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Purpose of Review: To review findings related to phantom genital sensation, emphasizing phantom sensation in the transgender and gender diverse (TGD) population. We discuss prevalence, presentation and potential implications for sensory outcomes in genital gender-affirming surgery., Recent Findings: There is a high prevalence of phantom genital sensations in the TGD population. The prevalence varies by body part, approaching 50% in the most frequently reported transgender phantom - the phantom penis. Unlike genital phantoms that occur after trauma or surgery which are often painful, transgender phantoms are typically neutral and often erogenous in experience. Phantom sensation in the TGD population can be an affirming experience and important part of sexual well being and embodiment., Summary: Recent studies have begun to characterize the prevalence and presentations of phantom genital sensations in TGD people, informing our evolving understanding of the sensory experiences of the transgender and gender diverse population. Targeting integration of these centrally-mediated phantom genital sensations with the peripherally generated sensation from genital stimulation may represent one potential avenue to improve sensation and embodiment following genital gender-affirming surgical procedures. Additionally, emerging techniques in modern peripheral nerve surgery targeting phantom pain may offer potential treatment options for painful phantom sensation seen after cases of genital surgery or trauma., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Gender affirming voice training is a service provided by speech language pathologists to members of the trans and gender diverse community. While there is some evidence to support the effectiveness of this training, the evidence base is limited by a lack of prospective studies with large sample sizes. Finally, there has been only limited research investigating the effectiveness of this training when delivered on intensive (compressed) schedules, even though such schedules are used in clinical practice and may have practical benefits such as increasing service access for this vulnerable population., Methodology: This study aimed to investigate and compare the effectiveness gender affirming voice training among 34 trans individuals presumed male at birth aiming to develop a perceptually feminine/female-sounding voice. Among these 34 participants, 17 received their training on a traditional schedule (one 45-minute session per week over 12 weeks) and 17 on an intensive scheduled (three 45-minute sessions per week over 4 weeks). Building on a previous mixed methodological study which indicated that these two training groups were equally satisfied with training outcomes, the current study utilised a wide range of self-report, acoustic, and auditory-perceptual outcome measures (including self-ratings and listener-ratings of voice) to investigate training effectiveness., Discussion: Results from this study indicated that both training programs were similarly effective, producing positive statistically significant change among participants on a range of outcome measures. Participants in both groups demonstrated significant auditory-perceptual and acoustic voice change and reported increased satisfaction with voice, increased congruence between gender identity and expression, and a reduction in the negative impact of voice concerns on everyday life. However, as has been the case in past studies, training was not sufficient for all participants to achieve their goal of developing a consistently feminine/female-sounding voice., Conclusion: This study provides evidence to suggest that gender affirming voice training for transfeminine clients may be similarly effective whether delivered intensively or traditionally. This study provides evidence to support the practice of using a wide range of outcome measures to gain holistic insight into client progress in gender affirming voice training programs., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: The voice is an important parameter for identifying the speaker's gender. Transgender people seek to adapt their bodies to gender identity, and transgender women have greater difficulties in achieving vocal acceptance. In this context, the evaluation of the various parameters of the voice of transgender and cisgender women is essential to make it possible to propose appropriate intervention measures., Objectives: To identify the differences in vocal characteristics of transgender and cisgender women., Methods: An sectional study was conducted. The sample comprised 20 transgender women and 20 cisgender women who underwent evaluation of acoustic parameters, emotional prosody, self-perception, and perception of gender by lay listeners., Results: The vocal characteristics of transgender and cisgender women differ in terms of the following parameters: f0, glottal noise excitation (GNE), vocal intensity, speech range profile (SRP), the first three formants of the vowel /a/, and in terms of emotional prosody, including duration and melodic contour. Higher values ​​were mostly found in the cisgender population, except for noise level and vocal intensity. In addition, in most cases lay listeners identified the voices of transgender women as belonging to the male gender. There was a negative correlation between vocal dissatisfaction and f0 among transgender women., Conclusions: Even though they perform vocal adjustments, the voices of transgender women are different from cisgender women in terms of acoustic parameters, vocal extension, and emotional prosody including duration and melodic contour. These differences have repercussions on the perception of gender by listeners., (Copyright © 2022. Published by Elsevier Inc.)

Aim: Voice interventions for transgender individuals can address several speech and voice parameters - fundamental frequency, resonance, intonation, rhythm, and intensity. In this study, we focus on fundamental voice frequency and build on existing research to test one technique that has been shown in a preliminary study to effectively adjust fundamental voice frequency in line with clients' goals., Method: More specifically, we employed an adaptation of melodic intonation therapy (MIT) to assess whether it can raise trans women's average fundamental frequency to a significant degree. Eleven trans women participated in two one-to-one therapy sessions, four weeks apart., Results: Results pointed to a statistically significant rise in both their singing and speaking fundamental frequencies following the adapted MIT therapy sessions. Participants were also successful in imitating upward fundamental frequency contours when singing and in producing them independently in the speech modality., Future Directions: Longitudinal studies are warranted to determine whether the observed positive results translate into long-term benefits.

Background: Due to recent changes in the legal framework, access to fertility preservation (FP) for transgender individuals has opened up in several countries. In Sweden and the Nordic countries, fertility preservation for medical reasons is fully reimbursed as part of the established tax-funded healthcare services. As this issue is relatively new, procedures for FP have seldom been reported in the transgender patient population. The very limited literature has indicated that transgender women may have poorer sperm quality than cisgender men when assessing samples aimed at semen banking., Objectives: To assess sperm quality parameters of semen samples provided for FP by transgender women before or after gender affirming hormone therapy (GAHT), and to compare sperm quality with a reference population of unscreened men defined by the World Health Organization (WHO). Additionally, we aimed to describe referral patterns over calendar time and estimate time from referral to semen cryopreservation., Material and Methods: Prospective cohort study of 212 transgender women referred for FP to the Reproductive Medicine Clinic of Karolinska University Hospital, Sweden, between 2013 and 2018. Among 177 individuals that provided semen samples for cryopreservation, 16 had previously received GAHT., Results: Individuals with previous GAHT presented with significantly lower total sperm count than individuals without GAHT (p = 0.002). However, higher proportions of sperm abnormalities were also noted among individuals who had not undergone previous GAHT, compared to the WHO reference population (p < 0.001). Referrals of transgender women for FP increased over time. The median time from referral to semen cryopreservation was 27 days., Conclusions: A high occurrence of sperm abnormalities was found in transgender women, especially among individuals who had previously received GAHT. The results underline the importance of thoroughly discussing parenthood options and FP with patients early after diagnosis and referring the patients for semen banking preferably before starting GAHT., (© 2021 The Authors. Andrology published by Wiley Periodicals LLC on behalf of American Society of Andrology and European Academy of Andrology.)

