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BACKGROUND: Facial feminization may be performed to alleviate gender dysphoria among transfeminine patients. The upper third of the face has several characteristics, including hairline shape and position, brow position, and forehead protrusion, that may confer feminine identity. The purpose of this study is to conduct a scoping literature review of techniques performed for forehead feminization and to additionally study clinical outcomes within an institutional cohort. METHODS: A systematic literature review was conducted to review articles that discussed techniques and clinical outcomes associated with procedures performed for feminization of the upper third of the face. A retrospective review of patients undergoing such procedures by the senior author was then conducted. Variables collected included demographic factors, operative details, and postoperative outcomes such as complications, revisions, and re-operations. RESULTS: Initial review yielded sixty-seven articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of twenty-two studies for analysis. Priorities of forehead feminization entail frontal bossing reduction, frontonasal angle widening, orbital contouring, brow lifting, and hairline advancement. Eighty-five patients were included for analysis. The majority were of Caucasian race (56%) and had type 3 forehead classification (92%). The average planned setback of the anterior table was 4.12 mm. CONCLUSIONS: The core tenets of the feminization of the forehead lie in the overall creation of a harmonic curvature of the forehead with other facial features. Our multi-pronged analysis presents an updated review of these principles, which may help plastic surgeons in performing procedures to feminize the upper third of the face. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Gender dysphoria is the imparity between a person's experienced gender and their birth-assigned gender. Gender transition is the process of adapting a person's sexual characteristics to match their experienced gender. The number of adults receiving sex hormone therapy for gender dysphoria is increasingly and these pharmacotherapies are increasing being prescribed in a general practice setting. The role of hormone therapy is to reverse or reduce physical sexual characteristics of the birth-assigned gender and enhance and build characteristics aligning to the expressed gender and these therapies apply to both transgender and gender nonconforming patients. Recognizing the options and interpreting the effects of gender transition therapies are fundamental to the discussion and treatment of gender dysphoria. This review summarizes pharmacodynamics, comparative dosing, adverse effects, monitoring, and potential pharmacogenetic influence of current pharmacotherapy. These include the use of 17-beta-estradiol, spironolactone, testosterone, GnRH agonists as well as adjunctive phosphodiesterase-5 inhibitors. The article also addresses gaps within the published literature including optimal routes of administration for individual patients, risks of malignancy and dosing reductions as transgender patients age. [ABSTRACT FROM AUTHOR]

AbstractThis paper critically examines the scientific and ethical underpinnings of gender-affirming care, particularly for minors. While major medical organizations endorse such interventions as medically necessary, the evidence supporting their long-term safety and efficacy remains limited. Research into hormonal, neuroanatomic, and genetic influences reveals a strong biological basis for gender identity, challenging social constructionist arguments. There is a lack of robust, long-term studies that definitively demonstrate the outcomes of gender-affirming medical treatments, such as puberty blockers or hormone therapy, for minors. Questions remain about how these interventions affect physical health (e.g., bone density, fertility) and mental well-being over decades. These gaps in the evidence, particularly for adolescents, raise ethical concerns about the appropriateness of irreversible medical treatments. This analysis highlights the tension between the social constructivist framework of gender and the medicalization of gender dysphoria. It explores the implications of rising desistance rates, co-occurring mental health conditions, and increasing non-binary identities within current clinical paradigms. Drawing on evidence from cases involving gender detransitioning, the impact of hormones, and neurological development in both straight, gay, and trans individuals, the paper underscores the importance of cautious, evidence-based approaches that prioritize psychological maturity and comprehensive mental health assessments. Ultimately, the paper advocates for rigorous longitudinal research, enhanced mental health evaluations, and the development of noninvasive therapeutic options in particular anda reevaluation of treatment models to ensure ethically sound and scientifically supported care for individuals experiencing gender dysphoria. [ABSTRACT FROM AUTHOR]

