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Jayasena CN, Devine K, Barber K, Comninos AN, Conway GS, Crown A, Davies MC, Ewart A, Seal LJ, Smyth A, Turner HE, Webber L, Anderson RA, Quinton R. Society for endocrinology guideline for understanding, diagnosing and treating female hypogonadism. Clin Endocrinol (Oxf) 2024. [PMID: 39031660 DOI: 10.1111/cen.15097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/18/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024]
Abstract
Female hypogonadism (FH) is a relatively common endocrine disorder in women of premenopausal age, but there are significant uncertainties and wide variation in its management. Most current guidelines are monospecialty and only address premature ovarian insufficiency (POI); some allude to management in very brief and general terms, and most rely upon the extrapolation of evidence from the studies relating to physiological estrogen deficiency in postmenopausal women. The Society for Endocrinology commissioned new guidance to provide all care providers with a multidisciplinary perspective on managing patients with all forms of FH. It has been compiled using expertise from Endocrinology, Primary Care, Gynaecology and Reproductive Health practices, with contributions from expert patients and a patient support group, to help clinicians best manage FH resulting from both POI and hypothalamo-pituitary disorders, whether organic or functional.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Kerri Devine
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | - Katie Barber
- Community Gynaecology (NHS), Principal Medical Limited, Bicester, Oxfordshire, UK
- Oxford Menopause Ltd, Ardington, Wantage, UK
| | - Alexander N Comninos
- Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Gerard S Conway
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Anna Crown
- Department of Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Ann Ewart
- Kallman Syndrome and Congenital Hypogonadotropic Hypogonadism Support Group, Dallas, Texas, United States
| | - Leighton J Seal
- Department of Endocrinology, St George's Hospital Medical School, London, UK
| | - Arlene Smyth
- UK Turner Syndrome Support Society, Clydebank, UK
| | - Helen E Turner
- Department of Endocrinology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lisa Webber
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Richard Quinton
- Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
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Bezuidenhout MC, Conradie-Smit M, Dave JA, de Vries E, Ross IL, Zemlin AE. Reference intervals for biochemical analytes in transgender individuals on hormone therapy. Ann Clin Biochem 2022; 59:183-192. [PMID: 35044249 DOI: 10.1177/00045632211066777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hormone therapy in transgender individuals may impact processes that lead to changes in biochemical analytes, and therefore reference intervals. Currently, few reference interval studies are available for the transgender population. We determined biochemical reference intervals for transgender individuals receiving hormone therapy. METHODS Our retrospective, laboratory-based, observational study included healthy transgender males (N = 24) and transgender females (N = 84) on hormone therapy. Various biochemical reference intervals were established for each cohort and compared to their cisgender counterparts. RESULTS We detected significant differences in reference intervals for sodium, 139-142 mmol/L vs. 136-145 mmol/L when comparing transgender males (TM) with cisgender males (CM). The following significant changes in upper reference limits (URL) for TM versus CM were detected, ALP (URL: 96 U/L vs. 128 U/L), GGT (URL: 27 U/L vs. 67 U/L) and testosterone (URL: 46.7 nmol/L vs. 29.0 nmol/L), respectively. Moreover, when comparing transgender female (TF) to cisgender female (CF), significant differences in creatinine (URL: 117 μmol/L vs. 90 μmol/L), albumin (lower reference limit: 41 g/L, vs. 35 g/L), AST (URL: 50 U/L vs. 35 U/L), ALP (URL: 118 U/L vs. 98 U/L) and oestradiol (URL: 934 pmol/L vs. 213 pmol/L) were noted, respectively. Significantly higher LDL-C was observed for TM on hormone treatment, compared to baseline (2.9 mmol/L vs. 2.2 mmol/L, p <0.01). CONCLUSIONS Biochemical results for TM and TF receiving hormone therapy can be evaluated against our transgender-specific reference intervals for some analytes, while others can be compared to their identified gender reference intervals.
