Female-to-male Research Articles

Application of magnetocardiography for myocarditis assessment in a testosterone-substituted female-to-male individual

BackgroundThe diagnosis of myocarditis remains challenging due to its diverse clinical manifestations. We recently demonstrated the ability of magnetocardiography (MCG) to screen for myocarditis and applied it successfully to detect myocarditis in this case study of a female-to-male (FtM) patient who had undergone sexual reassignment surgery. This case highlights two significant points: first, sex differences in myocarditis may be promoted by higher levels of testosterone, and second, the ability of MCG to diagnose myocarditis. Case presentationWe report on a 38-year-old FtM patient who was hospitalized for chest pain following testosterone therapy. The patient received testosterone every 2 weeks for 6 months following his FtM surgery. Two days after the last administration of testosterone, he developed chest pain. Electrocardiography identified non-significant ST elevations in V3–6, II and aVF and echocardiography revealed reduced left ventricular ejection fraction and apical hypokinesia. High-sensitivity troponin-T (539 ng/L to 676 ng/L) and creatine kinase elevation (592 U/L) were elevated. Coronary CT angiography ruled out coronary artery disease. Cardiac magnetic resonance imaging confirmed suspected myocarditis.Additionally, we used MCG to detect abnormalities in the electromagnetic field. A pathologic vector (0.179) supported the diagnosis of myocarditis in this patient. During therapy with ibuprofen the vector improved to 0.067 after 3 weeks accompanied by symptom improvement. ConclusionTestosterone treatment may have promoted myocarditis in a FtM individual. Additional MCG assessment was consistent with a diagnosis of myocarditis and highlights the promising potential of this method to facilitate diagnostic screening for cardiomyopathy in the future.

Female-to-male (FtM) transgender individuals’ multimodal and interactional practices in Japanese

Abstract This study explores the multimodal and interactional practices of female-to-male (FtM) transgender individuals in Japanese, focusing on their identity construction. Most previous studies on transgender identity in Japanese contexts examine male-to-female (MtF) transgender individuals’ linguistic practices, particularly the use of so-called Japanese women’s language. In contrast, this study explores how FtM individuals use not only linguistic but also other semiotic resources to construct and negotiate their gender and sexual identities. The study utilizes empirical data such as YouTube videos and draws on multimodal conversation analysis (CA) and membership categorization analysis (MCA) to analyze the participants’ accomplishment of social actions. The findings demonstrate the use of various resources for identity construction and how the participants challenge and/or conform to hegemonic gender ideologies. The study also unveils both the diversity among FtM transgender people (inter-individual variation) and the fluidity and complexity of identities that can exist within one person (intra-individual variation).

(001) Brain Activation Patterns Associated with Visually Evoked Sexual Arousal in Female-To-Male Transgender Individuals

Abstract Introduction Cross-sex hormones in female-to-male (FtM) transgender individuals play a crucial role in brain plasticity. Brain activity associated with sexual arousal in FtM transgenders receiving cross-sex hormones is poorly understood. Objective This study aimed to compare brain activation patterns associated with sexual arousal between FtM transgenders and premenopausal women using a 3.0 Tesla functional magnetic resonance imaging (fMRI). Methods This study included 13 FtM transgenders (mean age: 43.2±6.4 years) and 13 premenopausal women (mean age: 41.5 ± 8.3 years). The FtM transgender individuals, who have had sex-reassignment surgery, received testosterone supplementary therapy. Sexual orientation was evaluated using the Kinsey sexuality rating scale (0 = exclusively heterosexual; 6 = exclusively homosexual). Serum sex hormones were measured, including free testosterone (free-T), estradiol (E2), follicle-stimulating, and luteinizing hormones. Visual sexual stimulation began with a 30-s cross fixation (rest condition), followed by a 30-s natural documentary (neutral condition), 540-s erotic video (sexual activation condition), then a 30-s cross fixation (rest condition). The fMRI data were post-processed using SPM8 software. Results The average rating of the Kinsey scale in the FtM transgenders was 5.6 ± 0.5, indicating their sexual orientation falls within the category of homosexual. The FtM transgenders showed significant increases in the free-T levels (18.8±18.9 pg/mL vs. 0.4±0.4 pg/mL, p < 0.001) and significant decreases in the E2 levels (45.4±32.0 pg/mL vs. 279.2±247.3 pg/mL, p = 0.001) compared with premenopausal women. The brain areas with significantly higher activities during visual sexual stimuli in the FtM transgenders compared with premenopausal women included the superior parietal lobule, middle occipital gyrus, and superior frontal gyrus (p < 0.001). Conclusions This study illustrates the specific brain activation patterns associated with sexual arousal in female-to-male (FtM) transgenders. These findings could contribute to our understanding of the neural mechanisms associated with sexual arousal in relation to the levels of sexual hormones in FtM transgenders. This research was supported by grants from the National Research Foundation funded by the government (MSIT; 2022R1A2C2007809, 2021R1C1C2011748). Disclosure No.

Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study.

Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance. The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety. A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants' gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality. Among TGD young people, gender dysphoria was significantly positively associated with suicidality (β = 0.15, 95% CI = 0.11-0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (β = 0.07, 95% CI = 0.05-0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality. Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.

Preoperative hypocoagulative state is an independent risk factor for wound complications and infection in gender-affirming bottom surgeries

BackgroundBottom gender affirmation surgery (GAS) involves the risks of bleeding and associated complications. Effective preoperative blood management is paramount across surgical disciplines with international normalized ratio (INR)≤1.5 advised prior to certain surgeries. This study aimed to examine the proportion of patients who were hypocoagulative before they underwent bottom GAS and assess the influence of hypocoagulability on their 30-day post-operative outcomes. MethodA retrospective study on female-to-male (FtM) and male-to-female (MtF) bottom GAS was performed based on American college of surgeons national surgical quality improvement program (ACS-NSQIP) database from 2005 to 2021. Patients with hypocoagulation were identified when PTT> 60 s, PT > 30 s, and/or INR> 2. Multivariable logistic regression was used to compare the 30-day perioperative outcomes between patients with hypocoagulation and controls. ResultsIn this study, 380 patients (182 FtM, 198 MtF) with hypocoagulation and 1176 controls (886 FtM, 310 MtF) were included. Mortality and organ system complications were infrequent in both groups. Patients with hypocoagulation had higher wound complication rates (13.68% vs. 2.64%, aOR 2.858, p < 0.01), especially wound dehiscence (10.00% vs. 0.60%, aOR 4.424, p < 0.01) and organ space infection rates (2.11% vs. 0.26%, aOR 12.77, p < 0.01). Additionally, patients with hypocoagulation had higher sepsis (0.79% vs. 0.09%, aOR 15.508, p = 0.04) and readmission rates (4.74% vs. 2.47%, aOR 1.919, p = 0.03), but lower rates of discharge not to home (7.92% vs. 25.38%, aOR 0.324, p < 0.01). ConclusionPreoperative hypocoagulative state is observed in approximately a quarter of the patients undergoing bottom GAS and is an independent risk factor for increased risks of 30-day wound complications and infections. Therefore, meticulous monitoring of preoperative hemostasis and implementing hemostasis control before surgery may be necessary. Thus, it may be advisable to discontinue oral anticoagulants before the surgery.

