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The current study investigated the components of gender identity development using a neo-Eriksonian process model. We aimed to derive and validate the distinct combinations of commitment, in-depth exploration, and reconsideration of commitment that characterise different states of self-understanding (identity statuses) experienced by transgender individuals in relation to their gender. To do so, we used two-stage clustering to categorise 354 transmasculine respondents on the Utrecht-Management of Identity Commitments Scale, expecting to produce statuses consistent with the theoretical solution of Crocetti and colleagues (2008). Partially supporting the hypotheses, we found that a four-cluster solution comprising Achievement, Closure, Moratorium, and Diffusion optimally captured transgender identity development, consistent with findings in lesbian and gay identity development by Kranz and Pierrard (2018). The current statuses related differentially to identity functions and elements of positive transgender identity which further supports their validity. These findings suggest that the experience of gender identity development for transgender people can be partitioned into meaningful statuses characterised by unique features. [ABSTRACT FROM AUTHOR]

Background: We assessed access to pre-exposure prophylaxis (PrEP) and interest in integration of PrEP with gender-affirmative care in a global sample of transmasculine persons. Methods: Transmasculine persons (N = 590) aged 18 years and above from 57 countries completed a brief online survey from April to July 2022 about sexual behavior, knowledge, and interest in PrEP, current access to PrEP and gender-affirmative care, and preferred context for accessing PrEP. Descriptive analyses were stratified by country income group. Results: Most participants (54.4%) lived near a health center offering care to trans people. Overall, 1.9% of respondents reported ever receiving a positive HIV test result. Among those who had not (n = 579), more than a third reported engaging in receptive sex in the past year (35.2%) or anticipated doing so in the next year (41.5%), 86.9% had never received information about HIV prevention specific to transmasculine people, and 76.3% had heard of PrEP. Among those who had heard of PrEP (n = 440), only 18.9% had discussed or been offered it by a provider, and only 3.6% were currently taking it—yet 67.9% who had heard of it but were not using it would "definitely" (28.5%) or "maybe" (39.4%) be interested in taking it were it available for free. Out of these participants, the majority (60.5%) preferred the idea of accessing PrEP from the same clinic where they received gender-affirming care. Conclusions: Interventions are needed to improve PrEP access for transmasculine people globally. Clinics already providing gender-affirming care to trans people are acceptable clinical contexts to integrate such interventions. [ABSTRACT FROM AUTHOR]

ObjectivesMethodResultsConclusion\nKey PointsChest binding is a common gender-affirming practice that transmasculine individuals can engage in for a range of reasons, including masculinising their physical appearance, which can facilitate gender euphoria, or alleviate gender dysphoria. In this study, we explored chest-binding experiences with a focus on knowledge attainment, understandings of safety and accessibility factors for those interested in binding.The study involved 15 semi-structured qualitative interviews with transmasculine people in Australia (aged 20–37 years) who have past or current chest binding experiences. These were analysed using thematic analysis.Data analysis resulted in the generation of four themes: 1) Online and social communities influence understandings of binding practices; (2) Learning about safety in binding is often self-directed; (3) Difficulties of navigating the application of safe binding within daily life, and (4) Common accessibility barriers to binding can be mitigated by trans communities.The evidence in this study showed that chest-binding knowledge is acquired in diverse ways, and knowledge around safety and accessibility is not always readily available or easy to locate. However, participants unequivocally expressed that the practices are a crucial form of affirming care. Future research should continue to focus on creating strong, evidence-based affirming healthcare models for transmasculine Australians.What is already known about this topic: Chest binding is a range of non-medical gender-affirming practices for transmasculine individuals.These practices have a range of risks and benefits that binders can navigate to help reduce gender dysphoria and induce gender euphoria.Little is known about knowledge attainment and accessibility factors for those interested in binding.Chest binding is a range of non-medical gender-affirming practices for transmasculine individuals.These practices have a range of risks and benefits that binders can navigate to help reduce gender dysphoria and induce gender euphoria.Little is known about knowledge attainment and accessibility factors for those interested in binding.What this topic adds: Knowledge of how to access and safely wear binders can be hard to attain, and this knowledge often stems from wearer trial-and-error – engagement in safe binding practices was difficult to implement in many respects.The internet and online sources were important sources of knowledge, and trans social circles were key disseminators of chest binding information across all stages of transmasculine people’s binding journeys.Participants avoided healthcare providers as a source of guidance with binding practices – driven by a perceived lack of medical provider knowledge on chest binding.Knowledge of how to access and safely wear binders can be hard to attain, and this knowledge often stems from wearer trial-and-error – engagement in safe binding practices was difficult to implement in many respects.The internet and online sources were important sources of knowledge, and trans social circles were key disseminators of chest binding information across all stages of transmasculine people’s binding journeys.Participants avoided healthcare providers as a source of guidance with binding practices – driven by a perceived lack of medical provider knowledge on chest binding. [ABSTRACT FROM AUTHOR]

