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Am I Man Enough Yet? A Comparison of the Body Transition, Self-Labeling, and Sexual Orientation of Two Cohorts of Female-to-Male Transsexuals
Abstract
This study compares 2 cohorts of female-to-male (FtM) transsexuals, one who transitioned between 1969 and 1987 and the other, between 2000 and 2006. Eight individuals from each group were interviewed. Results revealed that FtMs transitioning since 2000 less often seek bottom surgery, use a greater variety of terms to label their gender identity, and more often identify themselves as attracted to both men and women (and, for some, being attracted to transgender persons). Findings suggest that the experience of feeling “man enough” (achieving satisfaction with his sex and/or gender) has changed for FtMs.
... The results of the quality appraisal can be found in Table 4. Three papers were rated as demonstrating less than half of the assessed criteria overall (Doorduin & van Berlo 2014;Schilt & Windsor, 2014;Yerke & Mitchell, 2011). All three of these papers scored lowest across the commitment and rigor, and transparency and coherence domains, with descriptions of epistemological perspectives, recruitment procedures, credibility checking, reflexivity, and user involvement all having limited to absent detail. ...
... (Bockting et al., 2009, p. 694) And when I started transitioning, in general, I didn't even want to think whether I liked a man or a woman […] You're so busy figuring out your gender that you're just attracted to somebody. ' (Nagoshi et al., 2012, p. 417) Participants in one paper (Pollock & Eyre, 2012) noted that an explicit choice to focus on (Hereth et al., 2020, p. 38) Many described issues of stigma and discrimination regarding opportunities and challenges of "coming out twice", and how societal norms, transphobia, and homophobia served as barriers to expressing their identities: "So, the funny thing was, early on, I went from one closet into another because I went from being trans to-oh my God, now I'm a lesbian?" (Mizock & Hopwood, 2016, p. 98) Being read or socially affirmed as their gender identity-specifically as a man in most paperswas a noted facilitator for comfort in exploring sexuality (Bockting et al., 2009;Lindley et al., 2020;Lindley et al., 2021;Schilt & Windsor, 2014;Tree-McGrath et al., 2018;Yerke & Mitchell, 2011) with others facing challenges in trying to find a TGNC-affirming partner, experiencing fetishization, and the pressure to conform to particular sex acts (Lindley et al., 2020). One paper noted that non-binary participants faced further issues of invisibility which constrained their access to spaces and their comfort in exploring and expressing their sexuality compared to binary-identified participants (Tree-McGrath et al., 2018). ...
... Four papers referred to the benefits of using labels for gender and sexuality, including facilitating understanding for the self and others (Hereth et al., 2020), giving access to communities and medical resources (Tree-McGrath et al., 2018), enabling a push back against binary norms and access to safe spaces (Platt & Bolland, 2017), and how the evolution of language enables access to a wider range of labels which capture one's identity more fully (Yerke & Mitchell, 2011). Conversely, numerous papers talked to the constraints that labels may bring by not adequately reflecting the entirety of one's sexual or gender identity, for example, some participants felt that the label queer was the closest fit they could find, but it did not quite capture their experiences. ...
Background: The current research builds on a previous review of the literature which explored sexuality during gender transition. There has been increased attention toward TGNC people across academic, political, and healthcare fields since the previous review, as well as shifts in language use and health interventions, justifying a need for more contemporary understandings. Aim: The current systematic review explores the experience of sexuality during gender transition. Methods: A meta-ethnography was conducted on 16 papers that focused specifically on TGNC people's experiences of their sexualities. Results: The main findings were the intersection of gender and sexuality; the importance of rewriting labels around sexuality, bodies and relationships; (re)negotiating changes in sexual, romantic and/or physical relationships due to transitioning; and changes in a sense of community and belonging. Discussion: The results have implications for supporting TGNC people navigating their identities by recognizing the multiple and intersecting levels of influence within which they are situated.
... TV unterschieden sich nicht von Männern ohne TV. Eine Kohortenstudie (Yerke & Mitchell, 2011) -Kontroll-Studien (Gomez-Gil, Zubiaurre-Elorza, de Antonio, Guillamon, & Salamero, 2014;Newfield, Hart, Dibble, & Kohler, 2006) befassten sich mit der Lebensqualität bei trans Männern. Diese war im Vergleich zur Normalbevölkerung niedriger, aber bei den Teilnehmern höher, die eine Hormonbehandlung, familiäre Unterstützung und eine Beschäftigung hatten. ...
... Evidenzbasiertes Statement (Evidenzgrad III) Quellen: (Koehler et al., 2018;Kuper et al., 2012;Monro, 2000;Yerke & Mitchell, 2011 Evidenzbasierte Empfehlung (Evidenzgrad III) Quellen: (Gomez-Gil et al., 2014;Hawkins, 2009;Kenagy & Hsieh, 2005;Kuper et al., 2012;Monro, 2000;Nuttbrock et al., 2013;Poteat et al., 2013;Schulz, 2012;Xavier et al., 2005;Yerke & Mitchell, 2011) Abstimmung der Empfehlung: Konsens __________________________________________________________________________ Es sollte erfasst werden, ob die Geschlechtsinkongruenz und/oder die Geschlechtsdysphorie konstant zumindest seit einigen Monaten bestehen, vorübergehend oder intermittierend ist. ...
... Evidenzbasiertes Statement (Evidenzgrad III) Quellen: (Koehler et al., 2018;Kuper et al., 2012;Monro, 2000;Yerke & Mitchell, 2011 Evidenzbasierte Empfehlung (Evidenzgrad III) Quellen: (Gomez-Gil et al., 2014;Hawkins, 2009;Kenagy & Hsieh, 2005;Kuper et al., 2012;Monro, 2000;Nuttbrock et al., 2013;Poteat et al., 2013;Schulz, 2012;Xavier et al., 2005;Yerke & Mitchell, 2011) Abstimmung der Empfehlung: Konsens __________________________________________________________________________ Es sollte erfasst werden, ob die Geschlechtsinkongruenz und/oder die Geschlechtsdysphorie konstant zumindest seit einigen Monaten bestehen, vorübergehend oder intermittierend ist. ...
IntroductionThis paper introduces the German S3-guideline Gender Incongruence, Gender Dysphoria and Trans Health: Diagnostics, Counselling and Treatment that was finalized in October 2018.Objectives
The objective of the guideline group was to adapt the 1997 Standards for Treatment and Expert Opinion on Transsexuals to current scientific developments and research results and to make them applicable for appropriate health care in Germany.Methods
The treatment recommendations of the guideline are based on empirical evidence which was systematically researched and evaluated. In a structured consensus process, the guideline group, who is representative for the target group, and a stakeholder group of trans people in Germany agreed on 100 recommendations.ResultsThe guideline aims to individualize and deregulate the field of trans health care. Reasonable options for the treatment of gender incongruence and/or gender dysphoria are identified. Based on empirical and clinical evidence, a procedure is recommended which is tailored to the individual conditions of the treatment.Conclusion
The guideline reflects the current international state of trans health care on the basis of empirical evidence and relates it to the German health care system. Its application should be backed up by clinical and therapeutic expertise.
... Bottom surgery is no longer a prerequisite for transsexuals to feel "man enough." 31,32 Yerke and Mitchell 31 found that current vs previous FtM transsexual patients seek bottom surgery less often, use a greater variety of terms to label their gender identity, and more often identify themselves as being attracted to people in more than one gender category. In contrast, having a flat chest without breasts is imperative for FtM patients to feel "man enough." ...
... Top surgery alleviates the burden of hiding the chest and gives joy when perceived as male by others in a wider range of settings, such as at the beach and in the locker room. 31 These trends suggest that the circumstances in which transsexuals experience themselves also are shaped by the sociocultural period in which they transition and not purely by anatomic and/or biological origin alone. 32 However, this is biased by the fact that transsexuals expressing doubt about any steps in the transition might have been deemed ineligible and excluded from treatment by medical and mental health "gatekeepers." ...