The effect of donor–recipient sex matches on lung transplant survival: An analysis of the United Network for Organ Sharing database

ObjectiveTo investigate the impact of donor–recipient (DR) sex matches on survival after lung transplantation while controlling for size difference in the United Network of Organ Sharing (UNOS) database. MethodsWe performed a retrospective study of 27,423 lung transplant recipients who were reported in the UNOS database (January 2005-March 2020). Patients were divided into groups based on their respective DR sex match: male to male (MM), male to female (MF), female to female, (FF), and female to male (FM). Kaplan–Meier curve and Cox regression with log-rank tests were used to assess 1-, 3-, 5-, and 10-year survival. We also modeled survival for each group after controlling for size-related variables via the Cox regression. ResultsKaplan–Meier curves showed overall significance at 1-, 3-, 5-, and 10-year end points (P < .0001). Estimated median survival time based on Kaplan–Meier analysis were 6.41 ± 0.15, 6.13 ± 0.18, 5.86 ± 0.10, and 5.37 ± 0.17 years for FF, MF, MM, and FM, respectively (P < .0001). After we controlled for size differences, FF had statistically significantly longer 5- and 10-year survival than all other cohorts. MF also had statistically significantly longer 5- and 10-year survival than FM. ConclusionsWhen variables associated with size were controlled for, FF had improved survival than other DR groups. A female recipient may experience longer survival with a female donor’s lungs versus a male donor’s lungs of similar size.

Androgen treatment effects on neurocognition in female-to-male transgender adolescents.

It has been hypothesized that cognitive and memory-related brain function in transgender during cross-sex hormonal treatment might be activated towards that of the subjective gender. However, research on this topic has produced inconsistent results, and to the best of our knowledge no studies have investigated neurocognitive changes in androgen-treated female-to-male (FM) transgender adolescents. A total of 15 FM transgender adolescents (14-17 years) underwent neuropsychological testing in order to examine the effects of androgen on visuo-spacial abilities, verbal memory language, processing speed and executive functions. We used a longitudinal design in which 10 participants were tested twice, before and after receiving 12 months of testosterone treatment. This group was also compared with 5 FM transgender adolescents off-androgen treatment. Participants tested before and after 12 months of androgen treatment improved significantly on processing speed in a visuo-spatial (Rey-Osterrieth complex figure test) and in a visuo-oral task (Stroop), their performance on a verbal memory task (TAVEC) and on interference (Stroop) and they exhibited lower impulsivity control (CARAS-R). On-androgen treatment adolescents exhibited worse cognitive impulsivity control than off-androgen treatment adolescents. The results indicate that androgen has an influence on immediate verbal memory, cognitive interference, impulsivity control and processing speed.

THE STUDY OF EDUCATION, HEALTH CARE AND WELFARE SCHEMES FOR TRANSGENDER IN DISTRICT NORTH DELHI

Transgender is the common term used for the expression, identity of transgender in the present socio-cultural context. The peculiar behaviour that differs from the norms expected from their birth or gender expression which does not match with ones assigned sex at the birth and identify them self with the transgender. The distinctiveness of transgender can be categories as transgender male, transgender female, male-to-female (MTF) and female to male (FTM). It also includes cross-dressers (those who wear clothes of the other), gender queer people (they feel they belonged to either both genders or neither gender) and trans-sexuals.

Instances of ocular findings in transgender patients undergoing hormonal therapy

PurposeTo describe the ophthalmological manifestations in transgender patients on gender-affirming hormone therapy. MethodsA retrospective chart review study was conducted. Female-to-male (FTM) and male-to-female (MTF) transgenders on gender-affirming hormone therapy evaluated at a single center were included. Candidates were collected using a phrase-identifying search tool within the electronic medical record system. Descriptive analyses were conducted to report the demographics, hormonal therapies, clinical findings, and visual outcomes. ResultsA total of 17 patients were included, seven were FTM, and ten were MTF transgenders. The median age was 26.0 years (range; 20.0–30.0) in the FTM group and 35.0 years (range; 23.0–67.0) in the MTF group. Testosterone therapy in FTM patients comprised 30–60 mg of intramuscular injections weekly or 50 mg of transdermal gel daily. MTF patients used mainly 2–4 mg of estradiol and 100–300 mg of spironolactone tablets daily. A total of 27 eyes were affected, 12 in FTM and 15 in MTF patients. The median visual acuity was 20/25 in FTM (range; 20/20-20/60) and 20/25 in MTF (range; 20/20-20/400). The most common diagnoses in FTM patients were neurologic (71.4 %), particularly idiopathic intracranial hypertension, while MTF transgenders presented mainly with chorioretinal diseases (40.0 %). Compliance with medical recommendations and follow-up appointments was seen in 71.4 % of FTM and 50.0 % of MTF patients. At the last visit, the median visual acuity was 20/50 (range; 20/20-20/70) in FTM and 20/25 (range; 20/20-20/70) in MTF patients. Conclusions and importanceTransgenders presented a variety of ocular findings. A cause-and-effect association cannot be stated, yet eye specialists must be cognizant of these findings to provide appropriate treatment.

