bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT394 Over-representation Of Adoptees Among Transgender Subjects Seeking Gender-Affirming-Hormonal-Therapy (GAHT) In A Large Tertiary Medical Center
Authors: Yaish Iris , Keltch Gali , Greenman Yona , Kolitz Tamara , Tordjman Karen Michele 
Published: October 2023

Abstract
Disclosure: I. Yaish: None. G. Keltch: None. Y. Greenman: None. T. Kolitz: None. K.M. Tordjman: None.
Background: The etiology of transgenderism is still unclear. Possible mechanisms range from inborn brain-specific anatomical characteristics, to endocrine-related genetic polymorphisms. In addition, psychosocial developmental factors, particularly trauma from early childhood, are believed to contribute. In line with a handful of previous reports, we were struck by what seemed to be an over-representation of adoptees among adult subjects seeking GAHT at our Transgender Health Center. Aims of Study: To confirm that adopted individuals are more likely to seek a gender transition process than nonadopted subjects, and to determine whether there are major differences between the 2 subgroups. Design and Methods: A retrospective study of treatment-naïve adult subjects seeking GAHT at our center between 01.05.2014 and 31.12.2022. The prevalence of adopted subjects in the cohort was compared with the national rate by one sample binomial test. Adoptees were compared to nonadopted subjects in the cohort by nonparametric tests. Results: During the study period, 671 new adult transgender subjects initiated GAHT at our clinic. Among them, 14 adoptees or 2.09%, which is an order of magnitude greater than the corresponding national rate of 0.22% (P&lt;0.0001). This rate is lower than that reported from clinics for transgender youth in Canada (7.6%), in the US (8.2%), and in Britain (3.8%). Age of adoption was at, or below, one year in 13 cases, and at age 2.7 yr in one. The distribution of assigned-at-birth sexes was different between the 2 groups. Among the 657 nonadopted subjects, the breakdown was quite balanced, 323 had been assigned male sex (49.2%), and 334 female (50.8%). Among adoptees, only 3/14 (21.4%) were born males, and 11 (78.6%) females, P=0.056, by Fisher’s exact test. There was also a trend for adopted subjects to be somewhat older than non-adopted subjects. Their median age was 25.5 yr [IQR 23-30.75], as opposed to 23 yr [IQR 19-30] in non-adopted subjects, P=0.08. Characterization, and comparisons of parameters such as socioeconomic status, co-morbidities, and others, are still ongoing. Conclusions: There is an over-representation of adopted adults requesting GAHT at our center. However, the rate is lower than what has been reported from pediatric clinics, suggesting some of these subjects may seek help at a younger age. The findings support a contributory role of adoption in early infancy and the trauma around it in the development of transgenderism. Further research should attempt to decipher the mechanisms through which this early life event interacts with inborn properties.
Presentation: Saturday, June 17, 2023
SAT396 Transgender Care From The VA Perspective
Authors: Nayak Pratima R 
Published: October 2023

Abstract
Disclosure: P.R. Nayak: None.
Background: Medically necessary care for transgender and gender non-conforming veterans was officially mandated in 2011 by the Veterans Health Administration. However, access to care can be difficult and tortuous to navigate. Additionally, the healthcare disparities experienced by transgender veterans extend beyond medical therapy; mental health services, appropriate sexual health education, and population specific needs and screenings are often inadequate.
