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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]

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]

The psychological challenges associated with gender identity in developing countries like India are only recently receiving research attention. The study aimed to understand self-esteem, perceived social support, and depression among trans men in India. A comparative analysis was also undertaken between those who have and have not undergone sex reassignment surgery. The sample comprised 30 trans men, out of which 15 had undergone sex reassignment surgery and 15 had not. The Multidimensional Scale of Perceived Social Support, Rosenberg Self-esteem Scale, and Beck's Depression Inventory-II were used. Perceived social support from family and friends was found to be a significant predictor of self-esteem. Support from all three sources—family, friends, and significant others significantly predicted depression among the total sample. Trans men who had undergone sex reassignment surgery, reported higher self-esteem and lower depression levels, as compared to those who were yet to undergo surgery. The findings highlighted the contribution of social support in fostering the mental health of trans men. The consequent psychological benefits of surgery were also demonstrated. The study has implications for planning and designing mental health interventions for this community. [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]

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]

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]

Intensive longitudinal designs have been increasingly leveraged to examine short-term risk factors for suicidal ideation and intent. Less understood, however, are factors that may increase risk for momentary engagement in suicidal behaviors (i.e., plans, preparations, and attempts). The present study examines commonly cited transdiagnostic suicide risk factors as predictors of suicidal behaviors at the prompt-, day-, and participant-levels using ecological momentary assessment (EMA). A sample of 237 community-based adults at high risk for suicide (Mage = 27.12 years, 61.6% cisgender women) completed six EMA prompts per day for two weeks. Three-level multilevel models, nesting prompts (Level 1) within days (Level 2) within participants (Level 3), were used to examine concurrent and prospective predictors of suicidal behaviors. Several factors, including general rumination (OR = 2.03, p =.049), suicide-specific rumination (OR = 13.88, p <.001), physical distance to suicide methods (OR = 3.09, p =.002), psychological distance to suicide methods (OR = 2.34, p =.042), and life event stress (OR = 1.96, p <.001), were significant prompt-level predictors of concurrent suicidal behaviors. However, no significant day-level or participant-level predictors of concurrent suicidal behaviors emerged. Furthermore, prospectively, there were no significant predictors of subsequent time-point suicidal behaviors at any level. Overall, this study provides preliminary evidence for the roles of perseverative thinking, lethal means accessibility, and stressful life events as correlates of suicidal behaviors. Notably, however, these findings also highlight the difficulties in predicting future suicidal behaviors. [ABSTRACT FROM AUTHOR]

This study aims to investigate the employment situation of trans people in the context of the Southern European welfare regime in Turkey. We observe that the welfare state has emerged as a product of the Industrial Revolution towards the end of eighteenth century. The Industrial Revolution led to a diversification of products in manufacturing along with technological change and reforms in this era brought many variations in social, economic, political, and cultural fields. Within this context, the Southern European welfare regime plays a critical role in establishing a patriarchal system, a gender-based division of labor, and sexual orientation and gender identity categories that are rejected in culture and the system. By looking at the previous studies that collected limited data, we aim to present the yearly changes in the employment rate and the situation of trans people in Turkey. Due to the hostile work environment, inadequate policies and actions, and the discrimination against trans people, the employment rate of both trans women and trans men working in the public sector is very low. Not surprisingly, the situation is not different for the trans individuals working in the private sector. [ABSTRACT FROM AUTHOR]

