Cisgender Research Articles

Are masculine faces “natural” for all men?: an experimental study about predictors of Chinese young adults’ attitudes towards trans men

ABSTRACT Researchers have increasingly paid attention to prejudice against trans people and its predictors. However, few studies have explored if potential predictors may interact to affect people’s attitudes towards trans people. In this experimental study, we examined the impacts of participant-related factors (i.e. gender and prior contact experience with gender or sexual minorities), target-related variables (i.e. gender identity and facial appearance), and their interactions on Chinese young adults’ attitudes towards trans men. We recruited 172 Chinese young adults to rate images of men with different gender identity labels (i.e. cisgender or trans men) and facial appearances (i.e. feminine or masculine). Results showed that a three-way interaction existed among targets’ gender identity labels, targets’ facial appearances, and participants’ genders. Overall, female participants were less likely than men to show more negative attitudes towards trans men than cisgender men. Participants showed more positive attitudes towards masculine-appearing trans men than feminine trans men. The current findings implied that people favoured trans men’s masculine faces, which match the roles of their gender identities.

Advancing preventive health care for men across the lifespan.

Historically, cisgender men have been found to be reluctant to utilize healthcare services, particularly preventive care services. NPs can bridge this gap to address health disparities among men, who are more likely to develop life-threatening conditions and who generally face higher mortality at younger ages than women. Focusing on advancing preventive care among men strengthens family, community, and societal health, and the NP is crucial in fostering a culture of preventive care in this population. To help drive this change, use of a life-stage approach that incorporates a preventive care mindset is critical. The NP should tailor health strategies to each life phase to ensure that men receive the best preventive care possible across the lifespan.

Use of an Ethinyl Estradiol/Etonogestrel Vaginal Ring Alters Vaginal Microbial Communities in Women with HIV.

HIV-1 antiretroviral therapy (ART) alters hormonal contraceptive levels delivered via intravaginal ring (IVR) in a regimen specific manner. We explored the role of the IVR on vaginal microbial communities, vaginal short chain fatty acids (SCFAs), vaginal HIV shedding, and the effect of vaginal microbes on hormone concentrations in cisgender women with HIV (WWH). Vaginal microbes were assessed by 16S RNA sequencing of weekly vaginal swabs, vaginal SCFA by mass spectrometry, HIV-1 shedding by nucleic acid amplification on vaginal aspirates, and bacterial vaginosis by Nugent scoring from 74 participants receiving an etonorgestrel/ethinyl estradiol (ENG/EE) intravaginal ring while on no ART (N=25), efavirenz-based ART (N=25), or atazanavir-based ART (N=24). At baseline, microbial communities of the 64 substudy eligible participants robustly classified as Lactobacillus crispatus--dominant (n=8), L. gasseri-dominant (n=2), L. iners-dominant (n=17), or mixed anaerobic communities (n=37). During IVR therapy, there was an increased probability of Lactobacillus-dominant community state types (CSTs) (odds-ratio=1.61, p=0.04). Vaginal CSTs were associated with Nugent scores. Bacterial vaginosis-associated bacteria were associated with significantly higher and L. iners with lower Nugent Scores (all p adj <0.1). Lactic acid levels were correlated with the relative abundance of Lactobacillus species (r2=0.574; p<0.001). Vaginal shedding of HIV-1 was less common in women with L. crispatus-dominant microbiomes (p=0.04). Mixed anaerobic vaginal communities modulated EE concentrations in a regimen-specific manner. Combined ENG/EE IVR therapy was associated with an increase in Lactobacillus-dominant vaginal microbial communities in WWH and may benefit those with bacterial vaginosis. EE levels were altered by the vaginal microbiota.

