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
Robotic surgery has expanded significantly across all surgical specialties due to the benefits of high-definition 3D visualization and 360-degree articulation of instruments.In the field of gender affirmation surgery(...Robotic surgery has expanded significantly across all surgical specialties due to the benefits of high-definition 3D visualization and 360-degree articulation of instruments.In the field of gender affirmation surgery(GAS),robotic surgery has numerous applications in both primary and revision surgery.We sought to review the current literature to discuss emerging robotic techniques for genital GAS in both the transmasculine and transfeminine population to determine feasibility,complication rates,and outcomes.展开更多
Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization...Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization of the pelvis,thereby facilitating certain procedures.In this scoping review,we will discuss the developing role of the robot in genital affirming genital surgery.Indications,techniques,and outcomes using the robot in both feminizing and masculinizing genital procedures will be reviewed.展开更多
Aim:Patients with Ehlers-Danlos Syndrome(EDS)are considered to have an increased risk for wound healing complications.Surgeons may therefore be hesitant to offer elective surgeries,including gender-affirming surgeries...Aim:Patients with Ehlers-Danlos Syndrome(EDS)are considered to have an increased risk for wound healing complications.Surgeons may therefore be hesitant to offer elective surgeries,including gender-affirming surgeries(GAS),to EDS patients.At our center,we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS.This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods:This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020.Data include EDS diagnosis,demographics,operation,and complications(including minor wound healing issues).Results:Of 1363 patients presenting for GAS,36(2.6%)had EDS diagnoses and were matched with 108 control patients.Major complications requiring surgical intervention in the OR occurred in 6 patients(4.2%),(2.8% EDS vs.5.4%controls;P=0.63),while 8.3% of EDS and 14% of controls required minor interventions(P=0.38).The rate of wound healing issues of any severity was 28% in EDS vs.47% in control groups(P=0.04).Conclusion:The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population.Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group.Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS.Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis.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 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
Double negative in English has three functions： to strengthen the affirmatives, and to affirm euphemism and to strengthen the negative meaning, which are analyzed in the present paper.
This paper argues that the affirmative philosophy of Gilles Deleuze opens for a generous ethic. Such ethic passes on new or different possibilities of life. The paper briefly outlines the basic ideas in Deleuze thinki...This paper argues that the affirmative philosophy of Gilles Deleuze opens for a generous ethic. Such ethic passes on new or different possibilities of life. The paper briefly outlines the basic ideas in Deleuze thinking that can be understood as generous. Then it suggests how paying attention is a prerequisite for practicing a generous ethics, that is, mainly being aware of what, how and why something happens. Finally, it exemplifies how--referring to Christopher Nolan＇s film Inception---we may practice a generous ethic.展开更多
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Robotic surgery has expanded significantly across all surgical specialties due to the benefits of high-definition 3D visualization and 360-degree articulation of instruments.In the field of gender affirmation surgery(GAS),robotic surgery has numerous applications in both primary and revision surgery.We sought to review the current literature to discuss emerging robotic techniques for genital GAS in both the transmasculine and transfeminine population to determine feasibility,complication rates,and outcomes.
文摘Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization of the pelvis,thereby facilitating certain procedures.In this scoping review,we will discuss the developing role of the robot in genital affirming genital surgery.Indications,techniques,and outcomes using the robot in both feminizing and masculinizing genital procedures will be reviewed.
文摘Aim:Patients with Ehlers-Danlos Syndrome(EDS)are considered to have an increased risk for wound healing complications.Surgeons may therefore be hesitant to offer elective surgeries,including gender-affirming surgeries(GAS),to EDS patients.At our center,we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS.This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods:This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020.Data include EDS diagnosis,demographics,operation,and complications(including minor wound healing issues).Results:Of 1363 patients presenting for GAS,36(2.6%)had EDS diagnoses and were matched with 108 control patients.Major complications requiring surgical intervention in the OR occurred in 6 patients(4.2%),(2.8% EDS vs.5.4%controls;P=0.63),while 8.3% of EDS and 14% of controls required minor interventions(P=0.38).The rate of wound healing issues of any severity was 28% in EDS vs.47% in control groups(P=0.04).Conclusion:The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population.Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group.Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS.Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis.
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 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Double negative in English has three functions： to strengthen the affirmatives, and to affirm euphemism and to strengthen the negative meaning, which are analyzed in the present paper.
文摘This paper argues that the affirmative philosophy of Gilles Deleuze opens for a generous ethic. Such ethic passes on new or different possibilities of life. The paper briefly outlines the basic ideas in Deleuze thinking that can be understood as generous. Then it suggests how paying attention is a prerequisite for practicing a generous ethics, that is, mainly being aware of what, how and why something happens. Finally, it exemplifies how--referring to Christopher Nolan＇s film Inception---we may practice a generous ethic.