Trans people face numerous barriers to access and permanence in health services, which makes it difficult, among other things, to know about their quality of life and satisfaction with health services related to these users. Thus, the objective was to describle the quality of life and satisfaction with pharmacotherapeutic follow-up in transgender people. A cross-sectional, descriptive, and quantitative study was conducted between January and September 2022 at a specialized outpatient clinic for transgender individuals. The following aspects were describle: sociodemographic and medication profiles; quality of Life, which was measured using the WHOQOL-BREF questionnaire; and levels of satisfaction with Pharmacotherapeutic Monitoring, assessed through the Pharmacy Services Satisfaction Questionnaire (QSSF). Descriptive analyses employed measures of central tendency, absolute and relative frequencies, while inferential analyses used the Student's t test. A total of 101 transgender individuals participated in the study, with a mean age of 25 years, the majority being single (79.2%/80), having more than 11 years of education (47.5%/n = 48), and comprising 48.5% (n = 49) transgender women. Hormone use was reported by 59.4% (n = 60) of the participants, with 18.3% (n = 11) of self-medication. Testosterone cypionate was the most common hormone used by transgender men (84%), while cyproterone acetate and estradiol represented 60.4% of hormone use among transgender women. Additionally, 36 transgender individuals were taking other drugs (n = 60), mainly antidepressives (28%). The WHOQOL-BREF showed higher scores in the domains of self-rated Quality of Life, and physical, and psychological well-being among transgender women compared to transgender men, but without statistical differences. Income revealed a statistically significant association with psychological domains and overall quality of life. The results of the QSSF indicated that the overall mean and average scores per question were higher than 4, suggesting that 100% of the sample was satisfied with the provided service. No statistically significant differences were observed in the Quality of Life between transgender men and women, but income was associated with the psychological domain and overall Quality of Life. All participants reported satisfaction with the Pharmacotherapeutic Monitoring service; however, there is a need to expand service offerings, such as medication dispensing. [ABSTRACT FROM AUTHOR]

Gender identity refers to the consciousness of being a man, a woman or other condition. Although it is generally congruent with the sex assigned at birth, for some people it is not. If the incongruity is distressing, it is defined as gender dysphoria (GD). Here, we measured whole-genome DNA methylation by the Illumina © Infinium Human Methylation 850k array and reported its correlation with cortical thickness (CTh) in 22 transgender men (TM) experiencing GD versus 25 cisgender men (CM) and 28 cisgender women (CW). With respect to the methylation analysis, TM vs. CW showed significant differences in 35 CpGs, while 2155 CpGs were found when TM vs. CM were compared. With respect to correlation analysis, TM showed differences in methylation of CBLL1 and DLG1 genes that correlated with global and left hemisphere CTh. Both genes were hypomethylated in TM compared to the cisgender groups. Early onset TM showed a positive correlation between CBLL1 and several cortical regions in the frontal (left caudal middle frontal), temporal (right inferior temporal, left fusiform) and parietal cortices (left supramarginal and right paracentral). This is the first study relating CBLL1 methylation with CTh in transgender persons and supports a neurodevelopmental hypothesis of gender identity. [ABSTRACT FROM AUTHOR]

To achieve stated targets in the United States of Ending the HIV Epidemic by 2030, it is necessary to decrease rates of pre-exposure prophylaxis use (PrEP) cessation. In particular, it is key to assess PrEP use and cannabis use frequency given the recent wave of cannabis decriminalization across the U.S., particularly among sexual minority men and gender diverse (SMMGD) individuals. We used data from the baseline visit of a national study of Black and Hispanic/Latino SMMGD. Among participants reporting any lifetime cannabis use, we further assessed the association between frequency of cannabis use in the past 3 months and: (1) self-reported PrEP use, (2) recency of last PrEP dose, and (3) HIV status using adjusted regression models. Compared to those who never used cannabis, odds of PrEP cessation were higher among those who used it once or twice (aOR 3.27; 95% CI 1.38, 7.78), those who used it monthly (aOR 3.41; 95% CI 1.06, 11.01), and those who used it weekly or more frequently (aOR 2.34; 95% CI 1.06, 5.16). Similarly, those reporting cannabis use 1–2 times in the past 3 months (aOR 0.11; 95% CI 0.02, 0.58) and those reporting weekly or more frequent use (aOR 0.14; 95% CI 0.03, 0.68) were each more likely to report more recent PrEP cessation. These results suggest that cannabis users in general may be a population at elevated risk of HIV diagnosis although more research regarding these findings is needed with nationally representative populations. [ABSTRACT FROM AUTHOR]

