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The vaginal microbiome of trans men and menopausal women is suspected to be similar due to a lack of estrogen leading to the absence of lactobacilli. However, data are scarce. We performed an analysis of the vaginal microbiome of trans men (n = 25) in comparison to that of menopausal (n = 25) and premenopausal women (n = 25). The vaginal microbiome of trans men and menopausal women showed a higher alpha diversity than that of premenopausal women. Various beta diversity indices (e.g., Bray‒Curtis (Un-)Weigthed Unifrac), showed significant differences in community composition between trans men and premenopausal (p < 0.001) and menopausal women (p < 0.001). The vaginal microbiome of trans men is characterized by a loss of Lactobacillus and an increase in bacteria associated with the intestinal flora (e.g., Campylobacter, Anaerococcus, Dialister, Prevotella). The abundance of Dialister and Prevotella decreased with the length of hormonal therapy in trans men. The Nugent score, Pap smear and HPV status did not differ between the study groups. The vaginal microbiome of trans men differs from that of premenopausal women but shows similarities to that of menopausal women. The duration of hormonal therapy in trans men may have important impacts on the vaginal microbiome and thus possibly on the risk for STIs. [ABSTRACT FROM AUTHOR]

\nThis study compared the qualitative nature of women and men’s sexual violence (SV) victimization, the types of experiences captured and missed on the Sexual Experiences Survey-Short Form Victimization (SES-SFV) across genders, and common interpretations of the SES-SFV items. Fifty-four university students (31 women, 21 cis men, 2 trans men) who had recent unwanted (but not necessarily nonconsensual) sexual experiences thought out loud while privately completing the SES-SFV. They also typed descriptions of experiences reported on SES-SFV items or similar experiences when nothing was reported on an item. Results indicated that women’s victimization was more frequent and severe than cis men’s, except when men were victimized by men. Although verbal coercion was common across genders, event descriptions indicated that women’s verbal coercion experiences were more often harsh and part of a partner’s ongoing SV or coercive control. The findings suggest that quantitative measurement can mask important gender differences in victimization and (based on analysis of false positives and negatives) may underestimate rape and attempted rape experiences, especially women’s. Findings suggested that responding to the SES-SFV was not traumatic or distressing. However, participants sometimes expressed confusion about the items and interpreted them in unintended ways.Read the transcriptWatch the video on Vimeo© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC. [ABSTRACT FROM AUTHOR]

Background: Limited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroids on gut microbiota taxonomy and function, addressing this gap. We prospectively analyzed gut metagenome changes associated with 12 weeks of GAHT in trans women and trans men, examining both taxonomic and functional shifts. Methods: Thirty-six transgender individuals (17 trans women, 19 trans men) provided pre- and post-GAHT stool samples. Shotgun metagenomic sequencing was used to assess the changes in gut microbiota structure and potential function following GAHT. Results: While alpha and beta diversity remained unchanged during transition, specific species, including Parabacteroides goldsteinii and Escherichia coli, exhibited significant abundance shifts aligned with affirmed gender. Overall functional metagenome analysis showed a statistically significant effect of gender and transition (R2 = 4.1%, P = 0.0115), emphasizing transitions aligned with affirmed gender, particularly in fatty acid-related metabolism. Conclusions: This study provides compelling evidence of distinct taxonomic and functional profiles in the gut microbiota between trans men and women. GAHT induces androgenization in trans men and feminization in trans women, potentially impacting physiological and health-related outcomes. Trial registration: Clinicaltrials.gov NCT02185274. [ABSTRACT FROM AUTHOR]

Transgender people experience distress due to gender incongruence (i.e., a discrepancy between their gender identity and sex assigned at birth). Gender-affirming hormone treatment (GAHT) is a part of gender reassignment treatment. The therapeutic goals of the treatment are to develop the physical characteristics of the affirmed gender as far as possible. Guidelines have been developed for GAHT, which recommend dosage as well as different formulations of oestrogen and testosterone for treatment. Questions arise about the metabolic side effects of hormone treatment. Establishing reference ranges for common analytes in transgender individuals remains a task for laboratory medicine. It has been suggested once GAHT is commenced, the reference ranges for affirmed gender are reported for red blood cells, haemoglobin and haematocrit. For transgender assigned-female-at-birth (AFAB) people, testosterone concentrations are recommended to be within the reference interval established for cisgender men and for transgender assigned-male-at-birth (AMAB) people, estradiol concentrations are within the reference range for cisgender women. Sex-specific reference ranges are available for certain laboratory tests, and these may be organ (e.g., heart)-specific. Transgender-specific reference ranges may be a requirement for such tests. Laboratories may need to make decisions on how to report other tests in the transgender population, e.g., eGFR. Interpretation of further tests (e.g., reproductive hormones) can be individualized depending on clinical information. Electronic medical record systems require fields for gender identity/biological sex at birth so that laboratory results can be flagged appropriately. In this review, we aim to summarise the current position of the role of the laboratory in the clinical care of the transgender individual. Prior to the review, we will summarise the genetics of sex determination, the aetiology of gender incongruence, and the recommendations for GAHT and monitoring for the transgender population. [ABSTRACT FROM AUTHOR]

Transgender individuals form a distinct community that often experiences marginalization within society. This marginalization is particularly pronounced in patriarchal countries, where transgender men encounter various challenges across psychological, medical, legal, and social domains during their transition. The study design to conduct a thorough analysis of the life experiences and perspectives of transgender men in Türkiye. It involved 15 participants and the collected data were subsequently analyzed using the constant comparative method, a key technique within grounded theory methodology. The coding process resulted in three main themes: "Realizing gender identity", "Impact of social support sources", and "The nature of being visible", and six sub-themes were formed, the core category being "... Despite the numerous challenges encountered along the way, when I gazed into the mirror, I realized I had attained the identity I had long desired". Transgender individuals in the study expressed encountering emotional, physical, and psychological challenges throughout their personal journeys. However, despite these difficulties, they reported experiencing a sense of satisfaction and contentment upon reaching the end of their transition process. It is recommended to implement counseling services specifically tailored for transgender individuals and their families and incorporate transgender-related content into the training programs of professionals working with transgender individuals. [ABSTRACT FROM AUTHOR]

Adolescent transgender medicine is a growing clinical field. Gender‐affirming medications for transgender youth may include gonadotropin‐releasing hormone (GnRH) agonists, gender‐affirming hormones or both. To evaluate the potential effects of GnRH agonists (puberty suppression) on pharmacokinetic processes for transgender youth, we searched PubMed from inception to May 2024 for publications on the effects of GnRH agonists on drug absorption, distribution, metabolism or excretion for transgender adolescents or effects on hormones (including gonadotropins, adrenal androgens, sex steroids) that are associated with changes in drug metabolism during puberty in the general adolescent population. No publications discussed the effects of GnRH agonist treatment on pharmacokinetic processes for adolescent transgender people. Sixteen publications observed marked decreases in gonadotropins and sex steroids for both adolescent transgender men and adolescent transgender women and slight effects on adrenal androgens. During GnRH agonist treatment, changes in body composition and body shape were greater for adolescent transgender people than for cisgender adolescent people. Further research is needed to better understand the effects of GnRH agonists on drug metabolism and other pharmacokinetic processes for transgender adolescents receiving GnRH agonists and other gender‐affirming medications. [ABSTRACT FROM AUTHOR]

