In the current report, we describe an 83-year-old biological male who self- identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. ...In the current report, we describe an 83-year-old biological male who self- identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. The medical history of this individual indicated complete penectomy without further specification. Postmortem physical examination revealed an absence of penis with a large scrotum, transposed urethral orifice, and small testes. The histological analysis of the testes identified abnormal epithelium in the seminiferous tubules that lacked germ and Sertoli cells as well as the interstitium without Leydig cells present. The exome sequencing of the individual’s DNA using the Next Generation Sequencing (NGS) Illumina platform revealed no genetic variants associated with either penile or urethral cancer that could have explained the complete penectomy, but pointed toward a potentially impaired production of T3 and T4 thyroid hormones which could account for the observed testicular malformation. Overall, the data obtained raise an important question as to whether the thyroid hormone axis could be an important part of the hormonal architecture supporting male sexual behavior.展开更多
Male breast disorders,though less prevalent,present unique diagnostic cha-llenges that differ significantly from their female counterparts.While benign entities such as gynecomastia are predominant,the risk of underly...Male breast disorders,though less prevalent,present unique diagnostic cha-llenges that differ significantly from their female counterparts.While benign entities such as gynecomastia are predominant,the risk of underlying malig-nancy,often diagnosed at an advanced stage,highlights the need for a systematic,image-guided assessment.Ultrasound and mammography are the first-line complementary tools,with magnetic resonance imaging reserved for problem-solving.This review outlines the anatomical,pathological,and radiological nu-ances of the male breast,describing crucial red flag signs,sonographic pitfalls,and mammographic mimics that aid in distinguishing benign entities from si-nister pathologies such as invasive ductal carcinoma.Given the increasing visi-bility of transgender individuals,this review also addresses imaging consider-ations and screening recommendations tailored to this population.By integrating clinical insights with radiologic imaging,this review offers a comprehensive approach to both common and not-so-common male breast lesions,with an em-phasis on an algorithmic stepwise diagnostic approach.展开更多
Robust preclinical models of transgender male(TGM) gender-affirming hormone therapy(GAHT) can inform clinicians of the isolated effects of GAHT;however existing models vary significantly in approach. We aimed to asses...Robust preclinical models of transgender male(TGM) gender-affirming hormone therapy(GAHT) can inform clinicians of the isolated effects of GAHT;however existing models vary significantly in approach. We aimed to assess existing methodology and how it influences circulating sex-hormone levels in rodent models of TGM GAHT to provide recommendations of best practise. Pub Med, Embase, and Scopus databases were systematically searched for studies that investigated GAHT in rodent models and were published from inception to the 1st of August 2024. Study characteristics and methodology were extracted and compared. Post-intervention circulating sex hormone concentrations were the primary outcome used to determine whether successful gender affirming hormone therapy had been achieved. Sixteen experimental rodent studies were included. Studies were performed on mice( n = 11) and rats( n = 5). Subcutaneous(SC) pellets and SC silastic implants were featured in some studies but weekly SC injections of testosterone enanthate was the preferred method. Sesame oil was the preferred solvent for injected testosterone formulations. Weekly doses of ~ 450 μg(mice) and ~ 420–900 μg(rats) consistently induced the testosterone levels of the male counterpart. Similarly, 10 mg of unesterified testosterone in a SC silastic implant in mice or 10 mg/100 g in rats were also successful methods. Most studies administered hormones for 6–8 weeks before performing post-treatment assessments. This review demonstrates that methods largely varied across studies and successfully identifies the effective methodological approaches that improve the reproducibility and accuracy of preclinical models. Representing an integral step forward to bridging gaps in preclinical transgender healthcare research.展开更多
Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill pa...Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill patients.In the setting of critical illness,the interactions between GAHT and the body's endocrine response are complex.GAHT can influence the hypothalamic-pituitary-adrenal axis,sex hormone levels,and metabolic parameters,potentially complicating the clinical picture.For example,estrogen therapy in transgender women increases the risk of venous thromboembolism,which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients.Testosterone therapy in transgender men can lead to erythrocytosis,increasing the risk of thromboembolic events during critical illness.The potential for drug interactions,particularly with medications used in the intensive care unit,also requires careful consideration.Monitoring hormone levels and adjusting GAHT in the acute setting are crucial,although evidence-based guidelines are lacking.The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.展开更多
Introduction:Direct-to-consumer(DTC)telemedicine has emerged as an option for transgender patients seeking gender affirming hormone therapy(GAHT).We aimed to characterize the healthcare services provided by DTC teleme...Introduction:Direct-to-consumer(DTC)telemedicine has emerged as an option for transgender patients seeking gender affirming hormone therapy(GAHT).We aimed to characterize the healthcare services provided by DTC telemedicine companies offering GAHT and to compare their costs to a tertiary care center.Methods:We identified DTC telemedicine platforms offering GAHT via internet searches and extracted information from their websites related to evaluation,treatment,monitoring,and cost.Cost of theDTC GAHT was compared to cost for comparable services at a tertiary care center.Results:Six DTC companies were identified.All platforms utilized an informed consent model without prerequisite mental health evaluation for GAHT.Platforms did not provide comprehensive mental health services.All platforms endorsed the use of regular follow up visits throughout the treatment period although interval of laboratory assessment varied.Cost estimates were comparable for uninsured patients and higher compared to those for insured patients.Cost estimates were lowest with private and public insurance at the tertiary center.Conclusions:DTC telemedicine platforms offering GAHT appear to be in line with the recently released World Professional Association for Transgender Health standards of care regarding the laboratory evaluation and monitoring,but it is unclear whether they are compliant with other recommendations.These platforms offer competitive costs for TGD patients without insurance.展开更多
Background: The degree to which one identifies as male or female has a profound impact on one’s life. Yet, there is a limited understanding of what contributes to this important characteristic termed gender identity....Background: The degree to which one identifies as male or female has a profound impact on one’s life. Yet, there is a limited understanding of what contributes to this important characteristic termed gender identity. In order to reveal factors influencing gender identity, studies have focused on people who report strong feelings of being the opposite sex, such as male-to-female (MTF) transsexuals. Method: To investigate potential neuroanatomical variations associated with transsexualism, we compared the regional thickness of the cerebral cortex between 24 MTF transsexuals who had not yet been treated with cross-sex hormones and 24 age-matched control males. Results: Results revealed thicker cortices in MTF transsexuals, both within regions of the left hemisphere (i.e., frontal and orbito-frontal cortex, central sulcus, perisylvian regions, paracentral gyrus) and right hemisphere (i.e., pre-/post-central gyrus, parietal cortex, temporal cortex, precuneus, fusiform, lingual, and orbito-frontal gyrus). Conclusion: These findings provide further evidence that brain anatomy is associated with gender identity, where measures in MTF transsexuals appear to be shifted away from gender-congruent men.展开更多
