BACKGROUND: Current evidence suggests that the etiology of gender dysphoria (GD) is multifactorial: this, however, remains unclear. Endocrine-disrupting chemicals (EDCs) are one of the etiological hypotheses.
OBJECTIVE: In this study, we aimed to evaluate the urinary levels of bisphenol A (BPA), thiamethoxam, and fipronil in hormone-naïve transmen compared with case-matched cis-women as well as the relation between sex hormone levels and EDCs.
METHODS: Drug-naïve transmen diagnosed with GD and who were referred from the psychiatry outpatient clinic to the outpatient clinic of the Department of Endocrinology, Marmara University Hospital, were included in the study. These individuals were assessed for eligibility; 38 drug-naïve transmen and 22 cis-women were recruited as the control group. After anthropometric evaluation laboratory tests for FSH, LH, total testosterone, and estradiol were carried out, spot urine samples were collected to evaluate the urine metabolic excretion of BPA, thiamethoxam, and fipronil.
RESULTS: We found that androgens, total testosterone, androstenedione, and DHEAS levels were significantly higher in transmen than in cis-women. Thiamethoxam was considerably higher in cis-women than in transmen, whereas fipronil and BPA levels were similar in both groups. A negative correlation was found between thiamethoxam and testosterone and between thiamethoxam and BPA levels.
CONCLUSIONS: The available data suggest that the EDCs that we are most exposed to in our lives are not the only factor in GD development. Even transmen who have not taken hormone replacement have high testosterone levels; however, the mechanism has not as yet been elucidated. The challenge is to determine whether this is a factor leading to GD or a condition that develops in common with GD.

When Old People Suffer Because of the Sex of the Young: A Commentary on Korte, A. & Tschuschke, V. (2023). The Media\'s Stranglehold on Sturm und Drang - The Sorrows of Generation Z Regarding Sex and Gender Abstract: In their article \"Sturm und Drang im Würgegriff der Medien - Die Leiden der jungen Generation am eigenen Geschlecht\" in the Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (volume 51, issue 5), our colleagues Korte and Tschuschke address the question of the extent to which the increase in gender identity deviations among adolescents \"also results from upheavals the cultural landscape and, above all, in media technology.\" The authors look critically at the planned German \"Self-Determination Law,\" the social transition of children and adolescents, the so-called puberty blockade, and hormone therapy in adolescents and justify their preference for a gender-critical over a transaffirmative therapy approach. Although the article introduces some interesting hypotheses from the perspective of cultural studies and philosophy (among others), it may contribute to uncertainty among colleagues in treating trans*people because of its trans-critical tone. This stems from linguistic devices, misleading and erroneous quotations, and incomplete or incorrect descriptions of facts. This contribution therefore takes a critical look at the article by Korte and Tschuschke, using critical linguistic analysis and examining the facts, data, and sources cited by the authors. It encourages our colleagues to engage in a joint, participatory, trans*respectful treatment process with gender-dysphoric children and adolescents while exploring the sizeable intermediate area between \"gender-critical\" and \"transaffirmative\" attitudes, which the authors Korte and Tschuschke barely touch on in their article.
Zusammenfassung: Im Artikel „Sturm und Drang im Würgegriff der Medien – Die Leiden der jungen Generation am eigenen Geschlecht“ in der Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (Jahrgang 51, Heft 5) setzen sich die Kollegen Korte und Tschuschke mit der Frage auseinander, inwiefern der Anstieg von Abweichungen im Geschlechtsidentitätserleben bei Jugendlichen „auch ein Resultat kultureller und vor allem medientechnologischer Umbrüche ist“. Die Autoren beziehen kritisch Stellung zum geplanten deutschen „Selbstbestimmungsgesetz“, zu sozialer Transition bei Kindern und Jugendlichen, zur sogenannter Pubertätsblockade sowie zur Hormontherapie bei Jugendlichen, und rechtfertigen den Vorzug eines genderkritischen gegenüber dem eines transaffirmativen Therapieansatzes. Obgleich der Artikel einige interessante Hypothesen aus dem Blickwinkel u. a. der Kulturwissenschaft und Philosophie einbringt, kann er doch auf Grund des transkritischen Grundtenors zur Verunsicherung von Kolleg_innen in der Behandlung von trans*Personen beitragen. Dies ist auf sprachliche Mittel, irreführende und fehlerhafte Zitate und unvollständige bzw. inkorrekte Schilderung von Fakten zurückzuführen. Die vorliegende Arbeit möchte sich daher kritisch mit dem zur Diskussion gestellten Artikel der Autoren Korte und Tschuschke befassen und bedient sich dabei einer sprachkritischen Untersuchung sowie einer Überprüfung der von den Autoren angeführten Fakten, Daten und Quellen. Sie möchte versuchen, Kolleg_innen dazu zu ermuntern, sich mit geschlechtsdysphorischen Kindern und Jugendlichen in einen gemeinsamen, partizipativen, trans*respektvollen Behandlungsprozess zu begeben und den von den Autoren Korte und Tschuschke im Artikel wenig beachteten, großen Zwischenbereich zwischen „genderkritischer“ und „transaffirmativer“ Haltung auszuloten.

