Male-to-Female Sex Reassignment Surgery in Transsexuals

ABSTRACT

The technique of male-to-female sex reassignment surgery in a sample of 500 patients is described in detail and illustrated by 27 figures. Appropriate technique and care results in a naturally looking vulva and a functioning vagina. The complication rate is low, and most complications can be overcome by adequate correctional interventions.     

变性术后患者心理状况的影响因素分析及对策

变性术后的患者是个特殊的弱势群体,心理问题非常突出,它是生理、个人、家庭、社会等多种因素交互影响的结果;因此,通过社会、家庭及个体的共同努力,帮助其建立良好的个体心理模式,稳定其心理状态,可促进其心理的健康发展,这对于变性手术的成功和帮助变性后患者重新走向社会有重要意义。     

Supporting Transgender and Sex Reassignment Issues

SUMMARY

For the care provider unfamiliar with supporting transsexual and transgender persons, as well as their partners, it becomes an imperative to be able to identify this population's unique needs, transition concerns and relationship dynamics. New challenges arise as transgender clients become more prevalent within the GLBT community and contact community clinical resources. These include distinguishing between sexual orientation and the complexities of gender identity; differentiating actual transgender issues and ordinary relationship concerns; and recognizing characteristics of strong relationships versus those doomed to fail when one or both partner's needs can no longer get met.

This article reviews an abundance of stereotypes adversely affecting transgender individuals, relationships and which can taint the treatment environment. At a core level, there exists the need for care providers to recognize when having a transgender identity stops being a disorder, such as when the client is no longer gender dysphoric, and where the care provider needs to advocate the individual's right of self-determination. This includes recognizing when situational depression or anxiety and social discrimination are the actual root of ongoing individual and relationship concerns. With basic transgender knowledge, effectively supporting transgender persons and their relationships is possible for cross-specialty providers, and is recommended.     

Evolution of Gonadal Axis After Sex Reassignment Surgery in Transsexual Patients in the Spanish Public Health System

ABSTRACT

Although the effects of hormone therapy on cardiovascular risk factors and bone metabolism have been studied, data are lacking on the gonadotropin profile after gonadectomy in the sex reassignment process (SRP). Accordingly, whether measurement of the gonadotropin profile is useful in order to adjust the postsurgical dose of gonadal hormones is unknown. We studied the evolution of LH, FSH, prolactin, testosterone, and estradiol in 50 transsexual persons, 41 male-to-female transsexuals (MtF) and 9 female-to-male transsexuals (FtM), following a proto-colized regimen of hormone therapy for 12–24 months before and after genitoplasty. The increase in gonadotropins after surgery was greater in the FtM than in the MtF (66% vs. 50%), with the increase continuing more than one year after surgery. No variable was significantly associated with this different level of gonadotropins.     

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

Abstract

Background: Different surgical procedures are available for transgender women wishing to undergo genital gender-affirming surgery.

Aim: To assess preoperative motivations, the frequency of orchiectomy procedures, and postoperative outcomes of orchiectomy in transgender individuals.

Methods: All transgender individuals who underwent orchiectomy in the period between January 2012 and January 2020 at our institution were retrospectively identified. A chart study was conducted, recording motivations, demographics, perioperative characteristics and surgical outcomes. The frequency of orchiectomy and vaginoplasty procedures during the study period were determined and compared.

Results: During the study period, an increase of performed orchiectomy procedures was observed. The orchiectomy/vaginoplasty ratio was 0.01–0.07 in the period 2012–2018 and 0.24 in 2019. A total of 43 transgender individuals were retrospectively identified. Sixteen (37%) initially wished to undergo a vaginoplasty, but did not meet institutional requirements (nonsmoker, BMI < 30kg/m²) or were not eligible for vaginoplasty surgery because of interfering somatic or mental health issues. Fourteen (33%) individuals who underwent orchiectomy regarded it as a preceding step to a future vaginoplasty procedure. Out of these fourteen, one person is now on the waiting list for vaginoplasty surgery. Thirteen (30%) others did not report a desire to pursue vaginoplasty in the future. This was mostly motivated by the absence of genital dysphoria or motivations related to their gender identity, with a desire to discontinue anti-testosterone treatment. The postoperative course was uncomplicated in 39 (91%) individuals.