BACKGROUND Transgender individuals receiving masculinising or feminising gender-affirming hormone therapy with testosterone or estradiol respectively,are at increased risk of adverse cardiovascular outcomes,including ...BACKGROUND Transgender individuals receiving masculinising or feminising gender-affirming hormone therapy with testosterone or estradiol respectively,are at increased risk of adverse cardiovascular outcomes,including myocardial infarction and stroke.This may be related to the effects of testosterone or estradiol therapy on body composition,fat distribution,and insulin resistance but the effect of genderaffirming hormone therapy on these cardiovascular risk factors has not been extensively examined.AIM To evaluate the impact of gender-affirming hormone therapy on body composition and insulin resistance in transgender individuals,to guide clinicians in minimising cardiovascular risk.METHODS We performed a review of the literature based on PRISMA guidelines.MEDLINE,Embase and PsycINFO databases were searched for studies examining body composition,insulin resistance or body fat distribution in transgender individuals aged over 18 years on established gender-affirming hormone therapy.Studies were selected for full-text analysis if they investigated transgender individuals on any type of gender-affirming hormone therapy and reported effects on lean mass,fat mass or insulin resistance.RESULTS The search strategy identified 221 studies.After exclusion of studies that did not meet inclusion criteria,26 were included(2 cross-sectional,21 prospectiveuncontrolled and 3 prospective-controlled).Evidence in transgender men suggests that testosterone therapy increases lean mass,decreases fat mass and has no impact on insulin resistance.Evidence in transgender women suggests that feminising hormone therapy(estradiol,with or without anti-androgen agents)decreases lean mass,increases fat mass,and may worsen insulin resistance.Changes to body composition were consistent across almost all studies:Transgender men on testosterone gained lean mass and lost fat mass,and transgender women on oestrogen experienced the reverse.No study directly contradicted these trends,though several small studies of short duration reported no changes.Results for insulin resistance are less consistent and uncertain.There is a paucity of prospective controlled research,and existing prospective evidence is limited by small sample sizes,short follow up periods,and young cohorts of participants.CONCLUSION Further research is required to further characterise the impact of genderaffirming hormone therapy on body composition and insulin resistance in the medium-long term.Until further evidence is available,clinicians should aim to minimise risk by monitoring cardiovascular risk markers regularly in their patients and encouraging healthy lifestyle modifications.展开更多
Background and Aims:The Union Cycliste Internationale has deemed transgender female athlete’s ineligible for the female category due to concerns about performance advantages.We conducted a follow-up analysis on labor...Background and Aims:The Union Cycliste Internationale has deemed transgender female athlete’s ineligible for the female category due to concerns about performance advantages.We conducted a follow-up analysis on laboratorybased performance indicators of sports performance using data from a longitudinally assessed transgender woman athlete undergoing gender-affrming hormone therapy(GAHT).Methods:We evaluated laboratory performance indicators in transgender and cisgender women athletes using dualenergy X-ray absorptiometry scanning,handgrip strength measurement,jump testing,and cardiopulmonary exercise.Additionally,we assessed a transgender sub-elite cyclist before and after undergoing GAHT.Results:After one year of GAHT,the transgender athlete showed declines in handgrip strength(7–13%),countermovement jump(23–29%),and V̇O_(2)max(15–30%).After 3 months,several performance indicators(absolute handgrip,peak power,relative peak power,average power,relative average power,V̇O2max and relative V̇O_(2)max)were above the mean of cisgender female athletes,while others(Relative handgrip,countermovement jump and relative countermovement jump)were below.Similar trends were observed at 6 months and 1 year.Summary:This hypothetical analysis,although with limited evidence,suggests the transgender athlete could compete equitably in elite cycling events within the female category after one year of GAHT.Adjustments based on competition data would ensure fairness.Further analysis after an additional 12 months is recommended to assess the impact of 2 years of GAHT.An outright ineligibility for the female category for transgender women athletes would hinder a true assessment of performance fairness.展开更多
Transgender people sometimes use cross-sex hormones without medical supervision. The use of cross-sex hormones, as well as the functional health and mental well-being, among male-to-female transgendered people （＇kat...Transgender people sometimes use cross-sex hormones without medical supervision. The use of cross-sex hormones, as well as the functional health and mental well-being, among male-to-female transgendered people （＇kathoeys＇） in Chiang Mai, Thailand, was studied. Sixty kathoeys were interviewed regarding their use of cross-sex hormones and their familyrelationships. Individuals also completed the Life Orientation Test Revised （LOT-R） to assess dispositional optimism, the Social Functioning Questionnaire （SFQ） and the Short Form Health Survey 36 （SF-36）. Three categories were established as follows： those who never cross-dress, those who sometimes cross-dress and those who always cross-dress in public. Of the 60 subjects, 44 had used hormones for prolonged periods （9.7＋6.1 years）. Their use was related to the permanence of cross-dressing but unrelated to functional health and mental well-being. Fifty percent of subjects had overdosed on commonly used oral contraceptives. Three people used injectable oestrogen in a higher-than-recommended dose. Self-acceptance was high or reasonably good （83%） compared to no acceptance （17%）, and neither was related to the permanence of cross-dressing. Their acceptance by parents and siblings was also relatively high （85% and 89%, respectively）. The permanence of cross-dressing had no effect on the scores of optimism, SF-36 scores and social functioning. Acceptance by oneself or one＇s parents did not seem to affect most aspects of functional health and mental well-being, but non-acceptance by siblings generated lower scores on the social functioning and general mental health subscales. Stressors tended to include physical rather than social factors. In conclusion, the unsupervised use of cross-sex hormones was common among kathoeys, and 50% of the sample had overdosed on them. Acceptance was relatively good, except by siblings. New strategies are needed for a more responsible use of cross-sex hormones.展开更多
Transgender persons constitute a non-negligible percentage of the general population.Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries tha...Transgender persons constitute a non-negligible percentage of the general population.Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity.Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex.The administration of testosterone is the typical masculinizing treatment in trans men,whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophinreleasing hormone agonists if testes are present.Exogenous androgenic steroids,estradiol agents,and anti-androgens have been implicated in a series of hepatotoxic effects.Thus,liver integrity is a major concern with the long-term administration of cross-sex therapy.Hepatic tissue is susceptible to coronavirus disease 19(COVID-19)through various pathophysiological mechanisms.Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients.Appropriate care is significant,with continuous laboratory monitoring,clinical observation and,if needed,specific treatment,especially in severe cases of infection and in persons with additional liver pathologies.The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.展开更多
