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Gutiérrez K, Moreno M, Sierra JA, Lemus R, Apraez K, Angulo MJ. Characteristics of the pediatric population with gender incongruence attending specialized care in Cali, Colombia: an observational, descriptive and retrospective study. Child Adolesc Psychiatry Ment Health 2024; 18:1. [PMID: 38172957 PMCID: PMC10763121 DOI: 10.1186/s13034-023-00689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Gender incongruence can often manifest itself from early childhood [Olson KR, Gülgöz S. Child Dev Perspect. 2018;12:93-7. https://doi.org/10.1111/cdep.12268 ] with a significant psychological impact, altering social and school dynamics without the appropriate care.[Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978 ] Early identification and gender-affirming care are essential to reduce adverse mental health outcomes, such as depression and self-harm [Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978 ]..This study aims to analyze characteristics and to estimate relative frequencies of gender incongruence in a population of children and adolescents receiving gender-affirming care at a high-complexity university hospital located in the third largest city in Colombia. METHODS This was a retrospective descriptive study of patients under 18 with gender incongruence that received gender-affirming care between January 2018 and June 2022 at Fundacion Valle del Lili in Cali, Colombia. Sociodemographic and clinical characteristics of 43 patients were assessed, as well as the relative frequencies of gender incongruence. Data analysis was performed with the statistical package STATA®. To determine significant differences between the characteristics of the patients who participated in the study, the Mann‒Whitney U test was performed for numerical variables with non-parametric distribution, while either Pearson's Chi-2 test or Fisher's exact test was performed for categorical variables. RESULTS For every ten individuals assigned female at birth, who manifested gender incongruence, there were eight assigned male at birth. The median age of onset of gender incongruence was ten years (IQR: 5-13 years), and the median time elapsed between the reported onset of gender incongruence and the first consultation with a multidisciplinary gender-affirming team was three years (IQR: 1-10 years). The frequency of transgender identity was notable in participants with ages between 15 and 17 years. Depressive symptoms, anxiety, and psychotropic drug use were significantly higher in individuals assigned female at birth. Among 25 individuals assigned female at birth who participated in this study, 60% self-recognized as transgender men.18 individuals assigned male at birth, 67% self-recognized as transgender women. The most frequent treatment was a referral to mental health services (46.51%). CONCLUSION Based on the cohort of our study, we can conclude that patients consult for gender-affirming treatment 3 years after the onset of gender incongruence. Anxiety and depression were higher in individuals assigned female at birth. Additionally, they presented at a later stage of sexual maturation, reducing the possibility of using puberty blockers.
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Affiliation(s)
- Kenny Gutiérrez
- Servicio de Endocrinología pediátrica, Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
| | - Mabel Moreno
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
- Universidad Icesi, Facultad de ciencias de la salud, Cl. 18 #122-135, Barrio Pance, 760032, Cali, Colombia
| | - Jimena Alexandra Sierra
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
| | - Rodrigo Lemus
- Servicio de Endocrinología pediátrica, Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
| | - Karen Apraez
- Universidad Icesi, Facultad de ciencias de la salud, Cl. 18 #122-135, Barrio Pance, 760032, Cali, Colombia
| | - Mario Jr Angulo
- Servicio de Endocrinología pediátrica, Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia.
- Universidad Icesi, Facultad de ciencias de la salud, Cl. 18 #122-135, Barrio Pance, 760032, Cali, Colombia.
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2
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Sueters J, Groenman FA, Bouman MB, Roovers JPW, de Vries R, Smit TH, Huirne JAF. Tissue Engineering Neovagina for Vaginoplasty in Mayer-Rokitansky-Küster-Hauser Syndrome and Gender Dysphoria Patients: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:28-46. [PMID: 35819292 DOI: 10.1089/ten.teb.2022.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Vaginoplasty is a surgical solution to multiple disorders, including Mayer-Rokitansky-Küster-Hauser syndrome and male-to-female gender dysphoria. Using nonvaginal tissues for these reconstructions is associated with many complications, and autologous vaginal tissue may not be sufficient. The potential of tissue engineering for vaginoplasty was studied through a systematic bibliography search. Cell types, biomaterials, and signaling factors were analyzed by investigating advantages, disadvantages, complications, and research quantity. Search Methods: A systematic search was performed in Medline, EMBASE, Web of Science, and Scopus until March 8, 2022. Term combinations for tissue engineering, guided tissue regeneration, regenerative medicine, and tissue scaffold were applied, together with vaginoplasty and neovagina. The snowball method was performed on references and a Google Scholar search on the first 200 hits. Original research articles on human and/or animal subjects that met the inclusion (reconstruction of vaginal tissue and tissue engineering method) and no exclusion criteria (not available as full text; written in foreign language; nonoriginal study article; genital surgery other than neovaginal reconstruction; and vaginal reconstruction with autologous or allogenic tissue without tissue engineering or scaffold) were assessed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, the Newcastle-Ottawa Scale, and the Gold Standard Publication Checklist were used to evaluate article quality and bias. Outcomes: A total of 31 out of 1569 articles were included. Data extraction was based on cell origin and type, biomaterial nature and composition, host species, number of hosts and controls, neovaginal size, replacement fraction, and signaling factors. An overview of used tissue engineering methods for neovaginal formation was created, showing high variance of cell types, biomaterials, and signaling factors and the same topics were rarely covered multiple times. Autologous vaginal cells and extracellular matrix-based biomaterials showed preferential properties, and stem cells carry potential. However, quality confirmation of orthotopic cell-seeded acellular vaginal matrix by clinical trials is needed as well as exploration of signaling factors for vaginoplasty. Impact statement General article quality was weak to sufficient due to unreported cofounders and incomplete animal study descriptions. Article quality and heterogenicity made identification of optimal cell types, biomaterials, or signaling factors unreliable. However, trends showed that autologous cells prevent complications and compatibility issues such as healthy cell destruction, whereas stem cells prevent cross talk (interference of signaling pathways by signals from other cell types) and rejection (but need confirmation testing beyond animal trials). Natural (orthotopic) extracellular matrix biomaterials have great preferential properties that encourage future research, and signaling factors for vascularization are important for tissue engineering of full-sized neovagina.
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Affiliation(s)
- Jayson Sueters
- Department of Gynaecology and Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Freek A Groenman
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Jan Paul W Roovers
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Theo H Smit
- Department of Gynaecology and Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Department of Medical Biology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Gynaecology and Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Research Institute Reproduction and Development, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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3
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Srivastava R. Gender Affirming Laryngeal and Voice Surgery. Indian J Plast Surg 2022; 55:174-178. [PMID: 36017405 PMCID: PMC9398523 DOI: 10.1055/s-0041-1740078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
AbstractGender affirmation laryngeal and voice surgeries are components of “voice-lift” or cosmetic voice surgeries. Feminization surgery can modify vocal folds (fundamental frequency [Fo]) and vocal tract (resonance frequency). For increased pitch, vocal folds should be shorter, thinner, and tighter. Cricothyroid approximation (CTA) surgery increases tension of the vocal folds. Endoscopic procedures for pitch raising are done by shortening the length and reducing mass of vocal folds. This shortening is achieved by surgically creating anterior glottic web. Comparing the results of various open and endoscopic surgical techniques, fundamental frequency (Fo) is raised maximally and remains stable after GL as compared with CTA.