Neuroimaging-Based Classification of Cisgender and Transgender Individuals Using MRI Brain Scans

In recent years, the study of gender identity has considerably evolved, moving beyond binary definitions and embracing a more comprehensive understanding of the experiences of both cisgender and transgender people. In the middle of this advancement, neuroimaging and neuroscience present encouraging paths toward comprehending the biological foundations of gender identity. Magnetic resonance imaging (MRI) has become essential in studying brain anatomy and function, allowing scientists to investigate possible variations in the neuroanatomy linked to different gender identities. Here, cisgender and transgender classification from brain MRI scans using a Convolutional Neural Network is presented. With the use of these methods, the possibility of identifying unique brain traits that differentiate cisgender from transgender individuals is explored, which may provide insight into the biological components of gender identity.

Doxycycline Post-Exposure Prophylaxis for Bacterial Sexually Transmitted Infections: The Current Landscape and Future Directions.

The incidence of bacterial sexually transmitted infections (STI) continues to rise particularly among men who have sex with men (MSM). Doxycycline post-exposure prophylaxis (doxy-PEP) has emerged as a promising biomedical prevention strategy. This review aims to summarize the results of recent studies, highlight the current normative guidance on the use of doxy-PEP, and discuss remaining questions. In the past decade, there have been four randomized controlled trials and three real-world analyses of doxy-PEP, which consistently demonstrated a reduction in Chlamydia trachomatis and Treponema pallidum infections among MSM. Questions remain regarding the efficacy of doxy-PEP for Neisseria gonorrhoeae infection and among cisgender women. Possible detrimental impacts include an increase in antimicrobial resistance as well as alterations to the gut microbiome Doxy-PEP is an effective strategy for preventing Chlamydia trachomatis and Treponema pallidum among MSM. Further work is needed to investigate the benefits among other populations, as well as to monitor for adverse effects.

Network determinants of relationship influence on HIV prevention decision-making among people in the social networks of women who have experienced incarceration in the US.

Many cisgender women in the US who have experienced incarceration are at substantial risk for HIV acquisition after they return to the community. Various network interventions have been leveraged for HIV prevention in this population. The objective of this study was to identify network and relationship determinants of influence on HIV prevention decisions, including PrEP. We conducted interviews with a network mapping exercise with participants recruited from the social and sexual networks of women who had experienced incarceration. Participants enumerated important individuals in their lives from the past six months and provided demographic and relationship data as well as whether each relationship influenced their HIV prevention decisions. We abstracted network data from the interview transcripts and described the data set using descriptive statistics and network density graphs. To measure associations between characteristics at each level and whether a relationship was considered influential regarding PrEP decision-making, we use multiple logistic regression with random intercepts for each respondent. We interviewed 32 participants, average age 33.5 years (SD = 8.98), majority female (n = 28, 87.5%), white (n = 23, 71.8%), heterosexual/straight (n = 25, 78.1%), and with a personal history of incarceration (n = 29, 90%). They reported 253 relationships (119 family, 116 friend, 18 sexual relationships). Most adult network members had used drugs or alcohol (n = 182, 80.9%), and of those, 30.8% had used them with the participant (n = 53). The mean network size was 7 (SD = 4) and network density was 52.2%. In the full model, significant positive predictors of an influential relationship included participant non-heterosexual identity (OR 27.8), older average age in the network (OR 3.9 per standard deviation), and being a current or prior sexual partner (OR 10.1). Significant negative predictors included relationships with individuals who use or had used drugs (OR 0.28), longer average relationship duration in the network (OR 0.09) and being in a network with at least one sexual partner (OR 0.2). There are significant positive and negative determinants of relationship influence related to PrEP at individual-, dyad-, relationship-, and network-levels. These support using nuanced network approaches to behavior change that respect and leverage the diversity of relationships that comprise the social networks of women who have experienced incarceration.