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., (© 2021. The Author(s).)

Transgender men experience a disharmony between their birth sex and their intimate sense of gender belonging. Gender-affirming hormone therapy and gender-affirming surgery (GAS) are often inherently part of the gender-affirming process. In this context, we should ask whether it is better to keep or remove the uterus. Keeping the uterus and ovaries avoids a surgical procedure and a pubic scar. Furthermore, it preserves fertility and the possibility of carrying a baby. On the other hand, keeping the uterus is often psychologically unbearable for transgender men and the long-term effects of androgens on the uterus and ovaries remain uncertain. Conversely, hysterectomy and oophorectomy are part of the GAS process. New mini-invasive surgery procedures for hysterectomies decrease the risks and limit the likelihood of scars to a minimum. In practice, the data suggest that very few transgender men carry a pregnancy and/or use their oocytes after gender-reaffirming treatment. Clinicians should counsel their transgender men patients about the definitive infertility consequences of hysterectomy and oophorectomy and discuss all fertility preservation options before undertaking GAS. Individualized approaches must be preferred to systematic procedures regarding the personal decision to keep or not keep the uterus and ovaries., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Gender dysphoria, a discrepancy between gender identity and genetically determined sex, is encountered in approximately 0.5% of people uniformly across the world. In the case of transgender men, formerly called female-to-male transsexuals, the available gender-affirming measures, hormone therapy and possible surgical procedures, are multiple and discussed in detail in this series of articles., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The medical profession is deeply involved in designating and amending the sex designations on legal records that themselves are not used clinically. The assumptions inherent in the current legal sex designation system and the criteria for amending such are being reexamined. The harms of the current legal sex designation system, especially for transgender people, have become increasingly recognized. Consequently, the appropriateness of the health care professional's participation in recording legal sex designations has been called into question. Herein, we describe the medicolegal challenges surrounding legal sex designations and their potential solutions., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Gender-affirming hormone therapy (GAHT) is often provided to transgender people. In this review of the literature, the current knowledge of ovarian, breast, and metabolic changes (body composition, insulin resistance, bone density, cardiovascular risk factors such as lipids, blood pressure, and hematocrit) observed following GAHT in adult transgender men is discussed. A body of literature concurs to describe that long-term androgen therapy in transgender men exerts atrophic effects on the breast. There is currently no evidence of an increased risk of breast cancer. Long-term testosterone treatment induces ovarian effects that become visible after 6 months of therapy. These changes consist of both macroscopic and microscopic alterations of ovarian morphology that mimic the typical ovarian aspect encountered in women with polycystic ovary syndrome but without an effect on antral follicle count. Metabolic effects of long-term androgen treatment in transgender men put them at par with cisgender men in terms of lipid profile, insulin resistance, and overall mortality. Body composition changes as desired after testosterone administration in most transgender men, and insulin resistance decreases with virilization. There are no detrimental effects on bone mineral density. Cardiometabolic risk and morbidity data are currently reassuring, even if certain studies show conflicting results. An increase in blood pressure and a decrease in high-density lipoprotein cholesterol have been reported as risk factors, whereas polycythemia is rare and treatable. Most available data are observational and based on biochemical markers instead of the more direct measures of cardiovascular damage. An explanation for these observed changes is mostly lacking. Psychological stress and lifestyle factors are often forgotten in a much needed integrated approach., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Gender dysphoria, the discordance between one's gender identity and anatomy, affects nearly 25 million people worldwide, and the prevalence of transgender and non-binary identities is increasing because of greater acceptance and awareness. Because of the improved accessibility to gender-affirming surgery (GAS), many providers will care for patients during and after gender transition. For trans men (female-to-male), GAS represents a combination of procedures rather than a single surgery. The particular combination of masculinizing procedures is chosen on the basis of informed patient-provider discussions regarding the patient's goals and anatomy and implemented through a multidisciplinary team approach. In this review, we describe the common procedures comprising masculinizing GAS to improve delivery of specialized care for this patient population., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To study the feasibility of in vitro maturation of ovarian tissue oocytes for fertility preservation in transgender men on testosterone treatment., Design: Cross-sectional study SETTING: University hospital PATIENT(S): Eighty-three transgender men enrolled from November 2015 to January 2019 INTERVENTION(S): In vitro maturation of cumulus-oocyte complexes (COCs) harvested at the time of gender confirmation surgery, and fertilization through intracytoplasmic sperm injection., Main Outcome Measure(s): In vitro maturation, fertilization, and blastulation rates; comparison of morphokinetics with vitrified-warmed oocytes; and analysis of the genetic profiles of embryos., Secondary Outcomes: association between serum hormone levels; COCs' morphologic characteristics, and vitrification rate., Result(s): All participants were on testosterone treatment for a median of 83 (64[Quartile 1]; 113.2[Quartile 2]) weeks. A total of 1,903 COCs (mean per participant, 23 ± 15.8) were collected. The in vitro maturation rate was 23.8%, vitrification rate was 21.5%, and survival rate after warming was 72.6% (n = 151). Intracytoplasmic sperm injection was performed in 139 oocytes. The rate of normal fertilized oocytes was 34.5%, and 25 (52.1%) embryos reached day 3. One blastocyst was achieved on day 5. Aberrant cleavage patterns and early embryo arrest were observed in 22 (45.8%) and 44 (91.7%) zygotes, respectively. Compared with vitrified-warmed donor oocytes, a delay was observed in pronuclei disappearance, t2 (time to reach 2 cell stage) timings, and CC1 (the duration of the 1st cell cycle) and SS3 (synchronization of cleavage pattern (calculated as t8-t5) time intervals. A normal genetic pattern was seen in 42% embryos. The proportion of vitrified oocytes was negatively associated with progesterone (odds ratio, 0.76) and positively associated with antimüllerian hormone serum levels (odds ratio, 1.23). The highest vitrification rate was achieved by the morphologic characteristic 344 at day 0 and by 433 at day 2., Conclusion(s): Ovarian tissue oocytes matured in vitro show low developmental capacity in transgender men, when collected under testosterone treatment., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Research Question: The reproductive potential of transgender people may be impaired by gender-affirming hormone treatment (GAHT) and is obviously suppressed by gender-affirming surgery involving bilateral orchiectomy. The evolution of medical support for transgender people has made fertility preservation strategies possible. Fertility preservation in transgender women mainly relies on sperm cryopreservation. There are few studies on this subject, and the sample sizes are small, and so it difficult to know whether fertility preservation procedures are feasible and effective in trans women., Design: This retrospective study reports the management of fertility preservation in transgender women referred to the study centre for sperm cryopreservation, and the semen parameters of trans women were compared with those of sperm donors., Results: Ninety-six per cent of transgender women who had not started treatment benefitted from sperm cryopreservation, compared with 80% of those who attempted a therapeutic window and 50% of those receiving hormonal treatment at the time of sperm collection. No major impairment of semen parameters was observed in transgender women who had not started GAHT compared with sperm donors. However, even though the frequency of oligozoospermia was no different, two transgender women presented azoospermia. Some transgender women who had started GAHT could benefit from sperm freezing. None of them were treated with gonadotrophin-releasing hormone (GnRH) analogues., Conclusions: Parenthood strategies for transgender people have long been ignored, but this is an important issue to consider, especially because medical treatments and surgeries may be undertaken in adolescents or very young adults. Fertility preservation should ideally be offered prior to initiation of GAHT., (Copyright © 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Context: Testosterone (T) or estradiol (E2) are administered to suppress gonadal function in female-to-male (FTM) and male-to-female (MTF) transgender patients. How often sex steroids cause adequate suppression without GnRH agonist (GnRHa) or progestin therapy has not been reported., Objectives: (1) To determine how often T and E2 therapy alone can effectively suppress gonadal function in MTF and FTM transgender patients, and (2) to determine the frequency and range of serum E2 levels above the normal male range in FTM patients receiving T therapy., Design: Retrospective cohort study., Setting: Outpatient reproductive endocrinology clinic at an academic medical center., Patients: A total of 65 FTM and 33 MTF patients were included who were > 18 years of age and not receiving progestin or GnRHa therapy., Intervention: Female-to-male patients were receiving T through injections or gel. Male-to-female patients were receiving oral or subcutaneous E2., Main Outcome Measurements: In FTM patients the indicator of ovary suppression was amenorrhea. In MTF patients, the indicator of testes suppression was T levels <50 ng/dL., Results: Median serum total T level for FTM patients was 712 ng/dL (range, 370-1164 ng/dL). On T therapy alone, 90.8% of patients achieved amenorrhea and 49.2% of patients had serum E2 levels above the normal range for women. For MTF patients, the median serum E2 level was 129.2 pg/mL (range, 75-197 pg/mL). On E2 therapy alone, 84.8% of MTF patients had adequate suppression of testicular function., Conclusions: Testosterone and E2 therapy are usually effective without progestin or GnRHa therapy to suppress gonadal function in transgender patients. Progestin and/or GnRHa therapy should only be initiated in those patients who do not have adequate gonadal suppression on optimized doses of T or E2 alone., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: Hormonal interventions in adolescents with gender dysphoria may have adverse effects, such as reduced bone mineral accrual., Objective: To describe bone mass development in adolescents with gender dysphoria treated with gonadotropin-releasing hormone analogues (GnRHa), subsequently combined with gender-affirming hormones., Design: Observational prospective study., Subjects: 51 transgirls and 70 transboys receiving GnRHa and 36 transgirls and 42 transboys receiving GnRHa and gender-affirming hormones, subdivided into early- and late-pubertal groups., Main Outcome Measures: Bone mineral apparent density (BMAD), age- and sex-specific BMAD z-scores, and serum bone markers., Results: At the start of GnRHa treatment, mean areal bone mineral density (aBMD) and BMAD values were within the normal range in all groups. In transgirls, the mean z-scores were well below the population mean. During 2 years of GnRHa treatment, BMAD stabilized or showed a small decrease, whereas z-scores decreased in all groups. During 3 years of combined administration of GnRHa and gender-affirming hormones, a significant increase of BMAD was found. Z-scores normalized in transboys but remained below zero in transgirls. In transgirls and early pubertal transboys, all bone markers decreased during GnRHa treatment., Conclusions: BMAD z-scores decreased during GnRHa treatment and increased during gender-affirming hormone treatment. Transboys had normal z-scores at baseline and at the end of the study. However, transgirls had relatively low z-scores, both at baseline and after 3 years of estrogen treatment. It is currently unclear whether this results in adverse outcomes, such as increased fracture risk, in transgirls as they grow older., (© Endocrine Society 2020.)