... Another aspect that has to be considered is the high costs and frequently unsatisfying results of these surgeries that might propel transsexuals toward a decision not to choose surgery. 31 Previously, transsexuals risked termination of genderconfirming surgery if they did not have the "correct" sexual orientation. To persuade medical and mental health "gatekeepers" of their GD and desire to transition, they had to show "manly" intentions by having a sexual orientation toward the "correct" gender. ...
Introduction:
Gender dysphoria is a mismatch between a person's biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty).
Aims:
To report the first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period.
Methods:
Electronic patient databases were used to identify patients diagnosed with gender identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported.
Main outcome measures:
Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery.
Results:
One hundred fifty-eight patients referred for gender-confirming surgery were included. Fifty-five cases (35%) were male-to-female (MtF) and 103 (65%) were female-to-male (FtM). In total, 126 gender-confirming surgeries were performed. For FtM cases, top surgery (mastectomy) was conducted in 62 patients and bottom surgery (phalloplasty and metoidioplasty) was conducted in 17 patients. For MtF cases, 45 underwent bottom surgery (vaginoplasty), 2 of whom received breast augmentation. The FtM:MtF ratio of the referred patients was 1.9:1. The median age at the time of surgery decreased from 40 to 27 years during the 20-year period.
Conclusion:
Gender-confirming surgery was performed on 65 FtM and 40 MtF cases at our hospital, and 21 transsexuals underwent surgery abroad. Mastectomy was performed in 62 FtM and bottom surgery in 17 FtM cases. Vaginoplasty was performed in 45 MtF and breast augmentation in 2 MtF cases. There was a significant decrease in age at the time of gender-confirming surgery during the course of the study period.
... The lack of reliable, durable, and desirable erectile devices has limited uptake of phalloplasty in the transgender community, where many individuals have chosen to wait for phalloplasty technology to improve before seeking out gender-affirming genital surgery. 1 Transgender men may be justifiably concerned about device failure and the possible need for additional surgery with existing options for internal erectile prostheses, particularly given the higher complication rates seen for these devices in transgender men when compared to cisgender men experiencing erectile dysfunction in a natal phallus. 2−4 As such, there is a need to develop alternative methods for helping transgender men achieve penetrative function after phalloplastythrough both surgical options 5 as well as non-surgical alternatives to assist with erectile function. ...
... Negative: Easy to use (1) Increased interest in sex (2) More sexual options (3) Appreciating getting to try something new (4) Improved confidence/sex life (2) Nothing enjoyable/Couldn't Use (10) Painful (2) Slipping (5) Didn't work well (4) Measurement/Fit issues − General (5) Fit issues − Specific to being trans (7) Neutral: Hopeful it could work with some improvements/size changes (3) Technique suggestions (5) There's a learning curve (1) Suggestions for a better device (4) The number of participants addressing the theme is in parentheses. ...
Introduction
Transgender men interested in achieving penetration after phalloplasty are currently limited to internal devices and makeshift supports. More options are needed to support sexual penetration after phalloplasty.
Aim
This study was designed to assess the feasibility of an external erectile prosthesis (the Elator) for transgender men who have undergone phalloplasty and wish to use their neophallus for sexual penetration, assess how the device affected the sexual experiences of men and their partners, and identify any side effects and concerns.
Methods
Transgender men and their partners were provided with an erectile device to use for one month. They were surveyed at 4 time points: enrollment, measurement, receipt, and after using the device, using a combination of pre-existing and device-specific measures.
Main Outcome Measure
The primary outcome was whether men found it feasible to use an external penile prosthesis for sexual penetration after phalloplasty – defined as interest in, and willingness to, use the device more than once over the study period; intention to continue using the device on the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS); and no decrease in relationship satisfaction on the Gay and Lesbian Relationship Satisfaction Scale (GLRSS). The secondary outcome was an increase in sexual or relationship satisfaction with use of the device, defined as a statistically significant increase on either the Quality of Sexual Experience Scale (QSE) or the GLRSS.
Results
Fifteen couples enrolled in the pilot study. Of the 10 who completed the study, only 3 found device use feasible and endorsed strongly positive experiences, while the remaining 7 found it unusable. There were no changes in QSE or GLRSS scores. Most device issues were related to proper fit.
Conclusion
There is a great deal of interest in non-surgical options for achieving penetration after phalloplasty. The tested external erectile device can work well, but its utility is limited to individuals with very specific post-phalloplasty anatomy. Most individuals and couples found the device unsuitable for the neophallus and/or that it could not be used comfortably.
Boskey ER, Jolly D, Mehra G, et al. Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty. Sex Med 2022;XX:XXXXXX.
... Most studies focussed exclusively on female-to-male (FtM) samples came from North America (Barrett 1998;Newfield et al. 2006;Pazos 2000;Yerke and Mitchell 2011). Barrett (1998) discussed the disappointment that could occur with the sur- geries available at the time, however there have been developments in procedures and skill over time that have not yet been explored exclusively for FtM transgender people in Australia. ...
... In response to these issues, we wanted to explore how FtM Austra- lians engaged in, and protected themselves during, sexual engagements with others. Yerke and Mitchell (2011) showed that a group of FtM transgendered individuals who transitioned 20 years beforehand were much more likely to go through hor- monal treatment and complete surgery procedures, whereas now trends have shifted so that a group who had transitioned more recently were more likely to only access hormonal treatment and top surgery (and did not see bottom surgery as an essential part of transition). The E-males research team therefore wanted to address the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. ...
Discrimination against transgender people on the basis of their gender identity or expression is illegal in Australia, however it is not always easy for Australian transgender people to find adequate social support. This chapter examines data on discrimination and social support generated by the 273 FtM transgender Australians in the 2013 E-Males study. Some participants had no experiences of discrimination on the basis of transphobia, others had experienced public humiliation and verbal and/or physical abuse. Coming out was fraught with difficulties including the potential end of key relationships. Mostly, it was a positive experience in that it relieved self-doubt, generated understanding and supported transitions. Sometimes participants felt they had to be advocates for FtM transgender communities, other times they reported “going stealth” for safety reasons or to more fully embody their gender identity. Respondents’ general wellbeing and quality of life was significantly influenced by relationships with family, friends and intimate partners.
... Most studies focussed exclusively on female-to-male (FtM) samples came from North America (Barrett 1998;Newfield et al. 2006;Pazos 2000;Yerke and Mitchell 2011). Barrett (1998) discussed the disappointment that could occur with the sur- geries available at the time, however there have been developments in procedures and skill over time that have not yet been explored exclusively for FtM transgender people in Australia. ...
... In response to these issues, we wanted to explore how FtM Austra- lians engaged in, and protected themselves during, sexual engagements with others. Yerke and Mitchell (2011) showed that a group of FtM transgendered individuals who transitioned 20 years beforehand were much more likely to go through hor- monal treatment and complete surgery procedures, whereas now trends have shifted so that a group who had transitioned more recently were more likely to only access hormonal treatment and top surgery (and did not see bottom surgery as an essential part of transition). The E-males research team therefore wanted to address the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. ...
Transgender people enliven sexualities research and can challenge traditional ideas about gender-based orientations or the mechanics of pleasure. This chapter examines data on sexuality, romance and relationships generated by the 273 FtM transgender Australians in the 2013 E-Males study. Over half of the participants were in a romantic/sexual relationship. Most had never married. Over one third of the E-males participants were attracted to both sexes and a quarter were attracted to people of the opposite sex. Many were attracted to all gender expressions, or challenged traditional “orientations”. The commencement of medical transition sometimes enabled greater sexual engagement due to increased libido and bodily comfort. FtM transgender people engaged in unpredictable variations on a broad range of sexual behaviours with varying risk levels, from kissing and giving oral sex using latex protections, through to receiving various types of penetrative sex without protection; revealing a need for tailored sexual health information.
... Most studies focussed exclusively on female-to-male (FtM) samples came from North America (Barrett 1998;Newfield et al. 2006;Pazos 2000;Yerke and Mitchell 2011). Barrett (1998) discussed the disappointment that could occur with the sur- geries available at the time, however there have been developments in procedures and skill over time that have not yet been explored exclusively for FtM transgender people in Australia. ...
