Search Results (74)

Introduction: Medical care for transgender minors is understudied, largely because these forms of care are relatively recent. The primary objective of this work was to describe the cohort of transgender adolescents who initiated follow-up at the Strasbourg University Hospital before the age of 18, whether or not they began hormone therapy prior to reaching adulthood. Method: This was an observational, retrospective, single-center, descriptive study conducted among adolescents who had attended at least one consultation in our center before the age of 18 between January 2017 and March 2024. Results: Our population consisted of 115 patients predominantly made up of transmasculine (AFAB) adolescents (68%). Compared with the general population, we observed significantly higher rates of psychiatric co-occurrences, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Only 46.1% initiated gender-affirming hormone therapy (GAHT) in our cohort, and just 34.8% before age 18. A total of 6% of adolescents received puberty blockers as monotherapy. The mean age at GAHT initiation was 16.99 years. Transition pathways appear to differ according to the adolescent’s type of schooling. The rate of retransition/treatment interruption in our sample ranged from 0% to 6.1%, depending on the criteria applied. We did not identify any adolescent who retransitioned to their sex assigned at birth after starting GAHT by the end of the data collection. Discussion: The high prevalence of psychiatric co-occurrences raises important questions regarding how to improve care for these adolescents. The predominance of AFAB adolescents similarly prompts reflection on the barriers that transfeminine adolescents may face when seeking to transition before adulthood. In addition, the substantial number of adolescents presenting with ASD or ADHD underscores the need for particular vigilance regarding their specific needs and overall well-being. Finally, the variability in retransition rates depending on the criteria applied highlights the absence of a consensual definition, which limits the comparability and validity of existing studies. Conclusions: Long-term prospective studies are needed to objectively demonstrate the effectiveness of current transition pathways. Academic research in this field should be strengthened, along with the development of larger prospective datasets, to improve the overall health of this population. Full article

Background/Objectives: Gender-affirming surgery (GAS) has become more accessible in recent years. It aims to align the physical characteristics of transgender individuals with their gender identity to alleviate distress associated with gender dysphoria. This may involve procedures such as genital reconstruction, breast augmentation or removal, and voice modification surgeries. However, the associations of these treatments on long-term mental health outcomes remain debated. This paper aims to review and synthesize current research on the associations of GAS on psychiatric outcomes and quality of life in transgender individuals. Methods: In accordance with the PRISMA statement, a search on PubMed, PsychInfo, and Embase yielded 867 articles, of which 14 studies of 3023 participants met the full inclusion criteria. Results: There is an initial improvement in psychological well-being and quality of life within the first year post-GAS, followed by subsequent plateau or decline thereafter. Factors such as younger age, higher levels of education, noticeable improvement in secondary sexual characteristics, and a supportive social environment have been identified as predictors of positive outcomes. Conversely, non-homosexual orientation and higher levels of pre-GAS psychopathology have been associated with poorer outcomes, highlighting the importance of tailored support and pre-operative mental health care to optimize long-term success. Conclusions: This study underscores the need for further research into long-term outcomes and tailored support strategies to optimize the mental health and well-being of transgender individuals undergoing GAS. Full article

