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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022;23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]

Abstract

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

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Affiliation(s)

E Coleman Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
A E Radix Callen-Lorde Community Health Center, New York, NY, USA Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
W P Bouman Nottingham Centre for Transgender Health, Nottingham, UK School of Medicine, University of Nottingham, Nottingham, UK
G R Brown James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA James H. Quillen VAMC, Johnson City, TN, USA
A L C de Vries Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
M B Deutsch Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA UCSF Gender Affirming Health Program, San Francisco, CA, USA
R Ettner New Health Foundation Worldwide, Evanston, IL, USA Weiss Memorial Hospital, Chicago, IL, USA
L Fraser Independent Practice, San Francisco, CA, USA
M Goodman Emory University Rollins School of Public Health, Atlanta, GA, USA
J Green Independent Scholar, Vancouver, WA, USA
A B Hancock The George Washington University, Washington, DC, USA
T W Johnson Department of Anthropology, California State University, Chico, CA, USA
D H Karasic University of California San Francisco, San Francisco, CA, USA Independent Practice at dankarasic.com
G A Knudson University of British Columbia, Vancouver, Canada Vancouver Coastal Health, Vancouver, Canada
S F Leibowitz Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
H F L Meyer-Bahlburg New York State Psychiatric Institute, New York, NY, USA Department of Psychiatry, Columbia University, New York, NY, USA
S J Monstrey Ghent University Hospital, Gent, Belgium
J Motmans Transgender Infopunt, Ghent University Hospital, Gent, Belgium Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
L Nahata Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
T O Nieder University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
S L Reisner Harvard Medical School, Boston, MA, USA Harvard T. H. Chan School of Public Health, Boston, MA, USA
C Richards Regents University London, UK Tavistock and Portman NHS Foundation Trust, London, UK
L S Schechter Rush University Medical Center, Chicago, IL, USA
V Tangpricha Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA Atlanta VA Medical Center, Decatur, GA, USA
A C Tishelman Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
M A A Van Trotsenburg Bureau GenderPRO, Vienna, Austria University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
S Winter School of Population Health, Curtin University, Perth, WA, Australia
K Ducheny Howard Brown Health, Chicago, IL, USA
N J Adams University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada Transgender Professional Association for Transgender Health (TPATH)
T M Adrián Asamblea Nacional de Venezuela, Caracas, Venezuela Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
L R Allen University of Nevada, Las Vegas, NV, USA
D Azul La Trobe Rural Health School, La Trobe University, Bendigo, Australia
H Bagga Monash Health Gender Clinic, Melbourne, Victoria, Australia Monash University, Melbourne, Victoria, Australia
K Başar Department of Psychiatry, Hacettepe University, Ankara, Turkey
D S Bathory Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
J J Belinky Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
D R Berg National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
J U Berli Oregon Health & Science University, Portland, OR, USA
R O Bluebond-Langner NYU Langone Health, New York, NY, USA Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
M-B Bouman Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
M L Bowers Icahn School of Medicine at Mount Sinai, New York, NY, USA Mills-Peninsula Medical Center, Burlingame, CA, USA
P J Brassard GrS Montreal, Complexe CMC, Montreal, Quebec, Canada Université de Montreal, Quebec, Canada
J Byrne University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
L Capitán The Facialteam Group, Marbella International Hospital, Marbella, Spain
C J Cargill Independent Scholar
J M Carswell Harvard Medical School, Boston, MA, USA Boston's Children's Hospital, Boston, MA, USA
S C Chang Independent Practice, Oakland, CA, USA
G Chelvakumar Nationwide Children's Hospital, Columbus, OH, USA The Ohio State University, College of Medicine, Columbus, OH, USA
T Corneil School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
K B Dalke Penn State Health, PA, USA Penn State College of Medicine, Hershey, PA, USA
G De Cuypere Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
E de Vries Nelson Mandela University, Gqeberha, South Africa University of Cape Town, Cape Town, South Africa
M Den Heijer Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
A H Devor University of Victoria, Victoria, BC, Canada
C Dhejne ANOVA, Karolinska University Hospital, Stockholm, Sweden Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
A D'Marco UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas D M A R C O Organization, Nassau, The Bahamas
E K Edmiston University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
