Principles of Transgender Medicine and Surgery

Description

A practical guide to state-of-the-art treatments and health care knowledge about gender diverse persons, this second edition of Principles of Transgender Medicine and Surgery presents the foremost international specialists offering their knowledge on the wide spectrum of issues encountered by gender diverse individuals. In this handy text, professionals of all types can get important information about various aspects of transgender health care for a full spectrum of clients, from childhood to advanced age. Key topics addressed include medical and surgical issues, mental health issues, fertility, the coming out process, and preventive care. This essential text is extensively referenced and illustrated, and instructs both novice and experienced practitioners on gender-affirming care. "Finally, science and compassion have replaced prejudice and politics! This marvelous book is essential reading for every person who provides care, or cares about, people who don't conform to society's ‘rules’ about gender. How I wish this wisdom and information had been available when I was a young pediatrician working with children and families struggling with these seemingly insurmountable issues."— M. Joycelyn Elders, MD, Professor Emeritus, University of Arkansas for Medical Sciences, 15th Surgeon General of the United States. Cover......Page 1 Half Title......Page 2 Endorsement......Page 3 Title Page......Page 4 Copyright Page......Page 5 Table of Contents......Page 6 List of Contributors......Page 9 Foreword......Page 12 Preface......Page 14 Introduction......Page 16 Historical Background......Page 18 Psychoanalytic Theories......Page 19 Early Biological Theories......Page 20 Anatomical Post-Mortem Studies......Page 21 Prenatal Hormonal Influences......Page 22 Genetic Influences......Page 23 Neurodevelopmental Cortical Hypothesis......Page 24 References......Page 27 Background......Page 31 Prevalence of Gender Confirmation Therapy......Page 33 Prevalence of Transgender-Related Diagnoses......Page 37 Prevalence of Self-Reported Transgender Identity......Page 42 Prevalence of Legal Name or Sex Changes......Page 45 Summary and Discussion......Page 46 References......Page 48 3 An Overview of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People......Page 51 History of the Standards of Care......Page 52 WPATH Standards of Care—Version 7......Page 53 References......Page 55 Introduction......Page 57 Variation in Gender Identity and Expression......Page 58 Primary Care......Page 59 Multidisciplinary Care and Referrals......Page 60 The Patient Who Is Seeking Initiation of Hormonal Treatment......Page 61 The Patient Who Has Been Using Informally Obtained Hormones, and Who Wishes to Begin Prescription Medications......Page 62 Family Members of Gender-Transitioning Persons......Page 63 Ten Principles of Transgender Medical Care......Page 64 References......Page 75 Challenges in Providing Preventive Care to the Transgender Population......Page 79 Assembling the Evidence: Methodology......Page 80 Incorporating Cisgender Evidence into the Transgender Context......Page 81 Patients Who Have Never Taken Estrogen......Page 84 Patients With Past or Current Estrogen Use......Page 85 Breast Cancer in Transmen......Page 86 Patients Who Have Had Chest Surgery, With or Without Testosterone Use......Page 87 Transmen With an Intact Cervix (No Hysterectomy or With Subtotal Hysterectomy), With or Without History .........Page 88 Transmen Who Have Had Total Hysterectomy (Cervix Completely Removed)......Page 89 Transmen With Intact Ovaries/Uterus (No Hysterectomy), With or Without a History of Testosterone Use......Page 90 Uterine (Endometrial) Cancer......Page 91 Transwomen With Past or Current Estrogen Use, With or Without Genital Feminizing Surgeries......Page 92 All Patients......Page 93 Transwomen, Using Estrogen......Page 94 Transmen, Using Testosterone......Page 95 Transwomen, Currently Using Estrogen......Page 96 All Patients, Not Currently on Hormone Therapy......Page 97 Transmen, Currently Using Testosterone......Page 98 All Transgender