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Stratulat D. Letter to the editor: Eating disorder symptoms among transgender and gender diverse youth seeking gender-affirming care. Clin Child Psychol Psychiatry 2025; 30:186-188. [PMID: 39363484 DOI: 10.1177/13591045241284706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Affiliation(s)
- Diana Stratulat
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
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2
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D'Onofrio V, Sékaly RP. The immune-endocrine interplay in sex differential responses to viral infection and COVID-19. Trends Immunol 2024; 45:943-958. [PMID: 39562265 DOI: 10.1016/j.it.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/17/2024] [Accepted: 10/20/2024] [Indexed: 11/21/2024]
Abstract
Men are at higher risk for developing severe COVID-19 than women, while women are at higher risk for developing post-acute sequelae of COVID-19 (PASC). This highlights the impact of sex differences on immune responses and clinical outcomes of acute COVID-19 or PASC. A dynamic immune-endocrine interface plays an important role in the development of effective immune responses impacting the control of viral infections. In this opinion article we discuss mechanisms underlying the transcriptional and epigenetic regulation of immune responses by sex hormones during viral infections. We propose that disruption of this delicate immune-endocrine interplay can result in worsened outcomes of viral disease. We also posit that insights into these immune mechanisms can propel the development of novel immunomodulatory interventions that leverage immune-endocrine pathways to treat viral infections.
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Affiliation(s)
- Valentino D'Onofrio
- Center for Vaccinology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Rafick Pierre Sékaly
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA; Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA.
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Cattelan L, Dayan S, Aguilera SB, Viscomi B, Fabi SG. A Review of Aesthetic Considerations for Treating the Transgender Patient. Dermatol Surg 2024; 50:S191-S200. [PMID: 38349851 DOI: 10.1097/dss.0000000000004112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques. OBJECTIVE The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population. METHODS A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques. RESULTS The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy. CONCLUSION The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.
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Affiliation(s)
- Leila Cattelan
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Steven Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois
| | - Shino Bay Aguilera
- Shino Bay Cosmetic Dermatology & Laser Institute, Fort Lauderdale, Florida
| | - Bianca Viscomi
- Bianca Viscomi Dermatologia Private Practice, São Paulo, Brazil
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Vijapura C, Wahab R, Patel M, Miles RC, Brown AL. Breast/chest imaging findings and clinical considerations in transgender patients. Clin Radiol 2024; 79:903-911. [PMID: 39322531 DOI: 10.1016/j.crad.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/11/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024]
Abstract
The transgender population, a historically marginalized group, is growing in size, visibility, and cultural acceptance. However, lack of provider knowledge contributes to the disparities and discrimination that this group continues to face in the healthcare setting. Special considerations for transgender individuals undergoing imaging for breast/chest care can improve health equity, including appropriate evidence-based screening, tailored protocols, and inclusive radiology facilities. This article will focus on the imaging findings that can be seen in transgender patients during the course of gender-affirming care, which may involve hormone therapy and/or surgery. Relevant examples of benign and malignant pathologies that can be seen in transgender patients will be highlighted, and their imaging on mammogram, ultrasound, and magnetic resonance imaging (MRI) will be reviewed.
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Affiliation(s)
- C Vijapura
- University of Cincinnati, 3188 Bellevue Ave, Cincinnati, OH 45219, USA.
| | - R Wahab
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, USA.
| | - M Patel
- The Ohio State University Wexner Medical Center, 395 W. 12(th) Avenue, Columbus, OH 43210, USA.
| | - R C Miles
- Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
| | - A L Brown
- University of Cincinnati, 3188 Bellevue Ave, Cincinnati, OH 45219, USA.
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5
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Brezin F, Busiah K, Leroy C, Fiot E, Bensignor C, Amouroux C, Caquard M, Cartault A, Castets S, Delcour C, Devernay M, Feigerlova E, Hoarau M, Lebon-Labich B, Lambert AS, Rouleau S, Trouvin MA, Vautier V, Martinerie L. Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group. Arch Pediatr 2024:S0929-693X(24)00176-3. [PMID: 39551654 DOI: 10.1016/j.arcped.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/25/2024] [Indexed: 11/19/2024]
Abstract
INTRODUCTION Requests for hormonal transition in minors are increasing. To date, there is no national recommendation to guide these practices in France. Therefore, the SFEDP (French Society of Pediatric Endocrinology and Diabetology) has commissioned a group of experts to draft the first national consensus on this topic. METHOD Each chapter was prepared by one to three authors who conducted a literature review, and it was then reviewed and revised by the group as many times as necessary to achieve a consensus position. The final document was reviewed by a group of external experts. RESULTS A consensus position was reached regarding the multi-professional nature of support for trans youth, the prescription of molecules aimed at inhibiting endogenous hormone secretion, and the use of gender-affirming hormone therapies, as well as the importance of offering gamete preservation. Non-hormonal aspects of support and various considerations, including ethical ones, were also discussed. CONCLUSION This work constitutes an initial set of recommendations for professionals involved in the hormonal transition of trans youth. Additional recommendations under the auspices of the French High Authority for Health would be worthy of being drafted, involving all relevant stakeholders to establish comprehensive official national guidelines that would secure the support and rights of these young individuals, especially those under 16 years old, as well as the professionals involved in their care.
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Affiliation(s)
- François Brezin
- Unité D'endocrinologie et Diabétologie Pédiatrique, Centre Hospitalier Régional Universitaire, Service de Pédiatrie 1, Strasbourg, France.
| | - Kanetee Busiah
- Unité D'endocrinologie, Diabétologie et Obésité Pédiatrique, Département Femmes-Mères-Enfants, Centre Hospitalier Universitaire, Lausanne, Suisse
| | - Clara Leroy
- Unité D'endocrinologie et Diabétologie Pédiatrique, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire, Lille, France
| | - Elodie Fiot
- Service d'Endocrinologie et Diabétologie Pédiatrique, EPPAT, Hôpital Universitaire Robert-Debré, GHU APHP Nord, Paris 75019, France
| | - Candace Bensignor
- Service de pédiatrie, Centre Hospitalier Universitaire, Dijon, France
| | - Cyril Amouroux
- Unité de Néphrologie et Endocrinologie, Service de Pédiatrie Multidisplinaire, Centre Hospitalier Universitaire, Montpellier, France; Département de Pédagogie, Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Marylène Caquard
- Service de Pédiatrie, Centre Hospitalier Universitaire, Nantes, France
| | - Audrey Cartault
- Unité D'endocrinologie, Génétique, Maladies Osseuses et Gynécologie Pédiatrique, Hôpital d'enfants, Centre Hospitalier Universitaire, Toulouse, France
| | - Sarah Castets
- Service de Pédiatrie Multidisplinaire, Hôpital Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Clémence Delcour
- Service de Gynécologie, EPPAT, Hôpital Universitaire Robert-Debré, GHU APHP Nord, Paris 75019, France; Faculté de Santé, UFR de Médecine, Paris Cité, Paris, France
| | - Marie Devernay
- Unité de Médecine Pour Adolescents, Hôpital Armand Trousseau, APHP, Paris, France
| | - Eva Feigerlova
- Service D'endocrinologie, Diabète et Nutrition, Centre Hospitalier Universitaire, Nancy-Brabois, France
| | - Marie Hoarau
- Service de Pédiatrie Générale, Centre Hospitalier Universitaire, Saint Pierre, La Réunion, France
| | - Béatrice Lebon-Labich
- Service de Médecine Infantile, Hôpital d'enfant, Centre Hospitalier Régional Universitaire, Nancy-Brabois, France
| | - Anne-Sophie Lambert
- Service D'endocrinologie et Diabète de L'enfant, Hôpital Kremlin-Bicêtre, APHP, Paris, France
| | - Stéphanie Rouleau
- Unité D'endocrinologie, Gynécologie et Diabétologie Pédiatrique, Service de Pédiatrie, Centre Hospitalier Universitaire, Angers, France
| | - Marie-Agathe Trouvin
- Service D'endocrinologie et Diabète de L'enfant, Hôpital Kremlin-Bicêtre, APHP, Paris, France
| | - Vanessa Vautier
- Unité de Diabétologie, Endocrinologie et Gynécologie Pédiatrique, Hôpital des Enfants, Centre Hospitalier Universitaire, Bordeaux, France
| | - Laetitia Martinerie
- Service d'Endocrinologie et Diabétologie Pédiatrique, EPPAT, Hôpital Universitaire Robert-Debré, GHU APHP Nord, Paris 75019, France; Faculté de Santé, UFR de Médecine, Paris Cité, Paris, France.