Musculoskeletal changes occur with gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS) used in the care of transgender adolescents and adults. Survey results have shown that orthopaedic surgeons desire to care for transgender individuals but express concern over a knowledge deficit. This article reviews the physiology and pathophysiology that may occur with GAHT and GAS. Transgender women have lower bone mineral density (BMD) prior to GAHT than cisgender men. Limited fracture data would suggest that transgender women >50 years of age have fracture rates similar to those of cisgender women. Transgender men have normal BMD prior to GAHT and are not at an increased risk for fracture compared with cisgender women. The use of puberty-blocking medications in the care of transgender youth does result in a decline in BMD, which returns to baseline with GAHT, but the effect of delaying puberty on maximal BMD and the lifetime fracture risk are unknown. At present, dual x-ray absorptiometry (DXA) is used to measure BMD and assess fracture risk. Attention should be paid to using the appropriate reference group in the interpretation of DXA for transgender individuals. Promote musculoskeletal health by ensuring appropriate calcium, vitamin D, weight-bearing activity, and a healthy lifestyle. Adherence to GAHT needs to be encouraged to avoid bone loss. Data with regard to therapy for osteoporosis in transgender patients have been lacking, but, at present, use of available therapies is expected to be effective. Information with regard to differences in other musculoskeletal health issues such as joint injuries has been lacking in transgender individuals. [ABSTRACT FROM AUTHOR]

Introduction Method Results Discussion and Conclusions There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia.Using data from a national survey of Australian trans young people (N = 859, Mage = 19.4), we estimated prevalence of past 6‐month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate‐adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open‐ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach.Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi‐levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction.While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self‐exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender‐affirming care. [ABSTRACT FROM AUTHOR]

Background: Transgender men (TGM) are underrepresented in genital microbiome research. Our prospective study in Birmingham, AL investigated genital microbiota changes over time in TGM initiating testosterone, including the development of incident bacterial vaginosis (iBV). Here, we present lessons learned from recruitment challenges encountered during the conduct of this study. Methods: Inclusion criteria were assigned female sex at birth, TGM or non-binary identity, age ≥18 years, interested in injectable testosterone but willing to wait 7 days after enrollment before starting, and engaged with a testosterone-prescribing provider. Exclusion criteria were recent antibiotic use, HIV/STI infection, current vaginal infection, pregnancy, or past 6 months testosterone use. Recruitment initiatives included community advertisements via flyers, social media posts, and referrals from local gender health clinics. Results: Between February 2022 and October 2023, 61 individuals contacted the study, 17 (27.9%) completed an in-person screening visit, and 10 (58.8%) of those screened were enrolled. The primary reasons for individuals failing study screening were having limited access to testosterone-prescribing providers, already being on testosterone, being unwilling to wait 7 days to initiate testosterone therapy, or desiring the use of topical testosterone. Engagement of non-White TGM was also minimal. Conclusion: Despite robust study inquiry by TGM, screening and enrollment challenges were faced including engagement by TGM not yet in care and specific study eligibility criteria. Excitement among TGM for research representation should be leveraged in future work by engaging transgender community stakeholders at the inception of study development, particularly regarding feasibility of study inclusion and exclusion criteria, as well as recruitment of TGM of color. These results also highlight the need for more clinical resources for prescribing gender-affirming hormone therapy, especially in the Southeastern US. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria, characterized by a misalignment between one's gender identity and assigned sex, propels individuals towards medical interventions like gender reassignment surgery (GRS) to harmonize their bodies with their gender. This process aims to enhance overall quality of life (QoL), functioning, and body image. Recognizing the importance of cultivating a positive body image for transgender individuals navigating societal norms, this narrative highlights the ongoing debate surrounding QoL post-GRS. In response, our study is outlined, aiming to scrutinize QoL and self-image among transgender men post-GRS, offering valuable insights into societal perceptions and psychological well-being in this context. Method: This cross-sectional survey focused on transgender men aged 15 to 35 who underwent gender reassignment surgery (GRS) in 2018–2022 in Shiraz, Iran. Participants, after passing psychiatric evaluations, completed World Health Organization Quality of Life (WHOQOL-100) questionnaires pre- and at least one-year post-surgery. The scores of the Brief-WHOQOL questionnaire were evaluated in four domains of physical health, psychological health, social relationships, and environmental health. Results: A total of 60 individual who underwent GRS completed our questionnaire. The average age of the patients was 24.1 ± 3.8 years. Following GRS, the most increase was observed in the psychological factor (by 25.6%). The increase in score was statistically significant in all subgroups (P < 0.001) after operation. Urban living location had a significant association with higher increase in physical health (P < 0.010), psychological health (P = 0.005), and environmental health (P = 0.012) after GRS. In regards to physical health, the low socioeconomic group had a significantly less physical score improvement in QoL compared to the moderate group (P = 0.024) following GRS. In regards to environmental health, the high socioeconomic groups had significantly higher improvement in QoL compared to the low (P = 0.006) and moderate (P < 0.001) group after operation. Conclusion: The results demonstrate that GRS brings about improvements across all aspects of QoL. However, this enhancement is less pronounced among patients hailing from low socioeconomic backgrounds and rural areas. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) young adults experience elevated risk for eating disorders (ED), partially due to cissexist discrimination and victimization; less is understood about how socioeconomic determinants contribute to their ED risk. Qualitative data collected from 66 TGD young adults (18–30 years old; 29% self-identified as transgender women, 29% as transgender men, 39% as nonbinary people, and 3% as another gender identity (e.g., māhū)) in eight asynchronous online focus groups explored how socioeconomic determinants in conjunction with other dimensions of identity and lived experience shape disordered eating behavior (DEB) and ED risk. Participants described how economic barriers—including poverty and dependency on others (e.g. parents for health insurance)—and challenges produced by insurance and healthcare systems impeded healthcare access to the detriment of their overall mental health and risk for ED. In addition, participants shared different ways they leveraged financial resources to cope with stress, sometimes in ways that impelled disordered eating behaviors. Finally, participants described how poverty, socioeconomic advantage and disadvantage, and classism compound other systems of oppression (e.g. racism, ableism, weight bias) to adversely impact their general health and ED risk. [ABSTRACT FROM AUTHOR]

Purpose: The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. Methods: Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. Results: Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. Conclusions: The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life. [ABSTRACT FROM AUTHOR]