A group of 39 Transgender subjects, 17 Female to Male (FtM) and 22 Male to Female (MtF), have been evaluated about their sexual desire, activity, and satisfaction during the period before and after Sex Reassignment by...A group of 39 Transgender subjects, 17 Female to Male (FtM) and 22 Male to Female (MtF), have been evaluated about their sexual desire, activity, and satisfaction during the period before and after Sex Reassignment by Surgery (SRS). Visual Analogue Scale from 0 to 10 has been used to assess sexual desire and satisfaction, number of sexual partners and number of sexual intercourses/ month have been evaluated to assess sexual activity. Moreover, after the surgery, the Sexual Desire Inventory-2 (SDI-2) was administered to patients and related to testosterone (total or free) levels. In FtM, after hysterectomy and bilateral ovariectomy, mean value of sexual desire (VAS 0 - 10) was 7.5 before beginning testosterone therapy, this value increased after six months of therapy and after one year. Just before SRS the value decreased, but increased to 8.42 after SRS. In the same patients the values (VAS 0 - 10) on sexual satisfaction were respectively 6.5, 6.9, 7.1, 6.5 and 7. Mean number of partners was 4, with 7.07 mean frequency of sexual intercourse/month, before starting therapy (after hysterectomy). During hormonal therapy (testosterone), No. of partners was 2.46 and 8.96 intercourses/month, while after SRS the partners were 1.25 and intercouses/month 7.91. MtF patients reported a sexual desire (VAS 0 - 10) before therapy of 7, this remained almost constant after 6 months, decreases after 12 months and just before surgery, and finally increased to 7.76 after SRS. For sexual satisfaction mean values of VAS were respectively: 6.1, 6.2, 6.3, 6, and 6.8. Regarding sexual activity, MtF report 3.81 mean No. of partners and 9.27 intercouses/month before the beginning of hormonal therapy, 1.36 partners and 4.36 intercourses after therapy, and 1.3 partners and 4.54 intercourses after SRS.展开更多
Objective: The purpose of this study is to estimate the prevalence of HIV infection among the clients attending ICTC, LHMC of New Delhi, for a period of five years, i.e., from 2008 to 2012. Material & Method: A to...Objective: The purpose of this study is to estimate the prevalence of HIV infection among the clients attending ICTC, LHMC of New Delhi, for a period of five years, i.e., from 2008 to 2012. Material & Method: A total of 25,413 clients attended ICTC, LHMC from the year 2008 to 2012. Serum samples were collected after taking informed consent and pre-test counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guidelines has been followed for HIV testing, reporting and release of results with post test counseling. Results: Out of the total 25,413 clients tested for HIV infection, 963 (3.78%) were found to be HIV-1 seropositive. Seropositivity was higher in male clients i.e. 625 (64.4%) than female i.e. 336 (34.8%) followed by transgender (TG), i.e., 2 (0.2%). Heterosexual route of transmission was the major route seen in 676 clients (70.1%). Maximum HIV seropositivity was in the age group of 25 - 34 years (35.4%). No HIV-2 case was found among the studied population. Conclusion: HIV prevalence of 3.78% among the clients attending ICTC, LHMC, New Delhi, puts light on the burden on HIV in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups.展开更多
BACKGROUND Literature focused on cancer screening and management is lacking in the transgender population.AIM To action to increase contributions to the scientific literature that drives the creation of cancer screeni...BACKGROUND Literature focused on cancer screening and management is lacking in the transgender population.AIM To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming(TGNC)patients.METHODS We performed a systematic search of PubMed on January 5th,2022,with the following terms:“TGNC”,OR“transgender”,OR“gender non-conforming”,OR“gender nonbinary”AND“cancer screening”,AND“breast cancer”,AND“cervical cancer”,AND“uterine cancer”,AND“ovarian cancer”,AND“prostate cancer”,AND“testicular cancer”,AND“surveillance”,AND“follow-up”,AND“management”.70 unique publications were used.The findings are discussed under“Screening”and“Management”categories.RESULTS Screening:Current cancer screening recommendations default to cis-gender protocols.However,long-term genderaffirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection.The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer.Management:Prior to undergoing Gender Affirmation Surgery(GAS),discussion should address cancer screening and management in the organs remaining in situ.Cancer treatment in this population requires consideration for chemotherapy,radiation,surgery and/or reconstruction.Modification of hormone therapy is decided on a case-by-case basis.The use of prophylactic vs aesthetic techniques in surgery is still debated.CONCLUSION When assessing transgender individuals for GAS,a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential.Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social,medical,surgical and gender affirming surgery related specifications.Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes.A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS.Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address.We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature.Further research is required to ensure more comprehensive and individualized care for this population.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can produce a wide range of clinical manifestations from asymptomatic to life-threatening.Various researchers have worked to elucidate the pathogen...BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can produce a wide range of clinical manifestations from asymptomatic to life-threatening.Various researchers have worked to elucidate the pathogenic mechanisms underlying these variable presentations.Differences in individual responses to systemic inflammation and coagulopathy appear to be modulated by several factors,including sex steroid hormones.Transgender men or non-binary individuals who undergo gender-affirming hormone therapy(GAHT)are a unique population of interest for exploring the androgen-mediated coronavirus disease 2019(COVID-19)hypothesis.As the search for reliable and effective COVID-19 treatments continues,understanding the risks and benefits of GAHT may mitigate COVID-19 related morbidity and mortality in this patient population.AIM To investigate the potential role of GAHT in the development of COVID-19 infections and complications.METHODS This systematic review implemented an algorithmic approach using PRISMA guidelines.PubMed,Scopus,Google Scholar top 100 results,and archives of Plastic and Reconstructive Surgery was on January 12,2022 using the key words“gender”AND“hormone”AND“therapy”AND“COVID-19”as well as associated terms.Non-English articles,articles published prior to 2019(prior to COVID-19),and manuscripts in the form of reviews,commentaries,or letters were excluded.References of the selected publications were screened as well.RESULTS The database search resulted in the final inclusion of 14 studies related to GAHT COVID-19.Of the included studies,only two studies directly involved and reported on COVID-19 in transgender patients.Several clinical trials looked at the relationship between testosterone,estrogen,and progesterone in COVID-19 infected cis-gender men and women.It has been proposed that androgens may facilitate initial COVID-19 infection,however,once this occurs,testosterone may have a protective effect.Multiple clinical studies have shown that low baseline testosterone levels in men with COVID-19 are associated with worsening outcomes.The role of female sex hormones,including estrogen and progesterone have also been proposed as potential protective factors in COVID-19 infection.This was exemplified in multiple studies investigating different outcomes in pre-and post-menopausal women as well as those taking hormone replacement therapy.Two studies related specifically to transgender patients and GAHT found that estrogen and progesterone could help protect men against COVID-19,and that testosterone hormone therapy may increase the risk of contracting COVID-19.CONCLUSION Few studies were found related to the role of GAHT in COVID-19 infections.Additional research is necessary to enhance our understanding of this relationship and provide better care for transgender patients.展开更多
Progesterone is an endogenous steroid hormone with an important role for the physiology of the female reproductive system and the mammary gland.It has additional significant actions in other tissues,such as the cardio...Progesterone is an endogenous steroid hormone with an important role for the physiology of the female reproductive system and the mammary gland.It has additional significant actions in other tissues,such as the cardiovascular system,the central nervous system,and bones.The present article explores potential clinical implications from the addition of bioidentical progesterone to genderaffirming treatment of trans women.For this purpose,it provides an overview of the physiological action of progesterone in target tissues and speculates on possible benefits for gender transitioning.Progesterone is expected to exert moderate anti-androgen action through suppression of the hypothalamicpituitary-gonadal axis and inhibition of the conversion of testosterone to dihydrotestosterone.It may also contribute to breast maturation.In the long-term,progesterone could prevent bone loss and protect cardiovascular health.The potential benefits are mainly inferred by extrapolating evidence from biological actions in cisgender women and medical assumptions and hence,clinicians need to be cautious when applying these data into practice.Further research is needed to ascertain the efficacy and safety of progesterone in current hormonal regimens.展开更多