In 2019, providers and staff at our VA medical center formed a multi-disciplinary team to provide coordinated and whole health focused gender-affirming care for this unique population. The team consists of an endocrinologist, mental health providers, social workers, clinical pharmacist, speech therapist, primary care provider, and a prosthetic representative.Case: A 32 year old transmale veteran with depression and bipolar disorder met with our social worker after expressing his desire to continue his transition. He had come out to his community and presented as male for over a year. He was referred to the endocrinologist who recommended egg harvesting prior to starting hormone replacement therapy per veteran's desire for biologic children. A social worker coordinated his consultation with a reproductive endocrinologist for the procedure. Simultaneously, a prosthetics representative helped veteran obtain a chest binder and a stand-to-pee device. Upon completion of egg harvesting, he started testosterone therapy, titrated to therapeutic levels.A year after starting hormones, he pursued top surgery and completed this locally. Due to ongoing menstrual bleeding on intramuscular testosterone, he was referred to ob-gyn and subsequently underwent hysterectomy and left oophorectomy. Post hysterectomy, he and his partner began experiencing relationship problems. They were referred to the sex therapist to work on their physical intimacy and sexuality. Three years on hormone therapy, veteran reported difficulty with the voice variations, though his voice had deepened to his liking far earlier in his medical transition. He started working with a speech therapist for voice masculinization with improvement noted at follow up. Conclusion: A multi-disciplinary approach to gender-affirming care is beneficial in providing patients with the care they deserve in a timely, respectful and coordinated manner. Our patient experienced a smoother and supportive transition due to the team of providers who were able to provide gender appropriate care across several disciplines during each phase of his transition. Without a team approach, this population often face several hurdles and delays to their transition. Since 2019, we have served over 50 transgender and gender non-confirming veterans in their transition. While not all have met their transition goals, most have benefited from the support and guidance of our team.
Presentation: Saturday, June 17, 2023
SAT403 Long-term Metabolic Effects Of Gonadotropin Releasing Hormone Agonist (GnRH) Therapy In Transgender Women Veterans
Authors: Le Guillaume , Pinkson Sheila , Trejo Jonathan , Hernandez Lyan Gondin , Mok Mary , Mendoza Amiel , Tripathy Devjit 
Published: October 2023

Abstract
Disclosure: G. Le: None. S. Pinkson: None. J. Trejo: None. L. Gondin Hernandez: None. M. Mok: None. A. endoza: None. D. Tripathy: None.
There is controversy regarding the effects of long-term GnRH agonist therapy on cardiovascular risk factors in older men with prostate cancer. GnRH agonists are used for gender affirming hormone therapy in adolescents and in adults who fail to suppress testosterone adequately. We examined the cardiometabolic effects of long-term GnRH agonist therapy in transwomen veterans. A retrospective chart review was performed on 74 transwomen veterans who were followed at the ALM VA Endocrinology clinic for at least 12 months and had detailed clinical, hormonal and biochemical profile (testosterone, estradiol, HbA1c, lipid profile) measured. Thirtytwo transwomen on GnRH agonist therapy (age 48 ± 2 yrs, BMI 28 ± 1 kg.m2) followed for 45 ± 5 months were compared with 22 transwomen (age 44 ± 3 yrs, BMI 28 ± 2 kg.m2) followed for 41 ± 7 months not on GnRH therapy. In the GnRH group, 14 were on oral E2, 12 on E2 patch and 6 were on E2 Injection. Similarly, in the non-GnRH group, the number of subjects on oral E2, E2 patch or E2 Injection were 17, 1, and 4 respectively. The average oral estrogen dose in both groups was 4 ± 0.4 mg. In the GnRH group, serum testosterone declined from 420 ± 36 ng/dl to 40 ± 5 ng/dL and serum estradiol before and after therapy was 39 ± 9 vs 89 ± 12 pg/mL. GnRH therapy led to increase in BMI (28 ± 1 vs 31 ± 2 kg.m2, p=0.006), though no difference was observed in SBP (126 ± 2 vs 120 ± 2 mmHg, p=ns), total Cholesterol (170 ± 7 vs 171 ± 8 mg/dL), HDL Cholesterol (45 ± 2 vs. 46 ± 2 mg/dL), LDL Cholesterol (98 ± 7 vs 99 ± 5 mg/dL) before and after treatment. There was no change in BMI (28 ± 2 vs 29 ± 1 kg.m2), SBP (121 ± 3 vs 125 ± 3, p=ns), total cholesterol (173 ± 5 vs. 170 ± 9 mg/dL), HDL chol (46 ± 2 vs. 49 ± 2 mg/dL), or LDL chol (97 ± 6 vs. 95 ± 7 mg/dL) in the control group. Plasma triglycerides increased in both the GnRH (134 ± 10 vs 168 ± 16 mg/dL, p&lt;0.05) as well as in the control group (154 ± 30 vs 167 ± 20 mg/dL, p&lt;0.05) after treatment. In conclusion, long-term estrogen therapy in transwomen increased plasma triglyceride. Concomitant GnRH agonist therapy was associated with greater weight gain, but did not affect other cardiovascular risk factors.
