Implementation of an Enhanced Recovery after Surgery Pathway for Transgender and Gender-Diverse Individuals Undergoing Chest Reconstruction Surgery: An Observational Cohort Study
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ABSTRACT:
SUBMITTER: Aquino N
PROVIDER: S-EPMC10672389 | biostudies-literature | 2023 Nov
REPOSITORIES: biostudies-literature
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| S-EPMC9577877 | biostudies-literature
Project description:BackgroundTransmasculine chest surgery is the most common surgery performed in transmasculine patients, with high overall acceptance and low postoperative complication rates. Trends have shown clear improvement in quality of life and satisfaction. However, to the best of our knowledge, overall patient satisfaction after transmasculine chest surgery and associated factors are largely unknown. The aim of this study is to estimate the overall patient satisfaction in transgender men and nonbinary population after transmasculine chest surgery and to assess associated factors.MethodsA systematic review was conducted by searching literature in several databases. Meta-analyses of prevalence with a random-effect model for overall and subgroup prevalence were performed. Meta-regression, publication bias, and sensitivity analyses were conducted.ResultsA total of 1052 transmasculine patients underwent any type of transmasculine chest surgery. The pooled overall postoperative satisfaction was 92% [95% confidence interval (CI) 88-96%]. In the subgroup metanalysis, patient satisfaction after periareolar mastectomy was 93% (CI 88%-97%) and after mastectomy with or without free nipple grafting was 90% (CI 84%-95%). Patient satisfaction for studies with mean follow-up >1 year was 91% (CI 83%-97%) and for mean follow-up of 1 year or less was 93% (CI 89%-96%).ConclusionsThis study shows a high level of satisfaction in transmasculine chest surgery for both techniques, which remain stable over time. Also, our results show that this procedure impacts patient satisfaction beyond chest appearance and surgical outcomes. This corroborates its broad acceptance and the improvements in the standard of care, and decision-making approach.
| S-EPMC8099412 | biostudies-literature
Project description:BackgroundFeminizing genital gender affirmation surgery (fgGAS) may be an essential adjunct in the care of some transgender women and gender diverse individuals with gender incongruence. However, the comparison of different techniques of fgGAS may be confounded by variable outcome reporting and the use of inconsistent outcomes in the literature. This systematic review provides the most in-depth examination of fgGAS studies to date, and summarizes all reported outcomes, definitions, and the times when outcomes were assessed following these surgical interventions. Aims/Methods: This work intends to quantify the levels of outcome variability and definition heterogeneity in this expanding field and provides guidance on outcome reporting for future study authors. Candidate studies for this systematic review were sourced via an electronic, multi-database literature search. All primary, clinical research studies of fgGAS were included with no date limits. Paired collaborators screened each study for inclusion and performed data extraction to document the outcomes, definitions, and times of outcome assessment following fgGAS.ResultsAfter screening 1225 studies, 93 studies proceeded to data extraction, representing 7681 patients. 2621 separate individual outcomes were reported, 857 (32.7%) were defined, and the time of outcome assessment was given for 1856 outcomes (70.8%) but relied on nonspecific ranges of follow-up dates. "Attainment of orgasm", "Neovaginal stenosis", and "Neovaginal depth/length" were among the most commonly reported outcomes. Profound heterogeneity existed in the definitions used for these and for all outcomes reported in general.DiscussionThe results demonstrate a need for clear outcomes, agreed definitions, and times of outcome assessment following fgGAS in transgender women and gender diverse individuals. The adoption of a consistent set of outcomes and definitions reported by all future studies of fgGAS (a Core Outcome Set) will aid in improving treatment comparisons in this patient group. This review is the first step in that process.
| S-EPMC10132236 | biostudies-literature
Project description:PurposeTransgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics.MethodsWe searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families.ResultsWe retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid.ConclusionsThere is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.
