scholarly journals Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017)

2020 ◽  
Vol 141 (6) ◽  
pp. 486-491 ◽  
Author(s):  
C. M. Wiepjes ◽  
M. den Heijer ◽  
M. A. Bremmer ◽  
N. M. Nota ◽  
C. J. M. Blok ◽  
...  
Keyword(s):  
Gender Dysphoria ◽  
Transgender People ◽  
Death Risk ◽  
Suicide Death

Female-to-Male Gender-Confirming Drainless Mastectomy May Be Safe in Obese Males

2019 ◽  
Vol 40 (3) ◽  
pp. NP85-NP93
Author(s):  
Eric M Pittelkow ◽  
Stephen P Duquette ◽  
Farrah Rhamani ◽  
Corianne Rogers ◽  
Sidhbh Gallagher
Keyword(s):  
Gender Dysphoria ◽  
Medical Condition ◽  
Perioperative Outcomes ◽  
Morbidly Obese ◽  
Level Of Evidence ◽  
Transgender People ◽  
Super Obese ◽  
Significant Difference ◽  
Transgender Men

Abstract Background Gender dysphoria is a medical condition associated with suicidality. Transgender men who have undergone female-to-male (FTM) chest reconstruction report higher quality of life and reduced gender dysphoria. It has been reported that transgender men are at higher risk of obesity. Objectives The objective of this study was to compare perioperative outcomes and complications between different classes of obesity in FTM transgender patients who underwent chest masculoplasty. Methods A retrospective review of 145 consecutive patients who underwent mastectomy with free nipple graft was conducted. Postoperative outcomes and complications were collected. Patients were divided into nonobese (body mass index [BMI] <30 kg/m2), obese (BMI 30-39.9 kg/m2), morbidly obese (BMI 40-49.9 kg/m2), and super obese (BMI >50 kg/m2) groups. Results Sixty-six of the 145 patients were not obese, 52 were obese, 22 were morbidly obese, and 5 were super obese. There was a statistically significant increase in amount of breast tissue resected between each of the 4 groups (866.8 g vs 1672.4 g vs 3157.1 g vs 4827.6 g; P ≤ 0.0005) as BMI increased, respectively. There was a significant difference in operative time between the nonobese and obese groups (128.7 vs 134.6 vs 150.5 vs 171 minutes; P = 0.026). A significant increase in postoperative infections was observed between the morbidly obese, super obese, and the nonobese group (P = 0.048). Conclusions Chest wall reconstruction in FTM and nonbinary transgender people is important in relieving gender dysphoria. Postoperative complications were not significantly increased in obese patients (30-39.9 kg/m2). Delaying surgery for weight loss may not be necessary unless patients are morbidly obese. Level of Evidence: 4

Gender Dysphoria, Eating Disorders and Body Image: An Overview

2020 ◽  
Vol 20 (4) ◽  
pp. 518-524 ◽  
Author(s):  
Walter Milano ◽  
Paola Ambrosio ◽  
Francesa Carizzone ◽  
Valeria De Biasio ◽  
Giuseppina Foggia ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Gender Identity ◽  
Gender Dysphoria ◽  
Eating Behaviors ◽  
The Body ◽  
Prevention Measures ◽  
Transgender People ◽  
Effective Prevention ◽  
Biological Sex ◽  
And Gender

Background:: Gender dysphoria is a clinical condition in which a state of inner suffering, stress and anxiety is detected when biological sex and a person's gender identity do not coincide. People who identify themselves as transgender people are more vulnerable and may have higher rates of dissatisfaction with their bodies which are often associated with a disorderly diet in an attempt to change the bodily characteristics of the genus of birth and, conversely, to accentuate the characteristics of the desired sexual identity. Aim:: The purpose of this work is to examine the association between dissatisfaction with one's own body and eating and weight disorders in people with gender dysphoria. Results:: Gender dysphoria and eating disorders are characterized by a serious discomfort to the body and the body suffers in both conditions. The results of our study suggest that rates of pathological eating behaviors and symptoms related to a disordered diet are high in patients with gender dysphoria and that standard screening for these symptoms must be considered in both populations at the time of evaluation and during the course of the treatment. Conclusions:: In light of this evidence, clinicians should always investigate issues related to sexuality and gender identity in patients with eating disorders, to develop more effective prevention measures and better strategies for therapeutic intervention..

scholarly journals Transgender embodiment: a feminist, situated neuroscience perspective

2020 ◽  
pp. 56-70 ◽  
Author(s):  
Reubs Walsh ◽  
Gillian Einstein
Keyword(s):  
Somatosensory Cortex ◽  
Gender Dysphoria ◽  
The Body ◽  
Social Constructionist ◽  
Individual Autonomy ◽  
Medical Necessity ◽  
Transgender People ◽  
Sexual Identities ◽  
Trans People ◽  
Biomedical Interventions