Recently, greater attention has been paid to the care of gender dysphoric and gender incongruent individuals. Gynecologists may be called upon to care for individuals who were assigned female at birth throughout or following social, medical, or surgical gender transition. Thus, gynecologists need to be aware of language regarding sex and gender, treatment typically used for the care of gender dysphoric or incongruent individuals, and aspects of well gynecologic care necessary for these individuals. This review highlights these aspects of care for transgender males to aid the general gynecologist in the care and treatment of these individuals.

Context.—: Bilateral mastectomy for chest masculinization is one of the gender-affirming procedures for transmasculine individuals., Objective.—: To optimize gross handling protocols and assess histopathologic findings in transmasculine breast tissue specimens., Design.—: We identified all gender-affirming mastectomies from 2015 to 2018. We sequentially identified reduction mammoplasty (RM) cases for macromastia from the same period as control. Significant findings were defined as atypical ductal or lobular hyperplasia (ADH, ALH), ductal or lobular carcinoma in situ (DCIS, LCIS), or invasive carcinoma., Results.—: Significant findings were present in 6 of 211 gender-affirming mastectomies (2.8%) as follows: ADH (n = 5) and LCIS together with ALH (n = 1). By comparison, 19 of 273 RM specimens (7%) yielded significant findings as follows: ALH (n = 11), ADH (n = 4), LCIS (n = 2), DCIS (n = 1), and invasive lobular carcinoma (n = 1). In the gender-affirming group, 142 transmen underwent androgen therapy before surgery, of whom 2 had significant pathologic findings. Thirty and 41 individuals had a family history of breast cancer in the gender-affirming and RM group, of whom 1 and 3 individuals had significant pathologic findings, respectively., Conclusions.—: Our study demonstrates that we handle transmasculine mastectomy specimens by examining 2.8 times more slides on average than for RMs, with a 2.5 times lower rate of significant pathologic findings. Prior family history of breast cancer or the use of androgen therapy before surgery in gender-affirming individuals did not increase the risk of identifying significant breast lesions. We recommend submitting 4 tissue blocks per mastectomy for individuals undergoing gender-affirming breast surgery., (© 2020 College of American Pathologists.)