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Ferreira MJ, Luís Castedo J, Mota M, Carvalho D. Characterization of a transgender population in Portugal. ANNALES D'ENDOCRINOLOGIE 2021; 83:35-39. [PMID: 34871600 DOI: 10.1016/j.ando.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/30/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Gender dysphoria (GD) is a condition in which the individual's gender identity does not correspond to their biological sex, causing significant distress. Biological males who identify as females are referred to as transgender females or as showing male-to-female GD (MtF GD) and biological females who identify as males are referred to as transgender males or as showing female-to-male GD (FtM GD). In our center, there is a multidisciplinary consultation to approach and follow patients with GD. AIM We aimed to analyze the characteristics of the individuals who attend this consultation. METHODS Retrospective study of individuals attending the Sexual Medicine Group Consultation. Age, comorbidities, symptom onset, and hormonal and surgical treatment were analyzed. RESULTS 114 patients were diagnosed with GD: 68.4% FtM GD and 31.6% MtF GD. Median age was 30.2±12 years. 63.2% reported symptom onset in childhood: 14.9% between 10 and 18 years, and 4.4% later than 18 years. Median age at treatment initiation was 23.1±7.1 years. Several individuals had concomitant medical conditions, notably smoking (n=37; 32.5%) and depression (n=26; 22.3%). The majority of (92.3% FtM GD and 88.9% MtF GD) were under hormone treatment, and about one-third had undergone some sex reassignment surgery. DISCUSSION We found higher prevalence of FtM than MtF, in contrast with most other studies. The reasons for this are not clear. A high percentage of our patients were self-medicated. Other characteristics were similar to those previously reported. CONCLUSION Medical requests by individuals with GD are increasing worldwide. To our knowledge, this is the first study to portray a case series in a consultation center dedicated to the diagnosis, treatment and follow-up of individuals with GD in Portugal.
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Affiliation(s)
- Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal.
| | - José Luís Castedo
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Márcia Mota
- Department of Psychiatry of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal; Faculty of Medicine and Instituto de Investigação e Inovação em Saúde of Universidade do Porto, Portugal
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5
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Abstract
Gender identity development is complex and involves several key processes. Transgender people experience incongruence between their biological and identified gender. This incongruence can cause significant impairment in overall functioning and lead to gender dysphoria (GD). The pathophysiology of GD is complex and is poorly understood. A PubMed search based on predetermined eligibility criteria was conducted to review neuropsychiatric articles focused on neurological, biological and neuroimaging aspects of gender development, transgender identity and GD. The information obtained from the literature was then used to formulize a GD model. Distinct gray matter volume and brain activation and connectivity differences were found in individuals with GD compared to controls, suggesting a neurobiological basis of GD; which leads to the concept of brain gender. Individuals with GD encounter a recurrent conflict between their brain gender and the societal feedback; which causes recurrent and ongoing cognitive dissonance, finally leading to GD and functional connectivity and activation changes in the transgender brain. GD has neurobiological basis, but it is closely associated with the individuals' interaction with the external world, their self-perception and the feedback received in return. We propose a novel model where the development of GD includes cognitive dissonance, involving anterior cingulate cortex and ventral striatum as the key brain structures. This model can be used to generate testable hypotheses using behavioral and neuroimaging techniques to understand the neuropsychobiology of GD.
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Affiliation(s)
- Murat Altinay
- Center for Behavioral Health, Cleveland Clinic, 9500 Euclid Avenue/P57, Cleveland, OH, 44195, USA.
| | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic, 9500 Euclid Avenue/P57, Cleveland, OH, 44195, USA
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6
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Narayan SK, Hontscharuk R, Danker S, Guerriero J, Carter A, Blasdel G, Bluebond-Langner R, Ettner R, Radix A, Schechter L, Berli JU. Guiding the conversation-types of regret after gender-affirming surgery and their associated etiologies. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:605. [PMID: 33987303 DOI: 10.21037/atm-20-6204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A rare, but consequential, risk of gender affirming surgery (GAS) is post-operative regret resulting in a request for surgical reversal. Studies on regret and surgical reversal are scarce, and there is no standard terminology regarding either etiology and/or classification of the various forms of regret. This study includes a survey of surgeons' experience with patient regret and requests for reversal surgery, a literature review on the topic of regret, and expert, consensus opinion designed to establish a classification system for the etiology and types of regret experienced by some patients. Methods This anonymous survey was sent to the 154 surgeons who registered for the 2016 World Professional Association for Transgender Health (WPATH) conference and the 2017 USPATH conference. Responses were analyzed using descriptive statistics. A MeSH search of the gender-affirming outcomes literature was performed on PubMed for relevant studies pertaining to regret. Original research and review studies that were thought to discuss regret were included for full text review. Results The literature is inconsistent regarding etiology and classification of regret following GAS. Of the 154 surgeons queried, 30% responded to our survey. Cumulatively, these respondents treated between 18,125 and 27,325 individuals. Fifty-seven percent of surgeons encountered at least one patient who expressed regret, with a total of 62 patients expressing regret (0.2-0.3%). Etiologies of regret were varied and classified as either: (I) true gender-related regret (42%), (II) social regret (37%), and (III) medical regret (8%). The surgeons' experience with patient regret and request for reversal was consistent with the existing literature. Conclusions In this study, regret following GAS was rare and was consistent with the existing literature. Regret can be classified as true gender-related regret, social regret and medical regret resulting from complications, function, pre-intervention decision making. Guidelines in transgender health should offer preventive strategies as well as treatment recommendations, should a patient experience regret. Future studies and scientific discourse are encouraged on this important topic.
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Affiliation(s)
- Sasha Karan Narayan
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Rayisa Hontscharuk
- Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sara Danker
- Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jess Guerriero
- Transgender Health Program, Oregon Health & Science University, Portland, OR, USA
| | | | | | | | | | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Loren Schechter
- The University of Illinois at Chicago, Chicago, IL, USA.,Rush University Medical Center, Chicago, IL, USA.,The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, Chicago, IL, USA
| | - Jens Urs Berli
- Division of Plastic & Reconstructive Surgery, Oregon Health & Science University, Portland, OR, USA
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7
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Paltura C, Yelken K. An Examination of Vocal Tract Acoustics following Wendler’s Glottoplasty. Folia Phoniatr Logop 2018; 71:24-28. [DOI: 10.1159/000494970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022] Open
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8
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Trombetta C, Scati L. Quality of Life before and after Andro-Gynoid and Gynoandroid Conversion Surgery. Urologia 2018. [DOI: 10.1177/039156030607300405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study intended to assess if surgery could be able to improve transsexuals’ QoL (quality of life); 16 subjects were asked to fill in a test form to verify quality of life before and after andro-gynoid conversion surgery. Other individuals were studied as follows: 18 MtoF (andro-gynoid) subjects awaiting surgery; 16 MtoF subjects who had been operated on more than one year before; 13 FtoM (gynoandroid) individuals waiting for surgery; 4 FtoM subjects after surgery. The “Quality of Life Enjoyment and Satisfaction Questionnaire - Q-LES-Q” (Endicott 1993) was drawn up: this is a self-report questionnaire which assesses the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. Outcomes confirmed the assumption of origin.