... In response to these issues, we wanted to explore how FtM Austra- lians engaged in, and protected themselves during, sexual engagements with others. Yerke and Mitchell (2011) showed that a group of FtM transgendered individuals who transitioned 20 years beforehand were much more likely to go through hor- monal treatment and complete surgery procedures, whereas now trends have shifted so that a group who had transitioned more recently were more likely to only access hormonal treatment and top surgery (and did not see bottom surgery as an essential part of transition). The E-males research team therefore wanted to address the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. ...
This chapter explores the data on parenting from the 2013 E-Males study of 273 FtM transgender Australians. Some participants were parents or knew of other FtM transgender people who were. They expressed frustration that their ability to parent was widely overlooked, as it was an important element in their identity. FtM transgender people had become parents through having had their own biological children, through fostering and adoption, through their partners or other pathways. Some respondents who were not intending to have children had given serious consideration to egg donation, and others enjoyed having children in their lives through other means, such as being uncles to nephews and nieces. The question of disclosure (or not) of one’s trans* status to one’s children was considered challenging to navigate by some participants, with significant positives and negatives to either path of action. There was a growing need for more resources in this area.
... Most studies focussed exclusively on female-to-male (FtM) samples came from North America (Barrett 1998;Newfield et al. 2006;Pazos 2000;Yerke and Mitchell 2011). Barrett (1998) discussed the disappointment that could occur with the sur- geries available at the time, however there have been developments in procedures and skill over time that have not yet been explored exclusively for FtM transgender people in Australia. ...
... In response to these issues, we wanted to explore how FtM Austra- lians engaged in, and protected themselves during, sexual engagements with others. Yerke and Mitchell (2011) showed that a group of FtM transgendered individuals who transitioned 20 years beforehand were much more likely to go through hor- monal treatment and complete surgery procedures, whereas now trends have shifted so that a group who had transitioned more recently were more likely to only access hormonal treatment and top surgery (and did not see bottom surgery as an essential part of transition). The E-males research team therefore wanted to address the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. ...
This chapter examines data on employment generated by the 273 FtM transgender Australians in the 2013 E-Males study. The majority of participants (58 %) were working (full-time, part-time or in an apprenticeship). However, 15 % were unemployed—a higher portion than in previous studies on broader populations. The qualitative data revealed there were clear obstacles to employment and promotion for FtM transgender people. These included the fear of coming out as transgender, transphobia both in recruitment and on-site, the desire to avoid work during transition, and uncertainty around the need to reveal gender history in applications. Some workplaces and industries were perceived as more supportive than others, and there were examples of sites with very transphobic masculine work cultures that had compromising impacts even on men who had fully transitioned and “passed” as male. Leadership had a pivotal role in whether workplaces were transphobic or supportive; poor and best-practice examples are described.
... Most studies focussed exclusively on female-to-male (FtM) samples came from North America (Barrett 1998;Newfield et al. 2006;Pazos 2000;Yerke and Mitchell 2011). Barrett (1998) discussed the disappointment that could occur with the sur- geries available at the time, however there have been developments in procedures and skill over time that have not yet been explored exclusively for FtM transgender people in Australia. ...
... In response to these issues, we wanted to explore how FtM Austra- lians engaged in, and protected themselves during, sexual engagements with others. Yerke and Mitchell (2011) showed that a group of FtM transgendered individuals who transitioned 20 years beforehand were much more likely to go through hor- monal treatment and complete surgery procedures, whereas now trends have shifted so that a group who had transitioned more recently were more likely to only access hormonal treatment and top surgery (and did not see bottom surgery as an essential part of transition). The E-males research team therefore wanted to address the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. ...
This chapter explores data on gender identity generated by the 273 FtM transgender Australians in the 2013 E-Males study. Most participants (51 %) identified simply as “male”. This group tended to have known their identity from a young age, and had struggled with the development of secondary sex characteristics during puberty. However, some were unsure about their identity until later in life. Participants who mainly identified as either “transgender”, “trans male”, “FTM” or “male with transgender or transsexual background” explained that referring to themselves only as only as male would be to deny part of themselves. “Genderqueer” was the preferred way to self-identify for those who rejected pressures to fit into female-male binary model or stereotypes—whether they did not relate to or agree with the binary, or were uncertain about gender. All participants expressed strong negative feelings against being referred to by female pronouns, regardless of their diverse gender identities.
... Most studies focussed exclusively on female-to-male (FtM) samples came from North America (Barrett 1998;Newfield et al. 2006;Pazos 2000;Yerke and Mitchell 2011). Barrett (1998) discussed the disappointment that could occur with the sur- geries available at the time, however there have been developments in procedures and skill over time that have not yet been explored exclusively for FtM transgender people in Australia. ...
... In response to these issues, we wanted to explore how FtM Austra- lians engaged in, and protected themselves during, sexual engagements with others. Yerke and Mitchell (2011) showed that a group of FtM transgendered individuals who transitioned 20 years beforehand were much more likely to go through hor- monal treatment and complete surgery procedures, whereas now trends have shifted so that a group who had transitioned more recently were more likely to only access hormonal treatment and top surgery (and did not see bottom surgery as an essential part of transition). The E-males research team therefore wanted to address the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. ...
Recent years have seen greater recognition of the right to non-discrimination in employment on the basis of gender identity in both international human rights law, and Australian national and state laws. However, there is a lack of employment-focused research on transgender people broadly, and Female to Male (FtM) transgender people particularly—existing studies typically focus on clinical concerns for MtF populations. This chapter reports on a 2013 national online study of 273 FtM transgender Australians, which combined an anonymous online survey gathering basic data with a communal discussion-board allowing participants to offer deeper discussions (using a pseudonym of their choice). The project was developed with a reference group and key gender centres and online support networks assisted in recruitment. Participants ranged in age from 16 to 64 and mostly identified simply as male, but other identities (transsexual male, genderqueer and so on) were represented. The majority were working (full-time, part-time or in an apprenticeship) on a broad range of incomes. However, the research revealed a higher portion of unemployment than in previous Australian studies. The qualitative data revealed clear obstacles to employment and promotion for FtM people; the fear of coming out as transgender, transphobia in the workspace and in recruitment, the desire to avoid work during transition, uncertainty around the need to reveal gender history in a job or police check applications, and fear of exposure in certain environments. Leadership had a pivotal role in whether workplaces were transphobic or supportive and best-practice leadership are outlined. The chapter concludes with a discussion of the urgent need for workplace equity training measures and related research.
... The developmental trajectories of transgender people have been shown to vary (Hillier et al., 2010;Jones & Hillier, 2013;Smith et al., 2014;Yerke & Mitchell, 2011). The Writing Themselves in 3 online national Australian survey (Hillier et al., 2010) included a sample of 91 gender-questioning youth aged 14-21, within a broader group of 3,134 same sex-attracted and genderquestioning youth. ...
... US Psychologist Pazos (2000) reflected on counselling experiences with several of her FtM clients and noted the recurrence of feelings of difference as early as 5 years of age, magical thinking and daydreaming about becoming a boy, and early attempts at "making the change" through trying to urinate standing up and engaging in attempts to look or act like boys. One US study which specifically interviewed (16) FtM individuals revealed that those transitioning since 2000 sought bottom surgeries less often and were less concerned about "being man enough" in a traditional physical and social sense (Yerke & Mitchell, 2011). The trends in these smaller US participant groups cannot be automatically assumed to apply to Australian FtM populations but are instead explored empirically in the study on which this article reports. ...
The aim of the study reported in this article was to gain an understanding of the experiences, developmental trajectories, and mental health status of Australian trans men. Participants were 279 trans men. The majority preferred to identify as “male”; from an early age, they had experienced their gender identity as different from that normatively expected of their natally assigned sex and had undertaken practices so as to facilitate their presentation as male in accordance with their gender identity. A majority reported a diagnosis of depression or anxiety within the last 12 months and attributed suicidal ideation and self-harm and attempted suicide to personal issues with gender identity. Going through a masculinisation process and coming out reportedly led to improved mental health. The findings highlight the need to educate mental health and health care professionals on trans issues.