Objectives: Transgender individuals submitted to hormone or surgical treatment may have alterations in their bone metabolism as these elements are important players in bone remodeling. We aimed to study bone mineral density (BMD) and body composition in transwomen undergoing cross-sex hormonal treatment (CSHT) from Brazil for over 3 years, comparing them with female and male controls., Methods: 93 individuals (31 transwomen, 31 females and 31 males paired for age and body mass index) were studied for bone mass, and body composition by densitometry (by DXA). Epidemiological and clinical data were collected through direct questioning., Results: Low bone mass (T score ≤2) was found in 12.9% of transwomen; in 3.2% of females and 3.3% of males. Transwomen individuals had lower spine Z score (0.26 ± 1.42 vs 0.50 ± 1.19) and femur Z score (-0.41 ± 0.95 vs 0.29 ± 1.04) than females. They had lower total femur Z score than males (-0.41 ± 0.95 vs 0.20 ± 0.83). Lean mass values correlated positively with total femur BMD (ρ = 0.40; 95% confidence interval = 0.009-0.68; p = 0.04) and BMD in femoral neck (ρ = 0.48; 95% confidence interval = 0.11-0.74; p = 0.01) but neither the type of therapy received nor the time that they were used, impacted bone mass., Conclusion: Low BMD is found frequently in transwomen and it is correlated with lean body mass., Advances in Knowledge: There are few studies of the effects of hormone therapy on the bones and muscles of transwomen. This study demonstrated that significant changes occur, and that the population studied needs greater care in musculoskeletal health.

Transgender individuals represent a medically underserved and under researched population. There is a growing number of studies illustrating the importance of hormone therapy treatments in transgender men and women to assist ameliorating gender dysphoria and promoting well-being. However, the cardiovascular effects of these hormones are controversial. Large longitudinal epidemiological studies of cardiovascular event outcomes in these populations do not exist. In addition, studies of cardiovascular complications of transgender hormone therapy are limited in number and complicated by poor control of medication regimen, presence of gender confirming surgery, use of prescribed medications for prevailing conditions, and alcohol, smoking or illicit substance use, and comorbidities, such as HIV infection. The following provides an overview of current guidelines for hormone therapy regimens used by transgender individuals, as well as what is known about the use of exogenous hormones on the cardiovascular system and cardiovascular disease risk. Several gaps in our understanding of the cardiovascular effects of endogenous and exogenous hormones in treated transgender individuals are identified, which provide direction for future study., (Copyright © 2018. Published by Elsevier Inc.)

Every cell has a genetic sex that is determined at the time of fertilization. However, the natal sex of cells may not match the hormonal environment in which they reside in transgender individuals. This discordance provides a unique opportunity to study the short- and long-term effects across a range of cellular functions, health conditions, physiologic processes and psychosocial outcomes to the benefit of transgender and cisgender communities. While there is a growing body of knowledge as the literature on sex differences in virtually every organ system accumulates, there remains a paucity of data on the effect of cross hormonal therapy on cellular function in transgender individuals. Beyond cellular function, the effect of cross hormonal therapy on neuroanatomy, the interpretation of neuropsychological assessments or even the effect of daily stressors of stigma and discrimination on long-term neurocognitive function remain unclear. In 2011 the Institute of Medicine indicated that transgender adults were an understudied population and in critical need of more biomedical and population health research, yet the experience of stigma, discrimination, microaggressions, limited access to culturally competent care continue to make this an unfulfilled mandate. In addition to using a life course perspective, it is essential to identify research gaps and formulate a responsive research agenda while maintaining scientific rigor and respectful involvement of the population under study. None of this, however, will enhance the participation of transgender communities in biomedical research until the transgender and biomedical research communities can engage in open, respectful and bidirectional dialogue. From respectful, sensitive and appropriate health care to culturally competent research engagement from study inception to data dissemination, transgender communities can make an important and valuable contribution to biomedical research. Inclusion of their voices at all levels, including investigators from transgender communities, are essential to advance this much overdue scientific agenda. Transgender, cisgender and the biomedical research communities will all benefit from a more inclusive and expansive research agenda., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