Objectives Despite regular gender-affirming hormone therapy (GAHT), the presence of uterine bleeding can occur occasionally and cause profound discomfort. This study aimed to evaluate the histologic features and immunohistochemical expression of estrogen (ER), progesterone (PR), and androgen receptors (AR) in the endometrium and myometrium of transgender men receiving testosterone therapy and relate them to clinical and hormonal characteristics. Design Retrospective cross-sectional study. Methods Thirty-four transgender men undergoing gender-affirming surgery were included. Clinical, sociodemographic, and laboratory data as well as anatomopathological and immunohistochemical findings were evaluated. Results The participants' mean age was 42.35 (SD, 10.00) years, and body mass index was 28.16 (SD, 5.52) kg/m2. The mean GAHT duration before surgery was 5.36 (SD, 3.24) years. The mean testosterone levels were 814.98 (SD, 407.13) ng/dL, and estradiol levels were 55.22 (SD, 25.27) pg/mL. The endometrium was atrophic in 61.8%, proliferative in 17.6%, and secretory in 20.6%. Immunohistochemical receptor analysis revealed that endometrial epithelial cells expressed ER (90%) and PR (80%), with a lower expression of AR (30%). In stromal tissue, the median ER, PR, and AR expression was lower than that in the epithelium (60%, 70%, and 25%, respectively). The myometrium showed high expression of PR (90%) and ER (70%), with the highest expression of AR (65%) being localized to this region. Conclusions In the present study, GAHT induced an atrophic condition of the endometrium in two-thirds of the transgender men, with a limited AR expression in the endometrial region. The present results suggest that testosterone-based GAHT for a mean of 5 years is safe in transgender men achieving amenorrhea. [ABSTRACT FROM AUTHOR]

Despite the benefits of pre-exposure prophylaxis (PrEP) in preventing HIV and its potential for reducing racial/ethnic HIV inequities, PrEP remains underutilized among African Americans who may benefit from it. Factors of PrEP uptake include awareness and acceptability of this prevention strategy among this group, yet few community-informed interventions have been developed and evaluated to address these challenges. Thus, this study evaluates the effectiveness of a community-informed, six-month multimedia campaign (print, digital media, internet radio, social media) for African American young adults (age 18–29) in Louisville, Kentucky to increase PrEP awareness and PrEP use intentions. Pretest surveys, posttest surveys, and digital analytic metrics were used to determine campaign effectiveness. Logistic regressions indicate increased PrEP awareness over time (p ≤ 0.0001) and greater PrEP intention among participants reporting greater campaign affinity (p ≤ 0.05). Campaign digital analytic performance was similar to or exceeded that of industry competitors (e.g., healthcare organizations). Findings indicate that a community-informed multimedia campaign increased PrEP use intentions among those exhibiting greater campaign affinity (the extent to which participants report a favorable view of the campaign) and demonstrated similar or greater effectiveness in digital elements as industry competitors at a cost-effective price. Future studies should incorporate community-engaged approaches in developing health communication products for greater PrEP acceptability and efficiency. Trial registration: ClinicalTrials.gov identifier: NCT0355959. [ABSTRACT FROM AUTHOR]

Introduction Methodology Results Discussion Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.In partnership with No More Secrets (NMS), a Philadelphia menstrual health non‐profit, we conducted a community‐based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18–45 recruited from NMS' catchment in Philadelphia participated in semi‐structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory‐driven approached based on the social‐ecological model was used to analyze the data.Varying emotional responses arose across social‐ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma.Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community‐based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non‐binary individuals who menstruate. [ABSTRACT FROM AUTHOR]

AbstractIncarcerated women are confined in institutions designed to punish. These sites often ignore the complex mental and physical health needs of people who are incarcerated. Despite the World Health Organization stressing the need for access to reproductive healthcare in carceral institutions, stigma surrounding abortion care and health inequalities create contextually specific issues for incarcerated people seeking to access these services. There is also a dearth of research conducted directly with incarcerated women, trans men and non-binary people to examine their experiences of abortion. A systematic review of international peer-reviewed and grey literature was completed to summarise existing evidence from research conducted on the experiences of needing abortion care whilst incarcerated. Various experiences were identified including: conditions of confinement shaping abortion decisions; bureaucratic obstacles to accessing abortion services; incarcerated women, carceral staff and carceral healthcare staff’s lack of understanding of abortion rights and procedures; and a scarcity of support and empathy, including experiences of stigmatisation and lack of confidentiality. There exists a significant gap in research examining the experiences of incarcerated people who may need an abortion, emphasising the need for international collaboration and advocacy to address systemic issues that extend beyond local contexts. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Conclusion Approximately, 11% of trans men experience erythrocytosis diagnosis due to testosterone administration during the first year of the gender‐affirming hormone treatment (GAHT).To identify and compare the effect of different testosterone formulations on hematocrit (Hct) and diagnose erythrocytosis in trans men.This systematic review was based on PRISMA guidelines. We performed an electronic search of PubMed, Embase, and Web of Science in January 2024. The Newcastle–Ottawa scale was used to evaluate the quality of evidence in the observational studies.Of the 152 records retrieved, 18 met the eligibility criteria. Studies observed an increase of up to 5% in Hct in trans men using injectable testosterone undecanoate (TU), and up to 6.9% in trans men using intermediate injectable testosterone esters (TE). Trans men using TE experience a larger increase in serum Hct levels compared to those receiving TU. Erythrocytosis prevalence varies according to the cutoff used (50%, 52%, and 54%). Erythrocytosis was also associated with tobacco use, age at initiation of hormone therapy, body mass index (BMI), and pulmonary conditions. Studies that evaluated the effect of testosterone formulation on erythrocytosis diagnosis present conflicting result. Trans men have a hazard ratio of 7.4 (95% CI: 4.1, 13.4) of developing erythrocytosis compared to cisgender men, using a 52% hematocrit cutoff.All testosterone formulations result in an increase in Hct, irrespective of dose, formulation, and administration method. Smoking, higher age at initiation of the testosterone therapy, higher BMI, and a predisposing medical history are associated with this increase in Hct. The difference in effect of TE and TU on Hct is conflicting, although it is important to point out that these data come from observational studies, retrospective, and with a small‐sample size. [ABSTRACT FROM AUTHOR]

Background Objective Materials and methods Results Discussion and conclusions There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.We used 2020–2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross‐sectional and longitudinal analyses. Our primary outcome was self‐reported CPP lasting 3 months or longer measured using the Michigan Body Map.Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post‐traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65–0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new‐onset CPP.The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new‐onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies. [ABSTRACT FROM AUTHOR]

