Hormonal therapy and sex reassignment: a systematic review and meta‐analysis of quality of life and psychosocial outcomes
M. Hassan Murad, Division of Preventive Medicine, Mayo Clinic College of Medicine,
200 First Street SW, Rochester, Minnesota 55905, USA. Tel.: (+1) 507 284 3097; Fax:
(+1) 507‐284‐0909; E‐mail: Murad.Mohammad@mayo.edu
Summary
Objective To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self‐reported psychosocial outcomes.
Methods We searched electronic databases, bibliography of included studies and expert files. All study designs were included with no language restrictions. Reviewers working independently and in pairs selected studies using predetermined inclusion and exclusion criteria, extracted outcome and quality data. We used a random‐effects meta‐analysis to pool proportions and estimate the 95% confidence intervals (CIs). We estimated the proportion of between‐study heterogeneity not attributable to chance using the I2 statistic.
Results We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male‐to‐female, 801 female‐to‐male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68–89%; 8 studies; I2 = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56–94%; 7 studies; I2 = 86%); 80% reported significant improvement in quality of life (95% CI = 72–88%; 16 studies; I2 = 78%); and 72% reported significant improvement in sexual function (95% CI = 60–81%; 15 studies; I2 = 78%).
Conclusions Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.
Citing Literature
Number of times cited: 111
- Bethany Alice Jones, Emma Haycraft, Walter Pierre Bouman and Jon Arcelus, The Levels and Predictors of Physical Activity Engagement Within the Treatment-Seeking Transgender Population: A Matched Control Study, Journal of Physical Activity and Health, 15, 2, (99)
- Angelo Brandelli Costa, Heitor Tome da Rosa Filho, Paola Fagundes Pase, Anna Martha Vaitses Fontanari, Ramiro Figueiredo Catelan, Andressa Mueller, Dhiordan Cardoso, Bianca Soll, Karine Schwarz, Maiko Abel Schneider, Daniel Augusto Mori Gagliotti, Alexandre Saadeh, Maria Inês Rodrigues Lobato, Henrique Caetano Nardi and Silvia Helena Koller, Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People, Journal of Immigrant and Minority Health, 20, 1, (115)
- Giovanna Motta, Chiara Crespi, Valentina Mineccia, Paolo Riccardo Brustio, Chiara Manieri and Fabio Lanfranco, Does Testosterone Treatment Increase Anger Expression in a Population of Transgender Men?, The Journal of Sexual Medicine, 15, 1, (94)
- Andreas Koehler, Jana Eyssel and Timo O. Nieder, Genders and Individual Treatment Progress in (Non-)Binary Trans Individuals, The Journal of Sexual Medicine, 15, 1, (102)
- Masoumeh Simbar, Soheila Nazarpour, Mahsa Mirzababaie, Mohammad Ali EmamHadi, Fahimeh Ramezani Tehrani and Hamid Alavi Majd, Quality of Life and Body Image of Individuals with Gender Dysphoria, Journal of Sex & Marital Therapy, (00)
- Emilia M. Jalil, Erin C. Wilson, Paula M. Luz, Luciane Velasque, Ronaldo I. Moreira, Cristiane V. Castro, Laylla Monteiro, Ana Cristina F. Garcia, Sandra W. Cardoso, Lara E. Coelho, Willi McFarland, Albert Y. Liu, Valdilea G. Veloso, Susan Buchbinder and Beatriz Grinsztejn, HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil, Journal of the International AIDS Society, 20, 1, (2017).
- Wylie C Hembree, Peggy T Cohen-Kettenis, Louis Gooren, Sabine E Hannema, Walter J Meyer, M Hassan Murad, Stephen M Rosenthal, Joshua D Safer, Vin Tangpricha and Guy G T’Sjoen, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, 102, 11, (3869)
- , , Endocrinology of the Testis and Male Reproduction, (1)
- Inés Arístegui, Pablo D. Radusky, Virginia Zalazar, Marcela Romero, Jessica Schwartz and Omar Sued, Impact of the Gender Identity Law in Argentinean transgender women, International Journal of Transgenderism, 18, 4, (446)
- Hayley Braun, Rebecca Nash, Vin Tangpricha, Janice Brockman, Kevin Ward and Michael Goodman, Cancer in Transgender People: Evidence and Methodological Considerations, Epidemiologic Reviews, 39, 1, (93)
- Vin Tangpricha and Martin den Heijer, Oestrogen and anti-androgen therapy for transgender women, The Lancet Diabetes & Endocrinology, 10.1016/S2213-8587(16)30319-9, 5, 4, (291-300), (2017).
