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Rezaei SJ, Miller AS, Miranda N, Ganor O. Gender-affirming surgeries for transgender and gender diverse individuals and associated health outcomes. BEHAVIORAL SCIENCES & THE LAW 2024. [PMID: 38889084 DOI: 10.1002/bsl.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Gender-affirming care is treatment that recognizes and affirms the gender identity of transgender and gender-diverse (TGD) individuals. Though not all TGD people choose to surgically transition, gender-affirming surgeries (GAS) are an important part of many TGD people's transition. GAS can include a wide array of procedures aimed at aligning an individual's physical characteristics and gender identity. This review describes the most common procedures considered to be GAS, detailing important relevant considerations for each procedure. These include transfeminine procedures (i.e., breast augmentation, penile inversion vaginoplasty, orchiectomy, tracheal shave, and facial feminization); transmasculine procedures (i.e., chest masculinization, hysterectomy, phalloplasty, and metoidioplasty); and other procedures (i.e., fertility preservation and hair removal). Patient outcomes and the legal landscape for GAS are also discussed to contextualize these procedures within largest discourses surrounding gender-affirming care.
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Affiliation(s)
- Shawheen J Rezaei
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amitai S Miller
- Harvard University John F. Kennedy School of Government, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Noah Miranda
- Stanford University School of Medicine, Stanford, California, USA
- UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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2
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Gu Y, Tang GT, Cheung ASZ, Sebaratnam DF. Dermatological considerations for transgender and gender diverse patients: An Australian perspective. Australas J Dermatol 2024; 65:24-36. [PMID: 37919972 DOI: 10.1111/ajd.14179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
Transgender and gender diverse (TGD) individuals are a group that experiences significant health disparities. In the multidisciplinary management of TGD patients, dermatologists may participate in managing skin- and hair-related issues which contribute to gender affirmation and to the cutaneous sequelae of gender-affirming hormone therapy. This review aims to highlight the unique needs of TGD patients, particularly from the perspective of Australian dermatologists. We review appropriate terminology critical for TGD care, gender affirmation in the Australian healthcare landscape, dermatological considerations for TGD patients and considerations for management.
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Affiliation(s)
- Yaron Gu
- Faculty of Medicine and Health, The University of New South Wales, Kensington, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Gia Toan Tang
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Ada Sau-Zhuen Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Deshan Frank Sebaratnam
- Faculty of Medicine and Health, The University of New South Wales, Kensington, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
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3
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Tang GT, Zwickl S, Sinclair R, Zajac JD, Cheung AS. Effect of gender-affirming hormone therapy on hair growth: a systematic review of the literature. Clin Exp Dermatol 2023; 48:1117-1127. [PMID: 37311161 DOI: 10.1093/ced/llad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023]
Abstract
Gender-affirming hormone therapy (GAHT) leads to changes in body composition, secondary sex characteristics and in the distribution and pattern of hair growth. Transgender individuals undergoing GAHT may experience altered hair growth patterns that may be affirming and desirable, or undesirable with a subsequent impact on their quality of life. Given increasing numbers of transgender individuals commencing GAHT worldwide and the clinical relevance of the impact of GAHT on hair growth, we systematically reviewed the existing literature on the impact of GAHT on hair changes and androgenic alopecia (AGA). The majority of studies used grading schemes or subjective measures of hair changes based on patient or investigator's examination. Very few studies used objective quantitative measures of hair parameters but demonstrated statistically significant changes in hair growth length, diameter and density. Feminizing GAHT with estradiol and/or antiandrogens in transgender women may reduce facial and body hair growth and also can improve AGA. Masculinizing GAHT with testosterone in transgender men may increase facial and body hair growth as well as induce or accelerate AGA. The impact of GAHT on hair growth may not align with a transgender person's hair growth goals and specific treatment for AGA and/or hirsutism may be sought. Further research on how GAHT affects hair growth is required.
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Affiliation(s)
- Gia Toan Tang
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | | | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | - Ada S Cheung
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
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Huang C, Gold S, Radi R, Amos S, Yeung H. Managing Dermatologic Effects of Gender-Affirming Therapy in Transgender Adolescents. Adolesc Health Med Ther 2022; 13:93-106. [PMID: 36237602 PMCID: PMC9552673 DOI: 10.2147/ahmt.s344078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Transgender adolescents seek gender-affirming medical care to address gender identity and incongruence. Improved understanding of the dermatologic impact of gender-affirming medical care such as pubertal suppression, hormone therapy, and surgeries can enhance patient outcome. Pubertal suppression treats dysphoria associated with development of secondary sex characteristics, including androgen-driven acne. Gender-affirming hormone therapy influences acne and hair development in transgender adolescents. Dermatologists can help manage skin effects associated with chest binding and gender-affirming hormone therapy and surgery. Provision of patient-centered gender-affirming care in dermatologic and multidisciplinary settings is essential to improve skin and overall outcomes of gender-affirming therapy.
