Gender Dysphoria Clinic Research Articles

Fracture risk assessment in an Italian group of transgender women after gender-confirming surgery.

Bone health is a critical issue in transgender women (TW) health care. Conflicting results have been reported on bone status after gender-confirming surgery (GCS). No recent data in Italian TW are available. The aim of this cross-sectional study was to evaluate fracture risk, lumbar spine BMD and 25OH vitamin D (25OHD) levels in a population of TW on estrogen replacement therapy (ERT) after GCS. We retrospectively analyzed a group of 57 TW, aged 45.3 ± 11.3years, referred to our Gender Dysphoria Clinic, at least 2years after GCS. Anthropometric parameters, patient compliance to ERT, biochemical and hormonal assessment, lumbar spine BMD and fracture risk were evaluated. Prevalence of low bone mass (Z-score ≤ -2) was 40% according to the natal gender. In this group, 17β-estradiol levels were significantly lower (median 21pg/ml [25th-75th percentile 10.6-48.5] vs 63pg/ml [38.5-99.5]; p < 0.001) and a higher prevalence of low compliance to ERT was recorded (83% vs 29%; p < 0.0001) compared to those with higher bone mass. An intermediate-high fracture risk was found in 14% of the sample. A high percentage (93%) of hypovitaminosis D was present. TW on ERT have a high prevalence of low bone mass, significantly associated with low estradiol levels and low compliance to ERT. A high prevalence of hypovitaminosis D was highlighted. Considering that one out of seven TW showed an intermediate-high 10-year fracture risk, such risk assessment may be considered to prevent and manage osteoporosis in this clinical setting.

Children and Adolescents with Gender Dysphoria in Israel: Increasing Referral and Fertility Preservation Rates

Objective: To describe patient characteristics at presentation, management, and fertility preservation rates among a cohort of Israeli children and adolescents with gender dysphoria (GD). Methods: We performed a retrospective chart review of 106 consecutive children and adolescents with GD (<18 years) referred to and followed at the multidisciplinary Israeli Pediatric Gender Dysphoria Clinic from March 2013 through December 2018. Results: Of the 106 patients, 10 were prepubertal (9 prepubertal transgender females), and 96 were pubertal (38 pubertal transgender females). The GD population increased 11-fold since the establishment of our clinic in 2013. The subject's median age at referral was 15.5 years (range, 4.6 to 18 years). At the time of referral, 91 (95%) of the pubertal group had completed sexual maturation in their assigned gender at birth. Thirteen (13.5%) patients had attempted suicide, and 11 (11.5%) reported having had suicidal thoughts. Fourteen (45%) pubertal transgender females and 3 (6.5%) pubertal transgender males completed fertility preservation. Gonadotropin-releasing hormone analog treatment was prescribed in 77 (80%) patients at a mean age of 15.9 ± 1.6 years. Gender-affirming hormones were prescribed in 61 (64%) patients at a mean age of 16.5 ± 1.3 years. No severe side effects were recorded. Two (2%) of the pubertal group expressed regret about medical treatment. Conclusion: Children and adolescents with GD are presenting for medical attention at increasing rates. Israeli adolescents with GD have high fertility preservation rates, perhaps attributable to cultural perspectives. Taking advantage of the option to preserve fertility can be achieved when proper counseling is both available and promoted by medical personnel. Abbreviations: GAH = gender-affirming hormone; GD = gender dysphoria; GnRHa = gonadotropin-releasing hormone analog; MHP = mental health professional.

Psychometric Evaluation of Adapted Transsexual Voice Questionnaire for Turkish Trans Male Individuals

This study aims to evaluate the psychometric properties of the adapted transsexual voice questionnaire for male-to-female (a-TVQFtM) for trans male individuals in order to determine the suitability for use in research and clinical practice among Turkish trans male individuals. This study was conducted by the Gender Dysphoria Clinic and Voice Clinic of a tertiary hospital referral center. The a-TVQFtM, voice-related quality of life, and self-perception of voice masculinity rating scale were administered to 50 trans male individuals, of whom 27 were hormone naïve and 23 were undergoing hormone treatment. Psychometric properties were investigated with reliability and validity analysis. The a-TVQFtM showed a strong internal consistency; the Cronbach's alpha coefficient for overall a-TVQFtM was 0.975, anxiety and avoidance factor was 0.948, vocal identity factor was 0.940, and vocal function factor was 0.923. No item needed to be deleted following adaptation. The a-TVQFtM scores showed a significant strong inverse correlation with the overall voice-related quality of life scores and the self-perception of voice masculinity rating (r=-0.863, r=-0.715, and P<0.001, respectively). The a-TVQFtM scores were significantly reduced in trans male individuals undergoing hormone treatment when compared with hormone naïve individuals. Although not specifically designed for trans male individuals, the current results provide confidence as to the psychometric properties of a-TVQFtM and, therefore, its suitability for use with Turkish trans male individuals.

