Dysphoric Patients Research Articles

Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Anti-Depressant Use in Patients with Gender Dysphoria.

Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental healthcare, and gender-affirming surgeries. Studies have described favorable surgical outcomes and patient satisfaction, however, the degree to which these procedures impact mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance abuse in the transgender population. A national insurance claims-based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score-matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included post-operative antidepressant use and the prevalence of mental health conditions. A total of 3,134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance abuse, and SSRI/SNRI use. There was an absolute decrease of 8.8% in SSRI or SNRI prescription after gender-affirming plastic surgery (p<0.001), and significant decreases in post-operative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol abuse (2.1%), and drug abuse (1.9%). Gender-affirming surgery in appropriately selected gender dysphoric patients is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.

Association Between California’s State Insurance Gender Nondiscrimination Act and Utilization of Gender-Affirming Surgery

Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies. To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents. Population epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019. California's Insurance Gender Nondiscrimination Act, implemented on July 9, 2013. Receipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure. A total of 25 252 patients (California: n = 17 934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001). Implementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.

看護師の性別違和への関わりにくさについての尺度作成

看護師の性別違和への関わりにくさについての尺度作成

Gender Dysphoria: A Medical and Ethical Perplexity as Distinct from Reality and the Rational Approach for Muslim Young People.

Gender dysphoria (GD), a conflict between one's self-perceived gender identity and the biological sex has been a wholly enigma and a source of contention between experts of various disciplines since long. This is a narrative review of the medical literature utilizing PubMed, Scopus, and Web of science databases, on the social status of GD patients, their therapeutic options, as well as the medical and ethical debate on GD that are of especial interest to the Muslim readers. Gender dysphoric patients or transgender people have a long history of social discrimination, marginalization, abuse, and neglect all around the world. Currently, large scale social developments supporting of transgender rights are rapidly underway in the west. Clinical evidence-based guidelines have also been published and are available for the management of GD, albeit with some medical and ethical concerns. On the other hand, the transgender community is continued to suffer profoundly in the developing and majority of Muslim nations, due to generalized unawareness, neglect, cultural and religious boundaries on this issue. Currently, Muslim youth or young adults are showing passionate interest in GD and are actively seeking information to comprehend its complexities, but they face more dilemma on this matter than the people in the West. This article addresses and discusses key transgender issues and controversies and provides a logical explanation that demonstrates that GD is real medical condition needing attention and that its treatment guidelines are justified. We hope this article will stimulate a new and broader perspective in minds of young Muslims and will urge them to take pragmatic steps in alleviating the travails of long-suffering and neglected transgender community.

Extreme 'gender critical' views will alienate many gender dysphoric patients.

Extreme 'gender critical' views will alienate many gender dysphoric patients.

Gender dysphoria in the field of obstetrics and gynecology

Obstetrics/gynecology (OB/GYN) clinicians often manage gender dysphoric patients but frequently lack the necessary training. These individuals comprise a vastly heterogeneous group and gender clinics, staffed by multi-disciplinary teams, should become the standard of care, promoting a holistic approach. All OB/GYN clinicians need to be aware of basic aspects of gender dysphoria.

P039. The quality of life (QOL) following breast surgery in Female-to-male (FTM) patients with gender dysphoria

Introduction: Gender dysphoria (GD) is the feeling of conflict between one's gender identity and their assigned sex. It is a condition recognized by the DSM-V2, associated with an increased risk of suicidal ideation and self-harm, thereby requiring multidisciplinary management. Evidence on the efficacy of mastectomy improving QOL in FtM gender dysphoric patients is building, but currently sparse.

