Transsexual Patients Research Articles

Volumétrie frontotemporale pour rajeunir et re-féminiser le visage

The author became interested in facial volume in the 1990s, during the period when he oversaw the feminization of the facial skeleton to improve the social integration of male transsexual patients. At that time, it was skeletal surgery. Very quickly, these techniques were extended to genetic women who wanted a more feminine face. The study of facial aging allowed the author to define criteria for frontotemporal aging, particularly an evolution with age towards a frontotemporal masculinization. The volumetric frontotemporal correction has thus become an essential element of facial rejuvenation. The evolution then, naturally took place towards the concept of frontotemporal beauty.

Féminisation faciale, historique, évolution des objectifs

The author's experience dates from 1990, during the period when he was in charge of the feminization of the facial skeleton in order to improve the social integration of male transsexual patients. Very quickly, these techniques were extended to genetic women who wanted a more feminine face. This facial skeletal surgery was then supplemented with soft tissue surgery. This skeletal and volumetric surgery has become an important contribution in the search of facial rejuvenation and beauty.

혼인중인 성전환자 성별정정과 혼인관계 종료에 대한 검토

The Supreme Court greatly contributed to the recognition of the basic rights of transsexual patients and the universal recognition of sexual identity. Although there were no regulations, it was interpreted that gender correction was included in the corrections in the family relations register, enabling gender correction of transgender people. For the protection of the basic rights of transgender people and the practical welfare of minors, gender correction of transgender people with underage children was permitted.
 However, gender correction of married transgender people is still not allowed. This is because the gender correction of married transgender people creates the appearance of same-sex marriage. If so, it is necessary to review whether divorce or marriage can be canceled or invalidated within the current law so that the appearance of same-sex marriage does not appear even if a transgender people have corrected their genders.
 If you have recognized your sexual identity since the time of marriage, but you have married, but there is no actual substance of married life, you can claim invalidity of the marriage because there is no agreement on marriage, but this case is very limited.
 Cancellation of marriage is difficult for transgender people to claim due to restrictions on reasons for cancellation, right to cancel, and exercise period.
 If the other party does not agree to a negotiated divorce, it is difficult to file a divorce suit. Because that the spouse at fault is not entitled to apply for judicial divorce. This position has been maintained by the Supreme Court.
 However, denying the gender correction of transgender people just by the fact that they are married is a great violation of the basic rights of transgender people.
 Therefore, gender correction is allowed on the condition of dissolving the marriage by borrowing the United Kingdom case.
 Alternatively, in the case of gender correction procedures, a bill is proposed to allow transgender people to engage in judicial divorce regardless of their responsibilities for marrirge life.

Pacjenci transpłciowi i transseksualni w medycynie paliatywnej

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kozlowski M, Dębowska P, Filipczak-Bryniarska I. Transgender and transsexual patients in palliative medicine. Medycyna Paliatywna/Palliative Medicine. 2022;14(3):155-157. doi:10.5114/pm.2022.126741. APA Kozlowski, M., Dębowska, P., & Filipczak-Bryniarska, I. (2022). Transgender and transsexual patients in palliative medicine. Medycyna Paliatywna/Palliative Medicine, 14(3), 155-157. https://doi.org/10.5114/pm.2022.126741 Chicago Kozlowski, Michael, Paulina Dębowska, and Iwona Filipczak-Bryniarska. 2022. "Transgender and transsexual patients in palliative medicine". Medycyna Paliatywna/Palliative Medicine 14 (3): 155-157. doi:10.5114/pm.2022.126741. Harvard Kozlowski, M., Dębowska, P., and Filipczak-Bryniarska, I. (2022). Transgender and transsexual patients in palliative medicine. Medycyna Paliatywna/Palliative Medicine, 14(3), pp.155-157. https://doi.org/10.5114/pm.2022.126741 MLA Kozlowski, Michael et al. "Transgender and transsexual patients in palliative medicine." Medycyna Paliatywna/Palliative Medicine, vol. 14, no. 3, 2022, pp. 155-157. doi:10.5114/pm.2022.126741. Vancouver Kozlowski M, Dębowska P, Filipczak-Bryniarska I. Transgender and transsexual patients in palliative medicine. Medycyna Paliatywna/Palliative Medicine. 2022;14(3):155-157. doi:10.5114/pm.2022.126741.