Context: As many sports are divided in male/female categories, governing bodies have formed regulations on the eligibility for transgender individuals to compete in these categories. Yet, the magnitude of change in muscle mass and strength with gender-affirming treatment remains insufficiently explored., Objective: This study explored the effects of gender-affirming treatment on muscle function, size, and composition during 12 months of therapy., Design, Settings, Participants: In this single-center observational cohort study, untrained transgender women (TW, n = 11) and transgender men (TM, n = 12), approved to start gender-affirming medical interventions, underwent assessments at baseline, 4 weeks after gonadal suppression of endogenous hormones but before hormone replacement, and 4 and 12 months after treatment initiation., Main Outcome Measures: Knee extensor and flexor strength were assessed at all examination time points, and muscle size and radiological density (using magnetic resonance imaging and computed tomography) at baseline and 12 months after treatment initiation., Results: Thigh muscle volume increased (15%) in TM, which was paralleled by increased quadriceps cross-sectional area (CSA) (15%) and radiological density (6%). In TW, the corresponding parameters decreased by -5% (muscle volume) and -4% (CSA), while density remained unaltered. The TM increased strength over the assessment period, while the TW generally maintained their strength levels., Conclusions: One year of gender-affirming treatment resulted in robust increases in muscle mass and strength in TM, but modest changes in TW. These findings add new knowledge on the magnitude of changes in muscle function, size, and composition with cross-hormone therapy, which could be relevant when evaluating the transgender eligibility rules for athletic competitions., (© Endocrine Society 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: This study aimed to identify the most salient set of acoustic predictors of (1) gender attribution; (2) perceived masculinity-femininity; and (3) perceived vocal naturalness amongst a group of transgender and cisgender speakers to inform voice and communication feminization training programs. This study used a unique set of acoustic variables and included a third, androgynous, choice for gender attribution ratings., Method: Data were collected across two phases and involved two separate groups of participants: communicators and raters. In the first phase, audio recordings were captured of communicators (n = 40) during cartoon retell, sustained vowel, and carrier phrase tasks. Acoustic measures were obtained from these recordings. In the second phase, raters (n = 20) provided ratings of gender attribution, perceived masculinity-femininity, and vocal naturalness based on a sample of the cartoon description recording., Results: Results of a multinomial logistic regression analysis identified mean fundamental frequency (f o ) as the sole acoustic measure that changed the odds of being attributed as a woman or ambiguous in gender rather than as a man. Multiple linear regression analyses identified mean f o , average formant frequency of /i/, and mean sound pressure level as predictors of masculinity-femininity ratings and mean f o , average formant frequency, and rate of speech as predictors of vocal naturalness ratings., Conclusion: The results of this study support the continued targeting of f o and vocal tract resonance in voice and communication feminization/masculinization training programs and provide preliminary evidence for more emphasis being placed on vocal intensity and rate of speech. Modification of these voice parameters may help clients to achieve a natural-sounding voice that satisfactorily represents their affirmed gender., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Context: Transgender men (TGM) are persons assigned female gender at birth with a male gender identity and are routinely treated with testosterone. Androgen excess is associated with endothelial dysfunction among cisgender females (CGF) and is an early sign of atherosclerosis and hypertension., Objective: To determine the effect of testosterone treatment on endothelial function in TGM., Setting: The John B. Pierce Laboratory and Yale School of Medicine., Subjects: Eleven TGM (age 27 ± 5 years; BMI 24.4 ± 3.7 kg/m 2 ) receiving testosterone (T) and 20 CGF (28 ± 5 years; BMI 26.0 ± 5.1 kg/m 2 ) during the early follicular phase of their menstrual cycle., Design and Outcome Measures: We evaluated brachial vasodilatory responses following stimuli designed to elicit shear stress using 5-minute occlusion to determine endothelial function (flow-mediated vasodilation, FMD)., Results: Total T was greater in the TGM compared to CGF (484.6 ± 122.5 vs 1.5 ± 0.7 ng/dL), as was free T (83.9 ± 32.4 vs 1.9 ± 0.8 pg/dL). FMD was markedly lower in the TGM (4.5 ± 2.7%) compared to the CGF (8.1 ± 2.9%, P = .002) indicating significantly diminished endothelial function in TGM., Conclusions: We have shown for the first time that in TGM the androgen-dominant hormonal milieu was associated with impaired endothelial function. Endothelial dysfunction precedes clinically detectable atherosclerotic plaque in the coronary arteries, so is an important marker for clinical cardiovascular risk. Therefore, attention to cardiovascular risk factors should be integral to the care of transgender men., (© 2019 John Wiley & Sons Ltd.)

Differences in formant frequencies between men and women contribute to the perception of voices as masculine or feminine. This study investigated whether visual-acoustic biofeedback can be used to help transgender women achieve formant targets typical of cisgender women, and whether such a shift influences the perceived femininity of speech. Transgender women and a comparison group of cisgender males were trained to produce vowels in a word context while also attempting to make a visual representation of their second formant (F2) line up with a target that was shifted up relative to their baseline F2 (feminized target) or an unshifted or shifted-down target (control conditions). Despite the short-term nature of the training, both groups showed significant differences in F2 frequency in shifted-up, shifted-down, and unshifted conditions. Gender typicality ratings from blinded listeners indicated that higher F2 values were associated with an increase in the perceived femininity of speech. Consistent with previous literature, we found that fundamental frequency and F2 make a joint contribution to the perception of gender. The results suggest that biofeedback might be a useful tool in voice modification therapy for transgender women; however, larger studies and information about generalization will be essential before strong conclusions can be drawn., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine the psychometric properties of the German translation of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (TVQ MtF ), an instrument assessing the voice-related quality of life (VrQoL) in trans women., Study Design: This is a cross-sectional study., Method: The conducted online survey contained the TVQ MtF as well as a generic measurement of VrQoL (Voice Handicap Index) and items on transition. Data of 127 trans women were analyzed computing coefficients of reliability and convergent validity. Additionally, confirmatory factor analysis and model modification were performed., Results: Analyses revealed excellent internal consistency (α = 0.97), split-half reliability (r SB  = 0.95) and good convergent validity. Significant associations were found between the total scores of the German TVQ MtF and the Voice Handicap Index (r = 0.88; P < 0.001) as well as the vocal self-perception (r = -0.57; P < 0.001). An acceptable model with a two-factor structure including 22 of the 30 items was found., Conclusions: The TVQ MtF is the first German reliable and valid measurement of VrQoL for trans women. Therefore, its utilization can be recommended for clinical and research purposes in the fields of voice therapy and surgery., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: This study explored trans women's experience and awareness of their vocal communication and voice use within sporting environments., Study Design: Mixed methods study., Methods: Twenty trans women were interviewed about their voice use and vocal communication during sport and its impact on their level of participation. The participants also completed the Transsexual Voice Questionnaire for Male-to-Female Transsexuals., Results: Three core themes emerged from analysis of the interview data. These were: importance of voice in a sport setting, voice production in sporting environments, and psychosocial moderators of voice within the sporting environment. Trans women perceived their voices to be the main barrier to their participation in sport. These women reported that the strong gendered environment of sport made them anxious that they would not be identified as women because their voice was not always congruent with their physical appearance. However, maintaining feminine voice was deemed less critical if participants felt comfortable at their sporting club and had strong relationships with their teammates and coaches. Findings from the Transsexual Voice Questionnaire for Male-to-Female Transsexuals supported the interview data as to the impact that voice has in the lives of trans women., Conclusion: Voice is critical for trans women who wish to integrate and be accepted as women in sporting environments. Participants suggested that voice training should target achieving a gender congruent voice and include minimalizing perceived barriers such as vocal fatigue and maintaining adequate breath support., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: Hormonal treatment in trans persons can affect bone health. In this review, recent studies published on this topic in adults are discussed., Recent Findings: Before starting hormonal treatment, trans women were found to have lower bone mineral density than cis men, which seems to be related to lower vitamin D concentrations and lower lean body mass, whereas this was not found in trans men. Short-term and long-term studies show that hormonal treatment does not have detrimental effects on bone mineral density in trans women and trans men. Low estradiol concentrations were associated with a decrease in bone mineral density in trans women., Summary: Based on the reassuring findings in these studies, regularly assessing bone mineral density during hormonal treatment does not seem necessary. This confirms the Endocrine Society Guideline stating that bone mineral density should be measured only when risk factors for osteoporosis exist, especially in people who stop hormonal treatment after gonadectomy. The relationship with estradiol concentrations indicate that hormone supplementation should be adequate and therapy compliance should be stimulated. As vitamin D deficiency frequently occurs, vitamin D supplementation should be considered. Future research should focus on fracture risk and long-term changes in bone geometry.

