Masculine Appearance Research Articles

Репродуктивное здоровье трансгендерных людей: серия случаев из Восточной Европы и Центральной Азии

Objective: Collection of data on psychological, social, legal, and economic barriers faced by transgender (TG) and non-binary (NB) individuals when approaching reproductive healthcare in Eastern Europe and Central Asia.Semi-structured interviews were conducted with TGL and NB who had experiences in reproductive healthcare.Six interviews were conducted with respondents who had experiences of pregnancy (an undisclosed country in Central Asia), oocyte retrieval for impregnation of the partner (Russia), abortion (Kazakhstan), postponing hormone therapy to conceive a child in the future (Russia), endometrial ablation to stop menses (Georgia), and artificial insemination (Russia). TG with a male gender in identification documents and masculine appearance face difficulties when trying to make an appointment for gynecological procedures, as well as the lack of understanding on behalf of other patients. In order to avoid bureaucratic barriers and intolerant treatment, TG and NB have to turn to private clinics, resulting in high financial expenses. TG who have a male gender marker and gave birth cannot be designated as a father in the birth certificate. None of the respondents suffered from gender dysphoria because of stopping/postponing hormone therapy. One experienced gender dysphoria after treatment with feminizing hormone therapy.Conclusion. The aforementioned legal barriers can be reduced by providing access to gynecological procedures for all patients irrespective of their gender marker. Clinical practice guidelines on reproductive health should be supplemented with information on TG and NB

Presumed Patriarchy: How a CEO's Masculine Appearance Affects Perceptions of Sexual Harassment in Organizations

Workplace sexual harassment remains an insidious yet pervasive component of organizational life. Building on research that has established that leaders play an important role in condoning or revoking sexual harassment, we theorize that a CEO's appearance—specifically, the extent to which their face is prototypically masculine—can influence employee assumptions about the patriarchal nature of organizational hierarchy, which, in turn, influences their perceptions of the degree to which sexual harassment will be tolerated. We test these ideas in three complementary studies. Study 1 observes that employees in large organizations headed by a CEO with a more masculine face report more instances of sexual harassment in online reviews. Study 2 uses an experiment to show that CEO facial masculinity drives followers’ perceptions that sexual harassment is tolerated in an organization by increasing the presumption that the organization is patriarchal. Study 3 affirms these results with a sample of new employees both before and after their first day on the job. Together, these studies provide evidence that a presumption of patriarchy increases the perceived tolerance for sexual harassment, which yields more observations of sexual harassment in the workplace.

Aspects sociologiques des transidentités

The surgery of trans people is not apprehended by most of plastic surgeons as a simple surgery for the purpose of morphological transformation. At the same time, the French trans population does not benefit from adequate surgical coverage. Over the past few years, French regulations have simplified the process of reassignment surgeries. In addition, we have witnessed a fairly rapid increase in requests for transition surgery with accelerated and sometimes atypical courses. In recent years, a number of specialists have warned the medical community about the risks of slippage due to a lack of psychological monitoring of certain people beginning a transition process. Quite recently, hybrid transition paths have also appeared which, from a surgical point of view, are no longer limited to ensuring that a native assigned female patient can take on the most masculine appearance possible or the reverse. In this manuscript, we expose the biological, historical and societal place of transidentity and then address the reasons for the warnings of a certain category of the medical population while reassuring the surgical community on the benefits of reassignment surgeries in a controlled context. We end by proposing a few ways to improve the care course of trans people applicable in France.

Féminisation du regard

Eye feminization embraces surgical and non-surgical aesthetic procedures used in order to feminize upper third of the face. Eye feminization is indicated for transwomen during facial gender affirming surgery, and also for aging women. During aging, volume of facial osseous and soft tissues is decreasing, the orbit is squeletonizing, with skin sagging, evolving in a more masculine appearance of the orbital area. Upper eye area analyze (forehead, temple, eyebrow, eyelid, external canthus) as lower eye area analyze (zygoma, dark circle, palpebral bags, eyelid skin) must be assessed in preferential order in order to maximize good post-therapeutic results. Procedures include bony surgery (frontoplasty, orbitoplasty), browlift, external canthoplasty, fat grafting, and also classic eyelid surgery or aesthetic medicine injections.