Abstract 18991: Effect of Sex Steroids on Lipid Profile in Female to Male Transgender Patients: A Systematic Review and Meta-Analysis

Background The medical transition of transgender individuals involves the administration of exogenous sex steroids to induce desired changes in secondary sexual characteristics. In the case of female-to-male (FtM) transgender individuals, the use of testosterone therapy is common. The impact of testosterone on lipid metabolism and dyslipidemia in this specific population is not well understood. Our study combines all the previous studies to study the impact of sex steroids in FtM transgender population. Aim To assess the effects of sex steroids on lipid profile in FtM transgender patients. Methods: PubMed, Cochrane, and Embase were searched from inception till May 2023 for all randomized control trials (RCTs) and observational studies. Primary outcomes were changes in basal metabolic profile (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride levels (TG), HDL, and LDL. All the baseline values before and after utilization of sex steroids were studied. A meta-cont module was used along with Inverse-variance method to calculate the pooled standard mean difference (SMD) for continuous outcomes with a probability value of p &lt; 0.05 considered to be statistically significant. Results: A total of 21 studies with 1208 FtM transgender patients were included. Sex steroids resulted in statistically significant elevation in LDL-C (SMD 0.2850 [0.1169; 0.4531] p &lt; 0.0009), TG (SMD 0.4312 [0.2522; 0.6101] p &lt; 0.0001), TC (SMD 0.1754 [0.0536; 0.2972] p &lt; 0.0048), and BMI (SMD: 0.2429 [0.0983; 0.3875] p &lt; 0.0010) while HDL levels were significantly reduced from the baseline. However, no significant relationship between SBP and DBP was studied (Figure 1). Conclusion: In conclusion, sex steroids increase lipid levels in transgender patients, potentially contributing to dyslipidemia and cardiovascular risk.

Masculinizing hormone therapy effect on breast tissue: Changes in estrogen and androgen receptors in transgender female-to-male mastectomies

PurposeAlmost two percent of individuals in the United States identify as gender non-conforming. In the female-to-male (FTM) transgender population, masculinizing hormone therapy with testosterone is commonly prescribed in gender transition. To date, the effects of exogenous androgens on breast tissue and its roles in altering breast cancer risk are poorly understood. This study examines the histopathologic findings in gender affirming mastectomy (GAM) in transgender FTM patients and the effects of exogenous androgens on estrogen receptors (ER) and androgen receptors (AR). MethodsA retrospective review of pathology specimens obtained between 2017 and 2020 was performed comparing androgen exposed breast tissue with breast tissue without androgen exposure. Breast specimens were obtained from patients who underwent FTM GAM with recorded exogenous androgen exposure. Control breast specimens were obtained from reduction mammoplasty (RM) procedures in cisgender women which were aged matched to the GAM cohort, as well as postmenopausal women with benign/prophylactic mastectomy procedures; all controls were without androgen exposure. The histopathologic findings were assessed. Immunohistochemistry for AR and ER was performed and the score interpreted by digital image analysis. ResultsAndrogen-exposed breast tissue revealed dense fibrotic stroma, lobular atrophy, thickened lobular basement membranes, and gynecomastoid changes. Longer duration of androgen exposure resulted in a more pronounced effect. The incidence of atypia or cancer was lower in GAM than RM cohort. ER and AR expression was highest in transgender male breast tissue with intermediate duration of exogenous androgen exposure. ConclusionIncreased androgen exposure is associated with lobular atrophy and gynecomastoid changes in breast parenchyma. Overall, ER and AR are expressed strongly in lobular epithelium in patients with prolonged androgen exposure. Exogenous testosterone does not appear to increase risk for breast cancer. Additional studies are needed to investigate the mechanism responsible for these changes at a cellular level and its role in cancer development.