Purpose The purpose of this study was to investigate whether there were indications of restrictions to voice function in our group of gender-diverse people assigned female at birth (GD people AFAB ) and whether the participants would benefit from professional voice support. Method We conducted a descriptive, cross-sectional, mixed-methods study combining qualitative content analyses of semistructured interviews, phoniatric examinations, and acoustical voice analyses. Fourteen German-speaking GD people AFAB participated. The data were examined for indications of restrictions to voice function according to the results of participant self-evaluation, auditory-perceptual analyses, laryngostroboscopic examinations, and acoustical measurements. Results All participants presented with indications of restrictions to voice function, with vocal power, voice quality, singing voice, laryngeal function, pitch range/variability, and vocal control having found to be most frequently affected (in over 60% of participants). Sixty-four percent of participants expressed an interest in professional voice support, with clinicians and researchers recommending professional voice support for 67% and 71%, respectively. Conclusions GD people AFAB may experience restrictions to a range of domains of voice function and request or be recommended to participate in professional voice support. Research into this area needs to be intensified so that a more in-depth understanding of the potential voice problems GD people AFAB might experience can be produced and members of this group can be provided with more comprehensive, evidence-based, and high-quality professional support if and when they need it.

Transgender MtF people (trans women) consult otorhinolaryngologists and vocologists with the aim of feminizing their voice and being consistently perceived as women. Treatment of these trans women always begins with a vocal assessment that is relatively unspecific as it was originally constructed for individuals with dysphonia., Objectives: This study examines the subjective portion of the assessment and specifically the self-assessment questionnaire. There is no French-language questionnaire designed to identify the issues facing people who want voice feminization and quantify the impact of their voice disorder on their daily lives. We present a translation and adaption into French of the questionnaire developed by Dacakis et al [6]., Methods: This work follows the World Health Organization recommendations [12] regarding translation. Thirty-six Belgian and French trans women took part in this study., Results: The results show excellent repeatability and reliability, while the construct validity measures show that the items correlate with six areas of concern for trans women identified by Davies and Johnson [7] in a previous study. The domains are the following: effect of voice on ease of social interaction, effect of voice on emotions, relationship between voice and gender identity, effort and concentration required to produce voice, physical aspects of voice production, and pitch. Concurrent validity could not be measured owing to lack of sufficiently detailed stories., Conclusion: The psychometric properties of the French version of the questionnaire are acceptable. The questionnaire can be used as is in daily clinical practice., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Although frequently discussed in terms of sex dimorphism, the neurobiology of sexual orientation and identity is unknown. We report multimodal magnetic resonance imaging data, including cortical thickness (Cth), subcortical volumes, and resting state functional magnetic resonance imaging, from 27 transgender women (TrW), 40 transgender men (TrM), and 80 heterosexual (40 men) and 60 homosexual cisgender controls (30 men). These data show that whereas homosexuality is linked to cerebral sex dimorphism, gender dysphoria primarily involves cerebral networks mediating self-body perception. Among the homosexual cisgender controls, weaker sex dimorphism was found in white matter connections and a partly reversed sex dimorphism in Cth. Similar patterns were detected in transgender persons compared with heterosexual cisgender controls, but the significant clusters disappeared when adding homosexual controls, and correcting for sexual orientation. Instead, both TrW and TrM displayed singular features, showing greater Cth as well as weaker structural and functional connections in the anterior cingulate-precuneus and right occipito-parietal cortex, regions known to process own body perception in the context of self., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Voice is an important gender marker in the transition process as a transgender individual accepts a new gender identity. The objectives of this study were to describe and relate aspects of a perceptual-auditory analysis and the fundamental frequency (F0) of male-to-female (MtF) transsexual individuals. A case-control study was carried out with individuals aged 19-52 years who attended the Gender Identity Program of the Hospital de Clínicas of Porto Alegre. Vocal recordings from the MtF transgender and cisgender individuals (vowel /a:/ and six phrases of Consensus Auditory Perceptual Evaluation Voice [CAPE-V]) were edited and randomly coded before storage in a Dropbox folder. The voices (vowel /a:/) were analyzed by consensus on the same day by two judge speech therapists who had more than 10 years of experience in the voice area using the GRBASI perceptual-auditory vocal evaluation scale. Acoustic analysis of the voices was performed using the advanced Multi-Dimensional Voice Program software. The resonance focus and the degrees of masculinity and femininity for each voice recording were determined by listening to the CAPE-V phrases, for the same judges. There were significant differences between the groups regarding a greater frequency of subjects with F0 between 80 and 150 Hz (P = 0.003), and a greater frequency of hypernasal resonant focus (P < 0.001) in the MtF cases and greater frequency of subjects with absence of roughness (P = 0.031) in the control group. The MtF group of individuals showed altered vertical resonant focus, more masculine voices, and lower fundamental frequencies. The control group showed a significant absence of roughness., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Systemic sclerosis (SSc) is a chronic, autoimmune connective tissue disease with a female predominance. The reason for the female predilection in SSc may relate to the difference in hormones between the genders. There are no current data on the influence male-to-female sex transition may have in the development of SSc. We report three patients who developed SSc after initiating the transgender process, and review current literature in regards to transgender patients with connective tissue disease (CTD)., Methods: We describe the clinical features and disease course of three transgender patients who developed SSc after their transition from male-to-female, who presented to our centre. Two additional transgender cases de- scribed in the literature with CTD were included in this review., Results: All three patients developed SSc after having started the hormonal therapy required to transition. Two patients had surgical procedures preceding their diagnosis of SSc. Antibody profile, time of onset and disease features differed among our patients. Hormonal therapies were continued in all patients and they received the standard therapy for SSc. One patient died from complications of her disease. Only two cases describing the development of CTD in transgender patients were identified in the literature and both of these patients were diagnosed with systemic lupus erythematosus (SLE)., Conclusions: This case series suggests that the hormonal modification as part of gender transition may be relevant in development of SSc. No further conclusions can be drawn on the continuation or not of HT.

