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Eitel KB, Zenno A, Di Blasi C, Fechner PY, Hodax JK. Gender-Diverse Youth with Turner Syndrome: Special Management Considerations. JCEM Case Rep 2024; 2:luae076. [PMID: 38707656 PMCID: PMC11066912 DOI: 10.1210/jcemcr/luae076] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Indexed: 05/07/2024]
Abstract
Turner syndrome (TS) is a sex chromosome abnormality characterized by short stature and primary hypogonadism with increased risk for cardiovascular disease, osteopenia, metabolic syndrome, diabetes mellitus, abnormal liver enzymes, and impairment of nonverbal learning skills. Gender-diverse youth include youth who have a gender identity that is different from their sex assigned at birth. They have an increased risk of suicidality, which is decreased in those who receive gender-affirming care. There have been no prior reports on the association or management of gender-diverse youth with TS. We describe 3 cases of gender-diverse youth with TS that highlight the importance of discussing gender identity in patients with hypogonadism in need of sex hormone replacement. Goals of care should be discussed to determine whether estrogen or testosterone replacement aligns best with gender identity. If a patient chooses to start testosterone, special considerations of risks such as erythrocytosis, osteopenia, and cardiovascular disease should be discussed in relation to their TS.
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Affiliation(s)
- Kelsey B Eitel
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Anna Zenno
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Department of Internal Medicine, University of Washington, Seattle, WA 98105, USA
| | - Carolina Di Blasi
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Patricia Y Fechner
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Juanita K Hodax
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
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2
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Stroumsa D, Maksutova M, Minadeo LA, Indig G, Neis R, Ballard JY, Popoff EE, Trammell R, Wu JP. Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives. Transgend Health 2024; 9:34-45. [PMID: 38312454 PMCID: PMC10835159 DOI: 10.1089/trgh.2022.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care. Methods We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively. Results We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals. Conclusion A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
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Affiliation(s)
- Daphna Stroumsa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Maksutova
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Leah A. Minadeo
- School of Information Sciences, Wayne State University, Detroit, Michigan, USA
| | - Gnendy Indig
- Department of Obstetrics, Gynecology, and Reproductive Services, University of Vermont, Burlington, Vermont, USA
| | - Rafael Neis
- Department of History, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Center for Judaic Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Jesse Y. Ballard
- Independent Researcher and Community Activist, Detroit, Michigan, USA
| | - Elliot E. Popoff
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Racquelle Trammell
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Justine P. Wu
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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3
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Grimstad FW, Boskey ER, Clark RS, Ferrando CA. Prevalence of pelvic pain in transgender individuals on testosterone. J Sex Med 2023; 20:1459-1465. [PMID: 37837637 DOI: 10.1093/jsxmed/qdad135] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Pelvic pain has been reported in transmasculine individuals taking testosterone. There is a need for further investigation to increase understanding of the prevalence and risk factors of this pain. AIM We sought to determine the prevalence of pelvic pain reported by transmasculine individuals who had both a uterus and ovaries and were taking testosterone. METHODS We conducted an institutional review board-approved retrospective study of all transmasculine individuals who had been taking testosterone for at least 1 year and had a uterus and ovaries at the time of testosterone initiation. Charts of participating patients were reviewed to determine patient characteristics, testosterone use, and pelvic pain symptoms both before and after initiation of testosterone. OUTCOMES Patients reported experiences of pelvic pain while on testosterone. RESULTS Of 280 individuals who had been on testosterone for at least 1 year, 100 (36%) experienced pelvic pain while on testosterone. Of those patients, 71% (n = 71) had not experienced pelvic pain prior to starting testosterone. There were 42 patients (15%) who had pelvic pain prior to starting testosterone, 13 (31%) of whom no longer experienced pain once starting testosterone. The median (IQR) age at initiation of testosterone was 22 (19-41) years and duration of testosterone treatment was 48 (27-251) months.Those patients who experienced pelvic pain while on testosterone were significantly more likely to have also reported pelvic pain prior to starting testosterone (29% vs 7%, P < .001). These patients were also more likely to have a pre-existing diagnosis of dysmenorrhea (27% vs 7%, P < .001), endometriosis (6% vs 2%, P = .049), or ovarian cysts and/or masses (12% vs 2% P < .001). Patients with pelvic pain were also more likely to have been on a menstrual suppression agent prior to and overlapping testosterone initiation (22% vs 12%, P = .03) and to have used menstrual suppression for longer durations (median [IQR] 18 [6-44] vs 8 [4-15] months, P = .04). CLINICAL IMPLICATIONS Pelvic pain is common in transmasculine individuals who are initiating testosterone treatment, although testosterone has both positive and negative effects on pelvic pain in different individuals. STRENGTHS AND LIMITATIONS The major strengths of this study included large numbers of patients, ability to assess for documentation of pelvic pain prior to testosterone, and ability to determine an actual prevalence of pelvic pain. Major limitations included the study being a retrospective analysis in a single tertiary care center, the limitations of clinical documentation, and the lack of a standard pelvic pain evaluation process. CONCLUSION More than one-third of transmasculine patients with a uterus and ovaries had pelvic pain while on testosterone, with the majority reporting onset of pain after initiating testosterone.