Eosinophilic Meningitis in a Patient With Early HIV Infection, Latent Syphilis and HSV-2 Meningitis

Abstract Eosinophilic meningitis is an unusual condition, particularly in patients with HIV infection or syphilis. The detection of herpes simplex virus (HSV)-2 and HIV-1 in cerebrospinal fluid from a patient with acute eosinophilic meningitis has not been previously reported. Herein, we report a case of a 26-year-old cisgender man newly diagnosed with HIV-1 infection and latent syphilis, presenting with headache and low-grade fever. He was diagnosed with both acute eosinophilic meningitis and HSV-2 meningitis, and his condition improved after treatment with acyclovir and penicillin. The compelling case indicates that HSV-2 meningitis may manifest concurrently with acute eosinophilia meningitis in patients coinfected with HIV and Treponema pallidum. Metagenomics next-generation sequencing plays an important role in identifying and further confirming pathogens responsible for central nervous system infections.

Bias-Motivated Physical or Verbal Violence Among Men Who Have Sex with Men: Findings from the Lisbon Cohort of MSM

Abstract Introduction Victimization based on sexual orientation or gender identity is a cause for concern. Bias-motivated violence affect not only the individuals targeted but also their communities and societies as a whole. Objective To estimate the proportion of bias-motivated victimization among cisgender men who have sex with men (MSM) and to compare sociodemographic and behavioral characteristics and HIV and syphilis test results between victims and non-victims. Methods We used data from the baseline visit of 2811 adult cisgender MSM from July 2017 to December 2020 in the Lisbon Cohort of MSM. Victimization was defined as self-reported lifetime or recent (in the previous 12 months) experience of physical or verbal violence motivated by sexual orientation or gender identity. Rapid HIV and syphilis tests determined serostatus. We conducted descriptive statistics to summarize the sociodemographic and behavioral characteristics and the prevalence of victimization and compared groups using the Student t-test or Mann–Whitney U test and chi-square test, as appropriate. Results Overall, 40.3% of participants reported lifetime bias-motivated physical or verbal violence, and 11.7% reported recent victimization. Recent victimization contexts more frequently reported were street/neighborhood (67.9%) and workplace/school (35.5%). Victimization was associated with younger age (mean age: 26.5 vs 30.2, p-value &lt; 0.001), being born in Brazil or other American countries, or being 14 or younger at their anal intercourse with a man debut (19.5% vs. 11.0%, p-value &lt; 0.001). Lifetime victimization was not significantly associated with reactive results for HIV (p-value = 0.135) or syphilis (p-value = 0.760). Conclusion The violence motivated by sexual orientation or gender identity was quite frequent in this community. The occurrence of violence based on sexual orientation or gender identity in the Lisbon Cohort of MSM was associated with adverse social conditions and health risk behaviors. Policy Implications Raising awareness about bias-motivated violence as a hate crime may deter potential aggressions. Primary violence prevention should tackle specificities of sexual and gender minorities.

Do transgender patients who receive gender-affirming hormone therapy have a different incidence of breast cancer compared with cisgender men and cisgender women?

Do transgender patients who receive gender-affirming hormone therapy have a different incidence of breast cancer compared with cisgender men and cisgender women?

Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy

Abstract Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy. Key messages • In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals. • The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.

1.O. Scientific session: Trans &amp; Gender-Diverse Individuals’ Mental &amp; Behavioral Health Risks &amp; Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

The “noise” of suicide attempts – relating LGBTQ+-specific vs. non-specific factors