... Further, trans people may use a range of labels to identify their sexual orientation, which may also shift over time and intersect with generational, cultural, and personal meanings (Doorduin & van Berlo, 2014;Galupo et al., 2016). Research suggests that unique labeling and othering processes may occur as a result of this, as trans people navigate their identity within cisgenderist norms, which can also influence how one perceives oneself, one's relationships, and how partners perceive them (Pollock & Eyre, 2012;Thurston & Allan, 2018;Yerke & Mitchell, 2011). For some, this offers opportunities and access to communities, while for others, this is constraining . ...
Previous research highlights mixed findings regarding how trans people experience sexual satisfaction during and after transition. Qualitative research in particular reflects a process of psychosocial adjustment during and after transition, which reciprocally impacts sex and pleasure. The current research explores trans women’s experiences of their sexualities during gender transition. A phenomenological qualitative methodology was used, and 12 trans women aged 22–67 years old were individually interviewed about their experiences of their sexualities in 2023. Participants had varied sexualities, disabilities, and employment statuses, were mostly White, and had started hormone therapy. Interpretative phenomenological analysis was used to analyze the data. Two group experiential themes were developed, each with two subthemes: transition affords me with the confidence and comfort to explore my sexuality, and doing sexuality differently as a result of transitioning. The results have implications for supporting trans women navigating their identities during the transition by highlighting the psychosocial process of relearning and/or rediscovering their sexualities. Recommendations for future research and practitioners are discussed.
... A qualitative study comparing older and younger TM found that younger TM who had transitioned recently placed more importance on chest reconstruction than on genital reconstruction. 34 It is possible that more GAP may be needed for TW to have any positive impacts on mood or anxiety problems if these symptoms are related to their transition process. In the current sample, no TM reported having genital reconstruction surgery so it is not possible to say how this procedure might impact their mental health. ...
Background:
Mental health needs of transgender individuals can be complex with individual, social, and medical factors impacting symptoms. This study examines predictors of mood or anxiety problems among transgender individuals seeking hormone therapy (HT).
Methods:
A retrospective chart review was conducted at 2 clinics providing gender-affirming HT. Cross-sectional data from initial patient encounters (N = 311) were used in this study. Bivariate correlations and multiple logistic regression analyses were carried out.
Results:
Transgender women (TW) were 2.2 times more likely to have mood or anxiety problems while transgender men (TM) were 2.6 times more likely as the number of medical comorbidities increased. For both TW and TM, White race significantly increased the likelihood of mood or anxiety problems. Neither previous nor current HT were associated with mood or anxiety problems for TW and TM. However, receiving multiple gender-affirming procedures decreased the likelihood of mood or anxiety problems for TM.
Conclusions:
Gender-affirming care and addressing comorbidities can be important aspects of mental health needs for transgender individuals.
... While these definitions still ring true for some people, for others manhood, womanhood, femininity, and masculinity are not related to any specific genitals or reproductive capacity. Research also demonstrates similar shifts in trans experiences: when comparing two cohorts of transmasculine people/ trans men, those who transitioned in the 1980s through 1990s were more likely to seek bottom surgery than those who recently transitioned (Yerke & Mitchell, 2011). Thus, "conflicts" over time between research reports could and often do reflect legitimate temporal differences in experiences and phenomena. ...
Hormone therapy (HT) is one of the most commonly used transition-related medical interventions for trans people. While there is much research on the impacts of HT, the literature related to sexuality is scattered across disciplines, leaving researchers, clinicians, and trans people themselves with little systematic guidance about expected changes to sexuality. In this article, we first delineate the limitations of the extant research on associations between HT and sexuality. We then synthesize this research, focusing on several key aspects of sexuality: physical changes, sexual desire, contributors to sexual satisfaction and sexual distress, experiences of sexual orientation or identity, and sexual behaviors. We find that the most well-established changes associated with HT are initial changes to libido and increased sexual satisfaction, likely through increased body satisfaction. We outline areas for future research and conclude that, though HT is a medical process, to fully understand the impacts of HT, research must incorporate a sociocultural lens.
... These significant challenges were supported by a recent systematic review of qualitative experiences [7]. Indeed, transgender patients have called for health care providers to have greater education on transgender issues [8] and to recognize more individual, diffuse combinations of care and transitions over time [9]. There is little current primary care population-based clinical data about transgender health. ...
Primary care must ensure high quality lifelong care is offered to trans and gender minority patients who are known to have poor health and adverse healthcare experiences. This quality improvement project aimed to interrogate and audit the data of trans and gender minority patients in one primary care population in England. A new data collection instrument was created examining pathways of care, assessments and interventions undertaken, monitoring, and complications. General practitioners identified a sample from the patient population and then performed an audit to examine against an established standard of care. No appropriate primary care audit standard was found. There was inconsistency between multiple UK gender identity clinics’ (GIC) individual recommended schedules of care and between specialty guidelines. Using an international, secondary care, evidence-informed guideline, it appeared that up to two-thirds of patients did not receive all recommended monitoring standards, largely due to inconsistencies between GIC and international guidance. It is imperative that an evidence-based primary care guideline is devised alongside measurable standards. Given the findings of long waits, high rates of medical complexity, and some undesired treatment outcomes (including a fifth of patients stopping hormones of whom more than half cited regret or detransition experiences), this small but population-based quality improvement approach should be replicated and expanded upon at scale.
... The nature of transition differs for AMAB vs. AFAB individuals as well. The AFAB individuals in the sample, regardless of binarity, were less likely to have undergone genital reconstruction surgery (10.8% phalloplasty) in comparison to AMAB individuals (45.8% vaginoplasty), similar to findings of other studies [22,30,51,67]. AFAB and AMAB individuals may thus have different transition goals, needs, or experiences on which they base their treatment desires. ...
The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.
... Multiple studies have been conducted to investigate the quality of life of transmasculine individuals (Factor & Rothblum, 2008;Motmans, Meier, Ponnet, & T'Sjoen, 2012;Newfield, Hart, Dibble, & Kohler, 2006;Yerke & Mitchell, 2011), some with a specific focus on mental health (Rotondi et al., 2011;Bariola et al., 2015) and socioeconomic limitations (Dispenza, Watson, Chung, & Brack, 2012;Motmans et al., 2012). A survey conducted by Meier, Pardo, Labuski, and Babcock (2013: 291) There is a strong social and medical movement towards the de-psyschopathologisation of gender diverse individuals (Coleman et al., 2012: 168). ...
Minimal research has been conducted on transmasculine individuals due to the prevailing belief that exogenous androgen hormone treatment lowers the f0 to a satisfactory masculine-sounding voice (Van Borsel et al., 2000; T’Sjoen et al., 2006), but it has shown a gender-conforming speaking fundamental frequency does not equate to a gender-affirming voice (McNeill et al., 2008).
The current study explores the vocal satisfaction of transmasculine individuals by employing a global online survey. It identifies psychosocial and communicative effects that may impact this diverse population and aims to place them into the conceptual framework developed by Azul et al. (2017) as feasible in an online survey. The dimensions of the framework include demographic information (e.g. gender identity, binding, smoking etc.), vocal and communicative impacts (e.g. personal, physical, socioeconomic etc.), acoustic measurements (e.g. mean and mode f0), and testosterone history, and self-perceived vocal masculinity.
The current study had methodology-related goals as well, namely to test the efficacy of using acoustic tools such as Language and Brain and Behaviour Corpus Analysis Tool (LaBB-CAT; Fromont & Hay, 2017) and Robust Epoch And Pitch EstimatoR (REAPER; Talkin, 2015) within a clinically applied area of research.
The following research questions were explored as part of the study:
1) What are the acoustic correlates of masculinity and the socio-cultural construct of the male gender identity?
2) What is the relationship between the transmasculine individuals’ voice and their quality of life?
3) How satisfied are transmasculine individuals with their speech?
The current study found that the vocal satisfaction of transmasculine individuals is not directly predictable from self-perceived vocal masculinity, or from the central tendency measures of the speaking fundamental frequency. Participants’ self-perception of both their vocal satisfaction and vocal masculinity was mediated by the individual’s self-assigned gender identity label.