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Affiliation(s)
- Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, United States
- Center for Urogynecology & Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Elizabeth R Boskey
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, United States
- Department of Surgery, Harvard Medical School, Boston, MA, United States
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Rachael S Clark
- Case Western University School of Medicine, Cleveland, OH, United States
- Department of Obstetrics & Gynecology, University of Massachusetts, Worcester, MA, United States
| | - Cecile A Ferrando
- Center for Urogynecology & Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States
- Case Western University School of Medicine, Cleveland, OH, United States
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4
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Kinnear HM, Moravek MB. Reproductive capacity after gender-affirming testosterone therapy. Hum Reprod 2023; 38:1872-1880. [PMID: 37573140 PMCID: PMC10546082 DOI: 10.1093/humrep/dead158] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/11/2023] [Indexed: 08/14/2023] Open
Abstract
Transgender and nonbinary people with female birth sex may utilize testosterone therapy for masculinization. Individuals interested in reproduction using their own gametes should be offered fertility preservation prior to starting testosterone. However, logistical and practical barriers prevent many from accessing fertility preservation options prior to starting testosterone. Some of these transmasculine and nonbinary individuals may later become interested in carrying a pregnancy or using their oocytes for reproduction after being on testosterone. Many questions remain about the reproductive impact of long-term masculinizing testosterone therapy. Emerging literature has documented pregnancies and successful assisted reproduction for some people after taking testosterone, but it is not known whether individuals can expect these successful outcomes. Testosterone appears to impact the reproductive tract, including the ovaries, uterus, and fallopian tubes, but the reversibility and functional impact of these changes also remain unclear. A greater understanding of the impact of masculinizing testosterone on reproductive capacity remains a priority area for future research.
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Affiliation(s)
- Hadrian M Kinnear
- Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI, USA
- Medical Scientist Training Program, University of Michigan, Ann Arbor, MI, USA
| | - Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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5
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Tordoff DM, Sequeira GM, Shook AG, Williams F, Hayden L, Kasenic A, Inwards-Breland D, Ahrens K. Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth. Transgend Health 2023; 8:420-428. [PMID: 37810940 PMCID: PMC10551760 DOI: 10.1089/trgh.2021.0116] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs). Methods We used longitudinal data from a prospective cohort of TNB youth seeking care at a multidisciplinary pediatric gender clinic between August 2017 and June 2018. We calculated the time between (i) initial clinic contact, (ii) phone intake, (iii) first medical appointment, and (iv) initiating PBs/GAHs. We estimated Kaplan-Meier curves for each time-to-care interval and used Cox regression models to estimate hazard ratios (HRs) for factors hypothesized to be barriers and facilitators of care. Results Our cohort included 104 youth aged 13-20 years. The median time from contacting the clinic to initiating PBs/GAHs was 307 days (range, 54-807). Lower income level, Medicaid insurance, and lack of family support were associated with longer times from contacting the clinic to completing the first medical appointment. In addition, older youth experienced longer times to first medical appointment relative to youth aged 13-14 years. Youth younger than 18 years of age who did not complete a mental health assessment before their first medical appointment experienced delays from first medical appointment to initiating PBs/GAHs (HR=0.44, 95% confidence interval, 0.22-0.88). Conclusion Certain subsets of youth disproportionately experienced delays in receiving gender-affirming medications, and these factors varied by stage of care engagement. Given the association between gender-affirming care and improved mental health, identifying sociostructural and clinic-level barriers to care is critically important to facilitating more equitable access.
