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Background: Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system., Methods: We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations., Results: We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women ( n = 13) and White ( n = 14). Participants lived in rural ( n = 4), suburban ( n = 5), or urban ( n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations)., Interpretation: Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences., Competing Interests: Competing interests:: Gianni Lorello reports funding from the Canadian Institutes of Health Research (CIHR), Social Sciences and Humanities Research Council, the Royal College of Physician and Surgeons of Canada, and the University of Toronto, as well as remunerated positions for the Royal College of Physicians and Surgeons of Canada as well as the University of Toronto, MD Program. He is a guest editor with the Canadian Journal of Anesthesia. Emery Potter reports funding from the CIHR and consulting fees from Rainbow Health Ontario. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)

From a Darwinian perspective we live to reproduce, but in various situations genetic males elect not to reproduce by choosing medical treatments leading to infertility, impotence, and, in the extreme, emasculation. For many men, infertility can be psychologically distressing. However, for certain genetic males, being infertile may improve their quality of life. Examples include (1) men who seek vasectomy, (2) individuals with Gender Dysphoria (e.g., transwomen, and modern day voluntary eunuchs), (3) most gay men, and (4) men treated for testicular and prostate cancer. Men who desire vasectomy typically have a Darwinian fitness W >1 at the time of their vasectomies; i.e., after they have their desired number of offspring or consider themselves past an age for parenting newborns. In contrast, prostate and testicular cancer patients, along with individuals with extreme Gender Dysphoria, do not necessarily seek to be sterile, but accept it as an unavoidable consequence of the treatment for their condition undertaken for survival (in case of cancer patients) or to achieve a better quality of life (for those with Gender Dysphoria). Most gay men do not father children, but they may play an avuncular role, providing for their siblings' offspring's welfare, thus improving their inclusive fitness through kin selection. In a strictly Darwinian model, the primary motivation for all individuals is to reproduce, but there are many situations for men to remove themselves from the breeding populations because they have achieved a fitness W ≥1, or have stronger medical or psychological needs that preclude remaining fertile.

Background: The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery., Methods: 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospital's Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction., Results: 119 (46.9% ) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1-7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now., Conclusion: The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.

This article takes an ethical approach to briefly analyze current therapeutic guidelines in Brazil for cases diagnosed as "ambiguous genitalia" (one of the "disorders of sexual development", DSD) in intersex children. Except when there is clear risk to the infant's life, there is no medical or institutional consensus on the definition of intersex, DSD, or recommended treatment. Parents or guardians of these minors have the legal right to provide consent for genital surgical interventions. The irreversibility of some procedures calls attention to reports by some intersex adults who underwent such interventions during their childhood or adolescence and now fail to acknowledge the physical or psychosocial benefits that were originally claimed to justify them.

In Croatia, transgender individuals face numerous social and medical obstacles throughout the process of transition. The aim of this study was to depict the factors contributing to the psychosocial adjustment of six transsexual individuals living in Croatia following sex reassignment surgery (SRS). A combination of quantitative and qualitative self-report methods was used. Due to the specificity of the sample, the data were collected online. Standardized questionnaires were used to assess mental health and quality of life alongside a series of open-ended questions divided into 4 themes: the decision-making process regarding SRS; social and medical support during the SRS process; experience of discrimination and stigmatizing behaviors; psychosocial adjustment after SRS. Despite the unfavorable circumstances in Croatian society, participants demonstrated stable mental, social, and professional functioning, as well as a relative resilience to minority stress. Results also reveal the role of pretransition factors such as high socioeconomic status, good premorbid functioning, and high motivation for SRS in successful psychosocial adjustment. During and after transition, participants reported experiencing good social support and satisfaction with the surgical treatment and outcomes. Any difficulties reported by participants are related to either sexual relationships or internalized transphobia. The results also demonstrate the potentially protective role that a lengthier process of transition plays in countries such as Croatia.

This paper reviews the development of gender reassignment in Thailand during the period of 1975-2012, in terms of social attitude, epidemiology, surgical patients' profile, law and regulation, religion, and patients' path from psychiatric assessment to surgery. Thailand healthcare for transsexual patients is described. Figures related to the number of sex reassignment surgeries performed in Thailand over the past 30 years are reported. Transsexual individuals are only apparently integrated within the Thail society: the law system of Thailand in fact, does not guarantee to transsexuals the same rights as in other Western countries; the governmental healthcare does not offer free treatments for transsexual patients. In favor of the transsexual healthcare, instead, the Medical Council of Thailand recently published a policy entitled "Criteria for the treatment of sex change, Census 2009." The goal of this policy was to improve the care of transsexual patients in Thailand, by implementing the Standards of Care of the World Professional Association of Transgender Health. Currently, in Thailand, there are 6 major private groups performing sex reassignment surgery, and mostly performing surgery to patients coming from abroad. Particularly, the largest of these (Preecha's group) has performed nearly 3000 vaginoplasties for male-to-female transsexuals in the last 30 years.

Introduction: In the UK, funding for a bilateral mastectomy (BLM) and associated chest recontouring for female-to-male transsexuals (trans men) has been rejected by some funding authorities on a number of unsustainable grounds., Methods: As funding is increasingly an important area for both surgeons and referrers, we undertook a review of the small amount of literature pertaining to this issue and considered it in light of our clinical experience of this group., Findings: The literature showed that BLM is necessary for trans men to live safely and effectively in their reassigned gender role, and further that it acts as a prophylaxis against distress, ameliorates extant distress as well as providing improved quality of life and global functioning for this patient group.

Objective: To evaluate the impact of sex reassignment surgery on the defense mechanisms of 32 transsexual patients at two different points in time using the Defensive Style Questionnaire., Method: The Defensive Style Questionnaire was applied to 32 patients upon their admission to the Gender Identity Disorder Program, and 12 months after they had undergone sex reassignment surgery., Results: There were changes in two defense mechanisms: anticipation and idealization. However, no significant differences were observed in terms of the mature, neurotic and immature categories., Discussion: One possible explanation for this result is the fact that the procedure does not resolve gender dysphoria, which is a core symptom in such patients. Another aspect is related to the early onset of the gender identity disorder, which determines a more regressive defensive structure in these patients., Conclusion: Sex reassignment surgery did not improve the defensive profile as measured by the Defensive Style Questionnaire.