Objectives HIV pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but some seroconversions occur due to poor adherence or PrEP discontinuation. Our objective was to estimate the incidence of PrEP discontinuation and describe the reasons and factors associated with discontinuations. Methods A retrospective cohort was conducted in three French hospitals between January 2016 and June 2022. PrEP users who attended at least twice within 6 months during study period were included and followed up until December 2022. The incidence rate of PrEP discontinuation was estimated by censoring lost to follow up individuals. Factors associated with PrEP discontinuations were identified using a multivariate Cox model. Results A total of 2785 PrEP users were included, with 94% men and 5% transgender people. Median age was 35 years. By December 2022, 653 users had stopped PrEP (24%). The incidence rate was 10.8 PrEP discontinuations for 100 person-years (PY). The main causes of discontinuation were being in a stable relationship (32%), and not judging the treatment useful anymore (12%). Individuals who discontinued PrEP were younger [<29, HR = 1.45 (1.17–1.80)], and more likely to be women [HR = 2.44 (1.50–3.96)] or sex workers [HR = 1.53 (0.96–2.44)]. They were more likely to report PrEP side effects [HR = 2.25 (1.83–2.77)] or ≥2 sexually transmitted infections [HR = 1.87 (1.53–2.27)] during the last year. Conclusion The incidence of PrEP discontinuations was quite low compared to rates observed in other cohorts. Users who stopped PrEP were sometimes still exposed to HIV, emphasizing the need for targeted interventions to prepare and support PrEP discontinuations and limit seroconversion risk. [ABSTRACT FROM AUTHOR]

Research on the daily experiences of transgender and gender diverse (TGD) youth 18 years or younger is limited, making it essential to gain a comprehensive understanding of their internal and external experiences related to gender identity. This systematic review and qualitative research synthesis fills this research gap by examining the lived experiences and coping of TGD youth, including prepubertal children. The review was pre-registered according to PROSPERO on the Open Science Framework and followed the ENTREQ reporting guidelines. A Qualitative research synthesis, according to Howell Major and Savin-Baden, was conducted. Seventeen peer-reviewed articles published between 2000 and 2023 fulfilled inclusion criteria and quality assessment. Synthesized themes were: (1) "Navigating gender identity", with two sub-themes, Meaning-making and Considering visibility (2) "Navigating relations", with four sub-themes: Longing for belonging, Supportive actions, Lack of safety and Coping inside out (3) "Navigating society with two sub-themes Inclusion and exclusion and Beyond control. Our findings demonstrate that TGD youth view gender identity as fluid and benefit from a supportive environment that facilitates genuine exploration. Coping strategies develop intricately, influenced by multifaceted factors. Unlike previous research on the negative effects of minority stress, our review underscores the cumulative impact of subtle daily stressors on TGD youth's well-being, highlighting the significance of an environment where gender is not a constant concern. By shedding light on these dynamics, this synthesis contributes to a comprehensive understanding of TGD youth's perspectives for professionals and a broader audience. [ABSTRACT FROM AUTHOR]

The present study explores how coming out to parents – in terms of both status (being out vs. not) and, if out, experience (continuum from rejection to acceptance) – affects trans people's mental health. Participants were 509 young adult trans individuals from Germany (community-based sample; 50% gender binary, 50% nonbinary; 16-35 years). The cross-sectional online study used standardized measures of coming out response, social support, and mental health. More participants were out to their mother than their father, but mothers did not respond with more acceptance. At the bivariate level, coming out experience, but not coming out status, was positively related to mental health. At the multivariate level, parental support mediated the association between both coming out variables and mental health. That is, trans people who were out to their parents and, if out, had a positive coming out experience received more parental support, which, in turn, was conducive to their mental health. There were no substantial differences between maternal and paternal effects, and effect sizes were equal for coming out status and experience. This study confirmed the crucial role that parents play when it comes to their child's coming out as trans – by accepting their child's gender identity early on and providing them with support. [ABSTRACT FROM AUTHOR]

'Gender dysphoria' is commonly used to describe feelings of psychological discomfort, unease, anxiety, or distress in trans individuals. Whilst the past decade has shown a significant rise in research on the experiences of trans individuals in society, the amount of literature dedicated to the experiences of trans men has been much more limited, and particularly research focused on the experiences of young trans men. As such, the range and scope of dysphoric experiences will not have been fully captured and there will be gaps in both general and clinical understanding and conceptualization. To provide a deeper insight into the dysphoric experiences of young trans men, and to use this insight, in conjunction with the wider body of literature, to formulate an original framework to conceptualize the experiential nature of dysphoria. Semi-structured interviews were carried out with seven white British trans men aged 18–29 living in England and Wales. Data was analyzed using Braun and Clarke's (2020) six stage reflexive thematic analysis. Several themes were drawn out of the data which underpinned the creation of a new conceptual framework for the experiential nature of dysphoria: the psychological nature of dysphoria which focuses on issues such as the notion of identity and desire to 'pass'; the corporeal nature of dysphoria which focuses on the techniques and methods used to modify physical appearance; and the structural nature of dysphoria which outlines the way that societal structures influence and affect dysphoria through waiting times and financial costs. As well as providing a deeper insight of the dysphoric experiences of young trans men, its significance lies in a new conceptual framework that can aid future studies and understanding. [ABSTRACT FROM AUTHOR]

Compared to previous generations, U.S. college students must increasingly rely on non-government sources of money to pay for college. Yet, paying for college looks markedly different for students from marginalized communities, given historical exclusion and inequitable access to financial capital. Using data from a longitudinal study of transgender men and non-binary students, I argue that identity management is a key tactic these students use to pay for college and navigate competing financial priorities. Ultimately, this study can help researchers and policymakers better address issues of affordability, while more clearly understanding the unique nature of identity management for transgender students. [ABSTRACT FROM AUTHOR]

Transgender people live in constant navigation of the gender binary to honor their gender identity and protect themselves against marginalization. Using Hermans' Dialogical Self Theory (DST), we explore the agentic process of negotiation within the self and how transgender men negotiate the field of tension between the internal I-position of being a man and society's imposed external I-position of being forced to be a woman. Using a multi-case study approach, in-depth interviews with five Filipino self-identifying transgender men were conducted. The negotiations between I-positions were analyzed following Aveling and colleagues' Analysis of Multivoicedness. Key patterns of negotiating tension among transgender men were resisting the gender binary characterized by an identity crisis; performing femininity as protection against rejection, discrimination, and danger; and the claiming (and reclaiming) of the authentic self with transgender and queer communities. Implications of DST, a dialogical approach to agency, and the need to create gender-affirming dialogical spaces are discussed. [ABSTRACT FROM AUTHOR]

Research has shown that LGBTQ+ candidates continue to face penalties at the ballot box, with particularly acute penalties for transgender candidates. However, the nuanced intersection of gender identity and sexual orientation has yet to be explored. Our project endeavors to do just that, by differentiating between transgender men, transgender women, and non-binary candidate gender identities, as well as including bisexual candidate sexual orientation. Our conjoint survey experiment finds, contrary to our expectations, that transgender women candidates do not face larger vote penalties than transgender men candidates, though candidates of either identity are more penalized than cisgender women and non-binary candidates. Also contrary to our expectations but in line with recent research, we find that bisexual men candidates (cis or transgender) are penalized more than bisexual women candidates (cis or transgender). Understanding the intersectionality of candidate gender identity and sexual orientation is critical for developing strategies to increase LGBTQ+ political representation. [ABSTRACT FROM AUTHOR]