The policing of boundaries of acceptable sexual identities and behaviour is a recurring theme in numerous marginalities. Gender (especially womanhood) is often instantiated socially through the harms to which members of that gender are subjected. For transgender people, the assumption that genitals define gender translates the ubiquitous misapprehension that genitals and sex are binary into an assumption that gender must also be binary. This circumscribes the potentiality of cultural intelligibility for trans gender identities, and may interfere with the ability of transgender people to select the most appropriate medical and social means of expressing their authentic identities, even altering what is possible or appropriate, thereby curtailing trans people’s authenticity and freedom. We therefore distinguish social from bodily aspects of gender dysphoria, proposing a model of their distinct, intersecting origins. We explore ways in which transgender medicine reflects aspects of other gendered surgeries, proposing a biopsychosocial understanding of embodiment, including influences of culture on the neurological representation of the body in the somatosensory cortex. This framework proposes that cultural cissexism, causes trans people to experience (neuro)physiological damage, creating or exacerbating the need for medical transition within a framework of individual autonomy. Our social-constructionist feminist neuroscientific account of gendered embodiment highlights the medical necessity of bodily autonomy for trans people seeking surgery or other biomedical interventions, and the ethical burden therein.

scholarly journals Zen in Distress: Theorizing Gender Dysphoria and Traumatic Remembrance within Sōtō Zen Meditation

Religions ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 582
Author(s):  
Ray Buckner
Keyword(s):  
Gender Dysphoria ◽  
The Body ◽  
Transgender People ◽  
Fundamental Nature ◽  
Soto Zen ◽  
Psychological Gender ◽  
Meditation Experience

Gender dysphoria is considered a pronounced experience of distress in the bodies and minds of some transgender people. Examining the text Zen Mind, Beginners Mind by Shunryū Suzuki, I analyze some of the difficulties that may arise for transgender practitioners experiencing acutely strong gender dysphoria within the Sōtō Zen meditation experience. I seek to understand how physical and psychological gender distress may make concentration, and thereby realization, challenging and potentially harmful within a context of Sōtō Zen meditation. I consider how meditation can exacerbate the panic and traumatic remembrance of the body and mind, leading both to embodied struggles, as well as undoubtedly philosophical ones too. This paper theorizes gender dysphoria to exist beyond a state of unitary “distress” to include trauma. I put forward an understanding of gender dysphoria that is grounded in traumatic, gendered remembrances—what I call “sustained traumas.” Within the meditation experience, I argue trans, gender dysphoric people may experience heightened disconnect, separation, and deepening into their solid and suffering “self” rather than open to the fundamental nature of emptiness, non-duality, and an empty and move-able core. Ultimately, I argue meditation may lead to a deepening of traumatic remembrance, posing potential corporeal and philosophical problematics for gender dysphoric practitioners within Sōtō Zen meditation.

scholarly journals Dramaturgical Accounts of Transgender Individuals: Impression Management in the Presentation of Self to Specialist Gender Services

2021 ◽  
Author(s):  
Katrin Lehmann ◽  
Michael Rosato ◽  
Hugh McKenna ◽  
Gerard Leavey
Keyword(s):  
Impression Management ◽  
Gender Dysphoria ◽  
Management Strategies ◽  
Presentation Of Self ◽  
Mental Health Needs ◽  
Transgender People ◽  
Adolescents And Adults ◽  
And Coping ◽  
Unmet Mental Health ◽  
Partial Success

AbstractDemand for gender dysphoria (GD) treatment has increased markedly over the past decade. Access to gender-affirming treatments is challenging for most people. For dysphoric individuals, much is at stake. Little is known about the specific needs, challenges, and coping strategies of this hard-to-reach group. We examined the experiences of treatment-seeking adolescents and adults using in-depth unstructured interviews with 26 people attending specialist gender services and 14 transgender people not referred to services. Patients with gender dysphoria distrust clinical services and describe considerable anxiety in sustaining their impression management strategies to obtain treatment. An authentic presentation is regarded by some participants, especially non-binary individuals, as inauthentic and emotionally difficult to maintain. Impression management strategies have partial success in accessing services. The presentation of “idealized” selves may result in unmet mental health needs of patients, and the receipt of interventions incongruent with their authentic selves.

scholarly journals Defensive Functioning of Individuals Diagnosed With Gender Dysphoria at the Beginning of Their Hormonal Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Guido Giovanardi ◽  
Marta Mirabella ◽  
Mariagrazia Di Giuseppe ◽  
Francesco Lombardo ◽  
Anna Maria Speranza ◽  
...  
Keyword(s):  
Gender Dysphoria ◽  
Defense Mechanisms ◽  
Rating Scales ◽  
Hormonal Treatment ◽  
The Body ◽  
Assessment Procedure ◽  
Transgender People ◽  
Defensive Functioning ◽  
Wide Range ◽  
Body Uneasiness