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Affiliation(s)
- Morné C Bezuidenhout
- Division of Chemical Pathology, Department of Pathology, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Marli Conradie-Smit
- Division of Endocrinology, Department of Medicine, 121470Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Joel A Dave
- Division of Endocrinology, Department of Medicine, 63726University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Elma de Vries
- Division of Family Medicine, School of Public Health and Family Medicine, 63726University of Cape Town, Cape Town, South Africa
| | - Ian L Ross
- Division of Endocrinology, Department of Medicine, 121470Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Annalise E Zemlin
- Division of Chemical Pathology, Department of Pathology, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Wu SS, Raymer CA, Kaufman BR, Isakov R, Ferrando CA. The Effect of Preoperative Gender Affirming Hormone Therapy Use on Perioperative Adverse Events in Transmasculine Individuals Undergoing Masculinizing Chest Surgery for Gender Affirmation. Aesthet Surg J 2022; 42:1009-1016. [PMID: 35417528 DOI: 10.1093/asj/sjac091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many providers require cessation of gender affirming hormone therapy (GAHT) for transgender patients prior to undergoing masculinizing chest surgery due to concern for increased adverse events in the presence of exogenous hormones. Evidence has suggested that continuation of GAHT for certain patients may be safe for gender affirming procedures. OBJECTIVES To compare adverse event rates in GAHT cessation versus GAHT continuation in patients undergoing masculinizing chest surgery. METHODS This multicenter, retrospective study included patients at the Cleveland Clinic and MetroHealth System who underwent masculinizing chest surgery between 2016 and 2020. RESULTS There were 236 patients who met inclusion criteria. Of these, 172 (72.9%) discontinued testosterone GAHT prior to surgery (T-GAHT cessation), and 64 (27.1%) patients continued testosterone GAHT prior to surgery (T-GAHT continuous). Mean (SD) age at surgery was 25 (8) years, and mean (SD) BMI was 29.5 (6.6). Average duration of testosterone therapy was 18 months (range 0-300). There was no significant difference in tobacco use (p=0.73), diabetes (p=0.54), thrombophilia (p=0.97), or history of thromboembolism (p=0.39). Most patients underwent double incision free nipple graft technique (77.9%). There was no significant difference in surgical time (p=0.12), intraoperative complications (p=0.54), or postoperative complications (p=0.34). The most common complication was postoperative bleeding/hematoma (7.2%). Other complications included seroma (2.1%), infection (1.3%), and nipple graft failure (0.4%). There were no thromboembolic complications. CONCLUSIONS There is no significant difference in the incidence of perioperative adverse events for patients who continue GAHT preoperatively versus patients who undergo GAHT cessation for masculinizing chest surgery.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, OH , USA
| | - Charles A Raymer
- Department of Plastic Surgery, Cleveland Clinic , Cleveland, OH , USA
| | - Bram R Kaufman
- Department of Plastic Surgery, MetroHealth System , Cleveland, OH , USA
| | - Raymond Isakov
- Department of Plastic Surgery, Cleveland Clinic , Cleveland, OH , USA
| | - Cecile A Ferrando
- Transgender Surgical Services, Cleveland Clinic , Cleveland, OH , USA
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Patel H, Samaha Y, Ives G, Lee TY, Cui X, Ray E. Chest Feminization in Male-to-Female Transgender Patients: A Review of Options. Transgend Health 2022; 6:244-255. [PMID: 34993297 DOI: 10.1089/trgh.2020.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Management of a transgender (TG) woman's gender dysphoria is individualized to address the sources of her distress. This typically involves some combination of psychological therapy, hormone modulation, and surgical intervention. Breast enhancement is the most commonly pursued physical modification in this population. Because hormone manipulation provides disappointing results for most TG women, surgical treatment is frequently required to achieve the goal of a feminine chest. Creating a female breast from natal male chest anatomy poses significant challenges; the sexual dimorphism requires a different approach than that used in cisgender breast augmentation. The options and techniques used continue to evolve as experience in this field grows.