Objective: The main objective of this study is to evaluate the prevalence of HIV infection among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, for a period of seven years, i.e., from Ap...Objective: The main objective of this study is to evaluate the prevalence of HIV infection among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, for a period of seven years, i.e., from April 2008 to March 2015. Material & Method: A total of 40,983 clients attended ICTC, Gauhati Medical College & Hospital from the year 2008 to 2015. Serum samples were collected after taking informed consent and pre-test counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guidelines has been followed for HIV testing, reporting and release of results with post test counseling. Results: Of the total 40,983 clients tested for HIV infection, 1919 (4.68%) were found to be HIV seropositive. Seropositivity was higher in male clients i.e. 1314 (68.47%) than female i.e. 604 (31.47%) followed by transgender (TG), i.e., 1 (0.0005%). Heterosexual route of transmission was the major route seen in 1666 clients (86.81%). Maximum HIV seropositivity was in the age group of 45 - 49 years (43.62%). Conclusion: HIV prevalence of 4.68 % among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, puts the spotlight on the HIV burden in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups.展开更多
Background: Transgender healthcare is not a formal learning requirement in Internal Medicine residency or fellowship. The National LGBTQ Task Force appealed to urgently train clinicians on the effective care of transg...Background: Transgender healthcare is not a formal learning requirement in Internal Medicine residency or fellowship. The National LGBTQ Task Force appealed to urgently train clinicians on the effective care of transgender patients. Few studies address the successful implementation of transgender healthcare teaching and education in graduate medical education. Purpose: The purpose was to design an online asynchronous curriculum to address the need for improved transgender healthcare education in graduate medical education and assess change in knowledge and comfort in transgender healthcare for residents and fellow learners. Methods: A 6-module curriculum was developed using established guidelines and ACGME competencies as a framework for content. To assess curriculum effectiveness, participants received anonymous pre- and post-curriculum surveys which included a multiple-choice knowledge assessment, Likert scale comfort questions focusing on healthcare skills, and open-ended feedback questions. Results: Twenty-six internal medicine residents and fellows participated in the curriculum (2022-2023). There was a 69% post-survey response rate. Participants improved their gender-affirming knowledge after completing the curriculum (p Conclusion: This online curriculum was successful in increasing knowledge and comfort in transgender care for IM residents and fellows. It provides a promising framework to address this gap in curricular content.展开更多
Introduction:Despite the well-documented benefits of exercise for adolescents’physical and mental health,exercise remains an underutilized strategy for improving the health of trans adolescents.This is notable becaus...Introduction:Despite the well-documented benefits of exercise for adolescents’physical and mental health,exercise remains an underutilized strategy for improving the health of trans adolescents.This is notable because,compared to their cisgender peers,trans adolescents experience greater health challenges and systemic barriers to being physically active.To date,no research has evaluated an evidence-based exercise service within specialist paediatric gender services in Australia.Methods:The study is a non-randomised type 2 effectivenessimplementation hybrid trial for adolescents engaged with Child and Adolescent Health Service Gender Diversity Service at Perth Children’s Hospital,Western Australia.The participant group will receive the intervention alongside standard care.The design of the program has incorporated input from the GENder idenTity Longitudinal Experience(GENTLE)Cohort Consumer Advisory group;trans young people,families,and health professionals;guidelines for commonmedical presentations within paediatric gender services and international physical activity guidelines for adolescents.Program implementation and feasibility(i.e.,participant engagement,perceptions and experiences of the intervention),as well as preliminary effectiveness of the targeted exercise programon health outcomes(i.e.,quality of life,wellbeing and markers of physical health),will be evaluated as part of a pilot trial.Discussion:This project addresses a significant gap in research and healthcare and aims to enhance service delivery by integrating exercise into standard care for specialist paediatric gender services in Australia.Anticipated impacts include shaping current and future practices by defining safe,effective exercise for trans adolescents while laying the groundwork for larger scale implementation and research on long-term health benefits.展开更多
Background Previous studies have shown evidence of health-related risk behaviors among women who have sex with women （WSW）, such as sex with men, multiple bisexual partners, and drug use. Women who have sex with wom...Background Previous studies have shown evidence of health-related risk behaviors among women who have sex with women （WSW）, such as sex with men, multiple bisexual partners, and drug use. Women who have sex with women have also been known to avoid routine physical examinations and conceal their same-sex history from physicians, which can affect their ability to receive an accurate diagnosis and treatment. No previous research has targeted women who have sex with women in China. We sought to describe women who have sex with women in China and explore risk factors for their reproductive tract infections （RTI）/sexually transmitted infections （STI）. Methods Participants were recruited through outreach in venues and online for a cross-sectional study. Data were collected using interviews and laboratory tests. Results We recruited 224 women who have sex with women. In the year preceding their participation in the study, 92% （206/224） of women reported sexual relations with women. The RTI rates were： gonorrhea （15.8%）, chlamydia （3.5%）, syphilis （0.5%）, bacterial vaginosis （14.4%）, hepatitis B virus （HBV） （0.9%）, hepatitis C virus （HCV） （0.5%）, and candidiasis （6.9%）. No HIV or herpes simplex virus （HSV） positive cases were detected. Factors associated with gonorrhea infection were non-Beijing local residency （odds ratio （OR）=2.1, 95% confidence interval （C/）： 1.2-3.8） and genital-genital contact （OR=3.1, 95% CI： 1.3-7.2）; factors associated with curable STI （excluding bacterial vaginosis, candidiasis, HBV and HCV） were non-Beijing local residency （OR=1.9; 95% CI： 1.2-3.0） and bleeding during or after sex （OR=18.1; 95% CI： 5.2-62.6）; and the factor associated with RTI （including all the infections tested） was bleeding during or after sex （OR=37.8, 95% CI： 11.2-127.4）. Conclusions Behaviors that may cause RTI/STI exist among Chinese women who have sex with women. Researchers should consider these behaviors when planninq correspondin.q prevention and interventions.展开更多
Background:HIV epidemic among men who have sex with men(MSM)remains a major public health concern in China.Despite a growing body of research on transgender women worldwide,little is known about Chinese transgender wo...Background:HIV epidemic among men who have sex with men(MSM)remains a major public health concern in China.Despite a growing body of research on transgender women worldwide,little is known about Chinese transgender women within MSM.We sought to estimate HIV incidence and distinguish risk factors of HIV acquisition among them from that among cisgener(non-transgender)MSM(cis-MSM).Methods:We conducted an open cohort study among Chinese MSM,including those who were identifed as transgender in Shanghai and Tianjin.Participants were initially recruited by local community-based organizations from January to June,2016,and were followed up approximately every 6 months until June 2018.At each visit,a structured questionnaire was used to gather information on demographics,sexual risk behaviors,and HIV status.HIV incidence was calculated as the number of seroconversions divided by total number of person-years of follow-up among HIV-negatives at baseline.Risk factors of HIV acquisition were assessed by univariate and multivariate Cox regression models with time-dependent variables.Results:A total of 1056 participants contributed 1260.53 person-years(PYs)of follow-up,33 HIV seroconversions occurred during the follow-up period,yielding an estimated HIV incidence of 2.62(95%CI 1.80–3.68)per 100 PYs.HIV incidence among transgender women was 4.42 per 100 PYs,which was signifcantly higher than that of 1.35 per 100 PYs among cis-MSM,demonstrating a threefold higher odds of HIV infection than cis-MSM.For transgender women,those lived locally≤2 years(adjusted hazard ratio[aHR]=1.76,95%CI 1.13–2.76)and unprotected anal sex last time(aHR=4.22,95%CI 1.82–9.79)were more likely to acquire HIV.For cis-MSM,factors associated with HIV acquisition were frequency of anal sex≥3 times in past one month(aHR=4.19,95%CI 1.06–16.47)and unprotected anal sex last time(aHR=5.33,95%CI 1.52–18.73).Conclusions:Compared to cis-MSM,transgender women were at higher risk of HIV acquisition,highlighting an urgent need of tailored prevention.Future HIV program should consider to include them to ensure that this population in China are not left behind.展开更多