Representations and narratives of F to M Gender Dysphoric subjects: Self, Body and psycho-traumatology in comparison with M to F transsexualism

The present study was aimed at extending the method previously used with M to F gender dysphoric patients, to F to M individuals. In particular, the aim of the study was to highlight global and particular representations of the subjects. The study involved 10 gender dysphoric subjects in F to M transition, aged between 18 to 26 years old. Rorschach and the Thematic Apperception Test were administered with particular attention to the detection of psycho-traumatic indexes. The data reached through the extension of the method to F to M subjects revealed a continuity between the two groups. Referring to Self-representation, the subjects produced mainly objectual responses, indicative of a global representation affected by the current physical condition. In terms of Body representation, the subjects provided answers demonstrating the presence of partiality and fragmentation, indicative of a body representation supporting the term dysphoria. Approximately 30% of the subjects' responses indicated the presence of consistent psycho-traumatology. In comparative terms, F to M subjects provided quantitatively and quantitatively similar answers to M to F subjects, with a greater number of fragmentary responses and a lower presence of psycho-traumatic indexes.

820 Transgender Patients with Assault by Burn

Abstract Introduction The transgender population is estimated at 25 million worldwide and 1 million in the United States. Transgender individuals or those experiencing gender dysphoria are at a higher risk of intimate partner violence and assault (60%) as well as suicide (40%), with reports of 18 transgender individuals killed this year alone in the United States. Trauma and burn care providers need to be aware of this population’s unique medical and surgical needs. To our knowledge, we describe the first reports of burn injuries in transgender patients. Methods We performed a retrospective review of all transgender or gender dysphoric patients admitted to a regional burn center from 2010 to 2019 with a major burn diagnosis (&amp;gt;20% total body surface area). Patients were identified by International Classification of Disease codes in addition to self-identification at time of admission. We describe the mechanism of injury, circumstances surrounding the incident, hospital course, disposition at discharge, and outcomes in clinic follow up. Results The cohort consisted of two patients who were transgender females (i.e. born biologic male and identified as female), aged 31 and 36. Both patients were homeless and had histories of substance abuse and mental health issues. The burn sizes were 20% and 80% and both were flame injuries. One was injured by her domestic partner. The other was injured in a tent fire from a camping stove. The 20% TBSA patient underwent 3 surgeries and was discharged to medical respite on PBD #55. The 80% TBSA patient underwent 9 surgeries and was discharged to inpatient rehabilitation on PBD #75. Regarding their transgender medical care, neither patient was actively being treated by a medical professional although they both reported taking estrogens. Neither patient had undergone transgender surgery. Hormone therapy was not continued during their hospital stay due to lack of information surrounding prior use and limited knowledge regarding the safety of hormonal therapy during burn treatment. Both patients were initially lost to follow up but subsequently reentered our health care system. Both patients have since been referred to our county transgender clinic and are now actively followed by a transgender provider. Conclusions Transgender patients are at high risk for violence and assault, which includes burn. These patients are more difficult to identify and may have inadequate transgender medical care. Burn providers of all levels should be aware of the unique needs of this population and involve transgender medical providers in the acute and rehabilitative care when feasible. Applicability of Research to Practice Raise public awareness regarding assault by burn in the transgender population.

Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review.

Although there has been an increase in the social acceptance of the gender dysphoria (GD) population, these individuals still suffer a high degree of emotional stress, which highlights the importance of knowing their mental illness diagnosis. A systematic review was conducted to identify the frequency of lifetime Axis I mental disorders in this population, using the MEDLINE/PubMed, SciELO, Cochrane, EMBASE, and PsychINFO databases and manual searching, examining articles published after 1980. The search used the key words: ('transgender' OR 'gender identity disorder' OR 'gender dysphoria' OR 'transsexualism' OR 'gender dysphoric patients' OR 'gender incongruence') AND ('mental disorder' OR 'axis I' OR 'psychiatric disorders') AND ('comorbidity' OR 'comorbid' OR 'prevalence'). From 233 papers found, five were included. The total sample comprised 577 individuals diagnosed with GD, of whom 307 (53.2%) had presented with at least one mental disorder in their lifetime. Among this high frequency of Axis I disorders, mood disorders were the most frequent (found in 243 individuals [42.1%]), followed by anxiety disorders (155 [26.8%]), and substance use/abuse disorders (85 [14.7%]). This study offers important data to researchers and clinicians so they can recognize and contribute to the development of public policy on the mental health of the population diagnosed with GD. The mental health of these individuals requires special attention as it contributes to their functional impairment.