Gonadotrophin releasing hormone analogues utilised in late and post-pubertal adolescents causes a reduction in bone density in transgender teenagers attending a national gender dysphoria clinic

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Voice-related gender dysphoria: quality of life in hormone naïve trans male individuals

Objectives: This study investigates voice-related gender dysphoria and its impact on quality of life in hormone-naive trans male individuals. Methods: The study was conducted by the Gender Dysphoria Clinic and Voice Clinic of a tertiary hospital referral center. Seventeen hormone naive trans males referred to Voice Clinic and completed all the scales in a single sitting were included. Voice Handicap Index-10, Voice-Related Quality of Life, Transsexual Voice Questionnaire, and Self-Perception of Voice Masculinity Scale were used to assess voice-related gender dysphoria and quality of life. Results: Voice-related measures scores were seen to be significantly adversely af-fected in the pretreatment period when compared with normative data. All the three instruments showed a signifi-cantly strong correlation with each other. The voice-related quality of life showed an increasing trend in accordance with the current self-perception of voice masculinity. This group's future voice desire showed variation among individuals. Discussion: Trans male individuals cannot be considered as a homogeneous group in terms of voice gender perception and expectation. Considering the heterogeneity, individually tailored management strategies should be established. Voice-related gender dysphoria should be evaluated and managed carefully from the very beginning for treatment-seeking trans male individuals

Overrepresentation of Adopted Adolescents at a Hospital-Based Gender Dysphoria Clinic.

Purpose: We have noted a greater than expected prevalence of adopted children presenting to our multidisciplinary gender program for evaluation of gender dysphoria.Methods: A retrospective review of 184 patient charts was conducted to assess the prevalence of adopted children presenting to gender clinic.Results: Fifteen of 184 patients seen were living with adoptive families (8.2%). This is significantly higher than expected based on U.S. census data.Conclusion: Adopted children are referred to our gender program more than would be expected based on the percentage of adopted children in our state and the United States at large. This may be due to a true increased risk of gender dysphoria in adopted children, or could represent presentation bias. Gender programs should be prepared to provide assessments for adopted children. Further work is needed to understand the relationship between adopted status and gender development.

Evaluation of Asperger Syndrome in Youth Presenting to a Gender Dysphoria Clinic.

There is evolving evidence that children and adolescents with gender dysphoria have higher-than-expected rates of autism spectrum disorder (ASD), yet clinical data on ASD among youth with gender dysphoria remain limited, particularly in North America. This report aims to fill this gap. We conducted a retrospective review of patient chart data from 39 consecutive youth ages 8 to 20 years (mean age 15.8 years, natal male: n = 22, natal female: n = 17) presenting for evaluation at a multidisciplinary gender clinic in a large U.S. pediatric hospital from 2007 to 2011 to evaluate the prevalence of ASD in this patient population. Overall, 23.1% of patients (9/39) presenting with gender dysphoria had possible, likely, or very likely Asperger syndrome as measured by the Asperger Syndrome Diagnostic Scale (ASDS). These findings are consistent with growing evidence supporting increased prevalence of ASD in gender dysphoric children. To guide provision of optimal clinical care and therapeutic intervention, routine assessment of ASD is recommended in youth presenting for gender dysphoria.

Assessing patient satisfaction with a multidisciplinary gender dysphoria clinic in Melbourne.

The Gender Dysphoria Clinic in Melbourne, Australia, assessed patient outcome by focusing on patients' subjective evaluation of the healthcare services they received through the clinic. A satisfaction survey, which was previously used in two established gender clinics in the US and UK, was adapted and then administered to consecutive patients who attended the Gender Dysphoria Clinic during a 1-month period. A total of 127 surveys were available for analysis: 88% of patients reported being satisfied with the services they received. Patients' perceived level of distress reduced significantly, following their involvement with the Gender Dysphoria Clinic. Feeling understood and heard in a non-judgmental manner by a specialist in the field of gender dysphoria was the most positive aspect of service provision. The most negative aspect of the clinic was a lengthy waiting list. Although the majority of trans-and-gender-diverse patients attending the Gender Dysphoria Clinic were satisfied with the service they received, there is a need to identify strategies to facilitate timely access to the clinic.