文摘In the current report, we describe an 83-year-old biological male who self- identified as a female by legally changing his first and middle names to female ones and whose death certificate states his sex as a female. The medical history of this individual indicated complete penectomy without further specification. Postmortem physical examination revealed an absence of penis with a large scrotum, transposed urethral orifice, and small testes. The histological analysis of the testes identified abnormal epithelium in the seminiferous tubules that lacked germ and Sertoli cells as well as the interstitium without Leydig cells present. The exome sequencing of the individual’s DNA using the Next Generation Sequencing (NGS) Illumina platform revealed no genetic variants associated with either penile or urethral cancer that could have explained the complete penectomy, but pointed toward a potentially impaired production of T3 and T4 thyroid hormones which could account for the observed testicular malformation. Overall, the data obtained raise an important question as to whether the thyroid hormone axis could be an important part of the hormonal architecture supporting male sexual behavior.
文摘Male breast disorders,though less prevalent,present unique diagnostic cha-llenges that differ significantly from their female counterparts.While benign entities such as gynecomastia are predominant,the risk of underlying malig-nancy,often diagnosed at an advanced stage,highlights the need for a systematic,image-guided assessment.Ultrasound and mammography are the first-line complementary tools,with magnetic resonance imaging reserved for problem-solving.This review outlines the anatomical,pathological,and radiological nu-ances of the male breast,describing crucial red flag signs,sonographic pitfalls,and mammographic mimics that aid in distinguishing benign entities from si-nister pathologies such as invasive ductal carcinoma.Given the increasing visi-bility of transgender individuals,this review also addresses imaging consider-ations and screening recommendations tailored to this population.By integrating clinical insights with radiologic imaging,this review offers a comprehensive approach to both common and not-so-common male breast lesions,with an em-phasis on an algorithmic stepwise diagnostic approach.
文摘Robust preclinical models of transgender male(TGM) gender-affirming hormone therapy(GAHT) can inform clinicians of the isolated effects of GAHT;however existing models vary significantly in approach. We aimed to assess existing methodology and how it influences circulating sex-hormone levels in rodent models of TGM GAHT to provide recommendations of best practise. Pub Med, Embase, and Scopus databases were systematically searched for studies that investigated GAHT in rodent models and were published from inception to the 1st of August 2024. Study characteristics and methodology were extracted and compared. Post-intervention circulating sex hormone concentrations were the primary outcome used to determine whether successful gender affirming hormone therapy had been achieved. Sixteen experimental rodent studies were included. Studies were performed on mice( n = 11) and rats( n = 5). Subcutaneous(SC) pellets and SC silastic implants were featured in some studies but weekly SC injections of testosterone enanthate was the preferred method. Sesame oil was the preferred solvent for injected testosterone formulations. Weekly doses of ~ 450 μg(mice) and ~ 420–900 μg(rats) consistently induced the testosterone levels of the male counterpart. Similarly, 10 mg of unesterified testosterone in a SC silastic implant in mice or 10 mg/100 g in rats were also successful methods. Most studies administered hormones for 6–8 weeks before performing post-treatment assessments. This review demonstrates that methods largely varied across studies and successfully identifies the effective methodological approaches that improve the reproducibility and accuracy of preclinical models. Representing an integral step forward to bridging gaps in preclinical transgender healthcare research.
文摘Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill patients.In the setting of critical illness,the interactions between GAHT and the body's endocrine response are complex.GAHT can influence the hypothalamic-pituitary-adrenal axis,sex hormone levels,and metabolic parameters,potentially complicating the clinical picture.For example,estrogen therapy in transgender women increases the risk of venous thromboembolism,which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients.Testosterone therapy in transgender men can lead to erythrocytosis,increasing the risk of thromboembolic events during critical illness.The potential for drug interactions,particularly with medications used in the intensive care unit,also requires careful consideration.Monitoring hormone levels and adjusting GAHT in the acute setting are crucial,although evidence-based guidelines are lacking.The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.
文摘Introduction:Direct-to-consumer(DTC)telemedicine has emerged as an option for transgender patients seeking gender affirming hormone therapy(GAHT).We aimed to characterize the healthcare services provided by DTC telemedicine companies offering GAHT and to compare their costs to a tertiary care center.Methods:We identified DTC telemedicine platforms offering GAHT via internet searches and extracted information from their websites related to evaluation,treatment,monitoring,and cost.Cost of theDTC GAHT was compared to cost for comparable services at a tertiary care center.Results:Six DTC companies were identified.All platforms utilized an informed consent model without prerequisite mental health evaluation for GAHT.Platforms did not provide comprehensive mental health services.All platforms endorsed the use of regular follow up visits throughout the treatment period although interval of laboratory assessment varied.Cost estimates were comparable for uninsured patients and higher compared to those for insured patients.Cost estimates were lowest with private and public insurance at the tertiary center.Conclusions:DTC telemedicine platforms offering GAHT appear to be in line with the recently released World Professional Association for Transgender Health standards of care regarding the laboratory evaluation and monitoring,but it is unclear whether they are compliant with other recommendations.These platforms offer competitive costs for TGD patients without insurance.
文摘Background: The degree to which one identifies as male or female has a profound impact on one’s life. Yet, there is a limited understanding of what contributes to this important characteristic termed gender identity. In order to reveal factors influencing gender identity, studies have focused on people who report strong feelings of being the opposite sex, such as male-to-female (MTF) transsexuals. Method: To investigate potential neuroanatomical variations associated with transsexualism, we compared the regional thickness of the cerebral cortex between 24 MTF transsexuals who had not yet been treated with cross-sex hormones and 24 age-matched control males. Results: Results revealed thicker cortices in MTF transsexuals, both within regions of the left hemisphere (i.e., frontal and orbito-frontal cortex, central sulcus, perisylvian regions, paracentral gyrus) and right hemisphere (i.e., pre-/post-central gyrus, parietal cortex, temporal cortex, precuneus, fusiform, lingual, and orbito-frontal gyrus). Conclusion: These findings provide further evidence that brain anatomy is associated with gender identity, where measures in MTF transsexuals appear to be shifted away from gender-congruent men.