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Affiliation(s)
- Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth Amos
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA,Clinical Resource Hub, Veterans Affairs Southeast Network Veterans Integrated Service Network 7, Decatur, GA, USA,Correspondence: Howa Yeung, Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE Suite 100, Atlanta, GA, 30322, USA, Tel +1 (404) 727-9838, Fax +1 (404) 727-5878, Email
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5
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Yuan N, Feldman AT, Chin P, Zaliznyak M, Rabizadeh S, Garcia MM. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022; 10:100545. [PMID: 35914381 PMCID: PMC9537259 DOI: 10.1016/j.esxm.2022.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care. Aim This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices. Methods Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed. Main Outcomes Measure Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction. Results Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency. Clinical Implications For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty. Strength and Limitations This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection. Conclusion When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty. Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.
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Affiliation(s)
- Nance Yuan
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexandra Terris Feldman
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick Chin
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Susan Rabizadeh
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maurice M Garcia
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Urology, University of California San Francisco, San Francisco, CA, USA; Department of Anatomy, University of California San Francisco, San Francisco, CA, USA.
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Swink SM, Castelo-Soccio L. Dermatologic considerations for transgender and gender diverse youth. Pediatr Dermatol 2021; 38 Suppl 2:58-64. [PMID: 34250638 DOI: 10.1111/pde.14685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sexual and gender minority individuals, including transgender and gender diverse people, are an underserved and vulnerable population in the field of dermatology. While the unique dermatologic needs for adult patients in this group are increasingly documented, the knowledge surrounding pediatric and adolescent transgender/gender diverse patients is lacking. We aim to summarize the unique dermatologic needs of transgender/gender diverse patients, with particular attention paid to the data available in younger groups. This review highlights the unique role pediatric dermatologists can play in the care of transgender and gender diverse youth including but not limited to treating acne and hair pattern changes as well as being knowledgeable about surgical and other cosmetic options for gender affirmation. It also highlights areas for potential future research including dermatologic effects of hormone therapy in children as well as treatments for those side effects.
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Affiliation(s)
- Shane M Swink
- Division of Dermatology, Lehigh Valley Health Network, Allentown, PA, USA
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Motosko CC, Tosti A. Dermatologic Care of Hair in Transgender Patients: A Systematic Review of Literature. Dermatol Ther (Heidelb) 2021; 11:1457-1468. [PMID: 34235628 PMCID: PMC8484383 DOI: 10.1007/s13555-021-00574-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/25/2021] [Indexed: 10/26/2022] Open
Abstract
Transgender patients on masculinizing and feminizing hormonal therapy undergo myriad physical and psychologic changes. Dermatologists are uniquely qualified to guide patients in the gender-affirming process, especially as it relates to hair. Given the paucity of literature guiding dermatologists in this process, a systematic review was performed to better understand the physiologic changes of hair in patients on masculinizing and feminizing hormonal therapy as well as the variety of treatment options that exist to help transgender patients to attain their desired hair growth pattern. This review reports findings and treatment options supported by the performed literature review as well as treatment recommendations based on the authors' own experiences treating this unique patient population.
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Affiliation(s)
- Catherine C Motosko
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA.
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Ragmanauskaite L, Zhang Q, Kim J, Getahun D, Silverberg MJ, Goodman M, Yeung H. Survey of Dermatologic Procedures in Transgender Adults. Dermatol Surg 2021; 47:1379-1383. [PMID: 34417383 PMCID: PMC8463491 DOI: 10.1097/dss.0000000000003179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dermatologists have the opportunity to provide medically necessary procedures, including laser hair removal, to transgender patients for gender affirmation. Further research is required to better assess the unique dermatologic needs of this population. OBJECTIVE To examine the prevalence of dermatologic procedures among transgender people in the context of gender-affirming treatment. METHODS This cross-sectional study examined survey responses from 696 transgender persons enrolled in the Study of Transition, Outcomes, and Gender cohort. Prevalence of self-reported dermatologic procedures was examined and compared across participant subgroups. RESULTS Electrolysis was the most commonly reported procedure (32.9%). Transfeminine patients were more likely to use dermatologic procedures compared with transmasculine patients. Only 19 participants (2.8%) reported the use of dermal filler injections. CONCLUSION Differences in utilization of dermatologic procedures were noted in transgender populations. Motivations, barriers, and optimal timing for gender-affirming dermatologic procedures among transgender persons should be examined in future studies.
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Affiliation(s)
| | - Qi Zhang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Jin Kim
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Michael Goodman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
- Regional Telehealth Service, VA Veterans Integrated Service Network 7 Southeast Network, Decatur, GA
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9
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Pathoulas JT, Flanagan KE, Walker CJ, Pupo Wiss IM, Marks D, Senna MM. Characterizing the role of facial hair in gender identity and expression among transgender men. J Am Acad Dermatol 2021; 87:228-230. [PMID: 34363904 DOI: 10.1016/j.jaad.2021.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/30/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Affiliation(s)
- James T Pathoulas
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly E Flanagan
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts
| | - Chloe J Walker
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts
| | - Isabel M Pupo Wiss
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts
| | - Dustin Marks
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pennsylvania
| | - Maryanne M Senna
- Department of Dermatology, Harvard Medical School-Massachusetts General Hospital, Boston, Massachusetts.