Introduction: Social isolation and reduced access to public life in response to SARS-CoV-2 (COVID-19) challenges health and well-being for many. Marginalized communities, including transgender and gender diverse (TGD) people, have been disproportionally impacted. Experiences of TGD people should be centered in pandemic-related research to better inform policy. Methods: A diverse sample of TGD people (N = 158) were recruited from Michigan, Nebraska, Oregon, and Tennessee to participate in the Trans Resilience and Health Study. Participants ranged from 19 to 70 years old (M = 33.06; SD = 12.88) with 27.2% identifying as trans men/men, 26% identifying as trans women/women, and remaining identifying with terms like genderqueer and nonbinary. Thirty percent identified as people of color. Participants completed a monthly COVID-19-related questionnaire April 2020–March 2021 including open-ended questions to learn what contributed to resilience during this time. Thematic analyses of responses enabled identification of salient themes. Results: Analyses revealed pandemic-related changes in social experiences of marginalization and mask-wearing. Twenty-six participants mentioned face masks as contributing to resilience while also elaborating the influence of masks on experiences of misgendering. Participants identifying as trans women reported decreased misgendering while trans men and nonbinary participants reported increased misgendering. Conclusions and Policy Implications: Mask-wearing helps reduce transmission of COVID-19. For some trans women, masks also reduce the threat of misgendering and possibly other forms of enacted stigma. However, increased risk for misgendering, as noted by trans men in our study, should be considered and increased supports should be provided. [ABSTRACT FROM AUTHOR]

The article presents the discussion on poem offers a personal political creative refection on the Gender Recognition Reform. Topics include broader project addressing trans, intersex and LGBTI activist relationships across the UK, Malta and Australia; and finding psychological and gender dysphoric-based inclusion of trans identities exclusionary and pathologising.

Introduction: The present study focuses on the microaggressions that transmasculine individuals are subjected to by their gynecological healthcare providers. While microaggressions have begun to be more frequently studied in the literature, no studies currently exist that examine how they are experienced by trans individuals undergoing gynecological care. Methods: Participants included 131 transmasculine adults who ranged in age from 18 to 49 (M = 27.12, SD = 5.77). Data were collected between January and March of 2020. Results: Results were analyzed via thematic analysis and revealed six data salient themes: (1) systemic erasure of identity, (2) societal parentification of medical providers, (3) environmental microaggressions, (4) trans medicalization, (5) rejection of identity, and (6) educational burdens. Conclusions: Discussion centers on how to use an understanding of microaggressions to improve gynecological care for trans patients. Policy Implications: Through understanding the microaggressions gynecologists perpetuate against trans patients, scholars can develop interventions designed to educate medical providers and implement medical-related policy changes to further protect transmasculine individuals as a marginalized population. [ABSTRACT FROM AUTHOR]

The article "Evaluation of Sexual Function of Transgender Individuals" by Roncato et al. aims to describe the sexual function of transgender individuals using validated questionnaires and a semi-structured questionnaire developed by the authors. The study found that both trans men and women reported high levels of sexual dysfunction, with trans women experiencing more dysfunction than trans men. The authors also noted a discrepancy between the results from validated questionnaires used in cisgender populations and their own questionnaire developed for the trans population. This article highlights the need for validated measures in order to provide appropriate sexual health care for trans individuals and conduct further research in this area. The authors emphasize the importance of addressing sexual dysfunction in trans patients and including them in pelvic floor research. [Extracted from the article]

The sexual partnerships of transmasculine (TM) adults—those assigned female at birth who identify as transgender men or a masculine spectrum gender identity—and characteristics associated with STI/HIV risk behavior remains understudied. Participants in the current study were TM adults (n = 141) receiving care at a community health center in Boston, Massachusetts between March 2015 and September 2016. Using generalized estimating equations, we examined individual- and partnership-level factors associated with TM adults' odds of engaging in sexual behavior with a sexual partner of unknown STI/HIV status in the past 12 months. TM adults with casual sexual partnerships (vs. monogamous partnerships) and those in partnerships with cisgender men, other TM individuals, or transfeminine partners (vs. cisgender women) had statistically significantly higher odds of engaging in sexual behavior with a partner of unknown STI/HIV status in the past 12 months. Findings may inform future efforts to improve sexual health communication and STI/HIV disclosure between TM adults and their sexual partners. [ABSTRACT FROM AUTHOR]