- , , Trauma, Resilience, and Health Promotion in LGBT Patients, (105)
- Swaytha Yalamanchi, Betiel Fesseha and Adrian Dobs, The Transsexual Adult, Principles of Gender-Specific Medicine, 10.1016/B978-0-12-803506-1.00015-2, (91-105), (2017).
- Tim C. van de Grift, Els Elaut, Susanne C. Cerwenka, Peggy T. Cohen-Kettenis, Griet De Cuypere, Hertha Richter-Appelt and Baudewijntje P.C. Kreukels, Effects of Medical Interventions on Gender Dysphoria and Body Image, Psychosomatic Medicine, 79, 7, (815)
- lore m. dickey, Anneliese A. Singh and Daniel Walinsky, Treatment of Trauma and Nonsuicidal Self-Injury in Transgender Adults, Psychiatric Clinics of North America, 40, 1, (41)
- , , Affimative Counseling With LGBTQI+ People, (183)
- Ryan Nicholas Gorton and Laura Erickson-Schroth, Hormonal and Surgical Treatment Options for Transgender Men (Female-to-Male), Psychiatric Clinics of North America, 40, 1, (79)
- Sari L. Reisner, Laura Jadwin-Cakmak, Jaclyn M. White Hughto, Miguel Martinez, Liz Salomon and Gary W. Harper, Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S., AIDS and Behavior, 21, 12, (3312)
- Stephen B. Levine, Transitioning Back to Maleness, Archives of Sexual Behavior
- Timothy Meagher and Karsten Filzmaier, The Medical Underwriting of Transgender Individuals, Journal of Insurance Medicine, 47, 1, (43)
- Linda M. Wesp and Madeline B. Deutsch, Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons, Psychiatric Clinics of North America, 40, 1, (99)
- Oralia Loza, Oscar Beltran and Thenral Mangadu, A qualitative exploratory study on gender identity and the health risks and barriers to care for transgender women living in a U.S.–Mexico border city, International Journal of Transgenderism, 18, 1, (104)
- Katherine G. Spencer, Alex Iantaffi and Walter Bockting, Treating Sexual Problems in Transgender Clients, The Wiley Handbook of Sex Therapy, (291-305), (2017).
- Sanne W. C. Nikkelen and Baudewijntje P. C. Kreukels, Sexual Experiences in Transgender People: The Role of Desire for Gender-Confirming Interventions, Psychological Well-Being, and Body Satisfaction, Journal of Sex & Marital Therapy, (1)
- Ida Linander, Erika Alm, Anne Hammarström and Lisa Harryson, Negotiating the (bio)medical gaze – Experiences of trans-specific healthcare in Sweden, Social Science & Medicine, 174, (9)
- Maiko A. Schneider, Tahiana Andreazza, Anna Martha V. Fontanari, Angelo B. Costa, Dhiordan C. da Silva, Bianca W. de Aguiar, Raffael Massuda, Mariana Pedrini, Clarissa S. Gama, Karine Schwarz, Marcia Kauer-Sant'Anna and Maria Ines R. Lobato, Serum concentrations of brain-derived neurotrophic factor in patients diagnosed with gender dysphoria undergoing sex reassignment surgery, Trends in Psychiatry and Psychotherapy, 39, 1, (43)
- Musa Mase Tshaba and Solly Matshonisa Seeletse, Patients’ Experiences of Incomplete Sex-Reassignment Surgery and Psychosocial Functioning, Journal of Psychology, 8, 2, (95)
- Stephanie L. Budge and lore m. dickey, Barriers, Challenges, and Decision-Making in the Letter Writing Process for Gender Transition, Psychiatric Clinics of North America, 40, 1, (65)
- Lydia A. Fein, Christopher J. Salgado, Clara Villalba Alvarez and Christopher M. Estes, Transitioning Transgender: Investigating the Important Aspects of the Transition: A Brief Report, International Journal of Sexual Health, 29, 1, (80)
- Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B Nippoldt, Larry J Prokop and Mohammad Hassan Murad, Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis, The Journal of Clinical Endocrinology & Metabolism, 102, 11, (3904)
- Justine Defreyne, Joz Motmans and Guy T’sjoen, Healthcare costs and quality of life outcomes following gender affirming surgery in trans men: a review, Expert Review of Pharmacoeconomics & Outcomes Research, 17, 6, (543)