The epistemological formations of area studies and critical regionality have been instrumental in situating the politics of gender-sexual variance in the Global South. Recent scholarship in India encourages further rescaling of queer and trans studies to account for the mutual entanglements of sexual and caste modernity, rights-based organizing, and metronormativity. Following this work, this article considers the possibilities offered by emphasizing the micro-locality of the urban neighborhood. A reading of two Delhi-based documentary films, Who Can Speak of Men? (2003) and Yeh Freedom Life (2019), the article troubles the idea of a unitary global and national trans subject. Conceptualizing the urban neighborhood as method and mode of reading transmasculinity compels a rethinking of the dichotomous framings of metropolitan queer as elite and transgender as abject. This article provides a trans microcartography wherein the world- and place-making work of transmasculine people enables a reimagining of masculinity in the neoliberalizing Indian "world-class city". [ABSTRACT FROM AUTHOR]

Introduction: Gynecological primary care is a public health issue, however, there is no French data on the transmasculine population, despite identified needs and a low coverage rate described in the international literature. The objective was to analyze the access of the French transmasculine population to gynecological primary care. Methods: The study "Trans men and Transmasculine non-binary individuals use and access to prevention and sexual health care 2022" is a non-interventional, self-administrated, anonymous online study targeting transmasculine adults living in France. Participants were recruited via social networks, LGBTQIA + associations, the FPATH and a caregivers network Results: A total of 622 surveys were included, the participants were mostly young (mean age: 25 years old), single (77%), students (40%), owners or tenants (73%) and living in large cities (47%). Among them, 77% had a cross-sex hormonal therapy, 41% underwent a torsoplasty and 6% a pelvic surgery. Only 26% of the participants had an up-to-date follow-up, while 40% never had access to a gynecological consultation. Only a quarter (26%) of the 25–65 years old population, targeted by secondary prevention for cervical cancer, had at least one cervical test in their lifetime. Moreover, regarding feedbacks about gynecological follow-up, they expressed its pertinence but also reported a low comfort level. Conclusions: This study highlighted the low access to gynecological primary care of a young transmasculine population in France. There is an urgent need of follow-up within this population, by increasing the education of health professionals and developing prevention programs. [ABSTRACT FROM AUTHOR]

Purpose: Genital gender-affirming surgery in transmasculine patients encompasses both metoidioplasty and phalloplasty. Some patients opt to undergo staged phalloplasty by metoidioplasty first (SPMF). The aim of this study was to evaluate whether SPMF is associated with less surgical complications compared with immediate phalloplasty (IP). Methods: Our institutional database was retrospectively evaluated to identify transmasculine patients who underwent SPMF between 2006 and 2020. These patients were matched based on the type of flap (radial forearm free flap vs. anterolateral thigh flap) and for the time period in regard to patients who underwent IP. Both groups were compared on patient characteristics, perioperative and postoperative outcomes. Results: Twenty-seven patients with SPMF were matched with 27 IP patients. Median follow-up after phalloplasty was held, respectively, 32 and 33 months after the intervention for SPMF and IP (p=0.99). There were no significant differences in age, body mass index, and smoking habits between both groups. For SPMF, metoidioplasty required subsequent corrective surgery before phalloplasty in three patients (11%). For SPMF and IP, median operation time was 396 and 410 min (p=0.6), median hospital stay was 16 and 17 days (p=0.5), and median catheter stay was 19 and 20 days (p=0.9). In both groups, 16 patients (59%) needed at least one additional surgical procedure for postoperative complications, urethral complications (stricture, fistula), and/or flap-related complications. Conclusion: In our cohort, complications were not reduced by SPMF. In case metoidioplasty is considered as a step toward phalloplasty, separate morbidity of metoidioplasty must be taken into account. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women. METHODS: Data were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbachs alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS: A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q from Grilo et al. (Obes Surg. 23:657-662, 2013), consistently evidenced the best fit across cisgender gay men and lesbian women. The internal consistencies of the three subscales were adequate in both groups, and measurement invariance across the groups was supported. CONCLUSIONS: Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in cisgender gay men and lesbian women. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse sexual minority samples across race, ethnicity, socioeconomic status, and age ranges.

OBJECTIVE: The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults. METHODS: Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbachs alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS: A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported. DISCUSSION: Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges. PUBLIC SIGNIFICANCE STATEMENT: Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.