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Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gina M. Sequeira
- Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Alic G. Shook
- Seattle University, College of Nursing, Seattle, Washington, USA
- Seattle Children's Center for Pediatric Nursing Research, Seattle, Washington, USA
| | | | - Lara Hayden
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ash Kasenic
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - David Inwards-Breland
- Rady Children's Hospital, San Diego, California, USA
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UC San Diego, San Diego, California, USA
| | - Kym Ahrens
- Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
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6
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Sánchez-Toscano E, Domínguez-Riscart J, Larrán-Escandón L, Mateo-Gavira I, Aguilar-Diosdado M. Cardiovascular Risk Factors in Transgender People after Gender-Affirming Hormone Therapy. J Clin Med 2023; 12:6141. [PMID: 37834785 PMCID: PMC10573211 DOI: 10.3390/jcm12196141] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION In the last decade, healthcare for the transgender population has increased considerably in many countries thanks to depathologization movements and the easier accessibility of medical assistance. The age at which they request to start gender-affirming hormones (GAHs) is increasingly younger. The cardiovascular risk associated with hormonal treatment is a novel research field, and the published studies are heterogeneous and inconclusive. Our objective is to determine the metabolic impact of GAHs in the transgender people treated in our Gender Identity Treatment Unit. METHODS We designed a pre-post study to analyze changes in anthropometric parameters (weight and body mass index), analytical determinations (fasting blood glucose, glycated hemoglobin, and lipoproteins), and blood pressure control in the transgender population treated with GAHs in Puerta del Mar University Hospital. These variables were collected before and one year after hormonal therapy. RESULTS A total of 227 transgender people were recruited between 2017 and 2020, 97 (40.09%) transwomen and 136 (59.91%) transmen. The average age at which GAHs began was 18 years. Weight, body mass index, and blood pressure increased significantly in both genders. Transmen showed a more atherogenic lipid profile, with a decrease in cholesterol LDL (p < 0.001) and an increase in triglycerides (p < 0.001). The risk of developing prediabetes or diabetes did not increase one year after treatment, although non-specific alterations in carbohydrate metabolism were detected, such as an increase in glycated hemoglobin in transmen (p = 0.040) and fasting blood glucose in transwomen (p = 0.008). No thromboembolic processes or cardiovascular events were reported during the first year of treatment. CONCLUSION In our setting, transgender people developed changes in their metabolic profiles in the first year after hormonal treatment. Both transmen and transwomen showed early alterations in lipid and carbohydrate metabolism, slight elevations in blood pressure, and a tendency to gain weight. This makes lifestyle interventions necessary from the beginning of GAHs.
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Affiliation(s)
- Esteban Sánchez-Toscano
- Endocrinology and Nutrition Department, Puerta del Mar University Hospital, 11009 Cádiz, Spain; (E.S.-T.); (L.L.-E.); (M.A.-D.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain;
| | - Jesús Domínguez-Riscart
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain;
- Pediatrics and Specific Areas Department, Puerta del Mar University Hospital, 11009 Cádiz, Spain
| | - Laura Larrán-Escandón
- Endocrinology and Nutrition Department, Puerta del Mar University Hospital, 11009 Cádiz, Spain; (E.S.-T.); (L.L.-E.); (M.A.-D.)