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Affiliation(s)
- Harsh Patel
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Yasmina Samaha
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Graham Ives
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Tian-Yu Lee
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Xiaojiang Cui
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Edward Ray
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
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Pirtea P, Ayoubi JM, Desmedt S, T’Sjoen G. Ovarian, breast, and metabolic changes induced by androgen treatment in transgender men. Fertil Steril 2021; 116:936-942. [DOI: 10.1016/j.fertnstert.2021.07.1206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/15/2023]
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Burinkul S, Panyakhamlerd K, Suwan A, Tuntiviriyapun P, Wainipitapong S. Anti-Androgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial. J Sex Med 2021; 18:1299-1307. [PMID: 37057417 DOI: 10.1016/j.jsxm.2021.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spironolactone and cyproterone acetate are commonly used in feminizing hormone therapy to achieve the goal of female range testosterone level; however, the data on the efficacy comparing between these two anti-androgens are scarce. AIM To compare the anti-androgenic effects between spironolactone and cyproterone acetate as the component of feminizing hormone therapy among transgender women population. METHODS The study was single-blinded randomized controlled trial involved 52 transgender women from two transgender health clinics. Each participant received oral estradiol valerate 4 mg/day combined with anti-androgen, spironolactone 100 mg/day or cyproterone acetate 25 mg/day, depending on which group they were randomized to. Clinical and biochemical variables were obtained at baseline and at 12 weeks of feminizing hormone therapy. MAIN OUTCOME MEASURES The change of testosterone level from baseline. Other changes including free testosterone, estradiol, prolactin and lipid profile after the therapy. RESULTS After a 12 weeks of feminizing hormone therapy, the change of testosterone level in the cyproterone acetate group [558.0 ng/dL (IQR 352.0 to 783.3)] was significantly higher than the spironolactone group [226.2 ng/dL (IQR,-4.3 to 480.1)](p value <0.001). Testosterone and calculated free testosterone in the cyproterone acetate group were significantly lower than the spironolactone group. Consequently, a proportion of the participants who achieved the female range testosterone (<50 ng/dL) was significantly higher in cyproterone acetate group (90%) compared to the spironolactone group (19%). Serious adverse effects observed in cyproterone acetate users were drug-induced liver injury and asymptomatic hyperprolactinemia. CLINICAL IMPLICATIONS The data on the differences between the two anti-androgen could be benefit for the transgender health-care providers in medication selection and adverse-effects counseling. STRENGTHS & LIMITATIONS The study design was randomized controlled trial and controlled the estrogen component by prescribed the same type and dose for each participant. However, the study was suffered from the confound feminizing effects from previous hormone therapy and the high drop-out rate. CONCLUSION For feminizing hormone therapy, cyproterone acetate had a higher testosterone suppression efficacy than spironolactone. Burinkul S, Panyakhamlerd K, Suwan A, et al. Anti-Andorgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial. J Sex Med 2021;18:1299-1307.
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Affiliation(s)
- Supanat Burinkul
- Division of Gender, Sexual and Climacteric medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krasean Panyakhamlerd
- Division of Gender, Sexual and Climacteric medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Ammarin Suwan
- Division of Gender, Sexual and Climacteric medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Punkavee Tuntiviriyapun
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Call DC, Challa M, Telingator CJ. Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes. Curr Psychiatry Rep 2021; 23:33. [PMID: 33851310 DOI: 10.1007/s11920-021-01245-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the evolving body of research on the mental health of transgender and gender diverse (TGD) youth. Minority stress experiences in families, schools, and the community impact the health and well-being of this population due to experiences of stigma, discrimination, and rejection. Poor healthcare access and outcomes may be compounded in youth with intersectional identities. RECENT FINDINGS There is increasing evidence that gender-affirming interventions improve mental health outcomes for TGD youth. TGD youth report worse mental health outcomes in invalidating school and family environments and improved outcomes in affirming climates. TGD youth experience significant healthcare disparities, and intersectional clinical approaches are needed to increase access to affirmative care. Providers can best support TGD youth by considering ways they can affirm these youth in their healthcare settings, and helping them access support in schools, family systems, and communities. Understanding the intersection of multiple minority identities can help providers address potential barriers to care to mitigate the health disparities seen in this population.
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Affiliation(s)
- David C Call
- Department of Psychiatry and Behavioral Sciences, Children's National Hospital, Washington, DC, USA
| | - Mamatha Challa
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cynthia J Telingator
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Gabrick KS, Chouiari F, Park KE, Allam O, Mozaffari MA, Persing JA, Alperovich M. A comparison of perioperative safety for breast augmentation in cis- vs. trans patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:601. [PMID: 33987299 DOI: 10.21037/atm-20-3355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Gender-affirming surgery provides a psychosocial benefit to transgender women. However, increased medical complexity within the transgender population has limited access for some transgender women. This study compared patient population comorbidities and 30-day peri-operative safety following primary augmentation mammoplasty between cis- and transgender women. Methods Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database between 2007 and 2016. Transgender patients were identified using ICD-9 &10 codes for gender dysphoria. Categorical variables were compared using chi-squared and Fisher's exact tests while independent t-tests were used for continuous variables. Statistical significance was set at P<0.05. Results There were 4,234 breast augmentations identified in cisgender women and 137 in transgender women. Transgender women had a higher frequency of ASA-II and ASA-III patients (P<0.001), diabetes (P<0.001), hypertension (P=0.006), and active smoking status (P<0.001). Despite the higher comorbidity burden and routine use of hormonal therapy, there were no significant differences between populations in major or minor peri-operative complication rates. Conclusions Top surgery improves quality of life in transgender women. Despite the more complex pre-operative risk profile in the transgender population, there is no difference in peri-operative safety profiles. Plastic surgeons treating this patient population should consider more liberal surgical indications for reconstructive top surgery compared with cosmetic breast augmentation.