Introduction: Mathematical models of HIV have been uniquely important in directing and evaluating HIV policy. Transgender and nonbinary people are disproportionately impacted by HIV; however, few mathematical models of HIV transmission have been published that are inclusive of transgender and nonbinary populations. This commentary discusses current structural challenges to developing robust and accurate trans‐inclusive models and identifies opportunities for future research and policy, with a focus on examples from the United States. Discussion: As of April 2024, only seven published mathematical models of HIV transmission include transgender people. Existing models have several notable limitations and biases that limit their utility for informing public health intervention. Notably, no models include transgender men or nonbinary individuals, despite these populations being disproportionately impacted by HIV relative to cisgender populations. In addition, existing mathematical models of HIV transmission do not accurately represent the sexual network of transgender people. Data availability and quality remain a significant barrier to the development of accurate trans‐inclusive mathematical models of HIV. Using a community‐engaged approach, we developed a modelling framework that addresses the limitations of existing model and to highlight how data availability and quality limit the utility of mathematical models for transgender populations. Conclusions: Modelling is an important tool for HIV prevention planning and a key step towards informing public health interventions, programming and policies for transgender populations. Our modelling framework underscores the importance of accurate trans‐inclusive data collection methodologies, since the relevance of these analyses for informing public health decision‐making is strongly dependent on the validity of the model parameterization and calibration targets. Adopting gender‐inclusive and gender‐specific approaches starting from the development and data collection stages of research can provide insights into how interventions, programming and policies can distinguish unique health needs across all gender groups. Moreover, in light of the data structure limitations, designing longitudinal surveillance data systems and probability samples will be critical to fill key research gaps, highlight progress and provide additional rigour to the current evidence. Investments and initiatives like Ending the HIV Epidemic in the United States can be further expanded and are highly needed to prioritize and value transgender populations across funding structures, goals and outcome measures. [ABSTRACT FROM AUTHOR]

Comparison of the applicability, safety, and surgical outcomes of total vaginal NOTES hysterectomy (TVNH) using natural orifice transluminal endoscopic surgery, which is considered a natural orifice surgery for hysterectomy with bilateral salpingo-oophorectomy (HBSO) in virgin transgender men, with conventional total laparoscopic hysterectomy (TLH). A retrospective cohort study was conducted between 2019 and 2021. The results of transgender male individuals who underwent HBSO operations using TVNH (n = 21) were compared with those who underwent operations using TLH (n = 62). TVNH was performed in 21 individuals, while TLH was performed in 62 individuals. Patients in the TVNH approach group had a longer operation duration than those in the TLH group (p =.001). Patients in the TVNH group experienced less pain at two hours (5 ± 1.56), six hours (4 ± 1.57), 12 h (2 ± 0.91), and 24 h (1 ± 0.62) postoperatively (p =.001). The postoperative hospitalization duration was shorter in the TVNH group (1.6 ± 1.01) than in the TLH group (2.9 ± 0.5) (p =.001). For the HBSO operation of female-to-male transgender individuals, TVNH, which is completely endoscopically performed, can be preferred and safely conducted as an alternative surgical method to conventional laparoscopy. [ABSTRACT FROM AUTHOR]

Iran's cultural, social, and historical characteristics contribute to different experiences for Iranian trans women and trans men compared with their peers in other countries where gender diversity and trans rights are acknowledged. We conducted an emergent fit analysis based on past grounded theory studies of Iranian trans women's and men's identity development to explore and compare the diverse gender developmental milestones of these groups and the underlying causes and mechanisms associated with any observed differences. In this study, emergent fit analysis revealed that trans women's and trans men's experiences are comparable across several general categories, but markedly diverge in many specific emergent details, including different child-parent relationships, school years experiences, peer and romantic relationships, social policy implications, gender taboos during different developmental stages, their experiences after transition/surgery, and legal and social status. Policymakers, academics, clinical associates, and medical professionals not specifically trained in working with gender-diverse populations and those who may not be familiar with Iran's cultural context can use these findings to enhance their professional knowledge and, as a result, implement policies and practices that acknowledge and support the diverse gendered experiences of trans people. [ABSTRACT FROM AUTHOR]

Gender minorities disproportionately experience stigma and violence after coming out. This study was conducted to examine how individuals perceive characters identified with various gender identity labels (transgender man, transgender woman, genderfluid, non-binary, cisgender man, cisgender woman), to better understand the effects of these labels on people's perceptions. Student participants (N = 498) were randomly assigned to one of the three conditions and read six vignettes briefly describing characters with the aforementioned identities. Conditions included explicit labels (e.g. 'Mike is a transgender man'), implicit labels (e.g. 'Mike was assigned female at birth, but now identifies as a man'), and no gender labels. Participants then rated each character on 19 different traits/attributes (e.g. 'likable', 'perverted', 'masculine'). All characters were rated more positively when described with an explicit or implicit gender identity label in comparison to the no label control condition. The manipulation of gender labels had little influence on ratings of negative traits. These positive and encouraging results may be partially attributed to the sample which predominantly comprised young, liberal, women and may be indicative of a welcoming university environment for gender minorities. Future studies could further explore this topic by expanding the scope to the larger national population. [ABSTRACT FROM AUTHOR]

Gay, bisexual and other men who have sex with men (GBMSM) and transgender individuals face heightened risks of HIV and other sexually transmitted infections (STIs). Surveillance within these populations is critical, and community testing services play a pivotal role in preventing and controlling HIV and STIs. This study investigates the trends in HIV, syphilis and hepatitis C (HCV) infections among participants in an apps-driven rapid test program from 2016 to 2023 in Barcelona, Spain, examining associated factors. Trend analysis utilized Wilcoxon-type test and associated factors were determined through multivariate logistic analysis. The prevalence of new HIV diagnosis was 1.81% (CI 1.18–2.64), active syphilis was 3.37% (CI 2.46–4.50) and acute HCV was 0.40% (CI 0.11–1.02). While infection rates showed no significant changes, there was significant increasing in sex work and chemsex and decreasing in condom use. Additionally, a peak in dating apps use for sex and a specific reduction in number of sexual partners were observed in 2020. Factors associated with HIV diagnoses included migrant status (aOR = 11.19; CI 2.58–48.53) and inconsistent condom use during the previous 12 months (aOR = 3.12; CI 1.02–9.51). For syphilis, associated factors were migrant status (aOR = 2.46; CI 1.14–5.29), inconsistent condom use (aOR = 3.38; CI 1.37–8.36), and chemsex practice during the previous 12 months (aOR = 2.80; CI 1.24–6.30). Our findings emphasize the need for tailored interventions, including culturally sensitive outreach for migrants and comprehensive strategies addressing substance use in sexual contexts. Technological innovations and targeted educational initiatives could reduce the burden of HIV and STIs within the GBMSM and transgender communities, providing valuable insights for public health strategies. [ABSTRACT FROM AUTHOR]