Conclusion: In the Netherlands, especially in the last year, the frequency of orchiectomy procedures has increased. Reasons that people chose to undergo this procedure include: not being eligible for a vaginoplasty procedure, seeing it as a preceding step to a possible future vaginoplasty or other identity-related motivations (i.e., non-binary gender identification or absence of genital dysphoria).     

Enlarged Range of Free Flaps for Phalloplasty in Transsexual Reassignment Surgery

ABSTRACT

Our concept for complete phalloplasty which we applied in 66 female-to-male transsexuals, using free prelaminated osteofasciocutaneous fibula or fasciocutaneous forearm flaps, consisted of the following three operative stages:

1. mastectomy, ovariohysterectomy, urethra lengthening, colpectomy, and neourethra prelamination

2. after 3–6 months, neophallus creation with free sensate and prelaminated osteofasciocutaneous fibula (n = 41) or radial forearm flaps (n = 25)

3. 3–6 months later, urethral connection, neoscrotum formation and testicle prosthesis implantation.

Results: After mastectomy 2 hematoma had to be removed, and twice colpectomy revision was needed because of hematoma. No complications occurred after ovariohysterectomy. Partial flap necrosis took place in 1 patient of the forearm group and total necrosis in 2 patients of the fibula group. Eleven patients presented urethral stricture, and 9 a fistula. In 7 patients an operative stricture expansion was required, and in 6 patients surgical closure of the fistula. Overall patients' satisfaction was excellent.

Conclusions: The applied results demonstrates the effectiveness of such a multistage and interdisciplinary approach for female-to-male transsexual and it shows, that the fibula flap is an equal routine method extending the therapeutical range of gender assignment operations in female-to-male transsexuals.     

Transgender Primary Medical Care

SUMMARY

Transgender medical care involves addressing general medical conditions and those related specifically to transgender issues. This article summarizes existing research in transgender medicine and provides guidance for family physicians and nurses in adapting standard primary care protocols relating to health maintenance, acute illness, and chronic disease management to address trans-specific clinical oncerns. Trans-specific issues in physical examination, health history, interpretation of laboratory tests, vaccination, screening, and treatment are explored, and the role of the primary care provider in caring for patients undergoing hormonal or surgical change is discussed.     

Counseling and Mental Health Care for Transgender Adults and Loved Ones

SUMMARY

Increasingly, transgender individuals and loved ones (partners, family, and friends) are seeking assistance from mental health professionals working in the community rather than in university or hospital-based gender identity clinics. Drawing on published literature specific to transgender mental health, interviews with expert clinicians, the authors' clinical experience, and three key guiding principles (a transgender-affirmative approach, client-centered care, and a commitment to harm reduction), we suggest protocols for the clinician providing mental health services in the community setting. Practice areas discussed include assessment and treatment of gender concerns, trans-specific mental health issues, and trans-specific elements in general counseling of transgender individuals and their loved ones.     

Ethical,Legal, and Psychosocial Issues in Care of Transgender Adolescents

SUMMARY

Complete care for transgender adolescents must be considered in the context of a holistic approach that includes comprehensive primary care as well as cultural, economic, psychosocial, sexual, and spiritual influences on health. Not all transgender adolescents have gender dysphoria or wish to undergo sex reassignment. In this article we focus on general care of transgender adolescents by the non-specialist working in primary care, family services, schools, child welfare, mental health, and other community settings.     