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Affiliation(s)
- C. Trombetta
- Clinica Urologica, Ospedale di Cattinara, Università di Trieste
| | - L. Scati
- Psicologa dell'AIED (Associazione Italiana Educazione Demografica), Pordenone
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9
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East EG, Gast KM, Kuzon WM, Roberts E, Zhao L, Jorns JM. Clinicopathological findings in female-to-male gender-affirming breast surgery. Histopathology 2017; 71:859-865. [DOI: 10.1111/his.13299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ellen G East
- Department of Pathology; Michigan Medicine; Ann Arbor MI USA
| | - Katherine M Gast
- Department of Surgery; Section of Plastic Surgery; Michigan Medicine; Ann Arbor MI USA
| | - William M Kuzon
- Department of Surgery; Section of Plastic Surgery; Michigan Medicine; Ann Arbor MI USA
| | - Emily Roberts
- Department of Biostatistics; University of Michigan; Ann Arbor MI USA
| | - Lili Zhao
- Department of Biostatistics; University of Michigan; Ann Arbor MI USA
| | - Julie M Jorns
- Department of Pathology; Michigan Medicine; Ann Arbor MI USA
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10
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Abstract
BACKGROUND Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. OBJECTIVES This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. RESEARCH DESIGN We used data from transgender Veterans collected in 2014 through an online, national survey. SUBJECTS In total, 298 transgender Veterans living in the United States. MEASURES We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. RESULTS Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. CONCLUSIONS Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.
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11
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Gillberg C, Fernell E, Kočovská E, Minnis H, Bourgeron T, Thompson L, Allely CS. The role of cholesterol metabolism and various steroid abnormalities in autism spectrum disorders: A hypothesis paper. Autism Res 2017; 10:1022-1044. [PMID: 28401679 PMCID: PMC5485071 DOI: 10.1002/aur.1777] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 12/15/2016] [Accepted: 01/30/2017] [Indexed: 01/25/2023]
Abstract
Based on evidence from the relevant research literature, we present a hypothesis that there may be a link between cholesterol, vitamin D, and steroid hormones which subsequently impacts on the development of at least some of the "autisms" [Coleman & Gillberg]. Our hypothesis, driven by the peer reviewed literature, posits that there may be links between cholesterol metabolism, which we will refer to as "steroid metabolism" and findings of steroid abnormalities of various kinds (cortisol, testosterone, estrogens, progesterone, vitamin D) in autism spectrum disorder (ASD). Further research investigating these potential links is warranted to further our understanding of the biological mechanisms underlying ASD. Autism Res 2017. © 2017 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research. Autism Res 2017, 10: 1022-1044. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Eva Kočovská
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Barts and London School of Medicine, Queen Mary University of London, Blizard Institute58 Turner StreetE1 2ABLondon
| | - Helen Minnis
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Institute of Health and Wellbeing, University of Glasgow, RHSC YorkhillGlasgowScotlandG3 8SJUnited Kingdom
| | - Thomas Bourgeron
- Institut Pasteur, Human Genetics and Cognitive Functions UnitParisFrance
- CNRS UMR 3571: Genes, Synapses and Cognition, Institut PasteurParisFrance
- Université Paris Diderot, Sorbonne Paris CitéHuman Genetics and Cognitive FunctionsParisFrance
- FondaMental FoundationCréteilFrance
| | - Lucy Thompson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Institute of Health and Wellbeing, University of Glasgow, RHSC YorkhillGlasgowScotlandG3 8SJUnited Kingdom
| | - Clare S. Allely
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- School of Health SciencesUniversity of SalfordManchesterEngland
- Honorary Research Fellow in the College of MedicalVeterinary and Life Sciences affiliated to the Institute of Health and Wellbeing at the University of Glasgow
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12
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Linander I, Alm E, Goicolea I, Harryson L. “It was like I had to fit into a category”: Care-seekers’ experiences of gender regulation in the Swedish trans-specific healthcare. Health (London) 2017; 23:21-38. [DOI: 10.1177/1363459317708824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The few previous studies investigating regulation of gender in trans-specific healthcare are mainly based on text material and interviews with care-providers or consist solely of theoretical analyses. There is a lack of studies analysing how the regulation of gender is expressed in the care-seeker’s own experiences, especially in a Nordic context. The aim of this study is to analyse narratives of individuals with trans experiences (sometimes called transgender people) to examine how gender performances can be regulated in trans-specific care in Sweden. The conceptual framework is inspired by trans studies, a Foucauldian analysis of power, queer phenomenology and the concept of cisnormativity. Fourteen interviews with people with trans experiences are analysed with constructivist grounded theory. The participants’ experiences indicate that gender is constructed as norm-conforming, binary and stable in trans-specific healthcare. This gendered position is resisted, negotiated and embraced by the care-seekers. Norms and discourses both inside and outside trans-specific care contribute to the regulation and limit the room for action for care-users. We conclude that a trans-specific care that has a confirming approach to its care-users, instead of the current focus on gender norm conformity, has the potential to increase the self-determination of gender performance and increase the quality of care.
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Affiliation(s)
| | - Erika Alm
- University of Gothenburg, Sweden
- Umeå University, Sweden
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13
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Pitch Elevation in Male-to-female Transgender Persons—the Würzburg Approach. J Voice 2017; 31:244.e7-244.e15. [DOI: 10.1016/j.jvoice.2016.07.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/22/2016] [Indexed: 11/21/2022]
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14
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Cussino M, Crespi C, Mineccia V, Molo M, Motta G, Veglia F. Sociodemographic characteristics and traumatic experiences in an Italian transgender sample. Int J Transgend 2017. [DOI: 10.1080/15532739.2016.1268082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Martina Cussino
- Department of Psychology, University of Turin, Turin, Italy
- Faculty of Communication Sciences, Institute for Public Communication, University of Lugano, Lugano, Switzerland
| | - Chiara Crespi
- Carlo Molo Onlus Foundation, Turin, Italy
- Division of Endocrinology, Diabetology and Metabolism, Centro Interdipartimentale Disturbi d'Identità di Genere Molinette, City of Health and Science, Turin, Italy
| | - Valentina Mineccia
- Carlo Molo Onlus Foundation, Turin, Italy
- Division of Endocrinology, Diabetology and Metabolism, Centro Interdipartimentale Disturbi d'Identità di Genere Molinette, City of Health and Science, Turin, Italy
| | | | - Giovanna Motta
- Division of Endocrinology, Diabetology and Metabolism, Centro Interdipartimentale Disturbi d'Identità di Genere Molinette, City of Health and Science, Turin, Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin, Turin, Italy
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15
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Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support. Eur Arch Otorhinolaryngol 2016; 274:2049-2058. [DOI: 10.1007/s00405-016-4420-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/02/2016] [Indexed: 11/26/2022]
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16
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Bentz EK, Schneeberger C, Hefler LA, van Trotsenburg M, Kaufmann U, Huber JC, Tempfer CB. A Common Polymorphism of the SRD5A2 Gene and Transsexualism. Reprod Sci 2016; 14:705-9. [PMID: 18000232 DOI: 10.1177/1933719107306230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eva-Katrin Bentz
- Department of Gynecologic Endocrinology and Reproductive Medicine Medical University Vienna, Vienna, Austria
| | - Christian Schneeberger
- Department of Gynecologic Endocrinology and Reproductive Medicine Medical University Vienna, Vienna, Austria
| | - Lukas A. Hefler
- Department of Obstetrics and Gynecology , Medical University Vienna, Vienna, Austria
| | - Mick van Trotsenburg
- Department of Obstetrics and Gynecology, Free University in Amsterdam, Amsterdam, Netherlands
| | - Ulrike Kaufmann
