Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person

Badania nad opracowaniem wymagań dotyczących fizycznej i psychicznej przydatności strażaków i kandydatów na strażaków

This report was compiled for the Belgian Federal Office for Internal Affairs. It contains a discussion of the creation and subsequent application of a test battery and questionnaires for assessing the physical and mental capacity of firemen. There are currently no uniform criteria for these in Belgium. They are coupled to a scientifically-based training programme.Autorzy zamieszczonego poniżej artykułu udowadniają, że kwestia predyspozycji psychofizycznych strażaków ma wymiar uniwersalny . podobny w każdym kraju. Fakt, iż przydatność do służby determinowana jest w jednakowym stopniu sprawnością i wytrzymałością fizyczną oraz cechami psychiki, potwierdza zarówno praktyka, jak i badania naukowe. Na zlecenie rządu Belgii (Federalnego Biura Spraw Wewnętrznych), grupa naukowców pod kierunkiem prof., prof. Lode Godderis'a i Veerle Hermans'a, opracowała jednolite kryteria oceny przydatności strażaków i kandydatów na strażaków. Ciekawy jest sposób podejścia do problemu. Diagnoza dokonana przez belgijską administrację rządową była jednoznaczna - brakuje jednolitych kryteriów oceny predyspozycji do pełnienia odpowiedzialnej i związanej z szeregiem ryzyk, służby w straży pożarnej. Celowo piszę "służby", a nie "pracy", bo nawet laik zdaje sobie sprawę, że strażak - to nie jest zawód podobny do innych. Wielu twierdzi wręcz, że trzeba mieć do niego powołanie. Zostawmy metafizyczne rozważania. Nie sposób jednak zaprzeczyć, że w tej służbie sprawdzą się ludzie, którzy charakteryzują się odpowiednimi cechami ciała, umysłu i psychiki. Jakimi? Aby odpowiedzieć na to pytanie, wybrano najprostszy i najskuteczniejszy, moim zdaniem, sposób - zlecono wybitnym specjalistom (naukowcom i wspierającym ich praktykom) zrealizowanie projektu naukowo-badawczego. Jak im się to udało

ESSM position statement 'Sexual wellbeing after gender affirming surgery'

Introduction: Much has been published on the surgical and functional results following Gender Affirming Surgery ('GAS') in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking. Aim: To review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine. Methods: The Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS. Main Outcomes Measure: The task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasureare provided for each statement separately. Results: The present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing. Conclusion: The available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Copyright (C) 2021 The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine