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Journal of Endocrinological... Sep 2023Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the... (Review)
Review
PURPOSE
Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the treatment of these patients to provide a practical approach for clinicians.
METHODS
A comprehensive literature search within PubMed was performed to provide updates of available evidence regarding the impact on bioethical, medical and fertility issues in gender incongruence during transition age.
RESULTS
Gender Affirming Hormone Treatment (GAHT) and Gender Affirming Surgery (GAS) can induce unsatisfaction with change, future regrets, and the risk of infertility. This raises ethical issues especially in the management of pubertal patients that remain unresolved. Therapy with GnRH analogues (GnRHa) is intended to delay puberty, so as to give the adolescent a longer period of time to decide whether to continue with the treatments. At the level of physical changes, this therapy may have an effect on bone mineralization and body composition; however, long-term longitudinal data are not yet available. An important feature related to the use of GnRHa is the risk of fertility. Gamete cryopreservation is the most established method of fertility preservation (FP) and should be counselled to transgender adolescents. However, these patients are not always interested in having biological children.
CONCLUSION
Based on the current evidence, there is a need to conduct further research to clarify certain issues and to standardize clinical practice and improve counselling in transgender adolescent decision making and avoid regrets in the future.
Topics: Child; Adolescent; Humans; Fertility Preservation; Counseling; Infertility; Cryopreservation; Transsexualism; Transgender Persons; Gender Dysphoria; Gender Identity
PubMed: 37071372
DOI: 10.1007/s40618-023-02077-5 -
American Journal of Obstetrics and... Aug 2014
Topics: Delivery of Health Care; Female; Gender Identity; Humans; Male; Physician's Role; Sex Reassignment Procedures; Sexual Behavior; Transsexualism
PubMed: 24705130
DOI: 10.1016/j.ajog.2014.03.063 -
International Review of Psychiatry... 2016
Topics: Female; Gender Dysphoria; Gender Identity; Humans; Male; Transsexualism
PubMed: 26769232
DOI: 10.3109/09540261.2016.1125740 -
Pediatrics May 2015
Topics: Female; Gender Identity; Humans; Male; Physician's Role; Transgender Persons; Transsexualism
PubMed: 25934902
DOI: 10.1542/peds.2015-0313B -
The Journal of Adolescent Health :... Dec 2021Many birth-assigned female/transgender male and nonbinary people (identified as masculine spectrum here) begin gender-affirming testosterone therapy by the age of 24... (Review)
Review
PURPOSE
Many birth-assigned female/transgender male and nonbinary people (identified as masculine spectrum here) begin gender-affirming testosterone therapy by the age of 24 years. Few data inform assessment of cardiovascular health of masculine spectrum youth as a specific subgroup of the 1.5 million transgender people in the United States. The purpose of this review is to help youth-serving practitioners consider, understand, and evaluate cardiovascular health in adolescent and young adult masculine spectrum patients receiving gender-affirming testosterone treatment.
METHODS
This is a narrative review intended to synthesize a broad body of clinical and research literature.
RESULTS
Common cardiovascular health changes associated with testosterone include increased red blood cell mass and likely insignificant changes in high-density lipoprotein and low-density lipoprotein levels. Changes in heart mass, heart electrophysiology, and endothelial reactivity are likely, based on extrapolation of data from adults. Testosterone may have indirect effects on cardiovascular health through influences on depression, anxiety, stress, and anorexia nervosa as well as on behaviors such as tobacco use.
CONCLUSIONS
Testosterone contributes importantly to the cardiovascular health and well-being of masculine spectrum gender-diverse youth. We need to do a better job of supporting these young people with data on cardiovascular health over the life span.