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6
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Tienforti D, Marinelli L, Vervalcke J, Spagnolo L, Antolini F, Bichiri A, Baroni MG, Motta G, T'Sjoen G, Barbonetti A. Short-Term Changes in Bone Metabolism Among Transgender Men Starting Gender-Affirming Hormone Therapy: A Systematic Review and Meta-analysis. Calcif Tissue Int 2024; 115:624-635. [PMID: 39356296 PMCID: PMC11531450 DOI: 10.1007/s00223-024-01296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 09/19/2024] [Indexed: 10/03/2024]
Abstract
Transgender and gender diverse individuals experience a gender identity that differs from the sex assigned at birth. Some transgender men may request testosterone to induce virilization; however, its impact on bone health remains to be fully elucidated. The objective of this systematic review and meta-analysis was to evaluate the modifications in bone metabolism over a short-term period among transgender men initiating testosterone therapy. A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library. The articles of interest had to report longitudinal evaluation conducted among transgender men, before starting testosterone and after 12 and 24 months of therapy. The analyzed parameters were BMD, calcium, phosphate, 25OHD, PTH, P1NP, BAP, osteocalcin and CTx. Mean differences with 95% coefficient intervals were combined using random effects models. Funnel plot, Egger's test, and trim-and-fill analysis were used to assess publication bias. Fourteen studies met the inclusion criteria, including 1484 subjects. In absence of heterogeneity, BMD did not significantly change at lumbar spine, hip, femoral neck, and whole-body evaluations. Calcium, phosphate, 25OHD and PTH remained stable over time. Regarding bone turnover markers, only P1NP showed a statistically significant increase after 12 months of T therapy, in absence of heterogeneity (SMD 0.61 mcg/l; 95% CI: 0.40-0.83; p < 0.0001; I2 = 0%, Pforheterogeneity = 0.48). Testosterone therapy among transgender men seems not to disrupt bone health after 12 and 24 months. A statistically significant elevation in P1NP levels after 12 months of therapy may indicate a positive anabolic effect of testosterone in the short-term.
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Affiliation(s)
- Daniele Tienforti
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Lorenzo Marinelli
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Jeroen Vervalcke
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Luca Spagnolo
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Federica Antolini
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Andreina Bichiri
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Giorgio Baroni
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Giovanna Motta
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Guy T'Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
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de Oliveira GMM, de Almeida MCC, Arcelus CMA, Espíndola L, Rivera MAM, da Silva-Filho AL, Marques-Santos C, Fernandes CE, Albuquerque CJDM, Freire CMV, Izar MCDO, Costa MENC, de Castro ML, Lemke VDMG, de Lucena AJG, Brandão AA, Macedo AVS, Polanczyk CA, Lantieri CJB, Nahas EP, Alexandre ERG, Campana EMG, Bragança ÉOV, Colombo FMC, Barbosa ICDQ, Rivera IR, Kulak J, Moura LAZ, Pompei LDM, Baccaro LFC, Barbosa MM, Rodrigues MAH, Albernaz MA, de Decoud MSP, Paiva MSMDO, Sanchez-Zambrano MB, Campos MDSB, Acevedo M, Ramirez MS, de Souza OF, de Medeiros OO, de Carvalho RCM, Machado RB, da Silva SCTF, Rodrigues TDCV, Avila WS, da Costa-Paiva LHS, Wender MCO. Brazilian Guideline on Menopausal Cardiovascular Health - 2024. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo100. [PMID: 39530071 PMCID: PMC11554338 DOI: 10.61622/rbgo/2024rbgo100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Universidade Federal do Rio de Janeiro Rio de JaneiroRJ Brazil Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
| | - Maria Cristina Costa de Almeida
- Centro Universitário de Belo Horizonte Belo HorizonteMG Brazil Centro Universitário de Belo Horizonte, Belo Horizonte, MG - Brazil
| | - Carolina María Artucio Arcelus
- Centro Cardiovascular de Sanatorio Galicia Montevideo Uruguay Centro Cardiovascular de Sanatorio Galicia,Montevideo - Uruguay
| | - Larissa Espíndola
- Hospital Santa Izabel SalvadorBA Brazil Hospital Santa Izabel, Salvador, BA - Brazil
- Hospital Municipal de Salvador SalvadorBA Brazil Hospital Municipal de Salvador, Salvador, BA - Brazil
| | | | - Agnaldo Lopes da Silva-Filho
- Universidade Federal de Minas Gerais Belo HorizonteMG Brazil Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Celi Marques-Santos
- Universidade Tiradentes AracajuSE Brazil Universidade Tiradentes (UNIT),Aracaju, SE - Brazil
- Hospital São Lucas Rede D'Or São Luis AracajuSE Brazil Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brazil
| | - César Eduardo Fernandes
- Faculdade de Medicina do ABC Santo AndréSP Brazil Faculdade de Medicina do ABC, Santo André, SP - Brazil
| | - Carlos Japhet da Matta Albuquerque
- Hospital Santa Joana Recife RecifePE Brazil Hospital Santa Joana Recife, Recife PE - Brazil
- EMCOR - Diagnósticos do Coração LTDA RecifePE Brazil EMCOR - Diagnósticos do Coração LTDA, Recife PE - Brazil
- Hospital Barão de Lucena RecifePE Brazil Hospital Barão de Lucena,Recife PE - Brazil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais Belo HorizonteMG Brazil Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Marildes Luiza de Castro
- Faculdade IPEMED de Ciências Médicas Belo HorizonteMG Brazil Faculdade IPEMED de Ciências Médicas, Belo Horizonte MG - Brazil
| | | | | | - Andréa Araujo Brandão
- Universidade do Estado do Rio de Janeiro Rio de JaneiroRJ Brazil Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro RJ - Brazil
| | | | - Carisi Anne Polanczyk
- Hospital de Clínicas da Universidade Federal do Rio Grande do Sul Porto AlegreRS Brazil Hospital de Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre RS - Brazil
| | | | - Eliana Petri Nahas
- Universidade Federal de São Paulo São PauloSP Brazil Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | | | - Erika Maria Gonçalves Campana
- Universidade do Estado do Rio de Janeiro Rio de JaneiroRJ Brazil Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro RJ - Brazil
| | | | - Fernanda Marciano Consolim Colombo
- Instituto do Coração Hospital das Clínicas FMUSP São PauloSP Brazil Instituto do Coração (Incor) do Hospital das Clínicas FMUSP, São Paulo SP - Brazil
| | - Imara Correia de Queiroz Barbosa
- Universidade Federal de Campina Grande Campina GrandePB Brazil Universidade Federal de Campina Grande, Campina Grande, PB - Brazil
| | - Ivan Romero Rivera
- Universidade Federal de Alagoas MaceióAL Brazil Universidade Federal de Alagoas (UFAL), Maceió AL - Brazil
| | - Jaime Kulak
- Universidade Federal do Paraná CuritibaPR Brazil Universidade Federal do Paraná (UFPR), Curitiba, PR - Brazil
| | - Lidia Ana Zytynski Moura
- Pontifícia Universidade Católica do Paraná CuritibaPR Brazil Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR - Brazil
| | - Luciano de Mello Pompei
- Faculdade de Medicina do ABC Santo AndréSP Brazil Faculdade de Medicina do ABC, Santo André, SP - Brazil
| | - Luiz Francisco Cintra Baccaro
- Universidade Estadual de Campinas CampinasSP Brazil Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brazil
| | - Marcia Melo Barbosa
- Hospital Socor Belo HorizonteMG Brazil Hospital Socor, Belo Horizonte, MG - Brazil
| | | | - Marco Aurelio Albernaz
- Hospital Estadual da Mulher GoiâniaGO Brazil Hospital Estadual da Mulher, Goiânia, GO - Brazil
| | | | | | - Martha Beatriz Sanchez-Zambrano
- Comité de Enfermedades Cardiovasculares de la Mujer Sociedad Venezolana de Cardiología Caracas Venezuela Comité de Enfermedades Cardiovasculares de la Mujer, Sociedad Venezolana de Cardiología, Caracas - Venezuela
| | | | - Monica Acevedo
- Pontificia Universidad Católica de Chile Santiago Chile Pontificia Universidad Católica de Chile, Santiago - Chile
| | - Monica Susana Ramirez
- Hospital Privado Rosario Rosario Argentina Hospital Privado Rosario, Rosario - Argentina
- Instituto Universitario Rosario Santa Fe Argentina Instituto Universitario Rosario (IUNIR), Santa Fe - Argentina
| | | | | | - Regina Coeli Marques de Carvalho