- , , Endocrinology of the Testis and Male Reproduction, (1199)
- Julia H. Meijer, Guus M. Eeckhout, Roy H.T. van Vlerken and Annelou L.C. de Vries, Gender Dysphoria and Co-Existing Psychosis: Review and Four Case Examples of Successful Gender Affirmative Treatment, LGBT Health, 4, 2, (106)
- Georgia Dacakis, Jennifer M. Oates and Jacinta M. Douglas, Further Evidence of the Construct Validity of the Transsexual Voice Questionnaire (TVQ MtF ) Using Principal Components Analysis, Journal of Voice, 31, 2, (142)
- Klaus Kapelari, Transgenderproblematik aus pädiatrisch-endokrinologischer Sicht, Gynäkologische Endokrinologie, 15, 1, (23)
- Ida Linander, Erika Alm, Isabel Goicolea and Lisa Harryson, ‘It was like I had to fit into a category’: Care-seekers’ experiences of gender regulation in the Swedish trans-specific healthcare, Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, (136345931770882)
- M. Kääriäinen, K. Salonen, M. Helminen and U. Karhunen-Enckell, Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results, Scandinavian Journal of Surgery, 106, 1, (74)
- Nick Drydakis, Trans employees, transitioning, and job satisfaction, Journal of Vocational Behavior, 98, (1)
- Ozgur B. Akan, Hamideh Ramezani, Tooba Khan, Naveed A. Abbasi and Murat Kuscu, Fundamentals of Molecular Information and Communication Science, Proceedings of the IEEE, 105, 2, (306)
- Simone Mahfouda, Julia K Moore, Aris Siafarikas, Florian D Zepf and Ashleigh Lin, Puberty suppression in transgender children and adolescents, The Lancet Diabetes & Endocrinology, 5, 10, (816)
- Seth O. Watt, Konstantin O. Tskhay and Nicholas O. Rule, Masculine Voices Predict Well-Being in Female-to-Male Transgender Individuals, Archives of Sexual Behavior
- R. Craig Sineath, Cory Woodyatt, Travis Sanchez, Shawn Giammattei, Theresa Gillespie, Enid Hunkeler, Ashli Owen-Smith, Virginia P. Quinn, Douglas Roblin, Robert Stephenson, Patrick S. Sullivan, Vin Tangpricha and Michael Goodman, Determinants of and Barriers to Hormonal and Surgical Treatment Receipt Among Transgender People, Transgender Health, 1, 1, (129)
- Bonnie Moradi, Elliot A. Tebbe, Melanie E. Brewster, Stephanie L. Budge, Alex Lenzen, Engin Ege, Elena Schuch, Sarah Arango, Nicholas Angelone, Eli Mender, Dylan L. Hiner, Kileigh Huscher, Jackson Painter and Mirella J. Flores, A Content Analysis of Literature on Trans People and Issues, The Counseling Psychologist, 44, 7, (960)
- Koray Başar, Gökhan Öz and Jale Karakaya, Perceived Discrimination, Social Support, and Quality of Life in Gender Dysphoria, The Journal of Sexual Medicine, 13, 7, (1133)
- Dhiordan Cardoso da Silva, Karine Schwarz, Anna Martha Vaitses Fontanari, Angelo Brandelli Costa, Raffael Massuda, Alexandre Annes Henriques, Jaqueline Salvador, Esalba Silveira, Tiago Elias Rosito and Maria Inês Rodrigues Lobato, WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals, The Journal of Sexual Medicine, 13, 6, (988)
- Ariel B. Handy, Robyn A. Jackowich, Erik Wibowo, Thomas Wayne Johnson and Richard J. Wassersug, Gender Preference in the Sexual Attractions, Fantasies, and Relationships of Voluntarily Castrated Men, Sexual Medicine, 4, 1, (e51)
- Georgia Dacakis, Jennifer M. Oates and Jacinta M. Douglas, Exploring the validity of the Transsexual Voice Questionnaire (male-to-female): Do TVQMtF scores differentiate between MtF women who have had gender reassignment surgery and those who have not?, International Journal of Transgenderism, 17, 3-4, (124)
- Sven E.S. Eriksson and Joshua D. Safer, EVIDENCE-BASED CURRICULAR CONTENT IMPROVES STUDENT KNOWLEDGE AND CHANGES ATTITUDES TOWARDS TRANSGENDER MEDICINE, Endocrine Practice, 22, 7, (837)