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Affiliation(s)
- Kyle S Gabrick
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Fouad Chouiari
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Kitae E Park
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Omar Allam
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | | | - John A Persing
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
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Pappas II, Craig WY, Spratt LV, Spratt DI. Efficacy of Sex Steroid Therapy Without Progestin or GnRH Agonist for Gonadal Suppression in Adult Transgender Patients. J Clin Endocrinol Metab 2021; 106:e1290-e1300. [PMID: 33247919 DOI: 10.1210/clinem/dgaa884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Indexed: 02/04/2023]
Abstract
CONTEXT Testosterone (T) or estradiol (E2) are administered to suppress gonadal function in female-to-male (FTM) and male-to-female (MTF) transgender patients. How often sex steroids cause adequate suppression without GnRH agonist (GnRHa) or progestin therapy has not been reported. OBJECTIVES (1) To determine how often T and E2 therapy alone can effectively suppress gonadal function in MTF and FTM transgender patients, and (2) to determine the frequency and range of serum E2 levels above the normal male range in FTM patients receiving T therapy. DESIGN Retrospective cohort study. SETTING Outpatient reproductive endocrinology clinic at an academic medical center. PATIENTS A total of 65 FTM and 33 MTF patients were included who were > 18 years of age and not receiving progestin or GnRHa therapy. INTERVENTION Female-to-male patients were receiving T through injections or gel. Male-to-female patients were receiving oral or subcutaneous E2. MAIN OUTCOME MEASUREMENTS In FTM patients the indicator of ovary suppression was amenorrhea. In MTF patients, the indicator of testes suppression was T levels <50 ng/dL. RESULTS Median serum total T level for FTM patients was 712 ng/dL (range, 370-1164 ng/dL). On T therapy alone, 90.8% of patients achieved amenorrhea and 49.2% of patients had serum E2 levels above the normal range for women. For MTF patients, the median serum E2 level was 129.2 pg/mL (range, 75-197 pg/mL). On E2 therapy alone, 84.8% of MTF patients had adequate suppression of testicular function. CONCLUSIONS Testosterone and E2 therapy are usually effective without progestin or GnRHa therapy to suppress gonadal function in transgender patients. Progestin and/or GnRHa therapy should only be initiated in those patients who do not have adequate gonadal suppression on optimized doses of T or E2 alone.
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Affiliation(s)
- India I Pappas
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Maine Medical Center, Portland, Maine, USA
| | - Wendy Y Craig
- Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Lindsey V Spratt
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Maine Medical Center, Portland, Maine, USA
| | - Daniel I Spratt
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Maine Medical Center, Portland, Maine, USA
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Harper J, O'Donnell E, Sorouri Khorashad B, McDermott H, Witcomb GL. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br J Sports Med 2021; 55:865-872. [PMID: 33648944 PMCID: PMC8311086 DOI: 10.1136/bjsports-2020-103106] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
Objectives We systemically reviewed the literature to assess how long-term testosterone suppressing gender-affirming hormone therapy influenced lean body mass (LBM), muscular area, muscular strength and haemoglobin (Hgb)/haematocrit (HCT). Design Systematic review. Data sources Four databases (BioMed Central, PubMed, Scopus and Web of Science) were searched in April 2020 for papers from 1999 to 2020. Eligibility criteria for selecting studies Eligible studies were those that measured at least one of the variables of interest, included transwomen and were written in English. Results Twenty-four studies were identified and reviewed. Transwomen experienced significant decreases in all parameters measured, with different time courses noted. After 4 months of hormone therapy, transwomen have Hgb/HCT levels equivalent to those of cisgender women. After 12 months of hormone therapy, significant decreases in measures of strength, LBM and muscle area are observed. The effects of longer duration therapy (36 months) in eliciting further decrements in these measures are unclear due to paucity of data. Notwithstanding, values for strength, LBM and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy. Conclusion In transwomen, hormone therapy rapidly reduces Hgb to levels seen in cisgender women. In contrast, hormone therapy decreases strength, LBM and muscle area, yet values remain above that observed in cisgender women, even after 36 months. These findings suggest that strength may be well preserved in transwomen during the first 3 years of hormone therapy.