Nipple-areola reconstruction is an integral part of breast reconstruction surgery. It has been shown to improve psychological and psychosexual outcomes after breast cancer surgery. There are many techniques that describe reconstruction of the nipple-areola complex including local flaps, free nipple grafts, tattooing, and combinations of all these. In transgender men, there is very little data available on chest disparity and nipple-areola reconstruction. However, it is now known that most surgeons prefer to use free nipple grafting over other techniques to accomplish their goals in chest masculinization. We present a case in which our patient who was in a same sex relationship had right sided breast cancer and was due for a modified radical mastectomy on the right side and a prophylactic mastectomy on the left side. She did not want breast mound reconstruction but wanted to keep her nipples with a more masculine appearing chest. Since we had only one native nipple to work with, we developed a novel design to accomplish our reconstructive goal. We decided to call this technique the Yin-Yang nipple-areola reconstruction based on its design pattern. This technique is easily reproducible and is based on the principles of free nipple grafting offering all its benefits. It can be applied on a wider set of patients; however, a larger cohort, longer follow-up time and comparison with other techniques need to be done. Level of evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

Spirituality is a well-established protective psychosocial determinant of health. The current study examined the psychometric properties of the Daily Spiritual Experiences Scale (DSES) among Black gay, bisexual and other sexual minority men (SMM) and Black transwomen (TW) in the Deep South. Data were collected via self-interview technology and analyzed using factor analyses and correlation coefficients. We demonstrated a single-factor structure of the DSES with high internal consistency (Cronbach's α = 0.96). DSES was positively and significantly associated with multiple dimensions of religion, resilience, optimism and social support and not significantly associated with cynicism and anger expressions. Spirituality should be included in HIV prevention, treatment and care strategies focused on Black SMM and Black TW, especially those residing in the Deep South, USA. [ABSTRACT FROM AUTHOR]

This article discusses the employment situation of transgender individuals in Turkey, focusing on the challenges they face in the workplace. The authors highlight the discrimination and mistreatment experienced by trans people, including job loss, workplace discrimination, and violence. They also note the high levels of unemployment and poverty among trans individuals, which often leads them to participate in the underground economy. The authors conclude by offering policy recommendations to address employment discrimination and workplace issues faced by trans people in Turkey. [Extracted from the article]

In 2014 approximately 14.4% of Americans ages 18 to 24 had some type of disability. Compared to their peers without disabilities, disabled emerging adults typically have more difficulty dating and finding romantic and sexual partners. One way that they may escape disability stigma and smaller dating pools is through online dating. However, little is known about their experiences seeking romantic and sexual relationships online, and even less is known about the experiences of emerging adults with disabilities who identify with sexual orientations and have gender identities that are not heterosexual or cisgender. In the present study 27 LGBTQ+ emerging adults with various disabilities, genders, and sexual orientations completed 47 item online surveys before COVID in which they described their experiences with online dating and starting and sustaining romantic relationships. Results from qualitative data analyses suggest that rather than being neutral spaces that exist separately from stigma and social prejudice, dating apps and web sites typically perpetuate normative ideas of ableism, sexuality, and gender and stimulate questions of timing of disability disclosure. Despite challenges, however, online dating also offers opportunities to interact with multiple interested daters and appears to offer LGBTQ+ emerging adults with disabilities an often beneficial though sometimes vexing venue for relationship development. [ABSTRACT FROM AUTHOR]

