Society of Family Planning clinical recommendations: Contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth.

Everyone of reproductive potential, no matter sex or gender, may have contraceptive needs. However, with no professional society guidelines and scant data on contraceptive use for transgender and gender-diverse (TGD) populations, clinicians' abilities to counsel patients on use, safety, side effects, and efficacy is severely limited. We know very little about how estrogen- and progestin-containing contraceptive methods interact with gender-affirming testosterone therapy. Consequently, providers must extrapolate from data on use of hormonal contraceptive methods in presumed cisgender women and rely on clinical expertise. Based on available literature and expert opinion, there are important considerations for each method that can help guide contraceptive counseling with TGD patients. Specific considerations include differential experience of side-effects in TGD patients, barriers to access, and potential misconceptions regarding menstruation and reproductive capacity. When counseling a TGD person about their contraception options, providers should engage in shared decision-making, acknowledging the spectrum of identities and experiences within these communities. In order to support gender-affirming patient-centered care, providers should also create a space that is welcoming, use language that promotes inclusivity, and perform physical exams that consider the potential physical and emotional discomforts specific to these patients. Given the lack of population-specific data and guidelines, we encourage providers to integrate what is known about contraceptive use in cisgender women with the unique needs of TGD persons to apply a shared decision-making contraceptive counseling approach with members of these communities.

Feasibility of Vaginal Hysterectomy for Female-to-Male Transgender Men.

OBJECTIVE: To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men. METHODS: This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed. RESULTS: Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups. CONCLUSION: Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.

Non-Prescribed Hormone Use and Barriers to Care for Transgender Women in San Francisco.

PURPOSE: Inconsistent access to healthcare represents a barrier to transgender patients receiving hormone therapy through a licensed provider. Inability to access care leads many transgender people to buy hormones from unlicensed sources and transition without medical supervision. Little is known about the factors predisposing people to rely on this method of transition. It is critical to understand what leads to non-prescribed hormone use to better support safe medical transitions for transgender people. METHODS: We conducted an analysis of a study with 314 transwomen in San Francisco from August-December 2010, using Respondent Driven Sampling (RDS). The study collected information on demographics, hormone use, gender identity milestones, violence and trauma experienced due to gender identity, substance use, sexually transmitted infections, law enforcement contact and sexual behaviors. We evaluated whether these demographic and behavioral characteristics were correlated in the following outcomes: taking hormones not prescribed by providers and taking hormones consistently without interruptions. RESULTS: Data demonstrate that 68.7% of transwomen were currently on hormone replacement therapy (HRT) but only 41% reported being on hormones consistently. In addition, 49.1% reported taking hormones for HRT not prescribed by a clinician. Consistent hormone use was independently and positively associated with being born in the United States, having contact with a health care provider, and currently living full-time as a female. Those who reported ever being forced to have sex or having been raped had 60% lower odds of being consistently on hormones. We found greater odds of non-prescribed hormone use among participants who had gender confirmation surgery and among those who had experienced verbal abuse due to their gender identity and presentation. CONCLUSION: Non-prescribed HRT in transwomen is a common and poorly characterized phenomenon. Increasing access to healthcare (with culturally-competent, affordable, and accessible providers) is crucial to assuring trans people are able to have safe, consistent access to the hormones they need.

Natural variation in life history and aging phenotypes is associated with mitochondrial DNA deletion frequency in Caenorhabditis briggsae.

BACKGROUND: Mutations that impair mitochondrial functioning are associated with a variety of metabolic and age-related disorders. A barrier to rigorous tests of the role of mitochondrial dysfunction in aging processes has been the lack of model systems with relevant, naturally occurring mitochondrial genetic variation. Toward the goal of developing such a model system, we studied natural variation in life history, metabolic, and aging phenotypes as it relates to levels of a naturally-occurring heteroplasmic mitochondrial ND5 deletion recently discovered to segregate among wild populations of the soil nematode, Caenorhabditis briggsae. The normal product of ND5 is a central component of the mitochondrial electron transport chain and integral to cellular energy metabolism. RESULTS: We quantified significant variation among C. briggsae isolates for all phenotypes measured, only some of which was statistically associated with isolate-specific ND5 deletion frequency. We found that fecundity-related traits and pharyngeal pumping rate were strongly inversely related to ND5 deletion level and that C. briggsae isolates with high ND5 deletion levels experienced a tradeoff between early fecundity and lifespan. Conversely, oxidative stress resistance was only weakly associated with ND5 deletion level while ATP content was unrelated to deletion level. Finally, mean levels of reactive oxygen species measured in vivo showed a significant non-linear relationship with ND5 deletion level, a pattern that may be driven by among-isolate variation in antioxidant or other compensatory mechanisms. CONCLUSIONS: Our findings suggest that the ND5 deletion may adversely affect fitness and mitochondrial functioning while promoting aging in natural populations, and help to further establish this species as a useful model for explicit tests of hypotheses in aging biology and mitochondrial genetics.