A retrospective review of gender-affirming hormone therapy was conducted in 101 transgender boys followed in the pediatric endocrine clinic. Eighty-seven percent were postmenarchal at the initial visit. Of the 44% prescribed gonadotropin-releasing hormone analogs (GnRHas), insurance coverage was denied in 34% and an average of 4.5 months elapsed before treatment could be started in the remainder. Patients prescribed GnRHas were younger than those who were not, 13.7±2.1 versus 15.5±2.0 years, p<0.001. Continued menstrual bleeding was reported by patients receiving testosterone alone at doses ranging from 50 to 200 mg every 2 weeks. [ABSTRACT FROM AUTHOR]

This article discusses the research gap in understanding the effects and risks of testosterone therapy in transmasculine individuals. Historically, research on transgender and gender diverse individuals has been limited, and most studies have focused on safety and mortality outcomes rather than the specific effects desired by patients. The article highlights the need for more research on testosterone doses, serum concentrations, and formulations to achieve desired outcomes such as voice deepening, body hair growth, and fat redistribution. It also emphasizes the importance of considering individual goals and preferences in hormone prescribing and the need for longitudinal studies to understand the long-term implications of testosterone therapy. [Extracted from the article]

Context Treatment for transmasculine youth (TMY) can involve testosterone treatment and is sometimes preceded by gonadotropin-releasing hormone agonist (GnRHa) treatment for puberty blockade. GnRHas can increase final height in birth-assigned females with central precocious puberty. Maximizing final adult height (FAH) is an important outcome for many TMY. Objective Our objective was to determine how GnRHa treatment before testosterone impacts FAH. Methods Retrospective cohort study at 5 US transgender health clinics. Participants were 32 TMY treated with GnRHas in early to midpuberty before testosterone (GnRHa + T group) and 62 late/postpubertal TMY treated with testosterone only (T-only group). Results The difference between FAH minus midparental target height (MPTH) was +2.3 ± 5.7 cm and −2.2 ± 5.6 cm in the GnRHa + T and T-only groups, respectively (P <.01). In the GnRHa + T group, FAH was 1.8 ± 3.4 cm greater than predicted adult height (PAH) (P <.05) and FAH vs initial height (IH) z-score was 0.5 ± 1.2 vs 0.16 ± 1.0 (P <.05). After adjusting for patient characteristics, each additional month of GnRHa monotherapy increased FAH by 0.59 cm (95% CI 0.31, 0.9 cm), stage 3 breast development at start of GnRHa was associated with 6.5 cm lower FAH compared with stage 2 (95% CI −10.43, −2.55), and FAH was 7.95 cm greater in the GnRHa + T group than in T-only group (95% CI −10.85, −5.06). Conclusion Treatment with GnRHa in TMY in early puberty before testosterone increases FAH compared with MPTH, PAH, IH, and TMY who only received testosterone in late/postpuberty. TMY considering GnRHas should be counseled that GnRHas may mildly increase their FAH if started early. [ABSTRACT FROM AUTHOR]

Topics surrounding transmasculinity, especially in Indonesia, are still overlooked, degraded, and understudied. This paper aims to explore the experience of priawan in Indonesia. Differentiating from the globally-renowned term ‘trans men’, a priawan identifies as a female-to-male transmasculine individual. We conducted in-depth interviews with eleven qualified informants. These interviews shed light on gender dysphoria or fluidity, gender-affirming processes, and discriminations they have faced, with hopes of proving and validating their existence. Eight of the informants express themselves as masculine and identify as lesbians. The most common gender-affirming process that they chose is name updating, followed by chest binding and hormone therapy. Five out of eleven reported having faced discrimination in various forms, such as verbal abuse, misgendering, stereotyping, and physical abuse. This study adds a new perspective on regional variability in transmasculine identities. Further research on chosen family dynamics and generational differences are encouraged to accentuate the visibility of transgender individuals in existing queer studies.

Introduction: Bacterial vaginosis (BV) is associated with non-optimal changes in the vaginal microbiome and increased susceptibility to STIs and HIV in cisgender women. Much less is known about the sexual health of transmasculine people and susceptibility to BV, STIs, and HIV. This study's objective was to assess BV testing and outcomes of transmasculine and cisgender women patient populations at a large, LGBTQ + federally qualified health center. Methods: Retrospective electronic health record data were extracted for eligible patients having at least one primary care visit between January 1, 2021, and December 31, 2021. Transmasculine patients were limited to those with a testosterone prescription in 2021. We conducted log binomial regression analysis to determine the probability of receiving a BV test based on gender identity, adjusting for sociodemographic characteristics. Results: During 2021, 4,903 cisgender women patients and 1,867 transmasculine patients had at least one primary care visit. Compared to cisgender women, transmasculine patients were disproportionately young, White, queer, privately insured, living outside Chicago, and had a lower rate of BV testing (1.9% v. 17.3%, p < 0.001). Controlling for sociodemographics, transmasculine patients were less likely to receive a BV test [Prevalence Ratio = 0.19 (95% CI 0.13-0.27)]. Discussion: The low rate of BV testing among transmasculine patients may contribute to disparities in reproductive health outcomes. Prospective community- and provider-engaged research is needed to better understand the multifactorial determinants for sexual healthcare and gender-affirming care for transmasculine patients. In particular, the impact of exogenous testosterone on the vaginal microbiome should also be determined. [ABSTRACT FROM AUTHOR]

