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Skorochod R, Rysin R, Wolf Y. Gender affirming surgery in non-binary patients: The importance of patient-centered care. J Plast Reconstr Aesthet Surg 2023; 84:176-181. [PMID: 37331039 DOI: 10.1016/j.bjps.2023.05.050] [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: 01/04/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Gender-affirming mastectomies are a growing necessity for transgender and gender-diverse patients. The preoperative evaluation and surgical outcome must be tailored to the individual, taking into consideration previous medical history, medications, hormonal therapy, patient anatomy, and expectations. Although non-binary patients constitute a significant portion of patients referring for gender-affirming mastectomies, current literature rarely acknowledges them as a separate patient category from trans-masculine patients. METHODS Retrospective cohort, demonstrating the single-surgeon experience with gender-affirming mastectomies over the course of 2 decades. RESULTS A total of 208 patients were included in this cohort, patients identifying as "non-binary" in gender accounted for 30.8% of the cohort. Non-binary patients were found to be younger (P value<0.001) at the time of surgery, at the time of HRT initiation (P value<0.001), at the first feeling of gender dysphoria, coming out to society, and use of non-female pronouns (P value = 0.04,<0.001 and<0.001, accordingly). In the non-binary patient group, a shorter period of time passed from the first feeling of gender dysphoria to initiation of HRT and surgery (P value<0.001 and<0.001, accordingly). However, the average time from HRT initiation to surgery and from the first use of non-female pronouns to HRT initiation or surgery did not statistically differ (P value= 0.34, 0.06, and 0.08, accordingly). CONCLUSION Non-binary patients demonstrate a significantly different timeline from trans-masculine patients in terms of gender development. In order to accommodate their needs, caregivers must take the information into consideration and develop appropriate guidelines and courses of action.
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Affiliation(s)
- Ron Skorochod
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel.
| | - Roman Rysin
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Wolf
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel
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Sousa JDC, Araújo ECD, Vasconcelos EMRD, Galindo-Neto NM, Ramalho MNDA, Abreu PDD. Tecnologia para consulta de enfermagem às mulheres transexuais à luz da teoria transcultural de Leininger. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0769pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Descrever a construção e validação de tecnologia para consulta de enfermagem às mulheres transexuais. Métodos: Estudo metodológico desenvolvido em três etapas com construção pautada na Teoria Transcultural de Leininger, validação de conteúdo realizada por especialistas em saúde sexual de transgêneros e avaliação por enfermeiros da assistência às mulheres transexuais. Consideraram-se validados os itens com concordância mínima de 80%, conforme o Índice de Validade de Conteúdo e teste binomial. Resultados: A tecnologia contém 59 itens em três blocos: o primeiro, para Identificação da mulher transexual; o segundo, com os Dados Clínicos; e o terceiro, referente à Propedêutica da Assistência. Todos os itens alcançaram concordância superior a 0,8 e Índice de Validade global de 80%. Conclusões: A tecnologia foi validada quanto ao conteúdo e avaliada pelos enfermeiros e pode ser aplicável tanto na prática clínica e ambulatorial quanto na academia a fim de promover a qualidade assistencial às mulheres transexuais.
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Sousa JDC, Araújo ECD, Vasconcelos EMRD, Galindo-Neto NM, Ramalho MNDA, Abreu PDD. Technology for nursing consultation with transsexual women in the light of Leininger’s transcultural theory. Rev Bras Enferm 2022; 75:e20210769. [DOI: 10.1590/0034-7167-2021-0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/12/2022] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objective: to describe the construction and validation of a nursing consultation technology for transgender women. Methods: a methodological study developed in three stages with construction based on the Leininger’s Cross-Cultural Theory, content validation performed by experts in transgender sexual health and evaluation by nurses of care for transgender women. Items with a minimum agreement of 80% were considered validated, according to the Content Validity Index and binomial test. Results: the technology contains 59 items in three blocks: the first, for identification of the transsexual woman; the second, with the Clinical Data; and the third, regarding the Propaedeutics of Care. All items reached agreement higher than 0.8 and an overall Validity Index of 80%. Conclusions: the technology was content-validated and evaluated by nurses and can be applicable in clinical and outpatient practice as well as in academia to promote quality care for transgender women.
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Falck F, Frisén L, Dhejne C, Armuand G. Undergoing pregnancy and childbirth as trans masculine in Sweden: experiencing and dealing with structural discrimination, gender norms and microaggressions in antenatal care, delivery and gender clinics. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:42-53. [PMID: 34939070 PMCID: PMC8040690 DOI: 10.1080/26895269.2020.1845905] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND A sterilization requirement to change legal gender was removed from Swedish law in 2013, facilitating pregnancy in trans masculine individuals. The limited number of studies investigating pregnancy and childbirth among trans masculine individuals indicate increased gender dysphoria and negative experiences of pre- and post-natal healthcare, highlighting a need to improve care. Research focusing on Europe or contexts where sterilization to change legal gender was previously required by national law remains minimal. AIMS This study aimed to investigate how trans masculine individuals experience healthcare encounters in connection with pregnancy, delivery and nursing, in a setting where mandatory sterilization to change legal gender was recently removed. METHODS In-depth face-to-face interviews were conducted with 12 trans masculine individuals who attended Swedish prenatal care and delivered a child after the law on legal gender recognition was amended. Thematic content analysis was used. RESULTS Providers in gender clinics, antenatal care and delivery were perceived to regard a masculine gender identity and pregnancy as incompatible. The main categories encompassed expectations and experiences of pregnancy related care and participant responses to it. Participants took charge of their care to ensure that their needs were fulfilled. The quality of care was inconsistent. DISCUSSION A lack of knowledge, narrow gender norms and the legacy of the former legal sterility requirement limited access to diagnostic evaluation of gender dysphoria, information on reproduction and gender-affirming treatment. Medical safety during pregnancy, childbirth and nursing was impeded, gender dysphoria increased, and participants experienced minority stress. Attempts to avoid microaggressions guided healthcare encounters and birth wishes. Navigating healthcare required considerable attention, personal resources and energy, leaving particularly vulnerable individuals at risk of a lower quality of care. The paper concludes with clinical recommendations.
