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Journal of Bioethical Inquiry Jun 2022Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be...
Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state-something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services.
Topics: Gender Identity; Health Services Accessibility; Humans; Transgender Persons; Transsexualism
PubMed: 35129785
DOI: 10.1007/s11673-021-10163-7 -
The Journal of Clinical Endocrinology... Sep 2022
Topics: Adolescent; Adult; Gender Identity; Hormones; Humans; Transgender Persons; Transsexualism
PubMed: 35678284
DOI: 10.1210/clinem/dgac356 -
International Journal of Impotence... Nov 2020Sexual and reproductive issues are essential elements of well-being in cisgenders as well as for the transgender population. Gender-affirming hormonal treatments (GAHTs)... (Review)
Review
Sexual and reproductive issues are essential elements of well-being in cisgenders as well as for the transgender population. Gender-affirming hormonal treatments (GAHTs) aim to induce phenotypical changes congruent with the desired gender and subsequent reduction of gender dysphoria. While genital surgical procedures including hysterectomy and/or adenectomy cause permanent loss of ability to conceive, GAHT may induce a varying degree of reversible loss of fertility. For these reasons, transgender men and women need to be counseled concerning contraceptive options and potential effects of treatment on reproductive function before initiating GAHT. The literature reports that sexual activity with genital involvement is performed by less than half of transgender persons who have been sexually active with a partner in the past. Testosterone (T) is the most commonly used compound in transmen and usually leads to amenorrhea within 1-12 months from first administration, however cessation of menses does not mean anovulation. Some studies report cases of unintended pregnancies among transgender men under masculinizing therapy, therefore T treatment cannot be considered a contraceptive option. Currently available contraceptive options have pros and cons in transmen and scarce literature exists on their use. The effects of GAHT on fertility in transwomen are even less well known. Prolonged estrogen exposure induces sperm suppression and morphological changes of the spermatozoa, however the degree of resulting pregnancy protection is unclear. Further research to inform the contraceptive counseling in this population is mandatory.
Topics: Contraception; Female; Gender Dysphoria; Gender Identity; Humans; Male; Pregnancy; Transgender Persons; Transsexualism
PubMed: 33558672
DOI: 10.1038/s41443-021-00412-z -
The Journal of Sexual Medicine Jun 2021In contrast to cisgender persons, transgender persons identify with a different gender than the one assigned at birth. Although research on the underlying neurobiology...
BACKGROUND
In contrast to cisgender persons, transgender persons identify with a different gender than the one assigned at birth. Although research on the underlying neurobiology of transgender persons has been accumulating over the years, neuroimaging studies in this relatively rare population are often based on very small samples resulting in discrepant findings.
AIM
To examine the neurobiology of transgender persons in a large sample.
METHODS
Using a mega-analytic approach, structural MRI data of 803 non-hormonally treated transgender men (TM, n = 214, female assigned at birth with male gender identity), transgender women (TW, n = 172, male assigned at birth with female gender identity), cisgender men (CM, n = 221, male assigned at birth with male gender identity) and cisgender women (CW, n = 196, female assigned at birth with female gender identity) were analyzed.
OUTCOMES
Structural brain measures, including grey matter volume, cortical surface area, and cortical thickness.
RESULTS
Transgender persons differed significantly from cisgender persons with respect to (sub)cortical brain volumes and surface area, but not cortical thickness. Contrasting the 4 groups (TM, TW, CM, and CW), we observed a variety of patterns that not only depended on the direction of gender identity (towards male or towards female) but also on the brain measure as well as the brain region examined.
CLINICAL TRANSLATION
The outcomes of this large-scale study may provide a normative framework that may become useful in clinical studies.
STRENGTHS AND LIMITATIONS
While this is the largest study of MRI data in transgender persons to date, the analyses conducted were governed (and restricted) by the type of data collected across all participating sites.
CONCLUSION
Rather than being merely shifted towards either end of the male-female spectrum, transgender persons seem to present with their own unique brain phenotype. Mueller SC, Guillamon A, Zubiaurre-Elorza L, et al. The Neuroanatomy of Transgender Identity: Mega-Analytic Findings From the ENIGMA Transgender Persons Working Group. J Sex Med 2021;18:1122-1129.