Background and Objectives: With the increasing demand for gender-affirming procedures, facial feminization surgery (FFS) has become an essential component in the management of patients with gender dysphoria. In this study, ‘male’ and ‘female’ refer to biological sex as recorded in the medical record; gender identity was not assessed. The mandible is widely recognized as one of the most sexually dimorphic facial bones and plays a critical role in defining masculine and feminine facial contours. However, quantitative mandibular data directly applicable to surgical planning for FFS, particularly in Asian populations, remain limited. The purpose of this study was to analyze gender differences in mandibular morphology using three-dimensional (3D) computed tomography (CT) images and to provide clinically relevant anatomic data applicable to mandibular contouring in FFS. Materials and Methods: In this single-center retrospective study, 275 Korean patients who underwent facial CT between January 2017 and December 2019 were enrolled. Three-dimensional cephalometric analysis was performed to obtain surgically relevant mandibular measurements, including angular, linear, and transverse parameters, as well as non-metric characteristics such as chin shape and inferior mandibular border contour. Statistical comparisons were conducted to evaluate gender differences. Results: Significant gender differences were observed in mandibular angle (p < 0.001), mandible length (p < 0.001), antegonial notch distance (p < 0.001), intercondylar width (p < 0.001), and intergonial width (p < 0.001). Ramus length and chin width did not demonstrate statistically significant differences. Non-metric analysis revealed significant gender differences in chin morphology and inferior mandibular border contour (p < 0.01). Males predominantly exhibited a round or square chin (79.5%) and a rocker-shaped inferior border, whereas females commonly demonstrated a pointed chin (82.3%) and a straight inferior mandibular border (94.4%). Conclusions: The sexual dimorphism of the mandible in the Korean population is characterized by differences in angularity, transverse width, antegonial morphology, and inferior border contour. These findings provide population-specific morphological reference ranges that may support individualized preoperative assessment for mandibular contouring in facial feminization surgery. Full article

Gender incongruence significantly impacts the family system, yet the subjective experiences of caregivers remain relatively underexplored. This narrative review synthesizes contemporary evidence regarding psychological distress, emotional burden, and quality of life among caregivers of transgender and gender-diverse individuals. A targeted literature search of PubMed, Scopus, PsycInfo, and Google Scholar (2015–2025) was conducted, identifying 16 studies for thematic synthesis. Results indicate that caregivers consistently report elevated emotional distress, characterized by chronic anxiety, hypervigilance, and ambiguous loss. This burden is primarily driven by prolonged exposure to uncertainty, the weight of complex medical decision-making—particularly regarding fertility and hormone therapy—and vicarious minority stress stemming from social stigma and systemic barriers. Notably, distress is often intensified by sociopolitical climates rather than the transition process itself. Conversely, access to peer support networks, healthcare relationships, and engagement in advocacy emerged as vital protective factors facilitating resilience and adaptive meaning-making. We can conclude that caregiver well-being is a multifaceted process deeply embedded in social and institutional contexts. These findings underscore the necessity of integrated, family-centered medical-psychological models that explicitly support caregivers to ensure more equitable and effective gender-affirming care pathways. Full article

This single health system, retrospective cohort study compared subcutaneous (SC) versus intramuscular (IM) estradiol administration in 70 adult patients with a diagnosis of gender incongruence or gender dysphoria seen in an LGBTQ Specialty Clinic within a safety-net institution between October 2018 and December 2024. The primary endpoint was patients who reached therapeutic estradiol levels at 6 months. Secondary endpoints included the incidence of sub- and supra-therapeutic and actual estradiol levels at months 3, 6, 9, and 12 and patients who received pharmacist-led injection technique education. At 6 months, the proportion of patients achieving therapeutic estradiol levels did not differ between IM and SC administration. In exploratory analyses of continuous estradiol concentrations, IM administration was associated with higher measured estradiol levels. Full article

Peter S. Beagle’s decision to feminize the formerly masculine figure of the unicorn in his influential 1968 fantasy novel The Last Unicorn represents a key moment in the evolution of this now ubiquitous image, one embraced today as a symbol of pride by LGBTQ+ communities. The novel and its 1982 animated film adaptation have themselves remained popular among queer and especially trans audiences, who have often found the narrative resonant with their own experiences. This essay provides a preliminary overview of the queer history of the unicorn symbol and continues into a trans reading of the novel, arguing that these responses to Beagle’s work by contemporary readers reflect dimensions of the narrative congruent with concerns about gender performance and misrecognition; gender dysphoria; and queer temporalities. The nature of the fantasy form itself, we maintain throughout, can also particularly enable reparative readings by queer and trans audiences. Full article

Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures—one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons. Full article