Presentation: Saturday, June 17, 2023
SAT405 Bone Analysis Of Transgender Women Amateur Athletes Undergoing Gender-affirming Hormone Therapy
Authors: dos Santos Lívia Marcela , Nakamoto Fernanda Patti , Simões Ferreira Raphael Einsfeld , Claudino Barbosa Renata Cleia , Costa Falcão Luiza Helena Degani , DIas Cruz Caroline Pinheiro , Achkar Gabriel Barasnevicius , Cardoso Sá Beatriz Meconi , Lima Fábio Mitsuo , dos Santos Quaresma Marcus Vinicius Lucio , Mobilia Alvares Leonardo Azevedo 
Published: October 2023

Abstract
Disclosure: L.D. Santos: None. F.P. Nakamoto: None. R.E. Ferreira: None. R.C. Barbosa: None. L.H. Falcão: None. C.P. Cruz: None. G.B. Achkar: None. B.M. Sá: None. F.M. Lima: None. L.A. Alvares: None.
Introduction: At the end of puberty, cisgender men (CM) have stronger bones and muscle mass than cisgender women (CW). Studies have shown a high prevalence of low bone mass in the general population of (transgender womenan) (TW). However, few articles are concerned with lean mass and bone mass in TW athletes. Objective: To assess the bone density of amateur volleyball TW athletes and compare them with CM and CW. Methods: A cross-sectional study was carried out with 8 TW (29 yo, range 27-36); BMI 24.1, range 19.3-31.7), 11 cisgender women (CW) and 8 cisgender men (CM) matched by age and BMI. The height (cm) of TW was 172 (range 164-181), that of CW was 176±0.1 and that of CM was 185±5.6. The TW had received hormone therapy for 3 (range 1-16) years. Measurements of BMD and body composition were taken with dual-energy X-ray absorptiometry. Results: The LS-BMD (lumbar spine) (g/cm2) of TW was 1.283 (range 0.9770-1.498), that of CW was 1.529±0.1614, and that of CM was 1.5115±0.1883 (TW vs. CW, p&gt;0.05; TW vs. CM, p&gt;0.05; CW vs. CM p&gt;0.05). The FN-BMD (femur neck) (g/cm2) of TW was 1.203 (range 0.9660-1.332), that of CW was 1.337±0.1629, and that of CM was 1.4448±0.1334 (TW vs. CW, p&gt;0.05; TW vs. CM, p&lt;0.05; CW vs. CM p&gt;0.05). Android/gynecoid (AG) ratio: TW: 0.85 (range 0.47-1.4); CW 0.73±0.13, CM 1.10±0.24. The lean corporal mass (kg) was 54.4 (range 44.3-66.9) in TW, 51.9±8.1 in CW, and 67.5±6.3 in CM (TW vs. CW, p&gt;0.05; TW vs. CM, p&lt;0.05; CW vs. CM p&lt;0.05). Discussion: We observed lower bone density in TW amateur athletes undergoing gender-affirming hormone therapy, as well as in the general TW population. Despite the lack of statistical significance, probably as a consequence of the number of volunteers, the AG ratio was intermediate in TW. Lean mass was equal between TW and CW, unlike in the general TW population in other cohorts thay analyzed non-athelets. Conclusion: Despite their high volume of physical activity, there was a lower BMD in the TW group than in the other groups.