L Edwards-Leeper Pacific University, Hillsboro, OR, USA Independent Practice, Beaverton, OR, USA
R Ehrbar Whitman Walker Health, Washington, DC, USA Independent Practice, Maryland, USA
D Ehrensaft University of California San Francisco, San Francisco, CA, USA
J Eisfeld Transvisie, Utrecht, The Netherlands
E Elaut Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
L Erickson-Schroth The Jed Foundation, New York, NY, USA Hetrick-Martin Institute, New York, NY, USA
J L Feldman Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
A D Fisher Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
M M Garcia Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
L Gijs Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
S E Green Mermaids, London/Leeds, UK
B P Hall Duke University Medical Center, Durham, NC, USA Duke Adult Gender Medicine Clinic, Durham, NC, USA
T L D Hardy Alberta Health Services, Edmonton, Alberta, Canada MacEwan University, Edmonton, Alberta, Canada
M S Irwig Harvard Medical School, Boston, MA, USA Beth Israel Deaconess Medical Center, Boston, MA, USA
L A Jacobs Independent Practice, New York, NY, USA
A C Janssen Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Northwestern Feinberg School of Medicine, Chicago, IL, USA
K Johnson RMIT University, Melbourne, Australia University of Brighton, Brighton, UK
D T Klink Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
B P C Kreukels Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
L E Kuper Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA Department of Endocrinology, Children's Health, Dallas, TX, USA
E J Kvach Denver Health, Denver, CO, USA University of Colorado School of Medicine, Aurora, CO, USA
M A Malouf Malouf Counseling and Consulting, Baltimore, MD, USA
R Massey WPATH Global Education Institute Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
T Mazur Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA John R. Oishei Children's Hospital, Buffalo, NY, USA
C McLachlan Professional Association for Transgender Health, South Africa Gender DynamiX, Cape Town, South Africa
S D Morrison Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
S W Mosser Gender Confirmation Center, San Francisco, CA, USA Saint Francis Memorial Hospital, San Francisco, CA, USA
P M Neira Johns Hopkins Center for Transgender Health, Baltimore, MD, USA Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
U Nygren Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
J M Oates La Trobe University, Melbourne, Australia Melbourne Voice Analysis Centre, East Melbourne, Australia
J Obedin-Maliver Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA Department of Epidemiology and Population Health, Stanford, CA, USA
G Pagkalos Independent PracticeThessaloniki, Greece Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
J Patton Talkspace, New York, NY, USA CytiPsychological LLC, San Diego, CA, USA
N Phanuphak Institute of HIV Research and Innovation, Bangkok, Thailand
K Rachlin Independent Practice, New York, NY, USA
T Reed Gender Identity Research and Education Society, Leatherhead, UK
G N Rider National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
J Ristori Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
S Robbins-Cherry Nottingham Centre for Transgender Health, Nottingham, UK
S A Roberts Harvard Medical School, Boston, MA, USA Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
K A Rodriguez-Wallberg Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
S M Rosenthal Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA UCSF Child and Adolescent Gender Center
K Sabir FtM Phoenix Group, Krasnodar Krai, Russia
J D Safer Icahn School of Medicine at Mount Sinai, New York, NY, USA Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
A I Scheim Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
L J Seal Tavistock and Portman NHS Foundation Trust, London, UK St George's University Hospitals NHS Foundation Trust, London, UK
T J Sehoole Iranti, Johannesburg, South Africa
K Spencer National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
C St Amand University of Houston, Houston, TX, USA Mayo Clinic, Rochester, MN, USA
T D Steensma Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
J F Strang Children's National Hospital, Washington, DC, USA George Washington University School of Medicine, Washington, DC, USA
G B Taylor Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
K Tilleman Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
G G T'Sjoen Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium Department of Endocrinology, Ghent University Hospital, Gent, Belgium
L N Vala Independent Practice, Campbell, CA, USA
N M Van Mello Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
J F Veale School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
J A Vencill Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
B Vincent Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
L M Wesp College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA Health Connections Inc., Glendale, WI, USA
M A West North Memorial Health Hospital, Robbinsdale, MN, USA University of Minnesota, Minneapolis, MN, USA
J Arcelus School of Medicine, University of Nottingham, Nottingham, UK Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

