Undergoing Sex Reassignment Surgery Research Articles

Perceived social support, self-esteem, and depression among Indian trans men with and without sex reassignment surgery

The psychological challenges associated with gender identity in developing countries like India are only recently receiving research attention. The study aimed to understand self-esteem, perceived social support, and depression among trans men in India. A comparative analysis was also undertaken between those who have and have not undergone sex reassignment surgery. The sample comprised 30 trans men, out of which 15 had undergone sex reassignment surgery and 15 had not. The Multidimensional Scale of Perceived Social Support, Rosenberg Self-esteem Scale, and Beck’s Depression Inventory-II were used. Perceived social support from family and friends was found to be a significant predictor of self-esteem. Support from all three sources—family, friends, and significant others significantly predicted depression among the total sample. Trans men who had undergone sex reassignment surgery, reported higher self-esteem and lower depression levels, as compared to those who were yet to undergo surgery. The findings highlighted the contribution of social support in fostering the mental health of trans men. The consequent psychological benefits of surgery were also demonstrated. The study has implications for planning and designing mental health interventions for this community.

Re-thinking Bodily Entrapment in Select Indian Trans Autobiographies

The present paper seeks to analyse two Indian trans autobiographies - The Truth About Me: A Hijra Life Story (2010) by A. Revathi, a distinguished trans activist; and Me Hijra, Me Laxmi (2015) by Laxmi Narayan Tripathi, a prominent Bharatnatyam dancer and trans activist. The autobiographical accounts critically explore the contribution of prevalent heteronormative ideologies to the marginalised status of transgender individuals in India. The narratives intricately depict the experiences of transgender individuals who grapple with a sense of mismatch between their assigned sex and psychological sex, ultimately leading them to undergo Sex Reassignment Surgery (SRS) and related medical procedures. Drawing upon the perspectives of post-transsexual scholars such as Jacques Juliet, Janice Raymond, Jay Prosser, Kate Bornstein, and Sandy Stone, the study asserts that the transgender body is "programmed to disappear," promotes a "denial of mixture," and perpetuates the "purity" of gender after the corporeal transition. Furthermore, the paper examines how trans individuals incorporate established medical discourse on transsexuality into their autobiographies. The research findings underscore the need to develop a transgender discourse capable of offering a counter-discourse to the binary explanations of gender.

Transgender & Fertility

TGD –Adults are transwomen and men with gender identity different from that assigned at birth. Unless they undergo sex reassignment surgery or medication their fertility is well preserved and they can reproduce. Presenting a case report of first transgender couple from Kerala, India with successful pregnancy and delivery.

High-risk Behaviors in Sex-Reassigned Trans-sexual People in Tehran, Iran

Background: Abundant high-risk behaviors in trans-sexual people make it necessary to investigate. Objectives: This study aimed to describe the frequency of high-risk sexual behaviors in sex-reassigned trans-sexual people in Tehran, Iran. Materials and Methods: This study was cross-sectional. Ninety-six sex-reassigned transsexual individuals of both genders presenting to Salamat Bonyan Psychology Clinic were enrolled in the study. The scales included a demographic characteristic form and a researcher-made questionnaire to evaluate high-risk behaviors and sexual health of sex-reassigned transsexual subjects. Results: According to the results, 96 individuals completed hormone therapy, of whom 43 underwent sex-reassignment surgery. Also, 73 persons were female-to-male, and 23 persons were male-to-female. In this study, 62.5% of the participants did not receive hepatitis B vaccine (CI: 0.52 - 0.72), and 95.83% of the participants did not receive human papillomavirus vaccine (CI: 0.92 - 0.99). Moreover, 87.09% of the participants did not take a human infection virus (HIV) test (CI: 0.68 - 0.85), and 97.9% had a Pap smear test (CI: 0.95 - 0.99). In addition, 96% of the participants were never screened for prostate cancer (CI: 0.89 - 0.99), and 91.66% were never screened for breast cancer (CI: 0.86 - 0.97). Oral sex was the most common sexual act (93.75%), and 72.91% of the subjects never used condoms (CI: 0.68 - 0.77). Finally, 30% of the participants smoked hookah and cigarettes and used alcohol (CI: 0.20 - 0.39). Conclusions: Considering high-risk behaviors and sexually risky behaviors in this group, it is necessary to carry out preventive interventions.