Endocrinological Approach to Adolescents with Gender Dysphoria: Experience of a Pediatric Endocrinology Department in a Tertiary Center in Turkey

A significant rise in the number of trans adolescents seeking medical interventions has been reported in recent years. The aim of this study was to report the clinical features, treatment, and follow-up of adolescents with gender dysphoria (GD) with our increased experience. Twenty-six male-to-female (MTF) and twenty-seven female-to-male (FTM) adolescents who were referred to the GD-outpatient clinic between 2016 and 2022 were reviewed. The clinical and laboratory findings of thirty transgender adolescents (15 FTM /15 MTF) who received medical intervention were evaluated retrospectively. Most individuals (60.4%) were admitted between 2020 and 2022, and the remaining (39.6%) were admitted between 2016 and 2019. At the time of referral, median age was 16.3 years [interquartile range (IQR) 1.53; range 13.2-19.4] in 26 MTF, and 16.4 years (IQR 1.74; range 11.7-21.6) in 27 FTM adolescents. The median age at pubertal blockage with gonadotropin-releasing hormone analog and androgen receptor blocker was 16.4 years (IQR 1.4; range 11.7-17.8) in 22 adolescents (9 MTF, 13 FTM), and 17.4 years (IQR 1.4; range 15.5-19.4) in 6 MTF individuals, respectively. Cross-sex hormone therapy was commenced in 21 adolescents (12 MTF, 9 FTM) at the median age of 17.7 years (IQR 0.61; range 16-19.5). Fifteen individuals (8 MTF, 7 FTM) have been transferred to the adult endocrinology department in transition clinics. All treatments were generally well tolerated and effective, including bicalutamide, and no significant side effects were observed. Transition clinics played an important role in the better management of gender reassignment processes.

The relationship between non-suicidal self-injury and childhood abuse in transgender people: a cross-sectional cohort study.

To explore the relationship between non-suicidal self-injury (NSSI) and childhood abuse in transgender people and the mediating effect of emotional dysregulation traits in the association between childhood abuse and non-suicidal self-injury. From May to October 2021, 296 female-to-male (FTM) and 675 male-to-females (MTF), with age of 24.5 ± 6.4 years, were recruited using peer-driven sampling and anonymous questionnaires in Guangdong Province. The Childhood Abuse Questionnaire (CTQ-SF), the Personality Diagnostic Questionnaire (PDQ-4+) emotion regulation ability scale and the DSM-5 Clinical Examination of Stereotypic Disorders were used to measure childhood abuse experiences, emotional dysregulation traits and self-injurious behaviour, respectively. Childhood abuse scores were positively correlated with both emotional dysregulation traits scores and non-suicidal self-injury (NSSI) behaviours (p < 0.01), and emotional dysregulation traits scores were positively correlated with NSSI behaviours (p < 0.01); emotional dysregulation traits partially mediated the association between childhood abuse and NSSI behaviours, with the mediating effect accounting for 23.23% of the total effect. In addition, among the factors of childhood abuse, emotional dysregulation traits mediated the association between emotional abuse, emotional neglect, sexual abuse, physical abuse, physical neglect and NSSI behaviour significantly, with the mediating effect accounting for 22.48%-32.58% of the total effect. Transgender NSSI behaviours are associated with childhood abuse and emotional dysregulation traits, and emotional dysregulation traits partially mediates the association between childhood abuse and NSSI behaviours, and screening for emotional dysregulation traits in transgender people and timely interventions are needed to improve the current situation of discrimination against transgender people.