Background: Two natural steroids derived from cholesterol pathways are testosterone and progesterone, androgen and antiandrogen receptor binding. Steroid androgen antagonists can be prescribed to treat an array of diseases and disorders such as gender dysphoria. In men, androgen antagonists are frequently used to treat prostate cancer and hyperplasia. Sex hormones regulate the expression of the viral receptors in COVID-19 progression, and these hormones may act as a metabolic signal-mediating response to changes in glucose and Reactive Oxygen Species (ROS). The objective of the present study is to use artificial intelligence (AI) applications in healthcare to predict the targets and to assess biological assays of novel steroid derivatives prepared in house from the commercially available 16-dehydropregnenolone acetate (DPA^®) aimed at achieving the metabolic stability of glucose and steroid brain homeostasis. This suggests the introduction of aromatic or aliphatic structures in the steroid B-ring and D-ring. This is important since the roles of 5α-reductase and ROS in brain control of glucose and novel steroids homeostasis remain unclear. Methods: A tool prediction was used as a tuned algorithm, with the novel steroid derivatives data in web interface to carry out their pharmacological evaluation. The new steroidal derivatives were determined with neuroprotection effect using the select biomarkers of oxidative stress on induced hypoglycemic male rat brain and liver. The enzyme kinetics was established by the inhibition of the 5α-reductase enzyme on the brain myelin. Results: We used novel chemical structures to order the information of a Swiss data bank that allow target predictions. Biological assays suggest that steroid derivatives with an electrophilic center can interact more efficiently with the 5α-reductase enzyme, and by this way, induce neuroprotection in hypoglycemia model. All compounds were synthesized with a yield of 30–80% and evaluated with tool target prediction to understand the molecular mechanisms underlying a given phenotype or bioactivity and to rationalize possible favorable or unfavorable side effects, as well as to predict off-targets of known molecules and to clear the way for drug repurposing. Apart, they turned out to be good inhibitors for the 5α-reductase enzyme. Conclusions: The probed efficacy of these novel steroids with respect to spironolactone control appears to be a promising compound for future hormonal therapy with neuroprotection activity in glucose disorder status. However, further research with clinically meaningful endpoints is needed to optimize the use of androgen antagonists in these hormonal therapies in COVID-19 progression. Full article

Background and Objectives: There is a worldwide increase in the demand for gender-affirming surgical treatments among transgender and gender-diverse (TGD) adults and adolescents. In Poland, transgender people generally lack trust in healthcare providers, which makes it more difficult for them to begin their transition process. This patient population is not well understood by many of the specialists who may potentially be involved in their care, in some way, reinforcing their concerns. The aim of this study is to present the sociodemographic characteristics of a group of female-to-male transgender patients who were admitted to a privately based plastic surgery center to undergo chest wall reconstruction. Materials and Methods: This study comprises a statistical analysis of data retrospectively obtained from the medical records of 100 patients from across the country undergoing female-to-male transition, who were operated on between 2021 and 2025 at a specialized private clinic in Poland. All individuals had already started gender-affirming medical treatment with testosterone at the time of first consultation. Results: The results show a trend toward a decreasing age at the time of the decision to undergo gender-affirming surgery. In the study group, 100% of patients were already undergoing hormone therapy. In our group of transgender individuals, we did not observe a correlation between cultural or social background, religion, and gender dysphoria. It is encouraging that more than half of the patients reported no longer needing psychiatric support, and that those who were still under specialist supervision stated that they experienced a significant improvement in their overall well-being. Conclusions: The rising demand for transgender healthcare highlights the need for studying and analyzing this group of patients in order to provide the best patient-centered care throughout the gender transition process by all specialists involved. Gender-affirming mastectomy, when combined with testosterone therapy, has a positive mental health impact on transgender individuals. Full article