Introduction: Stereotypes around sex and gender have played an important role in shaping experiences of discrimination and social injustice for trans individuals. In addition, trans identities have been historically associated with sexual deviance and pathology in the psychomedical literature. In the present study, we investigated stereotypes associated with trans people's sexuality. Methods: We recruited 297 transmasculine and nonbinary individuals for an online study. In an open-ended question, participants were asked to describe stereotypes they have encountered regarding the sex lives of trans people they felt were inaccurate. Results: Thematic analysis revealed four overarching themes: (1) deviance; (2) discomfort with trans sexuality as stigmatizing; (3) stereotypes based on gender; and (4) absence of stereotyping. Conclusion: Results highlight the ways trans sexuality is exoticized. Findings also underscore that sexual stereotyping of trans individuals is, at times, based on assigned sex and, at other times, based on gender identity. Policy Implications: Stereotypes, particularly those related to sexuality, may seem harmless, but they can have far-reaching consequences on interpersonal relationships and societal systems. Challenging stereotypes in policies and social environments is crucial for promoting inclusivity and community welfare. [ABSTRACT FROM AUTHOR]

The early months of the SARS-CoV2 pandemic exacerbated health disparities for vulnerable populations, including transgender (trans) communities, creating unique challenges for navigating sex and dating. This paper aims to expand upon the current literature regarding transmasculine populations by capturing their lived experiences during this critical time. We interviewed 20 assigned female sex at birth (AFAB) adults of the transmasculine spectrum - men, nonbinary, and transmasculine individuals - about their social and sexual experiences in the USA in May and June 2020. Transcripts were analysed using an inductive thematic approach. We found that sex drive decreased and uncertainty about health risks increased. Some participants found alternate ways to date and hook-up that reduced their COVID-19 risk, such as engaging in online sex (e.g. sexting, dating apps). Others expressed discomfort using virtual platforms for both personal/work and sexual lives, along with nuanced feelings around being objectified, compared to pornography, and fetishised as trans bodies. COVID-related shutdowns of queer spaces also amplified pre-existing concerns about interpersonal safety and rejection. When seeking new partners, participants sought behavioural characteristics that instilled trust. Future public health communications can take advantage of safety and sexual health strategies already present in trans communities to bolster wellbeing in trans lives. [ABSTRACT FROM AUTHOR]

There is limited literature about breast cancer in the transgender population. Very little is known about how gender-affirming hormone therapy affects their breast cancer risk. On the other end, for those diagnosed with breast cancer, there are no clinical guidelines to manage their breast cancer, specifically, how to manage their gender-affirming hormone therapy during breast cancer treatment. Here, we report a 52-year-old transman diagnosed with a grade 2 invasive ductal carcinoma (ER+/PR+/HER2−), and ductal carcinoma in situ (DCIS) of intermediate grade. We discussed his risk factors as well as treatment options.

Abstract Background Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women. Methods Data were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach’s alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. Results A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q from Grilo et al. (Obes Surg. 23:657–662, 2013), consistently evidenced the best fit across cisgender gay men and lesbian women. The internal consistencies of the three subscales were adequate in both groups, and measurement invariance across the groups was supported. Conclusions Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in cisgender gay men and lesbian women. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse sexual minority samples across race, ethnicity, socioeconomic status, and age ranges.

