few studies have explored employment characteristics and experiences of transgender people (TP). RTW is a dynamic process along with transition in itself, which should be tailored through supportive policies, education, a transition plan and work accommodations with the help of external experts. Future studies should include more occupational information and report RTW outcomes to enhance our knowledge about the guidance of TP and to make way for interventional studies.
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Affiliation(s)
- Joy Van de Cauter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hanna Van Schoorisse
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joz Motmans
- Department of Languages and Cultures, Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium
- Transgender Infopunt, Ghent University Hospital, Ghent, Belgium
| | - Lutgart Braeckman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Morgenstern SC, Sohn M. [Prosthetics after construction of the outer genitalia for transmen]. Urologe A 2021; 60:722-731. [PMID: 33938977 DOI: 10.1007/s00120-021-01532-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Growing awareness of gender identity issues and a rising prevalence of female-to-male transsexualism is increasing demand for surgical solutions that deliver both aesthetically and functionally satisfying outer genitalia for transmen. OBJECTIVE This article summarizes the available prosthetic options, describes different surgical approaches and reviews the outcome of prosthetics for transmen with a focus on penile prosthesis in phalloplasty. METHODS Current international standards of care, reviews and original publications are critically reviewed and correlated with our own experience with more than 400 transmen at two interdisciplinary referral centres in Frankfurt, Germany and London, UK. RESULTS Despite of a wide range of different phalloplasty techniques and prosthetic types, the currently most used technique is implantation of a three-piece, inflatable penile prosthesis in a radial-free-flap phalloplasty. There is still an ongoing debate about the number of implanted penile prosthesis cylinders, the use of customised corporoplasty-windsocks for the cylinder(s), and the location for the placement of the reservoir. At present there is only one penile prosthesis design for use in phalloplasties and long-term results are still pending. CONCLUSION There is still no ideal implant available for the use in phalloplasties. The current literature does not provide evidence-based treatment algorithms, which is also due to a lack of prospective randomised studies and validated measurement tools for the postoperative outcome. Initial data for the first transmen-specific penile prosthesis as well as an increase of transgender studies might lead to an improvement of treatment and the quality-of-life of the affected transmen.
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Affiliation(s)
- S C Morgenstern
- Sektion für rekonstruktive Urologie und geschlechtsangleichende Operationen, Klinik für Urologie und Klinik für roboterassistierte Urologie und Uroonkologie, AGAPLESION Markus-Krankenhaus Frankfurt, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland.
| | - M Sohn
- Sektion für rekonstruktive Urologie und geschlechtsangleichende Operationen, Klinik für Urologie und Klinik für roboterassistierte Urologie und Uroonkologie, AGAPLESION Markus-Krankenhaus Frankfurt, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland
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Meyer G, Boczek U, Bojunga J. Hormonal Gender Reassignment Treatment for Gender Dysphoria. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:725-732. [PMID: 33559593 DOI: 10.3238/arztebl.2020.0725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND No data are available at present on the prevalence of gender dysphoria (trans-identity) in Germany. On the basis of estimates from the Netherlands, it can be calculated that approximately 15 000 to 25 000 persons in Germany are affected. Persons suffering from gender dysphoria often experience significant distress and have a strong desire for gender reassignment treatment. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed database employing the searching terms "transsexualism," "transgender," "gender incongruence," "gender identity disorder," "gender-affirming hormone therapy," and "gender dysphoria." RESULTS In view of its far-reaching consequences, some of which are irreversible, hormonal gender reassignment treatment should only be initiated after meticulous individual consideration, with the approval of the treating psychiatrist/psychotherapist and after extensive information of the patient by an experienced endo - crinologist. Before the treatment is begun, the patient must be extensively screened for risk factors. The contraindications include severe preexisting thromboembolic diseases (mainly if untreated), hormone-sensitive tumors, and uncontrolled pre - existing chronic diseases such as arterial hypertension and epilepsy. Finding an appropriate individual solution is the main objective even if contraindications are present. Male-to-female treatment is carried out with 17β-estradiol or 17β-estradiol valerate in combination with cyproterone acetate or spironolactone as an antiandrogen, female-to-male treatment with transdermal or intramuscular testosterone preparations. The treatment must be monitored permanently with clinical and laboratory follow-up as well as with gynecological and urological early-detection screening studies. Prospective studies and a meta-analysis (based on low-level evidence) have documented an improvement in the quality of life after gender reassignment treatment. Female-to-male gender-incongruent persons often have difficulty being accepted in a gynecological practice as a male patient. CONCLUZION Further prospective studies for the quantification of the risks and benefits of hormonal treatment would be desirable. Potential interactions of the hormone preparations with other medications must always be considered.
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Affiliation(s)
- Gesine Meyer
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology, Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
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