Transsexual individuals with gender dysphoria or gender identity disorder are rare, with a prevalence reported to range from 0.002% to 0.014%. Studies have shown that mastectomy yields significant improvements in body image and self-esteem in female-to-male transsexual patients. In patients with grade III breast ptosis, mastectomy with a nipple-areolar complex (NAC) graft is the most commonly used technique, although it has several disadvantages. In the case described herein, a bilateral mastectomy preserving the NAC in an inferior pedicle was performed. Additionally, a thin superior thoracic dermal-fat flap was preserved and eventually sutured at the previous inframammary fold, preventing an inverted T scar. This case shows the advantage of this technique for preserving the blood supply and innervation of the NAC, with a low hypopigmentation risk. Furthermore, in this technique, the patch effect does not impair the results of the NAC graft, and there is no need to use an inverted T scar that may result in thoracic feminization.
Body Image ; Breast ; Cicatrix ; Feminization ; Gender Dysphoria ; Gender Identity ; Gynecomastia ; Humans ; Hypopigmentation ; Male ; Mastectomy ; Prevalence ; Thorax ; Transplants ; Transsexualism

Transsexualism refers to a condition or belief which results in gender dysphoria in individuals and makes them insist that their biological gender is different from their psychological and experienced gender. Although the etiology of gender dysphoria (or transsexualism) is still unknown, different neuroimaging studies show that structural and functional changes of the brain result from this sexual incongruence. The question here is whether these reported changes form part of the etiology of transsexualism or themselves result from transsexualism culture, behaviors and lifestyle. Responding to this question can be more precise by consideration of cultural neuroscience concepts, particularly the culture–behavior–brain (CBB) loop model and the interactions between behavior, culture and brain. In this article, we first review the studies on the brain of transgender people and then we will discuss the validity of this claim based on the CBB loop model. In summary, transgender individuals experience change in lifestyle, context of beliefs and concepts and, as a result, their culture and behaviors. Given the close relationship and interaction between culture, behavior and brain, the individual's brain adapts itself to the new condition (culture) and concepts and starts to alter its function and structure.
Brain* ; Gender Dysphoria ; Gender Identity ; Life Style ; Neuroimaging ; Neurosciences ; Transgender Persons ; Transsexualism*

Gender is determined at fertilization. However, gender mentally decision is another issue. Transgender is a familiar word in general populations, but the definition of transgender and exact managements are not familiar to physicians including gynecologists. Transgender is not well received for health care benefits, because primary care about the transgender is not known to the physicians. Transgender is hidden in the social health care system, Transgender individuals wish to be assisted to feminize or masculinize their bodies including gestures, facial expression etc. Primary health care for transgender diversely includes psychological, medical, and surgical treatments. Basic management of transgender is hormonal therapy, thus we should guide the management for appropriate hormone therapies. Our review article provides guidelines for the gynecologist to assist and to help the transgender for primary care.
Delivery of Health Care ; Facial Expression ; Fertilization ; Gestures ; Humans ; Primary Health Care ; Transgender Persons ; Transsexualism

The traditional binary classification of gender is repeatedly challenged throughout history with the presence of transgenders. Under the umbrella of transgenderism is transsexualism which pertains to individuals who identify with or desire to become the opposite sex. Transsexualism or Gender Dysphoria is classified as a medical condition under ICD 10 and DSM-5. The proposed treatment is sex reassignment that includes all treatments carried out to adapt to the desired sex. Sex reassignment involves a multidisciplinary approach wherein the psychiatrist or mental health practitioner, endocrinologist and surgeon play active roles. Certain legal and ethical issues exist in the treatment of transsexualism. This article provides a review of psychological, medical and surgical issues in the evaluation and treatment of Transgender individuals, with an Asian perspective, and in the context of an actual case.
Gender Dysphoria ; Transsexualism ; Transgender Persons

OBJECTIVE: This study used functional magnetic resonance imaging (fMRI) to contrast the differential brain activation patterns in response to visual stimulation with both male and female erotic nude pictures in male-to-female (MTF) transsexuals who underwent a sex reassignment surgery. MATERIALS AND METHODS: A total of nine healthy MTF transsexuals after a sex reassignment surgery underwent fMRI on a 3.0 Tesla MR Scanner. The brain activation patterns were induced by visual stimulation with both male and female erotic nude pictures. RESULTS: The sex hormone levels of the postoperative MTF transsexuals were in the normal range of healthy heterosexual females. The brain areas, which were activated by viewing male nude pictures when compared with viewing female nude pictures, included predominantly the cerebellum, hippocampus, putamen, anterior cingulate gyrus, head of caudate nucleus, amygdala, midbrain, thalamus, insula, and body of caudate nucleus. On the other hand, brain activation induced by viewing female nude pictures was predominantly observed in the hypothalamus and the septal area. CONCLUSION: Our findings suggest that distinct brain activation patterns associated with visual sexual arousal in postoperative MTF transsexuals reflect their sexual orientation to males.
Adult ; Arousal/physiology ; Brain Mapping/*methods ; Erotica ; Female ; Gonadal Steroid Hormones/blood ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Photic Stimulation ; Transsexualism/*psychology

BACKGROUNDThe surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies, we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively.

METHODSTotally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study. Of the 86 patients, 70 (81.4%) underwent primary operations and 16 (18.6%) secondary operations. Nineteen (22.1%) patients underwent total laparoscopic vaginoplasty and 67 (77.9%) patients underwent laparoscope-assisted vaginoplasty. The operation time, cost of hospitalization, and hospital duration were compared between the two laparoscopic groups. The Student's t test and the Mann-Whitney test were used to examine the differences.