This article sheds light on the normative dimension of birth registration and explores how birth registration practices intertwine with traditional notions of child care. It shows that, while birth registration may appear a straightforward and factual procedure, it actually rests upon and perpetuates the notion that care 'naturally' stems from gestation and birth, and is by definition maternal. This normative dimension of birth registration becomes especially apparent when trans families and families created through surrogacy are denied registration in line with their lived experience. By delving into two case studies, namely the Swiss Federal Supreme Court's latest case-law on surrogacy and recent cases involving trans birthing men, this article shows that birth registration practices fail to recognise caring relationships in non-traditional families on their own terms. In the context of surrogacy, the understanding of care as 'naturally' arising from gestation and birth downgrades the relationship between the child and the intended mother by requiring her to pursue step-child adoption, despite having cared for the child since birth and sometimes being genetically connected. In a similar vein, birth registration practices tend to (mis)classify a caring relationship between a trans birthing man and his child as 'mother-child', thus rendering trans male care invisible. [ABSTRACT FROM AUTHOR]

Background: Differences in immune responses between women and men are leading to a strong sex bias in the incidence of autoimmune diseases that predominantly affect women, such as multiple sclerosis (MS). MS manifests in more than twice as many women, making sex one of the most important risk factor. However, it is incompletely understood which genes contribute to sex differences in autoimmune incidence. To address that, we conducted a gene expression analysis in female and male human spleen and identified the transmembrane protein CD99 as one of the most significantly differentially expressed genes with marked increase in men. CD99 has been reported to participate in immune cell transmigration and T cell regulation, but sex-specific implications have not been comprehensively investigated. Methods: In this study, we conducted a gene expression analysis in female and male human spleen using the Genotype-Tissue Expression (GTEx) project dataset to identify differentially expressed genes between women and men. After successful validation on protein level of human immune cell subsets, we assessed hormonal regulation of CD99 as well as its implication on T cell regulation in primary human T cells and Jurkat T cells. In addition, we performed in vivo assays in wildtype mice and in Cd99-deficient mice to further analyze functional consequences of differential CD99 expression. Results: Here, we found higher CD99 gene expression in male human spleens compared to females and confirmed this expression difference on protein level on the surface of T cells and pDCs. Androgens are likely dispensable as the cause shown by in vitro assays and ex vivo analysis of trans men samples. In cerebrospinal fluid, CD99 was higher on T cells compared to blood. Of note, male MS patients had lower CD99 levels on CD4+ T cells in the CSF, unlike controls. By contrast, both sexes had similar CD99 expression in mice and Cd99-deficient mice showed equal susceptibility to experimental autoimmune encephalomyelitis compared to wildtypes. Functionally, CD99 increased upon human T cell activation and inhibited T cell proliferation after blockade. Accordingly, CD99-deficient Jurkat T cells showed decreased cell proliferation and cluster formation, rescued by CD99 reintroduction. Conclusions: Our results demonstrate that CD99 is sex-specifically regulated in healthy individuals and MS patients and that it is involved in T cell costimulation in humans but not in mice. CD99 could potentially contribute to MS incidence and susceptibility in a sex-specific manner. Plain Language Summary: The immune system protects us from bacterial and viral infections and impacts the outcome of many diseases. Thus, understanding immunological processes is crucial to unravel pathogenic mechanisms and to develop new therapeutic treatment options. Sex is a biological variable affecting immunity and it is known that females and males differ in their immunological responses. Women mount stronger immune responses leading to more rapid control of infections and greater vaccine efficacy compared to men. However, this enhanced immune responsiveness is accompanied by female preponderance and susceptibility to autoimmune diseases like systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis (MS). MS sex ratio varies around 2:1 to 3:1 with a steadily increasing incidence in female MS patients making sex one of the top risk factors for developing MS. However, the underlying biological mechanisms including sex hormones as well as genetic and epigenetic factors and their complex interplay remain largely unknown. Here, we discovered the gene and its encoded protein CD99 to be differentially expressed between women and men with men showing increased expression on many immune cell subsets including T cells. Since T cells are key contributors to MS pathogenesis, we examined the role of CD99 on T cells of healthy individuals and MS patients. We were able to identify CD99-mediated T cell regulation, which might contribute to sex differences in MS susceptibility and incidence indicating the importance to include sex as a biological variable. Of note, these differences were not reproduced in mice showing the necessity of functional research in humans. Highlights: Profiling of differential gene expression between sexes in the human immune system to delineate differential regulations that might impact immune responses. CD99 is genetically but not hormonally regulated on transcript and surface protein level with higher expression in men in healthy individuals as well as MS patients. Confirmation of CD99 as a critical co-stimulatory molecule on T cells, thus having an impact on T cell activation, proliferation and cluster formation. CD99 expression is elevated on T cells in the CSF compared to the blood. In male MS patients CD99 expression on CD4+ T cells from the CSF was lower in comparison to healthy men. Species difference in CD99 expression and its functional role with lack of differential CD99 expression in male and female mice as well as Cd99 deficiency not altering experimental autoimmune encephalomyelitis. [ABSTRACT FROM AUTHOR]

Transmasculine and non-binary individuals frequently experience stigma related to their gender identity, which leads to higher rates of mental health problems in comparison with the cisgender population. This study describes the prevalence of non-suicidal self-injury (NSSI) attempts and explores its association with indicators of violence, discrimination, and gender affirmation among people who self-identify within the transmasculine and non-binary spectrum from Argentina. Between May and September 2019, 415 participants completed an online survey. The median age was 23 years (IQR = 19–27). Most of the sample (84.6%) self-identified as transmasculine (e.g. trans man or male) and 15.4% as non-binary. The prevalence of NSSI attempts was high (74.6%). The first attempt frequently occurred during adolescence. NSSI attempts were negatively associated with indicators of psychological, medical, and legal gender affirmation only at the bivariate level. In the final multivariable model, NSSI attempts remained associated with younger age, bullying at school, violence from family members, and sexual abuse. Prevalence of NSSI attempts among transmasculine and non-binary people from Argentina is disproportionately elevated. It is critical to prioritise this population in policies and interventions to prevent this problem from an early age. Such interventions should address discrimination and violence against this community, since these are the factors primarily associated with occurrence of NSSI attempts. [ABSTRACT FROM AUTHOR]

