Injections with intramuscular (IM) testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive ...modality. However, they are difficult to self-administer and associated with some discomfort. Recently, subcutaneous (SC) administration of testosterone esters has gained popularity, as self-administration is easier with this route. Available data, though limited, support the feasibility of this route. Here we review the pharmacokinetics and safety of SC testosterone therapy with both long- and ultralong-acting testosterone esters. In addition, we provide guidance for clinicians on how to counsel and manage their patients who opt for the SC route.
Systematic review of available literature on SC testosterone administration including clinical trials, case series, and case reports. We also review the pharmacology of testosterone absorption after SC administration.
Available evidence, though limited, suggests that SC testosterone therapy in doses similar to those given via IM route results in comparable pharmacokinetics and mean serum testosterone levels. With appropriate training, patients should be able to safely self-administer testosterone esters SC with relative ease and less discomfort compared with the IM route.
Although studies directly comparing the safety of SC vs IM administration of testosterone esters are desirable, clinicians should consider discussing the SC route with their patients because it is easier to self-administer and has the potential to improve patient adherence.
The(y)ology Brumberg-Kraus, Max Yeshaye
2023
eBook
Odprti dostop
Every body contains multitudes, but no body is immune to the ideology of oneness: one true self, one sexuality, one gender, one vision of the world, one true God. For many who identify (or who have ...been named by others) as transgender, queer, and nonbinary, the refusal to fit within the illusion of one set of sex and gender expectations has been met with violence and suppression. While the myth of oneness is a powerful story that shapes the contours of our societies and our selves, it is not the only myth. Performances, fictions, rituals, and theologies can transform current realities. The(y)ology: Mythopoetics for Queer/Trans Liberation is a manifesto for artists, teachers, theologians, clergy, and activists looking for ways to resist rigid paradigms of gender, sexuality, self, and the sacred. In these pages, we are called to tell new stories about who we are and how we relate to each other within our ecosystems. The myths discussed wrestle with and transform the complex mytho-histories that have birthed and, often, harmed us. No story comes from nothing, and, more radically, perhaps no story is fully irredeemable. In The(y)ology, feminist philosophies join with trans poetics, literary theory with liberation theologies, drag performance with kabbalah, ecologies with pornographies, and ancient theater with queer autobiographies. However ambitious its scope might be, The(y)ology is fundamentally about encouraging us all to think playfully and to play thoughtfully with the mythologies that define our lives.
Falling into the Lesbi World offers a compelling view of sexual and gender difference through the everyday lives of tombois and their girlfriends ("femmes") in the city of Padang, West Sumatra. While ...likening themselves to heterosexual couples, tombois and femmes contest and blur dominant constructions of gender and heterosexuality. Tombois are masculine females who identify as men and desire women; their girlfriends view themselves as normal women who desire men. Through rich, in-depth, and provocative stories, author Evelyn Blackwood shows how these same-sex Indonesian couples negotiate transgressive identities and desires and how their experiences speak to the struggles and desires of sexual and gender minorities everywhere. Blackwood analyzes the complex and seemingly contradictory practices of tombois and their partners, demonstrating how they make sense of Islamic, transnational, and modern state discourses in ways that seem to align with normative gender and sexual categories while at the same time subverting them. The childhood and adolescent narratives of tombois and femmes offer bold new insights into a social process that is rarely addressed in anthropological, lesbian, gay, or transgender studies. We see how tombois and femmes come to view themselves as boys and girls, respectively, through their interactions with family and community, and how as teenagers tombois learn that masculinity needs its opposite: feminine women. By contrast femmes notice shifts in their desires as they develop long-term relationships with tombois. The book reveals the complexity of tomboi masculinity, showing how tombois enact both masculine and feminine behaviors as they move between the anonymity and vulnerability of public spaces and the familiarity of family spaces. Falling into the Lesbi World demonstrates how nationally and globally circulating queer discourses are received and reinterpreted by tombois and femmes in a city in Indonesia. Though less educated than many internet-savvy activists in major urban centers, their identities are clearly both part of yet different than global gay models of sexuality. In contrast to the international LGBT model of "modern" sexualities, this work reveals a multiplicity of sexual and gender subjectivities in Indonesia, arguing for the importance of recognizing and validating this diversity in the global gay ecumene.
Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental ...health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled.
This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs.
Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality.
Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.
Access to effective services is imperative to address the many health and mental health disparities that lesbian, gay, bisexual, and transgender (LGBT) people face. This population, however, remains ...underserved and often ill-served in health care environments. Furthermore, interactions between system- and individual-level dimensions of access create barriers to service engagement. Within much of the extant literature surrounding health care barriers among LGBT people, the rich narratives and varied experiences of LGBT community members from diverse backgrounds have often been excluded. The current interview-based study was conducted with a sample of 40 self-identified LGBT adults living in New York City. Participants were recruited through flyers distributed to LGBT-specific social and health service organizations. Twenty-nine participants who discussed health care access as a major health concern were included in the current study. Framework analysis revealed barriers stemming from characteristics of services and providers (system-level) and characteristics of care-seekers (individual-level) as major health concerns. The root causes of system-level barriers were all attributed to social-structural factors that worked to exclude and erase LGBT people from the institutions that shape the health and mental health systems. Individual-level barriers were attributed to both individual and social-structural factors, such as health literacy and stigma. Participants linked access barriers to forgone care and to other health and mental health concerns within their communities. We argue that addressing barriers at the individual and sociostructural levels will better serve LGBT communities.