... Existing research into transmasculine experiences with gender-affirming surgery is disproportionately concerned with genital reconstruction surgery (i.e., phalloplasty and metoidioplasty), despite the fact that, currently, few transgender men in the United States undergo these procedures. 1,5,12,13 Relatively minimal research has evaluated how masculinizing top surgery, independent of other gender-affirming procedures, affects patient-reported mental health, quality of life, and sexual confidence. ...
Background:
Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and non-binary individuals. Current literature is primarily focused on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality of life measures.
Methods:
An anonymous online survey was distributed to 81 of the senior author's former top surgery patients. Survey response rate was 72% (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery's role in gender affirmation.
Results:
Following top surgery, measures of quality of life and sexual confidence significantly improved (P < .001). Additionally, 86% reported improvement in gender dysphoria-related mental health conditions. All but 1 respondent reported that top surgery had an overall positive impact on their life.
Conclusions:
Top surgery had major positive effects on all mental health and quality of life metrics. Our findings contribute to a much-needed body of evidence that top surgery markedly improves the daily lives and functioning of transgender and non-binary individuals who choose to undergo it.
... The participant demographics reflect, broadly speaking, Vancouver Island ethnic distributions; participant identifications in regard to gender identity are consistent with research reflecting increasing adaptation of "transgender" or "genderqueer" identification among trans people (Ekins & King, 2006;Gay, Bisexual and MSM . . . , 2012;Yerke & Mitchell, 2011). The participants in this study reported few experiences of violence and crime; however, this survey reported on a convenience sample. ...
In 2010-2011, the Vancouver Island Transgender Needs Assessment, a community-based, applied research project, sought to identify the health and social needs of trans people on Vancouver Island, British Columbia, Canada. An advisory board consisting of trans-identified community members and trans-service providers guided this descriptive analysis. A total of 54 individuals identifying as transgender participated in a survey modeled after the TransPULSE Ontario instrument. Of the participants, 43% identified on the transmasculine spectrum, 39% on the transfeminine spectrum, and 18% as transgender/genderqueer only. Participants were surveyed in regard to education, employment, and income; housing; health care needs and services; suicidality; violence; life satisfaction and attitudes toward self; posttransition experiences; and community belonging. They reported health care, social support, and public education/acceptance as top needs. The article concludes with a specific needs profile and a community-generated set of recommendations stressing the need for an island-based information and resourcing center.
... Traditionally, bottom surgery was imperative for successful transition and transgendered individuals who did not desire bottom surgery were not found to be eligible for transition. Yerkea and Mitchella (2011) showed in a cohort study that participants were satisfied with their gender identity, expression, and body without bottom surgery. They concluded that genital surgery is not a necessary final step of transition for all transmen. ...
The WPATH Standards of Care (SOC) Revision Committee are reassessing criteria for sex reassignment surgery. The major points of discussion for which WPATH might provide additional guidelines are: (1) gender binary defying surgery, (2) gonad retention for fertility preservation prior to hysterectomy in transmen and castration (+ vaginoplasty) in transwomen, (3) the necessity for two referrals from qualified mental health professionals who have independently assessed the patients, prior to performing genital surgery, especially for hysterectomy and salpingo-oophorectomy, (4) the minimum age of 18 as eligibility to undergo irreversible (genital) surgery procedures. We have performed a literature search focussing on these subjects in order to formulate a supported opinion for changing the SOC regarding these topics.
... 209–211). Likewise, one transgender man said, " I wanna be a pretty boy " (Yerke & Mitchell, 2011, p. 68). The processes of transitioning included feeling uncomfortable with being in the " wrong " body, confusion, and negotiating the conflict between the " true " self and the bodily appearance which does not conform to the socially accepted gender identity and role. ...
This article synthesises findings from qualitative studies which have explored the lived experiences of transgender persons, using Noblit and Hare’s (1998) meta-ethnography method. Thirty-one qualitative
studies related to the lived experiences of transgender individuals, published between 1998 and 2013, met the inclusion criteria. A literature search was conducted between November 2012 and September 2013 using computerized searches from nine databases as well as online manual searches of key journals. Results from these individual studies revealed five major themes: (a) crossing gender and physical problems in life, (b) experiencing psychological distress, (c) encountering discrimination and social exclusion, (d) having relationships does matter, and (e) dealing with difficulties in life. Yet, despite these negative experiences, transgender people have tried to find ways to help them deal with their difficulties. We conclude that there is a need for health care providers, social workers, and health promoters to support transgender individuals, for their health and well-being. This meta-synthesis provides a clear account of what transgender individuals experience in their lives, to support the development of sympathetic health and social care services to assist them with their difficulties, and enhance their health and well-being.
... 209–211). Likewise, one transgender man said, " I wanna be a pretty boy " (Yerke & Mitchell, 2011, p. 68). The processes of transitioning included feeling uncomfortable with being in the " wrong " body, confusion, and negotiating the conflict between the " true " self and the bodily appearance which does not conform to the socially accepted gender identity and role. ...
... Although they may not necessarily use that label, those who might broadly be considered trans would include trans men (people assigned female at birth but who identify as male), trans women (people assigned male at birth but who identify as female), androgyne and polygender people, and cross-dressers/transvestites. 1 Some people within these categories may desire to undergo surgery or medical intervention to achieve a body congruent with their gender but many do not. For example, in one study (Yerke & Mitchell, 2011), it was found that it was not uncommon for trans men to undergo "top surgery" (i.e. mastectomy) but not to undergo "bottom surgery" (i.e. ...
Most societies are heavily organised around a dichotomous model of gender, and individuals are heavily policed on their conformity (or otherwise) to gender norms. This scrutinisation of gender has a profound impact on the identities and lived experiences of trans people, especially for those whose gender identity (or presentation) does not appear to match social expectations for that gender; or where someone's physical body in some way does not match the body conventionally associated with that gender. This might result in trans people avoiding certain situations to reduce the risk of being exposed. Based on a sample of 889 UK-based participants who self-defined as trans, the current paper explores situational avoidance with particular reference to gender identity and stage of transition. A key finding of this study concerned statistically significant associations between group (gender identity and stage of transition) and avoidance (or not) of certain situations, namely clothing shops, gyms, and public toilets. The implications of these findings for supporting trans people through transition – in particular, the real life experience – are also discussed.
... It is also possible that cohort effects may be a more powerful predictor for variations in psychological and physical health outcomes. A qualitative study comparing trans men who transitioned in the 1980s to those who transitioned in the 2000s revealed a more open conceptualization of gender and sexual identity among the younger sample, as well as a far less strict adherence to the gender binary and less inclination to seek GRS (Yerke & Mitchell, 2011). Similarly, Dhejne and colleagues (2011) reported that individuals who began transitioning before 1989 drove the reported mortality effect up, leading them to highlight that during that time the availability of quality GRS, hormonal treatment, and psychosocial care was limited. ...
The literature on the transgender/transsexual-spectrum persons is limited. Most studies are based on assumptions that trans persons are best understood within rigid and binary definitions of gender and sexuality and tend to focus on diagnostics, medical management and risk factors. Researchers and clinicians may assume that people who challenge cultural norms of gender and sexuality can be grouped together, which can result in harmful assumptions about the specific experiences of trans persons. The purpose of this study was to explore the gender and sexual identities of trans persons, investigate group differences, and examine factors that predict better psychological and physical well-being. Participants took part in an online study and provided information about their gender and sexual identity, social support, relationship quality, and mental/physical health. Results depicted diverse gender identities and sexual orientations among trans persons and emphasized that while many challenges faced by sexual and gender minorities are similar, trans persons report unique mental and physical health outcomes. Also, greater social support and relationship quality predicted mental, but not physical, health among trans persons. These results highlight the importance of acknowledging the complexity of trans identities and the key role of social and personal support.
http://utpjournals.metapress.com/content/g124p80727q2r278/
... The participant demographics reflect, broadly speaking, Vancouver Island ethnic distributions; participant identifications in regard to gender identity are consistent with research reflecting increasing adaptation of "transgender" or "genderqueer" identification among trans people (Ekins & King, 2006;Gay, Bisexual and MSM . . . , 2012;Yerke & Mitchell, 2011). The participants in this study reported few experiences of violence and crime; however, this survey reported on a convenience sample. ...