| | - Isabel Mateo-Gavira
- Endocrinology and Nutrition Department, Puerta del Mar University Hospital, 11009 Cádiz, Spain; (E.S.-T.); (L.L.-E.); (M.A.-D.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain;
| | - Manuel Aguilar-Diosdado
- Endocrinology and Nutrition Department, Puerta del Mar University Hospital, 11009 Cádiz, Spain; (E.S.-T.); (L.L.-E.); (M.A.-D.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain;
- School of Medicine, Cadiz University (UCA), 11003 Cádiz, Spain
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7
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Pfau DR, Schwartz AR, Dela Cruz C, Padmanabhan V, Moravek MB, Shikanov A. A Mouse Model to Investigate the Impact of Gender Affirming Hormone Therapy with Estradiol on Reproduction. Adv Biol (Weinh) 2023:e2300126. [PMID: 37688350 PMCID: PMC10920391 DOI: 10.1002/adbi.202300126] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/21/2023] [Indexed: 09/10/2023]
Abstract
Gender-affirming hormone therapy (GAHT) can help transgender and/or gender diverse (TGD) individuals achieve emobidment goals that align with their transition needs. Clinical evidence from estradiol (E)-GAHT patients indicate widespread changes in tissues sensitive to E and testosterone (T), particularly in the reproductive system. Notably, E-GAHTs effects on hormones and reproduction vary greatly between patients. With the goal of informing clinical research and practice for TGD individuals taking E, this study examines intact male mice implanted with capsules containing one of three different E doses (low 1.25 mg; mid 2.5 mg; high 5 mg), or a blank control capsule. All E-GAHT doses suppress T and follicle stimulating hormone levels while elevating E levels. Only the high E-GAHT dose significantly supresses luteinizing hormone levels. All E-GAHT doses affect epididymis tubule size similarly while seminiferous tubule morphology and bladder weight changes are dose-dependent. E-GAHT does not alter the presence of mature sperm, though E-exposed sperm have altered motility. These data represent the first evidence that mouse models offer an effective tool to understand E-GAHTs impact on reproductive health and the dose-dependent effects of this model permit examinations of diverse patient outcomes.
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Affiliation(s)
- DR Pfau
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
| | - AR Schwartz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
| | - C Dela Cruz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
| | - V Padmanabhan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA
| | - MB Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
- Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA
| | - A Shikanov
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI 48109, USA
- Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI 48109, USA
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI 48109, USA
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8
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Ciancia S, Klink D, Craen M, Cools M. Early puberty suppression and gender-affirming hormones do not alter final height in transgender adolescents. Eur J Endocrinol 2023; 189:396-401. [PMID: 37703317 DOI: 10.1093/ejendo/lvad125] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Early puberty suppression (ePS; Tanner stages 2 and 3) through gonadotropin-releasing hormone agonists (GnRHas) and gender-affirming hormones (GAHs) interferes with growth and may impact final height (FH). AIM To investigate the impact of ePS and GAH on FH in trans boys and trans girls. METHODS Retrospective study, including 10 trans boys and 22 trans girls at FH. Bone age (BA) was determined at the start of ePS and at the start of GAH according to Greulich and Pyle; predicted adult height (PAH) was calculated according to Bayley and Pinneau's tables; target height (TH) was calculated as adjusted mean of maternal and paternal height. Target height, PAH, and BA were determined according to sex registered at birth (SRAB) and experienced gender (EG). RESULTS The age at the start of PS was 12.37 ± 0.74 years in trans boys and 13.10 ± 1.12 years in trans girls. Total height gain since the start of ePS in trans boys was 14.62 ± 4.08 cm, with 70% achieved before the start of GAH. In trans girls, it was 20.68 ± 7.66 cm, with 61% achieved before GAH. Target height for SRAB was the most accurate predictor for FH in both trans boys and girls: the difference with FH was 1.57 cm ± 3.1 (P = .168) and -0.98 cm ± 4.17 (P = .319), respectively. Also the difference between FH and PAH at the start of PS for SRAB was nonsignificant in both trans boys and girls (2.62 cm ± 3.79, P = .056 and -2.35 cm ± 5.2, P = .051, respectively). CONCLUSION Early puberty suppression and GAH do not impact FH, supporting the safety of the treatment; however, trans adolescents achieve a FH in line with SRAB, rather than EG.
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Affiliation(s)
- Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
| | - Daniel Klink
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Margarita Craen
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
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9
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Tan KKH, Byrne JL, Treharne GJ, Veale JF. Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand. J Public Health (Oxf) 2023; 45:e225-e233. [PMID: 36468999 PMCID: PMC10273389 DOI: 10.1093/pubmed/fdac131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities. METHODS Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14-26 years; n = 608; Mage = 20.5). RESULTS Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02-3.98) of having attempted suicide in the last 12 months. CONCLUSIONS Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth.
