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Rapoport SK, Varelas EA, Park C, Brown SK, Goldberg L, Courey MS. Patient Satisfaction and Acoustic Changes in Trans Women after Gender Affirming Voice Training. Laryngoscope 2023; 133:2340-2345. [PMID: 36602085 DOI: 10.1002/lary.30543] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/31/2022] [Accepted: 12/03/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Gains in pitch from gender affirming voice training (GVT) alone in trans women have historically been shown to decline after 1 year. Currently no standard exists for length and type of GVT that yields meaningful behavioral change and patient satisfaction with voice outcomes in trans women. This study aims to determine whether GVT alone leads to sustained pitch elevation and patient satisfaction in trans women. METHODS Retrospective review from 2016 to 2020 of trans women patients who underwent GVT alone for voice change. Charts were reviewed for acoustic analysis of pitch including sustained vowel fundamental frequency, speaking fundamental frequency, and quality of life data from the Trans Woman Voice Questionnaire at pre-therapy, immediate post-therapy, and extended post-therapy time intervals. RESULTS A total of 157 patients presented to our Voice Center, of which 34 participated in the full course of GVT. Patients underwent an average of six sessions of GVT (range 5-7) over an average of 13.14 weeks (range 6-16). Average time between completing GVT and presenting for extended follow-up was 11.37 months (range 6-31). Compared to initial presentation prior to therapy, at extended follow-up after completing GVT average change in F0/a/, SF0, and TWVQ were 64.6 Hz, 31.3 Hz, and 32.45. No significant change was noted between immediate post-therapy and extended post-therapy acoustic measures. TWVQ demonstrated continued improvement between immediate post-therapy and extended post-therapy. CONCLUSIONS In self-selected patients who present for extended follow-up, GVT alone can result in sustained pitch elevation and voice-related quality life in trans women. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2340-2345, 2023.
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Affiliation(s)
- Sarah K Rapoport
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Eleni A Varelas
- Department of Otolaryngology Head and Neck Surgery, Division of Laryngology, Mount Sinai Health System, New York, New York, USA
| | - Christopher Park
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarah K Brown
- Department of Otolaryngology Head and Neck Surgery, Division of Laryngology, Mount Sinai Health System, New York, New York, USA
| | - Leanne Goldberg
- Department of Otolaryngology Head and Neck Surgery, Division of Laryngology, Mount Sinai Health System, New York, New York, USA
| | - Mark S Courey
- Department of Otolaryngology Head and Neck Surgery, Division of Laryngology, Mount Sinai Health System, New York, New York, USA
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Utnage R. Trans and Living in Prison: A First-Person Perspective. J Correct Health Care 2023; 29:16-18. [PMID: 36520589 DOI: 10.1089/jchc.2022.29020.ruu] [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: 12/23/2022]
Abstract
In this first-person account, the author describes key aspects of her experience in prison as a transgender woman seeking appropriate medical and mental health care as well as humane treatment from those who work in the prison system.
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du Plessis C, Halliwell SD, Mullens AB, Sanders T, Gildersleeve J, Phillips T, Brömdal A. A trans agent of social change in incarceration: A psychobiographical study of Natasha Keating. J Pers 2023; 91:50-67. [PMID: 35715895 PMCID: PMC10108085 DOI: 10.1111/jopy.12745] [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] [Received: 09/30/2021] [Revised: 04/30/2022] [Accepted: 06/13/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This psychobiography focuses on the advocacy work of Natasha Keating, a trans woman incarcerated in two male prisons in Australia between 2000 and 2007. Incarcerated trans women are a vulnerable group who experience high levels of victimization and discrimination. However, Natasha advocated for her rights while incarcerated and this advocacy contributed to substantial changes in the carceral system. This psychobiography uses psychological understandings of resilience as well as the Transgender Resilience Intervention Model (TRIM) to investigate the factors that enabled this advocacy. METHOD Data consisted of an archive of letters written by Natasha and interviews with individuals who knew her well. This psychobiography was guided by du Plessis' (2017) 12-step approach and included the identification of psychological saliencies and the construction of a Multilayered Chronological Chart. RESULTS Natasha's life is presented in four chapters, with each chapter including a discussion of resilience based on the TRIM. CONCLUSIONS The TRIM suggests that during incarceration, Natasha was able to access more group-level resilience factors than at any other time in her life. This, combined with individual resilience factors, enabled her advocacy. This finding has implications for advocacy in general as it highlights the importance of both individual- and group-level factors in enabling individuals to effectively advocate for change in their environments.
