Transmasculine Patients Research Articles

Contraception across the transmasculine spectrum

The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.

Chest Binding and Care Seeking Among Transmasculine Adults: A Cross-Sectional Study.

Purpose: Chest binding, or compressing the chest tissue, is a common practice among transmasculine individuals that can promote mental health, but frequently results in negative physical health symptoms. The purpose of this study was to assess the prevalence and correlates of care seeking for binding-related health concerns among transmasculine adults.Methods: Descriptive statistics were calculated and logistic regression models were run using data from the Binding Health Project, a cross-sectional online survey among transgender adults who had practiced chest binding (n=1800). The analysis was restricted to transmasculine individuals who had consistent access to health care and were female assigned at birth or intersex (n=1273).Results: Of 1273 participants, 88.9% had experienced at least one binding-related symptom and 82.3% believed that it was important to discuss chest binding with their health care provider, while 14.8% had sought care related to binding. Participants reporting pain, musculoskeletal, or neurological symptoms had 3.19, 1.85, and 1.72 times the adjusted odds, respectively, of seeking care compared to those who did not report those symptoms (95% confidence intervals [CIs]: 1.38–7.37; 1.12–3.06; 1.10–2.68). Care seeking was associated with feeling safe and comfortable initiating a conversation about binding with one's provider (adjusted odds ratio [AOR]=2.07, 95% CI 1.32–3.24). Care seeking was not significantly associated with feeling comfortable receiving a chest examination (AOR=1.07, 95% CI 0.71–1.62).Conclusion: Low rates of care seeking for binding-related symptoms may be driven by lack of access to a provider with whom patients feel safe and comfortable, rather than by general discomfort with chest examinations. While transmasculine patients may be most likely to present with musculoskeletal, neurological, or pain-related concerns, providers should also assess for other symptoms. Providers should be familiar with the benefits and potential complications of binding and initiate non-stigmatizing positive discussions about binding with their transmasculine patients.

Healthcare Mistreatment and Avoidance in Trans Masculine Adults: The Mediating Role of Rejection Sensitivity.

Given that prior mistreatment can lead to heightened vigilance to and perceptions of future rejection, the present study examined whether this heightened vigilance, known as rejection sensitivity, mediates the association between healthcare mistreatment and healthcare avoidance in trans masculine (TM) adults. Between 2015 and 2016, 150 TM adults completed a comprehensive survey assessing socio-demographics, sexual health, and healthcare experiences. A 5-item scale assessing participants' sensitivity to rejection in healthcare scenarios was administered and psychometrically evaluated. Structural equation modeling was used to test whether rejection sensitivity in healthcare mediated the relationship between lifetime mistreatment in healthcare and past 12-month healthcare avoidance among TM adults. Overall, 68% of participants had experienced some form of mistreatment in healthcare in their lifetime and 43% had avoided healthcare in the past 12 months. For 5% of the sample, healthcare avoidance in the past 12 months resulted in a medical emergency. Path analyses revealed that healthcare mistreatment was positively correlated with rejection sensitivity and sensitivity was positively correlated with past 12-month healthcare avoidance. Rejection sensitivity mediated the relationship between mistreatment and healthcare avoidance (all p-values < 0.05). Rejection sensitivity may contribute to healthcare avoidance among stigmatized TM patients; however, longitudinal research is needed to establish the temporal ordering of these processes. Multilevel interventions to reduce healthcare discrimination and help TM adults cope with the psychological and behavioral consequences of stigma are recommended.

Submitting Appropriately for Breast Surgery in Transmasculine Patients

Submitting Appropriately for Breast Surgery in Transmasculine Patients

Retrospective Review of Applied Surgical Techniques for 538 Subcutaneous Mastectomy among Transmasculine or Non-Binary Patients

Retrospective Review of Applied Surgical Techniques for 538 Subcutaneous Mastectomy among Transmasculine or Non-Binary Patients

Abstract: Preoperative Genital Surgery Priorities in Transgender Men

Many transgender men seek surgical interventions to create male genitalia. Such procedures are often referred to as “bottom surgery”. Phalloplasty and metoidioplasty are the most common procedures. Phalloplasty involves the surgical creation of a penis from a local or free-flap while metoidioplasty makes uses the body of the hormonally-enlarged clitoris as the penile shaft. Currently, there is no standardized tool to assess individual goals and expectations for bottom surgery. In this study, our group has designed and administered a questionnaire to determine the preoperative priorities of transgender men seeking phalloplasty and metoidioplasty. METHODS: A literature review was conducted in order to identify areas of importance to patients seeking phalloplasty and metoidioplasty. Primary areas of relevance were found to be size, sensation, interest in penetrative sex, ability to urinate standing up, types of sensation, and maintenance of orgasmic function. This information was used to construct an assessment of genital surgery priorities for transmasculine patients. Most questions were structured as five item Likert scales with values ranging from very unimportant to very important. The assessment was then administered to the first eight patients seeking phalloplasty or metoidioplasty at our center. EXPERIENCE: Use of the formal assessment increased the information available to the surgical team. Regular multidisciplinary team meetings about patients showed that patients regularly disclosed priorities on the formal assessment that they did not bring up during the clinical exam. The team also found that the assessment tool encouraged additional questions from patients about sexual concerns that did not spontaneously arise elsewhere in the discussion. RESULTS: Eight consecutive patients were administered the survey, with a 100 percent response rate. The mean age of patients was 26 years (SD=4.5). All patients (n=8) reported full comprehension of the questions, and both patients who were uncertain of which procedure they wanted stated that it helped clarify their goals and allowed them to choose the most appropriate surgical procedure. Patients reported a variety of goals for genital surgery. All patients (n=8) rated being able to stand to urinate as “very important”. Three patients stated that being able to penetrate a sexual partner was “very important”, with the rest of the answers ranging from “unimportant” to “neutral”. There was no consensus on the importance of length or girth of the desired phallus. Three patients rated erotic sensation, and three patients tactile sensation, as “very important.” All patients stated that they had been able to climax through clitoral stimulation, information that will allow for contextualizing sexual function after surgery. CONCLUSIONS: Using a standardized measure improves both patient and clinician understanding of patient priorities around genital surgery. Our findings demonstrate the diversity of patient priorities and consequently emphasize the importance of assessing individual goals in the preoperative period. Of note, our data suggest that transgender men, as a group, value the ability to stand to urinate more highly than they do sexual function. We hope to further assess the range of patient goals for surgery and also prospectively assess how orgasmic function is affected by genital surgery procedures.