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Affiliation(s)
- Joanna Harper
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Hilary McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gemma L Witcomb
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Meyer G, Boczek U, Bojunga J. Hormonal Gender Reassignment Treatment for Gender Dysphoria. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:725-732. [PMID: 33559593 DOI: 10.3238/arztebl.2020.0725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND No data are available at present on the prevalence of gender dysphoria (trans-identity) in Germany. On the basis of estimates from the Netherlands, it can be calculated that approximately 15 000 to 25 000 persons in Germany are affected. Persons suffering from gender dysphoria often experience significant distress and have a strong desire for gender reassignment treatment. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed database employing the searching terms "transsexualism," "transgender," "gender incongruence," "gender identity disorder," "gender-affirming hormone therapy," and "gender dysphoria." RESULTS In view of its far-reaching consequences, some of which are irreversible, hormonal gender reassignment treatment should only be initiated after meticulous individual consideration, with the approval of the treating psychiatrist/psychotherapist and after extensive information of the patient by an experienced endo - crinologist. Before the treatment is begun, the patient must be extensively screened for risk factors. The contraindications include severe preexisting thromboembolic diseases (mainly if untreated), hormone-sensitive tumors, and uncontrolled pre - existing chronic diseases such as arterial hypertension and epilepsy. Finding an appropriate individual solution is the main objective even if contraindications are present. Male-to-female treatment is carried out with 17β-estradiol or 17β-estradiol valerate in combination with cyproterone acetate or spironolactone as an antiandrogen, female-to-male treatment with transdermal or intramuscular testosterone preparations. The treatment must be monitored permanently with clinical and laboratory follow-up as well as with gynecological and urological early-detection screening studies. Prospective studies and a meta-analysis (based on low-level evidence) have documented an improvement in the quality of life after gender reassignment treatment. Female-to-male gender-incongruent persons often have difficulty being accepted in a gynecological practice as a male patient. CONCLUZION Further prospective studies for the quantification of the risks and benefits of hormonal treatment would be desirable. Potential interactions of the hormone preparations with other medications must always be considered.
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Affiliation(s)
- Gesine Meyer
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology, Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
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Hojbjerg JA, Saini SL, Hvas AM, Hojgaard AD. Current Treatment Regimens for Transfeminine Individuals in the Nordic Countries. J Sex Med 2021; 18:656-663. [PMID: 33582008 DOI: 10.1016/j.jsxm.2020.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The demand for gender-affirming hormone therapy is increasing worldwide prompting a growing requirement for solid evidence for efficacy and safety. AIM We aimed to report on the organization of transgender care and the current clinical practice of feminizing hormone therapy in specialized clinics in the Nordic countries. METHODS This study was a cross-sectional study performed as a questionnaire survey. A quantitative questionnaire was sent to 15 specialized clinics prescribing feminizing hormone therapy in the Nordic countries. OUTCOMES Twelve clinics responded to the inquiry. RESULTS The answers showed great variance in both number of clinics in each country as well as number of doctors responsible for prescribing gender-affirming hormone therapy. There was great difference in the width of the target ranges for estrogen plasma concentrations and in preferred route of administration for estrogens. Likewise, the risk assessment and monitoring of side effects were diverse. CLINICAL IMPLICATIONS To gather solid data on efficacy and safety of feminizing hormone therapy, the treatment regimens and the recording of side effects need to be consistent across the clinics responsible for the treatment of transfeminine patients. Strenghts & Limitations: This is to our knowledge the first report on treatment regimens for feminizing hormone treatment in the Nordic countries. The response rate was 80%; however, the included clinics only cover approximately 30% of the expected numbers of transfeminine individuals. CONCLUSION Despite the great diversity across clinics as regard to organization of clinics and to treatment regimens, the vast majority of clinics operated within the guidelines defined by The Endocrine Society. Hojbjerg JA, Saini SL, Hvas A-M, et al. Current Treatment Regimens for Transfeminine Individuals in the Nordic Countries. J Sex Med 2021;18:656-663.
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Affiliation(s)
- Johanne Andersen Hojbjerg
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark.
| | | | - Anne-Mette Hvas
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ramsey DC, Lawson MM, Stuart A, Sodders E, Working ZM. Orthopaedic Care of the Transgender Patient. J Bone Joint Surg Am 2021; 103:274-281. [PMID: 33252585 DOI: 10.2106/jbjs.20.00628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
» A transgender person is defined as one whose gender identity is incongruent with their biological sex assigned at birth. This highly marginalized population numbers over 1.4 million individuals in the U.S.; this prevalence skews more heavily toward younger generations and is expected to increase considerably in the future. » Gender-affirming hormone therapy (GAHT) has physiologic effects on numerous aspects of the patient's health that are pertinent to the orthopaedic surgeon, including bone health, fracture risk, and perioperative risks such as venous thromboembolism and infection. » Language and accurate pronoun usage toward transgender patients can have a profound effect on a patient's experience and on both objective and subjective outcomes. » Gaps in research concerning orthopaedic care of the transgender patient are substantial. Specific areas for further study include the effects of GAHT on fracture risk and healing, outcome disparities and care access across multiple subspecialties, and establishment of perioperative management guidelines.