Purpose: A disparity exists in cancer screening rates for the Sexual and Gender Minority (SGM) community. We sought to understand the perceptions and baseline knowledge of cancer screening among SGM community members.Methods: Survey administered via social media from June 2018 to October 2018. We asked 31 questions focused on cancer screening, human papillomavirus, emotional distress, and experience with the health care system. Those included were 18 years or older. Cancer screening attitudes and knowledge, as well as perceptions of the health care system were investigated.Results: There were 422 respondents analyzed: 24.6% identified as female, 25.5% as male, 40.1% transgender, and 9.6% as other. 65.4% of the SGM community is not certain what cancer screening to do for themselves. Only 27.3% and 55.7% knew that HPV was a risk factor associated with head and neck cancer and anal cancer, respectively. Half stated their emotional distress prevents them from getting cancer screening. It was identified that process changes in making appointments, comforts during the visit, and formal training for physicians and nurses could increase cancer screening compliance for this community. The transgender population had a trend in more gaps in knowledge of appropriate cancer screening and significant excess emotional distress.Conclusion: Gaps in cancer screening knowledge and emotional and financial distress may be responsible for the disparity of lower cancer screening rates for the SGM population and the transgender population may be most at risk. Appreciating the cancer screening concerns of the SGM population can help shape future clinical and institutional approaches to improve health care delivery. [ABSTRACT FROM AUTHOR]

This article describes the clinical outcomes after implantation of the erectile prosthesis for phalloplasty in trans men. Demographic data, type of prosthesis (hydraulic or semi-rigid), operative data and intra- and post-operative complications were collected. In addition, it was examined what percentage of the men were sexually active with penetrative sex. Of the 18 semi-rigid erectile prostheses, one was removed due to impending erosion and four were switched to the hydraulic one. Of these 42, four (9.5%) were removed because of an infection, in four men a (9.5%) longer prosthesis was placed and five (11.9%) reoperations were performed due to material problems. Implantation of the erectile prosthesis developed for phalloplasty shows favorable results. The majority of men are capable of penetrative sex. [ABSTRACT FROM AUTHOR]

This work examines the irritating awareness of the culturally conditioned attachment of one's own perceptions of gender difference and identity. The article addresses the uncertainties both personal and also theoretical, when we consider gender not only as biologically natural as in Freud but also as socially, culturally and historically constructed. These irritations and (un)certainties in gender, which masquerade as certainties, become apparent in a psychoanalytic treatment of a trans man and become active in the analyst's countertransference. Being able to hold gender irritations and (un)certainties within oneself is seen as an equally important task as avoiding a slide into pathologization and standardization of the gender in the thinking of the treating psychoanalyst and in psychoanalytic discourse. [ABSTRACT FROM AUTHOR]

Large-scale brain network interactions have been described between trans- and cis-gender binary identities. However, a temporal perspective of the brain's spontaneous fluctuations is missing. We investigated the functional connectivity dynamics in transmen with gender incongruence and its relationship with interoceptive awareness. We describe four states in native and meta-state spaces: (i) one state highly prevalent with sparse overall connections; (ii) a second with strong couplings mainly involving components of the salience, default, and executive control networks. Two states with global sparse connectivity but positive couplings (iii) within the sensorimotor network, and (iv) between salience network regions. Transmen had more dynamical fluidity than cismen, while cismen presented less meta-state fluidity and range dynamism than transmen and ciswomen. A positive association between attention regulation and fluidity and meta-state range dynamism was found in transmen. There exist gender differences in the temporal brain dynamism, characterized by distinct interrelations of the salience network as catalyst interacting with other networks. We offer a functional explanation from the neurodevelopmental cortical hypothesis of a gendered-self. [ABSTRACT FROM AUTHOR]

Although risk behaviors could place transgender people at increased risk of anal cancer, few studies have examined anal cancer knowledge and screening use among this population. This study assessed knowledge of anal cancer and associated screening tools, self-perceived risk for anal cancer, and willingness to undergo anal cytology testing among transgender persons in an HIV/sexually transmitted infection (STI)-dense region. Adult transgender persons were recruited locally and surveyed electronically. Descriptive statistics, student's t tests, ANOVA, and Pearson's chi-squared test were performed. Among 79 transgender persons, identified anal cancer risk factors included smoking, STI history, anoreceptive intercourse, and inconsistent condom use. Nearly half (43%) reported little to no knowledge of anal cancer. The vast majority (82%) had little to no perceived risk of developing anal cancer. Twenty-eight percent had heard of anal cytology, and few (17%) had undergone it. Despite susceptibility, transgender persons lack knowledge and have a low perception of personal risk of anal cancer, highlighting the need to increase awareness of anal cancer, risk factors, and screening methods among this population. [ABSTRACT FROM AUTHOR]