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Affiliation(s)
- Carol du Plessis
- School of Psychology and Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Sherree D Halliwell
- School of Humanities and Communication, Faculty of Business, Education, Law and Arts, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Amy B Mullens
- School of Psychology and Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Tait Sanders
- School of Psychology and Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jessica Gildersleeve
- School of Humanities and Communication, Faculty of Business, Education, Law and Arts, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Tania Phillips
- School of Psychology and Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Annette Brömdal
- School of Education, Faculty of Business, Education, Law and Arts, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
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Abstract
CONTEXT Breastfeeding is known to have many health and wellness benefits to the mother and infant; however, breastfeeding in trans women has been greatly under-researched. OBJECTIVE To review potential methods of lactation induction in trans women wishing to breastfeed and to review the embryological basis for breastfeeding in trans women. DESIGN This article summarizes a case of successful lactation in a trans woman, in which milk production was achieved in just over 1 month. SETTING This patient was followed in an outpatient endocrinology clinic. PARTICIPANT A single trans woman was followed in our endocrinology clinic for a period of 9 months while she took hormone therapy to help with lactation. INTERVENTIONS Readily available lactation induction protocols for nonpuerpural mothers were reviewed and used to guide hormone therapy selection. Daily dose of progesterone was increased from 100 mg to 200 mg daily. The galactogogue domperidone was started at 10 mg 3 times daily and titrated up to effect. She was encouraged to use an electric pump and to increase her frequency of pumping. MAIN OUTCOME MEASURE Lactation induction. RESULTS At one month, she had noticed a significant increase in her breast size and fullness. Her milk supply had increased rapidly, and she was producing up to 3 to 5 ounces of milk per day with manual expression alone. CONCLUSIONS We report the second case in the medical literature to demonstrate successful breastfeeding in a trans woman through use of hormonal augmentation.
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Affiliation(s)
- Rachel Wamboldt
- Division of Internal Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Shirley Shuster
- Division of Internal Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Bikrampal S Sidhu
- Division of Endocrinology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
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Abstract
OBJECTIVES There is a dearth of information on transgender individuals in Nepal, particularly studies exploring their use of hormone therapies. The objectives of this study therefore were to explore (1) how hormones are used, (2) types of hormones used and (3) side effects experienced by transgender women after hormone use. This is the first study of its kind in Nepal addressing this important public health issue. SETTING The study was conducted in four districts of Nepal: Kathmandu, Sunsai, Banke and Kaski. DESIGN AND PARTICIPANTS This qualitative study comprises eight focus group discussions (FGDs) and nine interviews. FGDs and three face-to-face interviews were held with transgender women aged 18 years and older and six interviews with stakeholders working with and advocating on behalf of this population. The study was conducted between September 2016 and March 2017. RESULTS Our participants were young. The majority of FGD participants had completed school-level education and 40% had been using hormones for 1 to 3 years. Five overlapping themes were identified: (1) reasons and motivations for hormone use; (2) accessibility and use of hormones; (3) side effects; (4) utilisation of healthcare services and (5) discontinuation of hormone use. CONCLUSION Hormone use was common in our sample. Most received information on hormone therapy online and through their peer networks. A few study participants sought doctors' prescriptions for hormone therapy, but hormones were more likely to be bought from local private pharmacies or abroad through friends. This kind of self-medication is associated with a range of risks to the physical and mental health of transgender individuals. Incorporating information, education and communication about hormone therapy into existing health promotion interventions targeted to this population may help transgender people to make better informed choices.
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Affiliation(s)
- Pramod R Regmi
- Nursing and Clinical Sciences, Bournemouth University, Bournemouth, UK
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, UK
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Rutledge R, Morozova O, Gibson BA, Altice FL, Kamarulzaman A, Wickersham JA. Correlates of Recent HIV Testing Among Transgender Women in Greater Kuala Lumpur, Malaysia. LGBT Health 2018; 5:484-493. [PMID: 30481120 DOI: 10.1089/lgbt.2018.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/11/2022] Open
Abstract
PURPOSE In Malaysia, an estimated 9.7%-12.4% of transgender women (TW) are HIV positive, with higher estimates among those engaged in sex work. According to the 90-90-90 Joint United Nations Programme on HIV/AIDS strategy, HIV testing is the first crucial step in curbing the HIV epidemic. This study examines correlates of recent HIV testing among TW in Greater Kuala Lumpur, Malaysia. METHODS TW (N = 199) in Greater Kuala Lumpur completed a survey on healthcare access and utilization, including HIV testing history. Bivariate logistic regression and penalized multivariate logistic regression were used to explore correlates of HIV testing in the last 12 months. RESULTS Overall, 41.7% of TW reported having ever been tested for HIV. Among participants who were HIV negative or not sure of their HIV status (n = 187), only 18.7% (n = 35) had been tested for HIV in the last 12 months. The multivariate analysis indicated that having a primary care provider (PCP), being 26-40 years of age, and having higher mental health functioning were positively associated with recent HIV testing. Active amphetamine use and previous depression diagnosis were also associated with recent HIV testing. CONCLUSION HIV testing is the first step in linking individuals to prevention and treatment interventions. Our findings suggest that having a PCP can improve engagement in HIV testing. Moreover, PCPs can serve as a valuable link to HIV treatment and prevention services. Current interventions that target social and behavioral risk factors for HIV, on their own, may be insufficient at engaging all HIV-vulnerable TW.
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Affiliation(s)
- Ronnye Rutledge
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Olga Morozova
- 2 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Britton A Gibson
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Frederick L Altice
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,2 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.,3 Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,3 Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- 1 AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,3 Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
Evidence of androgenetic alopecia, or male pattern baldness, can be distressing for transgender women. Here we present the case of a transgender woman with scalp hair regrowth after ∼6 months on oral estradiol and spironolactone therapy achieving testosterone levels within normal female range.
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Affiliation(s)
- Mary O Stevenson
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Naomi Wixon
- Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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