Presentation: Saturday, June 17, 2023
SAT414 Gender Identity And Sexual Orientation Among Patients Evaluated By Psychiatric In A Pediatric ED
Authors: Alejandro Diaz , Martinez Andrea , Escudero Carolina , Rieger Gina 
Published: October 2023

Abstract
Disclosure: D. Alejandro: None. A. Martinez: None. C. Escudero: None. G. Rieger: None.
Background: Over the two decades the number of transgender and Gender Non-Conforming (GNC) youth has increased significantly. The prevalence of depression, anxiety, and other psychiatric conditions has been reported to be high among this population. In this report we explore gender identity and sexual orientation among patients evaluated by psychiatry in an emergency room of a pediatric hospital.
Methods: We reviewed the charts of 220 patients who were evaluated by a psychiatric social worker in the emergency department between August and October 2022. Gender identity and sexual orientation were documented in 118 of these patients.
Results: Of 118 patients, ranging in age from 10 to 21 years, whose gender identity and sexual orientation were evaluated, 78 (66%) were Assigned Female at Birth (AFAB) and 40 (33%) were Assigned Male at Birth (AMAB). Hispanic ethnicity was represented in 78% (93) of our population followed by Non-Hispanic White in 13% (16).Of AFAB, 12 patients (15%) identified as trans-male and 10 (13%) identified as non-binary. Of AMAB, one (2.5%) was identified as non-binary and three (7%) were unsure. Regarding sexual orientation, 26 (33%) of AFAB reported being heterosexual, 23(29%) bisexual, 5 (6.4%) pansexual and 9 (11.5%) were unsure/exploring. Among trans-males, 4(33%) identified as bisexual, 3 (25%) as gay, 2(16%) as pansexual, 2(16%) were unsure and one (8%) did not respond. Twenty-eight (70%) of AMAB reported to be heterosexual, 4 (10%) bisexual, one (2.5%) gay, 4 (10%) were unsure/exploring. The only trans-female reported to be bisexual. Regarding identified psychiatric diagnoses, major depressive disorder was reported in 83% of our population, being AFAB the most affected in 67%.
Conclusions: The prevalence of transgender/GNC among pediatric patients evaluated by a psychiatric social worker at a children’s hospital emergency department is significantly higher than in the general population. Non-heterosexual sexual orientation is also higher than in the cisgender population. Emergency department providers in pediatric emergency facilities should receive formal training in the evaluation and management of LGBTQ youth.
Presentation: Saturday, June 17, 2023
SAT420 Bone Health In Transgender People
Authors: Grande Giuseppe , Ceolin Chiara , Vescovi Beatrice , Dall'Agnol Martina , Ziliotto Chiara , Pasqualini Sara , Petre Gabriel Cosmin , Scala Alberto , Giannini Sandro , Camozzi Valentina , Bertocco Anna , Sergi Giuseppe , Ferlin Alberto , Garolla Andrea 
Published: October 2023

Abstract
Disclosure: G. Grande: None. C. Ceolin: None. B. Vescovi: None. M. Dall’Agnol: None. C. Ziliotto: None. S. Pasqualini: None. G. Petre: None. A. Scala: None. S. Giannini: None. V. Camozzi: None. A. Bertocco: None. G. Sergi: None. A. Ferlin: None. A. Garolla: None.