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Affiliation(s)
- Kyle K H Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton 3240, New Zealand
| | - Jack L Byrne
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
| | - Gareth J Treharne
- Department of Psychology, University of Otago, Dunedin 9054, New Zealand
| | - Jaimie F Veale
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
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10
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Lavender R, Shaw S, Maninger JK, Butler G, Carruthers P, Carmichael P, Masic U. Impact of Hormone Treatment on Psychosocial Functioning in Gender-Diverse Young People. LGBT Health 2023. [PMID: 36989498 DOI: 10.1089/lgbt.2022.0201] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Purpose: Few studies have assessed the effects of hormonal treatments such as gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormones (GAH) on mental health outcomes in clinically referred gender-diverse young people from a younger age. Where this research has been conducted, findings have been mixed. This study investigated a cohort of young people before treatment, 1 year into GnRHa, and 1 year into GAH treatment to understand psychological and behavioral impacts over time. Methods: Thirty-eight young people (28 assigned female and 10 assigned male) referred to endocrinology, younger than 15 years at/beyond Tanner stage two, who received GnRHa followed by GAH treatment, were assessed in a retrospective analysis study. Young people completed the Youth Self Report (YSR), the Body Image Scale, and the Utrecht Gender Dysphoria Scale, while caregivers completed the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale-2 at all time points. Results: Dissatisfaction with primary sexual characteristics (p = 0.02), gender dysphoria (p = 0.01), and social motivation (p = 0.04) improved significantly over time. Self-harm and suicidality also showed a general decrease. Caregivers reported a significant reduction in internalizing (p = 0.03) behaviors on the CBCL after GnRHa. Other subcategories of the YSR and CBCL were within normal ranges with no significant difference (p > 0.05). Conclusion: These findings demonstrate some improvements in psychological and behavioral outcomes in young people concurrently receiving psychosocial support and hormone treatment. Future research with larger and more diverse samples is warranted to further understand generalizability.
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Affiliation(s)
- Rosemary Lavender
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Selina Shaw
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | | | - Gary Butler
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Paul Carruthers
- Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Polly Carmichael
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
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11
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Moravek MB, Dixon M, Pena SM, Obedin-Maliver J. Management of testosterone around ovarian stimulation in transmasculine patients: challenging common practices to meet patient needs-2 case reports. Hum Reprod 2023; 38:482-488. [PMID: 36644915 PMCID: PMC9977120 DOI: 10.1093/humrep/dead003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/05/2022] [Indexed: 01/17/2023] Open
Abstract
Approximately 50% of transmasculine people use testosterone for gender affirmation, yet very little is known about the effects of testosterone on future reproductive capacity. Moreover, there are no data to guide fertility specialists on how to manage testosterone leading up to or during ovarian stimulation. Most clinics require cessation of testosterone prior to ovarian stimulation in this setting of no data; however, the current literature does suggest a potential increase in dysphoria with cessation of testosterone and during stimulation. This divergence begs the question of whether clinicians may be doing more harm than good by enacting this requirement. Here, we present two cases of transmasculine individuals who were on testosterone prior to stimulation and maintained their testosterone dosage throughout stimulation as proof of concept, followed by a discussion of current clinical practice and providing some rationale to support continuation of testosterone throughout stimulation.
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Affiliation(s)
- Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Marjorie Dixon
- Anova Fertility and Reproductive Health, North York, Ontario, Canada
| | - Samantha M Pena
- Anova Fertility and Reproductive Health, North York, Ontario, Canada
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
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12
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de Nie I, van Mello NM, Vlahakis E, Cooper C, Peri A, den Heijer M, Meißner A, Huirne J, Pang KC. Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women. Cell Rep Med 2023; 4:100858. [PMID: 36652919 PMCID: PMC9873819 DOI: 10.1016/j.xcrm.2022.100858] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/08/2022] [Accepted: 11/18/2022] [Indexed: 01/19/2023]
Abstract
Increasing numbers of transgender individuals are presenting for gender-affirming medical care. For trans women, gender-affirming hormone therapy (GAHT) promotes feminization but also inhibits spermatogenesis. There is a common untested assumption that this inhibition is permanent, resulting in infertility. In this longitudinal study, we report the recovery of viable spermatozoa in nine trans women who stopped GAHT for reproductive purposes. Our preliminary findings suggest that the negative impact of GAHT on spermatogenesis can be reversed, casting doubt on previous claims that GAHT in trans women inevitably leads to permanent infertility. Larger studies are needed to confirm our findings, which have implications not only for fertility counseling and the reproductive options of transgender individuals but also efforts to restrict access to GAHT based on fertility grounds.
