Invisibilização e preconceitos velados: barreiras para o acesso aos serviços de atenção básica pela população trans / Invisibilization and veiled prejudices: barriers to access to primary care services for the transgender population / Invisibilización y prejuicios velados: barreras para el acceso de la población trans a los servicios de atención primaria

Introdução: No processo de edificação da Política Nacional de Saúde Integral LGBT+, a Atenção Básica ganha importante destaque, pois deveria funcionar como o contato preferencial dos usuários transgênero (trans). Objetivo: Investigar quais as percepções dos profissionais da Atenção Básica quanto às situações de vulnerabilidade enfrentadas pelas pessoas trans, bem como pesquisar os impedimentos que eles consideram existir na busca dessa população por acesso a esses serviços. Métodos: Utilizou-se uma abordagem qualitativa por meio de entrevistas semiestruturadas com 38 profissionais de saúde atuantes das Estratégias Saúde da Família de dois municípios do interior do estado de São Paulo. O material obtido foi submetido à análise de conteúdo de Bardin. Resultados: Os resultados apontaram para o desconhecimento quanto aos reais empecilhos que dificultam o acesso e seguimento de pessoas trans nos serviços de saúde. Observou-se ainda a manutenção de preconceitos e ideias que reforçam estereótipos ligados ao tema e que se estendem ao exercício da profissão. Isso se relaciona diretamente com a falta da abordagem de assuntos relacionados à sexualidade humana na graduação desses profissionais, além da falta de atualização quanto ao tema, o que impacta a qualidade do serviço que é ofertado à população em estudo. Conclusões: As normativas e portarias já existentes precisam ser efetivamente postas em prática, fazendo-se imperativas a ampliação e difusão do conhecimento a respeito da temática trans no contexto dos serviços públicos de saúde, o que pode servir como base para subsidiar a formação dos profissionais que atuam nesse setor, bem como políticas públicas efetivas.

Introduction: In the process of creating the National LGBT+ Comprehensive Health Policy, primary care has important prominence as it must work as the preferential contact of transgender (trans) users. Objective: To investigate the perceptions of primary care professionals about the vulnerability situations faced by trans persons and also hindrances they consider existing in this population's search for access to these services. Methods: A qualitative approach was used through semi-structured interviews with 38 health care professionals working in the Family Health Strategy of two cities in the countryside of the state of São Paulo. The material obtained was submitted to analysis of Bardin content. Results: The results pointed to a lack of knowledge about real hindrances that obstruct the access to and follow-up by health services for trans persons. It was also observed the maintenance of prejudices and ideas that reinforce stereotypes connected to the matter and extend to the practice of professionals. It is directly related to the lack of approach of issues related to human sexuality in the education of those professionals, in addition to lack of update about it, which impacts the quality of service offered to the population under study. Conclusions: The standards and ordinances already existing need to be effectively practiced, being crucial the extension and spread of knowledge about trans matters in the context of public health services. It can be the basis for subsidizing the education of professionals who work in this field, as well as effective public policies.

Introducción: En el proceso de edificación de la Política Nacional de Salud Integral LGBT+, la Atención Básica tiene importante destaque, pues debería funcionar como contacto preferente de los usuarios transgénero (trans). Objetivo: Investigar las percepciones de los profesionales de Atención Básica sobre las situaciones de vulnerabilidad que enfrentan las personas trans, así como investigar los impedimentos que consideran que existe en la búsqueda de esta población por el acceso a estos servicios. Métodos: Se utilizó un abordaje cualitativo por medio de entrevistas semiestructuradas con 38 profesionales de salud actuantes de las Estrategias de Salud de la Familia de dos municipios del interior del estado de São Paulo. El material obtenido fue sometido a análisis de contenido de Bardin. Resultados: Los resultados apuntaron al desconocimiento sobre los reales obstáculos que dificultan el acceso de personas trans a los servicios, además del segmento de los cuidados en las unidades. Se observó además que se mantienen los prejuicios e ideas que refuerzan estereotipos vinculados al tema y que se extienden al ejercicio de la profesión. Esto se relaciona directamente a la falta da abordaje de asuntos relacionados a la sexualidad humana en la graduación de estos profesionales, además de la falta de actualización sobre el tema, lo que impacta en la calidad del servicio que se ofrece a la población en estudio. Conclusiones: Las normas y ordenanzas ya existentes deben ser efectivamente puestas en práctica, por lo que es imperativo ampliar y difundir el conocimiento sobre la temática trans en el contexto de los servicios públicos de salud, que pueda servir de base para apoyar la formación de profesionales que actúan en este sector, así como políticas públicas efectivas.

