Endocrinology of Transgender Medicine

Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population

The role of interpersonal functioning in the maintenance of eating psychopathology:a systematic review and testable model

This review aims to systematically evaluate the empirical literature relating to the interpersonal functioning of those with eating disorder psychopathology and presents a preliminary model to help the formulation of patients' problems. Following a thorough literature search, 35 papers were included in this systematic review. The vast majority of studies indicate a strong association between eating psychopathology and certain maladaptive personality traits. The origins of social anxiety and poor social support that have been described as maintaining eating disorders appear to differ according to diagnostic groups. Interpersonal difficulties in people with restrictive behaviors such as anorexia appear to be related to the avoidance of expressing feelings to others and to giving priority to other people's feeling over their own. While interpersonal difficulties in patients with bulimia nervosa appear to be more related to interpersonal distrust and negative interaction and conflict with others. These concepts are presented in a preliminary model of interpersonal functioning in the eating disorders

Eating disorders

A concise and practical guide to the management of mental illness in sportsmen and sportswome

Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis

Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorde rs in dancers. A literature search, appraisal and meta-analysis were conducted. Thi rty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for bal let dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considere

Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours

This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16-25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample

Work demands, social support, and job satisfaction in eating disorder inpatient settings: A qualitative study

This qualitative study aimed to investigate work demands experienced by healthcare workers in an adult eating disorders inpatient service. It also aimed to investigate the use of social support and job satisfaction in this setting. Twelve healthcare workers from an eating disorders inpatient ward, including nurses, healthcare support workers and occupational therapists, participated in semi-structured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. A number of work demands were discussed relating to therapeutic care, physical care and organisational demands. Most participants discussed social support at work as being highly valuable formally and informally, whereas external support was viewed as less important. Despite the challenges of caring for eating disordered patients, the majority of participants reported good patient-related job satisfaction but poor job satisfaction in relation to organisational factors. Eating disorders inpatient care is complex and demanding, necessitating effective teamwork, communication and support systems among healthcare workers. Interventions should be developed to target barriers to care, including time constraints, administrative workload and insufficient allocation of staff

Responses of track and field coaches to athletes with eating problems

This study aimed to explore how track and field coaches respond to athletes with eating problems. Eleven experienced coaches participated in semi-structured interviews exploring their responses to, and challenges faced when, working with athletes with eating problems. The analysis revealed three themes relating to the strategies employed by coaches. The first theme indicated a supportive approach, where coaches were proactive in seeking support and in reducing training at the early stages of an eating problem. The second theme outlined an avoidant approach, characterized by coach reluctance to be involved in managing eating problems, and a lack of confidence in their knowledge of eating disorders. The third theme involved a confrontational approach, where coaches employed strict rules and engaged in coercion to persuade athletes to seek treatment. All of the coaches reported facing challenges in persuading athletes to seek treatment and were frustrated by the lack of available support. The study highlights the importance of providing resources and support services where coaches can seek advice. Coach-education packages can utilize the findings to highlight the strengths and limitations of different coach strategies, and to reinforce the importance of their role in identification and intervention when eating problems in athletes are suspected

Identifying and preventing disordered eating among athletes : perceptions of track and field coaches

Objective: This study aimed to identify the strategies employed by coaches when identifying disordered eating (DE) among track and field athletes. Design: This was a qualitative study and an inductive thematic analysis was conducted. Method: Semi structured interviews were conducted with eleven track and field coaches, with experience of coaching at national and international level. The interviews were recorded, transcribed verbatim and analysis was conducted. Results: Track and field coaches reported using physical, social and performance indicators to identify disordered eating in their athletes. Coaches also monitored their athletes' eating attitudes and behaviors. Weight loss (both observed and objectively monitored) was considered to be a key indicator of disordered eating. Coaches placed a high level of importance on weight for performance, and an “ideal” female athlete body. Previous experiences of detecting disordered eating and a close relationship with the athlete facilitated the identification of disordered eating. Athlete secrecy and masking behaviors, difficulties in communication and coaches' stereotypical beliefs were found to complicate the identification process. Conclusions: This study highlights the need for additional information, advice and guidance for track and field coaches to improve their knowledge and confidence in identifying disordered eating among their athletes