Comparing Smokeless Tobacco Use between Male-to-Female and Female-to-Male Transgender Adults in the United States

Background: The shifted gender social norms and tobacco cessation advice associated with estrogen therapy as a result of thrombosis risk could be responsible for the tobacco use differences between Male-to-Female (MTF) and Female-to-Male (FTM) transgender adults. Research has established this disparity in cigarette smoking, but none has looked at smokeless tobacco. Aim: This study aimed to compare smokeless tobacco use MTF and FTM transgender adults in the United States. Furthermore, it assessed the other potential determinants of smokeless tobacco use among the transgender population. Methods: The study analyzed data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), which included 1,070 transgender individuals aged 18 and above (382 MTF and 688 FTM). Gender identity (MTF vs. FTM) was used to predict smokeless tobacco use using logistic regression, adjusting for other socio-demographic and behavioral determinants. Results: The prevalence of smokeless tobacco use among the transgender population was 5.7%, 3.8% among MTF, 6.3% among FTM, and 6.7% among gender non-conforming transgender individuals. FTM transgender individuals were 2.23 times more likely to use smokeless tobacco than MTF transgender individuals. Smokeless tobacco use among MTF and FTM transgender individuals was also significantly associated with being older than 54 years (OR = 1.94), having a high school education or lower (OR = 1.98), living with at least a child (OR = 2.17), a current smoker (OR = 1.78) and a current e-cigarette user (OR = 2.97). Discussion: This study found a significant difference in smokeless tobacco use among transgender subgroups and addressed a critical tobacco knowledge gap among this population.

Interactional and categorial analyses of identity construction in the talk of female-to-male (FtM) transgender individuals in Japan

Abstract This study explores the identity construction of female-to-male (FtM) transgender individuals, utilizing membership categorization analysis and multimodal conversation analysis. ‘Identity’ in this study indicates a person’s display of category membership or ascription to category membership, which emerges in social actions. The study illustrates how participants make categories and associated features visible in their social actions through the use of multimodal resources. In particular, the study focuses on the participants’ orientation to Pn-adequate devices, particularly gender as a binary. The analysis shows that the participants’ orientation to gender ideologies, such as gender’s Pn-adequacy, plays a significant role in how they construct their FtM transgender identities.

A comprehensive analysis of YouTube videos on gender affirmation surgery.

The objective was to comprehensively analyze YouTube™ videos focusing on genital gender-affirmation surgery (GAS) from the perspective of urologists and gynecologists and to utilize results to create educational videos for transgender individuals with accurate and engaging content. A YouTube search was performed using the keywords "Metoidioplasty," "Phalloplasty," "Gender affirmation surgery," "Transgender surgery," "Vaginoplasty," and "Male-to-female surgery." Video results that were duplicated, non-English, of low relevance, non-audio, and/or short duration (under 2 min) were excluded. The upload source was classified as university/nonprofit physician or organization, health information websites, medical advertisement/for-profit organizations, or individual patient experience. Viewer engagement metrics were obtained for each video. Each video was evaluated using the DISCERN, Global Quality Score (GQS), and Patient Education Materials Assessment Tool for audio-visual content (PEMAT A-V) tools. A total of 273 videos were evaluated. Viewer engagement metrics of videos from the patient experience group were higher than those of both universities/nonprofit physicians and medical advertisement/for-profit groups. DISCERN and GQS scores were significantly lower in videos uploaded by the patient experience group than in each of the other upload sources. More videos covered female-to-male (FtM) transition (168, 61.5%) than covered male-to-female (MtF; 71, 26.0%), and both (34, 12.5%). MtF transition videos had significantly higher total view counts than videos from the other groups (p<0.001). The like counts of videos were significantly higher in both MtF transition and FtM transition groups than for videos explaining both types of transition within the same video. The total DISCERN score was significantly lower in FtM transition videos than in the other content groups. Two educational videos were prepared, informed by the tools and results of this study, and hosted on YouTube. The findings suggest that genital GAS videos with less technical content have higher audience engagement. This information should be used to aid medical organizations when creating YouTube content to provide accurate information to larger audiences in the transgender community.