Clinical Aspects of Transgender Speech Feminization and Masculinization

SUMMARY

Societal norms of speech, voice, and non-verbal communication are often strongly gendered. For transgender individuals who experience a mismatch between existing communication behaviours and felt sense of self, changes to the gendered aspects of communication can help reduce gender dysphoria, improving mental health and quality of life. While peer resources are often beneficial in changing overall appearance and presentation, speech and voice modification is best facilitated by a trans-competent speech professional. In this article we review clinical research relating to transgender speech and voice change and discuss clinical protocols for trans-specific assessment, treatment, and outcome evaluation.     

Sex vs. Gender

SUMMARY

This article was first published in D. R. Laub and P. Gandy, (eds), Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, Stanford University Medical Center, Stanford, California, 1973, pp. 20–24. Prince argues that previous contributors to the symposium in using such terms as “gender conversion surgery” and “anatomic and genetic gender” were failing to grasp the distinction between sex and gender. Genital anatomy is about sex; gender role is about a lifestyle. Out of 100 people applying for a surgery perhaps only 10 percent should have it. The majority confuse sex and gender and fail to appreciate that what they are seeking is a gender change and not a sexual change. Prince likes the word “dysphoria” but argues for distinguishing sexual dysphoria from gender dysphoria. They are different and people should be treated according to which one they happen to be suffering from.     

Social and Medical Transgender Case Advocacy

SUMMARY

While some clients are confident self-advocates, many transgender individuals and loved ones find it difficult to advocate for themselves and turn to a trusted clinician for assistance. This article discusses the role of the health and social service clinician in transgender case advocacy. Although the setting, circumstances, and client needs vary greatly, the overarching goal of clinical advocacy is to address the societal barriers that interfere with clients' functionality and well-being. We suggest a protocol for advocacy assessment in the clinical setting and discuss trans-specific advocacy concerns relating to financial assistance, employment, changing identification, general advocacy, and outline concerns of specific populations within the transgender community.     

Considerations on medical training for gender-affirming care: Motivations and perspectives

Abstract

Background: Many transgender individuals lack access to needed medical care, partially due to a lack of providers with experience in gender-affirming healthcare.

Aims: The purpose of this study was to identify professional motivators for medical providers seeking out training in gender-affirming care and to define which training experiences were most beneficial to their career development. By identifying experienced providers’ recommendations on which training modalities are most relevant to their practice, we aim to suggest future directions for medical education initiatives to effectively expand the transgender care workforce.

Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and publicly-available referral lists to interdisciplinary providers who self-identified as having experience in providing care to transgender individuals.

Results: One hundred and fifty-three (n?=?153) physicians, physician assistants, or advance-practice nurses responded to the survey. The majority (96.7%) were located in the United States, representing 37 states. The two most common motivators for seeking out training in gender-affirming care were filling a need in the community (73.0%) and/or having met a transgender-identified person in a clinical setting who requested care (63.8%). While many providers gained skills independently (57.3%), the two most commonly-available training opportunities were professional conferences (57.3%) and mentorship (41.3%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience (e.g., a rotation or longitudinal exposure during training), rather than additional didactic training.

Discussion: This study identifies key high-yield training methodologies which could improve access to quality gender-affirming healthcare. Through integration of structured clinical experiences during training, direct clinical mentorship, and professional development at conferences on gender-affirming care, the workforce of welcoming and prepared healthcare providers for transgender patients will increase. This will lead to a tremendous improvement on access to gender-affirming care in our communities.     

β2-糖蛋白Ⅰ依赖性自身抗体与自然流产的关系

为探讨β2-糖蛋白Ⅰ依赖性自身免疫抗体对自然流产病因诊断价值.将59名自然流产患者作为研究组,同时选择29名正常妊娠的产妇作为对照组.结论显示检测抗磷脂抗体能提高对自然流产患者病因诊断,β2-糖蛋白Ⅰ依赖性抗心磷脂抗体的特异性较单纯抗心磷脂抗体的特异性高,诊断妊娠丢失的病因更准确.     