- Department of Gynecologic Endocrinology and Reproductive Medicine Medical University Vienna, Vienna, Austria
| | - Johannes C. Huber
- Department of Gynecologic Endocrinology and Reproductive Medicine Medical University Vienna, Vienna, Austria
| | - Clemens B. Tempfer
- Department of Gynecologic Endocrinology and Reproductive Medicine Medical University Vienna, Vienna, Austria
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Majumder A, Sanyal D. Outcome and preferences in female-to-male subjects with gender dysphoria: Experience from Eastern India. Indian J Endocrinol Metab 2016; 20:308-311. [PMID: 27186545 PMCID: PMC4855956 DOI: 10.4103/2230-8210.179988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Awareness of gender dysphoria (GD) and its treatment is increasing. There is paucity of scientific data from India regarding the therapeutic options being used for alleviating GD, which includes psychotherapy, hormone, and surgical treatments. AIM To study the therapeutic options including psychotherapy, hormone, and surgical treatments used for alleviating GD. SETTINGS AND DESIGN This is a retrospective study of treatment preferences and outcome in 18 female-to-male (FTM) transgender subjects who presented to the endocrine clinic. RESULTS The mean follow-up was 1.6 years and only one subject was lost to follow-up after a single visit. All subjects desiring treatment had regular counseling and medical monitoring. All FTM subjects were cross-dressing. Seventeen (94.4%) FTM subjects were receiving cross-sex hormone therapy, in the form of testosterone only (61.1%) or gonadotropin-releasing hormone (GnRH) agonist in combination with testosterone (11.1%) or medroxyprogesterone acetate (MPA) depot in combination with testosterone (22.2%). FTM subjects preferred testosterone or testosterone plus MPA; very few could afford GnRH therapy. Testosterone esters injection was preferred by most (72.2%) subjects as it was most affordable while 22.2% chose 3 monthly injections of testosterone undecanoate for convenience and better symptomatic improvement, but it was more expensive. None preferred testosterone gels because of cost and availability concerns. About 33.3% of our subjects underwent mastectomy, 38.9% had hysterectomy with bilateral salpingo-oophorectomy, and only one subject underwent phalloplasty. About 16.7% of FTM subjects presented with prior mastectomy depicting a high prevalence of unsupervised or poorly supervised surgeries not following protocol wise approach. CONCLUSION Notwithstanding of advances in Standards of Care in the Western world, there is lack of awareness and acceptance in the FTM subjects, about proper and timely protocol-wise management options leading to suboptimal physical, social, and sexual results.
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Affiliation(s)
- Anirban Majumder
- Department of Endocrinology, KPC Medical College, Jadavpur, Kolkata, West Bengal, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Jadavpur, Kolkata, West Bengal, India
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Blosnich JR, Brown GR, Wojcio S, Jones KT, Bossarte RM. Mortality Among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000-2009. LGBT Health 2016; 1:269-76. [PMID: 26789855 DOI: 10.1089/lgbt.2014.0050] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status. METHODS The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5,117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000-2009 for 1,277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3,840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups. RESULTS Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years. CONCLUSION The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses.
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Affiliation(s)
- John R Blosnich
- 1 VA Pittsburgh Healthcare System , Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania.,2 Department of Psychiatry, University of Rochester , Rochester, New York.,3 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - George R Brown
- 4 Office of Health Equity , VA Central Office, Washington, D.C.,5 Department of Psychiatry and Behavioral Sciences, East Tennessee State University , Johnson City, Tennessee
| | - Sybil Wojcio
- 6 VISN2 Center of Excellence for Suicide Prevention, Canandaigua, New York
| | - Kenneth T Jones
- 4 Office of Health Equity , VA Central Office, Washington, D.C
| | - Robert M Bossarte
- 2 Department of Psychiatry, University of Rochester , Rochester, New York.,6 VISN2 Center of Excellence for Suicide Prevention, Canandaigua, New York
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Wendler Glottoplasty and Voice-Therapy in Male-to-Female Transsexuals: Results in Pre and Post-Surgery Assessment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Glotoplastia de Wendler y tratamiento logopédico en la feminización de la voz en transexuales: resultados de la valoración pre- vs. poscirugía. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:83-92. [DOI: 10.1016/j.otorri.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/02/2015] [Accepted: 02/06/2015] [Indexed: 11/19/2022]
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21
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Aydin D, Buk LJ, Partoft S, Bonde C, Thomsen MV, Tos T. Transgender Surgery in Denmark From 1994 to 2015: 20-Year Follow-Up Study. J Sex Med 2016; 13:720-5. [PMID: 26928773 DOI: 10.1016/j.jsxm.2016.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/21/2016] [Accepted: 01/24/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gender dysphoria is a mismatch between a person's biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty). AIMS To report the first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period. METHODS Electronic patient databases were used to identify patients diagnosed with gender identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported. MAIN OUTCOME MEASURES Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery. RESULTS One hundred fifty-eight patients referred for gender-confirming surgery were included. Fifty-five cases (35%) were male-to-female (MtF) and 103 (65%) were female-to-male (FtM). In total, 126 gender-confirming surgeries were performed. For FtM cases, top surgery (mastectomy) was conducted in 62 patients and bottom surgery (phalloplasty and metoidioplasty) was conducted in 17 patients. For MtF cases, 45 underwent bottom surgery (vaginoplasty), 2 of whom received breast augmentation. The FtM:MtF ratio of the referred patients was 1.9:1. The median age at the time of surgery decreased from 40 to 27 years during the 20-year period. CONCLUSION Gender-confirming surgery was performed on 65 FtM and 40 MtF cases at our hospital, and 21 transsexuals underwent surgery abroad. Mastectomy was performed in 62 FtM and bottom surgery in 17 FtM cases. Vaginoplasty was performed in 45 MtF and breast augmentation in 2 MtF cases. There was a significant decrease in age at the time of gender-confirming surgery during the course of the study period.
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Affiliation(s)
- Dogu Aydin
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark.
| | - Liv Johanne Buk
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark
| | - Søren Partoft
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Bonde
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark
| | - Michael Vestergaard Thomsen
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark
| | - Tina Tos
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Denmark
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Risk of hormonotherapy in transgender people: Literature review and data from the French Database of Pharmacovigilance. ANNALES D'ENDOCRINOLOGIE 2016; 77:14-21. [PMID: 26830952 DOI: 10.1016/j.ando.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE After the diagnosis of transsexualism, hormone therapy is an established stage of gender identity disorder treatment for inducing secondary sex characteristic development of the target gender while reducing that of the birth sex. The aim of this study was to review existing data about the risk of hormone therapy in transsexual people. METHODS A PubMed search was done to identify relevant data about adverse drug reactions (ADRs) and mortality associated to hormones exposure. Furthermore, case reports of hormonal therapy-induced ADRs were identified in the French Pharmacovigilance DataBase (FPDB). RESULTS Review of currently available data showed an increase of thromboembolic effects and hyperprolactinemia with oestrogens. Both oestrogens and testosterone derivatives could induce hepatic effects. Currently, there is no significant association between hormone exposure and cancer or mortality in transsexual people. Five ADRs were found in FPDB, and two of them were related to misuse (voluntary overdose and prescription error). CONCLUSION Potential for under-reporting and under-identification in the FPDB of hormonal therapy-induced ADRs in transsexual people should be underlined. Technical improvement of the FPDB could facilitate further identification of reports concerning the risk associated with hormonal therapy in transsexual subjects.
