Introduction
The intrauterine device (IUD) is a long‐acting and highly efficacious form of contraception that can also be used for menstrual suppression. Although IUD use is increasing, the type ...chosen, appeal, and satisfaction among individuals who are transgender and gender diverse and assigned female at birth (TGD‐AFAB) is unknown. The purpose of this study is to evaluate IUD usage among TGD‐AFAB individuals.
Methods
TGD‐AFAB individuals who had an IUD for a minimum of 6 months at the time of completing the survey or had one in the past completed an anonymous online survey. Descriptive statistics were used to analyze the data.
Results
One hundred and five TGD‐AFAB individuals completed the survey. Among participants who were sexually active, 88% reported they were in a relationship in which it was possible to get pregnant. There were 85 individuals who currently had an IUD: 62 (73%) chose a 52‐mg levonorgestrel (LNG) IUD, 5 (6%) chose a lower‐dose LNG IUD, 17 (20%) chose the copper IUD, and one chose an IUD unavailable in the United States. Menstrual suppression was the primary reason for choosing a 52‐mg LNG IUD (58%). Most individuals who opted for a copper IUD did so to avoid hormonal contraception (71%). Participants reported experiencing IUD side effects; however, few desired removal. Among the 36 respondents who had an IUD in the past, the most frequent reasons for removal were expiration of the device (LNG IUDs) and undesired side effects (copper IUD). Approximately half of participants who had an IUD removed had it replaced with another IUD.
Discussion
Pregnancy can occur among TGD‐AFAB individuals even if they are on testosterone and amenorrheic. IUDs are well tolerated in this population, with few current users desiring removal for unwanted side effects. Clinicians should counsel TGD‐AFAB individuals about the contraceptive and noncontraceptive benefits of IUDs and expected side effects.
Transgender and gender-nonbinary patients may present to primary care providers seeking gender-affirming hormone therapy. Patients who meet criteria for diagnosis of gender incongruence may start or ...continue hormone therapy after providing informed consent. Prescribing and monitoring of masculinizing and feminizing hormone therapy can be managed in primary care settings.
Through a review of current research, standards of care, and best practices, this paper serves as a resource for emergency physicians (EPs) caring for persons who identify as transgender and gender ...diverse (T/GD) in the emergency department (ED). Both patient‐ and physician‐based research have identified existent potential knowledge gaps for EPs caring for T/GD in the ED. T/GD have negative experiences related to their gender identity when seeking emergency medical care and may even delay emergency care for fear of discrimination. Through the lens of cultural humility, this paper aims to address potential knowledge gaps for EPs, identify and reduce barriers to care, highlight gender‐affirming hospital policies and protocols, and improve the care and experience of T/GD in the ED.
Contraception across the transmasculine spectrum Krempasky, Chance; Harris, Miles; Abern, Lauren ...
American journal of obstetrics and gynecology,
February 2020, 2020-02-00, 20200201, Letnik:
222, Številka:
2
Journal Article
Recenzirano
The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting ...intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication’s guidelines have been led by reproductive care clinicians of transgender experience.
INTRODUCTION:
Transgender individuals are more than four times more likely than cisgender people to experience traumatic events such as rape and sexual assault. The purpose of this study is to ...determine the percentage of transgender individuals in our cohort that experienced sexual assault and homelessness.
METHODS:
Transgender individuals aged 18-64 participated in an online survey that included demographics as well as social and reproductive history.
RESULTS:
996 surveys were collected. The mean age was 28 (SD 10, range 18-64). The majority of participants were White (810; 85%), non-Hispanic (859; 89%), and had insurance (893; 90%). 787 (79%) individuals identified as transmasculine or assigned female at birth, and 209 (21%) identified as transfeminine or assigned male at birth. Of all transgender people, 47% have ever been sexually assaulted: 362 (50%) of transmasculine individuals, and 72 (37%) of transfeminine individuals. Although 19% had been homeless, 88% of all transgender people currently feel safe where they live.
CONCLUSION:
Even in our predominately White, well-insured population, many survey respondents relayed a history of sexual assault, and one in five had been homeless. As obstetrics and gynecology providers, we should be aware of these numbers and consider universal screening for trauma. We should focus on providing trauma-informed care to help establish a safe physical and emotional environment for patients.
To describe choices of transgender and gender diverse (TGD) late adolescents assigned female at birth regarding gender-affirming surgery (GAS).
Participants aged 18-21 completed an online survey that ...included demographic characteristics, surgical history, desire for GAS, and barriers to care.
Two hundred and sixty surveys were completed. Forty-three (16.7%) respondents had undergone GAS. Of those who had not, 178 (83%) planned to do so in the future, and 15 (7%) reported no desire to undergo GAS. One hundred and sixteen (54%) had not due to financial reasons, 54 (25%) due to insurance difficulties, and 28 (13%) because they were unable to find a surgeon.
TGD late adolescents assigned female at birth have varying desires for future GAS that align with their gender expression. They also face many barriers to care. It is important for health care providers to be aware of the unique desires of TGD adolescents, not assume any particular surgical path for gender affirmation, and acknowledge the barriers experienced.
Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. ...As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty.
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