Although a gamut of sensational issues affecting transgender communities in Malaysia proliferates in academic scholarship and activism reports, and transgender experiences of tragedy and violence are often amplified in the news media, less attention is given to the everyday forms of aggression and vulnerability that transgender people encounter in seemingly innocuous spaces. Guided by a Constructivist Grounded Theory Methodology, I analyse selected narratives of three local transgender men to theorize their experiences of 'oblique hostility' in Malaysia, or subtle and implicit manifestations of discrimination and harassment that threaten to annul their gendered liveability. I argue that these spaces which initially and ostensibly do not target gender normativity for valid accessibility – such as airport x-ray scanners, road blocks and local Roman Catholic ecclesial communities – are actually implicitly grounded in normative gender expectations and thus perpetuate a condition of precarity for transgender men who struggle for recognizability, dignity and security in their everyday lives. My analysis is framed by Judith Butler's ideas on precarity as the consequence of exaggerated and protracted state-sanctioned exposure to vulnerability, and Judith/Jack Halberstam's concept of the bathroom problem writ large, an insightful reference to spatial apparatuses of gendered invigilation that pronounce the (in)validity of gendered lives. [ABSTRACT FROM AUTHOR]

Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population's attitudes toward gender self-identification. A self-report survey, entitled "Opinions of Gender Self-Identification," collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women's safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p <.01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents. [ABSTRACT FROM AUTHOR]

Gender expansive youth, including trans and non‐binary (TNB) individuals, encounter unique challenges in educational contexts, often marked by hostility, exclusion, and discrimination. This research, adopting the social justice youth development (SJYD) framework, aims to investigate the challenges experienced in Italian secondary schools, amplifying the voices of TNB activists. A total of 15 activists (average age 23.8), comprising 5 trans men, 2 trans women and 8 non‐binary individuals, were recruited. Most identified as White Italian, with one of Italian‐African descent and one multiracial. Interviews collected participants' perceptions of barriers and areas for improvement in school contexts. Reflexive thematic analysis confirmed schools as challenging contexts for TNB identities, highlighting critical flaws in the educational system, such as macro‐ and micro‐aggressions, insufficient knowledge among teachers and staff to support gender expansive students, and a tendency to systematically exclude LGBTQIA+ culture‐related content from curricula. Participants reported engaging in individual and collective activism, striving to adapt and transform educational environments into inclusive spaces for gender identity exploration. Activism stemmed from a sense of responsibility to enhance the well‐being and recognition of the TNB community. Practical implications for school community practices and policies, informed by the SJYD framework in dialogue with participants' experiences, are proposed. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) young people with disability are known to experience higher rates of harassment or abuse than LGBTQA+ young people without disability. This study focused on participants in Australia and identified factors associated with harassment or abuse among LGBTQA+ adolescents and young adults who reported a disability as well as associations with mental health outcomes. Analyses were conducted from a national survey that included 2,500 LGBTQA+ people who reported a disability and were aged 14 to 21 years. Measures included experiences in the past 12 months of verbal and physical harassment or abuse due to one's sexual orientation or gender identity, sexual harassment or abuse, mental health, suicidality, and sociodemographic traits. Overall, 48.4% of participants with disability reported experiencing verbal harassment or abuse, 12.4% physical harassment or abuse, and 29.7% sexual assault or harassment. In multivariable regression analyses, verbal harassment or abuse was significantly more likely among trans men, participants with an intellectual disability, and those who were "out" to most or all of their family. Physical harassment or abuse was significantly more likely among participants with a physical or sensory disability. Sexual harassment or abuse was significantly more likely among trans women and participants with a physical or sensory disability. Participants who experienced harassment or abuse were also significantly more likely to have attempted suicide in the past 12 months. These findings will assist policymakers and practitioners in identifying contexts linked to a heightened risk of abuse among LGBTQA+ young people with disability and further underscore an immediate need to address and prevent harm in this population. [ABSTRACT FROM AUTHOR]

Bisexual+ (bisexual, pansexual, queer, attraction to more than one gender) people are at elevated risk for sexual victimization relative to their heterosexual counterparts. Disclosure of sexual victimization and social reactions received upon disclosure can play a major role in recovery following an assault. Using an online survey, the current study examined whether bisexual+ and heterosexual survivors of sexual victimization (N = 657) varied in disclosure of victimization, the type of disclosure (in-person vs. online via #MeToo), and receipt of various social reactions to disclosure in person and online. A chi-square test examined differences in disclosure and differences in types of disclosure (in-person only vs. MeToo across sexual identity). MANOVAS were used to examine whether in-person and online reactions varied across sexual identity. Bisexual+ survivors were more likely to disclose sexual victimization relative to heterosexual survivors. Among those who disclosed, bisexual+ survivors were more likely to disclose in person only whereas heterosexual survivors were more likely to disclose online via #MeToo. Whereas we did not find any significant differences for in-person reactions, we did find significant differences for online social reactions using #MeToo. Heterosexual survivors received higher turning against reactions (e.g., avoided talking to you or spending time with you) and more unsupportive acknowledgment relative to bisexual+ participants. Whereas bisexual+ participants received less turning against reactions and unsupportive acknowledgment during #MeToo/online disclosure, they were also less likely to disclose using #MeToo. Findings suggest that bisexual+ and heterosexual people vary in the way they disclose sexual victimization, and in how they are responded to when disclosing in person and online. [ABSTRACT FROM AUTHOR]

Fear approach is a theorized mechanism of exposure treatment for anxiety-based disorders. However, there are no empirically established self-report instruments measuring the tendency to approach feared stimuli. Because clinical fears are heterogeneous, it is important to create a measure that is adaptable to person- or disorder-specific fears. The current study (N = 455) tests the development, factor structure, and psychometric properties of a self-report instrument of fear approach broadly and the adaptability of this measure to specific eating disorder fears (i.e., food, weight gain). Factor analyses identified a unidimensional, nine-item factor structure as the best fitting model. This measure had good convergent, divergent, and incremental validity and good internal consistency. The eating disorder adaptations retained good fit and strong psychometric properties. These results suggest that this measure is a valid, reliable, and adaptable measure of fear approach, which can be used in research and exposure therapy treatment for anxiety-based disorders. [ABSTRACT FROM AUTHOR]

Background and Objectives Surgery to masculinize the chest is a frequently sought-after procedure by transmen who wish to conform their physical appearance to their gender identity. In our study, the outcomes of surgical masculinization comprising subcutaneous mastectomy through a modified elliptical incision, liposuction, reduced inert nipple–areola grafting, and quilting stitches were analyzed. Materials and Methods Thirty-two transmen with large breasts and hypertrophied nipples and areolae underwent the above-mentioned masculinizing procedure in this prospective cohort study. Our statistically validated institutional aesthetic outcome assessment score (IAOAS) was used to analyze the outcomes at the end of the follow-up period. Results The average period of follow-up was 24.5 months. The average final IAOAS was 23.1. The rate of complications was found to be associated with using breast binders. In all, 22 of 32 patients (68.75%) had an excellent outcome score, while 10 patients (31.25%) had a good outcome score (p = 0.025). Conclusion Top surgery is crucial for transmasculine patients to achieve their desired gender identity as males. It is imperative that this procedure is performed to their complete satisfaction. Our single-staged comprehensive approach of subcutaneous mastectomy and liposuction with reduced inert nipple and areola grafts, which aids in a swift transition to a male role, is a prerequisite for bottom surgery at our institute. [ABSTRACT FROM AUTHOR]

