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Salim SM, Anilal L, Prabhakaran A. Sexual Orientation Change Efforts Among LGBT+ People of Kerala: Prevalence, Correlates, and Mental Health Aspects. JOURNAL OF HOMOSEXUALITY 2024; 71:1487-1506. [PMID: 36745044 DOI: 10.1080/00918369.2023.2174473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Sexual Orientation Change Efforts (SOCE) have been reported worldwide and have adverse psychiatric consequences. However, no data are available for India or Kerala. We assessed the prevalence of SOCE, its characteristics, and mental health aspects among LGBT+ individuals in Kerala. This cross-sectional survey used snowball sampling. An online questionnaire collected sociodemographic information and history and characteristics of SOCE. Religiosity and SOCE-associated distress were evaluated using 6-point Likert scales. Patient Health Questionnaire (PHQ-9) screened for depressive symptoms; its ninth question assessed death wishes and self-harm thoughts. Generalized Anxiety Disorder Assessment (GAD-7) screened for anxiety symptoms. Participants' (n = 130) mean age was 26.80 ± 7.12 years. Most common biological sex (63.1%) and gender identity (50.8%) were male, and sexual orientation was gay(42.3%). Prevalence of SOCE was 45.4%. In SOCE group, 39% reported very severe distress. SOCE was most commonly self-prompted (47.5%), performed through psychotherapy (28.8%), and performed by doctors (28.8%). SOCE group had significantly higher religiosity scores (t = 2.61, p = .01). Among cisgender men, 48.48% had SOCE history, against 28.57% among cisgender women (χ2 = 3.19, p = .07). SOCE is highly prevalent among the LGBT+ community in Kerala, with high associated distress. Multi-level approaches are necessary to mitigate this problem.
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Affiliation(s)
- Sreya Mariyam Salim
- Department of Psychiatry, Government Medical College, Thiruvananthapuram, India
| | - Lallchand Anilal
- Department of Psychiatry, Government Medical College, Thiruvananthapuram, India
| | - Anil Prabhakaran
- Department of Psychiatry, Government Medical College, Thiruvananthapuram, India
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2
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Klöbl M, Reed MB, Handschuh P, Kaufmann U, Konadu ME, Ritter V, Spurny-Dworak B, Kranz GS, Lanzenberger R, Spies M. Gender Dysphoria and Sexual Euphoria: A Bayesian Perspective on the Influence of Gender-Affirming Hormone Therapy on Sexual Arousal. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1859-1871. [PMID: 38216784 PMCID: PMC11106106 DOI: 10.1007/s10508-023-02778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
Self-reported sexual orientation of transgender individuals occasionally changes over transition. Using functional magnetic resonance imaging, we tested the hypothesis that neural and behavioral patterns of sexual arousal in transgender individuals would shift from the assigned to the experienced gender (e.g., trans women's responses becoming more dissimilar to those of cis men and more similar to those of cis women). To this aim, trans women (N = 12) and trans men (N = 20) as well as cisgender women (N = 24) and cisgender men (N = 14) rated visual stimuli showing male-female, female-female or male-male intercourse for sexual arousal before and after four months of gender-affirming hormone therapy. A Bayesian framework allowed us to incorporate previous behavioral findings. The hypothesized changes could indeed be observed in the behavioral responses with the strongest results for trans men and female-female scenes. Activation of the ventral striatum supported our hypothesis only for female-female scenes in trans women. The respective application or depletion of androgens in trans men and trans women might partly explain this observation. The prominent role of female-female stimuli might be based on the differential responses they elicit in cis women and men or, in theory, the controversial concept of autogynephilia. We show that correlates of sexual arousal in transgender individuals might change in the direction of the experienced gender. Future investigations should elucidate the mechanistic role of sex hormones and the cause of the differential neural and behavioral findings.The study was registered at ClinicalTrials.gov (NCT02715232), March 22, 2016.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Murray Bruce Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Patricia Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Melisande Elisabeth Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Vera Ritter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Benjamin Spurny-Dworak
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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3
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Auer MK, Joue G, Biedermann SV, Sommer T, Fuss J. The effect of short-term increase of estradiol levels on sexual desire and orgasm frequency in women and men: A double-blind, randomized, placebo-controlled trial. Psychoneuroendocrinology 2024; 160:106682. [PMID: 38056372 DOI: 10.1016/j.psyneuen.2023.106682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023]
Abstract
Estradiol (E2) has been implicated in sexual functioning in both sexes. E2 levels change distinctively over the menstrual cycle, peaking around ovulation. Data on short-term effects of fluctuating E2 levels on sexual desire are however sparse and mostly based on observational studies. To fill this gap, we ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of a short-term increase in E2 on sexual desire and orgasm frequency in healthy, young men and women. Circulating E2 levels were elevated through estradiol valerate (E2V) administered over two consecutive days to simulate the rise in E2 levels around ovulation. E2V had no effect on orgasm frequency and only minor effects on sexual desire. On average, the administered E2V dampened change in sexual desire compared to untreated participants with comparable baseline sexual desire in such a way that sexual desire was slightly reduced even in those with higher baseline sexual desire. These findings suggest that short-term increases in E2 have little effect on sexual function and are unlikely to explain the increase in sexual desire around ovulation.