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Van Mello N, De Nie I, Asseler J, Arnoldussen M, Steensma T, Den Heijer M, De Vries A, Huirne J. P-506 Reflecting on the Importance of Family Building and Fertility Preservation: Transgender People’s Experiences with Starting Gender-affirming Treatment as Adolescent. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open

Abstract Abstract Study question To investigate how adults of reproductive age (± 30 years), who started gender-affirming treatment during adolescence, reflect on their reproductive wishes. Summary answer Views regarding fertility and family building change over time, which may be related with reduced levels of gender dysphoria, matured intellectual and emotional cognitions. What is known already Within the last two decades, gender-affirming care for transgender youth has become widely available. One of the topical debates in adolescent transgender care concerns the difficulty of making decisions regarding fertility at an early age, since medical treatment for gender dysphoria negatively affects reproductive function. In transgender adolescents, data on the potential change in wishes and desires regarding fertility, family building and the importance of biological parenthood, when coming of reproductive age, are lacking. Hereby, the long-term consequences of acquired infertility in transgender adolescents who have now reached adulthood remain still unknown. Study design, size, duration This was a questionnaire study. Gender diverse adolescents who presented between 1989 and 2000 and started medical transition, were recruited for participation. As well as gender diverse adolescents who commenced medical treatment with gonadotropin-releasing hormone agonist (GnRHa) prior to gender affirming hormone treatment (GAHT), at least 9 years ago. 89 participants were eligible for inclusion in the study cohort. Participants/materials, setting, methods Data were collected through an online survey, and a subsequent telephonic interview to validate the provided answers in the survey. The fertility questionnaire focused on different themes, such as fertility counseling at initiation of medical treatment, decision-making about fertility preservation, current feelings about infertility, and a potential desire to have children. Main results and the role of chance The cohort consisted of 89 participants, among whom 66 trans masculine and 23 trans feminine people. Participants had a mean age of 32.4 years (SD 6.6, range 25.5-51.2) at time of the study, and 15.6 years (SD 2.2, range 11.5-20.6) at time of start of medical treatment. Since all participants initiated medical treatment before 2014, at that time laws requiring sterilization for legal gender recognition were still in place. Only 30% of participants received information about the options for fertility preservation, and none of them pursued fertility preservation. In addition, 96% of participants underwent gonadectomy and thus became permanently infertile. 27% of participants found becoming infertile troublesome, and 21% stated that they were not able to make decisions regarding fertility and future family building during adolescence. With today’s knowledge, 14% of trans masculine and 17% of trans feminine people would not have chosen to undergo gonadectomy. In addition, 44% of trans masculine and 35% of trans feminine people would pursue fertility preservation. The percentage of participants with a (future) desire for children changed from 34% at start of medical treatment to 56% at time of this study, of whom 23% had already started a family. Limitations, reasons for caution Since the participants reflect on a period in time in which fertility counseling was not offered on a structural basis and preservation options were not widely available, results of this study may not be fully translatable to current practice. Wider implications of the findings Transgender adolescents should be counselled on fertility and the options for fertility preservation, even in the absence of a desire for children upon initiation of treatment. Views on future family building might change over time, fertility counseling should be repeated at each step of the transition. Trial registration number na Collapse

Van Velzen D, Adorni M, Zimetti F, Palumbo M, Bernini F, Srazzella A, Simsek S, Sirtori C, Den Heijer M, Ruscica M. Hormone therapy impacts on HDL-CEC but not on HDL subclasses and serum loading capacity: A cohort of transgender individuals. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]

Van den Bosch MF, Wiepjes CM, Den Heijer M, Schoonmade LJ, Jonkman REG, Meursinge Reynders RA. Mapping evidence on the effects of gender-affirming hormone therapy on the hard and soft tissues of the craniofacial complex in transgender people: a protocol for a scoping review. Syst Rev 2021;10:109. [PMID: 33853686 PMCID: PMC8048340 DOI: 10.1186/s13643-021-01668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

Gender-affirming hormone (GAH) therapy aims to support the transition of transgender people to their gender identity. GAHs can induce changes in their secondary sex characteristics such as the development of breasts in transgender females and increased muscle mass in transgender males. The face and its surrounding tissues also have an important role in gender confirmation. The aim of this scoping review is to systematically map the available evidence in order to provide an overview of the effects of GAH therapy on the hard and soft tissues of the craniofacial complex in transgender people.