In 2012, transgender persons in Pakistan were granted right for a legal third gender identity, and in 2018 the Transgender Persons (Protection) of Rights Act affirmed transgender people's right for self-perceived identity. Further, gender affirming medical treatments were also legalized to support gender transitioning in transgender persons. The current study was conducted to explore barriers faced by female-to-male (FtM) transgender persons/trans men in accessing gender affirmative treatment for the purposes of gender transition. To achieve the objective, 11 trans men were interviewed who had Childhood Onset of Gender Dysphoria screened through Urdu translated versions of Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults and Recalled Childhood Gender Identity Questionnaire. Semi-structured in-depth interviews were conducted and grounded theory method was used for analysis. Analysis revealed medical, educational, social, legal, religious, financial, and psychological barriers that participants faced during the process of transitioning. Findings are discussed within the cultural context of Pakistan and in light of the existing literature. The findings of this research would help clinicians, academicians, policy makers and other stake holders in raising awareness regarding problems faced by FtM transgender persons. [ABSTRACT FROM AUTHOR]

Background: Past research on polycystic ovary syndrome (PCOS), a chronic endocrine condition, has focused on the experiences of cisgender women. Aims: The purpose of the present study was to address the knowledge gap about gender-diverse individuals by exploring their lived experiences with PCOS and to better understand if and how their gender identity affected their experience of PCOS. Methods: To explore this, we recruited nine non-binary people and one transgender man with a PCOS diagnosis for qualitative interviews. Results: Three overarching themes emerged: PCOS as a burden, PCOS as an occasion, and PCOS as a benefit. While some aspects of PCOS created an additional burden for our participants, other symptoms such as excess body and facial hair could be empowering and affirming, revealing a positive aspect of this chronic condition. Conclusion: This study is the first to describe the lived experiences of gender-diverse individuals with PCOS, uncovering burdens as well as some benefits. Future research in this population may reveal not only the particulars of what PCOS is like for them but also more generalizable insights into the highly gendered perception and treatment of PCOS. [ABSTRACT FROM AUTHOR]

Introduction: Using Asia’s first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea. Methods: We analyzed a two-wave (2020–2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transitionrelated healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD. Results: Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21–2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD. Conclusion: In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination. [ABSTRACT FROM AUTHOR]

The fearless ancient Amazons have been seen as forebears and prototypes by lesbians, feminists, and transgender men. In this introduction, I will explore why the Greek legends of the Amazons lend themselves to such interpretation. Ancient Greek literature details how the Amazons challenged patriarchy, lived without men, and defeated their male enemies, thus setting a precedent that would later be emulated by feminists and lesbians. Though the Amazons are clearly designated as women they are also identified with men in ancient Greek lore; in ancient Greek vase painting, they wear masculine outfits and engage in masculine habits, including fighting and hunting. Thus I will examine the Amazons' gender transgression in ancient Greek contexts in order to understand how and why these myths set the stage for the adoption of the Amazons as role models by later generations of gender nonconformists. I will also briefly examine the history behind those myths, a history which is just as important to lesbian and other queer communities as the myths which it spawned. Finally, I will weave my analysis of the ancient Greek ideology of Amazons with innovative, new research on the reception of the Amazons found in the six other articles that make up this special edition. These essays explore the powerful place of Amazons and Amazon-like women in the imaginaries of peoples ranging from the ancient Romans to modern lesbian feminists, and the importance of historical and legendary warrior women who defied patriarchy and colonialism in locales ranging from the West to Africa to India. [ABSTRACT FROM AUTHOR]

Background: Comprehensive healthcare for patients with gender dysphoria includes access to gender‐affirming hormone therapy. It may cause cutaneous and adnexal side effects, which often affect quality of life, are underdiagnosed, and do not receive timely treatment. The literature on this subject is scarce. The main objective was to identify skin manifestations secondary to hormone treatment in adults with gender dysphoria. Methods: Observational, descriptive, cross‐sectional study. A search was performed in the database of patients with gender dysphoria older than 18 years treated at the dermatology and/or endocrinology outpatient clinic of the Hospital de San José de Bogotá in the period 2015–2021. Medical records of patients on hormone therapy with skin manifestations were selected, while patients using other medications as possible triggers were excluded. Results: In total, 85 patients were included, with a predominance of young transgender men (average age was 27 ± 9 years) in whom the main manifestation was acne (87%), followed by androgenetic alopecia and acanthosis nigricans. Transgender women presented more acne, androgenetic alopecia, hypertrichosis, seborrheic dermatitis, and melasma. The majority received treatment, mainly topical therapies. More than half of the patients were treated by the endocrinology and dermatology services. Conclusions: Skin manifestations in patients with gender dysphoria on hormone therapy are frequent, so they should be known and taken into account in the multidisciplinary approach to these patients, which should involve dermatologists. This is the first Colombian and Latin American study focused on documenting skin manifestations in patients with gender dysphoria undergoing hormone therapy. [ABSTRACT FROM AUTHOR]

Background: The risk of breast cancer in trans men is currently a poorly understood subject and trans men likely carries a different level of risk from that of cis women. Aim: This review aims to review several aspects that affects breast cancer risk in trans men and to apply the Swiss cheese model to highlight these risks. The study takes its cue from a systematic review of all described breast cancer cases in trans men following medical or surgical intervention because of gender dysphoria. Methods: PubMed was systematically searched on the 14th of March 2023 to find all published cases of breast cancer following chest contouring surgery in trans men. Included articles had to involve trans men, the diagnosis of breast cancer had to be preceded by either a medical or surgical intervention related to gender dysphoria, and cases needed to involve invasive breast cancer or ductal carcinoma in situ. Articles were excluded if gender identity in the case subject was unclear and/or a full English version of the report was unavailable. Quality and risk of bias was evaluated using the GRADE protocol. A literature review of specific risk altering aspects in this population followed. The Swiss cheese model was employed to present a risk analysis and to propose ways of managing this risk. Results: 28 cases of breast cancer in trans men have been published. The Swiss cheese model identified several weaknesses associated with methods of preventing breast cancer in trans men. Clinical implications: This study may highlight the difficulties with managing risk factors concerning breast cancer in trans men to clinicians not encountering this patient group frequently. Conclusion: This review finds that evidence for most aspects concerning breast cancer in trans men are inadequate, which supports the establishment of a risk-management approach to breast cancer in trans men. [ABSTRACT FROM AUTHOR]

This article proposes a methodology of reaching in historicity. It does so by tracing the technical object of synthetic testosterone as it has been used by trans people for gender affirming care. To show the usefulness of the method, this article employs it first in relation to mentions of synthetic testosterone in the South African Medical Journal as a primer to understanding its relationship to the state and the law in South Africa from 1963 to 2003, reaching an apex in the Cape Town Transsexual/Transgender Groups advocacy for self‐identification, much of which hinged on the role of synthetic testosterone. [ABSTRACT FROM AUTHOR]