To carry out a systematic review of the literature and meta-analysis to identify studies or data that evaluated the patient's QoL after gender affirmation surgery. Data was collected from PubMed, Scielo, Google Scholar, and Science Direct from the inception of each database to 26 June 2018, in English, Spanish, and Portuguese. A network meta-analysis was applied and a two-tailed p value < 0.05 was the criterium of statistical significance. GRADE was used to assess the overall quality of evidence for each outcome collected. From 2843 articles, 14 studies met the inclusion criteria of the systematic review with 881 individuals. The majority of the 14 included studies originated from Europe. Seven studies involving 420 individuals met the criteria for inclusion in the meta-analysis. Statistical heterogeneity of the results was significant. Evidence of low quality suggests that gender affirmation surgery will likely improve the QoL of transgender individuals. Better overall QoL results were found in the trans men population that underwent chest surgery. [ABSTRACT FROM AUTHOR]

Some transgender men who have sex with men (trans MSM) are vulnerable to HIV infection and face stigma from sexual partners. We evaluated a brief 4-item measure of gender non-affirmation from cisgender male partners. A non-probability sample of American trans MSM (n = 843) reporting past 6-month sexual contact with a cisgender male completed a cross-sectional survey. Psychometric analyses assessed the scale and modeled HIV risk associations. Overall, 78% experienced past 6-month gender non-affirmation from cisgender male partners. The scale demonstrated good reliability (α = 0.78). Convergent validity was supported in associations with psychological distress and anxiety (p < 0.05). Lower frequency of cisgender male partner stigma was associated with increased odds of past 6-month HIV testing and decreased odds of past 6-month condomless receptive sex (all p < 0.01). The gender non-affirmation from cisgender male sexual partners scale found negative associations with protective health behaviors and can be used to better understand the context of trans MSM risk behavior. [ABSTRACT FROM AUTHOR]

This article examines the influence of geographic location on trans men's desire to pass in the southeastern United States. Through 51 in-depth interviews with trans men, I find three key reasons for passing in the South: 1) self-confidence and psychological health; 2) the privileges of being a man; and 3) safety and fear of violence. These motives for passing are amplified in the South, where transphobic and homophobic incidences of discrimination and fear are elevated. The trans men in this study linked their increased desire to pass in the South to conservative religion, racism, and increased fear of violence. Although passing was important for all but one respondent, some of the men also discussed problems with the concept of passing and the negative consequences of passing as cis men. [ABSTRACT FROM AUTHOR]

The present study assessed the prevalence of sexually transmitted infections (STIs) in 90 transsexual men (female-to-male transsexual persons) from southern Brazil. A retrospective review of the medical records of all transsexual men who visited an outpatient clinic in Rio Grande do Sul from 1998 to 2017 was performed. Although the sample had a high prevalence of risk factors for contracting STIs, such as drug use, one-third of the participants had never been tested for STIs and, when screened, it was mostly for HIV, but not for syphilis or other STIs. Based only on laboratory-tested transsexual men, the prevalence of syphilis and hepatitis C was 3.4% and 1.6%, respectively, which is higher than the general population. It is clear that health professionals need to broaden their understanding of transsexual men, acknowledging STIs as a possible diagnosis. [ABSTRACT FROM AUTHOR]

It is well known that sex steroids, particularly estrogen, play a crucial role in the attainment and maintenance of peak bone density in all people. Transgender (trans) have been frequently observed to have low bone density prior to initiation of gender-affirming hormone therapy, while trans men generally do not. With pharmacologic estrogen, many studies show improving bone density in trans women. With pharmacologic testosterone, bone density in trans men remains largely unchanged although androgens have indirect effects on bone health via changes in fat and lean mass. Much remains unknown about best practices to optimize bone health, interpret DXA scans and assess fracture risk in trans adults. [ABSTRACT FROM AUTHOR]

