Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

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.

Rapid breakthrough of 131I in an in vitro human epidermis model

Skin contamination with radionuclides may cause local radiation damage, but also systemic distribution if the nuclides penetrate the epidermal membrane. Detailed information of the skin absorption of radionuclides is of importance for e.g. dose estimations and development of decontamination strategies. In the present study, penetration of ¹³¹I through human epidermis was studied using an in vitro flow through diffusion chamber. Epidermis was exposed to a Na¹³¹I-solution, used in nuclear medicine, and the potential concentration-dependency of skin penetration was examined by including two concentrations of non-radioactive NaI. Penetration of ¹³¹I occurred after a few minutes of exposure and steady state penetration rate was obtained after about 50-70min independently of the iodine concentration and receptor solution used. The two receptor solutions evaluated; phosphate buffered saline solution and an ethanol and water-mixture (1:1), resulted in significantly higher penetration rate of ¹³¹I using the ethanol and water-mixture. The penetration of iodine was calculated to be concentration-dependent independently of the receptor solution utilized. In addition, radioactive iodine did not accumulate in epidermis in the in vitro-model used. In conclusion, the present study provides detailed information on the rapid iodine penetration at the early phase of radionuclide exposure, defined as the first 30min of the experiment, and is clearly suitable for decontamination studies. In addition, methodological aspects, e.g. impact of the receptor solution, should carefully be considered in studies of radionuclide skin penetration using in vitro-techniques.

240Pu/239Pu mass ratio in environmental samples in Finland

The (240)Pu/(239)Pu mass ratio was determined with SF-ICP-MS in lichen, peat, grass, air filter, and hot particle samples obtained in Finland. The main part of the air filters were sampled in northern Finland in 1963, whereas all the other samples were collected in southern and central Finland immediately after the Chernobyl accident in 1986. The (240)Pu/(239)Pu mass ratio varied between 0.13 ± 0.01 and 0.53 ± 0.03 in the environmental samples analyzed. The values for the (240)Pu/(239)Pu ratio confirm previous estimations, based on the (238)Pu/(239+240)Pu alpha activity ratio in the same samples, that global fallout from nuclear weapons testing and deposition from the Chernobyl accident have been the main Pu contamination sources in the environment in Finland.

Reasons among older Swedish women of not participating in a food survey

OBJECTIVES

To (a) examine participation rate as a function of municipality, age group and living status; and (b) investigate the main reasons for exclusion and declining as stated by the women themselves.

DESIGN

Analysis of participation rate and content analysis of statements given in phone calls explaining exclusion or declination from a project in which 24 h recalls and food-diaries were used.

SUBJECTS

Self-managing Swedish women (n=505) were systematically selected from a stratified random sample covering single living and cohabiting women aged 64-68, 74-78 and 84-88 y living in three municipalities.

RESULTS

No significant differences were found among included and declining women when municipalities and living status was analysed, but significantly more women in the oldest group were excluded (P>0.01). Among those in their 80s living at home, the usual reasons for exclusion were illness, disability or dementia, and many lived in institutions for old people. The four most used explanations to decline participation were 'lack of time', 'tired, fragile, sick or having bad memory', 'not willing to participate in scientific studies' and 'too old and nothing to contribute'.

CONCLUSIONS

The participation rate was, compared with other food surveys in the older generation, fairly good, especially among those in their 80s. However, the most active and the very ill and disabled did not participate.

SPONSORSHIP

The Swedish Council for Social Research, the Swedish Council for Forestry and Agricultural Research, the Swedish Foundation for Health and Care Sciences and Allergy Research and Uppsala University.

Qualitative analysis of the questions raised by patients with gynecologic cancers and their relatives in an educational support group

BACKGROUND

People's knowledge of cancer is generally inadequate to help them cope with a diagnosis of cancer. Educational support groups may allow cancer patients to receive information they want that is normally not covered in the individual clinical encounter. It was desired to identify the content of such information as reflected in the questions asked by cancer patients and their relatives in such support groups.

METHOD

The 329 questions asked by 41 patients and 11 of their relatives in 40 group sessions were analyzed and categorized.

RESULTS

The categories found are described. Almost 100 questions could be allocated to the category "the illness," of which the most common was, "Is cancer hereditary?" The questions made it clear that the patients had a wish and a need to understand cancer.

CONCLUSION

An educational support group provides a complement to, and not a substitute for, the clinical provision of medical information.