The increasing prevalence of gender dysphoria or transgender identity in children and adolescents has raised clinical, ethical and psychological concerns, particularly regarding the efficacy and appropriateness of medical interventions. This paper explores the critical role of thorough psychological assessment in addressing gender dysphoria, with a focus on the closure of the Tavistock NHS Gender Identity Service (GIDS) and the findings of the Cass Review. The author draws on her clinical experience to argue for a comprehensive, individualized approach to the treatment of children and young adults with gender identity conflicts. Key issues discussed include the lack of a robust evidence base for early medical treatments, such as puberty blockers and cross‐sex hormones, and the ethical implications of medicalising the bodies of children before psychological and physical maturity. The paper argues that many children presenting with gender confusion may be navigating complex psychological conflicts, including issues of identity, sexual orientation, anxiety and trauma, and that rushing into potentially harmful and life‐changing medical treatments may remove opportunities for addressing these emotional struggles. The author critiques the affirmative model of treatment, advocating for a more cautious, holistic and empathetic framework that prioritises improved assessment, psychological support and the time required between early adolescent pubertal changes and full sexual, psychological maturation. The paper highlights the implications of the Bell v. Tavistock Judicial Review and questions the issue of informed consent to hormone treatments. The author calls for the restoration of ethical clinical practices aiming to reduce potential harm and improve long‐term outcomes. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) adolescents are those whose gender identity is incongruent with societal expectations based on their sex assigned at birth.1 Some TGD adolescents may meet criteria for gender dysphoria, which requires at least 6 months of psychological distress related to gender incongruence.1 Such adolescents may seek pubertal suppression with a gonadotropin-releasing hormone agonist (GnRHa).1 GnRHa temporarily and reversibly suppress endogenous puberty, allowing adolescents to engage with care without puberty-related psychological distress.2 Most patients treated with GnRHa proceed to treatment with gender-affirming hormones (eg, estrogen or testosterone to induce puberty that aligns with their gender identity), whereas a small number choose to stop GnRHa treatment, allowing endogenous puberty to proceed.2 Longitudinal cohort and cross-sectional studies link GnRHa treatment to improved mental health outcomes, when provided in accordance with clinical guidelines.2 [ABSTRACT FROM AUTHOR]

In brief: Many transgender and gender diverse (TGD) people want to have biologically related children. This review summarizes and discusses the options for fertility treatment and preservation in TGD adults and adolescents, with an emphasis on gender-affirming hormone therapy in the context of fertility treatment, clinical management strategies to minimize gender dysphoria during treatment and major factors in future use of cryopreserved gametes. Abstract: Years of growing research demonstrate that TGD people desire fertility counseling and family building; however, social andmedical factors can impact future fertility options. Fortunately, TGD individuals havemany viable options for family building using their own gametes and/or reproductive organs. However, the nuanced ways in which different genderaffirming treatments affect reproduction, the interplay with nontreatment-related infertility factors and mitigation of likely dysphoria triggers are all critical to actual utilization. This review focuses on fertility treatment and preservation options for TGD patients and highlights these influential social and medical factors. Fertility treatments may be associatedwithworsening gender dysphoria in TGD people, and an affirming clinical environment and conscientious provider approach is paramount to treatment success. However, reducing gender dysphoria can also require specific changes to medically assisted reproduction and sperm collection protocols, some of which carry the potential for diminished outcomes or unknown effects. Adolescents undergoing fertility preservation treatments may need more support or additional protocolmodifications, and outcomesmay be poorer in this age group compared with adults. Testicular and ovarian tissue cryopreservation may present a fertility preservation option for prepubertal TGD children; however, in vitro gamete maturation remains experimental in this situation. [ABSTRACT FROM AUTHOR]