- Hospital Geral de Fortaleza FortalezaCE Brazil Hospital Geral de Fortaleza, Fortaleza CE - Brazil
- Secretaria de Saúde do Estado do Ceará FortalezaCE Brazil Secretaria de Saúde do Estado do Ceará, Fortaleza CE - Brazil
| | - Rogerio Bonassi Machado
- Faculdade de Medicina de Jundiaí JundiaíSP Brazil Faculdade de Medicina de Jundiaí, Jundiaí, SP - Brazil
| | | | - Thais de Carvalho Vieira Rodrigues
- Hospital São Lucas Rede D'Or São Luiz AracajuSE Brazil Hospital São Lucas, Rede D'Or São Luiz, Aracaju, SE - Brazil
- Universidade Federal de Sergipe AracajuSE Brazil Universidade Federal de Sergipe (UFS), Aracaju, SE - Brazil
| | - Walkiria Samuel Avila
- Instituto do Coração Hospital das Clínicas FMUSP São PauloSP Brazil Instituto do Coração (Incor) do Hospital das Clínicas FMUSP, São Paulo SP - Brazil
| | | | - Maria Celeste Osorio Wender
- Hospital de Clínicas de Porto Alegre Porto AlegreRS Brazil Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
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Kim HH, Thayer N, Bernstein C, Cruz R, Roby C, Keuroghlian AS. On the Frontlines: Protecting and Advancing Gender-Affirming Care in a Hostile Sociopolitical Environment. J Gen Intern Med 2024:10.1007/s11606-024-09080-3. [PMID: 39384688 DOI: 10.1007/s11606-024-09080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/24/2024] [Indexed: 10/11/2024]
Abstract
Since 2020, there has been a significant cultural and political backlash in the USA to growing acceptance of gender diversity and gender-affirming care. Legislative attacks, particularly targeting gender-affirming care access for transgender and gender diverse youth, have occurred in a media environment rife with misinformation and disinformation. Even in states where a ban is not enacted, we have seen significant harm caused by such misinformation and disinformation, to transgender and gender diverse patients, their families, and clinicians who provide this important and much needed care, in the form of clinic closures and disruption of services. In this hostile sociopolitical environment, we present strategies for health care organizations and workers to continue to provide this lifesaving care thoughtfully, to safeguard the protections currently in place, and to continue to advocate for patients, families, and health care staff.
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Affiliation(s)
- Hyun-Hee Kim
- Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts General Hospital, Yawkey Building, Suite 6A, 55 Fruit Street, Boston, MA, 02114, USA.
| | | | | | - Roxana Cruz
- Texas Association of Community Health Centers, Austin, TX, USA
| | - Christopher Roby
- Community Health Center Association of Mississippi, Jackson, MS, USA
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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9
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Liwinski T, Auer MK, Schröder J, Pieknik I, Casar C, Schwinge D, Henze L, Stalla GK, Lang UE, von Klitzing A, Briken P, Hildebrandt T, Desbuleux JC, Biedermann SV, Holterhus PM, Bang C, Schramm C, Fuss J. Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals. BMC Med 2024; 22:346. [PMID: 39218875 PMCID: PMC11367877 DOI: 10.1186/s12916-024-03548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Limited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroids on gut microbiota taxonomy and function, addressing this gap. We prospectively analyzed gut metagenome changes associated with 12 weeks of GAHT in trans women and trans men, examining both taxonomic and functional shifts. METHODS Thirty-six transgender individuals (17 trans women, 19 trans men) provided pre- and post-GAHT stool samples. Shotgun metagenomic sequencing was used to assess the changes in gut microbiota structure and potential function following GAHT. RESULTS While alpha and beta diversity remained unchanged during transition, specific species, including Parabacteroides goldsteinii and Escherichia coli, exhibited significant abundance shifts aligned with affirmed gender. Overall functional metagenome analysis showed a statistically significant effect of gender and transition (R2 = 4.1%, P = 0.0115), emphasizing transitions aligned with affirmed gender, particularly in fatty acid-related metabolism. CONCLUSIONS This study provides compelling evidence of distinct taxonomic and functional profiles in the gut microbiota between trans men and women. GAHT induces androgenization in trans men and feminization in trans women, potentially impacting physiological and health-related outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT02185274.
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Affiliation(s)
- Timur Liwinski
- Clinic for Adult Psychiatry, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland
| | - Matthias K Auer
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| | - Johanna Schröder
- Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
| | - Ina Pieknik
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| | - Christian Casar
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dorothee Schwinge
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lara Henze
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Günter K Stalla
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
- Medicover Neuroendocrinology, Munich, Germany
| | - Undine E Lang
- Clinic for Adult Psychiatry, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland
| | - Alina von Klitzing
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Jeanne C Desbuleux
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Social and Emotional Neuroscience Group, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Children and Adolescent Medicine I, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, D-24105, Germany
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig-Holstein, Rosalind-Franklin-Str. 12, Kiel, 24105, Germany
| | - Christoph Schramm
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Hamburg Centre for Translational Immunology (HCTI), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
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Carroll R, Rose SB, Ker A, Pettie MA, Garrett SM. Priorities for data collection through a prospective cohort study on gender-affirming hormone therapy in Aotearoa New Zealand: community and clinical perspectives. J Prim Health Care 2024; 16:301-307. [PMID: 39321077 DOI: 10.1071/hc23170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/20/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction Gender affirming hormone therapy (GAHT) is an important aspect of health care for many transgender and non-binary (TNB) people, but little is known about the long-term outcomes for TNB people in Aotearoa New Zealand (NZ). Pathways to access GAHT are shifting from secondary care towards primary care, so this is an opportune time to commence local research on long-term health and wellbeing outcomes for people initiating GAHT. Aim This paper aims to report on the key findings from four meetings held to inform the design of a prospective cohort study to follow the journey of people initiating GAHT in primary and secondary care settings in NZ. Methods We worked with a community advisory group of six TNB young people and sought input from 14 health care providers involved in the care of TNB people initiating GAHT (GPs, secondary care doctors, and mental health providers). Semi-structured interview schedules were used to guide discussions. Template analysis was used to initially code data based on themes identified from the interview schedule and new themes from discussions were added. Results Participants shared ideas about recruitment and data collection priorities for baseline and follow-up surveys. These included understanding the journey to starting hormone therapy (information-seeking, decision-making), access to services for GAHT initiation, appropriateness of information provision, receipt of the first prescription, goals for and experience of GAHT, and the unique needs of non-binary people. Discussion Input from a TNB advisory group and health care professionals has informed the development of a survey that will be used to understand the experience of, and outcomes for, people starting GAHT in NZ. Findings from this planned prospective cohort study have the potential to improve access to GAHT for TNB people who wish to pursue this option.