Purpose: Despite a variety of free flaps that have been described for creation of the neophallus in gender affirmation surgery, none present an ideal solution. We evaluated our patients and outcomes after gender affirmation phalloplasty using musculocutaneous latissimus dorsi free flap. Methods: Between January 2007 and May 2017, 129 female transsexuals, aged 20–53 years (mean 24 years) underwent total phalloplasty using latissimus dorsi free flap. Urethral lengthening was performed by combining a vaginal flap, labia minora flaps and a clitoral skin flap. Suitable sized testicular implants are inserted into the new scrotum. Penile prosthesis implantation, additional urethral lengthening and glans reshaping were performed in the following stages. Results: The mean follow-up period was 43 months (ranged from 13 to 137 months). There were one partial and two total flap necrosis. The average size of the neophallus was 14.6 cm in length and 12.4 cm in girth. Total length of the reconstructed urethra during the first stage ranged from 13.4 to 21.7 cm (mean 15.8 cm), reaching the proximal third or the midshaft of the neophallus in 91% of cases. Satisfactory voiding in standing position was confirmed in all patients. Six urethral fistulas and two strictures were observed and repaired by minor revision. Malleable and inflatable prostheses were implanted in 39 and 22 patients, respectively. Conclusion: Musculocutaneous latissimus dorsi flap is a good choice for phalloplasty in gender affirmation surgery. It provides an adequate amount of tissue with sufficient blood supply for safe urethral reconstruction and penile prosthesis implantation. [ABSTRACT FROM AUTHOR]

The present study tested a three-component model of homophobia and transphobia that differentiates between general and specifically gender-based social threats that motivate these prejudices. A sample of 187 female and 107 male heterosexual U.S. college undergraduates were randomly assigned to complete survey measures of homophobia and transphobia with either born-female (lesbian and female-to-male transgender, respectively) or born-male (gay man and male-to-female transgender, respectively) targets, as well as measures of religious fundamentalism, right wing authoritarianism, aggression, and ambivalent sexism. The participant by target-gender interaction for transphobia showed that transphobia was particularly high for male participants judging born-male transgender targets. Possibly reflecting a fear of any social non-conformity, religious fundamentalism and right wing authoritarianism were positively correlated with homophobia and transphobia regardless of participant or target gender. Possibly reflecting specific fears among men about threats to male privilege, physical aggression proneness was strongly positively correlated with homophobia and transphobia for men judging a male target. Aggression proneness was also positively correlated with homophobia for women judging a female target. Possibly reflecting specific fears among women about threats to female social roles, benevolent sexism was only positively correlated with transphobia for female but not for male participants, with no target-gender difference. Benevolent sexism was also correlated with homophobia for female participants judging a male target. These findings were largely supportive of the three-component model of gender-based prejudice. [ABSTRACT FROM AUTHOR]

Body dissatisfaction plays an important role in the development of psychiatric problems such as eating disorders as well as gender dysphoria (GD). Cross-sex hormonal treatment (CHT) alleviates the dissatisfaction by making various changes in the body. We examined the alteration of body uneasiness, eating attitudes and behaviors, and psychological symptoms longitudinally in Turkish participants with female-to-male gender dysphoria (FtM GD) after CHT. Thirty-seven participants with FtM GD and 40 female controls were asked to complete the Body Uneasiness Test to explore different areas of body-related psychopathology, the Eating Attitudes Test to assess eating disturbances, and the Symptom Checklist-90 Revised to measure psychological state, both before CHT and after 6 months of CHT administration. The baseline mean body weight, BMI scores, body uneasiness scores, and general psychopathological symptoms of participants with FtM GD were significantly higher than female controls, whereas baseline eating attitudes and behaviors were not significantly different. Over time, FtM GD participants' mean body weight and BMI scores increased, body uneasiness and general psychopathological symptoms decreased, and eating attitudes and behaviors had not changed at 24th weeks following CHT administration compared to baseline. CHT may have a positive impact on body uneasiness and general psychopathological symptoms in participants with FtM GD. However, CHT does not have an impact on eating attitudes and behaviors. [ABSTRACT FROM AUTHOR]