METHODS/DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) extension for Scoping Reviews was consulted for reporting this protocol. The methods were based on the Arksey and O'Malley's framework and the Reviewer's Manual of the Joanna Briggs Institute for conducting scoping reviews. Ten transgender people were involved in the development of the primary research question through short interviews. The eligibility criteria were defined for transgender people undergoing GAH therapy and for quantitative and qualitative outcomes on the hard and soft tissues of the craniofacial complex. Eligible sources of evidence include observational, experimental, qualitative, and mixed method studies. No exclusion criteria will be applied for the language of publication and the setting. To identify eligible sources of evidence, we will conduct searches from inception onwards in PubMed, Embase.com , the Cochrane Library, Web of Science Core Collection, Scopus, CINAHL, LIVIVO, and various grey literature sources such as Google Scholar. Two reviewers will independently select eligible studies in these information sources and will subsequently conduct data extraction. The same operators will chart, categorize, and summarize the extracted data. A narrative summary of findings will be conducted. Frequency counts of quantitative and qualitative data on items such as concepts, populations, interventions, and other characteristics of the eligible sources will be given. Where possible, these items will be mapped descriptively.

DISCUSSION

We chose the scoping review over the systematic review approach, because the research questions are broad-spectrum and the literature is expected to be widely scattered. No systematic review has previously assessed this topic. Identifying knowledge gaps in this area and summarizing and disseminating research findings are important for a wide spectrum of stakeholders, in particular, for transgender people who want to undergo additional interventions such as plastic or orthognathic surgery or orthodontics.

SYSTEMATIC REVIEW REGISTRATION

This protocol was registered in the Open Science Framework: https://osf.io/e3qj6.

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Adorni M, Van Velzen D, Zimetti F, Sirtori C, Macchi C, Den Heijer M, Ruscica M. Sex hormones therapy differentially modulates HDL function in transgender individuals. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]

de Nie I, De Blok C, Van der Sluis T, Barbé E, Pigot G, Wiepjes C, Nota N, Van Mello N, Valkenburg N, Huirne J, Gooren L, Van Moorselaar J, Dreijerink K, Den Heijer M. Prostate cancer incidence under androgen deprivation: A nationwide cohort study in trans women receiving hormone treatment. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open

de Nie I, Van Mello N, Den Heijer M, Kostelijk H, Soufan A, Voorn-De Warem I, Huirne J. Impaired semen quality in trans women: Prevalence and determinants. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open

Defreyne J, Kreukels B, T'Sjoen G, Den Heijer M, Elaut E. PS-01-001 Is anger intensity related to serum testosterone levels and/or exogenous testosterone therapy? Results from ENIGI, a large multicenter prospective cohort study in transgender people. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]

Defreyne J, Vantomme B, Van Caenegem E, Wierckx K, De Blok C, Klaver M, Nota NM, Van Dijk D, Wiepjes CM, Den Heijer M, T'Sjoen G. Prospective evaluation of hematocrit in gender-affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence. Andrology 2018;6:446-454. [DOI: 10.1111/andr.12485] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 01/09/2023]

ter Wengel PV, Martin E, Gooren L, Den Heijer M, Peerdeman SM. Meningiomas in three male-to-female transgender subjects using oestrogens/progestogens and review of the literature. Andrologia 2016;48:1130-1137. [DOI: 10.1111/and.12550] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/28/2022] Open

Hillebrand S, Christen T, Maan AC, Jukema JW, Lamb HJ, De Roos A, Rosendaal FR, Den Heijer M, Swenne CA, De Mutsert R. Visceral fat is stronger associated with electrocardiographic measures of sympathetic activation than subcutaneous fat in individuals with structurally normal hearts: the NEO study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open

Den Heijer M, van Asperen CJ, Harris H, Nippert I, Schmidtke J, Bouhnik AD, Julian-Reynier C, Evans DG, Tibben A. International variation in physicians' attitudes towards prophylactic mastectomy - comparison between France, Germany, the Netherlands and the United Kingdom. Eur J Cancer 2013;49:2798-805. [PMID: 23692813 DOI: 10.1016/j.ejca.2013.04.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/24/2013] [Accepted: 04/27/2013] [Indexed: 11/20/2022]