In transgender subjects, worse Bone Mineral Density (BMD) values were observed when compared to cisgender controls before initiating Gender-Affirming Hormonal Therapy (GAHT). The reasons have not yet been fully clarified. In this study we analyzed bone metabolism and body composition in a population of transgender people before initiating GAHT, and their possible correlation with endocrine profile, mental health, and lifestyle habits. Medical data, phosphocalcic metabolism and hormonal parameters, lumbar and femoral bone mineral density, body composition, strength and psychological well-being (by Patient Health Questionnaire-9-PHQ-9 and Perceived Stress Scale-PSS questionnaires), were collected in a sample of 32 transgender people before GAHT initiation and 32 cisgender controls. Assigned Female At Birth (AFAB) transgender people presented worse Z-score values at total hip and neck femoral sites (-0.52±0.94 vs 0.15±0.82, and -0.37±0.79 vs 0.19±0.66, p=0.04 respectively), while in Assigned Male At Birth (AMAB) transgender people also lumbar sites were compromised in comparison to cisgender controls. No significant difference in phospho-calcium metabolism (calcium, phosphate, PTH and vitamin D) or hormonal profile (Testosterone, estradiol, LH, FSH) was found between the transgender and the cisgender group. PHQ-9 (a questionnaire to screen for depression) scores were higher in the transgender population than cisgender controls (9.35±7.41 vs 4.08±3.14, p=0.03 in AFAB and 9.54±5.45 vs 4.46±3.59, p=0.02 in AMAB transgender people). Multiple regression analysis identified PSS (a tool to assess stress levels and identify which situations are perceived as stressful) score as an independent predictor of total femur BMD, explaining about 54% of the variance. Transgender people before GAHT have worse bone health than cisgender subjects. In particular, BMD was reduced at the hip and in AMAB even at lumbar site. The reduction in bone mass before GAHT seems independent by hormonal and phospho-calcic profile and associated mostly with psychological status. Further study will clarify the specific pathogenetic mechanisms involved in bone growth in transgender people. However, according to our evidences, the psychological stress might influence negatively lifestyle habits therefore being involved in reduced bone health. Early lifestyle and psychological interventions might so be beneficial also for bone health in the transgender population.
Presentation: Saturday, June 17, 2023
OR31-01 The Dose-dependent Effect Of Estrogen On Bone Mineral Density In Trans Girls
Authors: Boogers Lidewij S , van der Loos Marianne A T C , Wiepjes Chantal M , van Trotsenburg A S Paul , den Heijer Martin , Hannema Sabine E 
Published: October 2023

Abstract
Disclosure: L.S. Boogers: None. M.A. van der Loos: None. C.M. Wiepjes: None. A. van Trotsenburg: None. M. den Heijer: None. S.E. Hannema: None.
Introduction: Treatment in transgender girls can consist of puberty suppression with Gonadotrophin-releasing hormone agonists (GnRHa) followed by estrogen treatment. A decrease in bone mineral density (BMD) Z-scores is a known effect of GnRHa. After initiation of estradiol BMD Z-scores remain relatively low, even after several years of treatment. It has been hypothesized that the estradiol dosage may be insufficient, explaining the persistently low Z-scores. Some trans girls are treated with a higher dosage of estradiol or ethinylestradiol in order to limit growth. This provides the opportunity to evaluate if a higher estradiol dosage results in a greater increase in BMD Z-scores. Methods: Trans girls diagnosed with gender dysphoria were included if they were treated with GnRHa for a minimum of one year prior to treatment with estradiol. Estradiol was increased to the regular dosage (2 mg), or high growth-reductive dosages of estradiol (6 mg) or ethinyl estradiol (100-200 μg (EE)) before the age of 18 years. BMD was assessed using DXA scans performed regularly during GnRHa and estrogen treatment. Z-scores of the lumbar spine were adjusted for height, and the development over time was compared between the different treatment groups. Results: A total of 100 trans girls were included with a mean duration of GnRHa treatment of 2.3±0.7 years. Mean BMD Z-score of the lumbar spine at start of PS was -0.26±0.84. During PS, Z-scores decreased in all three treatment groups to a mean Z-score of -0.99±0.86. After two years of estrogen treatment, Z-scores increased by 0.15 (95% CI 0.00 to 0.30) in the 2 mg estradiol group (n=65) versus 0.35 (95%CI 0.08 to 0.62) in individuals treated with 6 mg estradiol (n=21), and 0.74 (95%CI 0.27 to 1.21) in the EE group (n=14). Compared with 2 mg estradiol, the increase in trans girls treated with EE was significantly higher (0.59, 95% 0.10 to 1.08). There was no difference in individuals treated with 2 mg or 6 mg estradiol (0.20 , 95%CI -0.11 to 0.51). After three years of estrogen treatment, only in the individuals treated with EE, Z-scores were not significantly different from start of GnRHa (-0.01, 95%CI -0.38 to 0.36). Conclusion: When compared to the regular 2 mg dosage of estradiol, a higher estradiol dose, and especially treatment with EE resulted in a greater increase in BMD Z-scores in the lumbar spine in trans girls. This might indicate that 2 mg estradiol is insufficient as a maintenance dose during adolescence and that a higher adult dose is required to optimise BMD.