(477) Ablation Vaginectomy is a Safe and Effective Technique in Transmasculine Gender Affirmation Surgery

Abstract Introduction Genital gender affirmation surgery ameliorates gender incongruence with the aim to align an individual’s genital appearance more closely to their experienced gender identity. Vaginectomy is commonly requested because it allows closure of the vaginal vault resulting in a masculine appearance to the perineum. Vaginectomy also allows a more appealing sac-like scrotoplasty and may reduce the risk of urethral complications. Transvaginal, laparoscopic (often combined with transvaginal) and robotically assisted approaches have been described. The transvaginal approach involves the excision of vaginal mucosa but blood loss may be significant and there is a risk of injury to adjacent organs like the bladder or rectum. Alternatively, the vaginal mucosa can be obliterated by high power electrocautery without excision. This technique has not been formally described in the literature before. Objective Pilot study to describe the technique for ablation vaginectomy (AV) and to assess the safety and efficacy of AV compared to traditional transvaginal excision vaginectomy (EV). Methods Retrospective review of a comprehensive prospective database and supplemented by medical records of transgender and non-binary persons requesting vaginectomy for gender affirmation surgery. AV was performed using high power electrocautery while EV was by a transvaginal approach. Follow-up was 30 days post-surgery. Data were reported as mean (standard error) unless specified otherwise. Results A hundred and thirty-seven patients were included in the study (62 following AV, 75 following EV). The median age (interquartile range) of both cohorts were similar [AV, 38 years (29-48); EV 37.7 years (31.5-43)]. Patients who underwent AV had a higher BMI but despite this, they had a lower intra-operative blood loss (99.8 ± 12.7mL vs 646.7 ± 63.4mL) and post-operative drain loss (90.9 ± 11.6mL vs 242.8 ± 23.6mL). More patients following EV required a transfusion (n=11) of 2.34 ± 0.5 units of packed red cells. Six patients had an intraoperative complication during EV (none for AV). Two patients had a recognised urethral perforation (one combined with a bladder injury) and 3 others had a bladder injury. All were repaired at the time. Complication rates after 30 days were similar although there was a trend for higher complications following EV (24% vs 11.3%, p=0.06). These were all related to bleeding and haematoma formation with 3.4% (AV cohort) and 8% (EV cohort) Clavien-Dindo grade 3b complications. Conclusions AV may be a feasible and safe approach when requested for gender affirmation surgery. Further prospective data with longer follow-up are required. Disclosure No

"Building that strong energy": An exploration of stigma coping strategies among sexual and gender minorities in Nigeria.

Sexual and gender minority stigma (SGM stigma) affecting Nigerian sexual and gender minorities (SGM) is associated with suboptimal HIV outcomes, and one mechanism found to explain the relationship is suicidal ideation. A better understanding of coping strategies may help mitigate the harmful impacts of SGM stigma. Interviews of 25 SGM from Abuja, Nigeria participating in the [Blinded for Review] study were thematically analyzed in regards to how they coped with SGM stigma. Four coping themes emerged: avoidant behaviors, self-monitoring so as to not attract stigma, seeking support and safe spaces to be themselves, and empowerment and self-acceptance through a process of cognitive change. They utilized multiple coping strategies, often believing that stigma could be avoided through the right actions and a masculine appearance. Multi-level and person-centered interventions that increase safety and support, facilitate resiliency, and improve mental health and engagement in HIV programming could mitigate the effects of SGM stigma and coping responses of isolation, blame, and mental health stressors among Nigerian SGM.

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.

Aesthetic Refinements in Male Chest Lifting.

Abstract The authors describe aesthetic refinements to the approach for male chest lifting in male patients with grade 3 gynecomastia and/or significant chest skin excess. An inferior pedicle is used to transpose the nipple–areolar complex allowing preservation of pigment and sensation, liposuction and direct excision are used to reduce volume and excess skin, and the resulting curvilinear scar along the inferior and lateral border of the chest provide a more masculine appearance. Early experience with this technique has shown it to be safe and effective. Perioperative management and the detailed steps of the procedure are outlined. Level of Evidence: 5

Fragmenting and defragmenting gender identity: An analysis of intersex gender identity performance in Jeffrey Eugenides Middlesex

