scholarly journals Transgender patients: considerations for routine gynecologic care and cancer screening

2020 ◽  
Vol 30 (12) ◽  
pp. 1990-1996
Author(s):  
Trinidad Labanca ◽  
Ivan Mañero ◽  
Marcelo Pannunzio
Keyword(s):  
Cancer Screening ◽  
Reproductive Tract ◽  
Hormone Treatment ◽  
Transgender Women ◽  
Cancer Risk Assessment ◽  
Bilateral Mastectomy ◽  
Long Term Effects ◽  
Transgender People ◽  
Personalized Cancer ◽  
Transgender Men

In the last several years, demand for transgender care from gynecologists has increased significantly. Transgender people comprise a diverse group who do not identify with the sex they were assigned at birth. Worldwide, it is estimated that 25 million people identify as transgender. Some undergo hormonal and/or surgical treatment aiming to feminize or masculinize their bodies. Cross-sex hormone treatment for transgender women—individuals assigned as male at birth who identify themselves as women—includes exogenous estrogen and/or progestin administration in combination with anti-androgens, whereas testosterone is used for transgender men—individuals whose natal sex is women but identify themselves as men. Although it is usually rare, hormone-sensitive malignancies may arise, and long-term effects remain unknown. In addition, reconstructive surgeries may include breast augmentation and vaginoplasty (creation of a vagina) for transgender women, and chest masculinization surgery (bilateral mastectomy) and metoidioplasty (lengthening of the clitoris to create a microphallus) or phalloplasty (creation of a phallus) for transgender men. Evidence relating to breast and reproductive tract cancers in the trans population is limited and insufficient to estimate cancer prevalence, and recommendations for screening and preventive care depend on the patients’ hormonal and surgical status. Even less information exists regarding the sub-set of individuals with genetic predisposition for these malignancies. In this review, we aimed to summarize current recommendations for gynecologists and gynecologic oncologists regarding cancer screening and personalized cancer-risk assessment in transgender people.

scholarly journals Personality Disorders and Personality Profiles in a Sample of Transgender Individuals Requesting Gender-Affirming Treatments

2020 ◽  
Vol 17 (5) ◽  
pp. 1521 ◽  
Author(s):  
Annalisa Anzani ◽  
Chiara De Panfilis ◽  
Cristiano Scandurra ◽  
Antonio Prunas
Keyword(s):  
Personality Disorders ◽  
Minority Stress ◽  
Transgender Women ◽  
Self Report ◽  
Personality Profiles ◽  
Transgender People ◽  
Dsm Iv ◽  
Personality Patterns ◽  
Minority Stress Model ◽  
Transgender Men

The study aims to explore the personality patterns of a group of transgender individuals who accessed an Italian gender clinic to undergo gender affirming treatments, by evaluating both dimensional personality domains proposed by the Alternative Model of Personality Disorders and categorical DSM-IV personality disorder (PD) diagnoses. Eighty-seven participants (40 transgender women and 47 transgender men) completed the Personality Inventory for DSM-5 and the Structured Clinical Interview for DSM-IV Axis II personality disorders. Scores obtained were compared to those of the normative samples of cisgender women and men. Results indicated that transgender women scored lower than cisgender women on two main domains (Negative Affectivity and Psychoticism) and on seven facets. As for transgender men, lower scores than cisgender men were found on Antagonism and on five facets. Transgender men scored higher than cisgender men on Depressivity. Nearly 50% of participants showed at least one PD diagnosis, with no gender differences in prevalence. Borderline PD was the most frequent diagnosis in the overall sample. Self-report measures provide a less maladaptive profile of personality functioning than the clinician-based categorical assessment. Results are interpreted in the light of the Minority Stress Model and support the need for a multi-method assessment of personality in medicalized transgender people.