People......Page 99 Transwomen, Currently on Feminizing Hormone Therapy......Page 100 Transwomen, With Current or Past Estrogen Use, Without Orchiectomy......Page 101 Transwomen, After Orchiectomy......Page 102 Transmen With Current or Previous Testosterone Use, and Postoopherectomy or Total Hysterectomy......Page 103 Sexual Health: Sexually Transmitted Infections......Page 104 Conclusion......Page 105 References......Page 106 Introduction......Page 115 Historical Notes......Page 116 Present ideas......Page 118 Co-morbidity......Page 119 Tasks of the Mental Health Professional (See in More Detail SOC Version 7)......Page 122 Effectiveness of Gender-Confirming Therapy......Page 124 Assessment......Page 126 Providing Information......Page 127 Psychotherapy......Page 128 Referral for Hormone and Surgical Treatment (See Also SOC Version 7)......Page 129 References......Page 130 Invisibility, Stigma, and the Importance of the Therapy Relationship......Page 135 Paradigm Shift......Page 136 Theories and Therapies......Page 137 Power of Words......Page 138 A Developmental Model of Transgender Identity......Page 139 Adolescence and Pre-Transition......Page 140 Adulthood—Paths to Trans and Other Related Identities......Page 141 Adulthood: Co-Occurring Conditions......Page 142 Adulthood: Concerns Raised During This Phase......Page 143 Adulthood: Clinician’s Role......Page 144 Adulthood: Identity Integration, Consolidation, and Presentation......Page 145 Aging and Returning to Therapy......Page 146 Assessment and Letter Writing as Part of the Therapy......Page 147 References......Page 148 Introduction......Page 152 Coming Out as a Developmental Process......Page 153 Pre-Coming Out......Page 154 Vignette A......Page 155 Coming Out......Page 156 Vignette C......Page 157 Exploration......Page 159 Vignette E......Page 162 Vignette F......Page 164 Intimacy......Page 165 Vignette H......Page 167 Identity Integration......Page 168 Vignette I......Page 169 Conclusion......Page 170 References......Page 171 Introduction......Page 174 References......Page 179 General Principles of Treatment......Page 182 Hormonal Gender-Affirming Therapy......Page 183 Estrogen......Page 184 Breast development......Page 185 Voice......Page 186 Results of Hormone Therapy for Female-to-Male People......Page 187 Ovaries......Page 188 Atherosclerosis......Page 189 Benign Prostate Hyperplasia......Page 190 Sexual Function After Surgery......Page 191 References......Page 192 Gender Variance Versus Gender Dysphoria......Page 195 Classification......Page 196 Epidemiology......Page 197 Sex Ratio......Page 198 Predicting Persistence of Childhood GD Into Adolescence and Adulthood......Page 199 Adolescents......Page 200 Vignette Sophie......Page 201 Co-Occurring Psychopathology......Page 202 Diagnosis in Children......Page 204 Instruments......Page 205 Ethics of Intervention; Models of Care for Children with GD......Page 206 Parent Organizations......Page 207 Treatment Effectiveness......Page 208 The Initial Phase; Creating a Working Alliance and Assessing Gender Dysphoria......Page 209 Differential Diagnosis......Page 210 The Desirability of Medical Interventions for Adolescents......Page 211 Psychological Interventions......Page 212 Physical Interventions......Page 214 Fully Reversible Interventions......Page 215 Results of Gender-Affirming Treatment......Page 216 Conclusion......Page 217 References......Page 218 Terms and Definitions......Page 223 Natural History of Transgenderism in Youth/Adolescents......Page 225 Early Pubertal Transgender Youth......Page 226 Potential Adverse Effects of GnRH Agonists in Transgender Youth......Page 228 Late Pubertal Transgender Youth......Page 229 Controversies and Areas of Uncertainty/Barriers to Ideal Practice......Page 230 References......Page 233 Introduction......Page 237 Typical Sexual Differentiation Process......Page 238 Klinefelter Syndrome......Page 241 Turner Syndrome......Page 242 Congenital Adrenal Hyperplasia (CAH)......Page 243 Androgen Insensitivity Syndrome (AIS)......Page 244 Hypospadias......Page 245 Mayer–Rokitansky–Küster–Hauser (MRKH)......Page 246 Cloacal