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Affiliation(s)
- Iris de Nie
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Norah M. van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Emanuel Vlahakis
- Coffs Harbour Sexual Health Clinic, Coffs Harbour, NSW, Australia
| | - Charlie Cooper
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, VIC, Australia,Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Angus Peri
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, VIC, Australia,Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Martin den Heijer
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Andreas Meißner
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands,Department of Urology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Judith Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Ken C. Pang
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, VIC, Australia,Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia,Corresponding author
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13
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Ciancia S, Dubois V, Cools M. Impact of gender-affirming treatment on bone health in transgender and gender diverse youth. Endocr Connect 2022; 11:e220280. [PMID: 36048500 PMCID: PMC9578106 DOI: 10.1530/ec-22-0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Both in the United States and Europe, the number of minors who present at transgender healthcare services before the onset of puberty is rapidly expanding. Many of those who will have persistent gender dysphoria at the onset of puberty will pursue long-term puberty suppression before reaching the appropriate age to start using gender-affirming hormones. Exposure to pubertal sex steroids is thus significantly deferred in these individuals. Puberty is a critical period for bone development: increasing concentrations of estrogens and androgens (directly or after aromatization to estrogens) promote progressive bone growth and mineralization and induce sexually dimorphic skeletal changes. As a consequence, safety concerns regarding bone development and increased future fracture risk in transgender youth have been raised. We here review published data on bone development in transgender adolescents, focusing in particular on differences in age and pubertal stage at the start of puberty suppression, chosen strategy to block puberty progression, duration of puberty suppression, and the timing of re-evaluation after estradiol or testosterone administration. Results consistently indicate a negative impact of long-term puberty suppression on bone mineral density, especially at the lumbar spine, which is only partially restored after sex steroid administration. Trans girls are more vulnerable than trans boys for compromised bone health. Behavioral health measures that can promote bone mineralization, such as weight-bearing exercise and calcium and vitamin D supplementation, are strongly recommended in transgender youth, during the phase of puberty suppression and thereafter.
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Affiliation(s)
- Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Vanessa Dubois
- Basic and Translational Endocrinology (BaTE), Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, Pediatric Endocrinology Service, Ghent University Hospital, Ghent, Belgium
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14
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Sinha A, Mei L, Ferrando C. The effect of estrogen therapy on spermatogenesis in transgender women. F S Rep 2021; 2:347-351. [PMID: 34553162 PMCID: PMC8441557 DOI: 10.1016/j.xfre.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To describe the histopathologic parameters of orchiectomy specimens obtained after gender-affirming surgery from transgender women who used gender-affirming hormone therapy (GAHT), which included estrogen and spironolactone. Our hypothesis was that an increasing duration of GAHT affects testicular health. Design Retrospective cohort study. Setting Tertiary referral center. Patient(s) All transgender women (individuals assigned male at birth who identified as female) who underwent orchiectomy with or without vaginoplasty between December 2015 and March 2020. Intervention(s) GAHT (estrogen and spironolactone) in the setting of patients with orchiectomy with or without vaginoplasty. Main Outcome Measure(s) Demographic and perioperative data and pathology records were reviewed. The following pathology parameters were recorded: testicular volume, testicular weight, presence of spermatogenesis (active vs. reduced), maturation arrest, testicular atrophy, hyalinization, scarring/fibrosis, and Sertoli cell and Leydig cell phenotypes. The patients were grouped into one of three categories describing the duration of GAHT use: 0–36 months, 37–60 months, and >60 months years. Descriptive statistics were performed and comparisons between outcomes (demographic data and pathology parameters) were made among the GAHT groups. Result(s) Eighty-five (N = 85) patients underwent orchiectomy during the study period with 85.9% (n = 73) undergoing concurrent vaginoplasty. The mean (SD) age and body mass index of the cohort were 39 ±16 years and 28.4 ± 5.4 kg/m2, respectively. In addition, although this was not statistically significant, patients in the 37–60 and >60-month groups were more likely to smoke marijuana than those in the 0–36-month group (26.3% and 21.2% vs. 4.2%, respectively). Mean testicular weight and volume across the cohort were 60.1 ± 24.9 grams and 65.5 ± 41.1 cm3, respectively. Spermatogenesis was present in 