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Affiliation(s)
- Duncan C Ramsey
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Michelle M Lawson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Ariana Stuart
- Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Emelia Sodders
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Zachary M Working
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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14
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Seal LJ. Cardiovascular disease in transgendered people: A review of the literature and discussion of risk. JRSM Cardiovasc Dis 2019; 8:2048004019880745. [PMID: 31620275 PMCID: PMC6775543 DOI: 10.1177/2048004019880745] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
This review examines the impact of gender affirming hormone therapy used in the transgendered and non-binary populations on cardiovascular outcomes and surrogate markers of cardiovascular health. Current evidence suggests that hormonal therapy for transgendered women decreases or is neutral regarding myocardial infarction risk. There is an increased incidence of venous thromboembolism (VTE), but newer studies suggest that the risk is significantly lower than previously described. For transgendered men, there appears to be an adverse effect on lipid parameters but this does not translate into an increased risk of cardiovascular disease above that of general male population. In all transgendered people, risk factor interventions such as smoking cessation, weight management and treatment of co-morbid conditions are important in optimising cardiovascular health. The effect of gender affirming hormonal therapy in transgendered people is difficult to interpret due to the variety of hormone regimens used, the relative brevity of the periods of observation and the influence of confounding factors such as the historical use of less physiological, oestrogens such as conjugated equine oestrogen and ethinylestradiol which are more pro-thrombotic than the 17β oestradiol that is used in modern practice.
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Affiliation(s)
- Leighton J Seal
- St George's Hospital Medical School, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
- Leighton John Seal, Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, 179-183 Fulham Palace Road, London W6 8QZ, UK.
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15
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Abstract
An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.
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16
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Khan J, Schmidt RL, Spittal MJ, Goldstein Z, Smock KJ, Greene DN. Venous Thrombotic Risk in Transgender Women Undergoing Estrogen Therapy: A Systematic Review and Metaanalysis. Clin Chem 2019; 65:57-66. [DOI: 10.1373/clinchem.2018.288316] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/16/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Transgender women are female individuals who were recorded men at birth based on natal sex. Supporting a person's gender identity improves their psychological health, and gender-affirming hormones reduce gender dysphoria and benefit mental health. For transgender women, estrogen administration has clinically significant benefits. Previous reviews have reported conflicting literature on the thrombotic risk of estrogen therapy in transgender women and have highlighted the need for more high-quality research.
CONTENT
To help address the gap in understanding thrombotic risk in transgender women receiving estrogen therapy, we performed a systematic literature review and metaanalysis. Two evaluators independently assessed quality using the Ottawa Scale for Cohort Studies. The Poisson normal model was used to estimate the study-specific incidence rates and the pooled incidence rate. Heterogeneity was measured using Higgins I2 statistic. The overall estimate of the incidence rate was 2.3 per 1000 person-years (95% CI, 0.8–6.9). The heterogeneity was significant (I2 = 74%; P = 0.0039).
SUMMARY
Our study estimated the incidence rate of venous thromboembolism in transgender women prescribed estrogen to be 2.3 per 1000 person-years, but because of heterogeneity this estimate cannot be reliably applied to transgender women as a group. There are insufficient data in the literature to partition by subgroup for subgroup prohibiting the analysis to control for tobacco use, age, and obesity, which is a major limitation. Additional studies of current estrogen formulations, modes of administration, and combination therapies, as well as studies in the aging transgender population, are needed to confirm thrombotic risk and clarify optimal therapy regimens.
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Affiliation(s)
- Jenna Khan
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT
| | - Matthew J Spittal
- Center for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Zil Goldstein
- Department of Medical Education, Icahn School of Medicine, New York, NY
| | - Kristi J Smock
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA
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Strang JF, Jarin J, Call D, Clark B, Wallace GL, Anthony LG, Kenworthy L, Gomez-Lobo V. Transgender Youth Fertility Attitudes Questionnaire: Measure Development in Nonautistic and Autistic Transgender Youth and Their Parents. J Adolesc Health 2018; 62:128-135. [PMID: 29033160 DOI: 10.1016/j.jadohealth.2017.07.022] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this study was to assess transgender youth and parent attitudes regarding (1) the potential impact of gender-affirming hormone therapy on fertility and (2) fertility preservation (FP) options. METHODS The Transgender Youth Fertility Attitudes Questionnaire was developed through a multistage participatory process with gender specialists and key stakeholders (transgender youth and their parents, N = 35). As up to 25% of youth gender referrals have co-occurring autism, measure development included a well-characterized supplementary sample of autistic transgender youth to maximize the applicability of the questionnaire. Following its development and refinement, the Transgender Youth Fertility Attitudes Questionnaire was pilot tested with transgender youth (nonautistic and autistic) and their parents (N = 51). RESULTS The participatory process produced parallel child and parent questionnaires addressing fertility and FP knowledge and attitudes. In the pilot trial, youth and parents expressed generally similar attitudes about fertility and FP. Most youth (92%) reported learning about gender-affirming hormone therapy-related fertility issues online. Although many transgender youth endorsed a wish to parent children at some point, few (24%) expressed desire to have their own biological child. However, many youth wondered, or did not know, if their feelings about having a biological child might change in the future. CONCLUSIONS This study presents a novel procedure for developing instruments for use with transgender youth. Although a majority of transgender youth in this study were uninterested in using FP, extending exploration of this topic with young people may be useful given findings of their openness to the idea that fertility attitudes may change in adulthood.
