The Anti-Discrimination Norm in Human Rights and Charter Law: Nixon V. Vancouver Rape Relief

This paper analyzes the issue of whether the human rights concept of discrimination should be consistent with the constitutional meaning. It includes a case study of whether it is discrimination for a women’s group to exclude male to female transsexual persons. The author concludes that given the purposes of human rights law, the meaning of discrimination should be sophisticated enough to address such complex cases where there are equality claims on both sides

Endoscopic and Stroboscopic Presentation of the Larynx in Male-to-Female Transsexual Persons

Background. Male-to-female transsexual (MFT) persons often attempt to produce a female-sounding voice as part of the transition process. Endoscopic and stroboscopic data about how they accomplish this with an anatomically male larynx are lacking. Objectives. To describe vocal fold activity in MFT persons producing their feminine voice and identify signs of vocal misuse or hyperfunction in MFT speakers, if any. Study Design. Prospective, nonrandomized, descriptive study of a convenience sample of MFT persons. Methods. All MFT persons had endoscopic and stroboscopic procedures completed. Images were rated on a range of parameters by two experienced voice therapists to derive the descriptions. MFT participant self-report of voice use/ symptoms and listener identifications of speaker gender from a perceptual task were also obtained. Results. Incomplete glottal closure was common with a posterior glottal gap predominating. Phase closure ratios also were skewed toward more ‘‘open’’ time for nearly half of the group. Supraglottic constriction was seen to varying degrees in all, and voice complaints were reported by 67% of the group. Conclusions. MFT speakers who reported a ‘‘passing’’ feminine voice had glottal gap configurations more similar to anatomic females than males and tended toward more open phase closure ratios, perhaps consistent with breathy or soft voice production. Indications of vocal hyperfunction were present for all participants either by self-report or on the laryngeal examination

Endoscopic and Stroboscopic Presentation of the Larynx in Male-to-Female Transsexual Persons

Background. Male-to-female transsexual (MFT) persons often attempt to produce a female-sounding voice as part of the transition process. Endoscopic and stroboscopic data about how they accomplish this with an anatomically male larynx are lacking. Objectives. To describe vocal fold activity in MFT persons producing their feminine voice and identify signs of vocal misuse or hyperfunction in MFT speakers, if any. Study Design. Prospective, nonrandomized, descriptive study of a convenience sample of MFT persons. Methods. All MFT persons had endoscopic and stroboscopic procedures completed. Images were rated on a range of parameters by two experienced voice therapists to derive the descriptions. MFT participant self-report of voice use/ symptoms and listener identifications of speaker gender from a perceptual task were also obtained. Results. Incomplete glottal closure was common with a posterior glottal gap predominating. Phase closure ratios also were skewed toward more ‘‘open’’ time for nearly half of the group. Supraglottic constriction was seen to varying degrees in all, and voice complaints were reported by 67% of the group. Conclusions. MFT speakers who reported a ‘‘passing’’ feminine voice had glottal gap configurations more similar to anatomic females than males and tended toward more open phase closure ratios, perhaps consistent with breathy or soft voice production. Indications of vocal hyperfunction were present for all participants either by self-report or on the laryngeal examination

Health considerations for transgender women and remaining unknowns : a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address

LARYNGEAL STRUCTURE AND FUNCTION IN MALE-TO-FEMALE TRANSSEXUAL PERSONS: ENDOSCOPIC AND STROBOSCOPIC PRESENTATION

Data are lacking regarding the physical correlates that accompany the methods used by male-to-female transsexual (MFT) persons to feminize their voices. Visual study of these alterations is needed to better understand the methods used by MFT individuals to feminize their voices and to observe any potentially harmful vocal behaviors in which they may be engaging. Nine MFT individuals who reported having a "passing" female voice were observed endo-/stroboscopically performing several vocal tasks. These examinations were rated for several physical parameters. Audio recordings were simultaneously captured and used in a listening experiment. The results indicated that MFT speakers attempting a more feminine voice often utilized incomplete glottal closure and a more open phase closure ratio. Signs of vocal hyperfunction were observed in all participants. The results of this study provide preliminary evidence of the physical adjustments seen in MFT speakers. Clinical implications and directions for future research are discussed