RESULTSAll the surgeries were successfully completed with no any intraoperative complication. There were three major surgical complications in the postoperative period: one case of intra-abdominal hemorrhage, one case of meatal stenosis, and one case of intestinal obstruction. The mean follow-up period of this series was 18 months. Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up. Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups, such as the operation time, cost of hospitalization, and hospital duration (P < 0.01). There were no significant differences in sexual function between the two groups.

CONCLUSIONSThe laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic, functional, and anatomic results. Vaginoplasty with an ileal segment, performed by either total laparoscopic or laparoscope-assisted techniques, has a high success rate for a functional vagina.

Adult ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Ileum ; transplantation ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Transsexualism ; surgery ; Treatment Outcome ; Vagina ; abnormalities ; surgery ; Young Adult

Sex segregation in competitive sports is regarded as fair. Before puberty boys and girls do not differ in height, muscle and bone mass. Testosterone (T) exposure during puberty leads to an ultimate average greater height in men of 12-15 cm, longer and larger bones and muscle mass and strength and higher hemoglobin levels. Postpubertal androgen ablation reverses, at least in part, previous anabolic effects of T on muscle, bone mineral density and hemoglobin but the long bones remain longer and wider. T administration dose dependently increases muscle mass and maximal voluntary strength. Therefore, exogenous androgens, being performance enhancing drugs, are banned for all athletes. An issue is the participation in competitive sports of people with errors of sexual differentiation and particularly transsexuals who have been sex-reassigned. In view of the effects of T, a clear demarcation is whether sex reassignment has taken place before or after hormonal puberty. Pubertal effects of T are in part reversible but there is no reliable evidence as to its completeness. The International Olympic Committee (IOC) has taken an inevitably arbitrary decision with regard to participation of sex-reassigned transsexuals in elite sports: sex reassignment must have taken place at least two years earlier, hormone treatment must be appropriate for the reassigned sex and the reassigned sex must be legally recognized. The IOC policy is not binding for other organizations.
Female ; Humans ; Male ; Sports ; Testosterone ; administration & dosage ; Transsexualism

PURPOSE: Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery(SRS). We evaluated psychologic status, health-related quality of life in female-to-male (FTM), male-to-female(MTF) transgender individuals. METHODS: We used the Minnesota Multiphasic Personality Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Moudsley obsessive-compulsive Inventory, SCL-90-R, Short-Form 36-Question Health Survey version 2(SF-36v2). We enrolled 40 transsexual participants. RESULTS: Analysis of quality of life health concepts demonstrated statistically significant(p<0.01) diminished quality of life among the transsexual participants as compared to the Korea male and female population. FTM transgender participants reported more higher hostile, phobic than MTF transgenders. Overall, in all psychologic status examination, Transgender individuals are within normal population boundary. On all category, result is improved post-operatively. CONCLUSION: Transgender participants reported mental status within normal boundary. SRS improved their quality of life and mental stability.
Anxiety ; Depression ; Female ; Gender Identity ; Health Surveys ; Humans ; Korea ; Male ; MMPI ; Quality of Life ; Transgender Persons ; Transsexualism

PURPOSE: The purpose of this study was to identify the attitude of nurses toward transsexuals. METHOD: The Q-methodology which provides a method of analyzing the subjectivity of each item was used. Twenty-nine nurses classified the 50 selected Q-statements into a normal distribution using a 9 point scale. The collected data was analyzed using the Quanl PC program. RESULT: Four types of attitudes toward transsexuals were identified. The first type (humanitarian acceptance) showed an attitude of respecting transsexuals as human beings and understanding and accepting their desires and difficulties. The second type (superficial understanding) understood the psychological conflicts and suffering of transsexuals but could not accept them as members of families or society. The third type (insufficient understanding) did not feel a sense of rejection toward transsexuals but showed a lack of understanding of their desires and difficulties. The fourth type (rejection) failed to understand the desires and difficulties of transsexuals and showed a sense of rejection toward them, in addition to regarding them as sexually immoral people. CONCLUSION: The results of the study indicate that different approaches of educational programs based on the four types of attitudes toward transsexuals are recommended.
Adult ; *Attitude of Health Personnel ; Demography ; Female ; Humans ; Models, Educational ; Nursing Staff/*psychology ; Q-Sort ; Questionnaires ; *Transsexualism

AIMTo evaluate the effect of testosterone (T) on adiponectin serum levels in transsexual female patients.

METHODSWe measured adiponectin, leptin, luteinizing hormone and follicle stimulating hormone, T, estradiol, lipid profile, biochemical parameters and body composition in 16 transsexual female patients at baseline and after 6 months of T treatment (100 mg Testoviron Depot /10 days, i.m.).

RESULTSAdiponectin levels were 16.9 +/- 7.3 mg/mL at baseline and 13.5 +/- 7.4 mg/mL at month 6 of T treatment (P < 0.05). Leptin and high-density lipoprotein cholesterol decreased significantly, whereas body mass index, waist circumference and lean body mass increased significantly after 6 months of T treatment. No changes in insulin or Homeostasis Model Assessment were detected.

CONCLUSIONT can significantly reduce adiponectin serum levels in transsexual female patients.

Adiponectin ; secretion ; Adipose Tissue ; drug effects ; Adult ; Body Mass Index ; Body Weight ; drug effects ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Female ; Humans ; Leptin ; blood ; Sex Hormone-Binding Globulin ; metabolism ; Testosterone ; blood ; therapeutic use ; Transsexualism ; drug therapy