Transgender health最新文献

Purpose: Little is known about transgender and gender expansive (TGE) adolescents' and young adults' (AYAs') pain and psychosocial experiences in the acute postsurgical period following gender-affirming surgery (GAS). This study describes pain symptomatology and psychosocial functioning within 1 month after GAS among TGE AYAs, examines immediate postsurgical associations of cannabis use with pain symptomatology, pain catastrophizing, and psychosocial functioning, and explores pain persistence, cannabis use, and psychosocial functioning in a subgroup of individuals 6 months after surgery.

Methods: AYAs (N = 64) underwent GAS at a large academic medical center in the Pacific Northwest between March 2019 and June 2023. Participants reported on pain intensity, pain interference, pain catastrophizing, anxiety, depression, and cannabis use. Independent and paired-samples t-tests examined differences by age, past 30-day cannabis use, and from the postsurgical period to 6-month follow-up.

Results: Participants reported acute and persistent pain following GAS. Younger age was associated with improved pain interference in the postoperative stage. Reports of past 30-day cannabis use were high in this sample, and cannabis use was associated with higher pain interference, anxiety, and depression.

Conclusion: This study is the first to assess AYA pain functioning, mental health, and cannabis use following GAS within 1 month of surgery and at 6 months. Findings suggest that 6 months after GAS is a postsurgical adjustment phase, necessitating more supportive perioperative and psychosocial resources, including attention to substance use, during this crucial window.

Purpose: Chest binding involves the compression of chest tissue for masculine gender expression among transgender and gender diverse (TGD) youth. This study aimed to assess binding trends and their associations with quality of life, self-esteem, and psychological symptoms among TGD youth in Türkiye.

Methods: This cross-sectional study was conducted between November 2019 and November 2023 and involved TGD youth and cisgender controls. Data collection included a survey on binding practices, the Rosenberg Self-Esteem Scale to assess self-esteem, the Turkish version of the World Health Organization's Quality of Life-BREF (WHOQOL-BREF-TR) to evaluate quality of life, and the Brief Symptom Inventory to measure psychological symptoms.

Results: Thirty-three TGD participants (20.2 ± 2.7 years old) and 30 controls (20.8 ± 3.0 years old) were included. Most participants reported that not binding posed significant challenges in social interactions, sports, and expressing gender-aligned behaviors. Anxiety and somatization were inversely correlated with weekly binding duration. The TGD group had significantly higher (p < 0.05) somatization and global severity scores, lower (p < 0.01) psychological and environment scores of quality of life, but similar self-esteem levels. The psychology domain of the WHOQOL-BREF-TR was lower (p < 0.001) in the shorter binding group compared with controls but similar in the control and longer binding groups. Overall, psychological symptoms were lower (p < 0.01) in the control group than in the shorter binding group and not different from the longer binding group.

Conclusion: These findings highlight the nuanced relationship between binding and mental health, with higher psychological distress and lower quality of life in the TGD group compared with controls, while longer binding may offer some psychological stability, underscoring the need for improved access to gender-affirming care for overall well-being.

Erythrocytosis is a well-described effect of testosterone therapy in adults, but less is known about this phenomenon in transgender and gender-diverse adolescents. To explore this further, we performed a retrospective study in 158 adolescents who received gender-affirming testosterone therapy from January 2007 to April 2020 at a pediatric gender service. Erythrocytosis (hematocrit [Hct] > 0.50 L/L) developed in 9.5% (15/158) of adolescents. Frequency increased with time; in the majority (67%, 10/15), erythrocytosis occurred in the second year of treatment. Overall, our findings indicate erythrocytosis occurs commonly in testosterone-treated transgender adolescents and support the need for regular ongoing monitoring of Hct.

Purpose: The study aimed to characterize transgender and nonbinary (TGNB) adolescents and young adults on subcutaneous (SC) estradiol for feminizing gender-affirming hormone therapy and demonstrate efficacy and safety in these individuals.