Bone health in transgender people: a narrative review

Bone health in transmen and transwomen is an important issue that needs to be evaluated by clinicians. Prior to gender-affirming hormone treatment (GAHT), transwomen have lower bone mineral density (BMD) and a higher prevalence of osteopenia than cismen probably related to external factors, such as hypovitaminosis D and less physical activities. Gonadotropin-releasing hormone (GnRH) analogues in transgender youth may cause bone loss; however, the addition of GAHT restores or at least improves BMD in both transboys and transgirls. The maintenance or increase in BMD shown in short-term longitudinal studies emphasizes that GAHT does not have a negative effect on BMD in adult transwomen and transmen. Gonadectomy is not a risk factor if GAHT is taken correctly. The prevalence of fractures in the transgender population seems to be the same as in the general population but more studies are required on this aspect. To evaluate the risk of osteoporosis, it is mandatory to define the most appropriate reference group not only taking into consideration the medical aspects but also in respect of the selected gender identity of each person

Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study

Purpose: Preliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity). Methods: Medical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ). Results: 14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 (p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people. Conclusions: Body composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT

Effect of Hormone Replacement Therapy on Bone Health and Density in Transgender Individuals

Background: This article is an examination of the effects of hormone replacement therapy on bone health and density in transgender individuals. The use of gender affirming hormone therapy and surgery is on the rise nationally. This bears the question: what side effects may result from use? Hormones have previously been studied for their protective effects on bone health, but there is a distinct lack of research into the effects of long-term gender-affirming hormone therapy. Objective: To answer the research question: What effect does gender-affirming hormone therapy have on bone density in adult and adolescent transgender individuals over at least a 12-month period. Design: Scoping literature review utilizing sources from January 2011 to September 2022. The academic databases used in the collection of sources include PubMed and CINAHL Complete. Participants/Setting: Studies selected must have participants that identify as transgender and currently be receiving, or have previously received, gender-affirming hormone therapy. Inclusion criteria for adolescent individuals was identical to adults, with the addition that they must be past Tanner Stage II in puberty. Main Outcome Measure: It was hypothesized that the use of estrogen therapy in individuals would have a protective effect on bone mineral density and health, whereas testosterone therapy would have a deleterious effect when used on its own. Results/Conclusion: The use of gender-affirming therapy in transgender individuals is recognized as safe for adults and adolescents. Estrogen therapy had a mostly protective effect on bone mineral density, which reduces fracture and osteoporosis risk. Testosterone therapy had less effect on bone mineral density. While there were some incidences of bone mineral density growth, overall testosterone had a neutral effect on bone health. In adolescents, GnHR agonists were the primary treatment and resulted a in decrease of bone mineral density. This deleterious effect was lessened with the addition of sex hormones