Background: Pelvic pain has been reported in transmasculine individuals taking testosterone. There is a need for further investigation to increase understanding of the prevalence and risk factors of this pain. Aim: We sought to determine the prevalence of pelvic pain reported by transmasculine individuals who had both a uterus and ovaries and were taking testosterone. Methods: We conducted an institutional review board–approved retrospective study of all transmasculine individuals who had been taking testosterone for at least 1 year and had a uterus and ovaries at the time of testosterone initiation. Charts of participating patients were reviewed to determine patient characteristics, testosterone use, and pelvic pain symptoms both before and after initiation of testosterone. Outcomes: Patients reported experiences of pelvic pain while on testosterone. Results: Of 280 individuals who had been on testosterone for at least 1 year, 100 (36%) experienced pelvic pain while on testosterone. Of those patients, 71% (n = 71) had not experienced pelvic pain prior to starting testosterone. There were 42 patients (15%) who had pelvic pain prior to starting testosterone, 13 (31%) of whom no longer experienced pain once starting testosterone. The median (IQR) age at initiation of testosterone was 22 (19-41) years and duration of testosterone treatment was 48 (27-251) months. Those patients who experienced pelvic pain while on testosterone were significantly more likely to have also reported pelvic pain prior to starting testosterone (29% vs 7%, P < .001). These patients were also more likely to have a pre-existing diagnosis of dysmenorrhea (27% vs 7%, P < .001), endometriosis (6% vs 2%, P = .049), or ovarian cysts and/or masses (12% vs 2% P < .001). Patients with pelvic pain were also more likely to have been on a menstrual suppression agent prior to and overlapping testosterone initiation (22% vs 12%, P = .03) and to have used menstrual suppression for longer durations (median [IQR] 18 [6-44] vs 8 [4-15] months, P = .04). Clinical Implications: Pelvic pain is common in transmasculine individuals who are initiating testosterone treatment, although testosterone has both positive and negative effects on pelvic pain in different individuals. Strengths and Limitations: The major strengths of this study included large numbers of patients, ability to assess for documentation of pelvic pain prior to testosterone, and ability to determine an actual prevalence of pelvic pain. Major limitations included the study being a retrospective analysis in a single tertiary care center, the limitations of clinical documentation, and the lack of a standard pelvic pain evaluation process. Conclusion: More than one-third of transmasculine patients with a uterus and ovaries had pelvic pain while on testosterone, with the majority reporting onset of pain after initiating testosterone. [ABSTRACT FROM AUTHOR]

Online patient education materials (PEMs) often exceed the recommended 6th grade reading level. This can negatively affect transmasculine patients' understanding of treatment plans, increasing barriers to care and worsening health outcomes and patient satisfaction. This study assessed the readability of online English and Spanish PEMs regarding phalloplasty and urethroplasty. The English and Spanish terms for phalloplasty and urethroplasty were queried on Google. The first fifty results were grouped into institutional (government, medical school, teaching hospital), noninstitutional (private practice, news channel, blog, etc.), and academic (journal articles, book chapters) categories. Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales. All PEMs exceeded recommended reading levels. For both procedures, English PEMs had an average reading level approximately of a university sophomore and Spanish PEMs had an average reading level approximately of a high school junior. For both procedures, English PEMs were harder to read than Spanish PEMs overall (P < 0.001) and when compared across the three categories between the two languages (P < 0.001). For Spanish urethroplasty PEMs, noninstitutional PEMs were more difficult to read than institutional PEMs (P < 0.05). Online information for phalloplasty and urethroplasty should be revised and/or standardized materials should be created by trans-affirming health-care providers and national organizations in order to more fully educate the public and prospective patients prior to intervention. A well-informed patient population will improve patient decision-making and surgeon-patient communication, ultimately leading to better health outcomes. [ABSTRACT FROM AUTHOR]

Transgender and nonbinary people with female birth sex may utilize testosterone therapy for masculinization. Individuals interested in reproduction using their own gametes should be offered fertility preservation prior to starting testosterone. However, logistical and practical barriers prevent many from accessing fertility preservation options prior to starting testosterone. Some of these transmasculine and nonbinary individuals may later become interested in carrying a pregnancy or using their oocytes for reproduction after being on testosterone. Many questions remain about the reproductive impact of long-term masculinizing testosterone therapy. Emerging literature has documented pregnancies and successful assisted reproduction for some people after taking testosterone, but it is not known whether individuals can expect these successful outcomes. Testosterone appears to impact the reproductive tract, including the ovaries, uterus, and fallopian tubes, but the reversibility and functional impact of these changes also remain unclear. A greater understanding of the impact of masculinizing testosterone on reproductive capacity remains a priority area for future research. [ABSTRACT FROM AUTHOR]

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]

In this article, I draw from in-depth interviews with 34 transmasculine and nonbinary escorts who were assigned female at birth (AFAB) to explore the complicated relationship between gender, race, sexuality, embodiment, and workplace inequalities in what I have called cisgendered workplaces. Cissexism, transmisogyny, and racism are embedded in workspaces, brothels, agencies, and the websites escorts use for advertising, and clients operate based on cisgender principles. These analyses demonstrate how cisgender privilege operates in and buttresses cisgendered workplaces, in ways that disadvantage trans and nonbinary people. I show how shifting trans embodiments and spaces of transition in workplaces adversely affect transmasculine and nonbinary escorts' wages and workplace experiences, but also disrupt cisgendered workplaces and challenge cisgender hegemony. Adopting the analytical frame of spaces of transition reveals critical insights into the role that embodiment (not just identity) plays in workplace inequalities. [ABSTRACT FROM AUTHOR]

Transmasculine individuals, considering whether to undergo total hysterectomy with bilateral salpingectomy, have the option to have a concomitant oophorectomy. While studies have evaluated hormone changes following testosterone therapy initiation, most of those patients have not undergone oophorectomy. Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries. We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver, British Columbia, Canada. Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included. We identified 12 transmasculine subjects as controls, who were on testosterone therapy and did not undergo oophorectomy, but additionally matched to the first group by age, testosterone dosing regimen, and body mass index. There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy, when compared to presurgical estradiol levels (P = 0.02). There was no significant difference between baseline estradiol levels between control and case subjects; however, the difference in estradiol levels at follow-up measurements was significant (P = 0.03). Total testosterone levels did not differ between control and case subjects at baseline and follow-up (both P > 0.05). Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone. Correlated clinical outcomes, such as impacts on bone health, were not available. The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.