28.2% (n = 24) of specimens with active spermatogenesis noted in 8.2% (n = 7). Hyalinization, scarring/fibrosis, and atrophy were present in 28.2% (n = 24), 20.0% (n = 17), and 25.9% (n = 22) of specimens, respectively. There were no differences in pathology parameters across the GAHT groups. Testicular weight and volume were not associated with any differences in pathology parameters. Additionally, age was not associated with testicular weight, volume, or pathology parameters with the exception of the following: when patients were categorized as either ≤40 years of age (n = 48) vs. > 40 years of age (n = 37), patients who were older were more likely to have hyalinization (43.2% vs. 16.7%) as well as atrophy (40.5% vs. 14.6%). Conclusion(s) The duration of GAHT use was not associated with any differences in orchiectomy pathology parameters in patients undergoing gender-affirming surgery, and some patients may still have some spermatogenesis based on the parameters observed in this study.
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Affiliation(s)
- Annika Sinha
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lin Mei
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Cecile Ferrando
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
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15
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Chen D, Lash B, Kim E, Hidalgo MA, Muldoon AL, Liu E, Jensen J, Grabert R, Chan YM, Garofalo R, Tishelman A. A Comparison of Demographic and Psychosocial Characteristics Between Transgender Youth Enrolling Versus Not Enrolling in a Multisite Study. Transgend Health 2021; 6:229-234. [PMID: 34414280 DOI: 10.1089/trgh.2020.0060] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To characterize demographics, psychosocial functioning, and gender-related experiences in transgender youth enrolling versus declining participation in a multisite research study. Methods: Clinical data were abstracted from patient charts at two study sites. Continuous variables were compared using t-tests, and categorical variables were compared using χ 2 tests based on study enrollment status. Results: Few significant differences were observed between enrolled and nonenrolled youth. None of these differences (i.e., designated sex at birth/gender identity; parent-reported separation anxiety; and youth-reported attention deficit/hyperactivity disorder) was replicated across sites. Conclusion: Trans Youth Care findings are likely generalizable to transgender youth initiating hormone treatment at pediatric academic centers.
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Affiliation(s)
- Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Pritzker Department of Child & Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brenna Lash
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ellie Kim
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Marco A Hidalgo
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Abigail L Muldoon
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Enju Liu
- Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Jensen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ren Grabert
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Yee-Ming Chan
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Tishelman
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
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16
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Ehrensaft D, Tishelman AC. Take the T out, put the T in: Gender-affirming hormones in youth. Andrology 2021; 9:1698-1706. [PMID: 34048640 DOI: 10.1111/andr.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND An increasing number of adolescents are seeking gender care at clinics and hospital programs, and requesting gender-affirming hormonal treatment. The interventions can either include suppression of testosterone and introduction of estrogen, or suppression of estrogen and introduction of testosterone. AIMS This review article focuses on the psychosocial experiences of youth who have completed their endogenous puberty and are now requesting one of these two forms of gender-affirming hormonal treatment. We investigate the comparative profiles of these two subgroups of transgender/gender-expansive youth. MATERIALS AND METHODS Review of research data, established standards of care and practice guidelines, and clinical observations. RESULTS Differences and similarities are noted and discussed in several realms: gender-related experiences prior to receiving hormonal treatment; the relationship between the physical changes and psychological experiences that accompany the introduction of testosterone or suppression of testosterone with replacement with estrogen; the intrapersonal and interpersonal implications of the treatment; considerations of fertility preservation for future family building; the role of the family in the decision-making process prior to starting a course of hormone therapy; and the capacity of youth to make informed decisions about these partially irreversible medical interventions. DISCUSSION Medical providers who offer gender-affirming hormonal care to youth should work with the family and allied professionals to assure that the youth's gender health is enhanced, barriers to care are removed, and mental health risks are reduced, whether the T is coming out or going in. CONCLUSION The cohort of youth who come to medical providers after completing puberty, and request gender-affirming hormones in the form of increases or reductions in T have a great deal in common, and also extensive variation among them.