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Eftekhar M, Ahmadzad-Asl M, Naserbakht M, Taban M, Jalali A, Alavi K. Bibliographic Characteristics and the Time Course of Published Studies About Gender Dysphoria: 1970–2011. INT J TRANSGENDERISM 2015. [DOI: 10.1080/15532739.2015.1080648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Meriggiola MC, Gava G. Endocrine care of transpeople part I. A review of cross-sex hormonal treatments, outcomes and adverse effects in transmen. Clin Endocrinol (Oxf) 2015; 83:597-606. [PMID: 25692791 DOI: 10.1111/cen.12753] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/03/2015] [Accepted: 02/09/2015] [Indexed: 02/07/2023]
Abstract
Gender dysphoria (GD) is characterized by discomfort with the assigned or birth gender and the urge to live as a member of the desired sex. The goal of medical and surgical treatment is to improve the well-being and quality of life of transpeople. The acquisition of phenotypic features of the desired gender requires the use of cross-sex hormonal therapy (CHT). Adult transmen are treated with testosterone to induce virilization. In adolescents with severe and persistent GD, consideration can be given to arresting puberty at Tanner Stage II and if dysphoria persists, CHT is generally started after 16 years of age. Currently available short- and long-term safety studies suggest that CHT is reasonably safe in transmen. Monitoring of transmen should be more frequent during the first year of cross-sex hormone administration reducing to once or twice per year thereafter. Long-term monitoring after sex reassignment surgery (SRS) includes annual check-ups as are carried out for natal hypogonadal men. In elderly transmen, special attention should be paid to haematocrit in particular. Screening for breast and cervical cancer should be continued in transmen not undergoing SRS.
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Affiliation(s)
- Maria Cristina Meriggiola
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Gava
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Simonsen R, Hald GM, Giraldi A, Kristensen E. Sociodemographic Study of Danish Individuals Diagnosed with Transsexualism. Sex Med 2015; 3:109-17. [PMID: 26185676 PMCID: PMC4498828 DOI: 10.1002/sm2.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Male-to-female (MtF) and female-to-male (FtM) individuals with transsexualism (International Classification of Diseases-10) may differ in core clinical and sociodemographic variables such as age, sexual orientation, marriage and parenthood, school, educational level, and employment. Assessing and understanding the implication of such differences may be a key to developing appropriate and effective treatment and intervention strategies for this group. However, research in the area remains sparse and is often on small populations, making the generalization of results from current studies on individuals diagnosed with transsexualism difficult. Aims (i) To describe and assess key sociodemographic and treatment-related differences between MtF and FtM individuals in a Danish population of individuals diagnosed with transsexualism; (ii) to assess possible implications of such difference, if any, for clinical treatment initiatives for individuals diagnosed with transsexualism. Methods Follow-up of 108 individuals who had permission to undergo sex reassignment surgery (SRS, meaning castration and genital plastic surgery) over a 30-year period from 1978 to 2008 through the Gender Identity Unit in Copenhagen, Denmark. The individuals were identified through Social Security numbers. Clinical and sociodemographic data from medical records were collected. Results The sex ratio was 1.16:1 (MtF : FtM). Mean age at first referral was 26.9 (standard deviation [SD] 8.8) years for FtM and 30.2 (SD 9.7) for MtF individuals. Compared with MtF, FtM had a significantly lower onset age (before 12 years of age) and lower age when permission for SRS was granted. Further, FtM individuals were significantly more often gynephilic (sexually attracted to females) during research period and less likely to start self-initiated hormonal sex reassignment (SR) (treatment with cross-sex hormones). The MtF and FtM groups did not differ in years of school, educational level, employment, or engagement in marriage and cohabitation. Conclusions As approximately half of MtF started cross-sex hormonal SR without attending a gender unit, future treatment needs to focus on this group of MtF individuals in order to accommodate the medical risks of self-initiated hormonal treatment.Earlier intervention with adolescents appears necessary since three-quarters of FtM individuals before age 12 had problems with their assigned sex. For both MtF and FtM, we found problems in areas of school, education, and employment and recommend further help in these core areas.
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Affiliation(s)
- Rikke Simonsen
- Psychiatric Center Copenhagen, Sexological Clinic, GIUUC Copenhagen, Denmark ; Department of Clinical Medicine, University of Copenhagen Denmark
| | | | - Annamaria Giraldi
- Psychiatric Center Copenhagen, Sexological Clinic, GIUUC Copenhagen, Denmark ; Department of Clinical Medicine, University of Copenhagen Denmark
| | - Ellids Kristensen
- Psychiatric Center Copenhagen, Sexological Clinic, GIUUC Copenhagen, Denmark ; Department of Clinical Medicine, University of Copenhagen Denmark
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Affective temperaments in subjects with female-to-male gender dysphoria. J Affect Disord 2015; 176:61-4. [PMID: 25702601 DOI: 10.1016/j.jad.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 01/21/2015] [Accepted: 02/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Males and females have different temperaments. In individuals with gender dysphoria (GD) there is marked incongruence between a person׳s expressed/experienced gender and their biological sex. The present study aimed to investigate the most common affective temperaments in individuals with female-to-male (FtM) GD. METHODS We performed a prospective and comparative study investigating affective temperaments in subjects with FtM GD. Eighty subjects with FtM GD and 68 female controls were enrolled. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was completed by all participants. RESULTS TEMPS-A scores were significantly higher in subjects with FtM GD for hyperthymic temperament (p≤0.001), whereas depressive (p≤0.001), anxious (p≤0.001), and cyclothymic (p=0.028) temperament scores were significantly higher in female controls. LIMITATIONS The study was limited by the lack of male-to-female subjects and male controls. CONCLUSIONS The results of our study indicate that individuals with FtM GD have significantly higher scores of hyperthymic temperament, measured by TEMPS-A. Biological basis underlying the development of gender identity independent from the biological sex might be related with affective temperaments.
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Capetillo-Ventura N, Jalil-Pérez S, Motilla-Negrete K. Gender dysphoria: An overview. MEDICINA UNIVERSITARIA 2015. [DOI: 10.1016/j.rmu.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hess J, Neto RR, Panic L, Rübben H, Senf W. Satisfaction with male-to-female gender reassignment surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:795-801. [PMID: 25487762 PMCID: PMC4261554 DOI: 10.3238/arztebl.2014.0795] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery. METHODS 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospital's Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction. RESULTS 119 (46.9% ) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1-7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now. CONCLUSION The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.
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Affiliation(s)
- Jochen Hess
- Department of Urology at the University Hospital Essen
| | - Roberto Rossi Neto
- Department of Urology at the University Hospital Essen
- Clinica Urologia, General Hospital Ernesto Simoes Filho, Salvador, Brasilien
| | - Leo Panic
- Department of Urology at the University Hospital Essen
| | | | - Wolfgang Senf
- Department of Psychosomatic Medicine and Psychotherapy, University of Essen
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Dhejne C, Öberg K, Arver S, Landén M. An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1535-45. [PMID: 24872188 DOI: 10.1007/s10508-014-0300-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/11/2013] [Accepted: 12/14/2013] [Indexed: 05/10/2023]
Abstract
Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960-2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89% (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3%, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30%. In contrast, the proportion of MF individuals 30 years or older increased from 37% in the first decade to 60% in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2% regret rate for both sexes. There was a significant decline of regrets over the time period.