Jeffrey Eugenides’ novel Middlesex is a hermaphrodite coming-of-age narrative often critiqued in the literary field for its depiction of unstable gender identity performance from the intersex perspective. The novel depicts its main protagonist, Cal, as having an unstable gender identity throughout the narrative, performing his gender in ways that conform to extreme heteronormative gender standards. However, little scholarly attention is given to how Cal’s gender identity is fragmented in this unstable portrayal and how his exploration of gender identity performances in the narrative allows for the defragmentation of his gender identity. This paper aims to highlight Cal’s gender metamorphosis in Eugenides’ Middlesex, working through his gender identity performances in their various states using Irvine Goffman’s presentation of the self and Judith Butler’s gender identity performance theory. Selected instances of Cal’s gender performances from childhood, adolescence and adulthood were textually analysed to examine the gender norms conformed to in each performance. Cal’s performances of gender during childhood and adolescence conformed to extreme heteronormative standards of feminine beauty, female heterosexuality, and female biology. However, in young adulthood Cal begins exploring gender identities, allowing for the onset of his metamorphosis. During adulthood, Cal’s gender is presented in ways that conform to heteronormative standards of masculine appearance, male heteronormativity, and male biology. It is this dramatic gender metamorphosis that allows Cal to stabilise his gender identity and that allows Middlesex to present the intersex condition as having a stable gender identity. It is this perspective of the novel’s depiction of gender that should be.

Facets of Gender Expression and Discrimination in Relation to Alcohol and Other Drug Use Severity Among Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth.

Purpose: Sexual minority women and gender diverse individuals assigned female at birth (SMW+) consistently report more alcohol and other drug (AOD) use severity than heterosexual women, with greater disparities reported among bisexual plus (bi+) SMW (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity). Furthermore, emerging evidence suggests that SMW with masculine gender expression (e.g., SMW with masculine gender appearance) disproportionately experience problematic AOD use compared to those with feminine gender expression. The minority stress model, which has predominantly been investigated in relation to internalized homonegativity and sexuality-based discrimination, may also account for these AOD use disparities. This study examined gender expression, related discrimination, and AOD use severity among SMW+. Methods: In a 2020 sample of SMW+ (n = 236), we investigated AOD use severity in relation to gender expression (appearance, emotional expression, and gender roles) and gender expression-based discrimination after controlling for internalized homonegativity and sexuality-based discrimination through an online survey. Results: Masculine gender roles were associated with AOD use severity, whereas masculine appearance and emotional expression were not. In multivariable models, gender identity was inconsistently associated with alcohol use severity, sexuality-based discrimination was consistently associated with alcohol use severity and inconsistently associated with other drug use severity, and gender expression-based discrimination was associated with neither. Conclusion: This study emphasizes the importance of examining intersecting aspects of minority identity among SMW+, including facets of gender expression, in relation to AOD use severity.

Nonconforming gender expression and insufficient sleep among adolescents during COVID-19 school closure and after school reopening

BackgroundGender nonconformity (GNC) (i.e., gender expression that differs from gender role expectations for feminine or masculine appearance and behavior) is an under-researched area of adolescent sleep health. The COVID-19 lockdown offers an opportunity to understand how the effect of GNC on adolescent health outcomes changes between school closure and reopening.MethodsWe conducted a cross-sectional study in Shanghai, China, in 2020. The sample size for analysis was 3,265. The age-specific insufficient sleep was estimated according to National Sleep Foundation's sleep duration recommendations. The self-perceived and self-rated GNC were measured by the two items “On the same scale that goes from 100% as a girl to 100% as a boy, where do you think others see you?” and “On a scale that goes from feeling 100% like a girl to feeling 100% like a boy, where do you see yourself?”, and birth sex. In addition, we calculated sex-stratified adjusted odds ratios (AORs) of insufficient sleep for students with high and moderate GNC compared to students with low GNC. Finally, we measured the AORs with self-perceived and self-rated GNC during COVID-19 school closure and reopening.ResultsAmong 3,265 students in grade 6–12 in the analytic sample, 1,567(48.0%) were assigned female at birth (AFAB), 3,188 (97.6%) Han, and 1,921(58.8%) in grade 6–9. Among AFAB students, high self-perceived GNC was significantly associated with insufficient sleep (AOR,1.65; 95%CI,1.30–2.09) during school closure. Insufficient sleep was associated with high self-rated GNC (AOR,1.73; 95%CI,1.23–2.44) and moderate self-rated GNC (AOR,1.69; 95%CI,1.29–2.22) during school closure. After school reopening, neither self-perceived nor self-rated GNC was associated with insufficient sleep among AFAB students. Among assigned male at birth (AMAB) students, none of the two kinds of GNC was associated with insufficient sleep in the two periods during the COVID-19 pandemic.ConclusionsThis study suggests GNC is only associated with insufficient sleep among AFAB students during school closure. Furthermore, the association is nonsignificant among AMAB students. These findings indicate that GNC-related stigma within the family could be a risk factor for insufficient sleep among AFAB adolescents.