Effect of testosterone formulations on hematocrit in transgender individuals: A systematic review.

BACKGROUND: Approximately, 11% of trans men experience erythrocytosis diagnosis due to testosterone administration during the first year of the gender-affirming hormone treatment (GAHT). OBJECTIVES: To identify and compare the effect of different testosterone formulations on hematocrit (Hct) and diagnose erythrocytosis in trans men. MATERIALS AND METHODS: This systematic review was based on PRISMA guidelines. We performed an electronic search of PubMed, Embase, and Web of Science in January 2024. The Newcastle-Ottawa scale was used to evaluate the quality of evidence in the observational studies. RESULTS: Of the 152 records retrieved, 18 met the eligibility criteria. Studies observed an increase of up to 5% in Hct in trans men using injectable testosterone undecanoate (TU), and up to 6.9% in trans men using intermediate injectable testosterone esters (TE). Trans men using TE experience a larger increase in serum Hct levels compared to those receiving TU. Erythrocytosis prevalence varies according to the cutoff used (50%, 52%, and 54%). Erythrocytosis was also associated with tobacco use, age at initiation of hormone therapy, body mass index (BMI), and pulmonary conditions. Studies that evaluated the effect of testosterone formulation on erythrocytosis diagnosis present conflicting result. Trans men have a hazard ratio of 7.4 (95% CI: 4.1, 13.4) of developing erythrocytosis compared to cisgender men, using a 52% hematocrit cutoff. CONCLUSION: All testosterone formulations result in an increase in Hct, irrespective of dose, formulation, and administration method. Smoking, higher age at initiation of the testosterone therapy, higher BMI, and a predisposing medical history are associated with this increase in Hct. The difference in effect of TE and TU on Hct is conflicting, although it is important to point out that these data come from observational studies, retrospective, and with a small-sample size.

Medical care for transgender individuals at a hospital in southern Brazil: why do they drop out from our service?

Objective: The objective of the study was to investigate dropout rates and discern potential factors contributing to the discontinuation of treatment provided to transgender individuals by the Transdisciplinary Gender Identity Program at the Hospital de Clínicas de Porto Alegre (PROTIG). Methodology: This study employs a descriptive, cross-sectional, retrospective design to analyze socio-demographic and clinical data obtained from medical records of patients treated at PROTIG between 2000 and 2018. A structured form, devised by PROTIG's professional team, was utilized to extract and evaluate several variables including: age, gender, education level, diagnosis of F64 according to the International Classification of Diseases (ICD-10: Version: 2010), clinical comorbidities (coded by ICD-10), laboratory diagnosis of sexually transmitted infections, distance between patients' residence and the hospital, and year of entry into PROTIG. The patient cohort was stratified into two categories based on their duration of attendance: dropout (defined as attendance for up to 365 days) and non-dropout (attendance exceeding 365 days). Categorical variables between dropout and non-dropout groups were compared using Pearson's chi-square test. Additionally, Poisson regression analysis was utilized, employing a 95% confidence interval (CI) and setting the significance level at 0.05. Results: The study included a total of 888 patients accessing PROTIG, with 275 (31%) classified in the dropout group. Of the patient population, 65.5% (n = 582) self-identified as transgender women, while 34.5% (n = 306) identified as transgender men. Significant differences were noted between the dropout and non-dropout groups. Specifically, differences were noted among transgender women (p < 0.001), individuals with lower levels of education (p < 0.001), those with fewer diagnoses classified under ICD-10 as F64 (p < 0.001), individuals exhibiting fewer clinical comorbidities recorded in ICD-10 (p < 0.001), and those who commenced inclusion in PROTIG after 2010 (p < 0.001). Conclusion: There exists a notable rate of treatment discontinuation among individuals receiving care at PROTIG, with statistically significant variances observed between groups. We posit potential rationales for this discontinuation, informed by care experiences and feedback from group attendees: Increased accessibility to outpatient services in our jurisdiction for Transgender Care, along with heightened societal awareness of gender identity fostering diverse gender expression avenues devoid of reliance on gender-affirming surgical interventions.

Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

Desde los últimos años es posible encontrar referencias internacionales sobre el abordaje vocal al grupo específico de las personas transgénero, aunque la literatura latinoamericana sigue muy tímida en este asunto. La propuesta de este artículo es identificar las normas vigentes, estadísticas y abordaje vocal hacia las personas transgénero en Chile y Argentina, considerando la experiencia de dos fonoaudiólogas con más de veinte años de experiencia en terapia vocal. Se hicieron reflexiones sobre la realidad transgénero en los países citados, se delinearon las limitaciones en la puesta en práctica de la despatologización del grupo transgénero, se expusieron algunas estadísticas -vigentes y poco confiables-, se plasmaron algunas acciones novedosas en el sistema público y el desconocimiento sobre los beneficios del trabajo vocal en hombres y mujeres transgénero. Los aspectos detectados podrían beneficiarse de investigaciones multicéntricas que fortalezcan acciones fonoaudiológicas con este grupo, contribuyendo a la despatologización y el abordaje positivo.

Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas.

INTRODUCTION: Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum. METHODS AND ANALYSIS: We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals. ETHICS AND DISSEMINATION: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. TRIAL REGISTRATION NUMBER: NCT03081559.

Cross-Cultural Adaptation and Face Validation of the Chilean Version of the Operated Male to Female Sexual Function Index.

INTRODUCTION AND HYPOTHESIS: Transgender and gender-diverse people often experience discrimination or even outright exclusion when undergoing medical attention. It has been shown that gender-affirming treatments improve quality of life in transgender patients, and genital-affirming surgery (GAS) is increasingly spreading worldwide. Sexual function after male-to-female GAS has long been evaluated by using tools designed for assigned female at birth (AFAB), resulting in suboptimal assessments. Currently, the operated Male to Female Sexual Function Index (oMtFSFI) is the only validated questionnaire to assess the sexual function of operated transgender women. The current study was aimed at performing cross-cultural adaptation and to test the face validity of the Chilean version of the oMtFSFI. METHODS: We carried out an observational descriptive study. The questionnaire was translated into Spanish, adapted, and face validated in five phases with eight participants. The study was approved by the Universidad del Desarrollo Scientific Ethics Committee. RESULTS: According to participants, the questionnaire was shown to both pertinently and exhaustively evaluate the sexual function of post-feminizing genitoplasty transgender women. The questionnaire was well understood by the participants, except for a difficulty in understanding certain terms. Some participants criticized the perspective of the instrument in terms of the assumption of having a partner or having penetrative intercourse via the neovagina. The amendments to the Italian version of the questionnaire were discussed until an agreement on adaptation considering the patient´s perspective was reached. The present preliminary data support the face validity of the Chilean version of the oMtFSFI in the assessment of sexual function in operated transgender women. CONCLUSIONS: This adapted questionnaire could be a valuable tool for clinicians and researchers.

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence.

Objective: Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Methods: Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Results: Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Conclusion: Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Health care: life stories by trans women in Colombia.

BACKGROUND: In Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia. METHODS: A qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research. RESULTS: This research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes. CONCLUSION: Participants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study.

INTRODUCTION AND HYPOTHESIS: The objective of this research is to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men. We hypothesize that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions. METHODS: A cross-sectional study was conducted between September 2022 and March 2023 using an online questionnaire, which included transgender men over 18 years old who underwent gender-affirming hormone therapy. Volunteers with neurological disease, previous urogynecology surgery, active urinary tract infection, and individuals without access to the internet were excluded. The questionnaire employed validated tools to assess urinary symptoms, such as urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation. The data were analyzed descriptively and presented as frequencies and prevalence ratios with their respective confidence intervals (95% CI), mean, and standard deviation. RESULTS: A total of 68 transgender men were included. Most participants had storage symptoms (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and flatal incontinence (39.7%). Participants with UI symptoms reported moderate severity of the condition. CONCLUSIONS: Transgender men on hormone therapy have a high incidence of PFD (94.1%) and experience a greater occurrence of urinary symptoms (86.7%).

Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil.

BACKGROUND: Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS: A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS: A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION: Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03525340.

Quality of life and level of satisfaction with pharmacotherapeutic follow-up in a transgender health center in Brazil.