Knowledge and attitudes of physicians in caring for transgender and transsexual patients

Abstract Background Currently, care for the community of transgender and transsexual patients has been specialized in different countries of the European Union, thereby favoring better medical care for this community of patients, however, in countries like Mexico there is still no these spaces, thereby favoring the lack of dignified treatment. Objective To determine the correlation between knowledge and attitudes of doctors in the care of transgender and transsexual patients in doctors from the State of Veracruz Ignacio de la Llave. Material and methods A cross-sectional, prospective, observational, analytical and correlational study was carried out. Doctors from the state of Veracruz were included and the tests of ‘Knowledge about transsexuality' and ‘evaluation of attitudes towards the transgender and transsexual community' (Cronbach's alpha of 0.75 and 0.85) were applied by means of electronic surveys, being selected by non-probability sampling. Results 359 doctors were included, of which 201 (56%) were men, with Catholic religion in 197 (54.4%) of the cases, cisgender in 333 (92.8%), hetero sexual 296 (82.5%) with older age. frequent between 23 to 29 years (56.3%). The correlation between the level of knowledge about transsexuality and the scale of attitude towards the transgender community was -0.08, while that of the level of knowledge about transsexuality and the scale of attitude towards the transgender community was -0.39. The Catholic religion, being a biological man, and being heterosexual showed values of p < 0.05 with respect to the presence of prejudices for the transgender and transsexual community. Conclusions There is no correlation between knowledge about transsexuality and the attitude towards this group by the doctors of the state of Veracruz. Key messages There is no correlation between knowledge about transsexuality and the attitude towards this group by the doctors of the state of Veracruz. To practice the catholic religion, being a biological man, and being heterosexual its associated to the presence of prejudices for the transgender and transsexual community.

The Medicalization of the Transsexual: Patient-Physician Narratives in the First Half of the Twentieth Century.

This article explores the history of what the German-American endocrinologist Harry Benjamin labeled in 1966, "the transsexual phenomenon." By mid-century, a growing number of individuals in both Europe and America were approaching physicians such as Benjamin searching for answers and means to change their bodies to match their gender. This phenomenon had started in Europe in the 1930s, when the Danish painter Einar Wegener underwent a series of operations that transformed a body defined at birth as male into the female body of Lili Elbe. The news of Elbe's transformation ignited interest and discussion among physicians as well as the public on the capacity science had to alter bodies to fit their intended selves. The case of Elbe combines the three main aspects studied in this article-the medicalization of the homosexual, the birth of the transsexual, and the physician-patient relationship in transsexual narratives. The study of physician and patient narratives allow us to see how the transsexual phenomenon was in fact created out of the intersection of interests from both physicians and their transsexual patients.

Quality of Life and Perceived Social Support Before and After Sex Reassignment Surgery.

This study aimed to explore the pre- and postoperative differences in quality of life and perceived social support of Female-to-Male transsexual patients who underwent mastectomy and complete hysterectomy. Sixty-three Female-to-Male female individuals who underwent complete hysterectomy and mastectomy between November 2019 and November 2020 were included in this study. Data were collected using the Personal Information Form, Multidimensional Scale of Perceived Social Support, and the World Health Organization Quality of Life Scale Short Form. The pre- and postoperative perceived social support mean scores of patients were 57.2 ± 9.0 and 74.9 ± 7.3, respectively. The pre- and postoperative quality of life mean scores of patients were 76.9 ± 8.3 and 107.8 ± 10.1, respectively. There were statistically significant differences between the measurements (p < .05). In addition, the patients whose education level was primary school, whose income was less than their expenditure, whose father was a primary school graduate, whose family had a strict family opinion on sexuality, whose family had a traditional view, and who had a high body mass index were found to have higher postoperative social support perceptions and quality of life. The patients' postoperative quality of life and perceived social support improved after sex reassignment surgery.

O-218 The effect of mTOR activation on human primordial follicle activation during in-situ culture