In 2010-2011, the Vancouver Island Transgender Needs Assessment, a community-based, applied research project, sought to identify the health and social needs of trans people on Vancouver Island, British Columbia, Canada. An advisory board consisting of trans-identified community members and trans-service providers guided this descriptive analysis. A total of 54 individuals identifying as transgender participated in a survey modeled after the TransPULSE Ontario instrument. Of the participants, 43% identified on the transmasculine spectrum, 39% on the transfeminine spectrum, and 18% as transgender/genderqueer only. Participants were surveyed in regard to education, employment, and income; housing; health care needs and services; suicidality; violence; life satisfaction and attitudes toward self; posttransition experiences; and community belonging. They reported health care, social support, and public education/acceptance as top needs. The article concludes with a specific needs profile and a community-generated set of recommendations stressing the need for an island-based information and resourcing center.
... We focus on one group of transgender people, transsexuals. Transsexuals usually choose to live permanently as the other sex and make physical changes to their bodies with hormone-replacement therapy and surgeries; however, individuals differ in their transition interests, and not all transsexuals seek full physical transition (Lev, 2004;Yerke & Mitchell, 2011). Although our focus is on transsexuals, our observations and conclusions often apply to all people who do not completely identify with their birth sex or assigned gender, including transvestites, cross-dressers, androgynous, intersex, genderqueer or other gender-variant people (Brown & Rounsley, 1996;Israel & Tarver, 1997;Lev, 2004). ...
The repeal of Don't Ask, Don't Tell offered legal equality to sexual minorities in the military. However, this big step forward had no impact on the policy of exclusion and rejection and the fear and secrecy that resulted for transgender people (whether lesbian, gay, bisexual, or heterosexual). In this article, we argue that transgender citizens should have equal opportunity to honorably serve their country, and to be treated with respect and sensitivity as they do so. Many transgender persons may be drawn to military service and its ethos of masculine values. However, they are currently not permitted entry, and, if they are to enter, must remain hidden or face dismissal, leaving them vulnerable to harassment. While they report both positive and negative experiences during their service, research documents discrimination in veterans' healthcare as well as mental health risks resulting from fear and harassment. In contrast to the United States, 11 countries include transgender people in their militaries. Drawing in part from their examples, we end with recommendations for change in the direction of respect and equality of opportunity.
In its everyday operation, the law presumes to narrate trans stories and shape trans lives. This article shines a light on law’s claims to authority over transgender identities and transgender bodies, and offers an alternate, intimate account of one transgender person’s interactions with law and society. The stories recounted here offer glimpses into the life of Georgio. Written from the perspective of someone who has had the privilege of bearing witness to his journey, this article assembles incomplete fragments of the joys and frustrations of Georgio’s gender transition and invites deeper reflection on legal assumptions about the lives of transgender people. It represents an attempt to breathe humanity into law’s cold scripts of gender identity.
Sexual or erectile dysfunction (ED) is the ineptitude to get or keep a hard penile erection. ED can have a detrimentaleffect on physical and psychological health. This review helps in understanding the detailed etiology of ED and variousapproaches for the management of ED. The occurrence and incidence of erectile dysfunction are on the rise among men.Various other factors greatly impact the progression of ED, including individual general health and physiological conditions suchas psychiatric or psychological problems, diabetes mellitus, genitourinary disease, cardiovascular disease, and chronic diseases.Erectile dysfunction occurs when the release of nitric oxide (NO) triggers the activation of the guanylate cyclase enzyme in thespongiosum and corpora cavernosa, leading to relaxation of the vascular smooth muscle and an increase in cyclic guanosinemonophosphate (cGMP) levels. This physiological process is essential for achieving and maintaining a firm penile erection. Somecommon and advanced methods, such as the physical method, sexual history, laboratory testing, apomorphine test, NPTR test,and color duplex Doppler ultrasound test, are used to diagnose erectile dysfunction. This review also focuses on emergingtreatments that address the medical need for effective ED management. This comprehensive review bridges gaps in the currentliterature, offering superior insights into ED management and improving the quality of life for individuals with ED.
This comprehensive and authoritative book is written by over seventy of the foremost experts working with the care of transgender and gender expansive patients for gynecologists and those working in neighboring disciplines. Among medical specialists, understanding of the complex reality and medical needs of transgender and gender diverse individuals is still limited. This book offers the opportunity to understand transgynecology in a way that is inclusive and up-to-date, with insights into liaison with specialties such as urology, dermatology, sexuology, physiotherapy amongst others. By contextualising transgender/gender diverse medicine before covering specific issues such as imaging, benign disorders, fertility maintenance, medico-legal concerns and uterine transplantation, this book is truly unique. Aimed at gynecologists, obstetricians, general practitioners, counsellors and all those who work with transgender, non-binary, or gender diverse patients, this book prepares the reader for the prerequisites and subtleties of transgynecology.
This comprehensive and authoritative book is written by over seventy of the foremost experts working with the care of transgender and gender expansive patients for gynecologists and those working in neighboring disciplines. Among medical specialists, understanding of the complex reality and medical needs of transgender and gender diverse individuals is still limited. This book offers the opportunity to understand transgynecology in a way that is inclusive and up-to-date, with insights into liaison with specialties such as urology, dermatology, sexuology, physiotherapy amongst others. By contextualising transgender/gender diverse medicine before covering specific issues such as imaging, benign disorders, fertility maintenance, medico-legal concerns and uterine transplantation, this book is truly unique. Aimed at gynecologists, obstetricians, general practitioners, counsellors and all those who work with transgender, non-binary, or gender diverse patients, this book prepares the reader for the prerequisites and subtleties of transgynecology.
Background
Transgender men who undergo gender-affirming phalloplasty have limited options for attaining sufficient rigidity for sexual penetration.
Aim
The goal of this study was to understand interest in and concerns about internal erectile prostheses among transgender men who had undergone phalloplasty.
Methods
As part of a pilot study of an external erectile device, transgender men (n = 15) were surveyed about their interest in, and concerns about, getting an internal prosthesis. Descriptive analyses were performed for structured questions and content analysis was used to analyze open responses.
Outcomes
Measured outcomes included closed- and open-ended questions assessing patient attitudes about internal erectile prostheses.
Results
Before starting the study, approximately half the men stated they were interested in getting an internal device, 20% said they weren't, and 33% said they didn't know. More than half of this postphalloplasty population stated they were somewhat or very concerned about the need for additional surgery (73%), side effects (pain, damage to the phallus; 100%), and the risk of device failure (100%). An additional 47% stated they were somewhat or very concerned about cost and 33% stated they were somewhat or very concerned about finding a surgeon.
Clinical Implications
There is a need to develop appropriate alternatives to current internal prostheses for penetrative function after phalloplasty.
Strengths & Limitations
Generalizability of results is limited by the fact that data are from men who had enrolled in a pilot study to test an external erectile prosthesis, and as such were explicitly interested in exploring nonsurgical alternatives to attain an erection. The combination of quantitative and qualitative data demonstrates that transgender men's concerns about internal prostheses are grounded in the current evidence.
Conclusion
Transgender men who have undergone phalloplasty have substantial concerns about the risks of getting an internal prosthesis and there is significant interest in alternatives to current devices.
Boskey ER, Mehra G, Jolly D, et al. Concerns About Internal Erectile Prostheses Among Transgender Men Who Have Undergone Phalloplasty. J Sex Med 2022;XX:XXX–XXX.
The field of language and gender has changed considerably over the past few decades, moving from the biologically defined categorization of sex common in the 1960s and 1970s toward the more socially constructed understanding of gender that is common today. This expanded understanding of “gender” has allowed researchers to explore the linguistic construction and reification of sexualities and trans identities, as well as multiple masculinities and femininities.
Zusammenfassung
Einleitung Am 9. Oktober 2018 wurde die Leitlinie „Geschlechtsinkongruenz, Geschlechtsdysphorie und Trans-Gesundheit: Diagnostik, Beratung und Behandlung“ nach methodischer Prüfung von der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) mit S3-Status in das Leitlinienregister aufgenommen und online veröffentlicht.