Voices convey important social information about an individual's identity, including gender. This is especially relevant to transgender individuals, who cite voice alteration as a primary goal of the gender alignment process. Although the voice is a primary target of testosterone therapy among female-to-male (FTM) trans people, little research has explored the effects of such changes on their psychological well-being. Here, we investigated how FTMs' vocal gender related to their well-being. A total of 77 FTMs (M age = 25.45 years, SD = 6.77) provided voice samples and completed measures of their well-being and psychological health. An independent group of 32 naïve raters (M age = 22.16 years, SD = 8.21) subsequently rated the voice samples for masculinity. We found that FTMs whose voices sounded more congruent with their experienced gender (i.e., sounded more masculine) reported greater well-being (better life satisfaction, quality of life, and self-esteem; lower levels of anxiety and depression) than FTMs with less gender congruent (i.e., more feminine) voices (β = .48). The convergence between outwardly perceived vocal gender and gender identity brought about through hormone replacement therapy may therefore support greater well-being for FTMs. [ABSTRACT FROM AUTHOR]

Diffusion-weighted imaging (DWI) is used to measure gray matter tissue density and white matter fiber organization/directionality. Recent studies show that DWI also allows for assessing neuroplastic adaptations in the human hypothalamus. To this end, we investigated a potential influence of testosterone replacement therapy on hypothalamic microstructure in female-to-male (FtM) transgender individuals. 25 FtMs were measured at baseline, 4 weeks, and 4 months past treatment start and compared to 25 female and male controls. Our results show androgenization-related reductions in mean diffusivity in the lateral hypothalamus. Significant reductions were observed unilaterally after 1 month and bilaterally after 4 months of testosterone treatment. Moreover, treatment induced increases in free androgen index and bioavailable testosterone were significantly associated with the magnitude of reductions in mean diffusivity. These findings imply microstructural plasticity and potentially related changes in neural activity by testosterone in the adult human hypothalamus and suggest that testosterone replacement therapy in FtMs changes hypothalamic microstructure towards male proportions. [ABSTRACT FROM AUTHOR]

We surveyed 122 trans men using a hybrid sampling method that included randomly selected physical and online venues and peer referral to measure HIV prevalence and risk behaviors. HIV prevalence was 0% (one-sided 97.5% confidence interval 0-3.3%). Of 366 partnerships described, 44.8% were with cisgender women, 23.8% with cisgender men, 20.8% with trans men, and 10.7% with trans women. Condomless receptive anal and front hole/vaginal sex averaged one to three episodes per six months. HIV prevalence in trans men is likely closer to heterosexual cisgender men and women in San Francisco than trans women or MSM. Prevention prioritizing trans women and MSM, coupled with individualized and relevant sexual health education for trans men with partners from these populations, may best address the HIV prevention needs of trans men. Systematic collection of transgender status in Census and health data is needed to understand other health disparities among trans men. [ABSTRACT FROM AUTHOR]

The present review focuses on the brain structure of male-to-female (MtF) and female-to-male (FtM) homosexual transsexuals before and after cross-sex hormone treatment as shown by in vivo neuroimaging techniques. Cortical thickness and diffusion tensor imaging studies suggest that the brain of MtFs presents complex mixtures of masculine, feminine, and demasculinized regions, while FtMs show feminine, masculine, and defeminized regions. Consequently, the specific brain phenotypes proposed for MtFs and FtMs differ from those of both heterosexual males and females. These phenotypes have theoretical implications for brain intersexuality, asymmetry, and body perception in transsexuals as well as for Blanchard's hypothesis on sexual orientation in homosexual MtFs. Falling within the aegis of the neurohormonal theory of sex differences, we hypothesize that cortical differences between homosexual MtFs and FtMs and male and female controls are due to differently timed cortical thinning in different regions for each group. Cross-sex hormone studies have reported marked effects of the treatment on MtF and FtM brains. Their results are used to discuss the early postmortem histological studies of the MtF brain. [ABSTRACT FROM AUTHOR]