Presentation: Sunday, June 18, 2023
OR31-03 Testosterone Gender-affirming Hormonal Therapy Is Associated With Decreased Cerebral Blood Flow In Transgender Teens
Authors: Cote Samantha , Fathy Karim , Lenet Stephanie , Espinosa-Bentancourt Oscar-Esteban , Lavallee Eric , Croteau Etienne , Rottembourg Diane , Lepage Jean-Francois , Whittingstall Kevin 
Published: October 2023

Abstract
Disclosure: S. Cote: None. K. Fathy: None. S. Lenet: None. O. Espinosa-Bentancourt: None. E. Lavallee: None. E. Croteau: None. D. Rottembourg: None. J. Lepage: None. K. Whittingstall: None.
There is increasing demand for gender-affirming hormonal therapy (GAHT) in recent years, with increased access to GAHT for transgender teenagers. While it is well documented that psychological outcomes and quality of life improve after GAHT, it remains unclear how cerebrovascular physiology changes with GAHT. Therefore, this study aimed to investigate the effects of testosterone GAHT on cerebral microvascular and macrovascular physiology in teenage transgender men receiving GAHT.
Six teenage transgender men were referred by their endocrinologist prior to the start of GAHT. Participants visited the research center before GAHT (session 1) and between 3 to 9 months into their GHAT (session 2). At each visit, participants completed a non-contrast-enhanced magnetic resonance imaging (MRI) protocol. This protocol assessed the macrovasculature using time-of-flight magnetic resonance angiography to visualize cerebral arteries and estimate diameters of the Circle of Willis and 2D-Phase Contrast to estimate large artery blood velocity. The microvasculature was assessed using pseudo-Continuous Arterial Spin Labelling, which estimates cerebral blood flow (CBF). Paired-sample t-tests were performed between sessions to determine if arterial diameters, CBF and blood velocity change with GAHT.
Whole-brain CBF significantly decreased with GAHT between session 1 and session 2 (CBFS1=69.15 +/- 5.85 ml/100g/min; CBFS2=59.30 +/- 8.11 ml/100g/min; t=3.19, p=0.02, df=5). The average percent change in CBF was -9.85%, and the largest decrease experienced by a participant was -20.44%. Note that even though CBF decreased, average whole-brain CBF for all participants remained in a healthy range. We observed no significant change in large artery blood velocity or arterial lumen diameters of the Circle of Willis after starting GAHT.
Our results suggest that GAHT influences the brain’s microvasculature. As women tend to have higher CBF than men, the reduction in CBF likely reflects a masculinization of the brain with GAHT. Without EEG to probe neuronal activity, it is difficult to determine if the change is due to decreased neuronal activity or a structural and/or functional change in the microvasculature. Considering that little is known about the long-term effects of GAHT on the brain, these results highlight the need to better understand how hormonal states impact human cerebrovascular physiology and how it may relate to risk for cerebrovascular disease and neurological disorders.
Presentation: Sunday, June 18, 2023