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Affiliation(s)
- Diane Ehrensaft
- Child and Adolescent Gender Center, University of California San Francisco, 5633 Ocean View Drive, Oakland, California, 94618, USA
| | - Amy C Tishelman
- Department of Psychology and Neuroscience, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States
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17
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Stroumsa D, Crissman HP, Dalton VK, Kolenic G, Richardson CR. Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey. Ann Fam Med 2020; 18:528-534. [PMID: 33168681 PMCID: PMC7708284 DOI: 10.1370/afm.2586] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/14/2020] [Accepted: 05/11/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE We undertook a study to assess the associations between barriers to insurance coverage for gender-affirming hormones (either lack of insurance or claim denial) and patterns of hormone use among transgender adults. METHODS We used data from the US Transgender Survey, a large national sample of 27,715 transgender adults, collected from August to September 2015. We calculated weighted proportions and performed multivariate logistic regression analyses. RESULTS Of 12,037 transgender adults using hormones, 992 (9.17%) were using nonprescription hormones. Among insured respondents, 2,528 (20.81%) reported that their claims were denied. Use of nonprescription hormones was more common among respondents who were uninsured (odds ratio = 2.64; 95% CI, 1.88-3.71; P <.001) or whose claims were denied (odds ratio = 2.53; 95% CI, 1.61-3.97; P <.001). Uninsured respondents were also less likely to be using hormones (odds ratio = 0.37; 95% CI, 0.24-0.56; P <.001). CONCLUSIONS Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.
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Affiliation(s)
- Daphna Stroumsa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan .,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Halley P Crissman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan.,Program on Women's Healthcare Effectiveness Research (PWHER), University of Michigan, Ann Arbor, Michigan
| | - Giselle Kolenic
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Caroline R Richardson
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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18
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Chiniara LN, Viner C, Palmert M, Bonifacio H. Perspectives on fertility preservation and parenthood among transgender youth and their parents. Arch Dis Child 2019; 104:739-744. [PMID: 30894340 DOI: 10.1136/archdischild-2018-316080] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the views of young people (YP) with gender dysphoria and their parents concerning fertility preservation and reproductive and life priorities. DESIGN A cross-sectional questionnaire-based study assessed knowledge of potential effects of treatments for gender dysphoria on fertility, current and future life priorities and preferences regarding future fertility/parenting options among YP and parents. RESULTS A total of 79 YP (81% assigned female at birth [AFAB], 19% assigned male at birth [AMAB], aged 12-18 years, 68% between ages 16 years and 18 years) and 73 parents participated. The top current life priority for YP among eight options was being in good health; the least important priority was having children. Anticipated life priorities 10 years from now were ranked similarly. Parents' rankings paralleled the YP responses; however, parents ranked having children as a significantly higher priority for AFAB compared with AMAB YP in 10 years. The majority of YP (66% AFAB, 67% AMAB) want to be a parent in the future. However, most do not envision having a biological child. A large majority (72% AFAB, 80% AMAB) were open to adoption. None of the YP surveyed pursued fertility preservation. CONCLUSION Fertility is a low current and future life priority for transgender YP. The majority of YP wish to become parents but are open to alternative strategies for building a family. These data may explain in part the reported low rates of fertility preservation among this population. Further studies are needed to assess if life priorities change over time.
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Affiliation(s)
- Lyne Noelle Chiniara
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christine Viner
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark Palmert
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herbert Bonifacio
- Department of Pediatrics, St-Michael's Hospital, Toronto, Ontario, Canada
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19
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Butler G, De Graaf N, Wren B, Carmichael P. Assessment and support of children and adolescents with gender dysphoria. Arch Dis Child 2018; 103:631-636. [PMID: 29650510 DOI: 10.1136/archdischild-2018-314992] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Gary Butler
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital NHS Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,National Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Nastasja De Graaf
- National Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Bernadette Wren
- National Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Polly Carmichael
- National Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
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