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]

Background: Black transmasculine people are disproportionately affected by a myriad of intersecting stressors including racism (specifically anti-Black racism), sexism, and cissexism. Black transmasculine people are exposed daily to systemic oppression such as transphobia, dehumanization, and violence, making this community more vulnerable to mental health and physical health concerns. These experiences are further compounded by the lack of relevant research about the unique experiences of Black transmasculine people during the COVID-19 pandemic. Aims: Utilizing a critical intersectionality lens and Prilleltensky's psychopolitical validity as guiding frameworks, the present study investigates the need for support and community for Black transmasculine people when navigating anti-Black racism and transphobia during the COVID-19 pandemic. Methods: The researchers integrated intersectionality and Prilleltensky's psychopolitical validity as frameworks paired with the constructivist grounded theory paradigm outlined by Charmaz to analyze data. The researchers co-constructed meaning from participants' (N = 32) perspectives to provide a theoretical understanding of how Black transmasculine participants' perceived community and support during COVID-19 pandemic. Results: The researchers developed a model of pathways toward community and support. The model suggests two levels: (a) locating awareness of community and support, and (b) integrated action toward community and support. The approaches are integrated from within group actions that can be facilitated from outside the community on micro and macro sociological levels to provide holistic support and community for Black transmasculine people. Discussion: This model extends the current literature on liberation and community psychology regarding the different levels of support for Black transmasculine people. This intervention can provide awareness and insight about working alongside the Black transmasculine community to address their unique needs of support and community. These findings hope to enhance clinical practices and identify strategies to promote wellness among Black transmasculine people. [ABSTRACT FROM AUTHOR]

Aims: The benefits of gender affirmation surgery have long been established, and with improved access to care, these operations are being performed with increased frequency. As these surgeries continue to be performed, the surgical techniques continue to evolve. Phalloplasty, or the creation of a phallus, remains one of the most complex surgical endeavors in which a variety of factors influence surgical decision making. This article aims to present the lesser known and less frequently performed means of phalloplasty in gender affirming genitourinary reconstruction. Methods: A literature review of relevant articles, whether case series or more comprehensive, was performed to describe some of the more obscure and less frequently utilized flaps for phalloplasty. Results: The most performed or widely accepted technique is that of the radial forearm free flap, but numerous other options decorate the surgical landscape. With limited and unreliable outcomes data, a standard of care is difficult to establish. Conclusions: Ultimately, phalloplasty reconstruction should aim to achieve standing micturition and penetrative intercourse, resolute tactile and erogenous sensation, desirable aesthetics of the phallus, and acceptable donor site morbidity. Although some procedures are more commonly performed, the standard for phalloplasty has not been established. Ultimately, approaching this reconstructive puzzle with persistent creativity will unearth more reliable options in the future. [ABSTRACT FROM AUTHOR]

Aims: The history of phallus construction parallels the advances made in plastic and reconstructive surgery whereby the era of microsurgery revolutionized numerous techniques. In 1993, we reported our early experience in phalloplasty. While the originally presented technique was a modification of the original design reported by Chang and Hwang, we now present further modifications of the past 30 years. Methods: Through critical review of our technical modifications, as well as others', we present a comprehensive review of elements of the radial forearm free flap phallus construction. Results: A radial forearm free flap is harvested and tubed to form the following components: urethra, shaft, and glans of the neophallus. When excess adipose tissue exists, the excess thickness is accommodated by increasing the proximal width of the flap. To optimize the venous drainage, the radial and ulnar superficial veins as well as the radial deep veins are included within the flap; however, venous flow is optimized through creation of an arteriovenous fistula within neo‐glans. To lengthen the native urethra, labia minora and vaginal mucosal flaps are employed at a preliminary stage during vaginectomy. New coronoplasty modifications offer esthetic refinements. Updates in scrotal reconstruction and implantation of erectile devices complete the total genitourinary reconstruction. Conclusions: Phallus construction has evolved significantly over time. While numerous techniques exist, no standard of care has been identified. Continue surgical evolution will provide modern solutions for problems most often encountered to improve overall outcomes for transgender and gender‐diverse patients pursuing masculinizing genitourinary reconstruction. [ABSTRACT FROM AUTHOR]