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Affiliation(s)
- Matthias K Auer
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro, and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Gina Joue
- Institute of Systems Neuroscience, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sarah V Biedermann
- Social and Emotional Neuroscience, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Tobias Sommer
- Institute of Systems Neuroscience, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro, and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
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4
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Shah NR, Cockrell HC, Keller NE, Diaz-Miron J, Meckmongkol TT, Yu P, Englum B, Richards MK, Martin K. Debunking Myths of Gender Informed Care: What Every Pediatric Surgeon Should Know. J Pediatr Surg 2023; 58:2286-2293. [PMID: 37690870 DOI: 10.1016/j.jpedsurg.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
As the transgender population in the United States grows, gender-affirming care is becoming increasingly relevant to the practice of pediatric surgery. Medical care for the transgender and gender diverse population is a politically charged topic with significant complexity and opportunities for clarification. It is important for providers to better understand this population's unique health and social needs. This review aims to debunk long-standing myths regarding gender-affirming care and highlight the current therapeutic and legislative landscapes within the scope of pediatric surgical practice. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Noah E Keller
- Department of Pediatric Surgery, Roseville Medical Center, Roseville, CA, USA
| | - Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Teerin T Meckmongkol
- Division of Pediatric Surgery, Nemours Children's Health Orlando, Orlando, FL, USA
| | - Peter Yu
- Division of General and Thoracic Surgery, Children's Hospital of Orange County, Orange CA, USA
| | - Brian Englum
- Division of Pediatric Surgery, University of Maryland Children's Hospital, Baltimore, MD, USA
| | - Morgan K Richards
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - Kathryn Martin
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
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Zhang G, Devo P, O'Leary VB, Ovsepian SV. Ageing perspective on cognitive outcomes from reproductive hormone adjustments. Heliyon 2023; 9:e19050. [PMID: 37664737 PMCID: PMC10470197 DOI: 10.1016/j.heliyon.2023.e19050] [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: 06/04/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Abstract
In addition to primary reproductive functions, gonadal hormones play an important role in an array of neural mechanisms across the human lifespan. The ageing-related decline in their activity has been linked to the deterioration of cognitive functions in otherwise healthy women, associated with menopause transition, contributing to higher incidents of post-menopause dementia. Given the growing utility of gonadal steroids for birth control, as well as for compensatory treatment of menopause and oophorectomy symptoms, and adjuvant transgender therapy, their long-term effects on neural mechanisms warrant comprehensive assessment. In this article, we present an ageing perspective on the cognitive outcomes from contraceptive and replacement therapeutic use of gonadal hormones and discuss their effects on the risk of developing Alzheimer's and Parkinson's dementia. Despite rising data supporting the ameliorative effects of reproductive hormones on cognitive facilities, their impact varies depending on study design and type of intervention, thus, implying dynamic neuro-endocrine interactions with complex compensatory mechanisms. Elucidating differential effects of reproductive hormone adjustments on cognition with underlying mechanisms is expected not only to shed light on important aspects of brain ageing and dementia but to facilitate their use in personalized medicine with improved safety margins and therapeutic outcomes.
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Affiliation(s)
- Grace Zhang
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
- Bader College, Herstmonceux Castle, Hailsham, BN27 1RN, United Kingdom
| | - Perry Devo
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, United Kingdom
| | - Valerie B. O'Leary
- Department of Medical Genetics, Third Faculty of Medicine, Charles University, Ruská 87, 10000 Prague, Czech Republic
| | - Saak V. Ovsepian
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, United Kingdom
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Kennis M, Kreukels BPC, Dewitte M. Sex & relationships in trans people. Best Pract Res Clin Obstet Gynaecol 2023; 86:102294. [PMID: 36635133 DOI: 10.1016/j.bpobgyn.2022.102294] [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: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.
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Affiliation(s)
- Mathilde Kennis
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands; Maastricht Brain Imaging Center, Maastricht, Netherlands.
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VU University, Amsterdam, Netherlands
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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7
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Szoko N, Sequeira GM, Coulter RWS, Kobey J, Ridenour E, Burnett O, Kidd KM. Sexual Orientation Among Gender Diverse Youth. J Adolesc Health 2023; 72:153-155. [PMID: 36216680 PMCID: PMC10748722 DOI: 10.1016/j.jadohealth.2022.08.016] [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: 04/13/2022] [Revised: 07/09/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Many youth are gender diverse, but our understanding of sexual orientation among gender diverse youth (GDY) is limited. We sought to compare sexual identity, attraction, and contact between cisgender youth and GDY and to describe these characteristics across GDY subgroups. METHODS We analyzed cross-sectional data from school-based surveys of 4,207 adolescents. Two-sample t-tests or chi-squared tests compared characteristics between GDY and cisgender youth. Sexual attraction/contact was summarized with frequencies/proportions and stratified by transmasculine, transfeminine, and nonbinary identities. RESULTS Two hundred eighty-one (9.1%) youth were GDY. Compared to cisgender peers, GDY were more likely to identify as sexual minority youth. In total, 29.9% of GDY were transmasculine, 36.7% transfeminine, and 33.5% nonbinary. Many transmasculine (45%) and transfeminine (58%) youth identified as heterosexual; most nonbinary youth (91%) identified as sexual minority youth. For transgender youth identifying as heterosexual, sexual attraction/contact varied. DISCUSSION Aspects of sexuality among GDY remain complex, warranting individualized approaches to sexual/reproductive healthcare.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Gina M Sequeira
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Robert W S Coulter
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaxon Kobey
- Centered Within Counseling, LLC, Columbia, Missouri
| | - Elissa Ridenour
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Kacie M Kidd
- Division of Adolescent Medicine, WVU Medicine Children's, Morgantown, West Virginia
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8
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Boskey ER, Ganor O. Sexual Orientation and Attraction in a Cohort of Transmasculine Adolescents and Young Adults. Transgend Health 2022; 7:270-275. [PMID: 36643063 PMCID: PMC9829161 DOI: 10.1089/trgh.2020.0190] [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: 01/18/2023] Open
Abstract
As part of an ongoing longitudinal study of transmasculine adolescents and young adults seeking gender-affirming surgery, this analysis examined sexual orientation and attraction in a cohort of 167 binary and nonbinary participants 15-35 years of age. Correlations were analyzed using Pearson's chi square. Binary and nonbinary transmasculine individuals had different patterns of orientation and attraction, with binary males more likely to be heterosexual and less likely to be queer (p<0.003). Nonbinary individuals were more likely to be attracted to and have history with other nonbinary people (p<0.01). Transmasculine sexual identities are variable, complex, and not well described by standard sexual orientation categories.
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Affiliation(s)
- Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Address correspondence to: Elizabeth R. Boskey, PhD, MPH, LICSW, Center for Gender Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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9
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Warwick RM, Araya AC, Shumer DE, Selkie EM. Transgender Youths' Sexual Health and Education: A Qualitative Analysis. J Pediatr Adolesc Gynecol 2022; 35:138-146. [PMID: 34619356 DOI: 10.1016/j.jpag.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To characterize transgender adolescents' sexual behaviors, identities, and their perceived experiences with sex education. DESIGN Semi-structured interviews were conducted and addressed sexual experiences and perceptions of sex education received from family, school educators, and healthcare providers. Interviews were audio recorded, transcribed, and analyzed utilizing NVivo 12 software for thematic analysis. SETTING Child and adolescent gender services clinic at a Midwestern university-based medical center in the United States. PARTICIPANTS 30 transgender adolescents between the ages of 15 to 20. INTERVENTIONS AND MAIN OUTCOME MEASURES Themes generated during semi-structured interviews. RESULTS Sexual orientations were inclusive of attractions to a spectrum of gender identities. Libido was perceived to be impacted by gender-affirming hormone therapy, which was unanticipated for some adolescents. Family and school-based sex education was perceived to be relevant only for heterosexual and cisgender adolescents. Inclusive education for transgender adolescents was desired. Counseling provided by gender-affirming providers on sexual health was trusted and other healthcare providers were perceived to lack training on gender-inclusive care. CONCLUSION This study demonstrated that families and school educators did not provide sex education perceived to be applicable to transgender adolescents. Similarly, healthcare providers of transgender adolescents were perceived to not provide inclusive or comprehensive medical care in comparison to physicians who routinely provide gender-affirming care. Gaps in education and healthcare could be improved with sex education outreach or training for families and school educators as well as the development and implementation of professional competencies for pediatricians on transgender adolescent healthcare.
