Search

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team. [Display omitted] [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). Inability to determine causation and limited generalizability. TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men. [ABSTRACT FROM AUTHOR]

Testosterone therapy is the main hormonal treatment offered in transmen to alleviate somatic gender dysphoria. Testosterone can be administered via topical or injectable preparations to achieve physical changes resulting in masculinisation and improve quality of life for the treated individuals. The aim of our paper is to outline methods for testosterone replacement, their impact on main body systems of transmen, potential associated health risks and long term follow up. Androgen use in transgender medicine is safe with appropriate endocrine guidance and monitoring. Studies with longer follow-up period, including those who may prefer low dose testosterone, interested in pregnancy or older people may further improve the management of female-to-male transgender persons. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the existence and strength of association between chest dysphoria and mental health in transmasculine and nonbinary adolescents. This is a cross-sectional cohort study of transmasculine and nonbinary adolescents designated female at birth between 12 and 18 years old. None had undergone prior top surgery. Patients complete the Chest Dysphoria Measure and Youth Inventory-4 (YI-4) upon presentation to our institution. Outcomes were retrospectively reviewed. The primary outcome of interest was the association between chest dysphoria and anxiety and depression symptom severity, as measured by the YI-4. One hundred fifty-six patients met inclusion criteria. Mean age was 15.3 years (standard deviation [SD] = 1.7). Most patients identified as transmasculine (n = 132); 18 identified as nonbinary and 6 as questioning. Mean (SD) YI-4 symptom severity scores were 10.67 (6.64) for anxiety and 11.99 (7.83) for depression. Mean (SD) Chest Dysphoria Measure composite score was 30.15 (9.95); range 2–49. Chest dysphoria was positively correlated with anxiety (r =.146; p =.002) and depression (r =.207; p <.001). In multivariate linear regression models, chest dysphoria showed a significant, positive association with anxiety and depression, after accounting for gender dysphoria, degree of appearance congruence, and social transition status. Chest dysphoria is associated with higher anxiety and depression in transmasculine and nonbinary adolescents designated female at birth. This association is independent of level of gender dysphoria, degree of appearance congruence, and social transition status. Treatment options aimed at alleviating chest dysphoria should be made accessible to adolescents and tailored to individual needs. [ABSTRACT FROM AUTHOR]

This case study measured the effects of manual laryngeal therapy on the fundamental frequency (f o), formant frequencies, estimated vocal tract length, and listener perception of masculinity of a 32-year-old transmasculine individual. The participant began testosterone therapy 1.5 years prior to the study. Two therapy approaches were administered sequentially in a single session: (1) passive circumlaryngeal massage and manual laryngeal reposturing, and (2) active laryngeal reposturing with voicing. Acoustic recordings were collected before and after each treatment and 3 days after the session. Speaking f o decreased from 124 Hz to 120 Hz after passive training, and to 108 Hz after active training. Estimated vocal tract length increased from 17.0 cm to 17.3 cm after passive training, and to 19.4 cm after active training. Eight listeners evaluated the masculinity of the participant's speech; his voice was rated as most masculine at the end of the training session. All measures returned to baseline at follow-up. Overall, both acoustic and perceptual changes were observed in one transmasculine individual who participated in manual laryngeal therapy, even after significant testosterone-induced voice changes had already occurred; however, changes were not maintained in the follow-up. This study adds to scant literature on effective approaches to and proposed outcome measures for voice masculinization in transmasculine individuals. [ABSTRACT FROM AUTHOR]

The purpose of this study was to comprehensively evaluate voice and speech changes in one healthy 30-year-old transgender male undergoing testosterone therapy for transition. Testing occurred at three timepoints before cross-sex hormone therapy and every 2 weeks thereafter for 1 year. Data collected included measures of acoustics, aerodynamics, and laryngeal structure and function via flexible laryngoscopy. Analysis included acoustic correlates of pitch, loudness, voice quality, and vocal tract length, as well as perceptual measures of voice quality and gender. Speaking fundamental frequency (f o) lowered from 183 Hz to 134 Hz. Phonatory frequency range (ie, minimum and maximum singing range) shifted from a range of D#3–E6 to a range of A2–A5. Perceptual measures of voice quality indicated no negative changes. Naïve listeners reliably rated the participant's speech samples as male after 37 weeks on testosterone. Few studies document in detail the variety of voice changes that occur during cross-sex hormone therapy, focusing instead on f o alone. This study adds to the literature a comprehensive case study of speech and voice changes experienced by one transmasculine participant undergoing testosterone therapy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training. The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery. A case report and literature review was undertaken. Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (f o) ranging from 70–344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean f o of 108 Hz on reading, 100 Hz in monologue, and a f o range of 85–134 Hz across these tasks. This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the factors and practices that have acted as facilitators or barriers to voice function in gender diverse people assigned female at birth (GD peopleAFAB) from a participant-centered perspective and to inform the role of speech-language pathologists in supporting GD peopleAFAB with developing and maintaining functional voice production. Transcripts of semistructured interviews with 14 German-speaking GD peopleAFAB were analyzed for the study objectives using a consensual approach to qualitative content analysis. The interviews and their interpretation were conceptualized as co-constructions of participants and researchers who were regarded as experts in their own right. Professional practices (testosterone treatment, professional voice support), speaker practices (self-care and voice use practices, self-evaluation of voice function), conversation partner practices, and supraindividual biocultural forces (vocal demands, normative practices, other biocultural forces) were identified as having influenced the participants' voice function. Professional voice support, a range of phonation practices, and general self- and voice care practices were frequently cited facilitators of functional voice production. The most frequent barriers to voice function included testosterone treatment, slouched posture, excess muscle tension, forceful voice use, and avoidance practices. Voice function in GD peopleAFAB is influenced by interactions of several forces, most of which may be shared by voice users of all genders. Professional practices should follow a person-centered approach to care in which all parties are well informed of the limitations and possibilities for any intervention, including the often-unquestioned contribution of testosterone treatment. [ABSTRACT FROM AUTHOR]

Summary Objectives To investigate effects of testosterone treatment regarding voice virilization, voice problems, and voice satisfaction in transsexual female-to-male individuals, referred to as trans men. Study Design Longitudinal. Methods Fifty trans men, diagnosed with transsexualism, 18–64 years, met the inclusion criteria. Voice data before treatment and after 3, 6, or 12 months were available from 49 participants, and for 28 participants also after 18 and/or 24 months of treatment. Digital audio recordings of speech range profiles and voice range profiles were carried out in a sound-treated booth following clinical routines. Acoustic analyses of fundamental frequency (F0) and sound pressure level were made. Endocrine data and answers from questionnaires concerning voice function and voice problems were collected from medical records. Results Mean F0 and mode F0 of the habitual voice decreased significantly after 3 months, 6 months, and up to 12 months, when group data were congruent with reference data for males. Mean F0 was 125 Hz after 12 months with a large interindividual variation. Sound pressure level values did not change significantly. Voice satisfaction correlated with lower F0 values. Twenty-four percent of the participants reported voice symptoms, for example, vocal instability and fatigue, and had received voice therapy. F0 values did not correlate with androgen levels. Conclusions Most trans men developed a male voice and were satisfied. However, it is important to detect the substantial group of trans men with voice problems and with insufficient voice virilization and who may need voice therapy. Therefore, we recommend systematic voice assessments during testosterone treatment. [ABSTRACT FROM AUTHOR]