Gender-related voice problems in transsexuals — therapeutical demands

  The paper presents a case study of a transsexual patient who underwent a voice pitch elevation surgery performed in Poland for the first time. The human voice is a reflection of the working of hormones and human psyche. This fact is of particular importance in transsexualism, a disorder consisting in incongruence between the individual’s biological sex and their identified gender. For many transsexual people, especially of the MTF (male to female) type, who have undergone hormonal and surgical sex change, the voice still presents a major problem, causing difficulties in everyday life. Hormonal treatment does not influence feminisation of the larynx. In the described MTF case, the patient’s low androphonic voice was perceived as a male voice. In order to feminise the patient’s voice a phonosurgical procedure was performed: the length of the vibrating portion of the vocal folds was shortened by over 50% of their total length by means of suturing of the anterior part of the vocal fold. As a result of the surgical treatment the pitch of voice was raised considerably, with F0 of spoken voice increased from 109 Hz to 209 Hz. The voice range also changed towards female tones, from 59–146 Hz to 148–343 Hz. Pitch elevation positively influenced the patient’s subjective voice assessment: total score of the Voice Handicap Index (VHI) improved from 99 to 19 points, and the score of its emotional sub-scale: 39 and 2 points, respectively. The described case of a surgical male-to-female voice change presents one of the dilemmas faced by modern medicine. (Endokrynol Pol 2016; 67 (4): 452–455)    Przedstawiono przypadek pacjentki transseksualnej, u której po raz pierwszy w Polsce przeprowadzono zabieg chirurgiczny zmiany głosu z męskiego na żeński. Głos ludzki — drugorzędowa cecha płciowa — jest odzwierciedleniem działania hormonów i psychiki. Fakt ten nabiera szczególnego znaczenia w transseksualizmie, zaburzeniu polegającym na niezgodności płci biologicznej z płcią psychiczną. Dla wielu osób transseksualnych, szczególne w postaci transseksualizmu M/K (mężczyzna/kobieta) po hormonalnej i chirurgicznej zmianie płci biologicznej ważnym problemem nastręczającym trudności w życiu codziennym pozostaje głos, gdyż leczenie hormonalne nie wpływa na feminizację krtani — aparatu głosowego. W opisywanym przypadku niski androfoniczny głos pacjentki był percepowany przez otoczenie jako męski. W celu feminizacji głosu wykonano leczenie fonochirurgiczne: skrócono fałdy głosowe o ponad 50% ich długości poprzez założenie szwów zespalających w ½ przedniej części głośni. W wyniku zabiegu podwyższono znacząco głos: przedoperacyjna częstotliwość głosu mówionego wyraźnie przesunęła się po operacji w górę z wartości 109 Hz do 209 Hz. Zakres głosu także zmienił się w kierunku tonów żeńskich z 59–146 Hz do 148–343 Hz. Zmiana wysokości głosu u pacjentki wpłynęła pozytywnie na jej subiektywną ocenę głosu: wynik kwestionariusza VHI (Voice Handicap Index) poprawił się z 99 pkt — przed operacją do 19 pkt — po operacji. Na poprawę jakości życia wskazuje także spadek problemów emocjonalnych związanych z głosem, ocenianych za pomocą podskali emocjonalnej VHI, której wynik wynosił odpowiednio: 39 pkt przed vs. 2 pkt po operacji. Prezentowany przypadek chirurgicznej zmiany głosu z męskiego na żeński, dokonany po raz pierwszy w warunkach polskich, przedstawia jeden z dylematów stawianych przed współczesną medycyną. (Endokrynol Pol 2016; 67 (4): 452–455)

Concentração sérica de fator neurotrófico derivado do cérebro em pacientes diagnosticados com disforia de gênero que realizaram cirurgia de redesignação sexual

Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one’s assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. Objectives: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Methods: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post- -SRS blood collections was also measured. Results: No significant difference was found in pre-SRS or post- -SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Conclusion: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person’s gender identity.O transexualismo (CID-10) é uma condição caracterizada por forte e persistente dissociação com o gênero atribuído. A cirurgia de redesignação sexual (CRS) e a terapia hormonal (TH) permitem que indivíduos transexuais se sintam mais congruentes com seu gênero e, por isso, têm desempenhado papel importante nos últimos 70 anos. O fator neurotrófico derivado do cérebro (BDNF) parece desempenhar um papel fundamental na recuperação do trauma cirúrgico agudo e vulnerabilidade ambiental à psicopatologia. Nós hipotetizamos que o BDNF pode ser um biomarcador de alívio do sofrimento de incongruência de gênero pós-CRS. Objetivos: Mensurar os níveis séricos de BDNF no pré e pós-operatório em indivíduos transexuais como biomarcador de alívio de estresse relacionado à incongruência de gênero após a CRS. Métodos: Trinta e duas pessoas transexuais masculino para feminino submetidas a cirurgia e tratamento hormonal foram selecionadas de nossa amostra inicial. O nível sérico de BDNF foi avaliado antes e depois da CRS pela técnica ELISA. O tempo decorrido entre as coletas de sangue pré e pós-CRS foi medido. Resultados: Não houve diferença significativa nos níveis de BDNF pré e pós-CRS ou em relação ao tempo decorrido entre a CRS e a coleta. Conclusão: O alívio do sofrimento relacionado à incongruência de gênero pós-CRS não pode ser avaliado apenas pelo BDNF. Soluções cirúrgicas podem não fornecer uma solução rápida para o sofrimento associado ao transexualismo, e a CRS pode servir como um passo em direção à, em vez de conclusão da, construção da identidade de gênero de uma pessoa