Conference Report: 2013 National Transgender Health Summit continued

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May 212013
 

Following up on the conference, I wanted to pass along a few articles and studies in need of participants.

 

Studies:

The Shine Study is looking to interview young trans women (or trans feminine-identified people) in the San Francisco Bay Area. They are looking for people aged 16-24.

Pregnancy After Transitioning Study, through UCSF, is looking for participants. Participants must have been assigned female at birth and male/masculine identified, and have completed a pregnancy within the last 10 years. Contact Lexi Light, the study coordinator, at LightA@obgyn.ucsf.edu or e-mail me for other contact information.

Survey on Access to Infertility Services for LGBT People, from the National Center for Lesbian Rights is looking for survey responses to assist their advocacy work. If you’re LGBT-identified, and have used or considered using assisted reproduction to conceive, please e-mail info@nclrights.org to get a series of questions to answer.

 

I also picked up a bundle of information on fertility including these articles…

Fertility Preservation Options for the LGBT Community

Reproductive Options for Transgender Women

Study: Reproductive Wish in Transsexual Men

 

Have a great week, folks! We’ll be back to our regular content soon.

Conference Report: 2013 National Transgender Health Summit (Preliminary)

 Conference reports  1 Response »
May 192013
 

I got back from the 2013 National Transgender Health Summit (NTHS) in Oakland last night. What a fabulous conference! I’m still processing a lot of my notes, but wanted to give a quick report on it before I flood the blog with new resources.

First some basic information. NTHS is cosponsored by UCSF’s Center of Excellence for Transgender Health and the World Professional Association for Transgender Health. It’s designed for medical professionals, mental health professionals, advocates, health administrators, students, and others. I can’t speak for previous years, but this year it was a two-day event. Sessions were broken into various tracks: research, medical, mental health, policy, and special topics. And boy, did we cover quite a lot! And, as always, I wanted to be in five different places all at once.

Aside from the official session topics, though, there were some themes that stood out to me…

  • There’s a very strong need for cross-cultural trans care. Trans care, like lots of medicine, has been focused on white people. I admit to being guilty of this too! I don’t know how being trans is handled in, for example, an urban latino/a community, and I don’t know how I can best respond to those needs as a future health care provider. I met some folks who were involved in the Trans People of Color Coalition, and I hope to not only educate myself but bring more awareness to my posts here.
  • There’s a disconnect in some areas between cultural knowledge about medical treatments in trans communities and medical knowledge. I want to give a shout out to Trystan Cotten, author of Hung Jury, for bringing attention to this within trans male communities. One of his examples? Something new for me, certainly: there are anecdotal reports that some trans men can have penetrative sex after metoidioplasty. Sounds like there needs to be a community-level conversation.
  • It sounds so far like the ICD-11 system will handle both the transgender/transsexual diagnoses and the paraphilia diagnoses much better than the previous ICDs and certainly better than the DSM system. More details when the preliminary criteria are out for comment.
  • Insurance coverages for trans-related care may improve with the Affordable Care Act. Again, more on this as information becomes more available.
  • There is a lot of research going on! Yay! I’ll try to link to some of the studies I heard about in a follow up.

Plus so much more! It was really exciting. I hope to post again with more information, links to lots of new resources and shout outs for on-going studies and organizations.

News Roundup for April 2013

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May 022013
 

 

CC BY-NC 2.0 - flickr - Jonathan Gill Summary of some of the interesting news bits from April 2013.

  • Researchers in Sweden find that early vaccinations against HPV are more effective than late vaccinations (93% effective before 14 years, 76% after 14 years and before 20 years). Abstract. Open Source Full Text.
  • Despite low risk of side effects and mild side effects, fewer U.S. parents were less likely to vaccinate against HPV in 2010 than in 2008 (43.9% unwilling to vaccinate in 2010 vs 39.8% unwilling in 2008). Abstract. Open Source Full Text.
  • Anal cancer rates have dramatically increased since 1973. Abstract.
  • Roughly 3/4ths of men who show “hypersexual” behavior report being distressed by it or having functional problems. Slightly more than half have relationship problems. Abstract.
  • Attitudes about female circumcisions have been assessed via Facebook in the “Middle East”. Female circumcision is done by doctors about half of the time, and was more common in rural areas than urban areas. Nearly half of the sample indicated that female circumcision was “necessary” or “very necessary.” Abstract.
  • Persistant genital arousal disorder may be caused by a mass, according to a recent case study.
  • In women with menstrual cycles, estrogen may have a delayed positive effect on libido. Progesterone may have a negative effect on libido. News article.
  • The U.S. Department of Justice has issued new guidelines for medical examinations after a rape. These guidelines now emphasize the survivor’s emotional and physical needs over any forensic needs. News article. Guidelines.
  • Recent cases of meningitis in gay men raised concerns that gay men may be at risk. After analysis the cases appear not to have been related. Gay men who have been sexually active in or around New York City since September 1st are still advised to get a meningitis vaccine to be on the safe side. News article.