- Ellen Marshall, Laurence Claes, Walter Pierre Bouman, Gemma L. Witcomb and Jon Arcelus, Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature, International Review of Psychiatry, 28, 1, (58)
- Matthias K. Auer, Rainer Hellweg, Peer Briken, Günter K. Stalla, Guy T’Sjoen and Johannes Fuss, Serum brain-derived neurotrophic factor (BDNF) is not regulated by testosterone in transmen, Biology of Sex Differences, 7, 1
- Walter Bockting, Eli Coleman, Madeline B. Deutsch, Antonio Guillamon, Ilan Meyer, Walter Meyer, Sari Reisner, Jae Sevelius and Randi Ettner, Adult development and quality of life of transgender and gender nonconforming people, Current Opinion in Endocrinology & Diabetes and Obesity, 23, 2, (188)
- Debra L. Safer, Kim D. Bullock and Joshua D. Safer, Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review, AACE Clinical Case Reports, 2, 3, (e268)
- Ann Danoff, TRANSGENDER CARE MATTERS, Endocrine Practice, 22, 7, (899)
- Jaclyn M. White Hughto and Sari L. Reisner, A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals, Transgender Health, 1, 1, (21)
- Timo O. Nieder, Els Elaut, Christina Richards and Arne Dekker, Sexual orientation of trans adults is not linked to outcome of transition-related health care, but worth asking, International Review of Psychiatry, 28, 1, (103)
- Rikke Kildevæld Simonsen, Annamaria Giraldi, Ellids Kristensen and Gert Martin Hald, Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality, Nordic Journal of Psychiatry, 70, 4, (241)
- Deborah Ann Hoch, Maya Bulman and Dorn W. McMahon, Cultural Sensitivity and Challenges in Management of the Transgender Patient With ESRD in Transplantation, Progress in Transplantation, 26, 1, (13)
- Timo O. Nieder, Peer Briken and Annette Güldenring, Geschlechtsinkongruenz, -dysphorie und Trans*-Gesundheit, InFo Neurologie & Psychiatrie, 18, 12, (38)
- Jamie Feldman, George R. Brown, Madeline B. Deutsch, Wylie Hembree, Walter Meyer, Heino F.L. Meyer-Bahlburg, Vin Tangpricha, Guy TʼSjoen and Joshua D. Safer, Priorities for transgender medical and healthcare research, Current Opinion in Endocrinology & Diabetes and Obesity, 23, 2, (180)
- Amanda Davey, Jon Arcelus, Caroline Meyer and Walter Pierre Bouman, Self-injury among trans individuals and matched controls: prevalence and associated factors, Health & Social Care in the Community, 24, 4, (485)
- Shane D. Morrison, Krishna S. Vyas, Saba Motakef, Katherine M. Gast, Michael T. Chung, Vania Rashidi, Thomas Satterwhite, William Kuzon and Paul S. Cederna, Facial Feminization, Plastic and Reconstructive Surgery, 137, 6, (1759)
- Cynthia S. Osborne and Anne A. Lawrence, Male Prison Inmates With Gender Dysphoria: When Is Sex Reassignment Surgery Appropriate?, Archives of Sexual Behavior, 45, 7, (1649)
- Sam Winter, Milton Diamond, Jamison Green, Dan Karasic, Terry Reed, Stephen Whittle and Kevan Wylie, Transgender people: health at the margins of society, The Lancet, 388, 10042, (390)
- Sari L. Reisner, Asa Radix and Madeline B. Deutsch, Integrated and Gender-Affirming Transgender Clinical Care and Research, JAIDS Journal of Acquired Immune Deficiency Syndromes, 72, (S235)
- Kenneth J. Zucker, Anne A. Lawrence and Baudewijntje P.C. Kreukels, Gender Dysphoria in Adults, Annual Review of Clinical Psychology, 12, 1, (217)
- C. A. Jones, L. Reiter and E. Greenblatt, Fertility preservation in transgender patients, International Journal of Transgenderism, 17, 2, (76)
- Galit Zeluf, Cecilia Dhejne, Carolina Orre, Louise Nilunger Mannheimer, Charlotte Deogan, Jonas Höijer and Anna Ekéus Thorson, Health, disability and quality of life among trans people in Sweden–a web-based survey, BMC Public Health, 16, 1
- Bryan M. Bishop, Pharmacotherapy Considerations in the Management of Transgender Patients: A Brief Review, Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 35, 12, (1130-1139), (2015).