Aims: Transmasculine genital reconstructive surgery involves the creation of a neourethra by way of metoidioplasty or phalloplasty. We aim to describe approaches in identifying complications associated with these procedures as well as the various reparative techniques that can be utilized to reestablish the neourethral tract. Methods: We prepared a guide to diagnostic and procedural interventions for urologic complications following transmasculine genital reconstructive surgery based on our clinical experience as well as those of our colleagues. We reviewed all current peer‐reviewed publications based on this topic. Results: These procedures have a considerable revision rate for urologic complications, which include urethrocutaneous fistulae, persistent vaginal remnant, and urethral strictures. These complications often present simultaneously and require appropriate workup and treatment. Conclusions: Several reconstructive techniques can be employed to restore the neourethral tract, as we describe in detail. [ABSTRACT FROM AUTHOR]

Purpose of Review : Summarize the effects gender-affirming hormone therapy (GAHT) and gender-affirming surgical therapy (GAST) have on fertility of the transgender and gender diverse (TGD) patient as well as current clinical approaches in fertility preservation for transgender individuals. Recent Findings: There are relatively limited data specific to fertility preservation for TGD individuals and current approaches to treatment are extrapolated from options for fertility preservation in cisgender individuals. Contemporary updates in this review include evolving research defining the reproductive potential of gametes that are exposed to pubertal suspension and GAHT in sequence, the persistent challenges of previously experimental ovarian tissue cryopreservation for TGD patients, and additional evidence that fertility can be largely conserved in TGD patients after testosterone use. Ultimately, several forms of fertility preservation options are available depending on the pubertal status of a transgender individual. Summary: Fertility treatment and preservation options should be discussed with transgender individuals regardless of stage of transition, but ideally before gender-affirming hormonal treatment or gonadectomy. Relatively few transgender individuals are seen for fertility care due to lack of provider awareness and patient perception of bias. [ABSTRACT FROM AUTHOR]

Transmasculine individuals, considering whether to undergo total hysterectomy with bilateral salpingectomy, have the option to have a concomitant oophorectomy. While studies have evaluated hormone changes following testosterone therapy initiation, most of those patients have not undergone oophorectomy. Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries. We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver, British Columbia, Canada. Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included. We identified 12 transmasculine subjects as controls, who were on testosterone therapy and did not undergo oophorectomy, but additionally matched to the first group by age, testosterone dosing regimen, and body mass index. There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy, when compared to presurgical estradiol levels (P = 0.02). There was no significant difference between baseline estradiol levels between control and case subjects; however, the difference in estradiol levels at follow-up measurements was significant (P = 0.03). Total testosterone levels did not differ between control and case subjects at baseline and follow-up (both P > 0.05). Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone. Correlated clinical outcomes, such as impacts on bone health, were not available. The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited. [ABSTRACT FROM AUTHOR]

To describe time to cessation of menses in adolescent and young adult transgender males with testosterone and/or other hormonal therapies Retrospective chart review Tertiary children's hospital Patients, aged 10-24, who began gender-affirming hormonal therapy between January 2013 and January 2019 (n = 220) None Time to cessation of menses Most patients identified as transgender male or transmasculine (211/220, 95.9%), with an average age of 15.8 (±1.9) years. Approximately 53.6% (118/220) of patients reported regular menstrual cycles; 18.2% (40/220) reported irregular cycles. Median time to cessation of menses for all patients was 182 days. Patients treated with testosterone alone (n = 105) reported a median time to cessation of menses of 151 days. Patients who concurrently began testosterone and norethindrone acetate (NETA) (n = 5) had a median time to cessation of menses of 188 days, compared with 168 days for those on testosterone and depot medroxyprogesterone acetate (DMPA, n = 15). In 15 patients who began testosterone, a progestin therapy was later added to induce menstrual suppression, and the median time to cessation of menses was 168 days (+DMPA, n = 4) or 56 days (+NETA, n = 11). Patients treated with NETA (n = 14) or depot leuprolide (n = 11) reported a median time to cessation of menses of 78 days or 77 days, respectively. Considerable variability in prescribing patterns was noted in the remaining 36.4% of patients (n = 80). Patients used a variety of different hormonal regimens for menstrual suppression. Less than half achieved cessation of menses within 6 months. NETA and depot leuprolide users reported the most rapid cessation of menses. [ABSTRACT FROM AUTHOR]

Gender-affirming hormone therapy (GAHT) is integral to the management of gender-incongruent (GI) individuals. GAHT greatly improves the quality of life for GI individuals. Current research about outcomes of GAHT and adverse events in adults receiving GAHT is limited in India and large cohort studies are absent. This document on medical management provides protocols for the prescribing clinician relating to counseling for GAHT, baseline evaluation, choice of therapy, targets for hormone therapy, clinical and biochemical monitoring, and perioperative hormone therapy.