Topics: Brain; Female; Gender Identity; Humans; Infant, Newborn; Male; Neuroanatomy; Transgender Persons; Transsexualism
PubMed: 34030966
DOI: 10.1016/j.jsxm.2021.03.079 -
The Journal of Clinical Endocrinology... Nov 2022
Topics: Adolescent; Humans; Transgender Persons; Transsexualism; Gender Identity; Cardiovascular Diseases
PubMed: 36221797
DOI: 10.1210/clinem/dgac592 -
Tidsskrift For Den Norske Laegeforening... Mar 2021
Topics: Female; Gender Identity; Humans; Transgender Persons; Transsexualism
PubMed: 33685095
DOI: 10.4045/tidsskr.21.0137 -
Zeitschrift Fur Kinder- Und... 2020Gender identities in transition In recent years, the healthcare system has been confronted with an increasing number of children and adolescents with gender... (Review)
Review
Gender identities in transition In recent years, the healthcare system has been confronted with an increasing number of children and adolescents with gender nonconformity, gender incongruence, and gender dysphoria. Medical professionals are still debating how to interpret this phenomenon and how best to meet the healthcare needs of this diverse group of young people. Meanwhile, the transgender and gender nonconforming youths themselves face enormous challenges in finding appropriate support and treatment in the mental healthcare system. This article reviews the available epidemiological data, the paradigm shift in the social, legal, and medical systems, the developments in diagnostic classifications (DSM-5, ICD-11) as well as important aspects of the AWMF S3 guideline for adults with gender incongruence and gender dysphoria. In addition, it describes the complexity of working with transgender, gender nonconforming, and gender-questioning youth in the context of the current discourse and the underlying ethical dilemmas. In conclusion, this article outlines the challenges facing child and adolescent psychiatry and psychotherapy in this complex environment.
Topics: Adolescent; Child; Delivery of Health Care; Gender Dysphoria; Gender Identity; Humans; Psychotherapy; Transgender Persons; Transsexualism
PubMed: 32162593
DOI: 10.1024/1422-4917/a000724 -
Revista Brasileira de Enfermagem 2022to identify scientific evidence on gender violence perpetrated against trans women. (Review)
Review
OBJECTIVES
to identify scientific evidence on gender violence perpetrated against trans women.
METHODS
integrative review, carried out in June 2020, without time frame, in the Scopus, MEDLINE, Embase, CINAHL, WoS, PsycInfo and LILACS databases. The controlled descriptors of DeCS, MeSH and their entry terms were used: "Transgender People", "Transgender", "Gender Identity", "Transsexuality", "Gender Violence", "Aggression", "Sexual Offenses", "Rape", "Violence", "Domestic Violence". The presentation and synthesis of the results were presented in the PRISMA-2009 flowchart.
RESULTS
the final sample, consisting of 16 articles, identified different types of violence (sexual, physical, verbal, psychological and financial), perpetrated by family members, strangers, police officers, intimate partners, health professionals, acquaintances, or friends.
CONCLUSIONS
trans women suffer violence and social exclusion that result from stigma and discrimination due to gender identity and result in unrestricted damage to physical health.
Topics: Domestic Violence; Female; Gender Identity; Gender-Based Violence; Humans; Intimate Partner Violence; Male; Sex Offenses; Transsexualism
PubMed: 35262561
DOI: 10.1590/0034-7167-2021-0173 -
Pediatric Clinics of North America Apr 2017Healthy sexual development is important for adolescents with and without disabilities, yet the topic of sexuality is often ignored in the disabled population.... (Review)
Review
Healthy sexual development is important for adolescents with and without disabilities, yet the topic of sexuality is often ignored in the disabled population. Adolescents with mild or moderate degrees of disability have rates of sexual activity and reproductive health needs comparable to their typically developing peers. Their need for support, risk reduction, and education in sexual health may exceed that of their peers. The medical provider may support healthy sexual development through education, anticipatory guidance, menstrual and contraceptive management, and by expanding the notion of sexuality to include a broader conceptualization of sexual behavior and expression.
Topics: Adolescent; Adolescent Development; Disabled Persons; Female; Health Promotion; Humans; Male; Psychosexual Development; Sex Education; Sexual Behavior; Social Support
PubMed: 28292457
DOI: 10.1016/j.pcl.2016.11.011 -
Best Practice & Research. Clinical... Feb 2023Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research... (Review)
Review
Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.
Topics: Humans; Male; Female; Gender Identity; Transsexualism; Sexual Behavior; Transgender Persons
PubMed: 36635133
DOI: 10.1016/j.bpobgyn.2022.102294