Body composition, volumetric and areal bone parameters in male-to-female transsexual persons

Context Male-to-female (M→F) transsexual persons undergo extreme changes in gonadal hormone concentrations, both by pharmacological and surgical interventions. Given the importance of sex steroids for developing and maintaining bone mass, bone health is a matter of concern in daily management of these patients. Objective To provide data on bone metabolism, geometry and volumetric bone mineral density in M→F transsexual persons. Design/setting/participants Twenty-three M→F transsexual persons, recruited from our gender dysphoria clinic and at least 3 yrs after sex reassignment surgery, together with 46 healthy age- and height-matched control men were included in this cross-sectional study. Main outcome measures Body composition, areal and volumetric bone parameters determined using DXA and peripheral quantitative computed tomography. Hormone levels and markers of bone metabolism assessed using immunoassays. Peak torque of biceps and quadriceps muscles and grip strength assessed using an isokinetic and hand dynamometer, respectively. Results M→F transsexual persons presented lower total and regional muscle mass and lower muscle strength as compared to controls (all P < 0.001). In addition, they had higher total and regional fat mass ( P < 0.010) and a lower level of sports-related activity index ( P < 0.010). Bone mineral content and areal density (aBMD) of the lumbar spine, total hip and distal radius, as well as trabecular vBMD of the distal radius was lower as compared to controls ( P < 0.010). At cortical sites, no differences in cortical vBMD were observed, whereas M→F transsexual persons were characterized by smaller cortical bone size at both the radius and tibia ( P < 0.010). Lower levels of biochemical markers of bone formation and resorption ( P < 0.010) suggested decreased bone turnover. Conclusion M→F transsexual persons have less lean mass and muscle strength, and higher fat mass. In addition, they present lower trabecular vBMD and aBMD at the lumbar spine, total hip and distal radius, and smaller cortical bone size as compared to matched controls. Both the lower level of sports-related physical activity as well testosterone deprivation could contribute to these findings. These results indicate that bone health should be a parameter of interest in the long-term follow-up care for M→F transsexual persons.

The Monash Gender Dysphoria Clinic: Opportunities and challenges

Objective: The paper describes the origin, and establishment of a gender dysphoria clinic at Monash Medical Centre, Melbourne. It aims at describing the various components of the service, especially the triadic notions of assessment, real life experience and surgery for gender identity disorders. Conclusion: This is a unique service offered by a public psychiatric service, and the viability of the service depends upon new resources and renewed interest from psychiatrists. Besides clinical services, the clinic offers enormous research, teaching and training opportunities.

Effects of ethinyl estradiol on semen quality and various hormonal parameters in a eugonadal male

To determine the influence of estrogens on male fertility. A 36-year-old eugonadal male was subjected to two different regimens of treatment with ethinyl estradiol (EE2). Sperm quality, immunoreactive luteinizing hormone (LH) and follicle-stimulating Hormone (FSH), testosterone (T), estrone (E1), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), prolactin (PRL) and sex hormone-binding globulin were determined at intervals of 2 weeks for 315 days. A gender dysphoria clinic. A transsexual male nurse. It was hypothesized (and confirmed) that by comparing the effects of increasing and constant dose of EE2 on fertility parameters, differences in estrogen-sensitivity would show more clearly. Furthermore, this procedure served to find the minimal dose of EE2 for complete testicular suppression. Low doses of EE2 (20 micrograms/d) had no negative effect on sperm motility and density for a period of approximately 4 weeks, whereas high doses (60 micrograms/d) reduced motility already after a few days and led to a pronounced decrease in sperm density after 2 weeks. After discontinuation of therapy, motility normalized faster than sperm density. Under increasing doses of EE2 there was a constant decrease of FSH that occurred several weeks earlier than that of LH. Under constant dose of EE2 (60 micrograms/d) the decrease of LH was delayed (with respect to FSH) by only a few days. The decrease in T showed a stronger correlation with that of FSH than with that of LH. Volume and fructose content of the seminal fluid correlated with the decrease in T. Rebound effects were observed for FSH, LH, T, and fructose during the therapy-free interval. Ethinyl estradiol therapy had no influence on the serum concentrations of E1, E2, and PRL. Estrone was the dominant estrogen before and after therapy with EE2. Adrenal gland activity was markedly suppressed by EE2, as reflected by the decrease in DHEAS. The suppressive effect of EE2 on FSH and sperm motility was more pronounced and consistent than on LH and sperm density. The T decrease appears to be mainly caused by a direct effect of EE2 on the testes.