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Affiliation(s)
- John F Strang
- Division of Pediatric Neuropsychology, Children's National Health System, Rockville, Maryland.
| | - Jason Jarin
- Section of Pediatric and Adolescent Gynecology, MedStar Washington Hospital Center, Children's National Health System, Washington, District of Columbia
| | - David Call
- Division of Psychiatry and Behavioral Sciences, Children's National Health System, Washington, District of Columbia
| | - Brett Clark
- Georgetown University School of Medicine, Georgetown University, Washington, District of Columbia
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing, The George Washington University, Washington, District of Columbia
| | - Laura G Anthony
- Division of Pediatric Neuropsychology, Children's National Health System, Rockville, Maryland
| | - Lauren Kenworthy
- Division of Pediatric Neuropsychology, Children's National Health System, Rockville, Maryland
| | - Veronica Gomez-Lobo
- Section of Pediatric and Adolescent Gynecology, MedStar Washington Hospital Center, Children's National Health System, Washington, District of Columbia
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Mamoojee Y, Seal LJ, Quinton R. Transgender hormone therapy: understanding international variation in practice. Lancet Diabetes Endocrinol 2017; 5:243-246. [PMID: 28340645 DOI: 10.1016/s2213-8587(17)30068-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Yaasir Mamoojee
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals NHS Trust, Newcastle-upon-Tyne, UK
| | - Leighton J Seal
- Department of Endocrinology, St George's Hospital Medical School, London, UK; Department of Endocrinology, St George's Healthcare NHS Trust, London, UK; Gender Identity Clinic, West London Mental Health NHS Trust, London, UK
| | - Richard Quinton
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals NHS Trust, Newcastle-upon-Tyne, UK; Endocrine Research Group, Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, NE1 3BZ, UK.
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Gorton RN, Erickson-Schroth L. Hormonal and Surgical Treatment Options for Transgender Men (Female-to-Male). Psychiatr Clin North Am 2017; 40:79-97. [PMID: 28159147 DOI: 10.1016/j.psc.2016.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Untreated transgender men face serious negative health care outcomes. Effective medical, surgical, and mental health treatment ameliorates these risks. Although the research is not as robust as would be ideal, hormone treatment is effective and generally well tolerated with few serious medical risks. Surgeries carry serious risks; but for most transgender men, the benefits outweigh the risks. This review describes current evidence-based medical treatments for transgender men and provides an overview of surgical therapy to enable practitioners to discuss these options with their transgender male patients.
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Affiliation(s)
- Ryan Nicholas Gorton
- Lyon-Martin Health Services, 1748 Market Street, #201, San Francisco, CA 94102, USA; Touro University California, 1310 Club Drive, Mare Island, Vallejo, CA 94592, USA.
| | - Laura Erickson-Schroth
- Comprehensive Psychiatric Emergency Program, Mount Sinai Beth Israel, 10 Nathan D Perlman Place, New York, NY 10003, USA; Hetrick-Martin Institute, 2 Astor Place, New York, NY 10003, USA
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20
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Aitken S. The primary health care of transgender adults. Sex Health 2017; 14:477-483. [DOI: 10.1071/sh17048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.
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Strang JF, Meagher H, Kenworthy L, de Vries ALC, Menvielle E, Leibowitz S, Janssen A, Cohen-Kettenis P, Shumer DE, Edwards-Leeper L, Pleak RR, Spack N, Karasic DH, Schreier H, Balleur A, Tishelman A, Ehrensaft D, Rodnan L, Kuschner ES, Mandel F, Caretto A, Lewis HC, Anthony LG. Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:105-115. [PMID: 27775428 DOI: 10.1080/15374416.2016.1228462] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.