Approximately 50% of transmasculine people use testosterone for gender affirmation, yet very little is known about the effects of testosterone on future reproductive capacity. Moreover, there are no data to guide fertility specialists on how to manage testosterone leading up to or during ovarian stimulation. Most clinics require cessation of testosterone prior to ovarian stimulation in this setting of no data; however, the current literature does suggest a potential increase in dysphoria with cessation of testosterone and during stimulation. This divergence begs the question of whether clinicians may be doing more harm than good by enacting this requirement. Here, we present two cases of transmasculine individuals who were on testosterone prior to stimulation and maintained their testosterone dosage throughout stimulation as proof of concept, followed by a discussion of current clinical practice and providing some rationale to support continuation of testosterone throughout stimulation. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Can mice serve as a translational model to examine the reproductive consequences of pubertal suppression with GnRH agonist (GnRHa) followed by testosterone (T) administration, a typical therapy in peripubertal transmasculine youth? SUMMARY ANSWER An implanted depot with 3.6 mg of GnRHa followed by T enanthate at 0.45 mg weekly can be used in peripubertal female mice for investigating the impact of gender-affirming hormone therapy in transmasculine youth. WHAT IS KNOWN ALREADY There is limited knowledge available in transgender medicine to provide evidence-based fertility care, with the current guidelines being based on the assumption of fertility loss. We recently successfully developed a mouse model to investigate the reproductive consequences of T therapy given to transgender men. On the other hand, to our knowledge, there is no mouse model to assess the reproductive outcomes in peripubertal transmasculine youth. STUDY DESIGN, SIZE, DURATION A total of 80 C57BL/6N female mice were used in this study, with n = 7 mice in each experimental group. PARTICIPANTS/MATERIALS, SETTING, METHODS We first assessed the effectiveness of GnRHa in arresting pubertal development in the female mice. In this experiment, 26-day-old female mice were subcutaneously implanted with a GnRHa (3.6 mg) depot. Controls underwent a sham surgery. Animals were euthanized at 3, 9, 21 and 28 days after the day of surgery. In the second experiment, we induced a transmasculine youth mouse model. C57BL/6N female mice were subcutaneously implanted with a 3.6 mg GnRHa depot on postnatal day 26 for 21 days and this was followed by weekly injections of 0.45 mg T enanthate for 6 weeks. The control for the GnRH treatment was sham surgery and the control for T treatment was sesame oil vehicle injections. Animals were sacrificed 0.5 weeks after the last injection. The data collected included the day of the vaginal opening and first estrus, daily vaginal cytology, weekly and terminal reproductive hormones levels, body/organ weights, ovarian follicular distribution and corpora lutea (CL) counts. MAIN RESULTS AND THE ROLE OF CHANCE GnRHa implanted animals remained in persistent diestrus and had reduced levels of FSH (P  = 0.0013), LH (P  = 0.0082) and estradiol (P  = 0.0155), decreased uterine (P  < 0.0001) and ovarian weights (P  = 0.0002), and a lack of CL at 21 days after GnRHa implantation. T-only and GnRHa+T-treated animals were acyclic throughout the treatment period, had sustained elevated levels of T, suppressed LH levels (P  < 0.0001), and an absence of CL compared to controls (P  < 0.0001). Paired ovarian weights were reduced in the T-only and GnRHa+T groups compared with the control and GnRHa-only groups. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Although it is an appropriate tool to provide relevant findings, precaution is needed to extrapolate mouse model results to mirror human reproductive physiology. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this study describes the first mouse model mimicking gender-affirming hormone therapy in peripubertal transmasculine youth. This model provides a tool for researchers studying the effects of GnRHa-T therapy on other aspects of reproduction, other organ systems and transgenerational effects. The model is supported by GnRHa suppressing puberty and maintaining acyclicity during T treatment, lower LH levels and absence of CL. The results also suggest GnRHa+T therapy in peripubertal female mice does not affect ovarian reserve, since the number of primordial follicles was not affected by treatment. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Michigan Institute for Clinical and Health Research grants KL2 TR 002241 and UL1 TR 002240 (C.D.C.); National Institutes of Health grants F30-HD100163 and T32-HD079342 (H.M.K.); University of Michigan Office of Research funding U058227 (A.S.); American Society for Reproductive Medicine/Society for Reproductive Endocrinology and Infertility grant (M.B.M.); and National Institutes of Health R01-HD098233 (M.B.M.). The University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core Facility was supported by the Eunice Kennedy Shriver NICHD/NIH grants P50-HD028934 and R24-HD102061. The authors declare that they have no competing interests. [ABSTRACT FROM AUTHOR]