Roumen-Klappe EM, Janssen MCH, Van Rossum J, Holewijn S, Van Bokhoven MMJA, Kaasjager K, Wollersheim H, Den Heijer M. Inflammation in deep vein thrombosis and the development of post-thrombotic syndrome: a prospective study. J Thromb Haemost 2009;7:582-7. [PMID: 19175493 DOI: 10.1111/j.1538-7836.2009.03286.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]

Vermeulen SHHM, Den Heijer M, Sham P, Knight J. Application of multi-locus analytical methods to identify interacting loci in case-control studies. Ann Hum Genet 2007;71:689-700. [PMID: 17425620 DOI: 10.1111/j.1469-1809.2007.00360.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]

Den Heijer M, Lewington S, Clarke R. Homocysteine, MTHFR and risk of venous thrombosis: a meta-analysis of published epidemiological studies. J Thromb Haemost 2005;3:292-9. [PMID: 15670035 DOI: 10.1111/j.1538-7836.2005.01141.x] [Citation(s) in RCA: 290] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]

Abstract

CONTEXT

It has been suggested that elevated total plasma homocysteine levels are associated with the risk of venous thrombosis.

OBJECTIVE

To assess the relationship of homocysteine and the MTHFR 677TT genotype and the risk of venous thrombosis by conducting a meta-analysis of all relevant studies.

DATA SOURCES AND SELECTION

Studies (case-control or nested case-control) were identified by searches of electronic literature for relevant reports published before July 2003 on homocysteine and the MTHFR 677TT genotype and venous thrombosis as an end-point, by hand-searching reference lists of original articles (including meta-analyses) on this topic and by contact with investigators in the field.

DATA EXTRACTION

A meta-analysis of 24 retrospective (n = 3289 cases) and three prospective studies (n = 476 cases) was carried out to examine the association of homocysteine with venous thrombosis. A meta-analysis of 53 studies (n = 8364 cases) of the MTHFR 677TT genotype (that increases homocysteine) was carried out to assess if this association is causal.

DATA SYNTHESIS

A 5 micromol L(-1) higher measured homocysteine level was associated with a 27% (95% CI: 1-59) higher risk of venous thrombosis in prospective studies and a 60% (95% CI: 10-134) higher risk in retrospective studies. The 677TT genotype was associated with a 20% (95% CI: 8-32) higher risk of venous thrombosis compared with the 677CC genotype. In contrast with non-American studies, the 677TT genotype had no effect on venous thrombosis in North America, due probably to the higher intake of folate and riboflavin in North America.

CONCLUSION

This meta-analysis of prospective and retrospective studies demonstrates a modest association of homocysteine with venous thrombosis. The elevated risk associated with the MTHFR 677TT genotype provides some support for causality.

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Heil SG, De Vriese AS, Kluijtmans LAJ, Mortier S, Den Heijer M, Blom HJ. The role of hyperhomocysteinemia in nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF)-mediated vasodilatation. Cell Mol Biol (Noisy-le-grand) 2004;50:911-6. [PMID: 15704255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]

Heil SG, Den Heijer M, Van Der Rijt-Pisa BJM, Kluijtmans LAJ, Blom HJ. The 894 G > T variant of endothelial nitric oxide synthase (eNOS) increases the risk of recurrent venous thrombosis through interaction with elevated homocysteine levels. J Thromb Haemost 2004;2:750-3. [PMID: 15099281 DOI: 10.1111/j.1538-7836.2004.00701.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]

Peeters ACTM, Van Den Berkmortel FWPJ, Novakova IRO, Den Heijer M. Homocysteine concentrations are associated with increased t-PA and PAI concentrations in smokers. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb03546.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]

Maraha B, Scheffer GJ, Kluytmans JA, Den Heijer M, Graafsma S, Peeters MF. [Chlamydia pneumonia and atherosclerosis]. Ned Tijdschr Geneeskd 1999;143:762-3. [PMID: 10347632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]

Willems HP, Den Heijer M, Gerrits WB, Bos GM. [The recommended daily intake of folic acid is insufficient for optimum homocysteine level]. Ned Tijdschr Geneeskd 1998;142:1473-4. [PMID: 9752063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]