Body Integrity Dysphoria and “Just” Amputation: State-of-the-Art and Beyond

Abstract This paper presents the foundation upon which the contemporary knowledge of body integrity dysphoria (BID) is built. According to the World Health Organisation’s International Classification of Diseases, 11th edition (ICD-11), the main feature of BID is an intense and persistent desire to become physically disabled in a significant way. Three putative aetiologies that are considered to explain the insurgence of the condition are discussed: neurological, psychological and postmodern theories. The concept of bodily representation within the medical context is highlighted, with the concept of dysphoria, which was brought to the fore with the introduction of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the ICD-11. Contemporary issues of “justice” are addressed to identify ethically relevant distinctions between BID and sex reassignment surgery. It is argued that there is no ethically relevant difference between the BID actor’s desire for invasive surgical intervention and the wish of gender dysphoric individuals to undergo sex reassignment surgery procedures. Some BID actors self-mutilate, and this presents medical professionals with difficult choices regarding whether or not to intervene in order to satisfy the BID patient’s desire. Both abstention and intervention may lead to severe ethical complications for doctors and patients despite the positive outcomes in terms of quality of life for BID individuals who manage to undergo such procedures.

Sex reassignment surgery and wellbeing of India’s transgender community

The research focuses on determining "the role of sex reassignment surgery in Hijra culture in India and what motivates people to undergo sex reassignment surgery." The transgender community that creates the shape of the body through gender reassurance relies on modern medicine. However, there are financial, physical, and institutional impediments to undergo sex reassignment surgery and transitioning into a woman or a man. The cultural background of the Hijra, the link between the ancient Hijra culture and modern transgender communities, and the policy implications for the protection of civil rights among transgender people are highlighted as significant subjects during the research study. The study draws on data from primary sources of transgender people, including MtF (Male to Female) and transgender (Hijra) activists, from various community-based organisations across India, implementing a qualitative research approach and contacting transgender people through primary and secondary sources. Intentional and snowball sampling techniques are used to undertake in-depth interview guides with the transgender community and for further research, evaluation, and data collection. Interviews involve transgender individuals who are not primarily involved in the organization. Secondary sources such as the Internet, newspapers, and NGO reports evaluate the content.

Self-administration of gender-affirming hormones and supratherapeutic dosing are relatively common in Japanese transgender women.

This study was performed to determine the proportion of transgender women with self-adjusted hormone administration and excess dosing. The medical records of 87 transgender women who visited our gender clinic from 2010 through 2019 were reviewed. The complete blood count and serum concentrations of D-dimer, gonadotropins, and sex steroids were compared between transgender women who were self-administering gender-affirming hormones and women not using such hormones. Fifty-eight of 87 (66.7%) transgender women had contravened the guideline and self-adjusted their hormone administration. The hormonal data of one woman with hypopituitarism were eliminated from the analyses. The serum gonadotropin and testosterone levels were significantly lower in the self-administration group than in the hormone-naïve group. Gonadotropin levels below the lower limit of normal were found in 32/86 (37.2%) transgender women. The testosterone levels in six transgender women were not analyzed because these women had undergone sex reassignment surgery before visiting our hospital. Testosterone levels below the lower limit of normal men were found in 36/80 (45.0%) transgender women. Unexpectedly, 29/36 (80.6%) transgender women who were classified as having suppressed serum testosterone levels had testosterone levels of <0.6ng/mL, which corresponds to the levels in cisgender women. The white blood cell count and hemoglobin concentration were significantly different between the groups. Self-initiated hormonal treatments seem to affect the serum concentrations of gonadotropin and sex steroids and the complete blood count. The prevalence of transgender women with self-adjusted use of gender-affirming hormones is high, and an excess dose of hormones occasionally occurs.