This article presents an ordered review of the role of sexual function in discussion and planning before genital gender-affirming surgery and through recovery to initiation of sexual activity after surgery. Strategies are proposed to optimize sexual function postoperatively. Clinical observations are reviewed and genital and surgical anatomy is reviewed to explain the rationale for the treatment strategies proposed. The importance of offering shallow-depth vaginoplasty to all patients is discussed. Lastly, specific strategies to maximize and enhance recovery of erogenous sensation after surgery are focused on., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: This study aimed to perform translation, cross-cultural adaptation, and validation of the Spanish version of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (TVQ MtF )., Study Design: This is a prospective study., Setting: The study was conducted by the Gender Identity Unit and the Voice Unit of a tertiary hospital referral center for surgical feminization of the voice., Subjects and Methods: The study had two parts: translation and adaptation of the TVQ MtF with the following actions: translation (with authorization and consensus of the authors of the original questionnaire), back-translation, pretesting, and final version; and preliminary study of the psychometric properties (feasibility, internal consistency, test-retest reliability, construct validity, discriminant validity, and ceiling and floor effects). Thirty male-to-female transsexual women filled out the questionnaire, and 18 of the 30 filled out the questionnaire approximately 2 weeks after filling it out for the first time., Results: Feasibility was 100%. Cronbach α was 0.976. The intraclass correlation coefficient was 0.885. The Spearman correlation coefficient between TVQ MtF and the physical component of SF-12 v2 was 0.102 (P value = 0.592) and between TVQ MtF and the mental component was -0.263 (P value = 0.161). A ceiling effect was not found. A floor effect was found in two questionnaires (6.7%)., Conclusion: Feasibility, internal consistency, and reliability outcomes in our study support the validity of the authorized Spanish version of the TVQ MtF ., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Context: Breast development is a key feature of feminization and therefore important to transwomen (male-to-female transgender persons). It is not exactly known when breast development starts after initiating cross-sex hormone therapy (CHT) and how much growth may be expected., Objective: To investigate breast development in transwomen during their first year of CHT and whether clinical or laboratory parameters predict breast development., Design: This study was performed as part of the European Network for the Investigation of Gender Incongruence, which is a prospective multicenter cohort study., Setting: Gender clinics in Amsterdam, Ghent, and Florence., Participants: Transwomen who completed the first year of CHT (n = 229)., Intervention: CHT., Main Outcome Measures: Breast development in centimeter and cup size., Results: The median age of the included transwomen was 28 years (range, 18 to 69). Mean breast-chest difference increased to 7.9 ± 3.1 cm after 1 year of CHT, mainly resulting in less than an AAA cup size (48.7%). Main breast development occurred in the first 6 months of therapy. Serum estradiol levels did not predict breast development after 1 year of CHT (first quartile, 3.6 cm [95% confidence interval (CI), 2.7 to 4.5], second quartile, 3.2 cm [95% CI, 2.3 to 4.2], third quartile, 4.4 cm [95% CI, 3.5 to 5.3], and fourth quartile, 3.6 cm [95% CI, 2.7 to 4.5])., Conclusion: This study shows that, after 1 year of CHT, breast development is modest and occurs primarily in the first 6 months. No clinical or laboratory parameters were found that predict breast development., (Copyright © 2017 Endocrine Society)

Background: Sex is an important determinant of lung capacity and function. This study examined the impact of using non-birth sex on the interpretation of spirometry data in transgender subjects with air-flow obstruction., Methods: This study was a retrospective analysis of anonymous spirometry data. Eighty adult male and 80 adult female subjects were chosen from the database via random sampling. FVC, FEV 1 , and FEV 1 /FVC were collected and analyzed. Differences in percent of predicted, Z scores, classification of disease severity, and the incidence of a value migrating above or below the lower limit of normal between sex assignments were examined., Results: For born male subjects, percent of predicted for FVC and FEV 1 were significantly higher when the female sex was used: 100.5% versus 118.5% and 78% versus 91.5%, respectively ( P < .001). FEV 1 /FVC Z score was -2.53 for male sex and -2.65 for female sex ( P = .004). The presence of obstruction was not affected by sex assignment. Use of non-birth sex moved some FVC and FEV 1 data above the lower limit of normal and improved severity classification in others. For born female subjects, percent of predicted for FVC and FEV 1 were significantly lower when the male sex was used: 102% versus 87.5% and 81.5% versus 70.5%, respectively ( P < .001). FEV 1 /FVC Z score was -2.17 for female sex and -2.12 for male sex ( P < .001). Six born female subjects had their FEV 1 /FVC normalized when male sex was used. Use of non-birth sex moved some FVC and FEV 1 data below the lower limit of normal and worsened severity classification in others. In total, using the non-birth sex affected spirometry interpretation in 45% of born male subjects and 70% of born female subjects., Conclusions: In transgender subjects with air-flow obstruction, using non-birth sex to calculate predicted spirometry values may have a significant impact on test interpretation and place these patients at risk for misdiagnosis and inappropriate treatment., (Copyright © 2018 by Daedalus Enterprises.)

Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals.