The number of scientific papers on gender-confirming surgeries as well as the surgeries themselves have increased by leaps and bounds in recent years. This leads to sometimes considerable waiting times for people seeking treatment. Social media and the internet do not always provide reliable and high-quality information. Therefore, it is necessary that both surgically and conservatively active urologists are familiar with topics regarding transgender persons. The establishment of structured training, the guarantee of minimum quality standards in the treatment of transgender persons and the further education and training of medical staff pose particular challenges. The German Society for Urology (DGU) and the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) have already founded their own working groups on the surgical side, which coordinate their work. Under the auspices of the professional societies DGU and DGPRÄC, a guideline on surgical procedures for gender incongruence was developed under the umbrella of the AWMF (\"Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften\") which is currently being finalised. For a long time, the health care of transgender people has been moving in a field of tension between the right of self-determination of those seeking treatment, on the one hand, and the fear of making the wrong medical decisions, on the other. In contrast to most other conditions in urology, the goal of treatment is largely determined by the person seeking treatment and does not necessarily follow predetermined schedules or content. The treatment should primarily aim at reducing the individual\'s suffering and promoting quality of life.
UNASSIGNED: Die Zahl wissenschaftlicher Arbeiten zu geschlechtsbestätigenden Operationen sowie die Operationen selbst haben in den letzten Jahren sprunghaft zugenommen. Das führt zu teils erheblichen Wartezeiten für Behandlungssuchende. Social Media und Internet halten nicht immer verlässliche und qualitativ hochwertige Informationen bereit. Daher ist es notwendig, dass sich sowohl operativ wie konservativ tätige Urolog*innen mit dem Phänomen „trans*“ auseinandersetzen. Die Etablierung einer strukturierten Ausbildung, die Sicherstellung von Mindestqualitätsstandards bei der Behandlung von Trans*-Personen und die Fort- und Weiterbildung ärztlichen Personals stellt eine besondere Herausforderung dar. Die Deutsche Gesellschaft für Urologie (DGU) und die Deutsche Gesellschaft für Plastische, Rekonstruktive und Ästhetische Chirurgie (DGPRÄC) haben auf chirurgischer Seite bereits eigene Arbeitskreise gegründet, die Ihre Arbeit inhaltlich aufeinander abstimmen. Unter der Federführung der beiden Fachgesellschaften DGU und DGPRÄC ist in den letzten Jahren unter dem Dach der Arbeitsgemeinschaft Wissenschaftlicher Medizinischer Fachgesellschaften (AWMF) eine Leitlinie zu chirurgischen Maßnahmen bei Geschlechtsinkongruenz erarbeitet worden, die vor der Konsultation steht. Die gesundheitliche Versorgung von Trans*-Menschen bewegt sich seit langem in einem Spannungsfeld zwischen dem Selbstbestimmungsrecht der Behandlungssuchenden einerseits und der Angst vor medizinischen Fehlentscheidungen. Im Gegensatz zu den meisten anderen Konditionen in der Urologie wird das Behandlungsziel maßgeblich von der behandlungssuchenden Person bestimmt und folgt nicht zwingend vorgegebenen zeitlichen oder inhaltlichen Ablaufschemata. Die Behandlung sollte v. a. die Reduktion des individuellen Leidensdruckes und die Förderung der Lebensqualität zum Ziel haben.

