Purpose: This study aimed to describe gender-affirming surgery (GAS) practice and perceived barriers among plastic surgeons in Argentina. Methods: This descriptive cross-sectional study was conducted using an online survey in October and November 2024 with plastic surgeons affiliated with the Argentine Society of Plastic, Aesthetic and Reconstructive Surgery who reported performing GAS. Data were collected on demographics and training, surgical activity, practice settings, interdisciplinary collaboration, perceptions of aesthetic outcomes, and barriers to access. Results: Forty-five of fifty-one surgeons (88.2%) responded, most of whom practiced in the City of Buenos Aires and Buenos Aires Province (57.8%). Chest feminization (88.9%) and chest masculinization (82.2%) were commonly performed, whereas genital procedures were less frequent (vaginoplasty 20%, phalloplasty 8.9%, and metoidioplasty 4.4%). Private-sector practice was reported by 93.3% of surgeons, and interdisciplinary collaboration by 26.7%. The most frequently reported barriers were economic (64.4%) and bureaucratic (31.1%), and the main priorities for improvement were expanded insurance coverage (37.8%) and specific training (31.1%). Conclusions: This study provides the first national description of GAS practice among plastic surgeons in Argentina. Practice was concentrated in a few jurisdictions, with most surgeons reporting private-sector activity. Barriers to care were mainly economic and bureaucratic. These findings highlight the distribution and training of surgical teams and service financing as key areas for access policies and training programs.
Purpose: We aimed to assess rates of autism spectrum disorder (ASD) diagnoses among patients who underwent genital gender-affirming surgery (GAS) using a statewide dataset.Methods: Using the California Department of Healthcare Access and Information ambulatory-surgery database (2012-2018), we identified individuals who underwent vaginoplasty, phalloplasty, or metoidioplasty via International Classification of Diseases-9/10 procedure codes. ASD diagnoses were identified with corresponding diagnosis codes. Rates of ASD among patients who underwent genital GAS were compared to the general adult population.Results: We analyzed 1226 patients (869 vaginoplasty; 357 phalloplasty/metoidioplasty) with a median of two years of observation before and after surgery. ASD was documented for 4 vaginoplasty patients (0.5%) and 3 phalloplasty/metoidioplasty patients (0.8%); this difference was not significant (p = 0.70). Overall, ASD prevalence in the surgical cohort (0.6%) fell below the 2.2% estimate for the general adult population.Conclusions: ASD prevalence among transgender and gender-diverse individuals undergoing genital GAS was lower than both general population estimates and broader TGD cohort reports. This finding may reflect differences in access to care or selection factors and warrants further investigation into care pathways for individuals with ASD. Further research is needed to clarify these disparities and to develop neurodiversity-informed care pathways that promote equitable access to GAS.
Purpose: This study examined whether experiences of social vulnerability and mental health differed between transgender immigrant women in the United States who reported involuntary versus voluntary migration. Methods: We analyzed data from the 2023 Transgender Women's Internet Survey and Testing (TWIST) study among immigrant transgender women. We compared sociodemographic characteristics, lifetime and past-year discrimination (Intersectional Day-to-Day Discrimination index and Intersectional Major Discrimination Index), lifetime trauma exposure, and depressive symptoms (Patient Health Questionnaire-9) among involuntary and voluntary migrants using Fisher’s exact tests, Fisher-Freeman-Halton tests, and independent-samples t -tests. Results: Among 61 transgender immigrant women, 39 (63.9%) migrated involuntarily and 22 (36.1%) voluntarily. The average age at migration across the sample was 7.1 years. Involuntary migrants migrated at younger ages and reported significantly higher past-year day-to-day discrimination and higher lifetime and past-year major discrimination. Conclusions: These findings suggest that involuntary migration may heighten discrimination and mental health vulnerability among transgender immigrant women.
Purpose: This study aimed to evaluate histological alterations and androgen receptor (AR) expression within breast tissue associated with masculinizing gender-affirming hormone therapy (GAHT) exposure of different duration in transgender men. Methods: A retrospective review of breast histopathological specimens obtained from 81 transgender men following gender-affirming mastectomy between 2017 and 2023 was conducted. Histological features and AR expression were compared between individuals with and without prior GAHT exposure, as well as between short-term (<24 months) and long-term (>= 24 months) exposure. Results: Breast tissue exposed to masculinizing GAHT showed significantly increased stromal fibrosis (p = 0.009), and reduced prevalence of usual ductal hyperplasia (p = 0.001) and fibrocystic changes (p = 0.041). No significant differences in atypia or malignant lesions were observed between groups. AR expression was significantly higher in GAHT-exposed tissue (p < 0.0001), particularly among individuals receiving therapy for >= 24 months (p = 0.019), and was associated with a greater proportion of strong AR staining intensity (p = 0.024). Fibrosis levels did not differ according to GAHT duration (p = 0.838). Conclusions: Masculinizing GAHT was associated with increased AR expression, particularly with prolonged exposure. Transgender men receiving GAHT in this study did not exhibit premalignant or malignant breast changes. These findings warrant further investigation in larger prospective cohorts with a follow-up period and utilization of molecular and genetic analysis to clarify the effects of masculinizing GAHT on breast carcinogenesis.
Purpose: This study aimed to examine which gender minority stressors explained differences in suicidal ideation and suicide attempt among transgender women in a human immunodeficiency virus (HIV) prevention and care context. Methods: Transgender women living with or impacted by HIV risk ( N = 79) were enrolled in the study in South Florida between 2020 and 2022. Distal and proximal minority stress experiences were assessed using the Gender Minority Stress and Resilience Measure, and suicidal ideation and suicide attempt were assessed using the Columbia Suicide Severity Rating Scale. We utilized stochastic search variable selection to identify which theoretical gender minority stressors were empirically relevant in this sample. We utilized linear and logistic regressions to examine the direct and indirect associations between data-driven gender minority stressors and suicidal ideation and suicide attempt. Results: Rejection, negative expectations, and nondisclosure were empirically selected and associated with suicidal ideation severity. Consistent with the minority stress model, negative expectations and nondisclosure were significant intermediary variables in the relationship between rejection and suicidal ideation. Contrary to the minority stress model, nondisclosure emerged as a protective factor. No gender minority stressors explained differences in suicide attempt. Conclusion: Specific components of gender minority stress explained differences in suicidal ideation but not suicide attempt among transgender women impacted by HIV risk. Rejection-based pathways (including via negative expectations and nondisclosure) may be particularly important to attend to when assessing suicide risk and tailoring psychosocial suicide prevention interventions for transgender women in HIV prevention and care settings.