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Affiliation(s)
| | - Adrian C Araya
- Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI
| | - Daniel E Shumer
- Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI
| | - Ellen M Selkie
- Division of Adolescent Medicine, Michigan Medicine, Ann Arbor, MI
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10
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Bray G, Giami A. Prises en charge médicales et psychologiques de la vie sexuelle des femmes trans : revue de la littérature internationale. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Jacobson R, Joel D. Gender identity and sexuality in an online sample of intersex-identified individuals: a descriptive study. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2019.1711447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Roi Jacobson
- Department of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Joel
- Department of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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12
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Ong C, Tan RKJ, Le D, Tan A, Tyler A, Tan C, Kwok C, Banerjee S, Wong ML. Association between sexual orientation acceptance and suicidal ideation, substance use, and internalised homophobia amongst the pink carpet Y cohort study of young gay, bisexual, and queer men in Singapore. BMC Public Health 2021; 21:971. [PMID: 34022843 PMCID: PMC8141135 DOI: 10.1186/s12889-021-10992-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/06/2021] [Indexed: 01/22/2023] Open
Abstract
Background Gay, bisexual and queer (GBQ) men are frequently subjected to minority stressors that have negative impacts on their health. Milestones that include the acceptance and disclosure of sexual identity amongst GBQ men are hence key instruments in understanding the prevalence of internalised homophobia and predicting health outcomes. As such, this work takes a novel approach to deduce the correlates of delayed acceptance of sexual orientation in young GBQ men as a measure of internalised homophobia through retrospective self-reporting and age-based analysis. Methods Participants were recruited as part of a cohort study exploring the syndemic risks associated with HIV acquisition among young GBQ men in Singapore. We examined their levels of internalised, perceived, experienced homophobia, as well as their health behaviours and suicidal tendencies. Two separate variables were also self-reported by the participants – the age of questioning of sexual orientation and the age of acceptance of sexual orientation. We subsequently recoded a new variable, delayed acceptance of sexual orientation, by taking the difference between these two variables, regressing it as an independent and dependent variable to deduce its psychosocial correlates, as well as its association with other measured instruments of health. Results As a dependent variable, delayed acceptance of sexual orientation is positively associated with an increase of age and internalised homophobia, while being negatively associated with reporting as being gay, compared to being bisexual or queer. As an independent variable, delayed acceptance of sexual orientation was associated with a delayed age of coming out to siblings and parents, suicide ideation, historical use of substances including smoking tobacco cigarettes and consuming marijuana, as well as reporting higher levels of experienced, internalised and perceived homophobia. Conclusion Greater levels of early intervention and efforts are required to reduce the heightened experience of minority stress resulting from communal and institutional hostilities. Areas of improvement may include community-based counselling and psychological support for GBQ men, while not forsaking greater education of the social and healthcare sectors. Most importantly, disrupting the stigma narrative of a GBQ ‘lifestyle’ is paramount in establishing an accepting social environment that reduces the health disparity faced by GBQ men. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10992-6.
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Affiliation(s)
- Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
| | - Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore.
| | - Daniel Le
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore.,National University Hospital, National University Health System, Singapore, Singapore
| | - Avin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Adrian Tyler
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Calvin Tan
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Chronos Kwok
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Sumita Banerjee
- Action for AIDS Singapore, 9 Kelantan Lane #03-01, Singapore, 208628, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore
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13
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Contraception across transgender. Int J Impot Res 2021; 33:710-719. [PMID: 33558672 DOI: 10.1038/s41443-021-00412-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/09/2022]
Abstract
Sexual and reproductive issues are essential elements of well-being in cisgenders as well as for the transgender population. Gender-affirming hormonal treatments (GAHTs) aim to induce phenotypical changes congruent with the desired gender and subsequent reduction of gender dysphoria. While genital surgical procedures including hysterectomy and/or adenectomy cause permanent loss of ability to conceive, GAHT may induce a varying degree of reversible loss of fertility. For these reasons, transgender men and women need to be counseled concerning contraceptive options and potential effects of treatment on reproductive function before initiating GAHT. The literature reports that sexual activity with genital involvement is performed by less than half of transgender persons who have been sexually active with a partner in the past. Testosterone (T) is the most commonly used compound in transmen and usually leads to amenorrhea within 1-12 months from first administration, however cessation of menses does not mean anovulation. Some studies report cases of unintended pregnancies among transgender men under masculinizing therapy, therefore T treatment cannot be considered a contraceptive option. Currently available contraceptive options have pros and cons in transmen and scarce literature exists on their use. The effects of GAHT on fertility in transwomen are even less well known. Prolonged estrogen exposure induces sperm suppression and morphological changes of the spermatozoa, however the degree of resulting pregnancy protection is unclear. Further research to inform the contraceptive counseling in this population is mandatory.
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14
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Sexual orientation in transgender individuals: results from the longitudinal ENIGI study. Int J Impot Res 2021; 33:694-702. [PMID: 33483604 DOI: 10.1038/s41443-020-00402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/05/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022]
Abstract
Transgender people and their next-of-kin may request information on sexual orientation and preferred partners during hormonal affirming process. Although previous research on sexual orientation in transgender people is extensive, this literature may already be outdated and/or the methodology of studies assessing sexual orientation may fall short. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Gender role and preferred partner in sexual fantasies, sexual orientation and gender of current sexual partner were assessed at baseline (initiation of HT) and every follow-up visit. Data from 469 transgender women (TW) and 433 transgender men (TM) were analyzed cross-sectionally and prospectively. At baseline, more than half reported having no partner (35% of TW, 47% of TM). After 12 months, more than half reported having a partner (59% of TW, 56% of TM), with no changes between one and three years of HT. The majority of TM preferred a female partner, TW preferred male and female partners. The sexual identity of their partner matched their sexual orientation in >80%. Sexual orientation did not change over time. We did not observe associations with serum levels of sex steroids or gender-affirming surgery (chest or genital surgery). Sexual orientation did not change during hormonal transition and was not associated with sex steroids or surgery. Also, preferences matched the partner's sexual identity. We do not assume that changing serum levels of sex steroids is directly associated with changes in partner choice. The number of people with a current partner increased, possibly due to the indirect effects of gender-affirming care.