UNASSIGNED: This study aims to analyze the influence of syphilis among people with sexual and gender diversity, different from the binary dimension.
UNASSIGNED: A systematic review was conducted as a method to address the objective of the study, based on the Dialectical Structural Model of Care (DSM), to obtain the phenomenon from the perspective of cultural history.
UNASSIGNED: In this review the analysis of 129 documents, of which 22 texts were used. The construction of sex and gender in Western civilization is based on the Judeo-Christian tradition, which permitted many people throughout history to be persecuted and mistreated for living a lifestyle different from that dictated by religious and traditional canons. Therefore, throughout history, gender-diverse people, sexual minorities, and prostitutes have suffered segregation, mockery, aggression, and health problems, including syphilis.
UNASSIGNED: Despite having a treatment and cure, syphilis has stood the test of time and has remained a secret pathology that is obscure and difficult to detect disease, which is still very much present in people of all social classes. It is necessary to review history to understand the reasons why syphilis is still prevalent in different societies today.

Media\'s Stranglehold on Storm and Stress - The Sorrows of Generation Z about Sex and Gender Abstract: The feeling of not belonging to one\'s birth sex is not new; one can trace this phenomenon back even to ancient mythology. Although it has always been rare, there has recently been a sharp increase in gender identity deviations among adolescents. This text addresses this problem by asking to what extent this development also results from upheavals in the cultural landscape and, above all, in media technology. Do they cause young people to believe they are in the \"wrong gender\" and, in extreme cases, to strive for transition? We present the most salient cornerstones of the planned German self-determination law (Self-ID), most of which, however, are unlikely to do justice to the underlying problem. The text concludes by describing several unanswered questions concerning this matter and by attempting to propose first answers. The advantages of a gender-exploratory over the trans affirmative therapy approach are summarized.
Zusammenfassung: Das Gefühl der Nichtzugehörigkeit zum Geburtsgeschlecht ist nicht neu, als Phänomen kann es bis in die antike Mythologie zurückverfolgt werden. Aber es war stets selten, wohingegen aktuell ein sprunghafter Anstieg von Abweichungen im Geschlechtsidentitätserleben bei Jugendlichen zu verzeichnen ist. Der Text geht dieser Problematik anhand der Frage nach, inwieweit diese Entwicklung auch ein Resultat kultureller und vor allem aber medientechnologischer Umbrüche ist, die bedingen, dass Jugendliche sich im „falschen Geschlecht“ wähnen und im Extremfall eine Transition anstreben. Die wichtigsten Eckpunkte des geplanten deutschen „Selbstbestimmungsgesetzes“ werden vorgestellt, das allerdings der zugrundeliegenden Problematik kaum gerecht werden dürfte. Der Text schließt damit, dass er diesbezüglich eine Reihe offener Fragen benennt, erste Antworten versucht und die Vorteile eines explorativen, genderkritischen gegenüber einem transaffirmativen Therapieansatz zusammenfasst.