Abstract Study question What is the effect of mTOR pathway activation on human primordial follicles in-situ activation and subsequent development following tissue cryopreservation? Summary answer Temporary treatment of cryopreserved human ovarian tissue with mTOR activators cause the initiation of primordial follicle development and influence steroidogenesis. What is known already In-vitro activation of primordial follicles to produce mature oocytes provides an alternative technique for fertility preservation. The employment of different stimulators of PI3K pathway has been successfully used to activate resting follicles during culture or prior to grafting in patients with premature ovarian insufficiency. The addition of phosphatidic acid (PA) and propranolol (PP), as mTOR stimulators, in the culture medium has promoted primordial follicle activation morphologically in mouse and human ovaries. Molecular and functional evaluations of primordial follicle activation after treatment with the mentioned stimulators has not been conducted. Study design, size, duration Ovarian tissues which were donated from 6 transsexual patients (23-35 years old), were dissected and cryopreserved with slow-freezing technique. After thawing, they were cut into 1x1x1 mm fragments and incubated with different stimulators in three groups: 1) Control (without stimulators), 2) PA (200µM), and 3) PA+PP (200µM &amp; 50µM respectively). In groups two and three, ovarian fragments were cultured for 24 hours in presence of stimulators and then cultured for additional 6 days without stimulators. Participants/materials, setting, methods The cultured ovarian fragments were directly processed for Hematoxylin and Eosin staining and Western blot analysis. The proportion of morphologically normal and degenerated primordial and growing follicles and 17β-estradiol (E2) level in the culture medium were compared after 1 and 7 days of culture to assess follicular development and function. Western blot analysis for phosphorylated and non-phosphorylated status of FOXO3a and RSP6 proteins expression were compared after 24 hours of incubation. Main results and the role of chance The proportion of primordial and growing follicles were not significantly different in the experimental groups after 24 hours of incubation with either of the stimulators. Western blot analyses indicated a significant reduction of FOXO3a in the PA+PP group compared to the control group. The phosphorylation level of RPS6 protein did not significantly change in either of the groups. The proportion of transitional follicles were significantly higher in the PA group compared to other groups after 7 days of culture. The E2 secretion level was significantly higher at the last day of culture compared to day 1 for all groups. At the end of the culture period, E2 levels was significantly higher in both PA and PA+PP groups compared to the control group. Limitations, reasons for caution Due to ovarian fragmentation before culture, the HIPPO pathway downstream molecules should have also been evaluated by western blot, which was not contributed in this study. Wider implications of the findings The results demonstrate the beneficial effect of mTOR signaling to accelerate early primordial follicle recruitment in cryopreserved-thawed human ovarian fragments. Trial registration number not applicable

Gender Identity Disorder Etiology and Medical Treatment: Between Scientific Evidence and Personal Experiences

Gender Identity Disorder (GID) is a condition characterized by a strong and persistent identification with the opposite sex. These people consider themselves victims of a sort of biological accident: “a soul in a wrong body”. There are numerous theories on the origin of transsexualism: genetic, hormonal and psychological causes have been hypothesized, but those currently most accredited are the neuroanatomical ones. The cornerstones of hormone conversion therapy (Gender Affirming Hormone Therapy, GAHT) are feminizing hormones for transgender women (MtFs or AMAB: Assigned Male at Birth) and virilizing for transgender males (FtMs or AFAB: Assigned Female at Birth). GID can be present among adolescents and older people. For adolescents is now accepted reversible treatment of puberty withdrawal with hormones that stops the progression of pubertal development in the biological direction not accepted; for elderly people are suggested GAHT in reduced doses. Physicians should consider and discuss with people with GID about fertility preservation, general and cancer risks. We present also data of 127 transsexual patients enrolled at the Garibaldi-Nesima Andrology Clinic in Catania (Italy) from 2003 to 2020. To optimize the conversion treatment with sex hormones, transsexuals require long-term follow-up. GAHT must be performed by a doctor who is familiar with these problems. Therefore, the “do-it-yourself ” trend and the lack of medical and laboratory checks over time should be absolutely discouraged. Before proceeding with the surgical sex reassignment, it is recommended to refer to an endocrinologist and psychologist or psychiatrist for a period of 2-3 years. The transition surgical conclusion process must be practiced by a quality surgical team.

Resolution of severe anorexia nervosa by testosterone treatment in two male transsexual young patients

Resolution of severe anorexia nervosa by testosterone treatment in two male transsexual young patients

A giant GIST of the greater omentum in a female transsexual patient, hopefully not a side effect of hormonal therapy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A modified microvascular “Tube-in-Tube” concept for penile construction in female-to-male transsexuals: Combined radial forearm free flap with anterolateral thigh flap