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Affiliation(s)
- Rona Carroll
- Department of Primary Health Care and General Practice, University of Otago, Te Whare Wananga o Otago ki Te Whanganui-a-Tara, PO Box 7343, Wellington South, Wellington 6242, New Zealand
| | - Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Te Whare Wananga o Otago ki Te Whanganui-a-Tara, PO Box 7343, Wellington South, Wellington 6242, New Zealand
| | - Alex Ker
- Department of Primary Health Care and General Practice, University of Otago, Te Whare Wananga o Otago ki Te Whanganui-a-Tara, PO Box 7343, Wellington South, Wellington 6242, New Zealand
| | - Michaela A Pettie
- Department of Public Health, University of Otago, Te Whare Wananga o Otago ki Te Whanganui-a-Tara, Wellington 6242, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, Te Whare Wananga o Otago ki Te Whanganui-a-Tara, PO Box 7343, Wellington South, Wellington 6242, New Zealand
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Oliveira GMMD, Almeida MCCD, Arcelus CMA, Neto Espíndola L, Rivera MAM, Silva-Filho ALD, Marques-Santos C, Fernandes CE, Albuquerque CJDM, Freire CMV, Izar MCDO, Costa MENC, Castro MLD, Lemke VDMG, Lucena AJGD, Brandão AA, Macedo AVS, Polanczyk CA, Lantieri CJB, Nahas EP, Alexandre ERG, Campana EMG, Bragança ÉOV, Colombo FMC, Barbosa ICDQ, Rivera IR, Kulak J, Moura LAZ, Pompei LDM, Baccaro LFC, Barbosa MM, Rodrigues MAH, Albernaz MA, Decoud MSPD, Paiva MSMDO, Sanchez-Zambrano MB, Campos MDSB, Acevedo M, Ramirez MS, Souza OFD, Medeiros OOD, Carvalho RCMD, Machado RB, Silva SCTFD, Rodrigues TDCV, Avila WS, Costa-Paiva LHSD, Wender MCO. Brazilian Guideline on Menopausal Cardiovascular Health - 2024. Arq Bras Cardiol 2024; 121:e20240478. [PMID: 39166619 PMCID: PMC11341215 DOI: 10.36660/abc.20240478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Affiliation(s)
| | | | | | - Larissa Neto Espíndola
- Hospital Santa Izabel, Salvador, BA - Brasil
- Hospital Municipal de Salvador, Salvador, BA - Brasil
| | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Carlos Japhet da Matta Albuquerque
- Hospital Santa Joana Recife, Recife PE - Brasil
- EMCOR - Diagnósticos do Coração LTDA, Recife PE - Brasil
- Hospital Barão de Lucena, Recife PE - Brasil
| | | | | | | | | | | | | | | | | | - Carisi Anne Polanczyk
- Hospital de Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre RS - Brasil
| | | | | | | | | | | | | | | | | | - Jaime Kulak
- Maceió AL - BrasilUniversidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Monica Acevedo
- Pontificia Universidad Católica de Chile, Santiago - Chile
| | - Monica Susana Ramirez
- Hospital Privado Rosario, Rosario - Argentina
- Instituto Universitario Rosario (IUNIR), Santa Fe - Argentina
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12
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Meade NG, Lepore C, Olezeski CL, McNamara M. Understanding and Addressing Disinformation in Gender-Affirming Health Care Bans. Transgend Health 2024; 9:281-287. [PMID: 39385955 PMCID: PMC11456759 DOI: 10.1089/trgh.2022.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Legislation undermining the human rights of transgender and gender-expansive (TGE) people is on the rise. Many U.S. states have passed or proposed laws that restrict gender-affirming health care (GAC), which are largely rooted in scientific disinformation, meaning intentional falsehood. Scientific disinformation presents a significant threat to TGE people, providers of GAC, health care professionals, and the general public. Clinicians, legal advocates, and others need effective strategies to rebut disinformation. This perspective reviews the status of GAC bans and the disinformation strategies that underlie them, and provides practical tools to challenge false claims.
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Affiliation(s)
- Nicolas G. Meade
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Christy L. Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Meredithe McNamara
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Fowler JA, Warzywoda S, Reyment M, Crilly T, Franks N, Bisshop F, Wood P, Dean JA. One person, many changes: a socioecological qualitative analysis of the experiences of transfeminine individuals undergoing feminising gender-affirming hormone therapy. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38829652 DOI: 10.1080/13691058.2024.2358099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Gender-affirming hormone therapy (GAHT) comes with many physical, psychological, and social changes that are often considered in isolation. This research uses a socioecological lens with a sample of 15 Australian transfeminine individuals to investigate the changes experienced during GAHT. Semi-structured interviews were conducted in 2022, with verbatim transcripts analysed using deductive thematic analysis with Bronfenbrenner's Socioecological Model (SEM) as a framework. Analyses revealed two themes intersecting multiple levels of the SEM. Theme 1 contained two sub-themes and broadly encapsulated how interactions with others influenced GAHT experiences. Sub-theme 1 spoke to how stigma creates positive or negative experiences (through the macrosystem, the exosystem, and proximal processes), while sub-theme 2 described how GAHT causes internal changes that promoted stronger interpersonal relationships (person and proximal processes). Theme 2 described how changes occurred over time, with some changes being temporary, and others being delayed (person and time). These themes highlight the interconnected nature of the physical, psychological, and social changes and experiences that can occur during GAHT. Best-practice care for trans people undergoing GAHT needs to be multi-faceted and holistic in order to embed support across different SEM components.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
| | - Sarah Warzywoda
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
| | - Mera Reyment
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Psychology, St Lucia, QLD, Australia
| | - Tyson Crilly
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Psychology, St Lucia, QLD, Australia
| | - Nia Franks
- School of Psychology and Counselling, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| | - Fiona Bisshop
- Holdsworth House Medical Practice, Brisbane, QLD, Australia
| | - Penny Wood
- Alexander Heights Family Practice, Perth, WA, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
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Naranjo AR, Krasowski MD, Hamdan A, O'Connor K, Carter C, Chen J, Greene DN. Reflex strategy to ensure accurate total testosterone results from consumer initiated, self-collected capillary samples. Clin Chim Acta 2024; 558:119676. [PMID: 38631605 DOI: 10.1016/j.cca.2024.119676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Self-collected capillary samples are convenient for direct access testing (DAT), but exogenous testosterone use may cause falsely elevated total testosterone (TT) results. We designed a quality assurance workflow to differentiate between accurate or erroneous supraphysiological TT concentrations. METHODS Clinical samples with TT > 1500 ng/dL were reflexed to luteinizing hormone (LH) and follicle stimulating hormone (FSH) and screened for exogenous testosterone use. Samples (n = 120) with normal TT were reflexed to LH/FSH as a control. RESULTS A total of 8572 TT samples were evaluated, of which 533 (6.2 %) had TT > 1500 ng/dL and were reflexed. Of these, 441 (82.7 %) had significantly decreased LH/FSH (<0.85/<0.7mIU/mL, respectively), 72 (13.5 %) had normal or borderline normal LH/FSH, and 20 (3.8 %) had insufficient plasma volume. In patients with TT > 1500 ng/dL, injectable exogenous testosterone use was most commonly accompanied by significantly decreased LH/FSH, while topical testosterone use was most commonly accompanied by detectable LH/FSH. Control samples were almost all (99.2 %) within or above the LH/FSH reference intervals. Unique patients ordered 351 TT tests where at least one TT result was > 1500 ng/dL. Based on TT and LH/FSH results, we hypothesized that patients were intermittently or consistently overusing exogenous testosterone, resolved elevated TT with recollection, or repeatedly contaminated their sample. CONCLUSION Self-collected capillary specimens are acceptable for TT testing. A quality assurance reflex to LH/FSH can determine the validity of supraphysiological TT results in a consumer initiated/DAT population.
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Affiliation(s)
| | | | - Amal Hamdan
- LetsGetChecked Laboratories, Monrovia, CA, United States
| | | | - Claire Carter
- LetsGetChecked Laboratories, Monrovia, CA, United States
| | - Joyce Chen
- LetsGetChecked Laboratories, Monrovia, CA, United States
| | - Dina N Greene
- LetsGetChecked Laboratories, Monrovia, CA, United States; University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, United States.