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McInroy LB, Beaujolais B, Leung VWY, Craig SL, Eaton AD, Austin A. Comparing asexual and non-asexual sexual minority adolescents and young adults: stressors, suicidality and mental and behavioural health risk outcomes. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1806103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren B. McInroy
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | | | - Vivian W. Y. Leung
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Shelley L. Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Andrew D. Eaton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Ashley Austin
- Ellen Whiteside McDonnell School of Social Work, Barry University, Miami, FL, USA
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Noack-Lundberg K, Liamputtong P, Marjadi B, Ussher J, Perz J, Schmied V, Dune T, Brook E. Sexual violence and safety: the narratives of transwomen in online forums. CULTURE, HEALTH & SEXUALITY 2020; 22:646-659. [PMID: 31286845 DOI: 10.1080/13691058.2019.1627420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
An online forum analysis was conducted to explore experiences of sexual violence and safety among transwomen, with a particular focus on transwomen of colour. Four online forums were chosen for the analysis. Three key themes were identified: dating and violence in intimate relationships; fear of violence and safety strategies; and coping after sexual assault. Forum posters faced heightened gender policing and scrutiny, due to not conforming to normative ideals of femininity. Femininity was also predicated on white, middle-class status, and associated with domesticity and romance. As a result, expressions of femininity from non-white backgrounds could be read as deviant or excessive. The intersection of deviation from gender norms and femininity based on whiteness meant that transwomen of colour faced disproportionate levels of violence, both in public and private spaces. Transwomen of colour also faced disadvantage due to participation in higher-risk forms of sex work, low socioeconomic status and employment, and institutional discrimination. Coping mechanisms to deal with cumulative disadvantage included seeking support from health professionals and transgender community networks. However, it also included more harmful forms of self-medicating such as heavy alcohol and drug use, self-harm and suicide attempts.
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Affiliation(s)
- Kyja Noack-Lundberg
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Brahm Marjadi
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Eloise Brook
- The Gender Centre, Sydney, New South Wales, Australia
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T'Sjoen G, Arcelus J, De Vries ALC, Fisher AD, Nieder TO, Özer M, Motmans J. European Society for Sexual Medicine Position Statement "Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction". J Sex Med 2020; 17:570-584. [PMID: 32111534 DOI: 10.1016/j.jsxm.2020.01.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice. AIM We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction. METHODS The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available. OUTCOMES The foci of the study are assessment and hormonal aspects of trans health care. RESULTS As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were developed based on clinical experiences and the available literature. With the multiple barriers to care that many trans people experience, basic care principles still need to be stressed. We recommend that health-care professionals (HCPs) working with trans people recognize the diversity of genders, including male, female, and nonbinary individuals. In addition, HCPs assessing gender diverse children and adolescents should take a developmental approach that acknowledges the difference between prepubescent gender diverse children and pubescent gender diverse adolescents and trans adults. Furthermore, trans people seeking gender-affirming medical interventions should be assessed by HCPs with expertise in trans health care and gender-affirming psychological practice. If masculinization is desired, testosterone therapy with monitoring of serum sex steroid levels and signs of virilization is recommended. Similarly, if feminization is desired, we recommend estrogens and/or antiandrogen therapy with monitoring of serum sex steroid levels and signs of feminization. HCPs should be aware of the influence of hormonal therapy on sexual functioning and satisfaction. We recommend HCPs be aware of potential sexual problems during all surgical phases of treatment. CLINICAL IMPLICATIONS This is an up-to-date ESSM position statement. STRENGTHS & LIMITATIONS These statements are based on the data that are currently available; however, it is vital to recognize that this is a rapidly changing field and that the literature, particularly in the field of sexual functioning and satisfaction, is limited. CONCLUSION This ESSM position statement provides relevant information and references to existing clinical guidelines with the aim of informing relevant HCPs on best practices when working with transgender people. T'Sjoen G, Arcelus J, De Vries ALC, et al. European Society for Sexual Medicine Position Statement "Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction". J Sex Med 2020;17:570-584.
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Affiliation(s)
- Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Gent, Belgium.
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Annelou L C De Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology, Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joz Motmans
- Transgender Infopunt, Ghent University Hospital, Ghent, Belgium
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Laube JS, Auer MK, Biedermann SV, Schröder J, Hildebrandt T, Nieder TO, Briken P, Fuss J. Sexual Behavior, Desire, and Psychosexual Experience in Gynephilic and Androphilic Trans Women: A Cross-Sectional Multicenter Study. J Sex Med 2020; 17:1182-1194. [PMID: 32147311 DOI: 10.1016/j.jsxm.2020.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND One of the most prominent etiological theories of gender incongruence in trans women proposes a paraphilic erotic target location error (ie, autogynephilia) as a causal factor in gynephilic (ie, exclusively gynephilic and bisexual) trans women. We hypothesized that a paraphilic erotic target location should manifest itself in various aspects of sexual behavior, solitary and dyadic sexual desire, and psychosexual experience. AIM To compare sexual behavior, sexual desire, and psychosexual experience of exclusively gynephilic and bisexual trans women with that of androphilic trans women to explore whether their sexuality differs substantially. METHODS Trans women diagnosed with gender dysphoria (Diagnostic and Statistical Manual of Mental Disorders-5) were recruited at 4 transgender healthcare centers in Germany. The present study analyzed items on sexual behavior, desire, and experience of a self-report questionnaire, collected as part of a cross-sectional multicenter study. MAIN OUTCOMES Multiple aspects of sexuality were examined using self-constructed items. Sexual desire was measured using the Sexual Desire Inventory and psychosexual experience using the Multidimensional Sexuality Questionnaire. RESULTS Significantly more exclusively gynephilic than androphilic trans women reported a history of sexual arousal in relation to cross-dressing. However, little evidence was found that gynephilic and androphilic sexual desire, behavior, and psychosexual experience differ profoundly. Interestingly, a statistically non-significant trend indicated that gynephilic trans women who had not yet undergone gender affirming surgery showed the highest levels of sexual desire (solitary and dyadic), whereas the opposite was the case for androphilic trans women. CLINICAL TRANSLATION Data of this study indicate that sexual orientation does not appear to be a good predicator for sexual behavior, desire, and psychosexual experience in trans women. STRENGTHS AND LIMITATIONS We investigated sexual desire and experience using standardized and evaluated measures such as the Sexual Desire Inventory and Multidimensional Sexuality Questionnaire. Future studies with a larger sample size should investigate how different gender affirming medical intervention might have diverging influences on sexual behavior, desire, and experience. CONCLUSION Ultimately, this study found little evidence for the hypothesis that sexual behavior, sexual desire, and psychosexual experience differ substantially in gynephilic (exclusively gynephilic and bisexual) and androphilic trans women. Laube JS, Auer M, Biedermann SV, et al. Sexual Behavior, Desire, and Psychosexual Experience in Gynephilic and Androphilic Trans Women: A Cross-Sectional Multicenter Study. J Sex Med 2020;17:1182-1194.