Methods: A retrospective single-center chart review of TGNB adolescents and young adults up to 25 years old who received SC estradiol cypionate or SC estradiol valerate and completed laboratory testing between January 1, 2021, and January 1, 2024, was conducted. Mann-Whitney U tests were used for analysis.

Results: From transgender female (n = 37, 93%) and nonbinary (n = 3, 7%) individuals, 30 (75%) individuals demonstrated therapeutic serum estradiol concentrations (100-300 pg/mL) on SC estradiol cypionate, SC estradiol valerate, or both. Of the 23 patients using SC estradiol cypionate, 52% (n = 12) had therapeutic concentrations, but many were unable to titrate dosing due to nationwide shortage. Of the 32 patients on SC estradiol valerate, 75% (n = 24) achieved therapeutic concentrations. Serum testosterone concentrations were suppressed in all but one instance (97%, n = 35) of therapeutic serum estradiol concentrations; the majority of patients used simultaneous anti-androgens. To achieve therapeutic serum estradiol concentrations, the SC estradiol valerate dose (median 4 mg weekly, interquartile range [IQR]: 4-5.5) was significantly higher than the SC estradiol cypionate dose (median 2 mg weekly, IQR: 2-2.5), p < 0.001. No clinically significant adverse events occurred, including new transaminase elevation, severe dyslipidemia, or thromboembolism.

Conclusion: Many TGNB adolescents and young adults on SC estradiol administration achieved appropriate serum estradiol concentrations and no adverse events were reported, supporting continued use of SC estradiol in gender-affirming care.

Purpose: This study aimed to explore potential factors impacting parental consent for gender-affirming medical care (GAMC) among transgender and nonbinary (TNB) young adults who desired GAMC as minors but were unable to receive it due to the lack of parental consent.

Methods: Participants were recruited in 2023 from patients age 18-20 years old receiving care through Plume, a virtual GAMC provider, and completed a single online survey about their experiences. Post hoc pairwise comparisons were used to test for differences in potential facilitators of parental consent and the characteristics of doctors, other parents, and support groups by demographic characteristics.

Results: Respondents (N = 224) indicated that parental interaction with supportive medical providers, other parents, and support groups may have aided in parental consent; meeting with a doctor supportive of GAMC was rated as most helpful. Desired characteristics of doctors, parents, and support groups varied by race, ethnicity, and rurality.

Conclusion: Critical in addressing barriers to GAMC, these data aid in our understanding of the support needs of parents of TNB adolescents and how these needs vary by race, ethnicity, and rurality. These data support a need for GAMC education and support for a diverse workforce in subspecialist and primary care settings.

Purpose: This study aimed to develop and establish the content validity of a patient-reported outcome measure for youth receiving gender-affirming care (GENDER-Q Youth).

Methods: This mixed-methods study involved concept elicitation interviews with youth who were seeking/receiving gender-affirming care (February 2019-October 2023). Data were used to develop a conceptual framework and set of independent functioning scales. Scales were refined through clinical and research expert input and cognitive debriefing interviews with youth (December 2023-April 2024). A pilot test was conducted to examine scale psychometric performance, overall content validity, and acceptability (July 2024).

Results: The concept elicitation interview sample included 47 youth aged 12-19 years. A conceptual framework with four main domains was created and included: health-related quality of life, gender practices, voice, and experience of care. To measure aspects of the framework, 17 scales (292 items) were developed and refined with input from 33 experts and 17 youth. The pilot test sample included 406 youth aged 18-25 years. Most respondents agreed that GENDER-Q Youth was easy to understand, thorough, asked important questions in a respectful way, felt safe to complete, and made them feel that their voice would be heard. The field test version of GENDER-Q Youth includes 16 scales (248 items).

Conclusion: Evidence of content validity of GENDER-Q Youth was established based on extensive input from experts and youth.

Purpose: We examined gender identity and gender-affirming care outcomes of autistic transgender adolescents followed into young adulthood, as well as relationships between gender-related medical care receipt and mental health across time.