基金Supported by Australian Government National Health and Medical Research Council,No.APP1143333Endocrine Society of Australia+2 种基金Austin Medical Research FoundationViertel Charitable Foundation Clinical Investigator Award,No.VIERCI2017009Royal Australasian College of Physicians Vincent Fairfax Family Foundation
文摘BACKGROUND Transgender individuals receiving masculinising or feminising gender-affirming hormone therapy with testosterone or estradiol respectively,are at increased risk of adverse cardiovascular outcomes,including myocardial infarction and stroke.This may be related to the effects of testosterone or estradiol therapy on body composition,fat distribution,and insulin resistance but the effect of genderaffirming hormone therapy on these cardiovascular risk factors has not been extensively examined.AIM To evaluate the impact of gender-affirming hormone therapy on body composition and insulin resistance in transgender individuals,to guide clinicians in minimising cardiovascular risk.METHODS We performed a review of the literature based on PRISMA guidelines.MEDLINE,Embase and PsycINFO databases were searched for studies examining body composition,insulin resistance or body fat distribution in transgender individuals aged over 18 years on established gender-affirming hormone therapy.Studies were selected for full-text analysis if they investigated transgender individuals on any type of gender-affirming hormone therapy and reported effects on lean mass,fat mass or insulin resistance.RESULTS The search strategy identified 221 studies.After exclusion of studies that did not meet inclusion criteria,26 were included(2 cross-sectional,21 prospectiveuncontrolled and 3 prospective-controlled).Evidence in transgender men suggests that testosterone therapy increases lean mass,decreases fat mass and has no impact on insulin resistance.Evidence in transgender women suggests that feminising hormone therapy(estradiol,with or without anti-androgen agents)decreases lean mass,increases fat mass,and may worsen insulin resistance.Changes to body composition were consistent across almost all studies:Transgender men on testosterone gained lean mass and lost fat mass,and transgender women on oestrogen experienced the reverse.No study directly contradicted these trends,though several small studies of short duration reported no changes.Results for insulin resistance are less consistent and uncertain.There is a paucity of prospective controlled research,and existing prospective evidence is limited by small sample sizes,short follow up periods,and young cohorts of participants.CONCLUSION Further research is required to further characterise the impact of genderaffirming hormone therapy on body composition and insulin resistance in the medium-long term.Until further evidence is available,clinicians should aim to minimise risk by monitoring cardiovascular risk markers regularly in their patients and encouraging healthy lifestyle modifications.
文摘Background and Aims:The Union Cycliste Internationale has deemed transgender female athlete’s ineligible for the female category due to concerns about performance advantages.We conducted a follow-up analysis on laboratorybased performance indicators of sports performance using data from a longitudinally assessed transgender woman athlete undergoing gender-affrming hormone therapy(GAHT).Methods:We evaluated laboratory performance indicators in transgender and cisgender women athletes using dualenergy X-ray absorptiometry scanning,handgrip strength measurement,jump testing,and cardiopulmonary exercise.Additionally,we assessed a transgender sub-elite cyclist before and after undergoing GAHT.Results:After one year of GAHT,the transgender athlete showed declines in handgrip strength(7–13%),countermovement jump(23–29%),and V̇O_(2)max(15–30%).After 3 months,several performance indicators(absolute handgrip,peak power,relative peak power,average power,relative average power,V̇O2max and relative V̇O_(2)max)were above the mean of cisgender female athletes,while others(Relative handgrip,countermovement jump and relative countermovement jump)were below.Similar trends were observed at 6 months and 1 year.Summary:This hypothetical analysis,although with limited evidence,suggests the transgender athlete could compete equitably in elite cycling events within the female category after one year of GAHT.Adjustments based on competition data would ensure fairness.Further analysis after an additional 12 months is recommended to assess the impact of 2 years of GAHT.An outright ineligibility for the female category for transgender women athletes would hinder a true assessment of performance fairness.
文摘Transgender people sometimes use cross-sex hormones without medical supervision. The use of cross-sex hormones, as well as the functional health and mental well-being, among male-to-female transgendered people （＇kathoeys＇） in Chiang Mai, Thailand, was studied. Sixty kathoeys were interviewed regarding their use of cross-sex hormones and their familyrelationships. Individuals also completed the Life Orientation Test Revised （LOT-R） to assess dispositional optimism, the Social Functioning Questionnaire （SFQ） and the Short Form Health Survey 36 （SF-36）. Three categories were established as follows： those who never cross-dress, those who sometimes cross-dress and those who always cross-dress in public. Of the 60 subjects, 44 had used hormones for prolonged periods （9.7＋6.1 years）. Their use was related to the permanence of cross-dressing but unrelated to functional health and mental well-being. Fifty percent of subjects had overdosed on commonly used oral contraceptives. Three people used injectable oestrogen in a higher-than-recommended dose. Self-acceptance was high or reasonably good （83%） compared to no acceptance （17%）, and neither was related to the permanence of cross-dressing. Their acceptance by parents and siblings was also relatively high （85% and 89%, respectively）. The permanence of cross-dressing had no effect on the scores of optimism, SF-36 scores and social functioning. Acceptance by oneself or one＇s parents did not seem to affect most aspects of functional health and mental well-being, but non-acceptance by siblings generated lower scores on the social functioning and general mental health subscales. Stressors tended to include physical rather than social factors. In conclusion, the unsupervised use of cross-sex hormones was common among kathoeys, and 50% of the sample had overdosed on them. Acceptance was relatively good, except by siblings. New strategies are needed for a more responsible use of cross-sex hormones.
文摘Transgender persons constitute a non-negligible percentage of the general population.Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity.Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex.The administration of testosterone is the typical masculinizing treatment in trans men,whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophinreleasing hormone agonists if testes are present.Exogenous androgenic steroids,estradiol agents,and anti-androgens have been implicated in a series of hepatotoxic effects.Thus,liver integrity is a major concern with the long-term administration of cross-sex therapy.Hepatic tissue is susceptible to coronavirus disease 19(COVID-19)through various pathophysiological mechanisms.Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients.Appropriate care is significant,with continuous laboratory monitoring,clinical observation and,if needed,specific treatment,especially in severe cases of infection and in persons with additional liver pathologies.The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.