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Affiliation(s)
- Jelena S Laube
- Human Behaviour Laboratory and Interdisciplinary Transgender Health Care Centre, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias K Auer
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Human Behaviour Laboratory and Interdisciplinary Transgender Health Care Centre, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Hildebrandt
- Department of Gynaecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Timo O Nieder
- Human Behaviour Laboratory and Interdisciplinary Transgender Health Care Centre, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Human Behaviour Laboratory and Interdisciplinary Transgender Health Care Centre, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Fuss
- Human Behaviour Laboratory and Interdisciplinary Transgender Health Care Centre, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Lindley LM, Nagoshi JL, Nagoshi CT, Hess R, Boscia A. An eco-developmental framework on the intersectionality of gender and sexual identities in transgender individuals. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1713873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Julie L. Nagoshi
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Craig T. Nagoshi
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
| | - Robert Hess
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
| | - Aedan Boscia
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
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20
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Grey BT. Furry Sexuality: Conditioned Fetishes a Better Explanation than Erotic Target Identity Inversion. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:49-52. [PMID: 31254129 DOI: 10.1007/s10508-019-01490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
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21
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Psychological Pathologies and Sexual Orientation in Transgender Women Undergoing Gender Confirming Treatment. Ann Plast Surg 2019; 84:312-316. [DOI: 10.1097/sap.0000000000002035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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22
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The pathologization of trans-sexuality: Historical roots and implications for sex counselling with transgender clients. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2019.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Prunas A. La pathologisation de la sexualité des personnes trans : racines historiques et implications pour la consultation sexologique avec des clients transgenres. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Julia Spielmann
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Chadly Stern
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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25
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Jacobson R, Joel D. Self-Reported Gender Identity and Sexuality in an Online Sample of Cisgender, Transgender, and Gender-Diverse Individuals: An Exploratory Study. JOURNAL OF SEX RESEARCH 2019; 56:249-263. [PMID: 30332297 DOI: 10.1080/00224499.2018.1523998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The relations between self-reported aspects of gender identity and sexuality were studied in an online sample of cisgender (n = 4,954), transgender (n = 406), and gender-diverse (n = 744) groups. Aspects of gender identity and sexual fantasies, attraction, behavior, and romantic relations were assessed using the Multi-gender Identity Questionnaire (Multi-GIQ) and a sexuality questionnaire. Results show a wide spectrum of gender experiences and sexual attractions within each group, an overlap among the groups, and very weak relations between atypical gender identity and atypical sexuality. At the group level, aspects of gender identity and sexuality were mainly predicted by gender and sex-gender configuration, with little contribution of sex assigned at birth. A principal component analysis (PCA) revealed that measures of gender identity and of sexuality were independent, the structure of sexuality was mostly related to gender, whereas the structure of gender identity was mostly related to sex-gender configuration. The results of both approaches suggest that measures of gender identity could roughly be divided into three classes: one including feeling as a man and feeling as a woman; a second including measures of nonbinary and "trans" feelings; and a third including feeling as a "real" woman and feeling as a "real" man. Our study adds to current scientific data that challenge dichotomous conventions within gender identity and sexuality research. Possible social and clinical implications are discussed.
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Affiliation(s)
- Roi Jacobson
- a School of Psychological Sciences , Tel-Aviv University
| | - Daphna Joel
- a School of Psychological Sciences , Tel-Aviv University
- b Sagol School of Neuroscience , Tel-Aviv University
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26
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Jacobson R, Joel D. An Exploration of the Relations Between Self-Reported Gender Identity and Sexual Orientation in an Online Sample of Cisgender Individuals. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2407-2426. [PMID: 29971652 PMCID: PMC6245116 DOI: 10.1007/s10508-018-1239-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 05/26/2023]
Abstract
The present study explored the relations between self-reported aspects of gender identity and sexual orientation in an online sample of 4756 cisgender English-speaking participants (1129 men) using the Multi-Gender Identity Questionnaire and a sexual orientation questionnaire. Participants also labeled their sexual orientation. We found a wide range of gender experiences in the sample, with 38% of the participants feeling also as the "other" gender, 39% wishing they were the "other" gender, and 35% wishing they had the body of the "other" sex. Variability in these measures was very weakly related to sexual orientation, and these relations were gender-specific, being mostly U shaped (or inverted-U shaped) in men and mostly linear asymptotic in women. Thus, in women, feeling-as-a-woman was highest in the exclusively heterosexual group, somewhat lower in the mostly heterosexual group, and lowest in the bisexual, mostly homosexual, and exclusively homosexual groups, which did not differ, and the reverse was true for feeling-as-a-man (i.e., lowest in the exclusively heterosexual group and highest in the bisexual, mostly homosexual, and exclusively homosexual groups). In men, feeling-as-a-man was highest at both ends of the sexual orientation continuum and lowest at its center, and the reverse was true for feeling-as-a-woman. Similar relations were evident also for the other aspects of gender identity. This study adds to a growing body of literature that questions dichotomous conventions within the science of gender and sexuality. Moreover, our results undermine the tight link assumed to exist between sexual and gender identities, and instead posit them as weakly correlated constructs.
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Affiliation(s)
- Roi Jacobson
- School of Psychological Sciences, Tel-Aviv University, POB 39040, Tel-Aviv, Israel
| | - Daphna Joel
- School of Psychological Sciences, Tel-Aviv University, POB 39040, Tel-Aviv, Israel.
- Sagol School of Neuroscience, Tel-Aviv University, POB 39040, Tel-Aviv, Israel.
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28
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Lapinski J, Covas T, Perkins JM, Russell K, Adkins D, Coffigny MC, Hull S. Best Practices in Transgender Health: A Clinician's Guide. Prim Care 2018; 45:687-703. [PMID: 30401350 DOI: 10.1016/j.pop.2018.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Providing culturally competent and medically knowledgeable care to the transgender community is increasingly falling within the realms of practice for primary care providers. The purpose of this article is to provide an overview of best practices as they relate to transgender care. This article is by no means a comprehensive guide, but rather a starting point for clinicians as they provide high-quality care to their transgender patients.