Exstrophy of the Bladder (CE)......Page 247 Events Post-2005 Consensus Meeting......Page 248 Global Legislation on DSD and Lawsuits......Page 250 Global Networks, Research, and Registries......Page 251 DSM-5: Gender Dypshoria In; Gender Identity Disorders Out......Page 252 Gender Dysphoria in DSD and Non-DSD......Page 254 Evaluation and Treatment Strategies......Page 256 Discussion......Page 258 Acknowledgment......Page 259 References......Page 260 History of Transwomen Surgery......Page 265 Standards of Care for Surgery......Page 267 Experience of Living in an Identity-Congruent Gender Role (the Former “Real-Life Experience”)......Page 268 Facial Feminization Surgery......Page 269 Forehead......Page 270 Chin......Page 271 Hair Transplantation......Page 272 Chondrolaryngoplasty and Voice Surgery......Page 273 Breast Development After Hormonal Therapy......Page 274 Surgical Techniques......Page 275 Complications......Page 277 Introduction......Page 278 Non-Genital Skin Grafts......Page 279 Penile-Scrotal Skin Flaps: The Technique of Choice......Page 280 Non-Genital Skin Flaps......Page 282 Pedicled Intestinal Transfer......Page 283 Acellular Dermal Matrix......Page 284 Clitoro-Labioplasty (Vulvoplasty)......Page 285 Complications......Page 287 References......Page 290 History of Transmen Surgery......Page 294 Standards of Care......Page 295 Referral Letter......Page 296 Forehead......Page 297 Introduction......Page 298 Surgical Techniques......Page 300 Recommendations......Page 308 Hysterectomy and Salpingo-Oophorectomy......Page 309 A “One-Stage” Procedure......Page 310 Voiding While Standing......Page 311 Sexual Intercourse......Page 312 An Aesthetically Pleasing Phallus and Scrotum......Page 314 Minimal Morbidity......Page 318 The Radial Forearm Flap......Page 319 Pedicled Anterolateral Thigh Flap......Page 323 Metoidioplasty......Page 325 Fibular Flap......Page 326 The Importance of a Multidisciplinary Approach......Page 327 References......Page 328 Prevalence of HIV in Trans People......Page 333 Risk Factors and HIV......Page 336 HIV Treatment in Transgender People......Page 339 HIV Reporting in the Trans Population......Page 340 Practical Implications for the Clinician......Page 341 Conclusions......Page 342 References......Page 343 Introduction......Page 346 The Right to Reproduce......Page 347 Transpeople and Fertility......Page 348 Cryopreservation of Sperm for Transwomen......Page 349 Cryopreservation of Oocytes, Embryos, or Ovarian Tissue in Transmen......Page 351 Embryo Banking......Page 352 Ovarian Tissue Banking......Page 353 Future Possibilities......Page 354 References......Page 355 Successful Aging and its Predictors: The Concept of “Aging Well”......Page 359 Transgender Aging and Psychological Health Care......Page 360 Substance Abuse......Page 361 Anxiety and Depression......Page 362 Cognitive Functioning......Page 363 General Medical Care......Page 364 Hormonal Treatment......Page 365 Risks of Hormone Use......Page 366 Estrogen Supplementation......Page 367 Type, Route, and Dosing of the Hormonal Preparation......Page 369 Concurrent Health Risks......Page 370 Androgen Supplementation......Page 371 Polycythemia......Page 372 Choice of Testosterone Preparation......Page 373 Surgery......Page 375 Osteoporosis......Page 376 HIV in Later Life......Page 378 Transgender Aging and Social Adjustment......Page 379 Graceful Exits: Living and Dying Well......Page 381 References......Page 382 Introduction......Page 394 Transgender Health Care and Human Rights......Page 396 Non-Discrimination......Page 397 De-Medicalization of Legal Gender Recognition......Page 398 Informed Decision Making......Page 399 Availability, Accessibility, and Quality of Transition-Related Information and Health Services......Page 402 Health Classifications, Transgender Health Care, and Human Rights......Page 405 Recognizing Children’s Rights in Relation to Transgender Health Care......Page 406 Privacy and Confidentiality......Page 407 Accountability, Participation, and Access to Remedies......Page 408 Conclusions......Page 409 Notes......Page 410 References......Page 411 Index......Page 417