Gender-Affirming Facial Feminization Surgery at a Public, Safety-Net Hospital: A Single-Center Early Experience.

BACKGROUND: Facial feminization surgery (FFS) remains inaccessible to many transgender patients. Zuckerberg San Francisco General Hospital (ZSFG) was among the first public, safety-net hospitals to perform FFS. The purpose of this study is to examine the postoperative outcomes of patients who underwent FFS at ZSFG and describe barriers to providing FFS in a public hospital setting. METHODS: A retrospective review identified patients who underwent FFS at ZSFG. Demographic data, comorbidity profiles, postoperative outcomes, and hospital utilization data were collected from the medical records. FACE-Q modules (scored 0-100) were used to survey patient satisfaction at least 1 year postoperatively. RESULTS: Seventeen patients underwent comprehensive FFS surgery at ZSFG. The median age was 41 years [interquartile range (IQR): 38-55], median body mass index was 26.4 (IQR: 24.1-31.3). Patients underwent a median of 9 procedures, the most common of which included frontal cranioplasty (n=13, 77%), open brow lift (n=13, 77%), rhinoplasty (n=12, 71%), and mandible contouring (n=12, 71%). There were no complications, readmissions, or reoperations within 30 days. Patients reported high satisfaction with the surgical outcome (median: 87, IQR: 87-100), excellent postoperative psychological functioning (median: 100, IQR: 88-100), and low levels of appearance-related distress (median: 3, IQR: 0-35). An estimated 243 operating room hours and 51 inpatient bed days were required to cover all FFS procedures. CONCLUSIONS: Performing FFS in a public, safety-net hospital was associated with zero postoperative complications, few revision procedures, and excellent patient satisfaction. Limited operating room hours and inpatient availability represented barriers to providing FFS in this setting.

Are rash impulsive and reward sensitive traits distinguishable? A test in young adults.

Adolescents and young adults are characterized as prone to risky behavior with a wide range of traits identified as predictors of individual differences in this behavior. Here we test a crucial difference between traits that reflect rash impulsivity, the tendency to engage in risky behavior without consideration of consequences, versus reward sensitivity, the tendency to be attracted to novel and rewarding experience. To test the validity of this distinction, we examined the factorial structure of eight risk-related traits in a sample of 899 18 to 22 year-olds. We predicted that rash impulsive traits would be separable in structure from reward sensitive traits and would uniquely predict relatively maladaptive risk-taking (e.g., drug use). In addition, we predicted that reward sensitive traits would be related to both adaptive (e.g., entering competitions) and maladaptive risk behaviors. Results revealed a factorial structure that distinguished these traits, with rash impulsive and reward sensitive traits uniquely predictive of different forms of risk-taking. The results suggest that it is possible to distinguish traits that reflect these two forms of risk-taking with implications for the measurement and interpretation of risk propensities in youth.

Testosterone treatment and MMPI-2 improvement in transgender men: a prospective controlled study.

OBJECTIVE: Most transgender men desire to receive testosterone treatment in order to masculinize their bodies. In this study, we aimed to investigate the short-term effects of testosterone treatment on psychological functioning in transgender men. This is the 1st controlled prospective follow-up study to examine such effects. METHOD: We examined a sample of transgender men (n = 48) and nontransgender male (n = 53) and female (n = 62) matched controls (mean age = 26.6 years; 74% White). We asked participants to complete the Minnesota Multiphasic Personality Inventory (2nd ed., or MMPI-2; Butcher, Graham, Tellegen, Dahlstrom, & Kaemmer, 2001) to assess psychological functioning at baseline and at the acute posttreatment follow-up (3 months after testosterone initiation). Regression models tested (a) Gender × Time interaction effects comparing divergent mean response profiles across measurements by gender identity; (b) changes in psychological functioning scores for acute postintervention measurements, adjusting for baseline measures, comparing transgender men with their matched nontransgender male and female controls and adjusting for baseline scores; and (c) changes in meeting clinical psychopathological thresholds. RESULTS: Statistically significant changes in MMPI-2 scale scores were found at 3-month follow-up after initiating testosterone treatment relative to baseline for transgender men compared with female controls (female template): reductions in Hypochondria (p < .05), Depression (p < .05), Hysteria (p < .05), and Paranoia (p < .01); and increases in Masculinity-Femininity scores (p < .01). Gender × Time interaction effects were found for Hysteria (p < .05) and Paranoia (p < .01) relative to female controls (female template) and for Hypochondria (p < .05), Depression (p < .01), Hysteria (p < .01), Psychopathic Deviate (p < .05), Paranoia (p < .01), Psychasthenia (p < .01), and Schizophrenia (p < .01) compared with male controls (male template). In addition, the proportion of transgender men presenting with co-occurring psychopathology significantly decreased from baseline compared with 3-month follow-up relative to controls (p < .05). CONCLUSIONS: Findings suggest that testosterone treatment resulted in increased levels of psychological functioning on multiple domains in transgender men relative to nontransgender controls. These findings differed in comparisons of transgender men with female controls using the female template and with male controls using the male template. No iatrogenic effects of testosterone were found. These findings suggest a direct positive effect of 3 months of testosterone treatment on psychological functioning in transgender men.

Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults.

PURPOSE: Enacted and anticipated stigma exist within healthcare settings for transgender people, but research has yet to examine the effects of these forms of stigma on the substance use behaviors of female-to-male (FTM) trans masculine people. METHODS: Data were analyzed from the cross-sectional U.S. National Transgender Discrimination Survey, a convenience sample of transgender adults purposively sampled in 2008. Trans masculine respondents (n=2,578) were identified using a two-step method: Step 1, Assigned birth sex; Step 2, Current gender identity. A gender minority stress model of substance use was tested to examine the relation of enacted and anticipated stigma with substance use to cope with mistreatment. RESULTS: Overall, 14.1% of the sample reported having been refused care by a provider (enacted stigma), 32.8% reported delaying needed medical care when sick/injured, and 39.1% delayed routine preventive care (anticipated stigma). Having been refused care was significantly associated with avoidance of healthcare, including delaying needed medical care when sick/injured and delaying routine preventive medical care. Substance use to cope with mistreatment was self-reported by 27.6% of the sample. Enacted stigma by providers was associated with self-reported substance use to cope. Delays in both needed and preventive care (anticipated stigma) were highly associated with substance use, and attenuated the effect of enacted stigma. CONCLUSION: Gender minority-related stressors, particularly enacted and anticipated stigma in healthcare, should be integrated into substance use and abuse prevention and intervention efforts with this underserved population.

Measures of clinical health among female-to-male transgender persons as a function of sexual orientation.

The present study examined the sexual orientation classification system that was used in the DSM-IV-TR for categorizing those who met the Gender Identity Disorder diagnostic criteria in order to determine the extent to which female-to-male transgender persons (FTMs) differ on psychological variables as a function of sexual orientation. Participants were 605 self-identified FTMs from 19 different countries (83 % U.S.) who completed an internet survey assessing their sexual orientation, sexual identity, symptoms of depression and anxiety, stress (Depression Anxiety Stress Scales), social support (Multidimensional Scale of Perceived Social Support), and health related quality of life (SF-36v2 Health Survey). Over half the sample (52 %) reported sexual attractions to both men and women. The most common sexual identity label reported was "queer." Forty percent of FTMs who had begun to transition reported a shift in sexual orientation; this shift was associated with testosterone use. Overall, FTMs ranged from normal to above average on all psychological measures. FTMs did not significantly differ by sexual attraction on any mental health variables, except for anxiety. FTMs attracted to both men and women reported more symptoms of anxiety than those attracted to men only. Results from the present study did not support a sexual orientation classification system in FTMs with regard to psychological well-being.

Individual Differences in Numeracy and Cognitive Reflection, with Implications for Biases and Fallacies in Probability Judgment.

Despite evidence that individual differences in numeracy affect judgment and decision making, the precise mechanisms underlying how such differences produce biases and fallacies remain unclear. Numeracy scales have been developed without sufficient theoretical grounding, and their relation to other cognitive tasks that assess numerical reasoning, such as the Cognitive Reflection Test (CRT), has been debated. In studies conducted in Brazil and in the USA, we administered an objective Numeracy Scale (NS), Subjective Numeracy Scale (SNS), and the CRT to assess whether they measured similar constructs. The Rational-Experiential Inventory, inhibition (go/no-go task), and intelligence were also investigated. By examining factor solutions along with frequent errors for questions that loaded on each factor, we characterized different types of processing captured by different items on these scales. We also tested the predictive power of these factors to account for biases and fallacies in probability judgments. In the first study, 259 Brazilian undergraduates were tested on the conjunction and disjunction fallacies. In the second study, 190 American undergraduates responded to a ratio-bias task. Across the different samples, the results were remarkably similar. The results indicated that the CRT is not just another numeracy scale, that objective and subjective numeracy scales do not measure an identical construct, and that different aspects of numeracy predict different biases and fallacies. Dimensions of numeracy included computational skills such as multiplying, proportional reasoning, mindless or verbatim matching, metacognitive monitoring, and understanding the gist of relative magnitude, consistent with dual-process theories such as fuzzy-trace theory.

The Role of Perceived Maternal Favoritism in Sibling Relations in Midlife.

Data were collected from 708 adult children nested within 274 later-life families from the Within-Family Differences Study to explore the role of perceived maternal favoritism in the quality of sibling relations in midlife. Mixed-model analyses revealed that regardless of which sibling was favored, perceptions of current favoritism and recollections of favoritism in childhood reduced closeness among siblings. Recollections of maternal favoritism in childhood were more important than perceptions of current favoritism in predicting tension among adult siblings, regardless of age. Taken together, the findings from this investigation are consistent with childhood studies showing that siblings have better relationships when they believe that they are treated equitably by their parents.