Mak Nyahs and Sex Reassignment Surgery – A Qualitative Study from Pahang, Malaysia

Introduction: Mak nyahs are locally known male-to-female transgenders in Malaysia. In Western countries, medicalization of transgenderism allows strictly selected patients to undergo sex reassignment surgery. However, a standardized treatment system is not yet available in Malaysia. A number of mak nyahs underwent sex reassignment surgery at their own will. This study aimed to explore mak nyahs’ knowledge and perception on sex reassignment surgery. Materials and Methods: A qualitative research was carried out from 13th July 2016 till 31st August 2016 among 8 adult mak nyahs in Kuantan, Pahang. Snowball sampling was used. Participants who gave verbal consent were interviewed individually and in focus groups. Data obtained was transcribed and used as the primary data source. Results: All informants were Malays and Muslims. They generally had some knowledge about the standard procedures and risks in sex reassignment surgery. All informants expressed their desire to have the surgery, but chose not to. Reasons discouraging them from having the surgery were: i) religion, ii) forbiddance from family, iii) fear of regret, iv) death from surgery, and v) the lack of necessity. Factors driving them to have the surgery: i) more income from sex work, ii) pressure from sex clients, iii) securing a stable relationship, iv) self-satisfaction, and v) hope for a better future. Conclusion: Religion seemed to be the main reason refraining them from undertaking the surgery. Counselling mak nyahs should include the advantages and disadvantages of sexual reassignment surgery. Islamic religious preaching is very important to help reduce high risk behaviours, as well as teaching mak nyahs to cope with challenges in adult life. Further research is necessary to show association between religious knowledge and successful rehabilitation of the mak nyahs’ community.

Voice And Gender Incongruence: Relationship Between Vocal Self-Perception And Mental Health Of Trans Women

To verify the association between vocal perception and Common Mental Disorders (CMD) suspicion in trans women. Cross-sectional observational study including 24 adult trans women with a minimum time of presentation as a woman of six months. The sampling of the subjects was supported by the "Snowball" technique. Three questionnaires were applied for data collection: sociodemographic and health data, Self-Reporting Questionnaire (SRQ-20) and Trans Woman Voice Questionnaire (TWVQ). The sociodemographic and health data collected were: age, marital status, education, smoking habits, speech therapy, use of hormones, and whether they had undergone Sex Reassignment Surgery (SRG). SRQ-20 was used for suspicion of CMD evaluation, such as depressive and anxiety symptoms. TWVQ is a vocal self-report questionnaire for trans women living the full-time gender role in which they self-identify. TWVQ has a minimum score of 30 points and a maximum of 120 points. Higher scores are associated with perceptions of a higher frequency of voice-related difficulties and psychosocial impacts. For statistical analysis, data were analyzed descriptively and statistically using Fisher's and Mann-Whitney's exact tests, both with a significance level of 5%. The average participants' age in this study was 28.2 years old (SD=6.5 / minimum=21 and maximum=48); 83.3% were single; most (41.7%) were high school graduates; and most (95.83%) had not undergone Sex Reassignment Surgery. All subjects reported using hormones; 37.5% were smokers; 4.2% had undergone speech therapy; and the average number of years of experience in the female role was 8.8 years (SD=7.2). The average TWVQ score was 55.4 points (SD=4.3). Through SRQ-20, it was verified the prevalence of suspected CMD in 58.3% of the participants. The study results indicated that communicative dissatisfaction in trans women due to inconsistent voice with the recognized gender is associated with probable CMD such as depression and anxiety (P= 0.001). Trans women who reported greater difficulties and voice-related effects in their lives had more symptoms of anxiety and depression. Although more research is needed, results indicate the need for inter-professional preventive and therapeutic actions directed towards assisting trans women. This fact encourages reflection on the care of this population and the role of health professionals, enhancing scientific production, clinical practice and the inclusion of the "transsexuality" theme in Speech Language and Hearing Sciences.