The Role of Gender Dysphoria in the Development of an Eating Disorder

The Role of Gender Dysphoria in the Development of an Eating Disorder

Abstract #1184630: Case of Familial Partial Lipodystrophy in a Female Presenting with Acromegaloid and Masculine Features

Familial partial lipodystrophy (FPL) is a rare metabolic disorder defined by a loss of subcutaneous fat in the extremities but there is great heterogeneity in its presentation. We present a case of FPL in a female with acromegaloid facial appearance and complaint of “masculine appearance”.

CHARACTERIZATION OF ENOLA HOLMES IN THE CASE OF THE MISSING MARQUESS: A STUDY OF LIBERAL FEMINISM

This study attempts to portray a female character, Enola Holmes, in Nancy Springer’s novel series entitled The Case of the Missing Marquess (2006). This research focuses on examining these research problems: 1) how is Enola Holmes characterized differently from most teenage girls at the setting of time, and 2) what spirit of feminism is illustrated by the novel through the character of Enola Holmes? The study confirms that the different portrayals are shown from Enola Holmes’ physical appearance, thought, and personality. Her masculine appearance was against the normative beauty standard for most women in the nineteenth-century tradition. Her critical and logical thought challenged the stereotypical gender role, which positioned women as less intelligent than men. Moreover, her independent and courageous personality highlighted the different traits of Enola Holmes as a young woman at that time. The characterizations reflect liberal feminism by emphasizing women’s autonomy and gender equality between men and women.

How stereotypes and relationships influence women and underrepresented minority students' fit in engineering

AbstractWomen and underrepresented minority (URM) undergraduates declare and complete science, technology, engineering, and mathematics majors at different rates in comparison to majority groups. Explanations of these differences have long been deficit oriented, focusing on aptitude or similar characteristics, but more recent work focuses on institutional contexts, such as academic climate and feelings of belonging (fit). This study examines the experiences of women and URM students in engineering undergraduate programs, focusing on how they fit, experiential factors affecting fit, and how fit is mitigated by social relationships from their networks and organizations in which they participate (i.e., social capital). Thematic analysis of 55 women and URM interviewee responses shows that students who fit well were those with majority characteristics, including race (i.e., White, White‐passing) and gender (i.e., men, masculine appearance), and those in groups well represented in their programs numerically (i.e., men, Asian). In contrast, women and Black students encountered threats to their fit due to stereotyping from bias and differential treatment from others (i.e., being excluded from group work). However, students received advice from their social networks (i.e., family, professors) in which they were warned to expect discrimination, or through organizations in which they participated (i.e., National Association of Black Engineers) where their sense of community was expanded. The advice and resources provided through this network‐based and participatory social capital mitigated fit for women and Black students, albeit in different ways, helping to preserve their feelings of belonging and promote their persistence in engineering. We offer suggestions to enact university policies to increase access to social capital with homophilious alters and educational opportunities for majority groups.

Sexual Dimorphism in Facial Contrast: A Case from Central Africa.

Apart from morphological differences, male and female faces also vary in color, especially in overall lightness and facial contrast, i.e., the contrast between the luminance and color of facial features (eyes, lips, or brows) and luminance and color of the surrounding skin. In many populations, it has been demonstrated that women tend to be lighter than men. Other differences were found in facial contrast: women have a higher contrast between the lightness of their eyes and lips and the surrounding skin. Manipulation of this contrast in an artificial genderless face can result in a masculine or feminine appearance. So far, however, this phenomenon has been studied mostly in Euro-American and East Asian samples, with little evidence from populations with darker facial tone. We explored natural sexual dimorphism in both facial contrast and lightness in an African, namely Cameroonian, sample, and compared it with results for a European, in particular Czech, population. Our findings showed that sexual differences in luminance contrast of eyes and brows were in both studied populations similar but in the Cameroonian sample, significant difference in lips contrast was absent. These results indicate that sex differences in facial contrast are a side effect of the sex differences in skin color and can be used as a proxy for skin color perception.

Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice.

Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density.

Classification of Transgender Man's Breast for Optimizing Chest Masculinizing Gender-affirming Surgery.