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Jasuja GK, Wolfe HL, Reisman JI, Vimalananda VG, Rao SR, Blosnich JR, Livingston NA, Shipherd JC. Clinicians in the Veterans Health Administration initiate gender-affirming hormone therapy in concordance with clinical guideline recommendations. Front Endocrinol (Lausanne) 2024; 15:1086158. [PMID: 38800485 PMCID: PMC11116601 DOI: 10.3389/fendo.2024.1086158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Gender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies have examined how current GAHT initiation compares to recommended GAHT initiation. Objective This study assessed guideline concordance around feminizing and masculinizing GAHT initiation in the Veterans Health Administration (VHA). Methods The sample included 4,676 veterans with a gender identity disorder diagnosis who initiated feminizing (n=3,547) and masculinizing (n=1,129) GAHT between 2007 and 2018 in VHA. Demographics and health conditions on veterans receiving feminizing and masculinizing GAHT were assessed. Proportion of guideline concordant veterans on six VHA guidelines on feminizing and masculinizing GAHT initiation were determined. Results Compared to veterans receiving masculinizing GAHT, a higher proportion of veterans receiving feminizing GAHT were older (≥60 years: 23.7% vs. 6.3%), White non-Hispanic (83.5% vs. 57.6%), and had a higher number of comorbidities (≥7: 14.0% vs. 10.6%). A higher proportion of veterans receiving masculinizing GAHT were Black non-Hispanic (21.5% vs. 3.5%), had posttraumatic stress disorder (43.0% vs. 33.9%) and positive military sexual trauma (33.5% vs.16.8%; all p-values<0.001) than veterans receiving feminizing GAHT. Among veterans who started feminizing GAHT with estrogen, 97.0% were guideline concordant due to no documentation of contraindication, including venous thromboembolism, breast cancer, stroke, or myocardial infarction. Among veterans who started spironolactone as part of feminizing GAHT, 98.1% were guideline concordant as they had no documentation of contraindication, including hyperkalemia or acute renal failure. Among veterans starting masculinizing GAHT, 90.1% were guideline concordant due to no documentation of contraindications, such as breast or prostate cancer. Hematocrit had been measured in 91.8% of veterans before initiating masculinizing GAHT, with 96.5% not having an elevated hematocrit (>50%) prior to starting masculinizing GAHT. Among veterans initiating feminizing and masculinizing GAHT, 91.2% had documentation of a gender identity disorder diagnosis prior to GAHT initiation. Conclusion We observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT. Findings suggest that VHA clinicians are initiating feminizing GAHT in concordance with clinical guidelines. Future work should assess guideline concordance on monitoring and management of GAHT in VHA.
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Affiliation(s)
- Guneet K. Jasuja
- Center for Healthcare Organization & Implementation Research, Veteran Affairs (VA) Bedford Healthcare System, Bedford, MA, United States
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Hill L. Wolfe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Joel I. Reisman
- Center for Healthcare Organization & Implementation Research, Veteran Affairs (VA) Bedford Healthcare System, Bedford, MA, United States
| | - Varsha G. Vimalananda
- Center for Healthcare Organization & Implementation Research, Veteran Affairs (VA) Bedford Healthcare System, Bedford, MA, United States
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Sowmya R. Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - John R. Blosnich
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Nicholas A. Livingston
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jillian C. Shipherd
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- LGBTQ+ Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, United States
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16
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Steininger J, Knaus S, Kaufmann U, Ott J, Riedl S. Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy. Front Endocrinol (Lausanne) 2024; 15:1258495. [PMID: 38774227 PMCID: PMC11106449 DOI: 10.3389/fendo.2024.1258495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Objective The aim of this study was to describe the treatment trajectories of Austrian children and adolescents with gender incongruence seeking gender-affirming medical care. Methods Patients who presented with gender incongruence at the pediatric outpatient clinic for differences in sex development at a large university hospital in Austria from January 2008 to December 2022 were included in a retrospective chart review, and analyzed regarding referral numbers, patient characteristics, treatment trajectories, fertility preservation, and legal gender marker changes. Results Of 310 eligible patients, 230 (74.2%) were assigned female at birth (AFAB), and 80 (25.8%) were assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018, whereafter it stabilized at around 50 per year. At the time of initial presentation, the median age of patients was 15.6 years (IQR 14.3-16.8). AMAB individuals tended to be younger (median 14.9 years, IQR 13.9-16.8) than AFAB individuals (median 15.8 years, IQR 14.4-16.8; p= 0.012). 207 (66,8%) completed the assessment process and were eligible for gender affirming medical treatment (GAMT). Of those, 89% (186/207) commenced gender affirming hormone therapy in the pediatric outpatient clinic (79/186 received GnRHa monotherapy, 91/186 GnRHa and sex steroids, and 16/186 sex steroid monotherapy). Of the 54 AMAB individuals receiving GAMT, 6 (11.1%) completed fertility preservation prior to therapy initiation. Only 1/132 AFAB adolescents receiving GAMT completed fertility preservation. Chest masculinization surgery was performed in 22 cases (16.7%), and breast augmentation in two cases (3.7%) between the ages of 16 and 18. Changes in legal gender marker were common, with 205 individuals (66.1%) having changed their legal gender marker. Conclusion This is the first time that treatment trajectories, fertility preservation rates, and changes of legal gender marker have been described in Austrian adolescents with gender incongruence seeking GAMT. The majority received GAMT and changed their legal gender marker, while gender affirming surgery rates were low, and utilization of fertility preservation treatment options was rare.
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Affiliation(s)
- Jojo Steininger
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Sarah Knaus
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Riedl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
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Draper L, Vikas A, Das S, Yadav S, Walker F, Bandilovska I. Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature. Case Rep Psychiatry 2024; 2024:5552781. [PMID: 38746078 PMCID: PMC11093682 DOI: 10.1155/2024/5552781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review. Materials and Methods Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline. Results The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies. Conclusion There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.
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Affiliation(s)
- Lachlan Draper
- North West Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Ashis Vikas
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Subhash Das
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Suresh Yadav
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
| | - Frances Walker
- Northern Area Mental Health Service Northern Health, Melbourne, VIC, Australia
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da Silva LMB, Freire SND, Moretti E, Barbosa L. Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study. Int Urogynecol J 2024; 35:1077-1084. [PMID: 38662108 DOI: 10.1007/s00192-024-05779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this research is to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men. We hypothesize that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions. METHODS A cross-sectional study was conducted between September 2022 and March 2023 using an online questionnaire, which included transgender men over 18 years old who underwent gender-affirming hormone therapy. Volunteers with neurological disease, previous urogynecology surgery, active urinary tract infection, and individuals without access to the internet were excluded. The questionnaire employed validated tools to assess urinary symptoms, such as urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation. The data were analyzed descriptively and presented as frequencies and prevalence ratios with their respective confidence intervals (95% CI), mean, and standard deviation. RESULTS A total of 68 transgender men were included. Most participants had storage symptoms (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and flatal incontinence (39.7%). Participants with UI symptoms reported moderate severity of the condition. CONCLUSIONS Transgender men on hormone therapy have a high incidence of PFD (94.1%) and experience a greater occurrence of urinary symptoms (86.7%).
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Affiliation(s)
| | - Silvana Neves Dias Freire
- Physical Therapy Postgraduate Program Student, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | - Eduarda Moretti
- Federal University of Pernambuco (UFPE), Human Anatomy Sector of the Institute of Biological and Health Sciences, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Leila Barbosa
- Federal University of Pernambuco (UFPE) PhD in Child and Adolescent Healthcare, Federal University of Pernambuco (UFPE). Federal University of Pernambuco, Recife, PE, Brazil.
- Physical Therapy Department, Av Prof. Moraes Rego, 1235. Cidade Universitária, Recife, Pernambuco, CEP: 50670-901, Brazil.
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Pamulapati S, Conroy M, Cortina C, Harding E, Kamaraju S. Systematic Review on Gender-Affirming Testosterone Therapy and the Risk of Breast Cancer: A Challenge for Physicians Treating Patients from Transgender and Gender-Diverse Populations. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1969-1980. [PMID: 38148450 DOI: 10.1007/s10508-023-02773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
Conflicting evidence exists about the risk of breast cancer in transgender and gender-diverse (TGD) patients treated with testosterone. This review aimed to summarize current knowledge regarding the risk of breast cancer associated with gender-affirming testosterone treatment (GATT). A systematic literature search using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was conducted in January 2023 through Ovid, Scopus, and Web of Science databases. English-language, peer-reviewed articles evaluating breast cancer in TGD patients after GATT that met the inclusion criteria were included. This review included 22 articles, with 14 case reports, 4 case series, and 4 retrospective cohort studies. The review identified 26 TGD patients who developed breast cancer post-GATT therapy, with inconclusive evidence on the relationship between testosterone and the risk of breast cancer in TGD patients. This uncertainty in part arises from the mechanisms governing testosterone's effects within breast tissue, with contrasting theories proposing both proliferative and antiproliferative impacts. Considering this ambiguity, it is imperative for healthcare providers to engage in informed discussions with patients prior to initiating hormone therapy to discuss potential adverse effects, including the possibility of breast cancer development in TGD individuals. Patient education and shared decision-making are essential components of responsible care in this context.