Morphological and morphometric changes in the faces of female-to-male (FtM) transsexual people

Facial changes associated with the administration of exogenous testosterone and bilateral oophorectomy in female-to-male (FtM) transsexual people (trans men; trans males) has not been previously documented. This study aimed to describe the qualitative and quantitative transformation from a female to a male facial appearance and to identify predictable patterns of change. Twenty-five trans men were studied using morphological and morphometrical analysis of pre-transition 2-D images and post-transition 3-D scan models. The mean subject age was 39 years and all subjects had been taking testosterone for at least 3 years, with a mean duration of therapy of 8.6 years. While 32% of subjects were classified by a majority of observers as male appearing in pre-transition photographs, this rose to 95.5% in post-transition images. Eighty-six percent of subjects demonstrated an increase in male classification after transition. Morphometrically, 44% of subjects became wider in the face overall and 100% of subjects measured demonstrated a narrower nose after transition. Testosterone virilizes adult female faces and will cause widening of the face. The most consistent facial change was the production of a narrower nasal width at the alae, which may be a result of fat re-deposition not related to ageing effects or body mass index (BMI).     

关于性别刻板印象的初步调查

性别刻板印象是一种重要的社会刻板印象。我们在 3 80名大学生中作了性别刻板印象的初步调查 ,并考察了性别和性别角色对性别刻板印象的影响。结果发现中国大学生的性别刻板印象与传统的性别观念比较一致 ,认为男性更坚强能干 ,女性更被动顺从 ,且这一印象不因性别和性别角色而改变。但男女被试的性别刻板印象仍存在明显差异。不同性别角色被试之间的性别刻板印象也有差异。总体而言 ,性别对性别刻板印象的影响比性别角色对性别刻板印象的影响大。     

Views of individuals with gender dysphoria and disorders of sex development on sexism: An Iranian study

ABSTRACT

Background: Ambivalent sexist attitudes have been previously measured regarding several factors such as sex, race and religion.

Aims: In this study, we evaluated the ambivalent sexism among Iranian individuals with gender dysphoria with or without disorders of sex development (DSD).

Methods: Attitudes towards gender stereotypes were investigated using Ambivalent Sexism Inventory (ASI) among three groups of participants with varying psychosexual outcome. These groups were transpeople (N = 152, M = 25.44, SD = 6.52), people with DSD (N = 40, M = 21.2, SD = 2.24) and cisgender people (N = 195, M = 25.9, SD = 5.59).

Results: Significant differences in both types of sexism, benevolent (F (2,383) = 134.217, p < .001) and hostile (F (2,383) = 93.765, p < .001), were found between transpeople, participants with DSD and controls. While scores of transpeople and people with DSD were not significantly different from each other (p = 0.191, Cohen's d = 0.38), both groups were significantly more sexist than controls on hostile sexism (p < 0.001, Cohen's d = 1.4 and 1.1). In benevolent sexism, there were significant differences between the scores of the trans, DSD and control groups, with individuals with DSD being most sexist followed by transgender people (p < 0.001) and controls showing the least degree of sexism (p < 0.001).

Conclusion: Using the Gender Self-Socialization Model (GSSM), we propose that increased scores of ASI among individuals whose gender identity is incongruent with all or some of their physical features are attempts to attain gender typicality. This may lead to a higher degree of sexist beliefs than when all sex and gender characteristics are congruent.     

微创外科手术的人文关怀

医学存在自然和人文双重属性,医疗服务必须体现人文关怀。人文关怀的核心是以人为本,强调对人的尊重、理解、关心和爱护,重视人的作用。微创外科是传统外科的一场深刻的技术革命,其哲学基础是以人为本。微创外科手术以患者为主体和中心,提出对患者的主体地位和自由权的尊重;以减少对患者的创伤和痛苦为目的,强调患者的价值和尊严,重视对患者的无限关怀,其开创和发展充分体现了人文关怀的精神实质。