scholarly journals Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations

Sexual Health ◽  
2017 ◽  
Vol 14 (5) ◽  
pp. 456 ◽  
Author(s):  
Sarah MacCarthy ◽  
Tonia Poteat ◽  
Zhiyu Xia ◽  
Nicolette L. Roque ◽  
Ashley (Hyun Jin) Kim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transgender Women ◽  
Transgender People ◽  
Sti Prevention ◽  
Healthcare Settings ◽  
Sexually Transmissible Infections ◽  
Individual Determinants ◽  
The Usa ◽  
Reported Data ◽  
Transgender Men

Transgender populations are heavily burdened by HIV and other sexually transmissible infections (STIs). However, data on co-infection with HIV and STIs among transgender people are limited. A systematic review was conducted of peer-reviewed articles and conference abstracts between January 2010 and November 2015 that focussed on HIV and STI infections among transgender populations globally. The literature was synthesised and opportunities for improving health research were commented on. Few studies reported HIV–STI co-infection (n = 4), while the majority of studies reported HIV and STI infections separately (n = 23). Most studies were conducted outside of the USA (n = 19), and all but one of these studies reported data on transgender women only. Among USA-based studies (n = 8), several reported data on both transgender men and transgender women (n = 3), whereas other studies reported exclusively on transgender men (n = 1) or transgender women (n = 4). Understanding HIV and STIs among transgender people requires research that simultaneously considers multilevel drivers of vulnerabilities. More data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations. Leveraging the knowledge of transgender-specific determinants of HIV and STIs should guide the content and approaches to future HIV and STI prevention and treatment efforts.

Timing of Puberty Suppression and Surgical Options for Transgender Youth

2021 ◽  
pp. 83-90
Author(s):  
Tim C. van de Grift ◽  
Zosha J. van Gelder ◽  
Margriet G. Mullender ◽  
Thomas D. Steensma ◽  
Annelou L.C. de Vries ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Transgender Women ◽  
Breast Development ◽  
Sex Characteristics ◽  
Long Term Effects ◽  
Endocrine Society ◽  
Puberty Suppression ◽  
Surgical Options ◽  
Transgender Men

OBJECTIVES Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitted or less invasive after PS. In transgender women, the mean penile length was significantly shorter in the PS groups compared with controls (by 4.8 cm [Tanner 2/3] and 2.1 cm [Tanner 4/5]). As a result, the likelihood of undergoing intestinal vaginoplasty was increased (odds ratio = 84 [Tanner 2/3]; odds ratio = 9.8 [Tanner 4/5]). CONCLUSIONS PS reduces the development of sex characteristics in transgender adolescents. As a result, transgender men may not need to undergo mastectomy, whereas transgender women may require an alternative to penile inversion vaginoplasty. These surgical implications should inform decision-making when initiating PS.

scholarly journals Management of endocrine disease: Optimal feminizing hormone treatment in transgender people

2021 ◽  
Author(s):  
Dorte Glintborg ◽  
Guy T'Sjoen ◽  
Pernille Ravn ◽  
Marianne Skovsager Andersen
Keyword(s):  
Gender Dysphoria ◽  
Cyproterone Acetate ◽  
Hormonal Treatment ◽  
Hormone Treatment ◽  
Transgender Women ◽  
Special Focus ◽  
Transgender People ◽  
Androgen Treatment ◽  
Randomized Protocols

Transgender women are assigned male at birth, but identify as women. The incidence of gender dysphoria is estimated to be around 1% of the population. Gender dysphoria may be associated with depression and low quality of life, which in most cases improves during gender affirming hormonal treatment (GAHT). Feminizing hormonal treatment for transgender women or gender non-binary people typically includes natural estrogen (estradiol). Additional testosterone-blocking treatment is often needed to ensure suppression of the pituitary gonadal axis and may include cyproterone acetate, a gonadotropin releasing hormone agonist (GnRH-a) or spironolactone. The health risks of cyproterone acetate as anti-androgen treatment are debated and randomized protocols with other anti-androgen treatments are requested. Orchiectomy is performed in some transgender women after various duration of GAHT. Currently, natural progesterone is not recommended as part of GAHT due to limited knowledge on the balance between risks and benefits. In the present article we discuss evidence regarding established and upcoming feminizing treatment for adult transgender women or for gender non-binary people seeking feminization. Data on study populations with transgender women are put into a wider context of literature regarding effects of sex steroid hormones in cisgender study populations. Relevant follow up and monitoring during feminizing treatment is debated. The review has special focus on the pharmacotherapy of feminizing hormonal therapy.

Long-Term Effects of Growth Hormone Treatment on Height in Turner Syndrome: Results of a 6-Year Multicentre Study in Japan

1995 ◽  
Vol 43 (4) ◽  
pp. 141-143 ◽  
Author(s):  
K. Takano ◽  
K. Shizume ◽  
I. Hibi ◽  
M. Ogawa ◽  
Y. Okada ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Multicentre Study ◽  
Turner Syndrome ◽  
Growth Hormone Treatment ◽  
Hormone Treatment ◽  
Long Term Effects

scholarly journals Altered sexual differentiation of hepatic uridine diphosphate glucuronyltransferase by neonatal hormone treatment in rats

1979 ◽  
Vol 180 (2) ◽  
pp. 313-318 ◽  
Author(s):  
Coral A. Lamartiniere ◽  
Cindy S. Dieringer ◽  
Etsuko Kita ◽  
George W. Lucier
Keyword(s):  
Enzyme Activity ◽  
Adult Male ◽  
Sexual Differentiation ◽  
Reproductive Tract ◽  
Testosterone Propionate ◽  
Hormone Treatment ◽  
Male Rats ◽  
Ventral Prostate ◽  
Uridine Diphosphate ◽  
Neonatal Administration

The hepatic microsomal enzyme UDP-glucuronyltransferase undergoes a complex developmental pattern in which enzyme activity is first detectable on the 18th day of gestation in rats. Prepubertal activities are similar for males and females. However, postpubertal sexual differentiation of enzyme activity occurs in which male activities are twice those of females. Neonatal administration of testosterone propionate or diethylstilboestrol to intact animals resulted in lowered UDP-glucuronyltransferase activity in liver microsomal fractions of adult male rats, whereas no changes were observed in the adult females and prepubertal male and female animals. Neonatal administration of testosterone propionate and diethylstilboestrol adversely affected male reproductive-tract development as evidenced by decreased weights of testes, seminal vesicles and ventral prostate. Diethylstilboestrol also markedly decreased spermatogenesis. Hypophysectomy of adult male rats resulted in negative modulation of microsomal UDP-glucuronyltransferase and prevented the sexual differentiation of enzyme activity. In contrast hypophysectomy had no effect on female UDP-glucuronyltransferase activity. A pituitary transplant under the kidney capsule was not capable of reversing the enzyme effects of hypophysectomy, therefore suggesting that the male pituitary factor(s) responsible for positive modulation of UDP-glucuronyltransferase might be under hypothalamic control in the form of a releasing factor. Neonatal testosterone propionate and diethylstilboestrol administration apparently interfered with the normal sequence of postpubertal UDP-glucuronyltransferase sexual differentiation.

scholarly journals A limited review of over diagnosis methods and long-term effects in breast cancer screening

2011 ◽  
pp. 143-147
Author(s):  
Dongfeng Wu ◽  
Adriana Pérez
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Early Detection ◽  
Breast Cancer Screening ◽  
Screening Program ◽  
Critical Issue ◽  
Long Term Effects ◽  
Screening Programs ◽  
Probability Modeling

Breast cancer screening programs have been effective in detecting tumors prior to symptoms. Recently, there has been concern over the issue of over-diagnosis, that is, diagnosis of a breast cancer that does not manifest prior to death. Estimates for over-diagnosis vary, ranging from 7 to 52%. This variability may be due partially to issues associated with bias and/or incorrect inferences associated with the lack of probability modeling. A critical issue is how to evaluate the long-term effects due to continued screening. Participants in a periodic screening program can be classified into four mutually exclusive groups depending on whether individuals are diagnosed and whether their symptoms appear prior to death: True-earlydetection; No-early-detection; Over-diagnosis; and Not-sonecessary. All initially superficially healthy people will eventually fall into one of these four categories. This manuscript reviews the major methodologies associated with the over-diagnosis and long-term effects of breast cancer screening.

scholarly journals Monitoring Long-Term Cardiovascular Risk from Estrogen Use in Transgender Women - Evidence Update for Clinicians

2002 ◽  
Author(s):  
Keyword(s):  
Hormone Therapy ◽  
Female Gender ◽  
The United States ◽  
Transgender Women ◽  
Cardiovascular Risks ◽  
Psychological Benefits ◽  
Transgender People ◽  
New Information ◽  
Primary Care Clinicians

A PCORI-funded study provides new information for primary care clinicians about the need to monitor long-term cardiovascular risks in transgender women receiving hormone therapy. Approximately 1.4 million transgender people live in the United States. Many transgender women pursue medical transition with hormone therapy including estrogen to align their bodies with their female gender identity. Evidence suggests that medical transition confers significant psychological benefits including reduced depression, anxiety, and suicidality and improved quality of life. However, the risks of using estrogen, including cardiovascular risks, are not well understood. Recent evidence on these risks can help inform decisions and improve care for transgender women who are currently using or formerly used estrogen.

scholarly journals Effects of reproductive tract development and hormonal treatment on estrous synchronization in heifers

2020 ◽  
pp. 198
Author(s):  
Jorge Alonso Peralta-Torres ◽  
Jesús Ricardo Aké-López ◽  
Carlos Luna-Palomera ◽  
José Candelario Segura-Correa ◽  
Oswaldo Margarito Torres-Chablé ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Reproductive Tract ◽  
Bos Indicus ◽  
Hormonal Treatment ◽  
Hormone Treatment ◽  
Fixed Time ◽  
Estradiol Benzoate ◽  
Visual Observation ◽  
Estrous Synchronization ◽  
Tropical Conditions

Evaluation of the reproductive tract development (RTD) is a criterion rarely used when heifers are included in estrous synchronization programs. The objective of the present study was to determine the effect of RTD (mature and immature) and hormonal treatment (EC and EB) on estrous expression rate and pregnancy rate in Bos indicus heifers under tropical conditions. RTD was evaluated with an ultrasound and classified as mature (n=99) or immature (n=101). Heifers received an intravaginal device (DIB®; day 0), 2 mg of estradiol benzoate (EB) and 250 µg of cloprostenol (PGF2α). The DIB was removed on day 7 post insertion, and 250 µg of PGF2α was applied and heifers were divided into two groups: One group of heifers received 0.5 mg of estradiol cypionate (EC group), and on day 8, a second group of heifers received 1 mg of estradiol benzoate (EB group). Estrus was detected by visual observation, and all heifers were inseminated at a fixed-time (FTAI). Fifteen days after insemination, bulls were introduced to the treatment groups. Data were analyzed using general modeling and binary logistic regression procedures. The percentage of estrus was similar for both mature and immature heifers (P>0.05), however, the heifers treated with EB had 17% animals in estrus, than the heifers that received EC (P <0.05). The pregnancy rate after FTAI (74.8%) and total pregnancy (FTAI + natural mating = 91.9%) was greater for the group of heifers with a mature reproductive tract (P<0.05). The hormone treatment had not effect (P>0.05) on the pregnancy rate. In conclusion, the heifers with mature reproductive tracts had the highest pregnancy rate after artificial insemination and total pregnancy. Hormonal treatment did not influence the pregnancy rate.

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