‘Clothes (don’t) make the man’: Fashioning the phallus in Sabine Bernardi’s Romeos

German director Sabine Bernardi’s Romeos presents a progressive and more complete view of transgender experience than a previous generation of films on the subject. Skilfully avoiding outdated tropes in her representation of the female-to-male (FTM) trans man Lukas’s transition, the film instead places it in a cultural and sociopolitical context that shows him confronting ‘cultural cisgenderism’ and negotiating the medicalization of his ‘condition’ to obtain the mastectomy he wants. Romeos, however, does not posit surgical intervention as the central element in its protagonist’s transition but shows how gender identity and expression are conceived internally, independently of the individual’s embodiment. Thus, this article argues that the developing maleness and masculinity that Lukas exhibits demonstrates that there exists a significant difference between the penis and the phallus. Lukas is able to ‘fashion the phallus’ – what social psychologists have called a ‘cultural genital’ – with a combination of appearance (including his fashionable male attire), hormone therapy and a strict workout regime. Even though a male genital may not be present in a physical sense, the significance attributed to his cultural genital allows Lukas to express his psychic gender identity and to establish the trans man, in the words of one gender theorist, as ‘attractive, appealing, and gendered while simultaneously presenting a gender at odds with sex, a sense of self not derived from the body’. Still the discrepancy between his gender identity and his embodiment at times causes considerable problems for Lukas, especially when his love interest, the cisgender Fabio, accidentally finds out that Lukas is trans and questions his physical genital. That Lukas nonetheless manages to establish himself as a desiring subject capable of establishing a romantic relationship with Fabio and consummating it by having sex with him bespeaks the power of self-definition and the significant role that the cultural genital plays in this process.

Risk and incidence of breast cancer in transgender individuals: a systematic review and meta-analysis.

The risk of developing breast cancer in transgender individuals [male-to-female (MtF) or female-to-male (FtM)] is still inadequately quantified. We aimed to evaluate the impact of breast cancer in this population. We conducted a systematic literature search and review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines through the PUBMED and SCOPUS databases. We identified six cohort studies (for both populations) plus 35 case reports. Incidence and breast cancer risk quantification were the main outcomes considered. FtM individuals had a higher risk of developing breast cancer in comparison to cisgender men [standardized incidence ratio (SIR) = 63.4; 95% confidence interval (CI), 32.2-124.9] but a lower risk than cisgender women (SIR = 0.42; 95% CI, 0.07-2.41). Similarly, MtF individuals were at higher risk of developing breast cancer in comparison to cisgender men (SIR = 22.5; 95% CI, 5.54-91.8) and at lower risk than cisgender women (SIR = 0.30; 95% CI, 0.22-0.42). In this systematic study and meta-analysis, we identified that FtM and MtF individuals are at substantially higher risk of developing breast cancer in comparison to cisgender men, though at lower risk than cisgender women. These individuals, in the absence of defined guidelines for breast cancer prevention, should periodically undergo breast or chest examinations.

Gender-affirming hair procedures

<h2>Abstract</h2> Hair transplantation can play a complementary role in the spectrum of gender affirming procedures. Amongst the hair restoration procedures sought by transgender patients, female hairline feminization, beard and eyebrow transplantation, surgical hairline lowering, and body hair transplantation are the most popular. Hairline lowering, hairline feminization, and eyebrow and pubic hair transplantation can play roles for the male to female (MTF) transitiong patient while beard and body hair transplantation can play integral roles for the female to male (FTM) transitioning patient to create a more feminine or masculine appearance and to help conceal prior surgical scarring. This chapter will delineate the role hair restoration plays for the transitioning patient. The various surgical approaches and treatment paradigms will be detailed for the hair restoration surgeon.

Sex transition from female to male as a risk factor for sleep-disordered breathing

AimThe female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. Patients and methodsAll reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. ResultsIn all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects’ age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48–43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. ConclusionSDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.