Notes

>We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. 2.5% of youth identified as cisgender and 3.5% as nonbinary

https://www.researchgate.net/publication/360373314_Gender_Identity_5_Years_After_Social_Transition

> Preoperative FFS patients were gendered as female 57.31% of the time with a CM of 1.41 despite hormone therapy, makeup, and hairstyle. Postoperative FFS patients were gendered as female 94.27% of the time with a CM of 7.78. Ninety-five percent of patients showed a significant improvement in CM after FFS.

https://pubmed.ncbi.nlm.nih.gov/31676906/

>Mental health-related quality of life was statistically diminished (P < 0.05) in transgendered women without surgical intervention compared to the general female population and transwomen who had gender reassignment surgery (GRS), facial feminization surgery (FFS), or both. There was no statistically significant difference in the mental health-related quality of life among transgendered women who had GRS, FFS, or both. Participants who had FFS scored statistically higher (P < 0.01) than those who did not in the FFS outcomes evaluation.
>Transwomen have diminished mental health-related quality of life compared with the general female population. However, surgical treatments (e.g. FFS, GRS, or both) are associated with improved mental health-related quality of life.

https://link.springer.com/article/10.1007/s11136-010-9668-7

>Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression
>Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents.

https://pubmed.ncbi.nlm.nih.gov/20646177/

>Social support emerged as the most significant predictor of depressive symptoms (p >.05), whereby persons endorsing higher levels of overall perceived social support tended to endorse lower levels of depressive symptoms. Second to social support, persons who endorsed having had some form of gender affirmative surgery were significantly more likely to present with lower symptoms of depression

https://www.tandfonline.com/doi/abs/10.1080/15532739.2014.890558

>At enrollment, transsexuals reported elevated CAR (cortisol awakening response); their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy, transsexuals reported significantly lower CAR (P < 0.001), falling within the normal range for cortisol levels. Treated transsexuals showed also lower perceived stress (P < 0.001), with levels similar to normative samples.

https://www.jsm.jsexmed.org/article/S1743-6095(15)30224-1/fulltext

>The results revealed that the majority of transsexual patients have no psychiatric comorbidity, suggesting that transsexualism is not necessarily associated with severe comorbid psychiatric findings. The condition, however, seemed to be associated with subthreshold anxiety/depression, psychological symptoms and functional impairment. Moreover, treated patients reported less psychiatric distress. Therefore, hormonal treatment seemed to have a positive effect on transsexual patients’ mental health.

https://www.sciencedirect.com/science/article/abs/pii/S030645301300348X?via%3Dihub

>The present study suggests a positive effect of hormone therapy on transsexuals' QoL after accounting for confounding factors. These results will be useful for healthcare providers of transgender persons but should be confirmed with larger samples using a prospective study design.

https://www.jsm.jsexmed.org/article/S1743-6095(15)33856-X/fulltext

>Suicidality is associated with barriers to gender affirming care, gender based victimization and institutionalized cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03084-7

>Most participants who started gender-affirming hormones in adolescence continued this treatment into adulthood. The continuation of treatment is reassuring considering the worries that people who started treatment in adolescence might discontinue gender-affirming treatment.

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/fulltext#%20

>The mean SADS and HADS scores were in the normal range except for the HAD-Anxiety subscale (HAD-A) on the non-treated transsexual group. SADS, HAD-A, and HAD-Depression (HAD-D) mean scores were significantly higher among patients who had not begun cross-sex hormonal treatment compared with patients in hormonal treatment
>Similarly, current symptoms of anxiety and depression were present in a significantly higher percentage of untreated patients than in treated patients (61% vs. 33% and 31% vs. 8% respectively).
>The results suggest that most transsexual patients attending a gender identity unit reported subclinical levels of social distress, anxiety, and depression. Moreover, patients under cross-sex hormonal treatment displayed a lower prevalence of these symptoms than patients who had not initiated hormonal therapy.

https://www.sciencedirect.com/science/article/abs/pii/S0306453011002629?via%3Dihub

>From 107 Dutch-speaking transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects' initial assessment or treatment.
>None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.

https://www.sciencedirect.com/science/article/abs/pii/S1158136006000491?via%3Dihub

>This qualitative research complements existing quantitative evidence on the importance of social transition, with childhood affirmation critical to the happiness and well-being of trans children.

