scholarly journals SUN-039 Estradiol Dose and Concentrations in Transfeminine Individuals

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Brendan J Nolan ◽  
Adam Brownhill ◽  
Ingrid Bretherton ◽  
Peggy Wong ◽  
Susan Fox ◽  
...  
Keyword(s):  
Position Statement ◽  
Target Range ◽  
Estradiol Valerate ◽  
Consensus Guidelines ◽  
Cross Sectional ◽  
Care Clinic ◽  
Gender Diverse ◽  
And Gender ◽  
Sectional Analysis ◽  
Estradiol Concentration

Abstract Background: Feminizing hormone therapy with estradiol is used to align an individual’s physical characteristics with their gender identity. Australian expert consensus guidelines (1) recommend targeting estradiol concentrations of 250-600 pmol/L (68-163 pg/mL) based on local cross-sectional data (2). We aimed to establish the proportion of individuals achieving estradiol concentrations in consensus guidelines. Methods: A retrospective cross-sectional analysis was performed of transfeminine individuals attending a primary or secondary care clinic in Melbourne, Australia who were prescribed oral estradiol valerate for at least 6 months and had estradiol dose and concentration available. Estradiol concentration was measured by immunoassay. Outcomes were (1) proportion of individuals achieving target estradiol concentrations and (2) influence of estradiol dose and BMI on estradiol concentrations. Results: 259 individuals (median age 25.8(IQR 21.9,33.5) years)) had data available for analysis. Median duration of estradiol therapy was 24(15,33) months. Median estradiol concentration was 328(238,434) pmol/L (89(65,118) pg/mL) on 6(4,8) mg estradiol valerate. 172 (66%) individuals had estradiol concentrations within the target range recommended in consensus guidelines. 70 (27%) individuals had estradiol concentrations below target, and 17 (7%) above target. There was a weak positive correlation between estradiol dose and estradiol concentration (r=0.156, p=0.012). There was no correlation between BMI and estradiol concentration achieved (r=-0.063, p=0.413). Conclusions: 66% of individuals achieved estradiol concentration recommended in consensus guidelines with a relatively high oral estradiol dose. There was significant interindividual variability. Estradiol concentration should be interpreted in conjunction with clinical features of feminization and weighed against potential risks of escalating estradiol dose. References 1. Cheung AS, Wynne K, Erasmus J, Murray S, Zajac JD. Position statement on the hormonal management of adult transgender and gender diverse individuals. Med J Aust 2019; 211:127-133 2. Angus L, Leemaqz SY, Ooi O, Cundill P, Silberstein N, Locke P, Zajac JD, Cheung AS. Cyproterone acetate or spironolactone in lowering testosterone concentrations for transgender individuals receiving estradiol therapy. Endocr Connect 2019

scholarly journals Relationships between body mass index with oral estradiol dose and serum estradiol concentration in transgender adults undergoing feminising hormone therapy

2020 ◽  
Vol 11 ◽  
pp. 204201882092454
Author(s):  
Brendan J. Nolan ◽  
Adam Brownhill ◽  
Ingrid Bretherton ◽  
Peggy Wong ◽  
Susan Fox ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hormone Therapy ◽  
Body Mass ◽  
Cross Sectional Study ◽  
Target Range ◽  
Estradiol Valerate ◽  
Consensus Guidelines ◽  
Cross Sectional ◽  
Care Clinic ◽  
Estradiol Concentration

Aim: Feminising hormone therapy with estradiol is used to align an individual’s physical characteristics with their gender identity. Given considerable variations in doses of estradiol therapy administered as gender-affirming hormone therapy (GAHT), we aimed to assess if body mass index (BMI) correlated with estradiol dose/concentration and assess the correlation between estradiol dose and estradiol concentrations. Methods: In a retrospective cross-sectional study, we analysed transgender individuals attending a primary or secondary care clinic in Melbourne, Australia who were prescribed oral estradiol valerate for at least 6 months and had estradiol dose and concentration available. Estradiol concentration was measured by immunoassay. Outcomes were the correlation between estradiol dose and BMI, and estradiol dose and estradiol concentration. Results: Data were available for 259 individuals {median age 25.8 [interquartile range (IQR) 21.9, 33.5] years}. Median duration of estradiol therapy was 24 (15, 33) months. Median estradiol concentration was 328 (238, 434) pmol/l [89 (65, 118) pg/ml] on 6 (4, 8) mg estradiol valerate. Median BMI was 24.7 (21.8, 28.6) kg/m2. There was a weak positive correlation between estradiol dose and estradiol concentration ( r = 0.156, p = 0.012). There was no correlation between BMI and estradiol concentration achieved ( r = −0.063, p = 0.413) or BMI and estradiol dose ( r = 0.048, p = 0.536). Estradiol concentrations were within the target range recommended in consensus guidelines in 172 (66%) individuals. Conclusion: Estradiol dose was only weakly correlated with estradiol concentration, suggesting significant interindividual variability. Prescription of estradiol dose should not be based upon an individual’s BMI, which did not correlate with estradiol concentration achieved. In all, 66% of individuals achieved estradiol concentrations recommended in Australian consensus guidelines with a relatively high oral estradiol dose.