Background/aim: To evaluate and stratify early cardiovascular risk of transsexuals who underwent pharmacological and/or surgical gender reassignment., Methods: Fifty-six transsexuals were divided into two groups: group 1 - underwent gonadectomy (orchiectomy for transwomen and hystero-annessiectomy for transmen); group 2 - hormone replacement therapy alone. All participants underwent carotid artery intima-media thickness (C-IMT) and flow-mediated vasodilation (FMD) of brachial artery evaluations., Results: FMD was lower in patients who had undergone gonadectomy compared with non-surgically treated patients (Group 1: 5.711 vs Group 2: 7.339, P < 0.0001). Mean C-IMT was higher in group 1 than group 2 (group 1: 0.733 vs group 2: 0.582). The duration of hormone therapy correlates positively with mean C-IMT (B = 0.001) and negatively with FMD (%) (B = - 0.007)., Conclusions: Cardiovascular risk, which is expressed in terms of endothelial (FMD) and morphological (C-IMT) dysfunction, increases in subjects undergoing gonadectomy compared with those receiving cross-sex reassignment therapy alone., (© 2017 Royal Australasian College of Physicians.)

Objective: Voice feminization is needed for male-to-female transsexuals, males with testicular feminization, and females with constitutional androphonia. Anterior glottic web formation affords advantages: endoscopic surgery without skin incision and scar, outpatient surgery, potential reversibility, and low risk for vocal fold and airway damage., Study Design: This is a nonrandomized prospective cohort study., Setting: University hospital., Materials and Methods: All 27 cases of androphonia were treated with endoscopic anterior glottic web formation. Voice Handicap Index (VHI-30); acoustic analysis with /a/ including F 0 , jitter, shimmer, noise-to-harmonic ratio; and acoustic analysis of connected speech for speaking F 0 were determined pre- and postoperatively. Patients and medical students rated pre- and postoperative voices as feminine, masculine, or neither., Results: The pre- and postoperative mean total VHI scores of patients were 38 and 24, respectively; this difference was statistically significant (P < 0.001). Their pre- and postoperative mean F 0 and speaking F 0 were 152 and 158 and 195 and 200 Hz, respectively; these differences were statistically significant (P < 0.001). Their pre- and postoperative acoustic analysis results were not significantly different (P > 0.05). Seven patients (26%) needed laser reduction glottoplasty for voice feminization because they were not satisfied with the voice result. Patients' self-evaluations of their postoperative voice revealed 20 feminine, 2 masculine, and 5 neither results, giving a rise to patient satisfaction rate of 74%. Medical students rated 85% of postoperative voice samples as feminine, giving rise to overall success rate of 85%., Conclusion: Anterior commissure web formation is a successful surgical option for voice feminization. However, additional surgery may be necessary for patient satisfaction., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The Transsexual Voice Questionnaire (TVQ MtF ) was designed to capture the voice-related perceptions of individuals whose gender identity as female is the opposite of their birth-assigned gender (MtF women). Evaluation of the psychometric properties of the TVQ MtF is ongoing., Aims: To investigate associations between TVQ MtF scores and (1) self-perceptions of voice femininity and (2) acoustic parameters of voice pitch and voice quality in order to evaluate further the validity of the TVQ MtF . A strong correlation between TVQ MtF scores and self-ratings of voice femininity was predicted, but no association between TVQ MtF scores and acoustic measures of voice pitch and quality was proposed., Methods & Procedures: Participants were 148 MtF women (mean age 48.14 years) recruited from the La Trobe Communication Clinic and the clinics of three doctors specializing in transgender health. All participants completed the TVQ MtF and 34 of these participants also provided a voice sample for acoustic analysis. Pearson product-moment correlation analysis was conducted to examine the associations between TVQ MtF scores and (1) self-perceptions of voice femininity and (2) acoustic measures of F0, jitter (%), shimmer (dB) and harmonic-to-noise ratio (HNR)., Outcomes & Results: Strong negative correlations between the participants' perceptions of their voice femininity and the TVQ MtF scores demonstrated that for this group of MtF women a low self-rating of voice femininity was associated with more frequent negative voice-related experiences. This association was strongest with the vocal-functioning component of the TVQ MtF . These strong correlations and high levels of shared variance between the TVQ MtF and a measure of a related construct provides evidence for the convergent validity of the TVQ MtF . The absence of significant correlations between the TVQ MtF and the acoustic data is consistent with the equivocal findings of earlier research. This finding indicates that these two measures assess different aspects of the voice-related experience., Conclusions & Implications: Evidence supporting the validity of the TVQ MtF is strong and indicates that it is a sound measure for capturing the MtF woman's self-perceptions of her vocal functioning and how her voice impacts on her everyday life., (© 2017 Royal College of Speech and Language Therapists.)

The World Professional Association for Transgender Health's standards of care recommend suspending puberty, preferably with the use of gonadotropin-releasing hormone agonists, in certain gender non-conforming minors (aged under 18 years) who have undergone a psychiatric assessment and have reached at least Tanner stage II of puberty. This approach seeks to lessen the discordance between assigned natal sex and gender identity by temporarily halting the development of secondary sexual characteristics, essentially widening the temporal window for gender clarification. Despite promising preliminary evidence on the clinical utility of this approach, there is a dearth of research to inform evidence-based practice. In view of these challenges, we review the available empirical evidence on the cognitive, physical, and surgical implications of puberty suppression in gender-incongruent children and adolescents. We also explore the historical underpinnings and clinical impetus for suspending puberty in this population, and propose key research priorities., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to prospectively examine changes in gender-related voice domain of pitch measured by fundamental frequency, function-related domains of vocal quality, range, and habitual pitch level and the self-perceptions of transmasculine people during their first year of testosterone treatment., Method: Seven trans men received 2 voice assessments at baseline and 1 assessment at 3, 6, 9, and 12 months after starting treatment., Results: Vocal quality measures varied between and within participants but were generally within normal limits throughout the year. Mean fundamental frequency (MF0) during reading decreased, although to variable extents and rates. Phonation frequency range shifted down the scale, although it increased in some participants and decreased in others. Considering MF0 and phonation frequency range together in a measure of habitual pitch level revealed that the majority of participants spoke using an MF0 that was low within their range compared with cisgender norms. Although the trans men generally self-reported voice masculinization, it was not correlated with MF0, frequency range, or habitual pitch level at any time point or with MF0 note change from baseline to 1 year of testosterone treatment, but correlations should be interpreted with caution due to the heterogeneous responses of the 7 participants., Conclusion: In trans men, consideration of voice deepening in the context of objective and subjective measures of voice can reveal unique profiles and inform patient care.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.