The surgery of trans people is not apprehended by most of plastic surgeons as a simple surgery for the purpose of morphological transformation. At the same time, the French trans population does not benefit from adequate surgical coverage. Over the past few years, French regulations have simplified the process of reassignment surgeries. In addition, we have witnessed a fairly rapid increase in requests for transition surgery with accelerated and sometimes atypical courses. In recent years, a number of specialists have warned the medical community about the risks of slippage due to a lack of psychological monitoring of certain people beginning a transition process. Quite recently, hybrid transition paths have also appeared which, from a surgical point of view, are no longer limited to ensuring that a native assigned female patient can take on the most masculine appearance possible or the reverse. In this manuscript, we expose the biological, historical and societal place of transidentity and then address the reasons for the warnings of a certain category of the medical population while reassuring the surgical community on the benefits of reassignment surgeries in a controlled context. We end by proposing a few ways to improve the care course of trans people applicable in France.

The high demand of assistance made by trans people in recent years has directed the focus of research towards the study of their clinical and sociodemographic aspects. The objective of this work was to compare and analyze some sociodemographic variables in trans people in two periods: the period when the unit began to operate and the most recent period.
A sample of 131 users who attended the Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA) between 2015-2019 was compared with a sample of 33 who attended between 2007-2009. Data were extracted from medical records.
Regarding 2007-2009, in 2015-2019 the ratio is inverted in favor of Trans Men (TM). Users of both genders request consultation at an earlier age (specially TM), come less from abroad, achieve higher educational and work qualifications, are less unemployed and request more name changes. And, although Trans Women (TW) continue to be those who are mostly engaged in prostitution and self-administration of hormones, in the most recent period they report it less and, furthermore, they live more accompanied tan in the past.
Changes are observed in the sociodemographic variables of UTIGPA users between 2007-2009 and 2015-2019, in the direction of a greater inclusion. However, the sociodemographic conditions of the TW are still at a disadvantage in comparison to those of the TM.

BACKGROUND: The surgical goals of gender reassignment surgery of the breast in female-to male transsexuals (FMT) is the aesthetic shaping of a male thoracic wall with minimal scarring, while preserving the sensitivity of the nipple-areola complex (NAC). For large and ptotic breasts, we perform a mastectomy over an inframammary access with inferior pedicled NAC under color Doppler visualization of the perforators. This paper presents the technique, including complications and assessment of quality of life, as part of a unicentric analysis.
METHODS: This was a retrospective analysis of 23 patients (46 mastectomies) performed between September 2014 and September 2020. The complication rate and the number of corrective surgeries were recorded for quality assessment. A semiquantitative score was used to evaluate aesthetic outcome, nipple sensitivity, quality of life, and sexuality.
RESULTS: A total of 46 mastectomies were performed in 23 patients. The patient survey showed high patient satisfaction. Loss of nipple sensitivity was observed after one mastectomy (2.17%). In 91.67% of cases, patients reported that their appearance reflected how they feel on the inside. In 75% of cases, patients reported feeling equal to other men. The overall complication rate was 10.87%. Shape correction due to persistent excess of volume was rare (2.17%, equivalent to one mastectomy).
CONCLUSIONS: Subcutaneous mastectomy with inferior nipple pedicle can be performed with a high degree of safety and satisfaction in FMT. Color Doppler-guided visualization of the perforator vessels is helpful in allowing a thin pedicle preparation, thus reducing the need for secondary surgeries to optimize the shape.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The article investigates scientific and journalistic discourses around differences in gender ratio among trans persons. The disparity between Poland and many other countries that was first noted in the 1980s was repeatedly associated with the different gender politics in the capitalist West and the (post) state-socialist East. Using Foucauldian methodology, the article claims that this discourse was constructed such that Poland\'s ratio-and consequently Poland\'s gender order-would always appear problematic, while Western countries were considered an invisible standard. Discourses around this ratio elucidate the role of heteronormativity and biological essentialism in the construction of the category of \"transsexuality\" in state-socialist Poland. The analysis also reveals that chronologies of LGBT and feminist movements had direct consequences for the theoretical and cultural spaces of trans identities.

BACKGROUND: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown.
OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment.
METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender.
RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found.
CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.