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Affiliation(s)
- Saagar Pamulapati
- Mercyhealth Javon Bea Hospital, 2400 N Rockton Ave., Rockford, IL, 61103, USA.
| | - Meghan Conroy
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chandler Cortina
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Harding
- Clinical Services Librarian, Froedtert Hospital, Milwaukee, WI, USA
| | - Sailaja Kamaraju
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
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20
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Christensen JD, Basheer HT, Lado Abeal JJ. Thyroid Cancer Prevalence, Risk Exposure, and Clinical Features Among Transgender Female Veterans. J Endocr Soc 2024; 8:bvae060. [PMID: 38633896 PMCID: PMC11023629 DOI: 10.1210/jendso/bvae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Transgender women experience higher-than-average rates of multiple medical conditions. Thyroid cancer occurs more frequently in those assigned female at birth than in those assigned male at birth. We sought to characterize thyroid cancer among transgender female veterans. Methods We reviewed charts of veterans who were (1) seen in Veterans Affairs clinics across the United States from July 2017 to December 2022, (2) had an International Classification of Diseases, revision 10, diagnosis code for thyroid cancer, and (3) had an International Classification of Diseases, revision 10, diagnosis code for gender dysphoria or were assigned male at birth and ever had a prescription for estrogens. Charts of cisgender veterans were also reviewed for comparison. Results Compared with calculated estimates of 0.641% (95% CI, 0.572-0.724) among cisgender females and 0.187% (95% CI, 0.156-0.219) among cisgender males, the measured prevalence among transgender female veterans was 0.341% (34/9988). Average age at thyroid cancer diagnosis in this population was 53.8 (± SEM 2.61) years. A total of 32.3% (11/34) of these patients had extrathyroidal disease at diagnosis. Discussion To our knowledge, this study represents the first report of thyroid cancer prevalence among transgender women in the United States. Risk exposure among all transgender veterans including further assessment of the possible contributions of obesity, smoking, and gender-affirming hormone therapy are important future analyses.
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Affiliation(s)
- John David Christensen
- Department of Internal Medicine, Division of Endocrinology, Diabetes & Metabolism, UC Davis Health, Sacramento, CA 95817, USA
- VA Northern California Healthcare System, Section of Endocrinology, Mather, CA 95321, USA
| | - Hiba T Basheer
- Department of Internal Medicine, Division of Endocrinology, Diabetes & Metabolism, UC Davis Health, Sacramento, CA 95817, USA
- VA Northern California Healthcare System, Section of Endocrinology, Mather, CA 95321, USA
| | - Jose Joaquin Lado Abeal
- Department of Internal Medicine, Division of Endocrinology, Diabetes & Metabolism, UC Davis Health, Sacramento, CA 95817, USA
- VA Northern California Healthcare System, Section of Endocrinology, Mather, CA 95321, USA
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21
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Cossío Aranda JE, Jain V, Figueiras-Graillet LM, Arias-Mendoza A, Cuéllar JL, Berni Betancourt A, Liprandi ÁS, Pinto F, Eiselé JL, Pineiro DJ. Toward a Better Understanding of Cardiovascular Risk in the Transgender and Gender-Diverse Community: A Global Call to Action. Glob Heart 2024; 19:27. [PMID: 38434153 PMCID: PMC10906342 DOI: 10.5334/gh.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024] Open
Abstract
On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.
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Affiliation(s)
| | - Viveka Jain
- World Heart Federation, Rue de Malatrex 32, 1201 Geneva, Switzerland
| | | | - Alexandra Arias-Mendoza
- Mexican Society of Cardiology, Juan Badiano 1, Col. Section XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Julio López Cuéllar
- Mexican Society of Cardiology, Juan Badiano 1, Col. Section XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Ana Berni Betancourt
- Inter-American Society of Cardiology, Juan Badiano 1, Col. Seccion XVI, 14080 Mexico City, Mexico
| | - Álvaro Sosa Liprandi
- Inter-American Society of Cardiology, Juan Badiano 1, Col. Seccion XVI, 14080 Mexico City, Mexico
| | - Fausto Pinto
- World Heart Federation, Rue de Malatrex 32, 1201 Geneva, Switzerland
| | - Jean-Luc Eiselé
- World Heart Federation, Rue de Malatrex 32, 1201 Geneva, Switzerland
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22
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Kamal K, Afzal N, Ziad A, Charrow A. Association between exogenous testosterone use and new diagnosis of hidradenitis suppurativa: A case series. JAAD Case Rep 2024; 44:27-29. [PMID: 38292574 PMCID: PMC10824676 DOI: 10.1016/j.jdcr.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- School of Medicine, University of California, Davis, Sacramento, California
| | - Amina Ziad
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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23
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Alibudbud R. Enhancing Nursing Education to Address LGBTQ+ Healthcare Needs: Perspectives from the Philippines. SAGE Open Nurs 2024; 10:23779608241251632. [PMID: 38681864 PMCID: PMC11055477 DOI: 10.1177/23779608241251632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/27/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024] Open
Abstract
Enhancing healthcare professionals' education and training to effectively manage the healthcare needs of People Identifying as Lesbian, Gay, Bisexual, Transgender, Queer, and other Sexual and Gender Minorities (LGBTQ+) is imperative. Recognizing the importance of mitigating LGBTQ+ health disparities, healthcare associations have affirmed their commitment to providing inclusive and culturally competent healthcare. However, despite these efforts, there is still a gap in LGBTQ+-specific teaching within nursing and other healthcare professionals' schools, resulting in healthcare professionals being ill-equipped to meet the unique needs of LGBTQ+. To address this gap, we suggest integrating LGBTQ+ health content into healthcare training programs, focusing on the Philippine nursing curriculum. Drawing from various reports, including insights from discussions with the local LGBTQ+, the suggested topics include LGBTQ+ identities, sexual health, trans health, mental health, and social determinants of LGBTQ+ health. By fostering understanding and competence through education, equitable and inclusive healthcare practices for LGBTQ+ can be better cultivated, helping to ensure that the unique healthcare needs of LGBTQ+ are met effectively. Furthermore, it is necessary to share best practices for providing health services to LGBTQ+ people. Additionally, future studies can explore the median time allocated to LGBTQ+ teaching, the optimal number of teaching hours for LGBTQ+ content, and the specific contents of local nursing curricula that can better address their needs. By undertaking these steps, we can move toward effectively addressing the unique healthcare needs of LGBTQ+.
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Affiliation(s)
- Rowalt Alibudbud
- Department of Sociology and Behavioral Sciences, De La Salle University, Manila City, Philippines
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24
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Hsu S, Bove R. Hormonal Therapies in Multiple Sclerosis: a Review of Clinical Data. Curr Neurol Neurosci Rep 2024; 24:1-15. [PMID: 38102502 PMCID: PMC10774191 DOI: 10.1007/s11910-023-01326-7] [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] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE OF REVIEW Given the potential for exogenous hormones to influence risk and course of MS, this narrative review aims to summarize current knowledge from observational and interventional studies of exogenous hormones in humans with MS. RECENT FINDINGS Large randomized clinical trials for combined oral contraceptives and estriol both show modest effect on inflammatory activity, with the latter showing potential neuroprotective effect. After fertility treatment, large actively treated cohorts have not confirmed any elevated risk of relapse. Preclinical data suggest that androgens, selective estrogen receptor modulators (SERMs), and selective androgen receptor modulators (SARMs) may be neuroprotective but clinical data are lacking. Gender affirming treatment, particularly estrogen in trans-women, could possibly be associated with elevated risk of inflammation. For women with MS entering menopause, hormone therapy appears safe during the appropriate menopausal window, but its long-term effects on neuroprotection are unknown. Exogenous hormones, used in varied doses and for diverse indications, have variable effects on MS risk, inflammatory activity, and neuroprotection. Large randomized trials are needed before it is possible to determine the true effect of exogenous hormones in a condition as complex as MS.