The Medical Management of Gender Dysphoric, Gender Fluid, Gender Nonconforming, Gender Queer, Nonbinary, and Transgender Patients: One Clinic’s Approach

To present a practical guide to the care and treatment of gender diverse patients with and without gender dysphoria. Gender diverse patients experience considerable discrimination in the healthcare system and often cannot obtain basic medical care or specialized hormonal management. There is scant evidence to guide the clinician in making the care decisions of gender diverse patients. Although some guidelines exist, these often lack the rationale and practical considerations that are necessary for the respectful care of this oppressed community. Providing healthcare to gender diverse patients, with and without gender dysphoria, and their partners can be challenging. The current article provides practical guidance and a review of the literature to support that guidance.

Metoidioplasty and groin flap phalloplasty as two surgical methods for the creation of a neophallus in female-to-male gender-confirming surgery: A retrospective study comprising 123 operated patients

BackgroundIn gender-confirming surgery of the female-to-male gender dysphoric patient, there is currently no ideal method for the creation of a neophallus. Historically, in our clinic, groin flap phalloplasty (GFP) has been the dominating method, but during the last 20 years, it has gradually been replaced with metoidioplasty (MP). The aim of this study was to investigate whether this change of method has influenced factors such as the frequency of complications and the number of operations needed to complete the reconstruction of the neophallus. MethodsThis is a retrospective, single-centre, study comprising 123 consecutive female-to-male patients receiving a neophallus by GFP or MP between 2002 and 2015 at Linköping University Hospital, Sweden. ResultsOne-hundred twenty-three patients underwent 126 primary surgical procedures (39 GFPs and 87 MPs) with the intention of reconstructing a neophallus. The mean number of procedures required in the GFP group was 5.2 ± 2.7 compared with that of 2.4 ± 1.7 in the MP group (p < 0.001). In the GFP group, 18/39 (46.2%) had a documented complication compared with 30/87 (34.5%) in the MP group; however, the difference was not statistically significant (p = 0.21). ConclusionsThe present study shows that the shift in method from GFP to MP has resulted in a decreased number of complications as well as a decrease in total surgical occasions. Both methods were found to be associated with relatively high frequencies of complications, however, mostly minor.

Investigating the relationship between family expressed emotion and symptomatic relapse in premenstrual syndrome/premenstrual dysphoric disorder patients

Investigating the relationship between family expressed emotion and symptomatic relapse in premenstrual syndrome/premenstrual dysphoric disorder patients

Gender-Related Facial Surgical Goals.

In the last several years, there has been an increasing demand for surgical facial feminization or masculinization to treat the gender dysphoric patient. However, while aesthetic ideals for facial rejuvenation are well described and taught, there is a relative paucity of literature on how to achieve a feminine or masculine morphology. It is thus becoming increasingly important for facial plastic surgeons to understand patient goals regarding facial feminization or masculinization, and to have a systematic approach for analyzing the female and male face.

Assessment of linear and nonlinear/complex heartbeat dynamics in subclinical depression (dysphoria)

Objective: Depression is one of the leading causes of disability worldwide. Most previous studies have focused on major depression, and studies on subclinical depression, such as those on so-called dysphoria, have been overlooked. Indeed, dysphoria is associated with a high prevalence of somatic disorders, and a reduction of quality of life and life expectancy. In current clinical practice, dysphoria is assessed using psychometric questionnaires and structured interviews only, without taking into account objective pathophysiological indices. To address this problem, in this study we investigated heartbeat linear and nonlinear dynamics to derive objective autonomic nervous system biomarkers of dysphoria. Approach: Sixty undergraduate students participated in the study: according to clinical evaluation, 24 of them were dysphoric. Extensive group-wise statistics was performed to characterize the pathological and control groups. Moreover, a recursive feature elimination algorithm based on a K-NN classifier was carried out for the automatic recognition of dysphoria at a single-subject level. Main results: The results showed that the most significant group-wise differences referred to increased heartbeat complexity (particularly for fractal dimension, sample entropy and recurrence plot analysis) with regards to the healthy controls, confirming dysfunctional nonlinear sympatho-vagal dynamics in mood disorders. Furthermore, a balanced accuracy of 79.17% was achieved in automatically distinguishing dysphoric patients from controls, with the most informative power attributed to nonlinear, spectral and polyspectral quantifiers of cardiovascular variability. Significance: This study experimentally supports the assessment of dysphoria as a defined clinical condition with specific characteristics which are different both from healthy, fully euthymic controls and from full-blown major depression.