Comparing self- and provider-collected swabbing for HPV DNA testing in female-to-male transgender adult patients: a mixed-methods biobehavioral study protocol

BackgroundCervical cancer, nearly all cases of which are caused by one of several high-risk strains of the human papillomavirus (hr-HPV), leads to significant morbidity and mortality in individuals with a cervix. Trans masculine (TM) individuals were born with female reproductive organs and identify as male, man, transgender man, or another diverse gender identity different from their female assigned sex at birth. Routine preventive sexual health screening of TM patients is recommended, including screening for cervical cancer and other sexually transmitted infections (STIs); however, as many as one in three TM patients are not up-to-date per recommended U.S. guidelines. Among cisgender (non-transgender) women, self-swab hr.-HPV DNA testing as a primary cervical cancer screening method and self-swab specimen collection for other STIs have high levels of acceptability. No study has yet been conducted to compare the performance and acceptability of self- and provider-collected swabs for hr.-HPV DNA testing and other STIs in TM patients.MethodsThis article describes the study protocol for a mixed-methods biobehavioral investigation enrolling 150 sexually active TM to (1) assess the clinical performance and acceptability of a vaginal self-swab for hr.-HPV DNA testing compared to provider cervical swab and cervical cytology, and (2) gather acceptability data on self-collected specimens for other STIs. Study participation entails a one-time clinical visit at Fenway Health in Boston, MA comprised of informed consent, quantitative assessment, venipuncture for syphilis testing and HIV (Rapid OraQuick) testing, randomization, collection of biological specimens/biomarkers, participant and provider satisfaction survey, and qualitative exit interview. Participants are compensated $100. The primary study outcomes are concordance (kappa statistic) and performance (sensitivity and specificity) of self-collected vaginal HPV DNA specimens vs provider-collected cervical HPV swabs as a gold standard.DiscussionThis study addresses critical gaps in current clinical knowledge of sexual health in TM patients, including comparing alternative strategies for screening and diagnosis of cervical cancer, hr.-HPV, and other STIs. Findings have implications for improving the delivery of sexual health screening to this often overlooked and underserved patient population. Less-invasive patient-centered strategies may also generalize to other at-risk cisgender female populations that face barriers to timely and needed STI and cervical cancer screening.Trial registrationClinicalTrials.gov ID: NCT02401867

Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study

Chest binding involves the compression of chest tissue for masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals. There are no peer-reviewed studies that directly assess the health impacts of chest binding, yet transgender community resources commonly discuss symptoms such as pain and scarring. A cross-sectional 32-item survey was administered online to an anonymous, non-random sample of adults who were assigned a female sex at birth and had had experience of binding (n = 1800). Multivariate regression models were used to identify practices associated with self-reported health outcomes. Of participants, 51.5% reported daily binding. Over 97% reported at least one of 28 negative outcomes attributed to binding. Frequency (days/week) was consistently associated with negative outcomes (22/28 outcomes). Compression methods associated with symptoms were commercial binders (20/28), elastic bandages (14/28) and duct tape or plastic wrap (13/28). Larger chest size was primarily associated with dermatological problems. Binding is a frequent activity for many transmasculine individuals, despite associated symptoms. Study findings offer evidence of how binding practices may enhance or reduce risk. Clinicians caring for transmasculine patients should assess binding practices and help patients manage risk.

Perceptions of cervical cancer risk and screening among transmasculine individuals: patient and provider perspectives

Transmasculine people (individuals assigned a female sex at birth who identify as male or masculine) are at risk of cervical cancer. Despite low rates of Pap test use in this population, research examining the determinants of cervical cancer screening among transmasculine individuals is scarce. We conducted in-depth interviews and focus groups with 49 participants (32 transmasculine patients and 17 healthcare providers) in order to examine transmasculine individuals’ and healthcare providers’ perceptions of cervical cancer risk and screening among individuals on the transmasculine continuum. Overall, patients believed that transmasculine individuals should receive regular Pap tests, especially in the event of gynaecological concerns. While healthcare providers’ views varied, many perceived transmasculine individuals to be at low risk of cervical cancer. Contrary to existing screening guidelines, several providers believed that transmasculine individuals who did not engage in penile-vaginal intercourse with cisgender men, expressed discomfort about Pap testing or intended to obtain a hysterectomy might not need to be screened regularly or at all. Our findings underscore the importance of educating patients and providers about cervical cancer risk among transmasculine individuals and establishing evidence-based guidelines for cervical cancer screening in this underserved population.