Abstract Background Despite the numerous research on the determinants and risk factors of suicide attempts, an understanding of suicide attempts as a process that holistically captures the perspectives of the actors involved is still lacking. Our study, therefore, aimed to better understand, from different perspectives, how (process) and why (subjective meaning, patterns of interpretation) (a) suicide attempt(s) among LGBTQ+ youth happen and to relate LGBTQ+-specific vs. non-specific factors. Methods From 2021 to 2024, we interviewed LGBTQ+ youth in Switzerland who had attempted suicide between the ages of 14 and 25. As part of a multi-perspective approach, we also interviewed people from their social environment where possible. Data were collected and analysed using Grounded Theory Methodology, including theoretical sampling. The final sample consisted of 41 people: 7 bisexual/lesbian cis women, 4 bisexual/gay cis men, 15 trans/non-binary people of different sexual orientations, 3 heterosexual cis people, and 12 people from their social environment. Results Sexual orientation and gender identity (SOGI) emerged as either background or foreground “music” of the suicidal processes. In some LGBTQ+ youth, SOGI were key factors influencing their suicidality, e.g. experiencing a major lack of acceptance and barriers to accessing gender-affirming transition (foreground music type). In others, suicidality was mainly related to other aspects than SOGI, especially fundamental ones such as unsafe familial circumstances or sexualised violence, which were accentuated by SOGI-related factors e.g. feeling a lack of belonging (background music type). Further, a mixed type was identified, with SOGI and non-SOGI-related factors being equally important for suicide attempt(s). Conclusions Our study implies the need to adapt health promotion, suicide prevention, and early detection and intervention strategies according to the identified types of suicidal processes.

Early exposure to (hetero)sexism in medical settings: young patients’ experiences with gynaecology

Abstract Background Gynaecology is a highly gendered specialty where gender norms are particularly susceptible to shape patient-provider interactions. Consultations about contraceptive practices, reproductive choices, and sexual activity are fertile settings for the potential confrontation of different sets of gender-related expectations, and the expression of gender-based discrimination, i.e. sexism and heterosexism. We therefore investigated young patients’ first experiences with gynaecological care in Germany with a focus on their experiences of (hetero)sexism. Methods We conducted 15 qualitative interviews with a gender-inclusive sample of patients aged 16-25 who narrated their first consultations and experiences of gynaecological care. We analysed the data thematically. Results Cis-gender heterosexual women composed the majority of the sample; a trans man and two persons who reported being at some point in same-sex relationships were also included. The main reasons for a first consultation were painful periods and contraception. Participants narrated examples of gender-based discrimination, with providers making what was perceived as gender-insensitive, demeaning, or plainly homophobic remarks. Those were particularly present in relation to conversations about the contraceptive pill, with either providers refusing to prescribe it on the account that the patient didn’t have sex or “real sex” (i.e. heterosexual intercourse) or with providers pushing for use of the pill “just in case”, even when patients didn’t need nor want it. Additionally, sexist, unrequited arguments about how the pill could enhance a patient’s breast or skin occurred in several conversations. Conclusions Our study shows clear occurrences of (hetero)sexism on the part of gynaecologists, from demeaning comments to more subtle reminders of sexist gender norms. It highlights the need to implement more patient-centred, gender-sensitive gynaecological practise to support the promotion of respectful care. Key messages • Young patients are exposed to various forms of gender-based discrimination in gynaecological care in Germany, highlighting how entrenched traditional, (hetero)sexist gender norms are among providers. • Promoting more gender-sensitive, respectful care could start with a reflection on consultations around the contraceptive pill, as they often crystallise the manifestation of damaging gender norms.

Exploring the mental health impact of asylum-seeking of sexual minority men: a qualitative study

Abstract Background Sexual minority individuals, often called LGBTQ+, encounter significant danger and violence in some countries worldwide. This forces many to seek asylum in a range of European countries. The study aimed to explore the experiences of seeking asylum and its implications for the mental health of sexual minority forced migrant men in Sweden. Methods An exploratory qualitative approach was used, and 15 adult gay and bisexual cisgender men were interviewed individually. Participants were recruited through a combination of purposeful, convenience, and snowball sampling. Systematic text condensation was used to analyze data. The analysis was conducted in close collaboration with three migrants with lived experience. Results The asylum-seeking process proved emotionally challenging, involving procedures with negative impacts on mental health. Challenges included disclosing intimate information during asylum interviews and enduring long periods of uncertainty with limited information on asylum case progress. Fundamental to participants’ experiences were the behaviors and attitudes of the professionals involved in legal procedures. Disrespectful and homophobic conduct during asylum interviews, enacted by interpreters and caseworkers, had been experienced by participants. The accuracy of interpretation emerged as crucial, possibly influencing the outcome of asylum claims as well as participants’ comfort in sharing information. Conclusions Sexual minority men seeking asylum in Sweden find themselves in an unfamiliar and emotionally challenging position. The challenges highlighted in this study implicates that the stressful asylum process may lead to health burdens among this population. The study emphasizes the critical role of a safe, affirming and supportive environment for asylum seekers. Further research is needed to develop effective support methods to ensure the health and well-being of sexual minority forced migrant populations during the asylum process. Key messages • The stressful asylum process may lead to health burdens among forced migrant sexual minority men. • There is a need for public health action to develop effective support methods addressing the mental health challenges faced by sexual minority forced migrants during their asylum process.