Male-to-Female Gender-Confirming Surgery

Advances in male-to-female gender-confirming surgery enable acquisition of female secondary sexual characteristics for gender dysphoric patients desiring surgical transition. It is imperative for medical professionals caring for transgender patients to be informed of the current standards of care and the available surgical options. This review discusses male-to-female chest and genital reconstructive surgical approaches. This review contains 27 figures, 5 tables and 52 references Key words: augmentation mammoplasty, gender-confirming surgery, genital reconstruction, male to female, transgender, vaginoplasty

Testis Morphologic Assessment in Patients undergoing Sex Reassignment Surgery with Gender Dysphoria: Case Series and Literature Review

Purpose: To study the morphologic changes to testicular architecture in response to estrogen therapy in gender dysphoric patients undergoing sexual reassignment surgery. Materials and methods: A retrospective morphologic review of testicular architecture was performed on ten cases of male-to-female sex reassignment surgery testis from the University of Illinois Hospital and Health Sciences system. Cases were from adult males undergoing sexual reassignment surgery at the University of Illinois Hospital and Health Sciences System between 2016 and 2017. Architectural changes were measured including Leydig cell changes, basement membrane fibrosis, spermatogonia maturation, and interstitium changes. Results: Various stages of maturation and regression were seen despite all patients being on estrogen therapy for at least one year prior to undergoing surgery. Conclusion: There are a range of estrogen therapy-related maturation and regression effects on testicular architecture in this growing patient population. It is important for the clinician and pathologist to know these effects as benign changes related to treatment.

Clinical Practice Guidelines for management of Sexual Disorders in Elderly.

Clinical Practice Guidelines for management of Sexual Disorders in Elderly.

Phenomenology of the Image and of Desire in Adolescent Gender Dysphoria

The study of desire at Rorschach implicate the phenomenological study of images conveyed by responses, at least those in which a clear portrait can be considered as forms of consciousness and of Ego manifestation. The optic to involve the portraits of desire with the Rorschach practice proposes that the meeting point is the affectivity related to desire. It reorganizes the Ego and allows the comparison between different human conventions. The article presents some portraits of desire, thus the study consists in the attempt to highlight how these portraits can be identified through pareidolia. The clinical reality of adolescent Gender Dysphoric patients appears as an area in which desire prevails over the symptom’s symbology and becomes clear and explicit from the first contact. The study therefore proposes that the peculiarities of desire, may allow a study in depth about more complex intrapsychic representations such as those of the Self and the Body, whose articulation is provided as an outcome the bad endurance (dysphoria) of a physic not experienced as own.

Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

Gender-affirmation surgery is often the final gender-confirming medical intervention sought by those patients suffering from gender dysphoria. In the male-to-female (MtF) transgendered patient, the creation of esthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta-analysis is to evaluate the epidemiology, presentation, management, and outcomes of neovaginal complications in the MtF transgender reassignment surgery patients. PUBMED was searched in accordance with PRISMA guidelines for relevant articles (n = 125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n = 13). Ultimately, studies reported on 1,684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non-esthetic reasons. The most common complication was stenosis of the neo-meatus (14.4%). Wound infection was associated with an increased risk of all tissue-healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina. Gender-affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of MtF gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. Clin. Anat. 31:191-199, 2018. © 2017 Wiley Periodicals, Inc.