Why the flower picture? It’s a tongue-in-cheek reference to the “flower of the month.” Besides, it’s pretty!

Did I miss anything? Let me know in the comments.

Hope you all had a lovely month!

Article Review: Hormonal Treatment Reduces Psychobiological Distress in Gender Identity Disorder, Independently of the Attachment Style

 Article Review  2 Responses »
May 012013
 

CC BY 2.0 - flickr user eamoncurry123Summary: Research now indicates that cross-sex hormone therapy is associated with a lower cortisol awakening response in trans people, regardless of attachment style. Many confounding variables, however, were present in this study.

Transgender people have long asserted that gender dysphoria can be extremely distressing and that transition, including hormone therapy, helps relieve that dysphoria. Hormone therapy is known to improve self-reported quality of life, as measured by questionnaire. To my knowledge no other study has looked at stress-related biological factors in trans people. Biological factors are important because self-report is notorious for validity problems. This study looked at one such biological factor, called the cortisol awakening response.

What is the cortisol awakening response? Readers of the blog may remember the last time I spoke about cortisol (paragraph #2). For those who don’t remember…. cortisol is a “stress hormone.” When we’re stressed, whether by speaking in public or running from a lion, cortisol is released. It helps our body be ready for immediate survival by increasing blood sugar and helping with metabolism. High cortisol levels over a long period of time can have many negative effects on health, including weakening the immune system. The cortisol awakening response is part of cortisol’s daily cycle, when cortisol blood levels spike about 20-30 minutes after waking in the morning. The cortisol awakening response is larger in stressed people than in non-stressed people and can be affected by many things, including burn out, fatigue, aspirin, and sleep schedule. Cortisol awakening response is thought to be a good indicator of general stress levels and as a good indicator for stress-related disease risks.

Participants in this study were 70 trans people seen at the Gender Identity Unit of the University of Bari Psychiatric Department, roughly 64% trans women. All the participants had the same hormonal treatment; transdermal estradiol gel and cyproterone acetate (an anti-androgen) for trans women, intramuscular testosterone esters for trans men. They were assessed before hormone therapy and 12 months after starting hormone therapy. There was no significant difference in age, education, or occupation between the two groups.

The researchers measured perceived stress (a self-report of how stressed a person feels) in addition to the cortisol awakening response. The cortisol awakening response was measured by a blood test at 8:00am on three consecutive days, 1 hour after waking.

The results were striking. Before treatment, both perceived stress and cortisol levels were above the  ”normal” range. After twelve months of hormone therapy, both were much lower and back within normal ranges. There were no statistically significant differences between trans men and trans women.

However there are a number of confounds for this study. Cortisol levels vary with sex hormones. For example, the cortisol levels of menstrual women will vary depending on which part of the menstrual cycle they’re in. Could cross-sex hormone therapy have caused this change in cortisol levels? Maybe, but then I’d expect there to be a difference between the trans men and trans women in this study and there weren’t.

The researchers also did not appear to attempt to control for other factors which could have impacted the cortisol awakening response. Changes in sleep patterns (e.g., naps) or sleep quality (e.g., a noisy environment) have effects on the cortisol awakening response. As far as I can tell the researchers did not screen for these changes.

Cortisol and stress were not the only things measured in this study. The researchers also looked at attachment styles. Attachment styles are a psychological concept. The idea is that when we are children our interactions with parents, and how they respond to our needs, affects the type of “attachment” we have. Attachment styles are secure or insecure. A secure attachment often results in happy adult relationships. Insecure attachments include avoidant, anxious, and unresolved/disorganized styles. Attachment styles may influence how we respond to stress, so they could have been a confound in this study if not examined.

The researchers determined the attachment style of the participants with a structured interview. They found that trans people are more likely to have an insecure attachment (70%) than the general population with no psychiatric diagnoses (44%). Attachment style did not, however, appear to be correlated with cortisol awakening response or perceived stress.

In other words, the relationship trans people have with their parents did not appear to affect the stress-reducing effects of hormone therapy.

I admit I do not really understand why these researchers chose to examine attachment style in this study. While I think that knowing attachment styles may be useful for therapy, or for the development of effective variations on therapies for trans people, I don’t feel that the inclusion of attachment style was sufficiently justified in this study. Why look at attachment and not, for example, socioeconomic status or social support? I would think either of those would be more likely to have an impact on stress levels than attachment.

On the whole, I think that the cortisol results of this study are decent validation of the anecdotal evidence from trans people themselves, but that the exploration of attachment style in this context is a red herring.

The abstract is publicly available.

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