Methods: This longitudinal two-timepoint study was conducted between 2018 and 2024, with 4 years between timepoints. Twenty-seven autistic transgender youth participated, with one lost to follow-up. Measures included self-reported gender, interest in and receipt of gender-related medical care, LGBT-related stigma (via the LGBT Stigma Scale), and anxiety and depression symptoms (via the Achenbach System of Empirically Based Assessment). Intelligence quotients were estimated using the Wechsler Abbreviated Scale of Intelligence-2. We employed data visualization of gender and gender-related care trajectories and multiple linear regression to understand the relationships between care trajectories and mental health.

Results: Most youth remained gender-diverse at Time 2. Two of 26 identified as cisgender as young adults. Half of the sample moved toward nonbinary identities either as an additional component to a binary identity (e.g., transgender nonbinary woman) or shifted from a binary identity to a nonbinary identity. For those who wanted gender-related care, earlier care receipt was associated with a significant reduction in anxiety across time. Care timing was not significantly related to changes in depression across time.

Conclusion: A majority of autistic gender-diverse youth (24/26; 92.3%) remained gender diverse into young adulthood. Unlike previous studies of autistic youth entering adulthood, which report worsening mental health, participants showed reductions in anxiety across time. Earlier receipt of gender-related care was associated with fewer anxiety symptoms at Time 2.

Purpose: Few studies have explored mental health needs and barriers to accessing care among transgender and nonbinary (TNB) individuals during adolescence. The purpose of this study was to explore TNB young adults' mental health care utilization, unmet care needs, and barriers to receiving care in adolescence.

Methods: A 42-item cross-sectional survey was administered to TNB individuals aged 18-20 years. Chi² and Fisher's exact tests were used to identify differences in receipt of mental health care by demographics. Post-hoc pairwise comparisons were conducted using the Bonferroni correction for multiple comparisons when indicated.

Results: Of 286 participants, approximately half (42.3%) were women and 50.7% reported being "out" to at least one parent before the age of 18. More than half (55.2%) reported having seen a mental health provider in adolescence; however, only 10.1% indicated that they had received enough mental health support. Significant differences were found in having seen a mental health provider by gender identity (p = 0.02) and outness to parents during adolescence (p < 0.001). The most common barriers included confidentiality (59.9%), unsupportive parents (58.0%), and uncertainty about where to get care (52.9%).

Conclusions: These findings provide a better understanding of the mental health care utilization and needs among TNB individuals in adolescence. Further research focused on ways to support TNB adolescents and how parents can support their TNB adolescents' mental health is warranted.

Purpose: In this retrospective study our purpose was to assess whether hormone interventions for gender dysphoria pose additional somatic risks for adolescents. We examined changes in metabolic laboratory parameters, body mass index (BMI), and blood pressure (BP) and analyzed adverse effects during gender-affirming hormonal treatment (GAHT).

Methods: We analyzed follow-up data on 119 transgender adolescents using GAHT at the adolescent gynecology clinic in Helsinki University Hospital, Finland from January 2010 to January 2022.

Results: During the study period, 99 (83%) transgender males and 20 (17%) transgender females started GAHT. The median GAHT follow-up duration was 34.0 (interquartile range 17.2) months. Mean hemoglobin (HB) and hematocrit (HCT) levels increased by 16% (p < 0.001) during testosterone treatment, decreased by 10% (p < 0.01) during estrogen treatment, and plateaued after one year. During the initial follow-up, no clinically relevant changes were seen in glucose and lipid metabolism, BMI, or BP. Adverse effects leading to testosterone dose reduction were reported in 19% of transgender males and were less common when gonadotropin-releasing hormone analog was used in testosterone treatment initiation (11.1% vs. 27.8%, p = 0.04). Somatic adverse effects requiring hospitalization or permanent discontinuation of GAHT were not reported.

Conclusion: The somatic changes observed in this study were typical for GAHT. No serious somatic adverse effects occurred. Regular measuring of HB and HCT in transgender males undergoing GAHT is warranted, but excessive monitoring of glucose and lipid metabolism, BMI, and BP during the initial follow-up period may not be necessary for somatically healthy adolescents.