Trans people face numerous barriers to access and permanence in health services, which makes it difficult, among other things, to know about their quality of life and satisfaction with health services related to these users. Thus, the objective was to describle the quality of life and satisfaction with pharmacotherapeutic follow-up in transgender people. A cross-sectional, descriptive, and quantitative study was conducted between January and September 2022 at a specialized outpatient clinic for transgender individuals. The following aspects were describle: sociodemographic and medication profiles; quality of Life, which was measured using the WHOQOL-BREF questionnaire; and levels of satisfaction with Pharmacotherapeutic Monitoring, assessed through the Pharmacy Services Satisfaction Questionnaire (QSSF). Descriptive analyses employed measures of central tendency, absolute and relative frequencies, while inferential analyses used the Student's t test. A total of 101 transgender individuals participated in the study, with a mean age of 25 years, the majority being single (79.2%/80), having more than 11 years of education (47.5%/n = 48), and comprising 48.5% (n = 49) transgender women. Hormone use was reported by 59.4% (n = 60) of the participants, with 18.3% (n = 11) of self-medication. Testosterone cypionate was the most common hormone used by transgender men (84%), while cyproterone acetate and estradiol represented 60.4% of hormone use among transgender women. Additionally, 36 transgender individuals were taking other drugs (n = 60), mainly antidepressives (28%). The WHOQOL-BREF showed higher scores in the domains of self-rated Quality of Life, and physical, and psychological well-being among transgender women compared to transgender men, but without statistical differences. Income revealed a statistically significant association with psychological domains and overall quality of life. The results of the QSSF indicated that the overall mean and average scores per question were higher than 4, suggesting that 100% of the sample was satisfied with the provided service. No statistically significant differences were observed in the Quality of Life between transgender men and women, but income was associated with the psychological domain and overall Quality of Life. All participants reported satisfaction with the Pharmacotherapeutic Monitoring service; however, there is a need to expand service offerings, such as medication dispensing.

Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches.

OBJECTIVES: We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT. METHODS: TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated. RESULTS: Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70-4.28), with algorithms including clinical examinations decreasing cost-effectiveness. CONCLUSIONS: High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended.

Homens transexuais e gestação: uma revisão integrativa da literatura / Transsexual men and pregnancy: an integrative literature review

Resumo A promoção da saúde sexual e reprodutiva no contexto da transmasculinidade representa uma nova temática para a organização dos serviços de saúde. A presente revisão integrativa tem por objetivo compreender as evidências atuais sobre a gestação em homens transexuais no contexto da atenção à saúde sexual e reprodutiva. A partir da busca nas bases de dados BVS, PubMed, Science Direct, Scopus, Capes, SciELO e PEPSIC, foi selecionada uma amostra de 11 artigos publicados entre 2010 e 2020, submetidos à análise de conteúdo e agrupados em quatro categorias de análise: serviços de saúde cis heteronormativos; serviços de saúde - experiências positivas; implicações da gestação nos corpos transexuais; repercussões da terapia de afirmação de gênero e gravidez. Verificou-se predomínio da lógica cis heteronormativa na atenção à saúde, que implica experiências negativas durante o pré-natal e o parto entre os homens transexuais. Estes apresentam necessidades singulares em saúde durante o ciclo gravídico puerperal, devendo ser incluído o cuidado à saúde mental. Sugere-se adoção de estratégias de qualificação profissional com vistas aos cuidados perinatais inclusivos e respeitosos para esse grupo populacional, além de novos estudos sobre o tema.

Abstract Promoting sexual and reproductive health in the context of transmasculinity constitutes a new issue for health service organisation. This integrative review sought to understand the current evidence on pregnancy in transsexual men in the context of sexual and reproductive health care. From a search of the BVS, PubMed, Science Direct, Scopus, Capes, SciELO and PEPSIC databases, from 2010 to 2020, a sample of 11 articles was selected, treated by content analysis and grouped into four analytical categories: health services - positive experiences; cis heteronormative health services; implications of pregnancy for transsexual bodies; and repercussions of gender-affirming therapy and pregnancy. A cis heteronormative logic was found to predominate in health care, leading to negative experiences during antenatal care and childbirth among transsexual men. Their unique health needs during the pregnancy-puerperium cycle should include mental health care. It is suggested that strategies be adopted to build capacity in health professionals with a view to respectful, inclusive perinatal care for this population group, as well as further studies on the subject.