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Affiliation(s)
- Stephanie Hsu
- UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
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25
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Fowler JA, Warzywoda S, Franks N, Bisshop F, Wood P, Dean JA. "Ever since I knew I was trans I knew I wanted hormone therapy": a qualitative exploration into the journey of Australian trans individuals accessing feminizing gender-affirming hormone therapy. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:840-854. [PMID: 39465078 PMCID: PMC11500556 DOI: 10.1080/26895269.2023.2290132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Background For many trans folks, gender-affirming hormone therapy (GAHT) is a desired affirming procedure that has been linked with positive health outcomes, however literature has had little focus on the journeys of trans people as they access GAHT. Aim To understand trans people's journey of accessing GAHT to delineate supports necessary to better engage trans individuals into gender-affirming care. Method This study conducted semi-structured interviews with a sample of 15 Australian trans adults who participated in a larger study investigating the effects of a cyproterone acetate titration protocol. Findings A four-factor thematic structure was created from the data. Theme one describes early cognizance of being trans and the pivotal moments in their trans realization. The second theme explores the rapid engagement with community to begin accessing information and affirming healthcare, including GAHT. The third theme explores barriers to engaging in GAHT and theme four reflects on advice participants have for other trans people who are considering GAHT. Conclusion Findings from this study emphasize the importance of providing support to young trans people to help reconcile their gender identity and assist them to engage into care as early as possible. It also highlights the key role that community plays in providing links to affirming information and providers of GAHT - but also emphasizes the importance of considering how to engage with community who may be missed. The experience of accessing GAHT is personal and contextual, but signaling of affirming safe spaces and access to salient information may be key strategies to better support trans people choosing to access GAHT.
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Affiliation(s)
- James A. Fowler
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Sarah Warzywoda
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Nia Franks
- School of Psychology and Counselling, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Fiona Bisshop
- Holdsworth House Medical Practice, Brisbane, Queensland, Australia
| | - Penny Wood
- Alexander Heights Family Practice, Perth, Western Australia, Australia
| | - Judith A. Dean
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- The University of Queensland, Poche Centre for Indigenous Health, Brisbane, Queensland, Australia
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26
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Šnobrová B, Burdová K, Weiss V, Šonka K, Weiss P. Screening for sleep apnoea risk in testosterone-treated transgender men. Front Neurol 2023; 14:1289429. [PMID: 38116111 PMCID: PMC10729444 DOI: 10.3389/fneur.2023.1289429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Obstructive sleep apnoea (OSA) is more prevalent in men. Several studies suggested that higher testosterone levels were associated with a greater risk of OSA. We aimed to determine whether testosterone administration in transgender men would accentuate symptoms of OSA. Methods The study involved 94 adult people undergoing a female-to-male transition with testosterone administration. The participants answered the Berlin Questionnaire (BQ) and a separate question on snoring before starting testosterone treatment and after at least 1 year of being on testosterone treatment. Results A higher proportion of participants at the follow-up answered positively to the first category of BQ devoted to snoring. A lower proportion of participants at follow-up answered positively to the second category of BQ devoted to tiredness. The percentage of subjects with a high risk of sleep apnoea, according to BQ, and of those who answered the question on snoring positively did not change significantly. Conclusion An increased number of transgender men who reported snoring in BQ after testosterone administration indicate a higher risk of OSA development.
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Affiliation(s)
- Bára Šnobrová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Kristina Burdová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Vladimír Weiss
- Department of Endocrinology, Poliklinika Modrany, Prague, Czechia
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Petr Weiss
- Institute of Sexology, General University Hospital, Prague, Czechia
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia
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27
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Wolfe HL, Boyer TL, Shipherd JC, Kauth MR, Jasuja GK, Blosnich JR. Barriers and Facilitators to Gender-affirming Hormone Therapy in the Veterans Health Administration. Ann Behav Med 2023; 57:1014-1023. [PMID: 37436725 DOI: 10.1093/abm/kaad035] [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] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND In 2011, the Veterans Health Administration (VHA) established a policy for the delivery of transition-related services, including gender-affirming hormone therapy (GAHT), for transgender and gender diverse (TGD) patients. In the decade since this policy's implementation, limited research has investigated barriers and facilitators of VHA's provision of this evidence-based therapy that can improve life satisfaction among TGD patients. PURPOSE This study provides a qualitative summary of barriers and facilitators to GAHT at the individual (e.g., knowledge, coping mechanisms), interpersonal (e.g., interactions with other individuals or groups), and structural (e.g., gender norms, policies) levels. METHODS Transgender and gender diverse patients (n = 30) and VHA healthcare providers (n = 22) completed semi-structured, in-depth interviews in 2019 regarding barriers and facilitators to GAHT access and recommendations for overcoming perceived barriers. Two analysts used content analysis to code and analyze transcribed interview data and employed the Sexual and Gender Minority Health Disparities Research Framework to organize themes into multiple levels. RESULTS Facilitators included having GAHT offered through primary care or TGD specialty clinics and knowledgeable providers, with patients adding supportive social networks and self-advocacy. Several barriers were identified, including a lack of providers trained or willing to prescribe GAHT, patient dissatisfaction with prescribing practices, and anticipated or enacted stigma. To overcome barriers, participants recommended increasing provider capacity, providing opportunities for continual education, and enhancing communication around VHA policy and training. CONCLUSIONS Multi-level system improvements within and outside the VHA are needed to ensure equitable and efficient access to GAHT.
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Affiliation(s)
- Hill L Wolfe
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Taylor L Boyer
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jillian C Shipherd
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington D.C., USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Michael R Kauth
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington D.C., USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - John R Blosnich
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Murphy CN, Delles C, Davies E, Connelly PJ. Cardiovascular disease in transgender individuals. Atherosclerosis 2023; 384:117282. [PMID: 37821271 DOI: 10.1016/j.atherosclerosis.2023.117282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/23/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023]
Abstract
The population of people identifying as transgender has grown rapidly in recent years, resulting in a substantive increase in individuals obtaining gender-affirming medical care to align their secondary sex characteristics with their gender identity. This has established benefits for patients including improvements in gender dysphoria and psychosocial functioning, while reducing adverse mental health outcomes. Despite these potential advantages, recent evidence has suggested that gender-affirming hormone therapy (GAHT) may increase the risk of cardiovascular disease. However, owing to a paucity of research, the mechanisms underpinning these increased risks are poorly understood. Moreover, previous research has been limited by heterogenous methodologies, being underpowered, and lacking appropriate control populations. Consequently, the need for evidence regarding cardiovascular health in LGBTQ + individuals has been recognised as a critical area for future research to facilitate better healthcare and guidance. Recent research investigating the effect of transmasculine (testosterone) GAHT on cardiovascular disease risk points to testosterone effecting the nitric oxide pathway, triggering inflammation, and promoting endothelial dysfunction. Equivalent studies focussing on transfeminine (oestrogen) GAHT are required, representing a crucial area of future research. Furthermore, when examining the effects of GAHT on the vasculature, it cannot be ignored that there are multiple factors that may increase the burden of cardiovascular disease in the transgender population. Such stressors include major psychological stress; increased adverse health behaviours, such as smoking; discrimination; and lowered socioeconomic status; all of which undoubtedly impact upon cardiovascular disease risk and offers the opportunity for intervention.
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Affiliation(s)
- Charlotte N Murphy
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Eleanor Davies
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Paul J Connelly
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom.
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Oberlin DJ. Sex differences and athletic performance. Where do trans individuals fit into sports and athletics based on current research? Front Sports Act Living 2023; 5:1224476. [PMID: 37964771 PMCID: PMC10641525 DOI: 10.3389/fspor.2023.1224476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
There are well known sex differences in parameters of physical fitness/performance due to changes occurring during sexual development. Thus, many sport and athletic events have regulations separating male and female participants. However, the inclusion or exclusion of transgender individuals in athletics has recently received outsized attention despite relatively few cases of transgender athletes. When determining which athletic gender category trans individuals should be permitted to compete in, it is important to understand the level of physical fitness/performance these individuals possess relative to their cisgender counterparts. Unfortunately, there are few studies investigating this topic, and several complications that confound this research. The current review seeks to discuss sex and gender as concepts, review sex differences in fitness/performance and how they develop, and then, consider how current evidence suggests that trans individuals compare to cis individuals. Finally, this review seeks to offer considerations for whether trans individuals should be excluded from sports and athletics, and how future research should proceed to better understand this marginalized population.