Gender identity differences in age of first mental health diagnosis: A population-based study of childhood and adolescence

Abstract Introduction Gender minority (GM; i.e., trans, non-binary, and other gender diverse) individuals have an increased risk of mental health disorders, but few studies have explored disparities using population-based samples or the age of onset of this risk. Objectives The aim of the current study was to identify the age at which the gender identity disparity in physician-assessed psychiatric diagnosis and treatment for common mental health disorders can be first identified in a population-based sample linked to national health care registries. Methods All individuals aged 16 to 25 (n = 18,793) participating in the nationwide probability-based Swedish National Public Health Survey in 2018, 2020, or 2021 were included in the analyses. This sample could be linked to mental health care treatment history data in nationally comprehensive health care registries starting at age 8 years old. Results Individuals reporting a GM identity in adulthood were seven times more likely to having been diagnosed with depression and/or anxiety and about five times more likely to having been diagnosed with a neurodevelopmental disorder during childhood or adolescence compared to individuals with a cisgender identity. GM individuals’ increased likelihood of being diagnosed with depression and/or anxiety was significantly elevated from age 13, while their neurodevelopmental disorder diagnosis risk was significantly elevated from age 10, compared to cisgender individuals. Conclusions The results from this study are the first population-based evidence to show that GM individuals are more likely to be diagnosed and treated for mental health disorders early during childhood and adolescence compared to cisgender individuals. The early emergence of this increased risk requires further inquiry into causes of these early disparities. It also suggests a potential benefit of interventions that facilitate social belonging and inclusion and reduce stressors related to societal expectations of gender.

Acute Cystitis in a Transfeminine Patient: Assessment and Treatment of Urinary Tract Symptoms.

Management of acute cystitis in a transfeminine patient is discussed as an example of treatment of urinary tract infections (UTIs). The case is an introduction for clinicians who typically care for cisgender women and wish to expand the populations they serve to include care of gender-diverse individuals. This is supportive of the 2021 American College of Nurse-Midwives Position Statement on Health Care for Transgender and Gender Non-Binary People. Possible differential diagnoses for urinary symptoms in transfeminine patients are discussed, as well as relevant history taking, examination skills, and treatment guidelines for acute cystitis of patients with penises along with discussion of basic care for transgender individuals seeking midwifery or primary care services.

Genital Stigma and Sexual Satisfaction Among Queer Women and Gender Expansive Individuals: The Roles of Sexual Communication and Identity Positivity

Under cisheteropatriarchy, women's and gender expansive individuals’ bodies are highly stigmatized. Research finds internalizing stigma about the genitals has negative implications for sexual satisfaction, but this work has predominantly focused on heterosexual cisgender women. We examined associations between genital stigma and partnered sexual satisfaction among Queer (including any minoritized sexual identity) women (cisgender and transgender) and gender expansive people. We also examined whether comfort communicating with a sexual partner mediated the relation between genital stigma and sexual satisfaction, and whether positive LGBTQ+ identity may buffer against internalized genital stigma (i.e., moderate relations between stigma, communication, and sexual satisfaction). We analyzed survey data from 452 Queer women and gender expansive people. We tested a moderated mediation model. Mediation was supported—greater genital stigma was associated with less comfort communicating with a sexual partner, and greater discomfort communicating was associated with lower sexual satisfaction. Moderated mediation was supported, as the negative association between genital stigma and comfort communicating with a partner increased as participants’ LGBTQ+ identity positivity decreased. Our findings offer novel insights into genital stigma and factors that may facilitate and hinder Queer women's and gender expansive individuals’ sexual satisfaction.