文摘A group of 39 Transgender subjects, 17 Female to Male (FtM) and 22 Male to Female (MtF), have been evaluated about their sexual desire, activity, and satisfaction during the period before and after Sex Reassignment by Surgery (SRS). Visual Analogue Scale from 0 to 10 has been used to assess sexual desire and satisfaction, number of sexual partners and number of sexual intercourses/ month have been evaluated to assess sexual activity. Moreover, after the surgery, the Sexual Desire Inventory-2 (SDI-2) was administered to patients and related to testosterone (total or free) levels. In FtM, after hysterectomy and bilateral ovariectomy, mean value of sexual desire (VAS 0 - 10) was 7.5 before beginning testosterone therapy, this value increased after six months of therapy and after one year. Just before SRS the value decreased, but increased to 8.42 after SRS. In the same patients the values (VAS 0 - 10) on sexual satisfaction were respectively 6.5, 6.9, 7.1, 6.5 and 7. Mean number of partners was 4, with 7.07 mean frequency of sexual intercourse/month, before starting therapy (after hysterectomy). During hormonal therapy (testosterone), No. of partners was 2.46 and 8.96 intercourses/month, while after SRS the partners were 1.25 and intercouses/month 7.91. MtF patients reported a sexual desire (VAS 0 - 10) before therapy of 7, this remained almost constant after 6 months, decreases after 12 months and just before surgery, and finally increased to 7.76 after SRS. For sexual satisfaction mean values of VAS were respectively: 6.1, 6.2, 6.3, 6, and 6.8. Regarding sexual activity, MtF report 3.81 mean No. of partners and 9.27 intercouses/month before the beginning of hormonal therapy, 1.36 partners and 4.36 intercourses after therapy, and 1.3 partners and 4.54 intercourses after SRS.
文摘Objective: The purpose of this study is to estimate the prevalence of HIV infection among the clients attending ICTC, LHMC of New Delhi, for a period of five years, i.e., from 2008 to 2012. Material & Method: A total of 25,413 clients attended ICTC, LHMC from the year 2008 to 2012. Serum samples were collected after taking informed consent and pre-test counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guidelines has been followed for HIV testing, reporting and release of results with post test counseling. Results: Out of the total 25,413 clients tested for HIV infection, 963 (3.78%) were found to be HIV-1 seropositive. Seropositivity was higher in male clients i.e. 625 (64.4%) than female i.e. 336 (34.8%) followed by transgender (TG), i.e., 2 (0.2%). Heterosexual route of transmission was the major route seen in 676 clients (70.1%). Maximum HIV seropositivity was in the age group of 25 - 34 years (35.4%). No HIV-2 case was found among the studied population. Conclusion: HIV prevalence of 3.78% among the clients attending ICTC, LHMC, New Delhi, puts light on the burden on HIV in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups.
文摘BACKGROUND Literature focused on cancer screening and management is lacking in the transgender population.AIM To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming(TGNC)patients.METHODS We performed a systematic search of PubMed on January 5th,2022,with the following terms:“TGNC”,OR“transgender”,OR“gender non-conforming”,OR“gender nonbinary”AND“cancer screening”,AND“breast cancer”,AND“cervical cancer”,AND“uterine cancer”,AND“ovarian cancer”,AND“prostate cancer”,AND“testicular cancer”,AND“surveillance”,AND“follow-up”,AND“management”.70 unique publications were used.The findings are discussed under“Screening”and“Management”categories.RESULTS Screening:Current cancer screening recommendations default to cis-gender protocols.However,long-term genderaffirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection.The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer.Management:Prior to undergoing Gender Affirmation Surgery(GAS),discussion should address cancer screening and management in the organs remaining in situ.Cancer treatment in this population requires consideration for chemotherapy,radiation,surgery and/or reconstruction.Modification of hormone therapy is decided on a case-by-case basis.The use of prophylactic vs aesthetic techniques in surgery is still debated.CONCLUSION When assessing transgender individuals for GAS,a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential.Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social,medical,surgical and gender affirming surgery related specifications.Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes.A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS.Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address.We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature.Further research is required to ensure more comprehensive and individualized care for this population.
文摘BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can produce a wide range of clinical manifestations from asymptomatic to life-threatening.Various researchers have worked to elucidate the pathogenic mechanisms underlying these variable presentations.Differences in individual responses to systemic inflammation and coagulopathy appear to be modulated by several factors,including sex steroid hormones.Transgender men or non-binary individuals who undergo gender-affirming hormone therapy(GAHT)are a unique population of interest for exploring the androgen-mediated coronavirus disease 2019(COVID-19)hypothesis.As the search for reliable and effective COVID-19 treatments continues,understanding the risks and benefits of GAHT may mitigate COVID-19 related morbidity and mortality in this patient population.AIM To investigate the potential role of GAHT in the development of COVID-19 infections and complications.METHODS This systematic review implemented an algorithmic approach using PRISMA guidelines.PubMed,Scopus,Google Scholar top 100 results,and archives of Plastic and Reconstructive Surgery was on January 12,2022 using the key words“gender”AND“hormone”AND“therapy”AND“COVID-19”as well as associated terms.Non-English articles,articles published prior to 2019(prior to COVID-19),and manuscripts in the form of reviews,commentaries,or letters were excluded.References of the selected publications were screened as well.RESULTS The database search resulted in the final inclusion of 14 studies related to GAHT COVID-19.Of the included studies,only two studies directly involved and reported on COVID-19 in transgender patients.Several clinical trials looked at the relationship between testosterone,estrogen,and progesterone in COVID-19 infected cis-gender men and women.It has been proposed that androgens may facilitate initial COVID-19 infection,however,once this occurs,testosterone may have a protective effect.Multiple clinical studies have shown that low baseline testosterone levels in men with COVID-19 are associated with worsening outcomes.The role of female sex hormones,including estrogen and progesterone have also been proposed as potential protective factors in COVID-19 infection.This was exemplified in multiple studies investigating different outcomes in pre-and post-menopausal women as well as those taking hormone replacement therapy.Two studies related specifically to transgender patients and GAHT found that estrogen and progesterone could help protect men against COVID-19,and that testosterone hormone therapy may increase the risk of contracting COVID-19.CONCLUSION Few studies were found related to the role of GAHT in COVID-19 infections.Additional research is necessary to enhance our understanding of this relationship and provide better care for transgender patients.
文摘Progesterone is an endogenous steroid hormone with an important role for the physiology of the female reproductive system and the mammary gland.It has additional significant actions in other tissues,such as the cardiovascular system,the central nervous system,and bones.The present article explores potential clinical implications from the addition of bioidentical progesterone to genderaffirming treatment of trans women.For this purpose,it provides an overview of the physiological action of progesterone in target tissues and speculates on possible benefits for gender transitioning.Progesterone is expected to exert moderate anti-androgen action through suppression of the hypothalamicpituitary-gonadal axis and inhibition of the conversion of testosterone to dihydrotestosterone.It may also contribute to breast maturation.In the long-term,progesterone could prevent bone loss and protect cardiovascular health.The potential benefits are mainly inferred by extrapolating evidence from biological actions in cisgender women and medical assumptions and hence,clinicians need to be cautious when applying these data into practice.Further research is needed to ascertain the efficacy and safety of progesterone in current hormonal regimens.