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Affiliation(s)
- Cecilia Dhejne
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
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Kirkovski M, Enticott PG, Fitzgerald PB. A review of the role of female gender in autism spectrum disorders. J Autism Dev Disord 2014; 43:2584-603. [PMID: 23525974 DOI: 10.1007/s10803-013-1811-1] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper reviews the literature exploring gender differences associated with the clinical presentation of autism spectrum disorders (ASD). The potentially mediating effect of comorbid psychopathology, biological and neurodevelopmental implications on these gender differences is also discussed. A vastly heterogeneous condition, while females on the lower-functioning end of the spectrum appear to be more severely affected, an altered clinical manifestation of the disorder among high-functioning females may consequently result in many being un- or mis-diagnosed. To date, there is strong bias in the literature towards the clinical presentation of ASD in males. It is imperative that future research explores gender differences across the autism spectrum, in order to improve researchers', clinicians' and the public's understanding of this debilitating disorder.
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Affiliation(s)
- Melissa Kirkovski
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia,
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Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria. PSYCHIATRY JOURNAL 2014; 2014:971814. [PMID: 25180172 PMCID: PMC4142737 DOI: 10.1155/2014/971814] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/19/2014] [Accepted: 07/20/2014] [Indexed: 11/17/2022]
Abstract
Objectives. Cooccurring psychiatric disorders influence the outcome and prognosis of gender dysphoria. The aim of this study is to assess psychiatric comorbidities in a group of patients. Methods. Eighty-three patients requesting sex reassignment surgery (SRS) were recruited and assessed through the Persian Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Results. Fifty-seven (62.7%) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%) were the three most prevalent disorders. Conclusion. Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity.
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Hoffman MR, Devine EE, Remacle M, Ford CN, Wadium E, Jiang JJ. Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension. Eur Arch Otorhinolaryngol 2014; 271:1621-9. [PMID: 24241252 PMCID: PMC4013228 DOI: 10.1007/s00405-013-2798-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
To evaluate type IIIB thyroplasty using the excised larynx bench apparatus and determine how altering vocal fold contour by performing bilateral medialization of the inferior vocal fold affects phonation. This procedure could be performed in patients for whom pitch lowering is desirable, such as female-to-male transsexuals or male patients with mutational falsetto in whom intensive voice therapy was insufficient. Aerodynamic, acoustic, and high-speed videokymographic data were collected for nine larynges at three subglottal pressure inputs for each of three conditions: normal; type IIIB thyroplasty; and combined type IIIB with modified bilateral type I thyroplasty intended to create a more rectangular glottal configuration. Each larynx served as its own control. Phonation threshold flow (p = 0.005), phonation threshold power (p = 0.031), and airflow varied across conditions with highest values for type IIIB thyroplasty and lowest for the combined procedure. Fundamental frequency was significantly different (p < 0.001), decreasing by approximately 100 Hz from control to type IIIB trials, and then by approximately 15 Hz from IIIB to combined procedure trials. Vibratory amplitudes and intrafold phase difference were highest for type IIIB trials. Addition of bilateral inferior medialization to type IIIB thyroplasty provided some further decrease in frequency, but mostly served to increase tension, reduce airflow, and produce a vibratory pattern which more closely mirrored control trials. Exploration of this combined procedure in patients may be warranted if not completely satisfied with the results from type IIIB thyroplasty alone.
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Affiliation(s)
- Matthew R. Hoffman
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Madison, WI, 53792
| | - Erin E. Devine
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Madison, WI, 53792
| | - Marc Remacle
- Department of Otorhinolaryngology – Head and Neck Surgery, Louvain University Hospital of Mont-Godinne, Yvoir, Belgium
| | - Charles N. Ford
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Madison, WI, 53792
| | - Elizabeth Wadium
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Madison, WI, 53792
| | - Jack J. Jiang
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Madison, WI, 53792
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Fernández R, Esteva I, Gómez‐Gil E, Rumbo T, Almaraz MC, Roda E, Haro‐Mora J, Guillamón A, Pásaro E. The (CA)n Polymorphism of ERβ Gene is Associated with FtM Transsexualism. J Sex Med 2014; 11:720-8. [DOI: 10.1111/jsm.12398] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Judge C, O’Donovan C, Callaghan G, Gaoatswe G, O’Shea D. Gender dysphoria - prevalence and co-morbidities in an irish adult population. Front Endocrinol (Lausanne) 2014; 5:87. [PMID: 24982651 PMCID: PMC4056308 DOI: 10.3389/fendo.2014.00087] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/28/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Gender dysphoria (GD) is a condition in which there is a marked incongruence between an individual's psychological perception of his/her sex and their biological phenotype. Gender identity disorder was officially renamed "gender dysphoria" in the DSM-V in 2013. The prevalence and demographics of GD vary according to geographical location and has not been well-documented in Ireland. METHODS We retrospectively reviewed medical records of 218 patients with suspected or confirmed GD referred to our endocrine service for consideration of hormonal therapy (HT) between 2005 and early 2014. We documented their demographics, clinical characteristics, and treatment during the study period. RESULTS The prevalence of GD in the Irish population was 1:10,154 male-to-female (MTF) and 1:27,668 female-to-male (FTM), similar to reported figures in Western Europe. 159 of the patients were MTF and 59 were FTM, accounting for 72.9% and 27.1% of the cohort, respectively. The rate of referral has increased year-on-year, with 55 patients referred in 2013 versus 6 in 2005. Mean ages were 32.6 years (MTF) and 32.2 years (FTM). 22 of the patients were married and 41 had children, with 2 others having pregnant partners. 37.6% were referred by a psychologist, with the remainder evenly divided between GPs and psychiatric services. There were low rates of coexistent medical illness although psychiatric conditions were more prevalent, depression being a factor in 34.4% of patients. 5.9% of patients did not attend a mental health professional. 74.3% are currently on HT, and 9.17% have had gender reassignment surgery (GRS). Regret following hormonal or surgical treatment was in line with other Western European countries (1.83%). CONCLUSION The incidence of diagnosis and referral of GD in Ireland is increasing. This brings with it multiple social, health, and financial implications. Clear and accessible treatment pathways supported by mental health professionals is essential.
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Affiliation(s)
- Ciaran Judge
- Department of Endocrinology, St. Columcille’s Hospital, Dublin, Ireland
| | - Claire O’Donovan
- Department of Endocrinology, St. Columcille’s Hospital, Dublin, Ireland
| | - Grainne Callaghan
- Department of Endocrinology, St. Columcille’s Hospital, Dublin, Ireland
| | | | - Donal O’Shea
- Department of Endocrinology, St. Columcille’s Hospital, Dublin, Ireland
- Department of Endocrinology, St. Vincent’s University Hospital, Dublin, Ireland
- *Correspondence: Donal O’Shea, Department of Endocrinology, St. Columcille’s Hospital, Loughlinstown and St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland e-mail:
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Blosnich JR, Brown GR, Shipherd Phd JC, Kauth M, Piegari RI, Bossarte RM. Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. Am J Public Health 2013; 103:e27-32. [PMID: 23947310 DOI: 10.2105/ajph.2013.301507] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. METHODS We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. RESULTS GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. CONCLUSIONS The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.