Public Policy Relevance Statement
Access to health and mental health services is a major health concern among LGBT community members. The LGBT population experiences poor health and mental health outcomes related to barriers to care. Policies set forth by the Patient Protection and Affordable Care Act (e.g., nondiscrimination protections, expanded insurance coverage) remain important initiatives to promote equitable health care access and enhance the health and wellbeing of LGBT care-seekers.
As more transfeminine patients (transgender and gender-diverse persons, sex assigned male at birth, who identify on the feminine spectrum of gender) are undergoing gender-affirming penile inversion ...vaginoplasty, gynecologists, as providers of vaginal care for both native and neovaginas, should be prepared to welcome these patients into their practice and offer long-term pelvic healthcare.
Many parts of the anatomy, clinical examination, and aftercare differ from both native vaginas and other neovaginal surgical techniques. Transgender and gender-diverse patients cite a lack of clinician knowledge as a barrier to accessing affirming and competent healthcare. Although publications are emerging regarding this procedure, most focus on intraoperative and postoperative complications. These studies are not positioned to provide long-term pelvic health guidance or robust instruction on typical examination findings.
This clinical opinion aims to address that knowledge gap by describing the gynecologic examination in the transfeminine person who has undergone a penile inversion vaginoplasty. We review the anatomic changes with surgery and the neovagina’s physiology. We describe the examination of the vulva, vagina, and urethra and discuss special considerations for performing pelvic examinations on patients with a penile inversion vaginoplasty neovagina. We will also address common pathologic findings and their initial management. This clinical opinion originates from the expertise of gynecologists who have cared for high volumes of transfeminine patients who have undergone penile inversion vaginoplasties at tertiary care centers performing gender-affirming genital surgery, along with existing research on postpenile inversion vaginoplasty outcomes. Gynecologists should be familiar with the anatomic changes that occur with penile inversion vaginoplasty gender-affirming surgery and how those changes affect care. Providing transgender patients with comprehensive care including this sensitive examination can and should be part of the gynecologist’s scope of practice.
Robotic-assisted peritoneal flap gender-affirming vaginoplasty (RPGAV) with the da Vinci Xi system has been reported to be a safe alternative to traditional penile inversion vaginoplasty. Utilizing ...the Single Port (SP) robot system, our surgical approach has evolved.
To describe a step-by-step technique for RPGAV using the SP robot and to compare outcomes between Xi and SP systems.
A total of 145 transgender women underwent RPGAV between September 2017 and December 2019. We retrospectively reviewed data for patients with a minimum 6 mo of follow-up.
Peritoneal flaps are harvested from the posterior bladder and pararectal fossa. The vaginal space is dissected transabdominally. Inverted penile flap with or without scrotal graft is sutured to the peritoneal flaps, which form the neovaginal apex.
Demographics, perioperative data, and clinical outcomes were evaluated.
A total of 100 (Xi = 47; SP = 53) patients had a minimum 6 mo of follow-up. The mean age was 36.2 (range 16.1–71.4) yr. Average procedure times were 4.2 and 3.7 h in Xi and SP cohorts, respectively (p <0.001). At the mean follow-up of 11.9 (range 6.0–25.4) mo, vaginal depth and width were 13.6 (range 9.7–14.5) and 3.7 (range 2.9–3.8) cm in the Xi group, and 14.1 (range 9.7–14.5) and 3.7 (range 3.5–3.8) cm in the SP group (p =0.07 and 0.04, respectively). Complications included transfusion (6%), rectovaginal fistula (1%), bowel obstruction (2%), pelvic abscess (1%), and vaginal stenosis (7%).
RPGAV using the SP robot reduces operative time by facilitating a dual-surgeon abdominal-perineal approach. There is no difference in complication rates between the two approaches.
We studied the outcomes of robotic peritoneal flap vaginoplasty with two robot systems. With both systems, patients had good vaginal depth and width at an average follow-up of 1 yr. Surgery time was shorter with the Single Port (SP) robot.
We studied the outcomes of robotic peritoneal flap vaginoplasty with two robot systems. With both systems, patients had good vaginal depth and width at an average follow-up of 1 yr. Surgery time was shorter with the Single Port (SP) robot.
Beyond bathroom accessibility, discrimination against transgender people is associated with many adverse health effects. The health care community can help through clinical care, research, and ...advocacy. But most clinicians lack expertise in transgender health.
One might have to go back to the era of racial desegregation of U.S. bathrooms to find a time when toilets received so much attention. Recently, several states have debated or passed legislation requiring people to use the public bathroom corresponding to their sex as “identified at birth” or “stated on a person’s birth certificate.”
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Some supporters of these laws have focused on the fear that male stalkers will claim to be transgender women in order to victimize girls and women in restrooms. Others have expressed vitriol and revulsion toward transgender people, describing them as “sexual predators,” “voyeurs,” and . . .
Identifying metabolic and cardiovascular risks of gender-affirming hormone therapy (GAHT) is challenging due to other confounding variables that affect patient outcomes and the diversity of treatment ...regimes. Masculinising hormone therapy produces atherogenic lipid profiles, while effects on other metabolic parameters are not consistent. There is insufficient evidence to conclude if cardiovascular disease risk among transmen is increased. The effects of feminising hormone therapy on metabolic parameters do not demonstrate a consistent pattern in the available literature. However, the risk of venous thromboembolism is greater in transwomen than in cis-gender men and women with a possible increase in cardiovascular disease risk. It is recommended to discuss the potential effects of GAHT on cardiovascular health and encourage patients seeking GAHT to adopt a healthy lifestyle. Performing baseline and periodic assessments of cardiovascular risk factors would enable early identification and interventions. In high-risk individuals, the cardiovascular effects of hormonal regimes might impact the treatment decision.