Phalloplasty is a complex surgical task and remains a significant challenge in plastic surgery. To date, there are various techniques; however, complication rates are still not satisfactory. Here, we present our surgical approach of a modified tube-in-tube concept combining a radial forearm free flap and an anterolateral thigh flap and assess its outcome in a series of female-to-male transsexuals. In this report, 21 female-to-male transsexual patients were included. The first surgical step includes colpectomy and elongation of the fixed part of the urethra with a full-thickness skin graft. Subsequently, a radial forearm free flap was adapted to build the inner tube which represents the neourethra. For the last step, a free anterolateral thigh flap is utilized as the outer tube of the neophallus. All patients were evaluated regarding aesthetic and functional outcomes as well as postoperative complications and revision surgeries. Our results showed a 100% flap survival rate with a mean follow-up of 4.4 years (range, 2.7-6). Three radial forearm free flaps and one free anterolateral thigh flap presented with partial flap necrosis. Generally, complications occurred in 11 patients (52.4%). The most common complications were related to urethral reconstruction including fistula formation (n = 8) and stenosis (n = 5). All except one patient obtained the ability to void while standing. Despite the complexity, the initial results are very promising for a single-stage phalloplasty with complete functional creation of a neophallus. Further improvements have to be implemented for reduction of postoperative complications particularly regarding urethral reconstruction. IV (Therapeutic).

"Single center experience of laparoscopic hysteroannessiectomy and histopathological outcomes in transgender men".

This article presents a retrospective descriptive analysis about female-to-male (FtM) gender-affirmation nongenital surgical procedures involving the gynecological team at the CIDIGeM (Centro Interdipartimentale Disturbi di Identità di Genere Molinette) Center in Turin. From 2004 to 2019, seventy FtM transsexual patients underwent hysteroannessiectomy: the chosen surgical technique involved a Total Laparoscopic Hysterectomy. The patients presented a median age of 30.5 years (range 21-53). No patients presented intraoperative complications, the median of surgery time was 80 min (range 40-150) and the hospital stay median was 5 days (range: 2-25). Histopathological examinations were negative for cancer in all patients except for one unknown case of grade 3 cervical intraepithelial neoplasia. Total Laparoscopic Hysterectomy is confirmed to be the method of choice in the group of FtM transsexuals: this approach has several advantages over abdominal hysterectomy, including more rapid recovery, fewer wound or abdominal wall infections; moreover, it has enabled us to preserve the vital structures needed for reconstruction of external genitalia. Cancer risk is still considered an area of priority in transgender research; thus, we underline the importance of performing a histopathological examination of the surgical specimen.

Novel Use of Feminization Laryngoplasty

Wendler glottoplasty is a voice feminization surgical procedure designed to increase the fundamental frequency (F0) in male-to-female transsexual patients with gender dysphoria. On average, Wendler glottoplasty has the most significant effect on F0 among voice feminization surgical procedures. We present the case of a young female patient with a testosterone-producing adrenocortical adenoma who underwent irreversible vocal changes secondary to virilization, which impacted her self-esteem and quality of life (QOL). Voice feminization surgery using Wendler glottoplasty was performed with significant improvement in F0 and QOL. Sex hormones have a profound impact on the voice. Increased testosterone and dihydrotestosterone are known to cause hypertrophy of the laryngeal muscles and ligaments, which leads to a drop in F0. However, women who present androphonia rarely require surgical management and improve with vocal therapy alone. Few cases of voice feminization procedures for the treatment of androphonia have been described in the literature. Our patient presented with severe masculinization of her voice with a F0 lower than the average adolescent male, which led to the requirement of surgical management. Patients with severe androphonia that significantly affect their QOL and show no improvement after the management of the underlying pathology and intense vocal therapy are candidates for voice feminization surgeries. These procedures offer positive results both in terms of F0 and in improving patient's self-esteem and QOL.

Resolution of Severe Anorexia Nervosa Associated with Gender Dysphoria (Dysphorexia) by Testosterone Therapy in Two Male Transgender Youth

Anorexia nervosa is a severe and potentially lethal eating disorder. In transgender youth with severe gender dysphoria, a severe eating disorder (proposed name: dysphorexia), coherent with anorexia nervosa may be triggered by the desire to avoid the cisgender pubertal transition. In these patients, gender-affirming hormone therapy can be extremely effective. We report hereby the cases of two female-to-male transsexual patients with severe gender dysphoria whose anorexia nervosa was related to their pubertal development and who promptly recovered when they started gender-affirming hormone therapy with testosterone, after very limited success with standard psychotherapy and pharmacotherapy for anorexia nervosa. Our patients could not access pubertal suppression due to lack of parental consent in one case and failure to express the conflict in the other. We postulate that avoiding the cisgender pubertal transition with GnRH agonist treatment might also be able to prevent the development of dysphorexia.