| S-EPMC10066778 | biostudies-literature
Project description: Not available
| S-EPMC11554503 | biostudies-literature
Project description:ImportanceTransgender and gender-diverse (TGD) communities experience disproportionate levels of violence, yet due to limitations in measuring TGD identity, few state-representative estimates are available.ObjectiveTo assess gender identity differences in experiences of violence among adults.Design, setting, and participantsCross-sectional data from the 2023 California Violence Experiences (CalVEX) survey, weighted to provide state-representative estimates, was used to assess associations between gender identity and past-year experiences of violence among adults 18 years and older. Data were analyzed from June to December 2023.ExposureGender identity (cisgender women, cisgender men, transgender women, transgender men, and nonbinary individuals).Main outcomes and measuresExperience of physical violence (including physical abuse and threat or use of a weapon), sexual violence (verbal sexual harassment, homophobic or transphobic slurs, cyber and physically aggressive sexual harassment, and forced sex), and intimate partner violence (IPV; emotional, physical, or sexual violence) using age-adjusted logistic regression.ResultsIn total 3560 individuals (weighted cumulative response rate, 5%) completed the 2023 CalVEX survey, with 1978 cisgender women, 1431 cisgender men, 35 transgender women, 52 transgender men, and 64 nonbinary respondents (mean [SD] age, 47.1 [17.5] years; 635 [17%] were Asian, 839 [37%] were Hispanic, and 1159 [37%] were White). Past-year physical violence was reported by 22 transgender men (43%), 9 transgender women (24%), and 9 nonbinary respondents (14%). Past-year sexual violence was reported by 23 transgender men (42%), 11 transgender women (14%), and 31 nonbinary respondents (56%). Compared with cisgender women, transgender women and transgender men had greater risk of past-year physical violence (any form) (transgender women adjusted incidence rate ratio [AIRR], 6.7; 95% CI, 2.5-18.2; transgender men AIRR, 9.7; 95% CI, 5.3-17.7), as well as past-year IPV (any form) (transgender women AIRR, 3.2; 95% CI, 1.3-8.0; transgender men AIRR, 6.7; 95% CI, 4.0-11.3). Relative to cisgender women, transgender men (AIRR, 3.0; 95% CI, 1.7-5.1) and nonbinary respondents (AIRR, 3.3; 95% CI, 2.1-5.2) had greater risk of past-year sexual violence (any form).Conclusions and relevanceIn this survey study of adults in California, results showed that TGD individuals, especially transgender men, are at higher risk of experiencing all forms of violence relative to cisgender women. Results highlight the need for gender-affirming violence prevention and intervention services as well as policies that protect TGD individuals from discriminatory violence.
| S-EPMC11200137 | biostudies-literature
Project description:BackgroundThe objective of this study is to evaluate the risk of being diagnosed with an eating disorder among transgender and gender-diverse (TGD) individuals, specifically examining how this risk differs following gender-affirming medical therapy (GAMT).MethodsThe study utilizes electronic medical record (EMR) data from the TriNetX database. A total of 90,955 TGD individuals were identified in the TriNetX database. TGD individuals were divided into cohorts according to gender-affirming interventions they received. To assess the risk of eating disorder diagnoses across groups, we applied a Cox proportional hazards model with gender-affirming care as a time-varying covariate.ResultsHere we show that transfeminine individuals receiving hormone therapy (HT) have a significantly higher likelihood of being diagnosed with an eating disorder compared to those without intervention (HR:1.67, 95% CI:1.41, 1.98). Conversely, transmasculine individuals on HT exhibit a reduced risk of being diagnosed with an eating disorder relative to those without intervention (HR: 0.83, 95% CI: 0.76, 0.90).ConclusionsAfter undergoing gender-affirming medical therapy, the risk of eating disorder diagnosis increases for transfeminine individuals and decreases for transmasculine individuals. The observed differences in risk between transfeminine and transmasculine individuals on GAMT may be attributed to factors such as gendered societal norms, variations in screening practices, and the physiological effects of hormone therapy on eating disorder symptomatology. Further research is needed to clarify these influences and support tailored interventions.
| S-EPMC11688434 | biostudies-literature
Project description:Transgender and gender-diverse people experience various minority stressors although minimal research has examined prospective effects on daily affect or mental health. We explored rates of marginalization for transgender and gender-diverse participants in a daily diary study and the concurrent and prospective associations with daily affect and weekly measures of depression and anxiety symptoms, as well as the mediating effects of internalized stigma, rumination, and isolation. There were 167 participants (82.2% white; M age = 25) retained in the daily surveys. Participants completed surveys for 56 days reflecting exposure to marginalization, gender nonaffirmation, internalized stigma, rumination, isolation, affect (negative, anxious, and positive affect), and mental health (anxiety and depression symptoms). Participants experienced marginalization on 25.1% of the days. Within-person analyses revealed concurrent associations between marginalization and gender nonaffirmation with increased negative and anxious affect and increased anxiety and depression symptoms, as well as associations for gender nonaffirmation and decreased positive affect. At the within-person level, there were prospective associations between marginalization and gender nonaffirmation with increased negative affect on the next day, as well as increased anxiety and depression symptoms the next week. Concurrent analyses revealed significant indirect effects with marginalization and gender nonaffirmation associated with all three affect variables and mental health via increases in internalized stigma, rumination, and isolation. However, only gender nonaffirmation was related to isolation and affect or mental health in the prospective analyses. Clinical considerations include strategies to address the immediate effects of minority stress as well as the long-term interpersonal effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
| S-EPMC10159909 | biostudies-literature
Project description: Not available
| S-EPMC8709605 | biostudies-literature
Project description:In the past decade, prenatal cell-free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi-structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de-gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPs educate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans-inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.
| S-EPMC11632582 | biostudies-literature