Topics: Adolescent; Adult; Anxiety; Female; Gender Identity; Humans; Male; Testosterone; Transgender Persons; Transsexualism; United States; Young Adult
PubMed: 34627656
DOI: 10.1016/j.jadohealth.2021.08.009 -
Tidsskrift For Den Norske Laegeforening... Nov 2018
Topics: Gender Identity; Humans; Politics; Sex Determination Analysis; Social Stigma; Transsexualism
PubMed: 30497235
DOI: 10.4045/tidsskr.18.0888 -
International Journal of Impotence... Feb 2023
Topics: Humans; Male; Child; Female; Gender Identity; Disorders of Sex Development; Transsexualism; Genitalia
PubMed: 36460787
DOI: 10.1038/s41443-022-00639-4 -
Current Pediatric Reviews 2015A review of gender role (GR) differentiation from early childhood through adulthood was conducted on males and females in general, as well as on females affected by... (Review)
Review
A review of gender role (GR) differentiation from early childhood through adulthood was conducted on males and females in general, as well as on females affected by congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency or complete androgen insensitivity syndrome (CAIS). Additionally, retrospective and current, self-rated GR assessments were evaluated from women with CAH (n = 9) or CAIS (n = 12), and unaffected women and men ranging in age from 16 to 59 years. Overall, GR differentiation occurs in early childhood and persists through adulthood. With advanced age, this differentiation may evolve into androgyny or even become undifferentiated for the general population. While more studies of GR exist for girls and women with CAH compared to those affected by CAIS, some developmental patterns can be observed from the limited data that exist. First, girls and women with CAIS report a female GR that persists through adulthood. Second, girls and women with CAH are more likely to report less feminine/ more masculine play in childhood followed by interests in male-typical leisure activities and career choices in adulthood. However, our data indicate that women with CAH report more feminine/ less masculine patterns of GR with age. Self-reported GR for women with CAH was indistinguishable from that of women with CAIS at the time of study participation in adulthood. With the availability of effective medications for treating hormone deficiencies associated with CAH, affected women are expected to live a full lifespan. Thus, our understanding of psychosexual development into older age is warranted.
Topics: Adolescent; Adrenal Hyperplasia, Congenital; Androgen-Insensitivity Syndrome; Child; Child, Preschool; Cross-Sectional Studies; Female; Gender Identity; Humans; Infant; Male; Play and Playthings; Psychosexual Development
PubMed: 25938375
DOI: 10.2174/1573396311666150501003541 -
Journal of Pediatric Urology Apr 2017Bladder-exstrophy-epispadias complex (BEEC) represents a spectrum of urogenital step-wise malformations: epispadias, complete exstrophy, and cloacal exstrophy....
INTRODUCTION
Bladder-exstrophy-epispadias complex (BEEC) represents a spectrum of urogenital step-wise malformations: epispadias, complete exstrophy, and cloacal exstrophy. Psychosexual development in adolescent patients with BEEC may become especially problematic. At present, there are few contributions in the literature investigating the validity of psychosexual treatment in order to tackle this particularly emotional and personal development phase.
OBJECTIVE
The study aimed at verifying the efficacy of an intervention methodology for psychosexual support of a group of adolescents with BEEC. The main goal of the intervention program was to educate the adolescents and re-frame how they see themselves or feel about themselves, especially in relation to BEEC. In particular it was predicted that the program could: (1) improve the perception of pleasure concerning the body, particularly regarding the genital area, giving proper and specific information on pleasure, masturbation and medical history of BEEC; and (2) elicit a more relational-affective perspective on sexuality.
STUDY DESIGN
13 adolescent patients took part in the 1-year program. The effects of the intervention program were verified through a test-retest methodology using Sexuality Evaluation Schedule Assessment Monitoring (SESAMO).
RESULTS
The results showed that participants changed their attitude in several psychosexual areas, more specifically: psycho-environmental situations, body experience, areas of pleasure, medical and sexual history, and motivation and conflict areas (Summary Table).
DISCUSSION
This study demonstrated, for the first time, that a targeted program may significantly improve the psycho-sexual condition of adolescents with BEEC. In particular, this research showed that adolescents need to be able to discuss and tackle topics of a psychological and sexual nature, as well as receive understandable answers that can be put into practice in their everyday lives. The study had several methodological limitations, especially owing to the limited number of participants, the absence of a follow-up period of a few months after the intervention, and the overall exploratory nature of the program.
CONCLUSION
This intervention methodology may be considered a first attempt at improving the self-esteem of adolescents with BEEC, by contrasting forms of psychological difficulties in order to improve the quality of life of these young people.
Topics: Adolescent; Bladder Exstrophy; Body Image; Cohort Studies; Epispadias; Female; Follow-Up Studies; Humans; Italy; Male; Pilot Projects; Psychosexual Development; Quality of Life; Retrospective Studies; Risk Assessment; Self Concept; Sexual Behavior; Surveys and Questionnaires; Urogenital Abnormalities; Urogenital Surgical Procedures
PubMed: 28254239
DOI: 10.1016/j.jpurol.2016.05.020 -
Archives of Sexual Behavior May 2022Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the...
Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.
Topics: Cross-Sectional Studies; Female; Gender Dysphoria; Gender Identity; Humans; Infant, Newborn; Sexual Behavior; Transgender Persons; Transsexualism
PubMed: 35449364
DOI: 10.1007/s10508-021-02242-y