scholarly journals Position statement on the hormonal management of adult transgender and gender diverse individuals

2019 ◽  
Vol 211 (3) ◽  
pp. 127-133 ◽  
Author(s):  
Ada S Cheung ◽  
Katie Wynne ◽  
Jaco Erasmus ◽  
Sally Murray ◽  
Jeffrey D Zajac
Keyword(s):  
Position Statement ◽  
Gender Diverse ◽  
And Gender

scholarly journals NOSACQ-50 for Safety Climate Assessment in Agricultural Activities: A Case Study in Central Italy

2020 ◽  
Vol 17 (24) ◽  
pp. 9177
Author(s):  
Mario Fargnoli ◽  
Mara Lombardi
Keyword(s):  
Safety Climate ◽  
Central Italy ◽  
Agricultural Activities ◽  
Cross Sectional ◽  
Safety Issues ◽  
Climate Assessment ◽  
And Gender ◽  
Sustainable Agricultural Systems ◽  
Sectional Analysis

Safety climate assessment has been recognized as a powerful tool to bring to light workers’ perceptions related to safety practices, attitudes and behaviors at the workplace. Accordingly, its investigation can provide useful information about safety problems within a company before accidents occur. In literature, numerous studies can be found investigating safety climates in different types of industry. However, safety climate assessment in agricultural activities is addressed scarcely, even though agriculture represents a very hazardous sector. To reduce this gap, the present study proposes an investigation of safety climate among farmers by means of the Nordic Safety Climate Questionnaire (NOSACQ-50). The results of the survey brought to light a low level of safety perception of the interviewed sample, especially as concerns safety commitment and risk-taking attitudes. In particular, a different attitude toward safety issues has been registered depending on both the position and gender of the interviewed farmers. Overall, the output of this cross-sectional analysis adds to the current literature by expanding knowledge of safety climate among farmers, representing a baseline for further investigations based on human-centered approaches to enhance safety in agriculture and consequently social and workplace aspects of sustainable agricultural systems.

Prevalence and associations of gender concordance in general practice consultations: a cross-sectional analysis.

2015 ◽  
Vol 3 (4) ◽  
pp. 470 ◽  
Author(s):  
Allison Thomson ◽  
Simon Morgan ◽  
Amanda Tapley ◽  
Mike Van Driel ◽  
Kim Henderson ◽  
...  
Keyword(s):  
General Practice ◽  
Female Physician ◽  
Gender Effects ◽  
Male Physician ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Gender Concordance ◽  
And Gender ◽  
Sectional Analysis ◽  
Physician Patient

Rationale, aims and objectives: Gender effects on physician-patient interactions are well-established and gender concordance of the physician-patient dyad influences consultation dynamics, person-centeredness and outcomes. We aimed to establish the prevalence and associations of gender-concordant and gender-discordant consultations of general practice (family medicine) trainees and to compare outcomes of gender-concordant and gender-discordant consultations.Method: A cross-sectional analysis from an ongoing cohort study. The outcome measure was whether a consultation included a gender concordant (female-female, male-male) or discordant (male-female, female-male) physician-patient dyad. Independent variables related to patient, physician (registrar), practice, consultation content and consultation outcome.Results: Five hundred and ninety-two general practice (GP) registrars (trainees) in 4 of Australia’s 17 regional training programs provided data on 56,234 individual consultations. Sixty-two point nine percent of consultations were gender-concordant (73.5% female-female, 26.5% male-male) and 37.1% were gender-discordant (47.0% male physician-female patient, 53% female physician-male patient). Associations of having a gender-concordant consultation were patient female gender and younger age (<55), the patient not being new to the registrar and the registrar being part-time, younger and having worked at the practice previously. Addressing a reproductive/contraceptive/ genital problem was associated with gender concordance. Gender-concordant consultations were  ‘complex’: significantly longer than gender-discordant consultations, addressed a greater number of problems, resulted in more pathology ordered, more follow-up organised and more learning goals generated.Conclusions: Gender-concordant consultations may be more complex and gender-concordance is ‘sought’ by patients rather than being random.  Thus, efforts could be made in general practice to provide access to both male and female GPs, especially for female patients or groups or patients with particular needs. 