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Affiliation(s)
- John R Blosnich
- John R. Blosnich is with the Department of Psychiatry, University of Rochester, Rochester, NY. George R. Brown is with the VA Office of Health Equity (10A6), Washington, DC. Jillian C. Shipherd is with VA Boston Healthcare System, Boston, MA. Michael Kauth is with VA South Central Mental Illness Research, Education, & Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX. At the time of this study, Rebecca I. Piegari was with Department of Veteran Affairs VISN-2 Center of Excellence for Suicide Prevention, Canandaigua, NY. Robert M. Bossarte is with the Department of Veteran Affairs VISN-2 Center of Excellence for Suicide Prevention
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Mastronikolis NS, Remacle M, Biagini M, Kiagiadaki D, Lawson G. Wendler Glottoplasty: An Effective Pitch Raising Surgery in Male-to-Female Transsexuals. J Voice 2013; 27:516-22. [DOI: 10.1016/j.jvoice.2013.04.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/08/2013] [Indexed: 11/25/2022]
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Meier SC, Labuski CM. The Demographics of the Transgender Population. INTERNATIONAL HANDBOOK ON THE DEMOGRAPHY OF SEXUALITY 2013. [DOI: 10.1007/978-94-007-5512-3_16] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Terada S, Matsumoto Y, Sato T, Okabe N, Kishimoto Y, Uchitomi Y. Factors predicting psychiatric co-morbidity in gender-dysphoric adults. Psychiatry Res 2012; 200:469-74. [PMID: 22884214 DOI: 10.1016/j.psychres.2012.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 06/22/2012] [Accepted: 07/15/2012] [Indexed: 11/25/2022]
Abstract
Persons with gender identity disorder (GID) often suffer from psychiatric co-morbidity, and it is an important prognostic factor for long-term psychosocial adjustment in GID. However, previous research has not addressed the risk factors of psychiatric co-morbidity. In this study, we tried to clarify the risk factors among individuals with GID in Japan. A total of 326 consecutive GID persons were evaluated independently by two senior psychiatrists at the GID clinic using personal clinical interviews and results of examinations. The prevalence of current psychiatric co-morbidity was 17.8% of the total sample. School refusal was significantly associated with psychiatric co-morbidity. Sexual attraction to neither males nor females among GID persons and sexual attraction to females among male-to-female (MtF) GID persons were also significantly related to psychiatric co-morbidity. This is the first report to demonstrate a close relationship between patterns of sexual orientation and psychiatric co-morbidity among GID persons. We should pay more attention to psychiatric co-morbidity, especially among GID persons with non-homosexual sexual orientations.
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Affiliation(s)
- Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Terada S, Matsumoto Y, Sato T, Okabe N, Kishimoto Y, Uchitomi Y. School refusal by patients with gender identity disorder. Gen Hosp Psychiatry 2012; 34:299-303. [PMID: 22227029 DOI: 10.1016/j.genhosppsych.2011.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The accumulating evidence suggests that school refusal behavior is associated with severe negative outcomes. However, previous research has not addressed school refusal by patients with gender identity disorder (GID). In this study, we tried to clarify the prevalence of school refusal among GID patients and the relationship of school refusal to demographic characteristics. METHODS A total of 579 consecutive Japanese GID patients at the outpatient GID Clinic of Okayama University Hospital between April 1997 and October 2005 were evaluated. RESULTS The prevalence of school refusal was 29.2% of the total sample. School refusal was more frequent among GID patients with divorced parents than those with intact families. Multiple logistic regression analysis showed that younger age at consultation and divorce of parents were significantly associated with school refusal among the male-to-female GID patients. CONCLUSION The rate of school refusal among GID patients is high, and school refusal is closely related with a low level of education and current unemployment. We should pay more attention to GID patients of school age to prevent their school refusal, which results in low educational achievement.
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Affiliation(s)
- Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
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Terada S, Matsumoto Y, Sato T, Okabe N, Kishimoto Y, Uchitomi Y. Suicidal ideation among patients with gender identity disorder. Psychiatry Res 2011; 190:159-62. [PMID: 21612827 DOI: 10.1016/j.psychres.2011.04.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
In this study, we tried to clarify the prevalence of suicidal ideation and self-mutilation including suicide attempts among patients with gender identity disorder (GID) and the relationship of those behaviors to demographic characteristics. A total of 500 consecutive Japanese GID patients without any other psychiatric comorbidity were evaluated at the outpatient GID Clinic of Okayama University Hospital. The lifetime rate of suicidal ideation was 72.0% of the total sample. There were no significant differences in the prevalence of suicidal ideation among groups divided by sex, age, age at onset or education. The lifetime prevalence of self-mutilation including suicide attempts was 31.8% of the total sample. Low level of education was significantly related to self-mutilation among both male-to-female and female-to-male GID patients. Younger age at onset was a significant factor affecting self-mutilation only among MTF GID patients. A lack of strategies to cope with severe distress among persons with lower education might induce a high frequency of self-mutilation including suicidal attempt. GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation.
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Affiliation(s)
- Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
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Martin KA, Bostwick JM, Vargas HE. Liver Transplant Case Report: Transgenderism and Liver Transplantation. Int J Transgend 2011. [DOI: 10.1080/15532739.2011.611364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Glottoplasty for Male-to-Female Transsexualism: Voice Results. J Voice 2011; 25:120-3. [DOI: 10.1016/j.jvoice.2009.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/08/2009] [Indexed: 11/20/2022]
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Hoshiai M, Matsumoto Y, Sato T, Ohnishi M, Okabe N, Kishimoto Y, Terada S, Kuroda S. Psychiatric comorbidity among patients with gender identity disorder. Psychiatry Clin Neurosci 2010; 64:514-9. [PMID: 20727112 DOI: 10.1111/j.1440-1819.2010.02118.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Psychiatric comorbidity and mental instability seem to be important unfavorable prognostic factors for long-term psychosocial adjustment in gender identity disorder (GID). However, psychiatric comorbidity in patients with GID has rarely been assessed. In this study, we investigated the psychiatric comorbidity and life events of patients with GID in Japan. METHODS A total of 603 consecutive patients were evaluated independently by at least two senior psychiatrists at the GID clinic using clinical information and results of examinations. RESULTS Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579). CONCLUSIONS Comparison with previous reports on the psychiatric comorbidity among GID patients revealed that the majority of GID patients had no psychiatric comorbidity. GID is a diagnostic entity in its own right, not necessarily associated with severe comorbid psychological findings.
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Affiliation(s)
- Masahiko Hoshiai
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Khandelwal A, Agarwal A, Jiloha RC. A 47,XXY female with gender identity disorder. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1021-1023. [PMID: 20464469 DOI: 10.1007/s10508-010-9628-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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45
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Bentz EK, Pils D, Bilban M, Kaufmann U, Hefler LA, Reinthaller A, Singer CF, Huber JC, Horvat R, Tempfer CB. Gene expression signatures of breast tissue before and after cross-sex hormone therapy in female-to-male transsexuals. Fertil Steril 2010; 94:2688-96. [PMID: 20537635 DOI: 10.1016/j.fertnstert.2010.04.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/01/2010] [Accepted: 04/08/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate gene expression signatures of breast tissue in female-to-male (FtM) transsexuals under cross-sex hormone therapy (HT). DESIGN Prospective cohort study. SETTING Academic research institution. PATIENT(S) Five hormone-naïve FtM transsexuals before and after HT. INTERVENTION(S) Breast tissue biopsy before and after 2 years of intramuscular testosterone undecanoate (1,000 mg every 12 wk) and oral lynestrenole (5 mg daily), and gene signature analysis by global gene expression array covering 28,869 genes. MAIN OUTCOME MEASURE(S) Differential regulation of specific genes and gene expression signatures. RESULT(S) We identified 2,250 differentially expressed probe sets. One hundred twenty probe sets showed >2-fold change, of which 77 (64.2%) were up-regulated and 43 (35.8%) down-regulated. Genes involved in transcription were most overrepresented, with 43 out of 97 (44.3%) annotated probes, e.g., the transcription factor complex activator protein 1, including all three Jun genes (c-Jun, JunB, and JunD), two Fos genes (c-Fos and FosB), and activating transcription factor 3. In a Database for Annotation, Visualization, and Integrated Discovery analysis of the 2,007 down-regulated probe sets, proteins of the ribosome pathway and of two pathways involved in protein degradation, i.e., proteasome- and ubiquitin-mediated proteolysis, were significantly down-regulated. We identified eight breast cancer-associated gene expression signatures significantly overlapping with differentially regulated probe sets after cross-sex HT. CONCLUSION(S) Cross-sex HT in FtM transsexuals leads to the up-regulation and down-regulation of 243 and 2,007 distinct genes, respectively, and is associated with breast cancer-related gene expression signatures.