Homem trans e gestação paterna: experiências durante o período gravídico-puerperal / Trans men and paternal pregnancy: experiences during the pregnancy-puerperal period

Resumo Este estudo objetiva analisar as experiências de um homem trans durante o período gravídico-puerperal e a perspectiva de enfermeiras obstetras em formação, a partir das dinâmicas e da organização dos cuidados de saúde obstétricos em ambiente hospitalar. Trata-se de um estudo de abordagem qualitativa, baseado em estudo de caso, em que utilizou entrevistas e observações diretas para a coleta das informações. A análise foi feita a partir do marco teórico e normativo do Processo de Enfermagem, da Teoria dos Cuidados e da perspectiva teórico/crítica do transfeminismo. Os resultados estão organizados em seis categorias: Homem trans em contexto de gestação, parto e puerpério; parceria e dimensões parentais; dilemas enfrentados pelo casal grávido; impressões registradas pela profissional de enfermagem; compreensão do caso sob a lente teórica e epistemológica; implicações para os profissionais da saúde. Destaca-se a necessidade de promover espaços de educação permanente junto aos profissionais da saúde e reformular legislações de maneira a viabilizar a elaboração de políticas públicas baseada no respeito à diversidade e cuidado equânime, reconhecendo as especificidades da população trans nos contextos da gestação, parto e puerpério.

Abstract This study aims to analyze the experiences of a transgender man during the gestational-puerperal period and the perspective of obstetric nurses in training based on the dynamics and organization of obstetric healthcare in a hospital setting. This qualitative study is based on a case study approach, employing interviews and direct observations to collect data. The analysis was based on the theoretical and normative framework of the Nursing Process, the Theory of Caring, and the theoretical/critical perspective of transfeminism. The results are organized into six categories: Transgender man in the context of pregnancy, childbirth, and postpartum; partnership and parental dimensions; dilemmas faced by the pregnant couple; impressions recorded by the nursing professional; understanding of the case through a theoretical and epistemological lens; implications for healthcare professionals. We underscore the need to promote spaces for continuing education among healthcare professionals and to reformulate legislation in a way that enables the development of public policies based on respect for diversity and equitable care, recognizing the transgender population's specificities in the contexts of pregnancy, childbirth, and postpartum.

Sentidos e significados de parentalidade entre homens trans que engravidaram antes da transição de gênero / Meanings and perceptions of parenthood among transgender men who became pregnant before gender transition

Resumo Buscou-se compreender os sentidos e significados do exercício parental entre homens trans que engravidaram antes da transição de gênero por meio de uma pesquisa qualitativa, na qual participaram cinco interlocutores, cuja análise foi realizada à luz das teorias sociais de gênero. Os resultados demonstraram uma experiência parental sujeitada a um campo de tensão e negociações, além de uma produção subjetiva que oscilava entre a transgressão e a acomodação da perspectiva cultural da sua própria vivência. Identificou-se práticas de violências que reiteraram as vulnerabilidades sociais, deflagraram as fragilidades dos serviços de saúde e provocaram efeitos deletérios em homens trans que engravidam antes da transição de gênero.

Abstract This qualitative study, with five participating interlocutors, sought to understand the senses and meanings of parenting among trans men who became pregnant before gender transition. Analysis was conducted in light of social theories of gender. The results demonstrated an experience of parenthood subject to a field of tensions and negotiations, as well as subjective production that oscillated between transgression and accommodation of the cultural perspective of their own experience. The forms of violence found to be practiced reiterated social vulnerabilities, exposed healthcare service weaknesses and produced harmful effects on transgender men who become pregnant before gender transition.

Educational booklet for preventing transphobic bullying at school / Cartilla educativa para prevenir el acoso transfóbico en la escuela / Cartilha educacional para prevenção do bullying transfóbico na escola

ABSTRACT Objective: to describe the process of developing, validating and assessing an educational booklet to prevent transphobic bullying at school. Method: this is a methodological study, carried out from February to December 2022 at a public school in João Pessoa, Paraíba, Brazil. The educational booklet was developed in accordance with the methodological trajectory proposed by Echer, and submitted to content validity and semantic assessment by expert judges and Elementary School II teachers, respectively. In data analysis, content validity and Intraclass Correlation Coefficients were used, in addition to semantic agreement index. Results: the educational booklet had its content validated with a validity coefficient of 0.981 and an Intraclass Correlation Coefficient of 0.833 for the set of items in the assessment instrument. In semantic assessment, teachers considered the booklet understandable, with a minimum agreement level of 94%. Conclusion: the booklet developed was considered valid by judges, to be used with teachers, individually and in continuing education or health actions, in order to contribute to preventing transphobic bullying at school.