scholarly journals Characterization of Thyroid Disease Prevalence Among Transgender and Gender-Diverse Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A837-A838
Author(s):  
John David Christensen ◽  
Caroline Davidge-Pitts ◽  
M Regina Castro ◽  
Pedro Caraballo
Keyword(s):  
Thyroid Hormone ◽  
Hormone Therapy ◽  
Thyroid Disease ◽  
Vital Signs ◽  
Overt Hypothyroidism ◽  
Care Clinic ◽  
Refractory Depression ◽  
Gender Diverse ◽  
And Gender ◽  
Thyroid Malignancies

Abstract Objective: Transgender and gender-diverse individuals are at risk of insufficient treatment of endocrine diseases due to a number of barriers to care. There are currently no data evaluating the prevalence of thyroid disease in this population, and it is unknown if gender-affirming hormone therapy affects treatment of thyroid disease in these individuals. Methods: Utilizing a registry of 676 patients over 18 years of age who were seen in our Transgender and Intersex Specialty Care Clinic from 2015-2019, we identified 554 individuals seeking medical therapy for gender dysphoria/incongruence. Of these, 56 patients were taking thyroid hormone or antithyroid medications or had a coded diagnosis of thyroid disease; 2 were excluded as they were receiving thyroid hormone as adjunctive therapy for refractory depression. 54 patients were therefore analyzed with respect to thyroid disease (TD+), and compared to those 498 patients without thyroid disease (TD-) with regard to average vital signs, demographics, and presence of common comorbidities. Results: Fifty percent of our TD+ patients were recorded female sex at birth, and 98% were Caucasian. TD+ patients were much more likely to have essential hypertension (OR 5.99), to use tobacco (OR 2.23), and to be overweight or obese (OR 2.16) than TD- patients. Due to the evolving natural history of disease, some TD+ patients belonged to multiple categories: 48 patients, 26 trans feminine and 21 trans masculine, had hypothyroidism, of whom 41 had overt hypothyroidism and 2 patients had subacute thyroiditis that progressed to the hypothyroid phase of illness. 5 patients (3 trans masculine and 2 trans feminine) demonstrated hyperthyroidism, 4 of whom had Graves’ Disease. 2 patients had multinodular goiter, both trans masculine. 2 patients had thyroid malignancies, both trans feminine, of whom one had proven follicular thyroid carcinoma and the other had unspecified thyroid malignancy. Among hypothyroid patients, there was a slight non-significant trend toward increased thyroid hormone requirements while receiving treatment with estradiol or testosterone. Conclusion: To our knowledge, this represents the first attempt to characterize the prevalence of various thyroid disease states in the gender diverse population. Our data corresponded to a prevalence of hypothyroidism of approximately 8.7%, which is higher than previously published estimates of 3-5% in the general population. Whether this represents actual increased prevalence or assessment bias is uncertain. It is important for all health professionals who care for gender diverse people to identify and appropriately treat thyroid disease, and to monitor thyroid function closely if gender-affirming hormone therapy is initiated.

scholarly journals Prominent seasonality of 25(OH)D vitamin deficiency in Latvia: Age and gender-related variations and testing regimen

2022 ◽  
Vol 131 ◽  
pp. 02004
Author(s):  
Sergey Nikulshin ◽  
Jana Osite ◽  
Stella Lapina ◽  
Anda Krisane ◽  
Iveta Dzivite-Krisane ◽  
...  
Keyword(s):  
High Latitude ◽  
Social Impact ◽  
Age Groups ◽  
Central Laboratory ◽  
Cross Sectional ◽  
Age And Gender ◽  
Younger Age ◽  
Optimal Period ◽  
And Gender ◽  
Sectional Analysis

Seasonality of 25(OH)D deficiency rate is a factor of major clinical and social impact and should be considered when planning for appropriate testing and tailored correction. We present retrospective cross-sectional analysis of over a million 25(OH)D tests performed in two leading Latvian laboratories – Central Laboratory and E.Gulbja Laboratory. Both series of tests demonstrated prominent seasonal variability of 25(OH)D deficiency rate (<20 ng/ml) and critical deficiency rate (<12 ng/ml): the lowest percentage of deficient tests was in August, while a significant peak was found in March-April. This trend was present at all ages and in both genders, variations were pronounced even for a high-latitude country and more prominent for critical deficiency, in younger age groups and in males. Analysis of testing regimens of both laboratories revealed that schedule was not optimal, period of higher testing intensity being far removed from the 25(OH)D deficiency peak.