Future directions in transmasculine genital gender-affirming surgery: tissue substitutes and transplant.

The present study reviews contemporary literature focused on transplantation and tissue substitutes for the purposes of masculinizing genital gender affirming surgery. Additional background is provided for both topics to provide a more comprehensive understanding of the modern applications. Genitourinary vascularized composite allotransplantation has become a reality in recent years with several cases reported worldwide in cisgender men with promising reports of urinary and sexual function. A natural extension might be to apply these techniques to gender affirming surgery (GAS). Technical barriers include anatomic differences between vasculature supporting penoscrotal and vulvovaginal anatomy as well as size discrepancies between the corporal bodies which complicate the required anastomoses. Whether the smaller caliber of biologic female pelvic vasculature can support erection of a neophallus is another obstacle. Ethically, resource allocation, elective immunosuppression, society response to organ donation and gender identity, as well as the psychosocial safety of the patient given charged public opinion must all be considered.Tissue substitutes have long been used in urologic reconstruction but more recently applied to masculinizing gender affirmation surgery which has traditionally relied on autografting. The focus has been on restoring form and function to the donor site as well as facilitating treatment of urethral stricture and wound complications after phalloplasty. Furthermore, aesthetic applications have also been described, most recently for glans atrophy. The field of masculinizing gender affirmation surgery represents an exciting frontier for surgeons and patients alike. Given the relative nascency of the specialty and its propensity to draw techniques from various surgical disciplines there exists a unique opportunity for rapid innovation to overcome challenging problems posed by these complex procedures as evidenced by discussions around applying penile transplantation and the use of novel tissue grafting techniques.

Major financial problems, low mental well-being and reduced HIV/STI testing among sex workers in the Netherlands during the COVID-19 pandemic: a repeated cross-sectional survey

ObjectivesTo determine associations between the banning of sex work during the COVID-19 pandemic, and work, financial problems, mental well-being and HIV/sexually transmittable infection (STI) testing among sex workers in the...

“The Only Self-Defense I Have is My Wedding Band”: Doing Heterosexuality, Evading Gender Harassment, and Becoming Respectable in the Street

The field of critical heterosexualities studies invites sociologists to untether heterosexuality from biology. In this article, I leverage the findings of 113 interviews with a racially diverse sample of cis and trans women to examine how women maintain everyday dignity in the street despite widespread gender harassment and systemic, racialized sexual inequalities. Drawing on social constructionist theory and applying an intersectional framework, I examine heterosexuality as a performance, uncovering how gender identity, race, and sexual orientation intersect to shape both the costs and benefits of “doing heterosexuality” in the street. Through practices such as wearing wedding rings, holding the hands of men friends, and displaying affection for men in public places, straight, queer, cis, and trans women creatively resist heteronormativity’s regulation of their social-sexual lives and strive to enunciate sexual unavailability; communicate the existence of a protector; and signal respectability by demonstrating conformity with racialized, cisnormative ideals of gender and sexual normativity. Findings demonstrate that racialized, queer, and trans participants tend to experience greater emotional costs and fewer symbolic rewards associated with “doing heterosexuality” than white, straight-identified, and cis participants. This intersectional analysis enriches extant research on gender and sexuality, illuminating the utility of the “doing heterosexuality” framework for uncovering intersections between heterosexual accountability and gender inequality across diverse organizational and interpersonal contexts.