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Affiliation(s)
- D. J. Oberlin
- Department of Exercise Sciences and Recreation, City University of New York, Lehman College, Bronx, NY, United States
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30
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Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, Conageski C, Downs L, Khan MJ. Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers. J Low Genit Tract Dis 2023; 27:307-321. [PMID: 37729043 PMCID: PMC10545069 DOI: 10.1097/lgt.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations. MATERIALS AND METHODS An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines. RESULTS Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk. CONCLUSIONS An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
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Affiliation(s)
| | | | - Lisa Flowers
- Emory University School of Medicine, Atlanta, GA
| | - Naomi Jay
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Serina Floyd
- Planned Parenthood of Metropolitan Washington, DC, Washington, DC
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | - Levi Downs
- Park Nicollet Health Services, Minneapolis, MN
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Goetz TG, Arcomano AC. "Coming Home to My Body": A Qualitative Exploration of Gender-Affirming Care-Seeking and Mental Health. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2023; 27:380-400. [PMID: 38078052 PMCID: PMC10707481 DOI: 10.1080/19359705.2023.2237841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/14/2023] [Indexed: 09/07/2024]
Abstract
Among transgender, non-binary, and/or gender expansive (TNG) persons, interest in medical and/or surgical forms of gender affirmation is heterogenous, as is access to those forms of medically necessary health care. Yet, the literature characterizing TNG persons' interest in medical and/or surgical gender-affirming care, barriers to accessing that care, and how societal narratives and expectations impact TNG individuals' self-image and mental health, as well as their personal choices regarding gender-affirming care remains sparse. Here we present qualitative research exploring TNG participants' interest in gender-affirming care and how such interventions impact identity formation. We conducted loosely structured interviews with a convenience sample of 54 TNG persons in the U.S. and Canada from Facebook pages used to recruit TNG research participants. One-hour interviews were conducted by an openly TNG researcher; participants were compensated. The most frequently sought gender-affirming care was hormone therapy, followed by chest ("top") surgery, genital ("bottom") surgery, electrolysis, breast augmentation, hysterectomy, and voice training. Less commonly desired interventions included fertility preservation, facial feminization/masculinization, and vocal surgery. Participants described four main categories of access barriers: financial (e.g., cost of medical/surgical care, inadequate insurance), logistical (e.g., no local providers, gatekeeping policies around body size and mental health, pandemic-related delays), personal fears about sub-optimal outcomes (e.g., complications, loss of sensation, undesired aesthetic and/or functional results), and societal discrimination (e.g., familial rejection, job loss, safety concerns). Participants reported primarily seeking this healthcare for social legibility, alleviating dysphoria/pursuing euphoria, and/or gender exploration. All who sought gender-affirming care reported improved mental health-including depression, anxiety, dissociation, and eating disorders-and social relationships, though many struggled to find TNG-competent mental health providers. This work provides key insights into how gender-affirming care can contribute to improving mental health for TNG communities, which will assist health providers in optimally treating TNG patients.
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Affiliation(s)
- Teddy G. Goetz
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA
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Abstract
ABSTRACT The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians' lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.
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Affiliation(s)
- Hyun-Hee Kim
- From Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Kim and Keuroghlian); University of Pennsylvania Department of Psychiatry (Dr. Goetz); University of Pittsburgh Department of Pharmacy and Therapeutics (Dr. Grieve)
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Cortes-Puentes GA, Davidge-Pitts CJ, Gonzalez CA, Dulohery Scrodin MM, Kennedy CC, Lim KG. A 64-year-Old patient assigned male at birth with COPD and worsening dyspnea while on estrogen and antiandrogen agents. Respir Med Case Rep 2023; 44:101876. [PMID: 37292171 PMCID: PMC10244681 DOI: 10.1016/j.rmcr.2023.101876] [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: 03/06/2023] [Revised: 04/25/2023] [Accepted: 05/20/2023] [Indexed: 06/10/2023] Open
Abstract
Among patients with COPD, ventilatory inefficiency in response to exercise can be due to respiratory muscle dysfunction or expiratory flow limitation causing air-trapping and dynamic hyperinflation. We discuss a case of severe ventilatory limitation in response to exercise due to reduced respiratory muscle mass in the setting of gender-affirming hormone therapy (GAHT), and how the interpretation of pulmonary function testing (PFT) and respiratory symptoms among transgender and gender diverse (TGD) patients can be influenced by GAHT.
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Affiliation(s)
- Gustavo A. Cortes-Puentes
- Mayo Clinic, Rochester MN, Division of Pulmonary and Critical Care Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Caroline J. Davidge-Pitts
- Mayo Clinic, Rochester MN, Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic Transgender and Intersex Specialty Care Clinic (TISCC), 200 First Street SW, Rochester, MN, 55905, USA
| | - Cesar A. Gonzalez
- Mayo Clinic, Rochester MN, Department of Psychiatry and Psychology, Department of Family Medicine, Mayo Clinic Transgender and Intersex Specialty Care Clinic (TISCC), 200 First Street SW, Rochester, MN, 55905, USA
| | - Megan M. Dulohery Scrodin
- Mayo Clinic, Rochester MN, Division of Pulmonary and Critical Care Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cassie C. Kennedy
- Mayo Clinic, Rochester MN, Division of Pulmonary and Critical Care Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kaiser G. Lim
- Mayo Clinic, Rochester MN, Division of Pulmonary and Critical Care Medicine, 200 First Street SW, Rochester, MN, 55905, USA
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Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Breaking Down Barriers to Facilitate Access to Healthcare Among Transgender People. J Adolesc Health 2022; 71:768-769. [PMID: 36403991 DOI: 10.1016/j.jadohealth.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health, and Environmental Sciences University of L'Aquila, L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis ASL Teramo Teramo, Italy; Technical Group for the Coordination of Gender Medicine Regione Abruzzo, Italy
| | - Lina Maria Magnanimi
- Department of Life, Health, and Environmental Sciences University of L'Aquila L'Aquila, Italy
| | - Lia Ginaldi
- Department of Life, Health, and Environmental Sciences University of L'Aquila L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis ASL Teramo Teramo, Italy; Technical Group for the Coordination of Gender Medicine Regione Abruzzo, Italy
| | - Massimo De Martinis
- Department of Life, Health, and Environmental Sciences University of L'Aquila L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis ASL Teramo Teramo, Italy; Technical Group for the Coordination of Gender Medicine Regione Abruzzo, Italy
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Fiot É, Lebrun C, Delcour C, Rogez C, Cohen A, Martinerie L. Accompagnement des transidentiteés chez l’enfant et l’adolescent(e). Med Sci (Paris) 2022; 38:897-904. [DOI: 10.1051/medsci/2022150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Depuis la création de consultations dédiées en 2014, les enfants et adolescent(e)s transgenres peuvent être accompagnés en France par des équipes pluridisciplinaires. L’accompagnement personnalisé qui s’y est développé s’appuie sur des recommandations internationales, reposant elles-mêmes sur des études scientifiques qui ont démontré l’impact bénéfique d’un tel accompagnement à court et moyen termes. De nombreuses questions persistent néanmoins, à la fois médicales, en particulier sur les effets à long terme des traitements ou l’impact sur la fertilité, mais aussi éthiques. L’accumulation de données au long cours permettra d’apporter à ces jeunes et à leur famille les informations les plus éclairées possibles.
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Restar A, Dusic EJ, Garrison-Desany H, Lett E, Everhart A, Baker KE, Scheim AI, Beckham SW, Reisner S, Rose AJ, Mimiaga MJ, Radix A, Operario D, Hughto JM. Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:304. [PMID: 36636110 PMCID: PMC9833814 DOI: 10.1057/s41599-022-01291-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/25/2022] [Indexed: 06/17/2023]
Abstract
Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less. Taking more hormones than prescribed was significantly associated with having the same provider for primary and gender-affirming care and gender-based discrimination. Income and insurance coverage barriers were significantly associated with taking less hormones than prescribed. Differences by gender identity were also observed. Addressing barriers to hormone access and cost could help to ensure safe hormone-dosing behaviors and the achievement trans people's gender-affirmation goals.
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Affiliation(s)
- Arjee Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Applied Transgender Studies, Chicago, IL, USA
| | - E. J. Dusic
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Henri Garrison-Desany
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Avery Everhart
- Center for Applied Transgender Studies, Chicago, IL, USA
- Population, Health, & Place Program, Spatial Sciences Institute, Dornsife College of Letters, Arts, & Sciences, University of Southern California, Los Angeles, CA, USA
| | - Kellan E. Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Whitman-Walker Institute, Washington, DC, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Adam J. Rose
- Hebrew University School of Public Health, Jerusalem, Israel
| | - Matthew J. Mimiaga
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Asa Radix
- Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Don Operario
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jaclyn M.W. Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
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