- Constanza Bartolucci, Esther Gómez‐Gil, Manel Salamero, Isabel Esteva, Antonio Guillamón, Leire Zubiaurre, Francisca Molero and Angel L. Montejo, Sexual Quality of Life in Gender‐Dysphoric Adults before Genital Sex Reassignment Surgery, The Journal of Sexual Medicine, 12, 1, (180-188), (2014).
- Rikke Simonsen, Gert Martin Hald, Annamaria Giraldi and Ellids Kristensen, Sociodemographic Study of Danish Individuals Diagnosed with Transsexualism, Sexual Medicine, 3, 2, (109-117), (2015).
- Maria Cristina Meriggiola and Giulia Gava, Endocrine care of transpeople part I. A review of cross‐sex hormonal treatments, outcomes and adverse effects in transmen, Clinical Endocrinology, 83, 5, (597-606), (2015).
- Maria Cristina Meriggiola and Giulia Gava, Endocrine care of transpeople part II. A review of cross‐sex hormonal treatments, outcomes and adverse effects in transwomen, Clinical Endocrinology, 83, 5, (607-615), (2015).
- Sarah E. Strandjord, Henry Ng and Ellen S. Rome, Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned, International Journal of Eating Disorders, 48, 7, (942-945), (2015).
- E. Castellano, C. Crespi, C. Dell’Aquila, R. Rosato, C. Catalano, V. Mineccia, G. Motta, E. Botto and C. Manieri, Quality of life and hormones after sex reassignment surgery, Journal of Endocrinological Investigation, 38, 12, (1373)
- Johannes Fuss, Rainer Hellweg, Eva Van Caenegem, Peer Briken, Günter K. Stalla, Guy T’Sjoen and Matthias K. Auer, Cross-sex hormone treatment in male-to-female transsexual persons reduces serum brain-derived neurotrophic factor (BDNF), European Neuropsychopharmacology, 25, 1, (95)
- Sarah MacCarthy, Sari L. Reisner, Amy Nunn, Amaya Perez-Brumer and Don Operario, The Time Is Now: Attention Increases to Transgender Health in the United States but Scientific Knowledge Gaps Remain, LGBT Health, 2, 4, (287)
- Joz Motmans, Koen Ponnet and Griet De Cuypere, Sociodemographic Characteristics of Trans Persons in Belgium: A Secondary Data Analysis of Medical, State, and Social Data, Archives of Sexual Behavior, 44, 5, (1289)
- Hale M. Thompson, Sari L. Reisner, Nicole VanKim and H. Fisher Raymond, Quality-of-Life Measurement: Assessing the WHOQOL-BREF Scale in a Sample of High-HIV-Risk Transgender Women in San Francisco, California, International Journal of Transgenderism, 16, 1, (36)
- Marco Colizzi, Rosalia Costa and Orlando Todarello, Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real?, Psychiatry Research, 226, 1, (173)
- , , Therapie Psychischer Erkrankungen, (e1)
- Carla Pelusi, Antonietta Costantino, Valentina Martelli, Martina Lambertini, Alberto Bazzocchi, Federico Ponti, Giuseppe Battista, Stefano Venturoli and Maria C. Meriggiola, Effects of Three Different Testosterone Formulations in Female‐to‐Male Transsexual Persons, The Journal of Sexual Medicine, 11, 12, (3002-3011), (2014).