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Affiliation(s)
- Eva-Katrin Bentz
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
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46
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Tønseth KA, Bjark T, Kratz G, Gross A, Kirschner R, Schreiner T, Diseth TH, Haraldsen I. [Sex reassignment surgery in transsexuals]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:376-9. [PMID: 20220861 DOI: 10.4045/tidsskr.08.0670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Rikshospitalet (The National Hospital) treats all transsexual patients in Norway. 50-70 patients are referred annually for assessment and about 20 of these are diagnosed as transsexual. Approximately 15 confirmed transsexuals, who have received hormone treatment, are referred to sex reassignment surgery per year. This article describes diagnosis and treatment of transsexualism with an emphasis on surgery. MATERIAL AND METHODS The article is based on a non-systematic review of the literature and our own clinical experience. RESULTS Patients are evaluated for sex reassignment surgery after at least one year of psychiatric evaluation and an additional year of endocrine treatment. Male-to-female patients are evaluated for breast augmentation if hormone therapy has given unsatisfactory results. Thereafter, genital surgery can be performed, i.e. the testis and corpus cavernosum are removed and a neovagina and neoclitoris are constructed. Female-to-male patients have the possibility to undergo breast reduction, hysterectomy, salpingoophorectomy and construction of a neopenis. If the patient responds well to male hormones, the clitoris can be straightened and reconstructed as a small neopenis with an erectile function (metaidoioplasty). Alternatively, phalloplasty is performed using the local groin flap or a microvascular free flap. INTERPRETATION Sex reassignment surgery mainly consists of operations on breasts and genitalia.
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Affiliation(s)
- Kim Alexander Tønseth
- Plastikkirurgisk avdeling, Oslo universitetssykehus, Rikshospitalet 0027 Oslo, Norway.
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Matsumoto Y, Sato T, Ohnishi M, Kishimoto Y, Terada S, Kuroda S. Stress-coping strategies of patients with gender identity disorder. Psychiatry Clin Neurosci 2009; 63:715-20. [PMID: 19781016 DOI: 10.1111/j.1440-1819.2009.02017.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Previous research has not addressed gender differences in coping strategies among patients with gender identity disorder (GID). Nor has the relationship of coping strategies to other demographic characteristics ever been clarified in GID. In this study, we tried to clarify the relationship between stress-coping strategies and demographic characteristics among patients with GID. METHODS The coping strategies of 344 patients with GID [227 female-to-male (FTM) and 117 male-to-female (MTF)] were assessed using the Japanese version of the Ways of Coping Questionnaires, Lazarus Stress-coping Inventory. RESULTS Comparison of the stress-coping inventory between MTF and FTM GID patients revealed that FTM GID patients were significantly more reliant on positive reappraisal strategies in stressful situations than MTF GID patients (P = 0.007). CONCLUSIONS The difference in the usage of positive reappraisal strategies between MTF and FTM type GID patients was not explained by other demographic characteristics, and we suppose that the gender difference in GID patients might influence the usage of positive reappraisal strategies. The ratio of FTM GID patients might be higher at our center because MTF GID patients can obtain vaginoplasty easily, whereas phalloplasty surgery for FTM GID patients is performed at only a few centers, including our clinic, in Japan. As a result, more FTM GID patients come to our clinic with a clear intention to undergo sexual rearrangement surgery, which might influence the gender difference in using positive reappraisal.
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Affiliation(s)
- Yosuke Matsumoto
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Imbimbo C, Verze P, Palmieri A, Longo N, Fusco F, Arcaniolo D, Mirone V. ORIGINAL RESEARCH—INTERSEX AND GENDER IDENTITY DISORDERS: A Report from a Single Institute's 14-Year Experience in Treatment of Male-to-Female Transsexuals. J Sex Med 2009; 6:2736-45. [DOI: 10.1111/j.1743-6109.2009.01379.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Persson DI. Unique challenges of transgender aging: implications from the literature. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2009; 52:633-46. [PMID: 19598043 DOI: 10.1080/01634370802609056] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Transgender elders are both underserved and understudied. Neither the etiology nor prevalence of transgender is well understood. Because sex, gender, and sexuality are at the very core of individual identity, it is difficult to dislodge one's ideas and feelings about them. Unlike biological sex and sexual orientation, gender has several aspects: gender identity, gender expression, and gender classification. A discussion of the terminology of transgender is presented, and the issues facing aging transgender individuals are identified. Although the challenges of adequate healthcare, social support, and legal obstacles are faced by many elderly individuals, the way they are presented and managed are unique to this often invisible group.
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Affiliation(s)
- Diane I Persson
- School of Nursing, Center on Aging, University of Texas, Houston, Texas 77030, USA.
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Gómez-Gil E, Trilla A, Salamero M, Godás T, Valdés M. Sociodemographic, clinical, and psychiatric characteristics of transsexuals from Spain. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:378-92. [PMID: 18288600 DOI: 10.1007/s10508-007-9307-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 06/13/2007] [Accepted: 08/04/2007] [Indexed: 05/21/2023]
Abstract
The aim of this study was to examine the characteristics of transsexuals from Spain. A total of 252 consecutive applicants for sex reassignment were evaluated using a standardized semistructured clinical interview and the Mini International Neuropsychiatric Interview (Spanish Version 5.0.0) to record demographic, clinical, and psychiatric data. Transsexualism was diagnosed in 230 patients, with a male to female (MF)/female to male (FM) ratio of 2.2:1. Transsexual patients frequently had low employment status, lived with their parents, and mainly had a sexual orientation toward same-sex partners. The most frequent psychiatric diagnoses were adjustment disorder and social phobia in both groups, and alcohol and substance-related disorders in the MF group. MF transsexuals were older than FM transsexuals when requesting sex reassignment, but did not differ in age when starting hormonal therapy (often on their own); fewer MFs were in employment requiring high educational qualification, more were non-Spanish natives, and more had previous and current histories of alcohol and substance abuse or dependence. The basic characteristics of transsexuals from Spain were similar to those of other European countries, except for the higher proportion of patients living with their parents and the higher proportion of MFs who reported same-sex sexual orientation compared with previous studies.
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Affiliation(s)
- Esther Gómez-Gil
- Department of Psychiatry, Institute of Neurosciences, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona, Spain.
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