Forschungsziele Die Leitlinie verfolgt das Ziel, die „Standards zur Begutachtung und Behandlung von Transsexuellen“ aus dem Jahr 1997 an die gegenwärtigen Bedingungen und Forschungsergebnisse anzupassen und sie für eine adäquate Versorgung in Deutschland nutzbar zu machen.
Methoden Die Behandlungsempfehlungen der Leitlinie basieren auf empirischer Evidenz, die systematisch recherchiert und bewertet wurde. Die für den Kreis der Adressat_innen repräsentative Leitliniengruppe hat gemeinsam mit einer Interessensvertretung von trans Menschen im Zuge einer strukturierten Konsensfindung 100 Empfehlungen konsentiert.
Ergebnisse Die Leitlinie soll das Feld der Trans-Gesundheitsversorgung individualisieren und damit auch deregulieren. Optionen für eine zielführende Behandlung der Geschlechtsinkongruenz und/oder Geschlechtsdysphorie werden aufgezeigt. Anschließend wird ein empirisch und klinisch fundiertes Vorgehen empfohlen, das auf individuelle Bedingungen bei der Behandlung bedarfsgerecht eingehen kann.
Schlussfolgerung Die Leitlinie reflektiert aktuelle internationale Standards der Trans-Gesundheitsversorgung auf Basis empirischer Evidenz und bezieht sie auf das deutsche Gesundheitssystem. Ihre Anwendung sollte mit klinisch-therapeutischer Expertise abgesichert werden.
Little is understood about how sexual orientation and gender identity actually interconnect with transgender men. Eight transgender men were interviewed in depth, multiple times, and their perspectives gave insight into how sexual and gender identities are related, and how one informs the other. The present study found fluidity in gender and sexual identities among transgender men, but some trans men were more binary than others with regard to gender. These binary-leaning trans men also tended to be more binary in their sexual orientation. Fluidity in gender in pre-transition often reflected fluidity in sexual orientation. Mental health professionals may gain a better understanding of how the intersectionality of sexual and gender identities manifests in trans men. Implications for practitioners are included.
Research regarding trans individuals is beginning to emerge, yet much of this has focused on medical factors, mental health statistics, and the broader trans population. Less is known about the lived experience of trans individuals in Australia, especially those assigned female at birth (AFAB). The current study aimed to investigate the lived experience of trans individuals AFAB undertaking a transition in Australia. Interpretative Phenomenological Analysis (IPA) was used to analyse transcripts from semi-structured interviews, which were conducted with eight participants AFAB who had begun a transition. Umbrella themes of authenticity and courage, as well as four superordinate themes were deduced: (a) gender fluidity; (b) identity formation; (c) the transition process; and (d) mental health and support. Results support recent findings, which indicate that minority stressors, including discrimination and expecting rejection, may be influential in the poor mental health outcomes for trans individuals AFAB. The process of transition was not without its challenges and sacrifices; however, participants’ experiences were better than they expected. Additionally, the positive impact of transition on mental health and wellbeing, appeared to outweigh the sacrifices involved. Medical and counselling services were seen as necessary for support prior to, and during a transition; however further education regarding trans-related issues is needed for professionals.
Keywords: Transgender, AFAB, lived experience, transition, IPA, minority stress.
There is a general paucity of research concerning the sexual health of transgender individuals, and most existing research focuses on transgender women. A scoping review concerning the sexual health of transgender men was conducted to identify gaps in the literature and to highlight opportunities for future research and intervention. A comprehensive search of seven databases was conducted. The Joanna Briggs Institute Reviewers' Manual was used as a framework. Some 7,485 articles were initially identified using a search strategy applied to seven online databases: 54 articles were identified as relevant to the research questions and reviewed in detail; of those, 33 were included in the final analysis. Studies were conceptualized into four broad themes: sexual behaviors, sexual identity, sexual pleasure and sexual function, and transactional sex. Besides an overall lack of research, existing studies were often characterized by small convenience samples that do not allow for generalization to the larger population of transgender men. Significant gaps in the literature regarding sexual coercion, sexual and intimate partner violence, and relationship quality and functioning among transgender men exist. There is a need to improve the scope and depth of research examining the sexual health of this population, especially concerning sexual risk behaviors and structural barriers to sexual health care access.
This research examined the factors, which influenced the decisions of people who had considered female-to-male genital reconstructive surgery. The sample consisted of 27 people who had been born as female and had male gender identities. Subjects were recruited from a support group for female-to-male transsexuals (FTMs) in New York City and from participants at a conference for female-to-male transsexuals in San Francisco. A questionnaire was designed to explore subject demographics and surgical decision-making. Respondents rated contact with other FTMs and information from within the FTM community as the most important sources influencing their decision. Lack of money and inadequate medical technology were the most frequent obstacles to implementing their choice. Results illustrate the growing influence of community and peer support services. Results also challenge the expectation that FTMs will request genital reconstructive surgery (phalloplasty in particular) and identify some of the numerous reasons why FTMs may not undergo such surgery
Female-To-Male (FTM) transgender individuals were approached at a conference and several peer support groups in the United States and asked to complete a short questionnaire regarding their medical care. Results from the 122 completed questionnaires indicated that a high number of respondents were taking testosterone (n = 106) and had some gender-confirming surgery (n = 68). Seventy percent of respondents rated their overall quality of health care "good" or "excellent." A surprising finding was the low number (7%) reporting diagnoses of polycystic ovarian syndrome--the incidence of which has been reported elsewhere as high as 50%. Also notable were the high levels of employment, insurance, knowledge of standards of care, and access to providers, contrasting with reports from studies involving predominantly Male-To-Female (MTF) individuals. Finally, FTM's usage of transition-related medical resources can vary, but many within this study are foregoing genital surgery.
The author reviews the relevant current literature on the subject. He goes on to outline detailed treatment recommendations for MTFs with estrogens and antiandrogens. He highlights side effects and complications such as venous thrombosis, breast cancer in individuals with a predisposing family history and the rare incidence of prolactin producing tumors. Similarly, a detailed review of androgen administration in FTMs is provided describing the cessation of menstruation and the development of a male hair pattern. Contraindication against high dose use of sex steroids consist of serious liver, cardiovascular, cerebrovascualar, and thromboembolic disease, marked obesity, and poorly controlled diabetes mellitus. Finally, the complicated medicolegal issues of juvenile gender dysphoria are mentioned. Rather than giving heterotypical sex steroids, the author recommends hormonal delay of the onset of puberty until an age when a responsible decision can be made.
In Self-Made Men, Henry Rubin explores the production of male identities in the lives of twenty-two FTM transsexuals-people who have changed their sex from female to male. The author relates the compelling personal narratives of his subjects to the historical emergence of FTM as an identity category. In the interviews that form the heart of the book, the FTMs speak about their struggles to define themselves and their diverse experiences, from the pressures of gender conformity in adolescence to being mistaken for "butch lesbians," from hormone treatments and surgeries to relationships with families, partners, and acquaintances. Their stories of feeling betrayed by their bodies and of undergoing a "second puberty" are vivid and thought-provoking. Throughout the interviews, the subjects' claims to having "core male identities" are remarkably consistent and thus challenge anti-essentialist assumptions in current theories of gender, embodiment, and identity. Rubin uses two key methods to analyze and interpret his findings. Adapting Foucault's notions of genealogy, he highlights the social construction of gender categories and identities. His account of the history of endocrinology and medical technologies for transforming bodies demonstrates that the "family resemblance" between transsexuals and intersexuals was a necessary postulate for medical intervention into the lives of the emerging FTMs. The book also explores the historical emergence of the category of FTM transsexual as distinguished from the category of lesbian woman and the resultant "border disputes" over identity between the two groups. Rubin complements this approach with phenomenological concepts that stress the importance of lived experience and the individual's capacity for knowledge and action. An important contribution to several fields, including sociology of the body, gender and masculinity, human development, and the history of science, Self-Made Men will be of interest to anyone who has seriously pondered what it means to be a man and how men become men.