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Affiliation(s)
- Jessica Lapinski
- Department of Community and Family Medicine, Duke University Health System, Duke University, 2100 Erwin Road, Durham, NC 27710, USA.
| | - Tiffany Covas
- Department of Community and Family Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Jennifer M Perkins
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Kristen Russell
- Department of Case Management, Duke Child and Adolescent Gender Care, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Deanna Adkins
- Duke Child and Adolescent Gender Care, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | | | - Sharon Hull
- Department of Community and Family Medicine, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27710, USA
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29
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Desire to Have Children Among Transgender People in Germany: A Cross-Sectional Multi-Center Study. J Sex Med 2018; 15:757-767. [DOI: 10.1016/j.jsxm.2018.03.083] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
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Baker WB. Sexual and gender identities in transgender men: Fluid and binary perspectives. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018. [DOI: 10.1080/19359705.2018.1458677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- William B. Baker
- Counselor Education, Montclair State University, Montclair, New Jersey, USA
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Funabashi T, Sakakibara H, Hirahara F, Kimura F. Reduced Luteinizing Hormone Induction Following Estrogen and Progesterone Priming in Female-to-Male Transsexuals. Front Endocrinol (Lausanne) 2018; 9:212. [PMID: 29867755 PMCID: PMC5949340 DOI: 10.3389/fendo.2018.00212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/16/2018] [Indexed: 12/19/2022] Open
Abstract
Anatomical studies have suggested that one of the brain structures involved in gender identity is the bed nucleus of the stria terminalis, though this brain structure is probably not the only one to control gender identity. We hypothesized that, if this brain area also affected gonadotropin secretion in humans, transsexual individuals might produce different gonadotropin levels in response to exogenous stimulation. In the present study, we examined whether estrogen combined with progesterone might lead to a change in luteinizing hormone (LH) secretion in female-to-male (FTM) transsexual individuals. We studied female control subjects (n = 9), FTM transsexual subjects (n = 12), and male-to-female (MTF) transsexual subjects (n = 8). Ethinyl estradiol (50 μg/tablet) was administered orally, twice a day, for five consecutive days. After the first blood sampling, progesterone (12.5 mg) was injected intramuscularly. Plasma LH was measured with an immunoradiometric assay. The combination of estrogen and progesterone resulted in increased LH secretion in female control subjects and in MTF subjects, but this increase appeared to be attenuated in FTM transsexual subjects. In fact, the %LH response was significantly reduced in FTM subjects (P < 0.05), but not in MTF subjects (P > 0.5), compared to female control subjects. In addition, the peak time after progesterone injection was significantly delayed in FTM subjects (P < 0.05), but not in MTF subjects (P > 0.5), compared to female control subjects. We then compared subjects according to whether the combination of estrogen and progesterone had a positive (more than 200% increase) or negative (less than 200% increase) effect on LH secretion. A χ2 analysis revealed significantly different (P < 0.05) effects on LH secretion between female controls (positive n = 7, negative n = 2) and FTM transsexual subjects (positive n = 4, negative n = 8), but not between female controls and MTF transsexual subjects (positive n = 7, negative n = 1). Thus, LH secretion in response to estrogen- and progesterone priming was attenuated in FTM subjects, but not in MTF subjects, compared to control females. This finding suggested that the brain area related to gender identity in morphological studies might also be involved in the LH secretory response in humans. Thus, altered brain morphology might be correlated to altered function in FTM transsexuals.
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Affiliation(s)
- Toshiya Funabashi
- Department of Physiology, Yokohama City University School of Medicine, Yokohama, Japan
- Department of Physiology, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Toshiya Funabashi,
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Fukuko Kimura
- Department of Physiology, Yokohama City University School of Medicine, Yokohama, Japan
- Tanaka Clinic Yokohama-Koen, Yokohama, Japan
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Violeta KJ, Langer SJ. Integration of desire, sexual orientation, and female embodiment of a transgender woman previously diagnosed with autism spectrum disorder: A case report. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2017. [DOI: 10.1080/19359705.2017.1354794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karalyn J. Violeta
- Institute for Contemporary Psychotherapy, Fordham University, New York, New York, USA
| | - S. J. Langer
- Department of Art Therapy, School of Visual Arts, New York, New York, USA
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33
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Marinkovic M, Newfield RS. Chest reconstructive surgeries in transmasculine youth: Experience from one pediatric center. Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1349706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Maja Marinkovic
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Ron S. Newfield
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, CA, USA
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Abstract
Purpose: The “transgender tipping point” has brought transgender social and health issues to the forefront of American culture. However, medical professionals have been lagging in academic research with a transgender-specific focus resulting in significant knowledge gaps in dealing with the care of our transgender patients. The aim of this article is to analyze all published Medline-available transgender-specific articles, identify these knowledge gaps, and direct future research to where it is most needed. Methods: We surveyed all Medline-available articles up to June 2016 using a combination of medical subject headings and keywords in titles and abstracts. Articles meeting inclusion criteria were reviewed, categorized, and analyzed for content and study design. Results: In our review of the literature, we identified 2405 articles published from January 1950 to June 2016 that focused on transgender health, primarily in the fields of surgery, mental health, and endocrinology. Conclusion: Significant knowledge gaps were found across the subspecialties, and there was a lack of prospective robust research and representation of transgender-specific data in the core medical journals. More data and research are needed to bridge the knowledge gaps that currently exist and improve the care of the transgender community.
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Affiliation(s)
- Jonathon W Wanta
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Cecile A Unger
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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Katz-Wise SL, Reisner SL, White Hughto JM, Budge SL. Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1425-1439. [PMID: 27542082 PMCID: PMC5316507 DOI: 10.1007/s10508-016-0812-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/05/2016] [Accepted: 07/11/2016] [Indexed: 05/12/2023]
Abstract
This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sari L Reisner
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA.
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
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Fein LA, Salgado CJ, Sputova K, Estes CM, Medina CA. Sexual Preferences and Partnerships of Transgender Persons Mid- or Post-Transition. JOURNAL OF HOMOSEXUALITY 2017; 65:659-671. [PMID: 28569625 DOI: 10.1080/00918369.2017.1333808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The process of gender transition has varying effects on various aspects of sexuality. The purpose of this study was to investigate the effects of transitioning on transgender persons' sexual preferences and partnerships. Data were collected through an anonymous online survey. Questions focused on timing of gender transition in relation to change in sexual preference. Transgender individuals have a variety of sexual partners, predominantly cisgender, and may change sexual preference when they transition. Transitioning can be associated with having no primary sexual partner, despite past sexual partnerships. Length of time between identifying as transgender and starting the transition might be associated with changing sexual partner preference, particularly in transgender women. The emerging trends of sexual partnerships and changing sexual preferences related to the transition in this study warrant further investigation. These data provide more understanding of the relationship between transitioning and sexual preferences and partnerships.