RESUMEN Objetivo: describir el proceso de desarrollo, validación y evaluación de una cartilla educativa para prevenir el acoso escolar transfóbico. Método: se trata de un estudio metodológico, realizado de febrero a diciembre de 2022 en una escuela pública de João Pessoa, Paraíba, Brazil. La cartilla educativa fue elaborada de acuerdo con la trayectoria metodológica propuesta por Echer, y sometida a validación de contenido y evaluación semántica por jueces expertos y docentes de la Escuela Primaria II, respectivamente. En el análisis de los datos, se utilizaron los coeficientes de validez de contenido y de correlación intraclase, y el índice de concordancia semántica. Resultados: la cartilla educativa tuvo su contenido validado con un coeficiente de validez de 0,981 y un coeficiente de correlación intraclase de 0,833 para el conjunto de ítems del instrumento de evaluación. En la evaluación semántica, los docentes consideraron comprensible el cuadernillo, con un nivel mínimo de acuerdo del 94%. Conclusión: la cartilla desarrollada fue considerada válida por los jueces, para ser utilizada con docentes, de manera individual y en acciones de educación continua o de salud, con el fin de contribuir a la prevención del acoso escolar transfóbico en la escuela.

RESUMO Objetivo: Descrever o processo de desenvolvimento, validação e avaliação de cartilha educacional para prevenção do bullying transfóbico na escola. Método: Trata-se de um estudo metodológico, realizado no período de fevereiro a dezembro de 2022 em uma escola pública de João Pessoa, Paraíba, Brasil. A cartilha educacional foi desenvolvida de acordo com a trajetória metodológica proposta por Echer, e submetida à validação de conteúdo e avaliação semântica por juízes especialistas e professores do Ensino Fundamental II, respectivamente. Na análise dos dados, utilizaram-se os coeficientes de validade de conteúdo e correlação intraclasse, e o índice de concordância semântica. Resultados: A cartilha educacional teve seu conteúdo validado com coeficiente de validade de 0,981 e coeficiente de correlação intraclasse de 0,833 para o conjunto de itens do instrumento de avaliação. Na avaliação semântica, os professores consideraram a cartilha compreensível, com nível de concordância mínima de 94%. Conclusão: A cartilha desenvolvida foi considerada válida por juízes, para ser utilizada com professores, de forma individual e em ações de educação permanente ou em saúde, a fim de contribuir na prevenção do bullying transfóbico na escola.

Estigma na percepção de médicas e enfermeiras sobre o pré-natal de homens transexuais / Estigma en la percepción de médicas y enfermeras sobre el control prenatal de hombres transexuales / Stigma in doctors' and nurses' perception regarding prenatal care for transgender men

Resumo Objetivo Analisar o estigma evidenciado nas percepções de médicas e enfermeiras sobre o pré-natal de homens transexuais. Métodos Estudo qualitativo desenvolvido com nove profissionais de saúde (seis enfermeiras e três médicas) atuantes em Unidades de Saúde da Família em um município na Bahia. Foram realizadas entrevistas em profundidade, submetidas à Análise Temática Reflexiva e interpretação baseada na teoria do estigma e do conceito de cisheteronormatividade. Resultados Foram derivados dois temas que explicitaram o estabelecimento de rótulos e estereótipos ao corpo, mente e identidade de gênero do homem trans grávido: (des)preparo profissional e distanciamento das demandas e perspectivas cisheteronormativas para o cuidado pré-natal de homens trans. Elementos do estigma evidenciados: afastamento, rótulos, estereótipo, descrédito e discriminação. Tais elementos (percepções estigmatizantes) se manifestaram dentro da lógica da normalidade e equiparação cisgênero das necessidades de saúde dos homens trans no contexto pré-natal. Conclusão Há estigma na percepção de médicas e enfermeiras sobre o pré-natal de homens trans. A estigmatização pode impactar negativamente a qualidade do pré-natal e da saúde e segurança de homens trans no ciclo gravídico puerperal, antecipando pensamentos, atitudes e práticas que contribuem para a deteriorar a identidade transmasculina na gestação.