- Gunter Heylens, Charlotte Verroken, Sanne De Cock, Guy T'Sjoen and Griet De Cuypere, Effects of Different Steps in Gender Reassignment Therapy on Psychopathology: A Prospective Study of Persons with a Gender Identity Disorder, The Journal of Sexual Medicine, 11, 1, (119-126), (2013).
- Katherine P. Smith, Christina M. Madison and Nikki M. Milne, Gonadal Suppressive and Cross‐Sex Hormone Therapy for Gender Dysphoria in Adolescents and Adults, Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34, 12, (1282-1297), (2014).
- Alessandra D. Fisher, Giovanni Castellini, Elisa Bandini, Helen Casale, Egidia Fanni, Laura Benni, Naika Ferruccio, Maria Cristina Meriggiola, Chiara Manieri, Anna Gualerzi, Emmanuele Jannini, Alessandro Oppo, Valdo Ricca, Mario Maggi and Alessandra H. Rellini, Cross‐Sex Hormonal Treatment and Body Uneasiness in Individuals with Gender Dysphoria, The Journal of Sexual Medicine, 11, 3, (709-719), (2013).
- Marco Colizzi, Rosalia Costa and Orlando Todarello, Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: Results from a longitudinal study, Psychoneuroendocrinology, 39, (65)
- Esther Gómez-Gil, Leire Zubiaurre-Elorza, Isabel Esteva de Antonio, Antonio Guillamon and Manel Salamero, Determinants of quality of life in Spanish transsexuals attending a gender unit before genital sex reassignment surgery, Quality of Life Research, 23, 2, (669)
- , , Therapie Psychischer Erkrankungen, (1)
- Nataša Jokić-Begić, Anita Lauri Korajlija and Tanja Jurin, Psychosocial Adjustment to Sex Reassignment Surgery: A Qualitative Examination and Personal Experiences of Six Transsexual Persons in Croatia, The Scientific World Journal, 2014, (1)
- Juyeon Park and Melissa Cozza, Research Trends in Measurement of Quality of Life Following Bariatric Surgery: Emerging Interest in Appearance, Bariatric Surgical Practice and Patient Care, 9, 4, (160)
- Sari M van Anders, Nicholas L Caverly and Michelle Marie Johns, Newborn bio/logics and US legal requirements for changing gender/sex designations on state identity documents, Feminism & Psychology, 24, 2, (172)
- Cécile A. Unger, Care of the transgender patient: the role of the gynecologist, American Journal of Obstetrics and Gynecology, 210, 1, (16)
- Daphna Stroumsa, The State of Transgender Health Care: Policy, Law, and Medical Frameworks, American Journal of Public Health, 104, 3, (e31)
- W.P. Bouman, C. Richards, R.M. Addinall, I. Arango de Montis, J. Arcelus, D. Duisin, I. Esteva, A. Fisher, F. Harte, B. Khoury, Z. Lu, A. Marais, A. Mattila, D. Nayarana Reddy, T.O. Nieder, R. Robles Garcia, O.M. Rodrigues, A. Roque Guerra, D. Tereshkevich, G. T’Sjoen and D. Wilson, Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?, Sexual and Relationship Therapy, 29, 4, (377)
- Chance Nicholson and Teena M. McGuinness, Gender Dysphoria and Children, Journal of Psychosocial Nursing and Mental Health Services, 52, 8, (27)
- Marco Colizzi, Rosalia Costa, Valeria Pace and Orlando Todarello, Hormonal Treatment Reduces Psychobiological Distress in Gender Identity Disorder, Independently of the Attachment Style, The Journal of Sexual Medicine, 10, 12, (3049-3058), (2013).