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Affiliation(s)
- Lydia A Fein
- a Department of Obstetrics and Gynecology , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Christopher J Salgado
- b Division of Plastic, Aesthetic, and Reconstructive Surgery , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Klara Sputova
- b Division of Plastic, Aesthetic, and Reconstructive Surgery , University of Miami Miller School of Medicine , Miami , Florida , USA
| | | | - Carlos A Medina
- a Department of Obstetrics and Gynecology , University of Miami Miller School of Medicine , Miami , Florida , USA
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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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Gaither TW, Awad MA, Osterberg EC, Romero A, Bowers ML, Breyer BN. Impact of Sexual Orientation Identity on Medical Morbidities in Male-to-Female Transgender Patients. LGBT Health 2016; 4:11-16. [PMID: 28005497 DOI: 10.1089/lgbt.2016.0097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We aim to describe the relationship between sexual orientation identity and medical morbidities in a large sample of male-to-female (MTF) transgender patients. METHODS We reviewed medical records of patients presenting for MTF sex reassignment surgery (SRS) by a single, high-volume surgeon from 2011 to 2015. Sexual attraction to men (heterosexual), women (lesbian), or both (bisexual) was asked of each patient. We examined 16 medical morbidities for this analysis. RESULTS During the study period, 330 MTF transgender patients presented for SRS. The average age at the time of surgery was 38.9 (range 18-76). One hundred and one patients (32%) reported being heterosexual, 110 patients (34%) reported being lesbian, and 108 patients (34%) reported being bisexual. Lesbian patients presented for SRS at older ages (mean = 43 years old) compared with heterosexual patients (mean = 36 years old) and bisexual patients (mean = 37), P < 0.01. No differences were found in the majority of coexisting medical morbidities by sexual orientation identity. Lesbian patients had greater odds of having a history of depression, age-adjusted odds ratio (aOR) = 2.36, 95% confidence interval (CI) 1.26-4.40, compared with heterosexual patients. Lesbian patients had higher odds of being married or partnered, aOR = 2.31, 95% CI (1.27-4.19), compared with heterosexual patients. Heterosexual patients had higher odds of having human immunodeficiency virus (HIV), aOR = 9.07, 95% CI (1.08-76.5) compared with lesbian patients. CONCLUSIONS Sexual orientation identity in MTF transgender patients is variable. The majority of medical morbidities are not associated with sexual orientation identity. Although HIV and depression are common morbidities among MTF patients seeking SRS, the prevalence of these morbidities differs by sexual orientation identity, but these findings need replication. Counseling and future research initiatives in transgender care should incorporate sexual orientation identity and associated risk behavior.
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Affiliation(s)
- Thomas W Gaither
- 1 Department of Urology, San Francisco General Hospital, University of California San Francisco , San Francisco, California
| | - Mohannad A Awad
- 1 Department of Urology, San Francisco General Hospital, University of California San Francisco , San Francisco, California
- 2 Department of Surgery, King Abdulaziz University , Rabigh, Saudi Arabia
| | - E Charles Osterberg
- 1 Department of Urology, San Francisco General Hospital, University of California San Francisco , San Francisco, California
| | - Angelita Romero
- 3 Department of Gynecological Surgery, Bay Area Reproductive Healthcare and Mills Peninsula Hospital , Burlingame, California
| | - Marci L Bowers
- 3 Department of Gynecological Surgery, Bay Area Reproductive Healthcare and Mills Peninsula Hospital , Burlingame, California
| | - Benjamin N Breyer
- 1 Department of Urology, San Francisco General Hospital, University of California San Francisco , San Francisco, California
- 4 Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco, California
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Nieder TO, Elaut E, Richards C, Dekker A. Sexual orientation of trans adults is not linked to outcome of transition-related health care, but worth asking. Int Rev Psychiatry 2016; 28:103-11. [PMID: 26754566 DOI: 10.3109/09540261.2015.1102127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Since the beginning of contemporary transition-related care at the outset of the 20th century, sexual orientation has ben considered to be closely connected with gender identity and the developmental trajectories of trans people. Specifically, health professionals have regarded the anticipated post-transitional heterosexual behaviour of trans adults as predictive of a good outcome of cross-sex hormones and gender-confirming surgeries. This article reviews the current literature according to the question of whether the sexual orientation of trans people is linked to outcome measures following transition-related interventions. A comprehensive review was undertaken using the Medline database, searching for empirical studies published between 2010 and 2015. Out of a total of 474 studies, only 10 studies reported a follow-up of trans adults and assessed sexual orientation in the study protocol at all. Sexual orientation was predominantly assessed as homosexual versus non-homosexual related to sex assigned at birth. Only one 1 of 10 follow-up studies found a significant association according to the outcome between groups differentiated by sexual orientation. Empirically there is no link between sexual orientation and outcome of transition-related health care for trans adults. In order to provide comprehensive health care, we recommend asking for sexual behaviours, attractions and identities, as well as for gender experiences and expressions; however, this knowledge should not drive, but simply inform, such comprehensive care.
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Affiliation(s)
- Timo O Nieder
- a Interdisciplinary Transgender Health Care Centre Hamburg, Department for Sex Research and Forensic Psychiatry , University Medical Centre Hamburg-Eppendorf (UKE) , Germany
| | - Els Elaut
- b Centre for Sexology and Gender, Ghent University Hospital , Belgium
| | - Christina Richards
- c Nottingham Centre for Gender Dysphoria , Nottingham , UK ;,d Charing Cross Gender Identity Clinic , London , UK
| | - Arne Dekker
- a Interdisciplinary Transgender Health Care Centre Hamburg, Department for Sex Research and Forensic Psychiatry , University Medical Centre Hamburg-Eppendorf (UKE) , Germany
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Wenzlaff F, Briken P, Dekker A. Video-Based Eye Tracking in Sex Research: A Systematic Literature Review. JOURNAL OF SEX RESEARCH 2016; 53:1008-1019. [PMID: 26689496 DOI: 10.1080/00224499.2015.1107524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although eye tracking has been used for decades, it has gained popularity in the area of sex research only recently. The aim of this article is to examine the potential merits of eye tracking for this field. We present a systematic review of the current use of video-based eye-tracking technology in this area, evaluate the findings, and identify future research opportunities. A total of 34 relevant studies published between 2006 and 2014 were identified for inclusion by means of online databases and other methods. We grouped them into three main areas of research: body perception and attractiveness, forensic research, and sexual orientation. Despite the methodological and theoretical differences across the studies, eye tracking has been shown to be a promising tool for sex research. The article suggests there is much potential for further studies to employ this technique because it is noninvasive and yet still allows for the assessment of both conscious and unconscious perceptional processes. Furthermore, eye tracking can be implemented in investigations of various theoretical backgrounds, ranging from biology to the social sciences.