The Status of Transgender Men Heir in Patrilineal System of Adat Inheritance Law

Technology has enabled individuals with gender dysphoria - that is, those with a sense of incompatibility between gender and biological sex, to undergo sex reassignment surgery. Indonesia is one country which recognizes the right to legal recognition of sex reassignment. Nonetheless, the issue of sex change remains a taboo one in Indonesia, where religion and adat play important roles. Many Adat systems in Indonesia adopt a patrilineal inheritance system, where only sons may inherit, but have no established rules as to the ability of transgender men, born as women, to inherit. This article seeks to answer the question of whether transgender men have the right to a share of any, if at all, of their fathers’ inheritance. The author uses normative legal research using various sources of law, especially those found in statutes and regulations doctrines, and jurisprudences. In addition, secondary sources on Adat and inheritance law are used as supplementary sources. The research concludes that the change of biological sex does enable transgender men, who were prior to sex reassignment surgery not entitled to any inheritance, to inherit their fathers’ inheritance. This is owed to the fact that the ability to inherit in Indonesian Adat systems is concerned solely with the ability to carry family name, and not the ability to procreate as a man.

Development of EU Law before the Grand Chamber of the EU to Benefit Transpersons

This case—MB v. Secretary of State for Work and Pensions—concerned a transperson who was born male and subsequently married a woman in her birth sex. Seventeen years after the marriage, the applicant underwent sex reassignment surgery but never received a full gender recognition certificate. This was because the UK’s Gender Recognition Act 2004 (‘GRA’) required married applicants to annul their marriage in order to obtain more than an interim certificate. As MB did not wish to annul her marriage to her long-term wife, she never received the full gender recognition certificate. When she subsequently sought to claim her state pension from the younger age of 60, which applicable to women, her claim was rejected. This was because the UK government still officially classified her as a male. The argument made on behalf of the UK Secretary of State for Work and Pensions was that it should be for Member States “‘to determine the conditions under which a person’s change of gender may be legally recognised’ (paragraph 23 MB v Secretary of State for Work and Pensions Case C-451/16 ).” This, it was argued, should not only relate not only to physical and psychological criteria, but also to criteria relating to marital status (paragraph 23 MB v Secretary of State for Work and Pensions Case C-451/16) and that this should be within the scope of the UK’s discretion. The Grand Chamber of the Court of Justice of the European Union determined that the requirement to annul an pre-existing marriage in order to obtain a full Gender Recognition Certificate, subsequently entitling the applicant to access her state pension at the younger age applicable to women, contravened Article 4 Council Directive 79/7/EEC on the basis of sex discrimination.

Histerectomía por laparoscopia en un transexual masculino: reporte de caso y revisión de la literatura

Objetivo: reportar un caso de histerectomía por laparoscopia convencional en cambio de sexo female-to-male en Colombia, en un paciente diagnosticado como transexual, y realizar una revisión de la literatura respecto a las distintas alternativas de histerectomía en el contexto de esta condición.Materiales y métodos: paciente de 35 años, transexual, en tratamiento hormonal con undecanoato de testosterona, sometido a histerectomía laparoscópica como parte de reasignación de sexo, en una institución de III nivel de complejidad, con evolución posoperatoria favorable. Se realizó búsqueda en las bases de datos de Medline vía PubMed, Embase y Lilacs, con los términos MESH: “hysterectomy”, “laparoscopy”, “transsexualism”, en inglés, español y checo, sin limitación de tiempo.Resultados: la investigación incluyó 11 estudios: 3 estudios de serie de casos, 6 cohortes, 1 ensayo clínico controlado y 1 reporte de caso. La histerectomía laparoscópica es la más utilizada para la reasignación de sexo en transexuales masculinos. La histerectomía vaginal es una alternativa por considerar si se requiere musculatura abdominal para futura faloplastia.Conclusiones: la histerectomía por laparoscopia surge como una alternativa a la histerectomía vaginal en pacientes transexuales masculinos sometidos a cirugía de reasignación de sexo. Se requieren ensayos controlados aleatorizados para una mejor evaluación comparativa de las alternativas quirúrgicas disponibles.