- Gurvinder Kalra and Nilesh Shah, The Cultural, Psychiatric, and Sexuality Aspects of Hijras in India, International Journal of Transgenderism, 14, 4, (171)
- Erik Wibowo and Richard J. Wassersug, The effect of estrogen on the sexual interest of castrated males: Implications to prostate cancer patients on androgen-deprivation therapy, Critical Reviews in Oncology/Hematology, 87, 3, (224)
- Maria Cristina Meriggiola and Marta Berra, Safety of hormonal treatment in transgenders, Current Opinion in Endocrinology & Diabetes and Obesity, 20, 6, (565)
- Matthias K. Auer, Nina Höhne, María Ángeles Bazarra-Castro, Hildegard Pfister, Johannes Fuss, Günter K. Stalla, Caroline Sievers, Marcus Ising and Brett Thombs, Psychopathological Profiles in Transsexuals and the Challenge of Their Special Status among the Sexes, PLoS ONE, 8, 10, (e78469)
- K. Wierckx, E. Elaut, E. Declercq, G. Heylens, G. De Cuypere, Y. Taes, J. M. Kaufman and G. T'Sjoen, Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study, European Journal of Endocrinology, 169, 4, (471)
- Antonietta Costantino, Silvia Cerpolini, Stefania Alvisi, Paolo Giovanni Morselli, Stefano Venturoli and Maria Cristina Meriggiola, A Prospective Study on Sexual Function and Mood in Female-to-Male Transsexuals During Testosterone Administration and After Sex Reassignment Surgery, Journal of Sex & Marital Therapy, 39, 4, (321)
- Isabel Esteva de Antonio and Esther Gómez-Gil, Coordination of healthcare for transsexual persons, Current Opinion in Endocrinology & Diabetes and Obesity, 20, 6, (585)
- L. Zachary Dubois, Associations between transition‐specific stress experience, nocturnal decline in ambulatory blood pressure, and C‐reactive protein levels among transgender men, American Journal of Human Biology, 24, 1, (52-61), (2011).
- Annelou L. C. de Vries and Peggy T. Cohen-Kettenis, Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach, Journal of Homosexuality, 59, 3, (301)
- Gennaro Selvaggi, Cecilia Dhejne, Mikael Landen and Anna Elander, The 2011 WPATH Standards of Care and Penile Reconstruction in Female-to-Male Transsexual Individuals, Advances in Urology, 2012, (1)
- E. Coleman, W. Bockting, M. Botzer, P. Cohen-Kettenis, G. DeCuypere, J. Feldman, L. Fraser, J. Green, G. Knudson, W. J. Meyer, S. Monstrey, R. K. Adler, G. R. Brown, A. H. Devor, R. Ehrbar, R. Ettner, E. Eyler, R. Garofalo, D. H. Karasic, A. I. Lev, G. Mayer, H. Meyer-Bahlburg, B. P. Hall, F. Pfaefflin, K. Rachlin, B. Robinson, L. S. Schechter, V. Tangpricha, M. van Trotsenburg, A. Vitale, S. Winter, S. Whittle, K. R. Wylie and K. Zucker, Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7, International Journal of Transgenderism, 13, 4, (165)
- Audrey Gorin‐Lazard, Karine Baumstarck, Laurent Boyer, Aurélie Maquigneau, Stéphanie Gebleux, Jean‐Claude Penochet, Dominique Pringuey, Frédérique Albarel, Isabelle Morange, Anderson Loundou, Julie Berbis, Pascal Auquier, Christophe Lançon and Mireille Bonierbale, Is Hormonal Therapy Associated with Better Quality of Life in Transsexuals? A Cross‐Sectional Study, The Journal of Sexual Medicine, 9, 2, (531)
- William Byne, Susan J. Bradley, Eli Coleman, A. Evan Eyler, Richard Green, Edgardo J. Menvielle, Heino F. L. Meyer-Bahlburg, Richard R. Pleak and D. Andrew Tompkins, Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder, Archives of Sexual Behavior, 41, 4, (759)
- Louis J. Gooren, Care of Transsexual Persons, New England Journal of Medicine, 364, 13, (1251)
- Louis Gooren, Where medicine meets the boundaries of manhood and womanhood, Asian Journal of Andrology, 13, 5, (669)
- Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, Anna L. V. Johansson, Niklas Långström, Mikael Landén and James Scott, Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden, PLoS ONE, 6, 2, (e16885)