Background:The purpose of mastectomy for the female-to-male transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique; these have generally been based on the degree of breast ptosis and the quality and elasticity of the skin. We present a series of subcutaneous mastectomies operated on by 1 surgeon during the last 2 decades. Based on our experience, we suggest a classification system for selecting surgical technique.Methods:Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003–2019. The data included background and surgery information. Pictures from the clinic’s archive of the patients before, during, and after surgery were collected and analyzed.Results:In total, 220 mastectomies were performed on 110 patients aged 13.5–50 years (mean 22.5 ±6.1). The excision averaged 443 g per breast (range: 85–2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple–areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple–areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple–areola complex graft in 56 (50.9%). Complications included 2 hypertrophic scars, 6 hematomas requiring revision surgery, 3 wound dehiscences, and 3 cases of partial nipple necrosis.Conclusions:Analysis of the data led to a proposed classification for female-to-male transgender mastectomy (Wolf’s classification), based on skin excess and the distance between the original and the planned position of the nipple–areola complex.

Masculine and metrosexual: Indonesian actor’s clothing style on Instagram from the Foucauldian perspective

This study seeks to explore the fashion styles of Indonesian actors on Instagram from Foucault’s perspective. Appearance is a demand that is not only aimed at women but also for men. Appearance is an important part, especially for men, so that also increases the metrosexual side. The enhancement of men’s appearance in clothing has increased metrosexuality. The metrosexual side has been viewed by society as indicating the waning masculine side of a man. Thus, some people believe that metrosexual men lose their identity entirely because excessive attention to appearance is associated with women identity. The method used in this study was the Krippendorff content analysis carried out on Joe Taslim’s Instagram account Instagram posts from October 2019 to February 2020. Joe Taslim, known as an Indonesian action actor, is a figure with a masculine appearance chosen in this study to represent a masculine men figure but still looks metrosexual. The results of this study indicate that Joe Taslim’s Instagram is used as a medium in creating fantasies about the men body metrosexual, which is run by the capitalist industry to create a masculine impression.

SUN-050 Isolated Hyperprolactinemia Caused by Chest Binding in a Transgender Male

Background: Prolactin levels are routinely measured in patients evaluated for PCOS. Compared with the general population, PCOS is more common among transgender men, with prevalence estimates as high as 30 to 50%1,2. Nipple stimulation is a recognized cause of hyperprolactinemia, and many transgender men engage in chest binding, which involves compressing the breast tissue to produce a more masculine appearance. Clinical Case: A 22-year old natal female with gender dysphoria, who presented to our clinic for initiation of masculinizing hormone therapy, revealed a history of irregular menstrual cycles, hirsutism, and moderate acne. The patient was on a combination OCP to regulate menstrual cycles but no other medications or supplements. Laboratory evaluation revealed normal TSH, creatinine, 24-hour urine cortisol, testosterone, 17 hydroxyprogesterone, and DHEA-S. LH was 2.4 mIU/mL, FSH was 6.0 mIU/mL, and prolactin was elevated at 55.6 ng/mL (4.8-23.3 ng/mL). Polycystic ovaries were not present on pelvic ultrasound. Pituitary MRI was ordered for further evaluation of hyperprolactinemia and no pituitary adenoma or other structural abnormality was seen. The patient denied nipple discharge and tenderness but endorsed chest binding. In the absence of another explanation, nipple stimulation through chest binding was hypothesized to be the cause of hyperprolactinemia. After withholding chest binding for one week, the patient’s prolactin level normalized to 13.95 ng/dL. The patient was diagnosed with PCOS according to Rotterdam criteria after exclusion of alternative etiologies. It was presumed that five years of consistent OCP use had normalized androgen levels and suppressed the appearance of polycystic ovaries on ultrasound. The patient was initiated on testosterone cypionate for gender affirmation. Prolactin increased again to 29.33 ng/mL one year later after resumption of continuous chest binding. Conclusion: This is the second reported case of hyperprolactinemia induced through chest binding.3 Transgender men are at increased risk for irregular periods due to underlying PCOS and therefore more likely to undergo an evaluation that includes prolactin measurement. By recognizing chest binding as a cause of isolated hyperprolactinemia, physicians can minimize unnecessary testing and anxiety in patients who engage in this practice.1. Baba, T. et al. Hum Reprod. 2007;22;1011-16. 2. Becerra-Fernandez, A. et al. Endorinol Nutr. 2014;61; 351-8.3. Patel, S., & Abramowitz, J. (2019, April). Hyperprolactinemia in a Transgender Male. Poster session presented at the Annual Scientific & Clinical Congress of the AACE, LA, CA.