Gender dysphoria stems from incongruence between gender identity and assigned sex, often causing significant distress related to breast anatomy in transmasculine individuals. Gender-affirming hormone therapy typically precedes mastectomy, which is a fundamental intervention in transgender healthcare. Surgical challenges arise in patients with large breasts on lean frames, requiring customized techniques to achieve a natural, proportional, androgynous chest. This case report describes a 23-year-old transmasculine patient with macromastia and a tall, lean build who underwent gender-affirming mastectomy with free nipple grafts and muscular sculpture aimed at an androgynous esthetic. Pre- and postoperative evaluations showed marked improvements in body image, physical strength performance, and emotional well-being. Psychological assessments revealed significant reductions in body uneasiness and gender dysphoria, while human figure drawings demonstrated increasing bodily integration and identity congruence. A general improvement in physical performance over time was reported, particularly in upper body strength, with minor fluctuations potentially related to the surgical intervention and recovery phase. The narrative literature review supports these outcomes, highlighting satisfaction rates above 90%, minimal regret, and consistent gains in psychosocial functioning and sexual and mental health, including reduced anxiety and depression. This evidence reinforces that gender-affirming mastectomy is medically necessary, particularly when tailored to individual anatomical and esthetic needs, affirming identity and alleviating distress. Full article

Background/Objectives: Gender-affirming care is a complex, multidisciplinary process that has gained increasing recognition worldwide. This practice report presents the unique clinical model developed at the Kocaeli University Hospital Gender Dysphoria Clinic, one of the pioneering centers in Türkiye. Methods: An experience-based descriptive approach was adopted to capture two decades of clinical experience, institutional processes, and socio-political challenges not fully reflected in systematic reviews. The article reflects on the authors’ direct practice in a university-based transgender health clinic in Türkiye, structured around the multidisciplinary team model, patient pathways, institutional processes, and the sociopolitical context of care. Results: The Kocaeli University model integrates psychiatry, endocrinology, surgery, nursing, social work, and legal consultation. Since 2004, the clinic has evaluated and treated hundreds of transgender individuals and produced numerous theses and peer-reviewed publications. Key strengths include a structured board system, the training of psychiatry residents, and close interdepartmental collaboration. Conclusions: This model illustrates how gender-affirming care can be effectively implemented in a challenging sociopolitical context. Sharing this experience may inform global practices and support the dissemination of multidisciplinary approaches to transgender health. Full article

Introduction/Background: Medical treatments received by transgender and/or gender diverse (TGD) people can impact fertility, yet the literature lacks data on factors that influence fertility decisions among TGD people. Specific Aim(s): This study aimed to identify predictors of interest in fertility preservation (IFP). Materials and Methods: This retrospective observational study utilized data from 2021–2023 from an adult gender registry for patients receiving care at academic medical center (n = 206). Patient demographic data and survey responses to questions about fertility were queried and analyzed. Bivariate and multivariate analyses were conducted using logistic regression. Results: Most patients (73.8%, n = 152) were not interested in fertility preservation (FP) and 16.5% (n = 34) were unsure. Reasons most often cited were not wanting biological children (55.9%, n = 104), preferring adoption (20.4%, n = 38), cost (19.9%, n = 37), and dysphoria (19.4%, n = 36). Bivariate analyses showed that increasing age, being married, and already having children were significantly inversely associated with IFP (p = 0.03, 0.01, 0.02, respectively). Non-Hispanic Black race/ethnicity (OR (95% CI): 3.43 (1.19, 9.84)) and disability or unemployment (OR (95% CI): 4.19 (1.42, 13.00)) were significantly associated with IFP vs. Non-Hispanic White race/ethnicity and full-time employment, respectively. In multivariate models, being married was significantly inversely associated with IFP, e.g., OR (95% CI): 0.30, (0.07, 0.99), when accounting for age and already having children. Race/ethnicity and employment comparisons remained significant after adjusting for other factors. Conclusions: Most patients did not desire FP. Among those IFP, potential predictors include age, marital status, already having children, race and ethnicity, and employment and disability status. Full article