https://onlinelibrary.wiley.com/doi/10.1111/fare.12764

>A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89 % (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS).
>There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2 % regret rate for both sexes. There was a significant decline of regrets over the time period.

https://link.springer.com/article/10.1007/s10508-014-0300-8

>For participants who recalled GAH access in early adolescence, these results represent a 222% decrease in adjusted odds for past-month severe psychological distress and a 135% decrease for past-year suicidal ideation
>(GAH during late adolescence) These results represent a 153% decrease in the adjusted odds for past-month severe psychological distress and a 62% decrease for past-year suicide ideation.
>Access to GAH during adulthood was associated with an 81% decrease in adjusted odds of past-month severe psychological distress and a 21% decrease in past-year suicidal ideation

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039

>Youth whose restroom and locker room use was restricted were more likely to experience sexual assault compared with those without restrictions,
>Pediatricians should be aware that sexual assault is highly prevalent in transgender and nonbinary youth and that restrictive school restroom and locker room policies may be associated with risk.

https://publications.aap.org/pediatrics/article/143/6/e20182902/76816/School-Restroom-and-Locker-Room-Restrictions-and

>In this prospective cohort of 104 TNB youths aged 13 to 20 years, receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423

>GnRHa cohort youth appear to be functioning better from a psychosocial standpoint than GAH cohort youth, pointing to possible benefits of accessing gender-affirming treatment earlier in life.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897328/

>Advanced spermatogenesis may occur in the presence of a GnRH agonist. Cessation of GnRH agonist therapy may not be essential for semen cryopreservation in adolescent transgender females.

https://www.liebertpub.com/doi/abs/10.1089/trgh.2021.0034

>We successfully used letrozole to maintain low serum estradiol in a transgender male adolescent during ovarian stimulation. Maintaining low estradiol to minimize pubertal development and possibly prevent gender dysphoria symptoms may make oocyte cryopreservation more desirable for transgender male adolescents.

https://pubmed.ncbi.nlm.nih.gov/33795140/

>124 out of 140 minors were confirmed as being transgender, 83.1% of them were adolescents. The assigned male/female ratio was 1:1.2. 97.6% persisted in their transgender identity after a median follow-up time of 2.6 years.

https://www.sciencedirect.com/science/article/pii/S1888989122000283

>704 (98%) people who had started gender-affirming medical treatment in adolescence continued to use gender-affirming hormones at follow-up. Age at first visit, year of first visit, age and puberty stage at start of GnRHa treatment, age at start of gender-affirming hormone treatment, year of start of gender-affirming hormone treatment, and gonadectomy were not associated with discontinuing gender-affirming hormones.

https://doi.org/10.1016/S2352-4642(22)00254-1

>These preliminary data show that GnRHa therapy is effective in suppressing pubertal changes with no impact on mean arterial BP and BMI in trans adolescents; GAHT had no impact on mean BP. Also, puberty suppression together with psychological support showed efficacy in improving psychological functioning.

https://www.sciencedirect.com/science/article/abs/pii/S1743609522016472

>After adjustment for sociodemographic factors and exposure to other types of gender-affirming care, undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio [aOR], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001)

https://jamanetwork.com/journals/jamasurgery/fullarticle/2779429

>Moreover, GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months of GnRHa (67.4 ± 13.9) compared with when they had received only psychological support (60.9 ± 12.2, P = 0.001).
>Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.13034

>A difference in SCL-90 overall psychoneurotic distress was observed at the different points of assessments (P = 0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P < 0.001). Significant decreases were found in the subscales such as anxiety, depression, interpersonal sensitivity, and hostility. Furthermore, the SCL-90 scores resembled those of a general population after hormone therapy was initiated.
>A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy

https://www.sciencedirect.com/science/article/abs/pii/S1743609515305336

>recalled exposure to gender identity conversion efforts was significantly associated with increased odds of severe psychological distress during the previous month and lifetime suicide attempts compared with transgender adults who had discussed gender identity with a professional but who were not exposed to conversion efforts. For transgender adults who recalled gender identity conversion efforts before age 10 years, exposure was significantly associated with an increase in the lifetime odds of suicide attempts.
>The findings suggest that lifetime and childhood exposure to gender identity conversion efforts are associated with adverse mental health outcomes.