An absorbing account of the sociocultural aspects of gender transition...[a] carefully crafted, clearly written monograph which scholars of both sexuality and gender can profitably read. Contemporary Sociology A fascinating study, perceptive and well written, an excellent piece of work. Martin S. Weinberg, Indiana University Anne Bolin illuminates the array of social, psychological and physical changes experienced by a group of people in the process of changing gender.
El tratamiento de los trastornos de género está dirigido por estandares salidos de la Asociación Mundial Profesional para la Salud de los Trastornos de Género (WPATH). Aunque no definitivos, los criterios de eligibilidad a un tratamiento hormonal y/o a la cirugía de conversión sexual de la WPATH, incluyen una participación psicoterapéutica. Además, se pide a los candidatos a la cirugía de conversión sexual vivir al menos un año de dedicación permanente en el rol de género preferido, periodo designado por el numero de experiencia de vida real (EVR). El razonamiento subjacente al EVR es de preparar al cliente en la medida de lo posible a tomar una decisión estando enteramente acorde con la realidad, tratándose de una cirugía irreversible. La psicoterapia puede jugar un rol importante para la proyección de la experiencia de vida real y el desarrollo de la resistencia frente a los inevitables desafios psicosociales. Las tareas del profesional de salud mental incluyen la evaluación de la identidad de género y el impacto de este estigma durante el ajuste psicológico; el tratamiento de los problemas de salud mental; el tratameinto de los problemas de salud mental coexistentes; la confrontación a la transfobia internalizada; el permiso de explorar el género y la sexualidad; la gestión del rol desempeñado;el apoyo y las recomendaciones durante el EVR y su contexto. Además, el deseo de cambiar “de sexo” de una manera binaria y la realidad de vivir como una persona de género variable pueden ser completammente diferentes; la psicoterapia puede facilitar el duelo de la pérdida del ideal para hacer sitio a un nivel mas profundo de aceptación de su identidad de transgénero (en oposición a masculino y femenino).
The aim of the study was to determine the image of female-to-male transsexuals (FtM) in the opinion of women and men. Methods. The questionnaire studies were carried out in a group of 300 students. Respondents answered questions concerning their age, sex, birthplace and the questions related to different aspects of female-to-male transsexuals' life (their childhood, occupational preferences, social and sexual relationships).
The results showed that the image of FtM transsexuals created in the male and female group varies because of the lack of opinion expressed more frequently by male students.
(1) Students' opinion on psychical, social and sexual life of transsexuals indicates a lack of understanding of their problems. (2) Men do not report much opinion about FtM transsexuals' different aspects of lives which may result from their insufficient knowledge and little interest in the topic of transsexualism.
This paper explores how some individuals’ talk about sexual desire is rendered as incomprehensible when those desires are not easily talked about through categories of sexual identity. Using data from an ‘alternative lifestyles’ support group in New York City, I argue that paying attention to expressions of desire is vital for understanding what ‘sexuality’ has come to mean in contemporary theoretical accounts. Moreover, such an approach enables a critical view of both the political systems which underpin sexual identity as well as the relationships among language, gender, sexuality, and desire.
The transsexual is a person who suffers from a deep identity disturbance caused by physical characteristics which do not correspond to mental traits and tendencies. The persistent sense of contradiction between his or her deceptive sexual appearance and his or her inner perception, causes a strong desire to achieve harmonization of the two. This aspiration, even if modification of chromosomal sex is impossible, can be fulfilled by undergoing SRS (Sex Reassignment Surgery). SRS represents the last major step of a clinical, therapeutic and diagnostic program involving skilled professionals in the physical and psychological sciences. Their assistance and counseling helps the patient to calmly and consciously decide to undergo SRS. A surgeon has the obligation not only to validate the operation outcome, but to also to maintain a long-term follow-up. A transsexual is not just like any other person; he or she should therefore be treated with sympathy and understanding. The surgeon should try his best to establish a relationship of mutual trust, taking into account the causes of anxiety and stress felt by the patient, and keeping in mind the ultimate objective, which is an improvement in the quality of life. At present, the most widely used surgical techniques are the Simple Penile Skin Inversion, the Penile-scrotal flap Inversion and the enterovaginoplasty. Each surgical technique has its own advantages and disadvantages, and it is up to the surgeon, in discussion with the patient, to make the appropriate choice. The surgical technique performing the Simple Penile Skin Inversion seems to ensure a better cosmetic appearance and an adequate lubrication, but a lower rate of satisfaction, in relation to the neocavity depth. On the contrary, the Penile-Scrotal Flap Inversion guarantees an adequate vaginal depth and lubrication, even though the cosmetic appearance is not always completely satisfactory. In our experience, a significant number of patients were satisfied with the chosen surgery and felt comfortable with their new post-operative gender. Taking into account all the complications involved, none of the patients did regret; actually, they would recommend the same operation to others. The overall results of some studies carried out on patient satisfaction before and after SRS show a marked post-surgery improvement of sexual life.
We studied a North American sample of female-to-male (FtM) transsexuals sexually attracted to men, aiming to understand their identity and sexuality in the context of a culture of transgender empowerment. Sex-reassigned FtM transsexuals, 18 years or older and attracted to men, were recruited via an FtM community conference and listserv. Participants (N = 25) responded to open-ended questions about identity development, sexual behavior, and social support. Data were analyzed by content analysis. Scores for sexual identity, self esteem, sexual functioning, and psychological adjustment were compared to those of a comparison group (N = 76 nontransgender gay and bisexual men). Of the 25 FtMs, 15 (60%) identified as gay, 8 (32%) as bisexual, and 2 (8%) as queer. All were comfortable with their gender identity and sexual orientation. The FtM group was more bisexual than the nontransgender gay and bisexual controls. No significant group differences were found in self esteem, sexual satisfaction, or psychological adjustment. For some FtMs, sexual attractions and experiences with men affirmed their gender identity; for others, self-acceptance of a transgender identity facilitated actualization of their attractions toward men. Most were "out" as transgender among friends and family, but not on the job or within the gay community. Disclosure and acceptance of their homosexuality was limited. The sexual identity of gay and bisexual FtMs appears to mirror the developmental process for nontransgender homosexual men and women in several ways; however, participants also had experiences unique to being both transgender and gay/bisexual. This signals the emergence of a transgender sexuality.
The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This "gender identity movement" has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.
Descriptions of female-to-male transsexuals who are sexually attracted to men are rare. This is a report on nine of them. Their awareness of gender dysphoria preceded their awareness of their attraction to men. Their wish to undergo sex reassignment as a means of resolving their gender dysphoria superseded any concerns about their sexual orientation or sexual adaptation after surgery. Several had had sexual relationships with men before sex reassignment which were unsatisfactory because these men viewed our subjects as women. After sex reassignment, the subjects successfully established sexual relationships with gay men; in some of them even penovaginal intercourse was part of their sexual activities. While hormonally and surgically reassigned, none of our subjects had had phalloplasty. All nine subjects were interviewed and given psychological tests measuring sexual satisfaction and psychological adjustment. Their results were compared to those of a group of self-identified gay men. No major differences in sexual satisfaction and psychological adaptation were found. The phenomenon of female-to-male transsexuals who develop a sexual orientation toward men may be more common than previously thought. Regarding female gender dysphoric individuals, our findings challenge the issue of using sexual orientation in classification systems of gender dysphoria syndromes and as a risk factor in the decision regarding sex reassignment. Further, our study invites us to rethink the genital criterion in the assessment of sexual orientation.
The aim of this study was to examine the social and sexual adjustments of Singapore female transsexuals following sex reassignment surgery. All female transsexuals who were operated on since 1989 were interviewed. There were a total of 17 transsexuals with a mean age of 29 years (range, 20 to 41 years) at the time of inception. Before surgery, all were single. After surgery, 6 out of 11 subjects had married abroad. Before surgery, some had problems with identity cards, passports, travelling and work which were resolved with surgery. They were better accepted and had better sexual adjustment after surgery. All were satisfied with the change in sex, but only 65% were satisfied with the surgery. Only 59% said they were willing to undergo the operation again. After a test case in court, they were unable to marry in Singapore. Their primary motive to undergo sex reassignment surgery was to become a member of the opposite sex, so that they could be recognised socially and legally.
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