Background/Objectives: Gender-affirming surgery (GAS) is associated with improved mental health outcomes in transgender and gender-diverse (TGD) individuals. However, TGD populations experience disproportionately high rates of substance use disorders (SUDs), which are established risk factors for surgical complications. Despite this, the relationship between preoperative SUDs and postoperative outcomes following GAS has not been studied. Our objective was to evaluate how specific SUD subtypes, including tobacco, alcohol, and cannabis, impact short- and medium-term postoperative complications following GAS. Methods: A retrospective cohort study was conducted using the TriNetX Research Network, which includes de-identified electronic health records from over 100 million U.S. patients. Adults with documented gender dysphoria who underwent GAS between April 2015 and April 2025 were included. Patients were divided into four groups: no SUD, tobacco use, alcohol use, and cannabis use. Propensity score matching was used to control for demographic variables. Postoperative complications were assessed at 30 days and 6 months. Results: Alcohol use was significantly associated with increased rates of delayed wound healing, wound dehiscence, gastrointestinal symptoms, and postoperative pain at both 30 days and 6 months. Cannabis use was linked to higher rates of wound dehiscence, infections, GI symptoms, and pain. Tobacco use showed the broadest impact, significantly associated with nearly all complications measured except pain at 30 days. These associations persisted at six months. Conclusions: This is the first study to quantify the relationship between substance use and GAS outcomes. Preoperative use of tobacco, alcohol, and cannabis was independently associated with increased postoperative complications. These findings underscore the need for systematic preoperative screening and the development of SUD-specific perioperative care pathways to improve outcomes and advance equity in surgical care for TGD patients. Full article

Background: Apathy predicts functional and cognitive decline in community-dwelling older adults. However, the behavioral correlates of apathy, which could promote cognitive decline have not been described. Our objective was to investigate the associations of apathy with leisure and social engagement. Methods: N = 538 older adults enrolled in the Central Control of Mobility in Aging study. We used the GDS3A, a 3-item subscale of the Geriatric Depression Scale, to define apathy and the frequency of participation in cognitive, physical, and social leisure activities. Linear regression models were conducted to assess the association between apathy and its behavioral correlates: social engagement and leisure activity participation. Covariates included age, gender, education level, multimorbidity, and dysphoria. Results: Apathy was present in 29.7% of participants and was significantly associated with less frequent participation in physical activity days per week (−1.688. p = 0.003) but not cognitive (−1.094, p = 0.252) or social (−0.654, p = 0.103) leisure activities. Apathy was also associated with a decreased social behavior composite score (−0.055, p < 0.001), Social Network Index (−0.478, p = 0.003), and Medical Outcomes Study Social Support scores (−0.26, p = 0.001). Conclusions: Our findings suggest that apathy presents with reduced participation in physical leisure activities and reduced social engagement, which may provide a way for clinicians and caregivers to identify apathy in the future. Full article

Background: Gender dysphoria refers to the psychological distress arising from a mismatch between an individual’s physical embodiment and their internal sense of gender. Gender-affirming mastectomies can be a pivotal component of gender affirmation for transgender, non-binary, and gender expansive individuals assigned female at birth. The impact of obesity on the outcomes of gender-affirming mastectomies has yet to be fully defined. Methods: A retrospective review of 205 gender-affirming mastectomies performed by the senior author was conducted. Patients were categorized into obese (BMI ≥ 30) and non-obese groups. Baseline characteristics, intraoperative variables, and complication rates were compared. Univariate and multivariate models were performed to evaluate the association between obesity and postoperative complications. Results: Obese patients had higher mean resection weights and liposuction volumes (p < 0.001). Significant differences were observed in the prevalence of fibromyalgia, prior chest surgeries, and hormone therapy usage (p = 0.002, 0.002, and 0.03, respectively). However, no statistically significant differences were found in overall complication rates between obese and non-obese groups in the univariate or multivariate analyses. Conclusions: Our study suggests that obesity is not a significant risk factor for complications in gender-affirming mastectomies patients. The varying impact of high BMI and obesity on surgical outcomes in different surgical fields highlights the importance of patient-centered care and a holistic and individual approach for each patient. Full article