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Archives of Sexual Behavior Oct 2023
Topics: Humans; Gender Identity
PubMed: 37697095
DOI: 10.1007/s10508-023-02694-4 -
Anesthesia and Analgesia Jul 2023Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often... (Review)
Review
Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often perpetuated in medical spaces. Despite such barriers, TGD people are seeking gender-affirming care (GAC) with increased frequency. GAC facilitates the transition from the sex assigned at birth to the affirmed gender identity and is comprised of hormone therapy (HT) and gender-affirming surgery (GAS). The anesthesia professional is uniquely poised to serve as an integral support for TGD patients within the perioperative space. To provide affirmative perioperative care to TGD patients, anesthesia professionals should understand and attend to the biological, psychological, and social dimensions of health that are relevant to this population. This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations. Psychosocial factors are reviewed, including mental health disparities, health care provider mistrust, effective patient communication, and the interplay of these factors in the postanesthesia care unit. Finally, recommendations to improve TGD perioperative care are reviewed through an organizational approach with an emphasis on TGD-focused medical education. These factors are discussed through the lens of patient affirmation and advocacy with the intent to educate the anesthesia professional on the perioperative management of TGD patients.
Topics: Infant, Newborn; Humans; Male; Female; Transgender Persons; Gender Identity; Transsexualism; Testosterone; Sex Reassignment Surgery
PubMed: 37010957
DOI: 10.1213/ANE.0000000000006480 -
Archives of Sexual Behavior Oct 2023
Topics: Humans; Gender Identity
PubMed: 37277576
DOI: 10.1007/s10508-023-02628-0 -
American Journal of Transplantation :... Jun 2023Sexual orientation and gender identity (SOGI)-diverse populations experience discrimination in organ and tissue donation and transplantation (OTDT) systems globally. We... (Review)
Review
Sexual orientation and gender identity (SOGI)-diverse populations experience discrimination in organ and tissue donation and transplantation (OTDT) systems globally. We assembled a multidisciplinary group of clinical experts as well as SOGI-diverse patient and public partners and conducted a scoping review including citations on the experiences of SOGI-diverse persons in OTDT systems globally to identify and explore the inequities that exist with regards to living and deceased OTDT. Using scoping review methods, we conducted a systematic literature search of relevant electronic databases from 1970 to 2021 including a grey literature search. We identified and screened 2402 references and included 87 unique publications. Two researchers independently coded data in included publications in duplicate. We conducted a best-fit framework synthesis paired with an inductive thematic analysis to identify synthesized benefits, harms, inequities, justification of inequities, recommendations to mitigate inequities, laws and regulations, as well as knowledge and implementation gaps regarding SOGI-diverse identities in OTDT systems. We identified numerous harms and inequities for SOGI-diverse populations in OTDT systems. There were no published benefits of SOGI-diverse identities in OTDT systems. We summarized recommendations for the promotion of equity for SOGI-diverse populations and identified gaps that can serve as targets for action moving forward.
Topics: Female; Humans; Male; Gender Identity; Sexual Behavior
PubMed: 36997028
DOI: 10.1016/j.ajt.2023.03.016 -
American Journal of Public Health Mar 2022
Topics: Gender Identity; Humans; Sexual and Gender Minorities
PubMed: 35196044
DOI: 10.2105/AJPH.2021.306709 -
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 -
Psychoneuroendocrinology Sep 2023Sex-specific differences in brain connectivity were found in various neuroimaging studies, though little is known about sex steroid effects on insular functioning. Based...
BACKGROUND
Sex-specific differences in brain connectivity were found in various neuroimaging studies, though little is known about sex steroid effects on insular functioning. Based on well-characterized sex differences in emotion regulation, interoception and higher-level cognition, gender-dysphoric individuals receiving gender-affirming hormone therapy represent an interesting cohort to investigate how sex hormones might influence insular connectivity and related brain functions.
METHODS
To analyze the potential effect of sex steroids on insular connectivity at rest, 11 transgender women, 14 transgender men, 20 cisgender women, and 11 cisgender men were recruited. All participants underwent two magnetic resonance imaging sessions involving resting-state acquisitions separated by a median time period of 4.5 months and also completed the Bermond-Vorst alexithymia questionnaire at the initial and final examination. Between scans, transgender subjects received gender-affirming hormone therapy.
RESULTS
A seed based functional connectivity analysis revealed a significant 2-way interaction effect of group-by-time between right insula, cingulum, left middle frontal gyrus and left angular gyrus. Post-hoc tests demonstrated an increase in connectivity for transgender women when compared to cisgender men. Furthermore, spectral dynamic causal modelling showed reduced effective connectivity from the posterior cingulum and left angular gyrus to the left middle frontal gyrus as well as from the right insula to the left middle frontal gyrus. Alexithymia changes were found after gender-affirming hormone therapy for transgender women in both fantasizing and identifying.
CONCLUSION
These findings suggest a considerable influence of estrogen administration and androgen suppression on brain networks implicated in interoception, own-body perception and higher-level cognition.
Topics: Humans; Male; Female; Gender Dysphoria; Gender Identity; Transsexualism; Brain; Magnetic Resonance Imaging; Gonadal Steroid Hormones; Steroids
PubMed: 37499299
DOI: 10.1016/j.psyneuen.2023.106336 -
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 -
The Lancet. Diabetes & Endocrinology Sep 2022
Topics: Adolescent; Gender Identity; Humans; Transgender Persons
PubMed: 35964634
DOI: 10.1016/S2213-8587(22)00224-8 -
The Journal of Adolescent Health :... May 2023Pediatricians and youth service providers frequently interface with vulnerable populations, including gender minority youth (e.g., transgender, nonbinary, gender...
PURPOSE
Pediatricians and youth service providers frequently interface with vulnerable populations, including gender minority youth (e.g., transgender, nonbinary, gender questioning, and other gender diverse individuals) and youth experiencing homelessness. The purposes of this study are to estimate the prevalence of homelessness and types of homelessness experienced among gender minority youth and their corresponding health outcomes.
METHODS
Data for this study came from gender minority (n = 3,194) and cisgender (n = 93,337) high school students who answered questions on transgender status and homelessness status in the 2017 and 2019 Youth Risk Behavior Survey (YRBS). We compared the prevalence of homelessness between gender minority and cisgender youth and assessed where youth experiencing homelessness had slept in the prior month: shelters, nonparental homes, streets, hotel, or other locations. Finally, logistic regression models and marginal effects (ME) were used to examine health outcomes at the intersection of gender minority status and homelessness.
RESULTS
22% of gender minority youth reported homelessness during the prior month. Cisgender youth were significantly less likely to report being homeless (3%). Transgender youth experiencing homelessness were significantly more likely to live on the streets than cisgender youth experiencing homelessness (ME = 0.20; 95% CI = 0.10-0.30; p < .001). Gender minority youth experiencing homelessness reported elevated health-risk behaviors in excess of nonhomeless gender minority youth and cisgender youth experiencing homelessness.
DISCUSSION
Public health campaigns, housing interventions, and youth service providers should consider and create tailored programs to secure housing and to promote the health of gender minority youth experiencing homelessness.
Topics: Humans; Adolescent; Sexual and Gender Minorities; Ill-Housed Persons; Transgender Persons; Gender Identity; Transsexualism
PubMed: 36646565
DOI: 10.1016/j.jadohealth.2022.11.229