文摘Objective: The main objective of this study is to evaluate the prevalence of HIV infection among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, for a period of seven years, i.e., from April 2008 to March 2015. Material & Method: A total of 40,983 clients attended ICTC, Gauhati Medical College & Hospital from the year 2008 to 2015. Serum samples were collected after taking informed consent and pre-test counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guidelines has been followed for HIV testing, reporting and release of results with post test counseling. Results: Of the total 40,983 clients tested for HIV infection, 1919 (4.68%) were found to be HIV seropositive. Seropositivity was higher in male clients i.e. 1314 (68.47%) than female i.e. 604 (31.47%) followed by transgender (TG), i.e., 1 (0.0005%). Heterosexual route of transmission was the major route seen in 1666 clients (86.81%). Maximum HIV seropositivity was in the age group of 45 - 49 years (43.62%). Conclusion: HIV prevalence of 4.68 % among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, puts the spotlight on the HIV burden in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups.
文摘Background: Transgender healthcare is not a formal learning requirement in Internal Medicine residency or fellowship. The National LGBTQ Task Force appealed to urgently train clinicians on the effective care of transgender patients. Few studies address the successful implementation of transgender healthcare teaching and education in graduate medical education. Purpose: The purpose was to design an online asynchronous curriculum to address the need for improved transgender healthcare education in graduate medical education and assess change in knowledge and comfort in transgender healthcare for residents and fellow learners. Methods: A 6-module curriculum was developed using established guidelines and ACGME competencies as a framework for content. To assess curriculum effectiveness, participants received anonymous pre- and post-curriculum surveys which included a multiple-choice knowledge assessment, Likert scale comfort questions focusing on healthcare skills, and open-ended feedback questions. Results: Twenty-six internal medicine residents and fellows participated in the curriculum (2022-2023). There was a 69% post-survey response rate. Participants improved their gender-affirming knowledge after completing the curriculum (p Conclusion: This online curriculum was successful in increasing knowledge and comfort in transgender care for IM residents and fellows. It provides a promising framework to address this gap in curricular content.
基金funded by a NHMRC Investigator Grant(#2010063)the MRFF-funded Australian Research Consortium for Trans Youth and Children(ARCTYC,MRF2032119).
文摘Introduction:Despite the well-documented benefits of exercise for adolescents’physical and mental health,exercise remains an underutilized strategy for improving the health of trans adolescents.This is notable because,compared to their cisgender peers,trans adolescents experience greater health challenges and systemic barriers to being physically active.To date,no research has evaluated an evidence-based exercise service within specialist paediatric gender services in Australia.Methods:The study is a non-randomised type 2 effectivenessimplementation hybrid trial for adolescents engaged with Child and Adolescent Health Service Gender Diversity Service at Perth Children’s Hospital,Western Australia.The participant group will receive the intervention alongside standard care.The design of the program has incorporated input from the GENder idenTity Longitudinal Experience(GENTLE)Cohort Consumer Advisory group;trans young people,families,and health professionals;guidelines for commonmedical presentations within paediatric gender services and international physical activity guidelines for adolescents.Program implementation and feasibility(i.e.,participant engagement,perceptions and experiences of the intervention),as well as preliminary effectiveness of the targeted exercise programon health outcomes(i.e.,quality of life,wellbeing and markers of physical health),will be evaluated as part of a pilot trial.Discussion:This project addresses a significant gap in research and healthcare and aims to enhance service delivery by integrating exercise into standard care for specialist paediatric gender services in Australia.Anticipated impacts include shaping current and future practices by defining safe,effective exercise for trans adolescents while laying the groundwork for larger scale implementation and research on long-term health benefits.
文摘Background Previous studies have shown evidence of health-related risk behaviors among women who have sex with women （WSW）, such as sex with men, multiple bisexual partners, and drug use. Women who have sex with women have also been known to avoid routine physical examinations and conceal their same-sex history from physicians, which can affect their ability to receive an accurate diagnosis and treatment. No previous research has targeted women who have sex with women in China. We sought to describe women who have sex with women in China and explore risk factors for their reproductive tract infections （RTI）/sexually transmitted infections （STI）. Methods Participants were recruited through outreach in venues and online for a cross-sectional study. Data were collected using interviews and laboratory tests. Results We recruited 224 women who have sex with women. In the year preceding their participation in the study, 92% （206/224） of women reported sexual relations with women. The RTI rates were： gonorrhea （15.8%）, chlamydia （3.5%）, syphilis （0.5%）, bacterial vaginosis （14.4%）, hepatitis B virus （HBV） （0.9%）, hepatitis C virus （HCV） （0.5%）, and candidiasis （6.9%）. No HIV or herpes simplex virus （HSV） positive cases were detected. Factors associated with gonorrhea infection were non-Beijing local residency （odds ratio （OR）=2.1, 95% confidence interval （C/）： 1.2-3.8） and genital-genital contact （OR=3.1, 95% CI： 1.3-7.2）; factors associated with curable STI （excluding bacterial vaginosis, candidiasis, HBV and HCV） were non-Beijing local residency （OR=1.9; 95% CI： 1.2-3.0） and bleeding during or after sex （OR=18.1; 95% CI： 5.2-62.6）; and the factor associated with RTI （including all the infections tested） was bleeding during or after sex （OR=37.8, 95% CI： 11.2-127.4）. Conclusions Behaviors that may cause RTI/STI exist among Chinese women who have sex with women. Researchers should consider these behaviors when planninq correspondin.q prevention and interventions.
文摘Background:HIV epidemic among men who have sex with men(MSM)remains a major public health concern in China.Despite a growing body of research on transgender women worldwide,little is known about Chinese transgender women within MSM.We sought to estimate HIV incidence and distinguish risk factors of HIV acquisition among them from that among cisgener(non-transgender)MSM(cis-MSM).Methods:We conducted an open cohort study among Chinese MSM,including those who were identifed as transgender in Shanghai and Tianjin.Participants were initially recruited by local community-based organizations from January to June,2016,and were followed up approximately every 6 months until June 2018.At each visit,a structured questionnaire was used to gather information on demographics,sexual risk behaviors,and HIV status.HIV incidence was calculated as the number of seroconversions divided by total number of person-years of follow-up among HIV-negatives at baseline.Risk factors of HIV acquisition were assessed by univariate and multivariate Cox regression models with time-dependent variables.Results:A total of 1056 participants contributed 1260.53 person-years(PYs)of follow-up,33 HIV seroconversions occurred during the follow-up period,yielding an estimated HIV incidence of 2.62(95%CI 1.80–3.68)per 100 PYs.HIV incidence among transgender women was 4.42 per 100 PYs,which was signifcantly higher than that of 1.35 per 100 PYs among cis-MSM,demonstrating a threefold higher odds of HIV infection than cis-MSM.For transgender women,those lived locally≤2 years(adjusted hazard ratio[aHR]=1.76,95%CI 1.13–2.76)and unprotected anal sex last time(aHR=4.22,95%CI 1.82–9.79)were more likely to acquire HIV.For cis-MSM,factors associated with HIV acquisition were frequency of anal sex≥3 times in past one month(aHR=4.19,95%CI 1.06–16.47)and unprotected anal sex last time(aHR=5.33,95%CI 1.52–18.73).Conclusions:Compared to cis-MSM,transgender women were at higher risk of HIV acquisition,highlighting an urgent need of tailored prevention.Future HIV program should consider to include them to ensure that this population in China are not left behind.