The Psychological Society of South Africa’s guidelines for psychology professionals working with sexually and gender-diverse people: towards inclusive and affirmative practice

2019 ◽  
Vol 49 (3) ◽  
pp. 314-324 ◽  
Author(s):  
Chris/tine McLachlan ◽  
Juan A Nel ◽  
Suntosh R Pillay ◽  
Cornelius J Victor
Keyword(s):  
Professional Development ◽  
Best Practices ◽  
Practice Guidelines ◽  
Development Process ◽  
Gender Diversity ◽  
Position Statement ◽  
Affirmative Practice ◽  
Gender Diverse ◽  
And Gender

In this article, we outline the practice guidelines for psychology professionals working with sexually and gender-diverse people, ratified by the Psychological Society of South Africa’s Council in 2017. The guidelines are an augmentation of the Psychological Society of South Africa’s position statement of 2013 providing a framework for understanding the challenges that sexually and gender-diverse people face in patriarchal and hetero- and cis-normative societies. An affirmative stance towards sexual and gender diversity enables psychology practitioners to work ethically, effectively, and sensitively in this field. The guidelines – a first for Africa – are aspirational in nature and call on psychology professionals to become aware of their own biases, conscientise themselves of the best practices in the field by continued professional development, and to utilise the guidelines as a resource in their related work. Brief mention is made of the development process, before the rationale and possible applications of the 12 guidelines are explored.

scholarly journals The mental health and experiences of discrimination of LGBTQ+ people during the COVID-19 pandemic: Initial findings from the Queerantine Study

2020 ◽  
Author(s):  
Dylan Kneale ◽  
Laia Becares
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Perceived Stress ◽  
Explanatory Variable ◽  
Depression Scale ◽  
Average Score ◽  
Cross Sectional ◽  
Depressive Symptomology ◽  
Gender Diverse ◽  
And Gender

Objective: To assess mental health status and experiences of discrimination among a sample of Lesbian, Gay, Bisexual, Transgender, Queer people (LGBTQ+, the + including those who don't identify with any such label) during the COVID-19 pandemic. Design: Cross-sectional web-based survey. Setting: Responses were collected during the COVID-19 pandemic between April 27th and July 13th. Participants: 398 LGBTQ+ respondents forming an analytical sample of 310 in the main models. Methods: We used a combined measure of gender identity or expression and sexual orientation as the main explanatory variable. We assessed mental health with the 4-item Perceived Stress Scale (PSS-4), and with the 10-item Center for Epidemiological Studies Depression scale (CES-D-10). We measured experiences of discrimination with a battery of questions that asked respondents whether they had experienced a set of discriminatory experiences because of their LGBTQ+ identity during the coronavirus pandemic. Experiences of discrimination was considered a mediating factor and examined both as an outcome as well as an explanatory variable. Models were adjusted for a range of demographic and socioeconomic variables. Results: The prevalence of depression and stress were both high, with the majority of the sample exhibiting significant depressive symptomology (69%). Around one-in-six respondents reported some form of discrimination since the start of the pandemic because they were LGBTQ+ (16.7%). In regression models, the average score for perceived stress increased by 1.44 (95% Confidence Interval (CI): 0.517-2.354) for those who had experienced an instance of homophobic or transphobic harassment, compared to respondents who had not. Similarly, the odds of exhibiting significant depressive symptomology (CES-D-10 scores of 10 or more) increased three-fold among those who had experienced harassment based on their gender or sexuality compared to those who had not (OR: 3.251; 95% CI: 1.168-9.052). These marked associations remained after adjustment for a number of socioeconomic and demographic covariates. Cis-female respondents who identify as gay or lesbian had the lowest scores for perceived social or depressive symptoms; conversely transgender and gender diverse individuals had the highest scores. Conclusions: We found high levels of stress and depressive symptoms, particularly among younger and transgender and gender diverse respondents. These associations were partially explained by experiences of discrimination which had a large, consistent and pernicious impact on stress and mental health.

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