In response to negative media attention regarding gender affirming medical interventions (GAMI), the current manuscript explores the content of messages trans and nonbinary (TNB) individuals receive regarding the impacts of GAMI on gender dysphoria. Further, TNB individuals' experiences of the effects of GAMI on gender dysphoria are described. A sample of responses from 105 TNB participants were analyzed utilizing qualitative content analysis. These qualitative results revealed that the messages participants received were split between trans negative and trans affirming aspects. Relatedly, participants' experiences also reflected a dichotomy between current limitations and positive impacts of GAMI on gender dysphoria. The discussion focuses on how participants' positive experiences with GAMI, which resulted in decreased gender dysphoria and psychological distress, challenge the current political discourse that attempts to ban GAMI. Clinical implications focus on how to translate the current findings regarding the limitations of GAMI into more fully informed consent processes. [ABSTRACT FROM AUTHOR]

Introduction: Gender dysphoria (GD) is associated with profound mental health challenges, including heightened suicide risk. This study aimed to explore the mental health status and attitudes toward suicide among individuals with GD in Iran. Methods: A comprehensive assessment was conducted using three validated tools: the General Health Questionnaire (GHQ-28) to gauge emotional distress and psychological well-being, the Beck Depression Inventory (BDI-II) to evaluate the severity of depressive symptoms, and the Predicament Questionnaire (PQ) to measure attitudes toward suicide in the context of social crises. Results: Among the 78 participants, 43 (55.1%) were identified as experiencing significant mental health issues, while 21 (26.9%) were found to suffer from severe depression. The average PQ score was 57.92, which aligns with findings from similar populations in previous studies, highlighting a concerning trend in suicide-related attitudes. Further statistical analysis revealed significant correlations between psychological distress (GHQ-28 scores) and attitudes toward suicide (PQ scores), as well as between depressive symptoms (BDI-II scores) and suicide-related attitudes. Conclusions: These findings indicate a pervasive prevalence of psychological disorders, particularly depression, within this group, and underscore the strong association between depressive states and suicidal ideation. The study underscores the urgent need for targeted mental health interventions and comprehensive healthcare policies tailored to the specific needs of individuals with GD in Iran. Given the substantial mental health burden observed, particularly the risk of suicide, this research highlights the critical importance of integrating mental health care into broader support systems for this population. [ABSTRACT FROM AUTHOR]

Since the development of the Adult Attachment Interview (AAI) in 1985, more than 26,000 AAIs have been administered, coded, and reported, representing 170 (wo-)man-years of work. We used multinomial tests and analyses of correspondence to compare the AAI distributions in various cultural and age groups, in mothers, fathers, high-risk, and clinical samples with the combined samples of North American non-clinical, non-risk mothers (22% dismissing, 53% secure, 8% preoccupied, and 17% unresolved loss or other trauma). Males were more often classified as dismissing and less frequently classified as secure compared to females (except adoptive fathers), and females were more frequently classified as unresolved (but not more often preoccupied) compared to males. A combination of high scores on the unresolved and insecure-preoccupied dimensions was shared by borderline personality disorder, autism spectrum disorders, and gender dysphoria, while combined high scores on the unresolved and insecure-dismissing dimensions characterized anxiety problems, obsessive-compulsive and thought disorders. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion We aimed to describe treatment trajectories, detransition and mortality rate among children and adolescents referred to the Norwegian National Center for Gender Incongruence (NCGI).The cohort included all 1258 persons under 18 years at referral to the NCGI from 2000 to 2020. Trajectories were registered until end of 2023.In total, 861/1258 (68.4%) were assigned female gender at birth (AFAB). Mean age at referral was 14.4 years. Puberty suppression with gonadotropin‐releasing hormone agonists (GnRHa) was initiated among 135/1258 (10.7%), significantly more persons assigned male gender at birth (AMAB) than AFAB (p < 0.001). Gender‐affirming hormonal treatment (GAHT) was initiated in 783/1258 (62.2%). The continuation rate from GnRHa to GAHT was 97%. Discharge rate from NCGI without gender‐affirming medical treatment among those who attended at least one appointment, was 264/1198 (22.0%). Eighteen AFAB detransitioned after initiated GAHT, eleven due to a cessation of transgender identity. Mortality rate in the cohort until end of 2023 was 11/1258 (0.9%).Different trajectories including medical pathways and assessments without gender‐affirming treatment were observed. GAHT was initiated in 783/1258 (62.2%), including eighteen AFAB detransitioning after testosterone treatment. There was a high continuation rate from GnRHa to GAHT. Various trajectories highlights the need for long‐term follow‐up in care. [ABSTRACT FROM AUTHOR]