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Affiliation(s)
- John F Strang
- a Division of Pediatric Neuropsychology , Children's National Health System
| | - Haley Meagher
- a Division of Pediatric Neuropsychology , Children's National Health System
| | - Lauren Kenworthy
- a Division of Pediatric Neuropsychology , Children's National Health System
| | | | - Edgardo Menvielle
- c Division of Psychiatry and Behavioral Sciences , Children's National Health System
| | - Scott Leibowitz
- d Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine
| | - Aron Janssen
- e Department of Child and Adolescent Psychiatry , New York University School of Medicine
| | | | - Daniel E Shumer
- g Division of Pediatric Endocrinology , University of Michigan Health System
| | | | - Richard R Pleak
- i Division of Child & Adolescent Psychiatry , Hofstra Northwell School of Medicine
| | - Norman Spack
- j Division of Endocrinology , Boston Children's Hospital
| | - Dan H Karasic
- k Department of Psychiatry , University of California San Francisco School of Medicine
| | - Herbert Schreier
- l Department of Psychiatry , University of California San Francisco-Benioff-Children's Hospital Oakland
| | - Anouk Balleur
- f Department of Medical Psychology , VU University Medical Center
| | - Amy Tishelman
- m Departments of Psychiatry , Endocrinology and Urology, Boston Children's Hospital and Harvard Medical School
| | - Diane Ehrensaft
- n Child and Adolescent Gender Center , Department of Pediatrics, University of California San Francisco Benioff Children's Hospital
| | - Leslie Rodnan
- o Division of Psychiatry and Behavioral Sciences, Children's National Health System
| | - Emily S Kuschner
- p Department of Radiology and Center for Autism Research , The Children's Hospital of Philadelphia
| | - Francie Mandel
- q Divisions of Endocrinology and Social Work , Boston Children's Hospital
| | | | - Hal C Lewis
- s Division of Psychiatry and Pediatrics , University of Colorado
| | - Laura G Anthony
- t Division of Pediatric Neuropsychology , Children's National Health System
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Fernandez JD, Tannock LR. METABOLIC EFFECTS OF HORMONE THERAPY IN TRANSGENDER PATIENTS. ENDOCRINE PRACTICE : OFFICIAL JOURNAL OF THE AMERICAN COLLEGE OF ENDOCRINOLOGY AND THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS 2015. [PMID: 26574790 DOI: 10.4158/ep15950.or.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Transgender patients may seek hormone therapy to induce physical changes to simulate their expressed or experienced gender. However, many providers are uncomfortable prescribing transgender hormones due to fears over safety. The goal of this study was to determine if transgender hormone therapy with estrogen and spironolactone for male-to-female (MtF) patients or with testosterone for female-to-male (FtM) patients had adverse anthropomorphic or metabolic effects. METHODS This retrospective chart review study analyzed changes over time for 33 MtF and 19 FtM endocrine clinic patients at an academic endocrine practice with follow-up for up to 18 months after hormone initiation. RESULTS Compared to baseline labs obtained prior to the initiation of hormone therapy, significant changes for the MtF cohort included an increase in high-density lipoprotein (HDL) and decrease in creatinine; however, triglycerides did not show a statistically significant change. In the FtM cohort, there were significant increases in body mass index, creatinine, hemoglobin, and hematocrit. Although statistically significant, these changes were minimal for both cohorts. CONCLUSION In our practice, hormone therapy was found to be safe in this retrospective study.
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Abstract
OBJECTIVE Transgender patients may seek hormone therapy to induce physical changes to simulate their expressed or experienced gender. However, many providers are uncomfortable prescribing transgender hormones due to fears over safety. The goal of this study was to determine if transgender hormone therapy with estrogen and spironolactone for male-to-female (MtF) patients or with testosterone for female-to-male (FtM) patients had adverse anthropomorphic or metabolic effects. METHODS This retrospective chart review study analyzed changes over time for 33 MtF and 19 FtM endocrine clinic patients at an academic endocrine practice with follow-up for up to 18 months after hormone initiation. RESULTS Compared to baseline labs obtained prior to the initiation of hormone therapy, significant changes for the MtF cohort included an increase in high-density lipoprotein (HDL) and decrease in creatinine; however, triglycerides did not show a statistically significant change. In the FtM cohort, there were significant increases in body mass index, creatinine, hemoglobin, and hematocrit. Although statistically significant, these changes were minimal for both cohorts. CONCLUSION In our practice, hormone therapy was found to be safe in this retrospective study.
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Survey of the Literature for September 2015 Issue of Sexual Medicine Journal. Sex Med 2015. [PMCID: PMC4599550 DOI: 10.1002/sm2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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