Resumen Objetivo Analizar el estigma constatado en las percepciones de médicas y enfermeras sobre el control prenatal de hombres transexuales. Métodos Estudio cualitativo llevado a cabo con nueve profesionales de la salud (seis enfermeras y tres médicas) que trabajan en Unidades de Salud de la familia en un municipio del estado de Bahia. Se realizaron entrevistas en profundidad, que fueron sometidas al análisis temático reflexivo e interpretación con base en la teoría del estigma y del concepto de cisheteronormatividad. Resultados Se derivaron dos temas que explicitaron el establecimiento de rótulos y estereotipos del cuerpo, mente e identidad de género de hombres trans embarazados: (falta de) preparación profesional y distanciamiento de las demandas y perspectivas cisheteronormativas para el cuidado prenatal de hombres trans. Se constataron los siguientes elementos del estigma: distanciamiento, rótulos, estereotipos, descrédito y discriminación. Tales elementos (las percepciones estigmatizantes) se manifestaron dentro de la lógica de la normalidad y equivalencia cisgénero de las necesidades de salud de los hombres trans en el contexto del control prenatal. Conclusión Existe un estigma en la percepción de médicas y enfermeras sobre el control prenatal de hombres trans. La estigmatización puede impactar negativamente en la calidad del control prenatal y de la salud y seguridad de hombres trans durante el embarazo y el puerperio, y puede anticipar pensamientos, actitudes y prácticas que contribuyen al deterioro de la identidad transmasculina en el embarazo.

Abstract Objective To analyze the stigma evidenced in doctors' and nurses' perception regarding prenatal care for transgender men. Methods A qualitative study developed with nine health professionals (six nurses and three doctors) working in Family Health Units in a municipality in Bahia. In-depth interviews were carried out, subjected to reflective thematic analysis and interpretation based on the theory of social stigma and the concept of cisheteronormativity. Results Two topics were derived that explained the establishment of labels and stereotypes on the body, mind and gender identity of pregnant trans men: professional (un)preparedness and distancing from cisheteronormative demands and perspectives for prenatal care for trans men. Elements of stigma observed were distance, labels, stereotype, discredit and discrimination. Such elements (stigmatizing perceptions) manifested themselves within the logic of normality and cisgender equality of trans men's health needs in the prenatal context. Conclusion There is stigma in doctors' and nurses' perception regarding prenatal care for trans men. Stigmatization can negatively impact the quality of prenatal care and trans men's health and safety in the pregnancy and puerperal cycle, anticipating thoughts, attitudes and practices that contribute to the deterioration of transmasculine identity during pregnancy.

Produção científica sobre saúde mental de pessoas transexuais na base de dados scopus: estudo bibliométrico / Scientific production on the mental health of transgender people in the scopus database: a bibliometrics study / Producción científica sobre la salud mental de las personas transexuales en la base de datos scopus: estudio bibliométrico

RESUMO: Objetivo: mapear a produção científica sobre a saúde mental de pessoas transexuais, indexada na base de dados Scopus. Método: estudo bibliométrico, compreendendo o estudo de artigos, incluindo os de revisão, no período de janeiro 2001 a junho de 2023, com análise dos indicadores com número de documentos por ano, idioma, periódicos mais utilizados, autores mais produtivos, produtividade dos autores, filiação da autoria, país dos autores e palavras-chave. Resultados: identificaram-se 988 documentos, concentrados nos anos de 2023 (9,8%), 2022 (17,2%), 2021 (18,8%), 2020 (12,7%) e 2019 (10,1%). Os dez autores que mais publicaram sobre a temática são dos Estados Unidos (90%). O periódico com maior número de artigos foi a LGBT Health. Os termos mais utilizados nos estudos foram: Female, Male, Transgender, Human, Humans, Adult, Transgender Persons e Mental Health. Conclusão: verificou-se a necessidade de maior incentivo às publicações tanto em periódicos brasileiros quanto internacionais sobre a temática voltada à população Transexual.

ABSTRACT Objective: to map scientific production on the mental health of transgender people, indexed in the Scopus database. Method: Bibliometric study, comprising the study of articles, including reviews, from January 2001 to June 2023, with analysis of indicators such as number of documents per year, language, journals most used, most productive authors, productivity of authors, affiliation of authorship, country of authors and keywords. Results: 988 documents were identified, concentrated in the years 2023 (9.8%), 2022 (17.2%), 2021 (18.8%), 2020 (12.7%), and 2019 (10.1%). The ten authors who have published the most on the subject are from the United States (90%). The journal with the highest number of articles was LGBT Health. The most used terms in the studies were: Female, Male, Transgender, Human, Humans, Adult, Transgender Persons, and Mental Health. Conclusion: There was a need for greater encouragement of publications in both Brazilian and international journals about the transsexual population.