ABSTRACT Individuals with gender dysphoria (GD) often exhibit suicidal inclinations. In the present study, we investigated the scope of suicidal ideation and attempts and the roles of perceived social support, stress, and psychological distress in mediating social problem‐solving and suicidality in individuals with GD. Two hundred and five adults with GD (110 GD assigned female at birth [AFAB]; 95 GD assigned male at birth [AMAB]) completed a self‐report survey including questions about suicide ideation and attempts, as well as the General Health Questionnaire (GHQ‐12), Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Stress Scale (PSS), and Social Problem‐Solving Inventory‐Revised (SPSI‐R). We utilized correlation, regression, and mediation analyses to assess models. Overall, both suicidal ideation (for AFAB = 61.8%; for AMAB = 61.1%; p = 0.91) and suicide attempts (for AFAB = 43.6%; for AMAB = 37.9%; p = 0.41) were common in individuals with GD. The two groups did not differ in GHQ‐12, PSS, and SPSI‐R total scale scores, but AMAB scored lower on the MSPSS total score. Perceived social support, perceived stress, and psychological distress partially mediated social problem‐solving and suicidal ideation, whereas perceived stress and psychological distress fully mediated social problem‐solving and suicide attempts. There is a need to develop interventions to improve the psychological well‐being of people with GD. Current results suggest that problem‐solving therapy may effectively suit the need to manage suicidality in people with GD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Permanent hair reduction is an integral part of gender-affirming medical care, especially for transgender patients undergoing surgeries such as phalloplasty and vaginoplasty. Hair removal helps reduce complications and alleviate gender dysphoria associated with unwanted facial and body hair. OBJECTIVE: To examine the methods, efficacy, and access issues of hair removal in transgender patients, with a focus on its role in surgical preparation and gender dysphoria reduction. MATERIALS AND METHODS: A literature review was conducted to analyze the effectiveness of laser hair removal (LHR) and electrolysis for permanent hair reduction. The review also explored regional regulatory barriers and insurance coverage limitations affecting access to these services. RESULTS: Laser hair removal and electrolysis are both effective for hair removal, with LHR being less painful and faster. Laser hair removal is often preferred but requires multiple treatments and proper laser settings. Insurance coverage remains inconsistent, limiting access to these procedures. Postoperative hair regrowth in neovaginal or neourethral sites can be managed with hormonal adjustments and further treatments. CONCLUSION: Hair removal plays an essential role in reducing surgical complications and gender dysphoria in transgender patients. A multidisciplinary approach between dermatologists and surgeons is essential, and addressing regulatory and access barriers is critical for equitable care. [ABSTRACT FROM AUTHOR]

Background. Overall, children and adolescents diagnosed with dyslexia or ADHD show an increased risk for psychological and mental health problems, and dyslexia and ADHD tend to coexist frequently. Thus, the main objective of this study was to examine psychological and mental health problems in dyslexia. Method. Participated 95 adolescents with dyslexia (DG), comorbid dyslexia + attention-deficit hyperactivity disorder, combined subtype (D + ADHD-CG), and a comparison group with typical development (TDCG). Self-reported measures of anxiety and depression, and parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were used. Results. Self-reports of internalizing problems showed that adolescents in the GD and D + ADHD-CG groups had more depression and stated anxiety problems with a very high percentage above the clinical cut-off point than the CG. Both the parent and teacher reports showed that the DG and D + ADHD-CG groups obtained higher mean values and a higher number of adolescents above the clinical cut-off of internalizing, externalizing, and total problems than the TDCG. The comorbid D + ADHD-CG group had the highest internalizing and externalizing problems. Conclusions. In conclusion, our findings indicate that the internalizing and externalizing problems experienced by adolescents with dyslexia and comorbid ADHD should be recognized early and treated promptly by education professionals. [ABSTRACT FROM AUTHOR]