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Affiliation(s)
- Frederike Wenzlaff
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Peer Briken
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Arne Dekker
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
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Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W, Reisner S, Sevelius J, Ettner R. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes 2016; 23:188-97. [PMID: 26835800 PMCID: PMC4809047 DOI: 10.1097/med.0000000000000232] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. RECENT FINDINGS Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. SUMMARY Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
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Affiliation(s)
- Walter Bockting
- aDivision of Gender, Sexuality, and Health New York State Psychiatric Institute/Columbia Psychiatry and the School of Nursing, Columbia University Medical Center, New York bProgram in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota cSchool of Medicine, University of California, San Francisco, California dDepartment of Psychobiology, National Distance Education University, Madrid, Spain eThe Williams Institute, University of California, Los Angeles School of Law, Los Angeles, California fDivision of Psychiatry, University of Texas Medical Branch, Galveston, Texas gFenway Institute, Fenway Health hDepartment of Epidemiology, Harvard T.H. Chan School of Public Health iDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts jSchool of Medicine, University of California, San Fransisco, California kPrivate Practice, Evanston, Illinois
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Becker I, Nieder TO, Cerwenka S, Briken P, Kreukels BPC, Cohen-Kettenis PT, Cuypere G, Haraldsen IRH, Richter-Appelt H. Body Image in Young Gender Dysphoric Adults: A European Multi-Center Study. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:559-74. [PMID: 25836027 DOI: 10.1007/s10508-015-0527-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 12/22/2014] [Accepted: 01/01/2015] [Indexed: 05/23/2023]
Abstract
The alteration of sex-specific body features and the establishment of a satisfactory body image are known to be particularly relevant for individuals with Gender Dysphoria (GD). The aim of the study was to first develop new scales and examine the psychometric properties of the Hamburg Body Drawing Scale (Appelt & Strauß 1988). For the second part of this study, the satisfaction with different body features in young GD adults before cross-sex treatment were compared to female and male controls. Data collection took place within the context of the European Network for the Investigation of Gender Incongruence (ENIGI) including 135 female-to-male (FtMs) and 115 male-to-female (MtFs) young GD adults and 235 female and 379 male age-adjusted controls. The five female and six male body feature subscales revealed good internal consistency. The ENIGI sample reported less satisfaction with overall appearance (d = 0.30) and with all of their body features than controls, but no subgroup differences for sexual orientation (FtM and MtF) and Age of Onset (FtM) were found. Body dissatisfaction was higher with regard to sex-specific body features (largest effect sizes of d = 3.21 for Genitalia in FtMs and d = 2.85 for Androgen-responsive features and genitalia in MtFs) than with those that appeared less related to the natal sex (d = 0.64 for Facial features in FtMs and d = 0.59 for Body shape in MtFs). Not only medical body modifying interventions, but also psychosocial guidance with regard to body image might be helpful for GD individuals before transitioning.
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Affiliation(s)
- Inga Becker
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Susanne Cerwenka
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | | | - Peggy T Cohen-Kettenis
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - GrietDe Cuypere
- Department of Sexology and Gender Problems, Ghent University Hospital, Ghent, Belgium
| | - Ira R Hebold Haraldsen
- Division of Clinical Neuroscience, Department of Neuropsychiatry and Psychosomatic Medicine, Rikshospitalet, Oslo, Norway
| | - Hertha Richter-Appelt
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Lopez X, Stewart S, Jacobson-Dickman E. Approach to Children and Adolescents with Gender Dysphoria. Pediatr Rev 2016; 37:89-96; quiz 97-8. [PMID: 26933223 DOI: 10.1542/pir.2015-0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ximena Lopez
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas TX
| | - Sunita Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas TX
| | - Elka Jacobson-Dickman
- Department of Pediatrics, Division of Pediatric Endocrinology, Maimonides Medical Center, Brooklyn, NY
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Katz-Wise SL, Reisner SL, Hughto JW, Keo-Meier CL. Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts. JOURNAL OF SEX RESEARCH 2016; 53:74-84. [PMID: 26156113 PMCID: PMC4685005 DOI: 10.1080/00224499.2014.1003028] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine individuals were more likely than trans feminine individuals to report sexual fluidity in their lifetime (aRR = 1.69; 95% CI = 1.34, 2.12). Among those who transitioned, 64.6% reported a change in attractions posttransition, and trans masculine individuals were less likely than trans feminine individuals to report sexual fluidity (aRR = 0.44; 95% CI = 0.28, 0.69). Heterogeneity of sexual orientation identities and sexual fluidity in attractions are the norm rather than the exception among gender minority people.
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Affiliation(s)
- Sabra L Katz-Wise
- a Division of Adolescent/Young Adult Medicine , Boston Children's Hospital
- b Department of Pediatrics , Harvard Medical School
| | - Sari L Reisner
- c Department of Epidemiology , Harvard School of Public Health
- d The Fenway Institute, Fenway Health
| | - Jaclyn White Hughto
- d The Fenway Institute, Fenway Health
- e Chronic Disease Epidemiology Department , Yale School of Public Health
| | - Colton L Keo-Meier
- f Department of Psychology , University of Houston
- g Michael E. DeBakey VA Medical Center
- h Menninger Department of Psychiatry and Behavioral Services , Baylor College of Medicine
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Abstract
PURPOSE OF REVIEW With the advent of medical treatments such as puberty suppression and cross-sex hormones in gender dysphoric minors, there has been a debate around questions of gender identity and brain development. This review aimed to identify recent empirical studies that addressed this controversial topic. RECENT FINDINGS Epidemiological data from several countries indicate that gender dysphoria in children and adolescents is far more common than initially anticipated. This is in line with the currently observed steady increase in referrals to gender clinics. Minors with gender dysphoria are a vulnerable population as they may face a high psychopathological burden. Recently published data on the long-term outcome of puberty suppression and subsequent hormonal and surgical treatment indicate that young people with gender dysphoria may benefit substantially with regard to psychosocial outcomes. Brain development studied by neuroimaging methods seems not to be disturbed by puberty suppression. SUMMARY The first reports about long-term outcome in adolescents having undergone puberty suppression have shown promising results. However, in a substantial part of gender dysphoric minors, puberty suppression is not indicated so far because of psychiatric comorbidity and long-term follow-up data from these patients are still scarce.
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Tozdan S, Briken P. The Earlier, the Worse? Age of Onset of Sexual Interest in Children. J Sex Med 2015; 12:1602-8. [DOI: 10.1111/jsm.12927] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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