P130 - Urodynamic studies in patients undergone sex reassignment surgery: Pre and postoperative assessment in male to female patients

P130 - Urodynamic studies in patients undergone sex reassignment surgery: Pre and postoperative assessment in male to female patients

Testis Morphologic Assessment in Patients undergoing Sex Reassignment Surgery with Gender Dysphoria: Case Series and Literature Review

Purpose: To study the morphologic changes to testicular architecture in response to estrogen therapy in gender dysphoric patients undergoing sexual reassignment surgery. Materials and methods: A retrospective morphologic review of testicular architecture was performed on ten cases of male-to-female sex reassignment surgery testis from the University of Illinois Hospital and Health Sciences system. Cases were from adult males undergoing sexual reassignment surgery at the University of Illinois Hospital and Health Sciences System between 2016 and 2017. Architectural changes were measured including Leydig cell changes, basement membrane fibrosis, spermatogonia maturation, and interstitium changes. Results: Various stages of maturation and regression were seen despite all patients being on estrogen therapy for at least one year prior to undergoing surgery. Conclusion: There are a range of estrogen therapy-related maturation and regression effects on testicular architecture in this growing patient population. It is important for the clinician and pathologist to know these effects as benign changes related to treatment.

Serum concentrations of brain-derived neurotrophic factor in patients diagnosed with gender dysphoria undergoing sex reassignment surgery.

Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.

403 Comparison of Sexual Function in Transsexual Women Who Underwent Sex Reassignment Surgery by Two Different Techniques

403 Comparison of Sexual Function in Transsexual Women Who Underwent Sex Reassignment Surgery by Two Different Techniques

Present Without Past: The Disruption of Temporal Integration in a Case of Transsexuality

ABSTRACTIn this article, I examine the impact of extensive modification of the body on the temporal link, which is an important feature of human identity, as it provides continuity between different representations of the self over time. I illustrate this with a case of a young boy who underwent sex reassignment surgery in late adolescence after the artificial suspension of puberty through sex hormones. I argue that when hormones are used in this way, one can observe in some cases not only the desired suspension of physical time during which the body’s given biological trajectory is artificially halted, but also of psychological time. In some instances, this biological and psychic detour can result in a marked distortion in the young person’s relationship to time and impacts on their psychological adaptation following surgery.

Fertility preservation in transgender patients

ABSTRACTFertility preservation is an important consideration for transgender people prior to initiating cross-sex hormones or undergoing sex reassignment surgery. We performed a retrospective chart review identifying all transgender patients referred for fertility preservation at one university-affiliated fertility clinic from November 2011 to March 2014. Eleven male-to-female (MtF) transgender patients and 3 female-to-male (FtM) transgender patients were seen for sperm banking or fertility preservation consultation. FtM transgender patients were referred for fertility preservation at a later age and after being on a longer duration of cross-sex hormone therapy than MtF transgender patients. Nine of eleven MtF patients cryopreserved sperm resulting in 1 pregnancy following IVF-ICSI. None of the FtM patients underwent any cryopreservation techniques. This study highlights the need to increase awareness on the effects of age on fertility for FtM patients, and to improve awareness of and access to fertility preservation technologies for all transgender people early on in their transition.

Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death.

IntroductionStudies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark.AimsTo investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010.MethodsSomatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register.Main Outcome MeasuresSomatic morbidity and cause of death.ResultsOverall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male).ConclusionOf 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.

Experiences of Discrimination, Harassment, and Violence in a Sample of Italian Transsexuals Who Have Undergone Sex-Reassignment Surgery.

The present study aims to provide an overview of experiences of discrimination, harassment, and violence in a sample of Italian transsexuals who have undergone sex-reassignment surgery (SRS). Lack of support for gender transition from family members was also assessed, before and after SRS. Data were collected in the context of a multicentric study (Milan, Florence, and Bari) on SRS outcome. Patients who underwent SRS were contacted and asked to fill out a questionnaire concerning experiences of discrimination, harassment, violence, and crime they might have experienced in previous years. Seventy-two participants took part in the research: 46 were male-to-female (MtF; 64%) and 26 were female-to-male (FtM; 36%). Thirty-six percent of the total sample (with no differences between MtF and FtM) experienced at least one episode of harassment, violence, or discrimination. The workplace was reported to be the social area with the highest risk of discrimination and harassment (22% of participants). Reports of more than one incident of discrimination, harassment, and violence characterized the majority of participants in the MtF sample. Compared with previous studies carried out in other countries, a much larger proportion of participants could count on a supportive family environment before and after transition. Our results show that Italian society at large is prejudiced against transsexuals, but at a more "micro" level, having a trans person as a family member might result in a protective and tolerant attitude.