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Thoreson N, Marks DH, Peebles JK, King DS, Dommasch E. Health Insurance Coverage of Permanent Hair Removal in Transgender and Gender-Minority Patients. JAMA Dermatol 2020; 156:561-565. [PMID: 32211825 DOI: 10.1001/jamadermatol.2020.0480] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy's medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.
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Affiliation(s)
- Nick Thoreson
- Medical student, Boston University School of Medicine, Boston, Massachusetts
| | - Dustin H Marks
- Medical student, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - J Klint Peebles
- Department of Dermatology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Dana S King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Erica Dommasch
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Zhang H, Tang K, Wang Y, Fang R, Sun Q. Understanding and caring for lesbian, gay, bisexual, and transgender patients in dermatologic clinics: A dermatologist's perspective from China. J Cosmet Dermatol 2020; 19:3446-3447. [PMID: 32757371 DOI: 10.1111/jocd.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China.,Eight-year MD Program, Peking Union Medical College, Beijing, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China.,Eight-year MD Program, Peking Union Medical College, Beijing, China
| | - Yuchen Wang
- Eight-year MD Program, Peking Union Medical College, Beijing, China
| | - Rouyu Fang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
| | - Qiuning Sun
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
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12
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Panagiotakopoulos L, Chulani V, Koyama A, Childress K, Forcier M, Grimsby G, Greenberg K. The effect of early puberty suppression on treatment options and outcomes in transgender patients. Nat Rev Urol 2020; 17:626-636. [PMID: 32968238 DOI: 10.1038/s41585-020-0372-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
In the past 10-15 years, paediatric transgender care has emerged at the forefront of several general practice and subspecialty guidelines and is the topic of continuing medical education for various medical disciplines. Providers in specialties ranging from family medicine, paediatrics and adolescent medicine to endocrinology, gynaecology and urology are caring for transgender patients in increasing numbers. Current and evolving national and international best practice guidelines recommend offering a halt of endogenous puberty for patients with early gender dysphoria, in whom impending puberty is unacceptable for their psychosocial health and wellness. Pubertal blockade has implications for fertility preservation, transgender surgical care and psychosocial health, all of which must be considered and discussed with the patient and their family and/or legal guardian before initiation.
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Affiliation(s)
| | - Veenod Chulani
- Department of Paediatrics, Chief of Adolescent Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Atsuko Koyama
- Department of Paediatrics, Emory University, Atlanta, GA, USA
| | | | - Michelle Forcier
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, RI, USA
| | - Gwen Grimsby
- Division of Adolescent Medicine, Departments of Paediatrics and Obstetrics/Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Katherine Greenberg
- Division of Paediatric Urology, Phoenix Children's Hospital, Phoenix, AZ, USA
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13
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Benson TA, Boskey ER, Ganor O. The Effect of Forearm Tattoos on Flap Choice in Transmasculine Phalloplasty Patients. MDM Policy Pract 2020; 5:2381468320938740. [PMID: 32647747 PMCID: PMC7325467 DOI: 10.1177/2381468320938740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/10/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose. The radial forearm free flap (RFFF) is considered the gold standard for gender affirming phalloplasty. Ideally, a nondominant forearm flap is used to minimize the risk of functional morbidity. However, many transmasculine individuals have tattooed forearms, which can affect decision making. The purpose of this study was to understand the prevalence of forearm tattoos among transmasculine patients seeking phalloplasty and how and whether tattoos affected decision making about flap source. Methods. Participants were 50, consecutive, adult, transmasculine patients seeking phalloplasty. The presence and location of tattoos were assessed using consult notes in the electronic medical record. A one-tailed test of proportions was used to test whether forearm tattoos increased the likelihood of alternative flap choice. Results. More than half of patients (56%) had tattoos on either one or both forearms (n = 28), 75% on their nondominant arm (n = 21). Among the patients with forearm tattoos, the presence of tattoos affected the flap site decision for 46% of patients (n = 13). For the patients that chose an alternative flap site, 46% chose a dominant forearm RFFF (n = 6) and 54% an anterolateral thigh flap (n = 7). The percentage of patients whose records indicated that they were planning on using an alternative flap due to a tattoo on their nondominant forearm was significantly higher than the percentage of patients without such tattoos, indicating the desire for an alternate flap (P < 0.01). Conclusion. Many transmasculine patients seeking phalloplasty have tattoos on either one or both of their forearms. Because of this, a substantial fraction of patients may choose flap donor sites that are less ideal. Providers from all disciplines may wish to educate young transmasculine patients about how tattoo placement may affect surgical options earlier during transition.
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Affiliation(s)
| | - Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Oren Ganor
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
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