The association between autism spectrum disorder (ASD) and gender dysphoria (GD) has attracted a great deal of interest among child and adolescent psychiatrists in Japan. In clinical settings, it is common to hear complaints or concerns related to GD from adolescents with ASD. In the past few years, several review articles have been published on ASD and GD. The Initial Clinical Guidelines for co-occurring ASD and GD in adolescents were published in 2018, suggesting the increasing need of intervention for these conditions worldwide. Although a large amount of evidence has been accumulated regarding the co-occurrence of ASD and GD, all review articles were based solely on case reports and articles published in English. In this article, we performed a bilingual literature review using English- and Japanese-language literature databases. We found 13 case reports in English and 11 case reports in Japanese. The Japanese literature included articles on gender-related symptoms in ASD, but not limited to ASD with comorbid GD. Wattel and her colleagues proposed 15 theories on the link between ASD and GD. We classified the reported cases into one or more of the fifteen theories proposed by Wattel. These theories seemed useful in understanding the co-occurrence of ASD and GD, especially in AMAB cases. Wattel's 15 theories are categorized into biological, psychological, and social factors, respectively. With regard to the social factors, we discussed Japanese school culture and psychological burden among gender-dysphoric students. Further studies are awaited. [ABSTRACT FROM AUTHOR]

Summary: Gender disappointment can be defined as subjective feelings of sadness when discovering that the sex/gender of a child is the opposite of what the parent had hoped or expected. Wanting a boy (or 'son preference') has long been noted in many cultures, particularly in South and East Asian communities, but it is now becoming more recognised in the UK, Europe and North America. This article aims to improve understanding of gender disappointment by exploring medical and social sciences research; it also discusses the clinical and risk implications of assessing and managing gender disappointment (or not doing so) when individuals present to perinatal and/or community mental health services. [ABSTRACT FROM AUTHOR]

Science, health and law are three dimensions that must be related when regulating matters that may affect the life or physical integrity of the person in the legal sphere. One of the areas in which this interdisciplinarity is necessary is that of transsexuality, since gender self-determination in young people can give rise to irreversible and harmful effects on health. The new Spanish law on the subject is not only oblivious to the reports that have been published on this issue by different consultative, judicial and scientific bodies, but it has opted for an alternative where scientific concerns in relation to access to sex change and gender transition for minors over 16 years of age are ignored, regardless of the consequences this may have for the health of the person. [ABSTRACT FROM AUTHOR]

Research has increasingly focused on the intersection between gender diversity and autism. Understanding the foci, methods, and rigor of recent studies could help guide and maximize impact in this accelerating research area. We conducted a scoping review of peer-reviewed literature on this topic published between 2018 and 2023. The search generated 1432 records after deduplication. Included studies (N = 84) were of English language, featured original qualitative or quantitative findings, and examined a psychosocial connection between autism and gender spectra variables. Autism prevalence among gender-diverse people was the most-studied sub-topic. Methodological rigor was acceptable overall; however, we identified recurrent threats to generalizability and validity, including inconsistent conceptualization of constructs (e.g. gender dysphoria), weak participant sampling and characterization, and reliance on unvalidated measures. Addressing these limitations and meaningfully engaging with community shareholders will be critical to enhancing the replicability and clinical impact of future research. Research has increasingly focused on the intersection between gender diversity and autism. To better understand this literature, this scoping review systematically searched five databases for peer-reviewed literature on gender diversity and autism published between 2018 and 2023. Included studies (N = 84) were of English language, featured original qualitative or quantitative findings, and examined a psychosocial connection between autism and gender spectra variables. Most studies focused on measuring prevalence of autism among gender-diverse individuals. While the overall study rigor was acceptable, weaknesses in measurement, sample selection, and definition of key terms were noted. Promisingly, studies in this area appear to be shifting away from a pathologizing lens and towards research methods that engage in meaningful collaboration with the autistic, gender-diverse community to investigate how to best enhance the quality of life and wellbeing of this population. [ABSTRACT FROM AUTHOR]