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Affiliation(s)
- Felicitas Falck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- ANOVA Karolinska University Hospital, Stockholm, Sweden
- Psychiatry Southwest, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Louise Frisén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Dhejne
- ANOVA Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Gabriela Armuand
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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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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Byne W, Karasic DH, Coleman E, Eyler AE, Kidd JD, Meyer-Bahlburg HFL, Pleak RR, Pula J. Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:336-350. [PMID: 33343244 DOI: 10.1176/appi.focus.18304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Copyright © William Byne et al. 2018; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.).
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Anzani A, De Panfilis C, Scandurra C, Prunas A. Personality Disorders and Personality Profiles in a Sample of Transgender Individuals Requesting Gender-Affirming Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1521. [PMID: 32120872 PMCID: PMC7084367 DOI: 10.3390/ijerph17051521] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022]
Abstract
The study aims to explore the personality patterns of a group of transgender individuals who accessed an Italian gender clinic to undergo gender affirming treatments, by evaluating both dimensional personality domains proposed by the Alternative Model of Personality Disorders and categorical DSM-IV personality disorder (PD) diagnoses. Eighty-seven participants (40 transgender women and 47 transgender men) completed the Personality Inventory for DSM-5 and the Structured Clinical Interview for DSM-IV Axis II personality disorders. Scores obtained were compared to those of the normative samples of cisgender women and men. Results indicated that transgender women scored lower than cisgender women on two main domains (Negative Affectivity and Psychoticism) and on seven facets. As for transgender men, lower scores than cisgender men were found on Antagonism and on five facets. Transgender men scored higher than cisgender men on Depressivity. Nearly 50% of participants showed at least one PD diagnosis, with no gender differences in prevalence. Borderline PD was the most frequent diagnosis in the overall sample. Self-report measures provide a less maladaptive profile of personality functioning than the clinician-based categorical assessment. Results are interpreted in the light of the Minority Stress Model and support the need for a multi-method assessment of personality in medicalized transgender people.
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Affiliation(s)
- Annalisa Anzani
- Department of Psychology, University of Milano–Bicocca, 20126 Milan, Italy;
- CREST, Centro per lo studio e la terapia dei disturbi di personalità, 20145 Milan, Italy
| | - Chiara De Panfilis
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy;
| | - Antonio Prunas
- Department of Psychology, University of Milano–Bicocca, 20126 Milan, Italy;
- CREST, Centro per lo studio e la terapia dei disturbi di personalità, 20145 Milan, Italy
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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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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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Byne W, Karasic DH, Coleman E, Eyler AE, Kidd JD, Meyer-Bahlburg HF, Pleak RR, Pula J. Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists. Transgend Health 2018; 3:57-70. [PMID: 29756044 PMCID: PMC5944396 DOI: 10.1089/trgh.2017.0053] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition). The article will also be helpful for other mental health professionals. The following areas are addressed: evolution of diagnostic nosology, epidemiology, gender development, and mental health assessment, differential diagnosis, treatment, and referral for gender-affirming somatic treatments of adults with GD.
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Affiliation(s)
- William Byne
- Mental Illness Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai and Center for Transgender Medicine and Surgery at Mount Sinai, New York, New York
| | - Dan H. Karasic
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - A. Evan Eyler
- Departments of Psychiatry and Family Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Jeremy D. Kidd
- Department of Psychiatry, Division on Substance Use Disorders, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Heino F.L. Meyer-Bahlburg
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Richard R. Pleak
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Hofstra North Shore-LIJ School of Medicine, Albert Einstein College of Medicine, Zucker Hillside Hospital, Ambulatory Care Pavilion, Glen Oaks, New York
| | - Jack Pula
- Department of Psychiatry, Division of Gender, Sexuality and Health, College of Physicians and Surgeons of Columbia University, New York, New York
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Lingiardi V, Giovanardi G. Challenges in assessing personality of individuals with Gender Dysphoria with the SWAP-200. J Endocrinol Invest 2017; 40:693-703. [PMID: 28238165 DOI: 10.1007/s40618-017-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/30/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Personality assessment can be useful to better understand the complexity of transgender and transsexual people. In particular, the Shedler Westen Assessment Procedure-200 (SWAP-200) is a measure that provides an accurate dimensional evaluation of personality. When assessing gender non-conforming people, however, clinicians can encounter some difficulties in giving appropriate ratings to all the items. PURPOSE OF THE REVIEW A brief guide to the use of SWAP-200 with transgender patients is provided, taking into account three areas of psychological functioning: identity, relationships and sexuality. The authors review, one by one, the SWAP-200 items related to these areas, and, relying on their clinical experience and on scientific literature on Gender Dysphoria, they propose recommendations for making personality diagnoses meaningful. CONCLUSION This paper facilitates a better clinical understanding of transgender people, and help clinicians to be more knowledgeable in the assessment of this heterogeneous population.
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Affiliation(s)
- V Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - G Giovanardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
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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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