RESUMEN Objetivo: mapear la producción científica sobre la salud mental de las personas transexuales, indexada en la base de datos Scopus. Método: estudio bibliométrico de artículos, incluyendo revisiones, desde enero de 2001 hasta junio de 2023, analizando indicadores como número de documentos por año, idioma, revistas más utilizadas, autores más productivos, productividad de los autores, filiación de la autoría, país de los autores y palabras clave. Resultados: Se identificaron 988 documentos, concentrados en los años 2023 (9,8%), 2022 (17,2%), 2021 (18,8%), 2020 (12,7%) y 2019 (10,1%). Los diez autores que más han publicado sobre el tema son de Estados Unidos (90%). La revista con mayor número de artículos fue LGBT Health. Los términos más utilizados en los estudios fueron: Female, Male, Transgender, Human, Humans, Adult, Transgender Persons y Mental Health. Conclusión: hubo necesidad de mayor estímulo a las publicaciones en revistas brasileñas e internacionales sobre el tema de la población transexual.

Depressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study / Síntomas depresivos y factores asociados entre travestis y transexuales: estudio transversal / Sintomas depressivos e fatores associados entre travestis e transexuais: estudo transversal

ABSTRACT Objectives: to estimate the prevalence of depressive levels and their associated factors among transvestite and transsexual individuals. Methods: this cross-sectional study involved 58 participants assisted by non-governmental organizations. The Beck Depression Inventory was utilized to assess levels of depression, complemented by a sociodemographic questionnaire and a questionnaire on experiences of violence. Data were analyzed using descriptive statistics and Poisson regression with robust variance. Results: a prevalence of 27.6% (95% CI = 11.50-39.10) for moderate to severe levels of depression was observed. This prevalence was associated with being unmarried (PR = 1.19; 95% CI = 1.10-1.28) and experiencing violence in healthcare services (PR = 2.30; 95% CI = 1.10-4.81). Conclusions: the absence of a partner and experiences of violence in healthcare settings negatively impacted mental health, leading to an increased prevalence of depressive symptoms among transvestite and transsexual individuals. Advocating for transgender rights and providing ongoing education in health care for professionals are critical strategies in promoting the mental health of this population.

RESUMEN Objetivos: estimar la prevalencia de niveles depresivos y factores asociados entre personas travestis y transexuales. Métodos: estudio transversal con 58 participantes asistidos por organizaciones no gubernamentales. Se utilizó el Inventario de Depresión de Beck para la evaluación de los niveles depresivos y un cuestionario sociodemográfico y de experiencias de violencia. Los datos fueron analizados mediante estadística descriptiva y regresión de Poisson con varianza robusta. Resultados: se observó una prevalencia del 27,6% (IC95%=11,50-39,10) de niveles depresivos moderados a graves, asociada al estado civil soltero (RP=1,19; IC95%=1,10-1,28) y a la violencia en los servicios de salud (RP=2,30; IC95%=1,10-4,81). Conclusiones: vivir sin pareja y experimentar violencias en los servicios de salud perjudicaron la salud mental y aumentaron la prevalencia de síntomas depresivos entre personas travestis y transexuales. La defensa de los derechos de las personas trans y la educación permanente en salud para los profesionales son estrategias esenciales para promover la salud mental de esta población.

RESUMO Objetivos: estimar a prevalência de níveis depressivos e fatores associados entre pessoas travestis e transexuais. Métodos: estudo transversal com 58 participantes assistidos por organizações não governamentais. Utilizou-se o Beck Depression Inventory para avaliação dos níveis depressivos e um questionário sociodemográfico e de experiências de violência. Os dados foram analisados por meio de estatística descritiva e regressão de Poisson com variância robusta. Resultados: observou-se uma prevalência de 27,6% (IC95%=11,50-39,10) de níveis depressivos moderados a graves, associada ao estado civil solteiro (RP=1,19; IC95%=1,10-1,28) e à violência nos serviços de saúde (RP=2,30; IC95%=1,10-4,81). Conclusões: viver sem companheiro(a) e experienciar violências nos serviços de saúde prejudicaram a saúde mental e aumentaram a prevalência de sintomas depressivos entre pessoas travestis e transexuais. A defesa dos direitos de pessoas trans e a educação permanente em saúde para profissionais são estratégias essenciais para promover a saúde mental dessa população.

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

Abstract Objective: Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Methods: Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Results: Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Conclusion: Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.