Objective: To assess the sociodemographic, clinical, and psychiatric characteristics of individuals with gender dysphoria (GD) and the impact of these characteristics on treatment compliance. Methods: All individuals with GD who were admitted to the clinic for endocrinological treatment were asked to participate in this cross-sectional study. Individuals with GD who came for control every three months in the first year and every six months from the second year were regarded as "regularly followed," and those who did not comply were regarded as "loss to follow-up." The GD group was also paired with age-matched cisgender male and female volunteers. Data regarding the individuals' Gender-Affirming Treatment processes were obtained retrospectively from medical charts. All participants were asked to complete the Social Adaptation Self-evaluation Scale, childhood trauma questionnaire (CTQ), and Multidimensional Scale of Perceived Social Support. Results were compared between groups. Results: This study included 50 individuals with GD who were assigned female at birth (AFAB-GD), 50 individuals with GD who were assigned male at birth (AMAB-GD), 28 cis-males, and 48 cis-females. AMAB-GD had higher CTQ, emotional, and sexual abuse scores than AFAB-GD (P = .04; P = .03; P = .012; respectively). The rate of regular follow-up was higher for AFAB-GD (n = 48, 77.1%) than AMAB-GD (n = 39, 56.4%) (P = .04). Among GD individuals who missed follow-up sessions, AMAB-GD (n = 17, 64.7%) had higher suicide rates than AFAB-GD (n = 11, 9.1%) (P = .004). Conclusions: Childhood trauma, particularly in the subcategories of emotional and sexual abuse, may be some of the reasons why AMAB-GD fail to follow up and comply with treatment. [ABSTRACT FROM AUTHOR]

The article explores the argument that obesity should be recognized as a qualifying disability under the Americans with Disabilities Act (ADA) due to weight discrimination faced by millions of adults in the US. It discusses court cases that have addressed the issue, showing a divide in opinions on whether obesity should be considered a disability under the ADA, with some circuits requiring an underlying physiological cause. The text suggests that while the ADA may offer some protections, federal legislation outlawing weight discrimination nationally could be beneficial in addressing the rights of individuals of all body sizes to equal opportunities and freedom from prejudice. [Extracted from the article]

Purpose: In trans people undergoing feminizing hormone therapy, optimal estradiol concentrations are unclear, and anecdotally, some individuals desire supraphysiologic estradiol concentrations. We aimed to assess associations between estradiol concentration and psychological distress, well-being, and dysphoria. Second, we aimed to explore relationships between estradiol concentration and the risk of medical conditions potentially associated with estradiol therapy. Methods: This exploratory online cross-sectional study was conducted between June 2020 and March 2021, using a nonprobability snowball sampling method. Inclusion criteria included the following: (1) Currently living in Australia, (2) identification as transgender and using estradiol for gender affirmation purposes, and (3) 16 years of age or older. Estradiol concentrations were correlated with the Kessler Psychological Distress Scale (K10), the Personal Wellbeing Index (PWI-A), and gender dysphoria as measured by the Gender Congruence and Life Satisfaction Scale. Results: There were 172 participants, and the median estradiol concentration was 420 pmol/L (interquartile range 269–614). No clinically significant association was found between estradiol concentration with psychological distress, wellbeing, or gender dysphoria. While there was a statistically significant lower K10 score and higher PWI-A General Life Satisfaction score with higher estradiol concentrations, the order of magnitude was small and not clinically significant. There was no association between estradiol concentration and thrombosis, malignancy, stroke, myocardial infarction, migraine, or hypertension. Conclusions: Given no clear association between higher estradiol concentrations, psychological distress, wellbeing, or dysphoria, approaches to estradiol hormone therapy should be individualized. Further prospective research, with larger sample sizes, is required to more thoroughly investigate optimal feminizing hormone therapy regimens. [ABSTRACT FROM AUTHOR]