Defense mechanisms are relevant indicators of psychological functioning and vulnerability to psychopathology. Their evaluation can unveil individuals' unconscious strategies for mediating reactions to emotional conflict and external stressors. At the beginning of their journey toward gender reassignment, individuals diagnosed with gender dysphoria (GD) may experience conflict and stressful experiences that trigger a wide range of defense mechanisms. Mature defenses may strengthen these individuals as they travel along this important path, while neurotic and immature defenses may exacerbate their body dissatisfaction (BD) and hinder their processing of change. Only a few studies have investigated self-reported defensive functioning in transgender people, finding a higher frequency of maladaptive defense mechanisms relative to controls. The present study was the first to apply an in-depth clinician-rated tool to assess the entire hierarchy of defense mechanisms within a sample of transgender people. Defensive functioning and personality organization were assessed in 36 individuals diagnosed with GD (14 trans women, 22 trans men, mean age 23.47 years), using the Defense Mechanisms Rating Scales (Perry, 1990) and the Shedler-Westen Assessment Procedure-200 (Shedler et al., 2014). Body uneasiness was assessed using the Body Uneasiness Test (BUT; Cuzzolaro et al., 2006). The findings showed that defensive functioning correlated positively with healthy personality functioning and negatively with BD. Compared to cisgender controls, participants with GD who presented greater defensive functioning were found to be more immature and to demonstrate significant differences in many levels of functioning. The clinical implications of the results suggest that psychological interventions aimed at improving defensive functioning in individuals with GD will be important in helping them manage the challenges posed by their gender transition.

scholarly journals Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden

2021 ◽  
Author(s):  
Cathrine Axfors ◽  
Stavros I. Iliadis ◽  
Lovisa L. Rasmusson ◽  
Ulrika Beckman ◽  
Attila Fazekas ◽  
...  
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Gender Dysphoria ◽  
Treatment Options ◽  
Treatment Preferences ◽  
Transgender People ◽  
Genital Surgery ◽  
Facial Surgery ◽  
Somatic Comorbidities ◽  
Top Surgery

Abstract Introduction Gender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms. Methods Cross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment. Results The proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses. Conclusions In this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity. Policy Implications The study findings underline the need for individualized care and flexible gender affirming treatment options. The role of somatic comorbidities should be further explored, and support should be offered to transgender people in need. There is an unmet need for facial surgery among aM.

scholarly journals The primary health care of transgender adults

Sexual Health ◽  
2017 ◽  
Vol 14 (5) ◽  
pp. 477 ◽  
Author(s):  
Stuart Aitken
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Disparity ◽  
Gender Dysphoria ◽  
Well Being ◽  
Primary Care Providers ◽  
Transition Services ◽  
Care Providers ◽  
Transgender People ◽  
Significant Health

Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.

scholarly journals Principles of Transgender Care for the Primary Care Physician

2020 ◽  
pp. 30-37
Author(s):  
Robert Gotfried
Keyword(s):  
Health Care ◽  
Gender Identity ◽  
Health Care Providers ◽  
Gender Dysphoria ◽  
Mental Health Problems ◽  
Care Physician ◽  
Internal Conflict ◽  
Care Providers ◽  
Transgender People ◽  
Transgender Persons

The term transgender includes people whose gender identity differs from their sex assigned at birth. People identified as male at birth but possess a female gender identity are called transwomen and people identified as female at birth but experience a male gender identity are called transmen. Transgender individuals may also identify outside the binary norm. The prevalence of transgender people who seek medical treatment has dramatically increased in recent years. Transgender individuals have a higher prevalence of mental health problems, suicidality and premature mortality risk versus the general population. However, many transgender persons avoid medical care due to perceived stigma, in conjunction with transgender-specific knowledge deficits among health care providers. Integral to understanding transgender health is the concept of gender dysphoria. This refers to the internal conflict individuals experience due to incongruence between their birth sex and their self-perceived gender. For these individuals, the inconsistency causes significant internal conflict, often to the point that it interferes with functioning. To address gender dysphoria, many transgender people elect to transition to a gender role that is consistent with their gender identity. These individuals opt for medical and/or surgical interventions to do so. Medical therapy incorporates the use of cross-sex hormones to facilitate the acquisition of secondary sexual characteristics consistent with the individual’s internalized identity. Many transgender people choose to undergo gender-confirming surgeries in conjunction with hormonal therapy. Health care is transgender-affirming when it supports the patient’s inherent identity. Educating providers about this population’s unique needs can help reduce health disparities and promote respectful transgender care.

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