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2749479

> A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years).
>After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.

https://pubmed.ncbi.nlm.nih.gov/25201798/

>This study examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on between 1994 and 2000 by one surgeon using a consistent technique
>None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery.

https://link.springer.com/article/10.1023/A:1024086814364

>The aim of this study was to re-examine individuals with gender identity disorder after as long a period of time as possible. To meet the inclusion criterion, the legal recognition of participants' gender change via a legal name change had to date back at least 10 years. The sample comprised 71 participants (35 MtF and 36 FtM). The follow-up period was 10-24 years with a mean of 13.8 years (SD = 2.78).
>Positive and desired changes were determined by all of the instruments: Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation

http://europepmc.org/article/med/25690443

>Out of 5107 trans women (median age at first visit 28 years, median follow-up time 10 years) and 3156 trans men (median age at first visit 20 years, median follow-up time 5 years), 41 trans women and 8 trans men died by suicide

https://pubmed.ncbi.nlm.nih.gov/32072611/

>The results showed that 3.8% of the patients who were sex reassigned during 1972-1992 regretted the measures taken
>The results of logistic regression analysis indicated that two factors predicted regret of sex reassignment, namely lack of support from the patient's family, and the patient belonging to the non-core group of transsexuals

https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1998.tb10001.x

>Eighty-nine percent engaged in postsurgical sexual activities. Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. Seventy-eight percent were satisfied with their neovagina's esthetic appearance, whereas only 56% were satisfied with depth. Almost all of the patients were satisfied with their new sexual status and expressed no regrets.

https://www.jsm.jsexmed.org/article/S1743-6095(15)32275-X/fulltext

>No patients reported rectal-vaginal fistula or deep-vein thrombosis and reports of other significant surgical complications were uncommon
>No single complication was significantly associated with regretting SRS. Satisfaction with most physical and functional outcomes of SRS was high; participants were least satisfied with vaginal lubrication, vaginal touch sensation, and vaginal erotic sensation

https://link.springer.com/article/10.1007/s10508-006-9104-9

>Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.

https://link.springer.com/article/10.1007/s11606-015-3529-6

>The patients benefited significantly from treatment. The noncompliant patients achieved equally good results as the compliant ones, and did so in a shorter time.

https://www.tandfonline.com/doi/abs/10.1080/15532739.2011.618399

>In this prospective, noncomparative, cohort study, the current results suggest that the gains in breast satisfaction, psychosocial well-being, and sexual well-being after male-to-female transsexual patients undergo breast augmentation are statistically significant and clinically meaningful to the patient at 4 months after surgery and in the long term.

https://journals.lww.com/plasreconsurg/Abstract/2013/12000/Patient_Satisfaction_with_Breasts_and.9.aspx

>The results show that gender reassignment surgery improves the QoL for transsexuals in several different important areas: most are satisfied of their sexual reassignment (28/30), their social (21/30) and sexual QoL (25/30) are improved. However, there are differences between male-to-female (MtF) and female-to-male (FtM) transsexuals in terms of QoL: FtM have a better social, professional, friendly lifestyles than MtF. Finally, the results of this study did not evidence any influence by certain aspects of the personality, such as extraversion and neuroticism, on the QoL for reassigned subjects.

https://www.sciencedirect.com/science/article/abs/pii/S1158136009000796?via%3Dihub

>we found that social, psychological, and medical gender affirmation were significant predictors of lower depression and higher self-esteem
>Findings support the need for accessible and affordable transitioning resources for transgender women in order to promote better quality of life among an already vulnerable population.

https://pubmed.ncbi.nlm.nih.gov/27747257/

>In line with earlier reports, we reveal that a change in self-reported sexual orientation is frequent and does not solely occur in the context of particular transition events. Transsexual persons that are attracted by individuals of the opposite biological sex are more likely to change sexual orientation

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110016

>This case report is on a 22-year follow-up of a female-to-male transsexual, treated with GnRH analogs at 13 years of age and considered eligible for androgen treatment at age 17, and who had gender reassignment surgery at 20 and 22 years of age. At follow-up, he indicated no regrets about his treatment. He was functioning well psychologically, intellectually, and socially
>There were no clinical signs of a negative impact on brain development. He was physically in good health, and metabolic and endocrine parameters were within reference ranges. Bone mineral density was within the normal range for both sexes. His final height was short as compared to Dutch males

https://pubmed.ncbi.nlm.nih.gov/21503817/