Interposition of a unilateral singapore posteriorly based fasciocutaneous axial flap for treating rectoneovaginal fistula in a male-to-female trans-sexual patient

Rectoneovaginal fistula (RnVF) is one of the major complications for the gender reassignment surgery. Closure of the RnVF with interposition of a pedicled tissue flap is a useful surgical approach to reconstruct the perineal space and provide neovascularization. Martius flap, gracilis muscle flap, and Singapore flap are the options of pedicled tissue flap. An HIV-positive 37-year-old male-to-female trans-sexual patient presented with a large RnVF (8–9 cm × 4 cm) after penile inversion vaginoplasty. A modified Singapore flap was performed to repair RnVF and to reconstruct the perineal space. Vaginal reconstruction with a fasciocutaneous Singapore flap can be considered for male-to-female trans-sexual patients with a complex RnVF as it provides excellent neovascularization with a sensate flap and desirable cosmetic outcome.

Severe complication by irregular use of industrial silicone in a transsexual patient: a case report

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Evaluation of concentric periareolar subcutaneous mastectomy outcomes in transsexual patients during 2016–2017 in Iran: A clinical study

Background: Transsexual (TS) people are those who assigned one sex at the birth but identified their gender in what society considers the opposite direction. Studies showed that gender reassignment surgery (GRS) had greatly improved the quality of life in TS patients. Materials and Methods: We studied 20 patients who had legally the permission of being underwent the sex reassignment surgery in Imam Khomeini Hospital Complex of Tehran, Iran. For all patients, concentric periareolar subcutaneous mastectomy was performed. The patients were followed up for 1 year and the results were evaluated. Results: Our findings show an acceptable scar formation after 1 year of the sex reassignment surgery. There was only one complication which was managed conservatively. About 90% of patients were satisfied from the results of surgery, and no one was less/unsatisfied. The average score of nipple sensation was 7.9 and no changes in nipple pigmentation was observed. Conclusion: Concentric periareolar mastectomy is probably a good technique of subcutaneous mastectomy in female to male GRS in patients with small and medium size of the breast and poor skin elasticity. The result scar in this method is acceptable and gives the patients a good feeling of having male chest.

The Comparison of A New Durable Coronaplasty Technique with Norfolk Method for Glans Reconstruction after Phalloplasty.

BACKGROUNDPhalloplasty is the most amazing reconstructive surgery, and has a vital role in the quality of life of transsexual patients. There are several techniques for glans sculpting, but none of them had long-lasting results. In the present study, a new technique was introduced and compared with Norfolk technique for coronaplasty following phalloplasty. METHODSIn the present randomized controlled study, 40 transgender patients were enrolled from February 2016 to December 2018, at St. Fatima Plastic and Reconstructive Surgery Center. The patients were randomly assigned in two groups including 20 patients with anterolateral thigh flap (ALT)/radial forearm free flap (RFFF) phalloplasty followed with our new coronaplasty technique (group 1) and 20 patients with ALT flap/RFFF phalloplasty followed with Norfolk technique (group 2). RESULTSAlmost 85% of the patients underwent the surgery with the new technique were satisfied with the outcome of surgery and considered it acceptable within 6-month follow-up, however, only 70% of the patients in Norfolk technique group reported acceptable results, which was significantly lower than the new technique. Similarly, within 12-month follow-up, 80 and 40% of the patients, respectively in new and Norfolk groups reported acceptable results, which was also significantly higher in the new technique. CONCLUSIONThis new technique showed remarkably better results relative to the usual technique for glans sculpting in transsexual patients. Moreover, it had the ability to be easily applied along with ALT/RFFF flaps in both immediate and delayed situations.

How do elevated levels of testosterone affect the function of the human fallopian tube and fertility?—New insights

Excess testosterone levels affect up to 20% of the female population worldwide and are a key component in the pathogenesis of polycystic ovary syndrome. However, little is known about how excess testosterone affects the function of the human fallopian tube-the site of gamete transport, fertilization, and early embryogenesis. Therefore, this study aimed to characterize alterations caused by long-term exposure to male testosterone levels. For this purpose, the Fallopian tubes of nine female-to-male transsexuals, who had been undergoing testosterone treatment for 1-3 years, were compared with the tubes of 19 cycling patients. In the ampulla, testosterone treatment resulted in extensive luminal accumulations of secretions and cell debris which caused ciliary clumping and luminal blockage. Additionally, the percentage of ciliated cells in the ampulla was significantly increased. Transsexual patients, who had had sexual intercourse before surgery, showed spermatozoa trapped in mucus. Finally, in the isthmus complete luminal collapse occurred. Our results imply that fertility in women with elevated levels of testosterone is altered by tubal luminal obstruction resulting in impaired gamete transport and survival.