Sexual Functions of Transgender Individuals Before Gender Transition

Objective: It is important to evaluate sexual function during the follow-up of transgender individuals in the gender pre-transition period. However, there exists inadequate literature evaluating the sexual functions of transgender individuals who have not received hormone therapy and/or undergone gender-affirming surgery. The aim of this study was to evaluate sexual function in transgender individuals in the gender pre-transition period. Material and Methods: Transgender individuals who were admitted consecutively to the tertiary care hospital between February and December 2019 were evaluated. Those who agreed to fill the questionnaires were included. Sexual functions of participants were evaluated using the Golombok-Rust Inventory of Sexual Satisfaction developed for cisgender and heterosexual individuals. In addition, the Arizona Sexual Experiences Scale was used for a psychometric test. Results: Sixty-five participants who did not receive hormone therapy and/or undergone gender-affirming surgery were included. Of these, 45 individuals were trans men (TM), and 20 were trans women (TW). The mean ages of TW and TM were 25.05 +/- 6.73 and 24.23 +/- 5.58 years, respectively. The percentages of sexual dysfunction were found to be 87.8 degrees/o in TM and 92.3% in TW, according to the Arizona Sexual Experiences Scale. According to the common subscales of the Golombok-Rust Inventory of Sexual Satisfaction, the most common problem in both groups was low sexual frequency. Conclusion: Owing to the importance of evaluating the sexual function in transgender individuals during the gender pre-transition period or in those who do not intend to undergo gender-affirming treatment, a scale should be developed for this period

Fatigue is Related to Insulin Use by Acting Via Depressive Mood in Patients with Diabetes Mellitus

Objective: Fatigue is a common symptom in diabetes mellitus. The aim of this study was to determine the factors leading to fatigue and to investigate the effect of insulin use on fatigue among the diabetic population. Material and Methods: One-hundred diabetic patients attending the diabetes clinic of Cerrahpasa Medical Faculty between October 2017-January 2018 and 42 healthy controls were evaluated in this cross-sectional study. Questionnaires including demographic and disease characteristics, Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), quality of life scale (SF-36), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Ages (47.6 +/- 14.8 and 45.7 +/- 14.1 years; p=0.47) and body mass indices (26.6 +/- 4.1 and 25.3 +/- 3.5 kg/m(2); p=0.08) of 100 patients with diabetes (Type 1 Diabetes/Type 2 Diabetes=29/71) and 42 healthy volunteers were similar. The diabetic group had worse FIS total (p=0.05), FIS psychological (p=0.04) scores and SF-36 scores compared to the healthy controls. When the patients with diabetes were divided into two groups according to insulin use and compared with healthy controls, the ESS and PSQI were similar but all FIS parameters (total p=0.005, cognitive p=0.007, physical p=0.01, psychological p=0.009) and BDI (p=0.05) were significantly worse in patients with insulin use than non-insulin and control groups. The relationship between fatigue and insulin use was independent of glycemic control and duration of diabetes but was affected by the BDI (p=0.001). Conclusion: Insulin use leads to fatigue in patients with diabetes, regardless of diabetes type, and this effect is influenced by depressive mood. Psychotherapeutic approaches prior to insulin treatment might yield fruitful results

Effectiveness of Cabergoline Treatment in Patients with Acromegaly Uncontrolled with SSAs: Experience of a Single Tertiary Center

Purpose To evaluate the effectiveness of cabergoline and the parameters affecting cabergoline response as add-on treatment to somatostatin analaogues (SSA) in patients with acromegaly uncontrolled with SSAs

The Effects of Psychological Focus Group Therapy on the Quality of Life of Female Patients with Acromegaly

Objective: Chronic diseases such as acromegaly affect psychological health. This study aimed to evaluate the effects of a 1-year-long psychological focus group therapy on the quality of life of patients with acromegaly. Material and Methods: Seven female patients with acromegaly, followed-up at the endocrinology outpatient clinic of Cerrahpasa Medical Faculty, were evaluated. The weekly group psychotherapy sessions were conducted by a psychoanalyst and a clinical psychologist between May 2018 and May 2019. Beck Depression Inventory (BDI) and Acromegaly Quality of Life (AcroQoL) scales were assessed at baseline, 3-months, 6-months, and 1-year of group therapy. Results: The mean age of the patients was 43.7 +/- 6.2years, and the median duration of disease was 8 [3-10] years. Six patients were in disease remission. There was a significant improvement in the BDI (p=0.008) and AcroQoL-total scores (p=0.04) from the beginning till the end of the study. A strong negative correlation was observed between BDI and AcroQoL-2 (p=0.003; r=-0.91 vs. p=0.04; r=-0.77) and AcroQoL-t(o)tal (p=0.03; r=-0.78 vs. p=0.01; r=-0.85) scores at baseline and the 3-months of therapy, respectively. Moreover, the psychoanalyst reported that the patients showed an improved ability to face difficulties caused by their illnesses, expressed their emotional reactions more freely, and were more capable of enduring the disease. Conclusion: Patients with acromegaly benefited from the 1-year psychological focus group therapy in terms of psychological well-being, along with improved AcroQoL and BDI scores. Psychotherapeutic approaches, starting with the diagnosis of the disease, might be a significant intervention that improves the quality of life of patients with acromegaly

Transphobic Attitudes of Physicians Who Play an Active Role in the Gender-Affirming Treatment in Turkey

Introduction Transgender people are exposed to many health inequality practices while receiving healthcare. In this study, we aimed to investigate the levels of transphobia among physicians who play an active role in the gender-affirming treatment (GAT) in Turkey. Methods In this cross-sectional study, 530 physicians from the disciplines of psychiatry, endocrinology, gynecology, urology, and plastic surgery were assessed. Respondents completed a web-based survey consisting of sociodemographic data form and Genderism and Transphobia Scale (GTS) from May to June 2020. Results Among the 530 physicians, 126 were psychiatrists, 107 were endocrinologists, 119 were gynecologists, 111 were urologists, and 67 were plastic surgeons. We concluded that the transphobic attitude was the lowest in psychiatrists and the highest in urologists. In addition, we found that males were more transphobic than females (for GTS, p < .001; morality/shame and teasing, p < .001; for violence, p = .003), married individuals than single ones (for GTS, p = .012; morality/shame, p = .006), and residents than other academic status (for teasing, p = .024). Finally, we showed that transphobic attitudes are higher among the religious and those belonging to a religion people, respectively, and lower among the atheists and the deists. Conclusions Our findings indicate that transphobia is quite common among physicians in Turkey other than psychiatrists who are more in contact with transgender people. Policy Implications It can be said that it may be important to establish more relationships with transgender individuals and develop policies regarding this situation in order to reduce the common transphobia among physicians

Primary hypophysitis: Experience of a Single Tertiary Center

Purpose The authors review the clinical outcomes of patients with primary hypophysitis (PH)

Patients with acromegaly might not be at higher risk for dopamine agonist- induced impulse control disorders than those with prolactinomas

Objective: To evaluate the prevalence of impulse control disorders (ICD) and psychiatric symptoms in patients with acromegaly receiving dopamine agonists (DA) in comparison with those with prolactinoma, nonfunctioning pituitary adenomas (NFA), and healthy controls (HC)

Does treatment with sodium-glucose co-transporter-2 inhibitors have an effect on sleep quality, quality of life, and anxiety levels in people with Type 2 diabetes mellitus?

Background/aim: To evaluate the impact of treatment with sodium-glucose co-transporter-2 (SGLT2) Inhibitors on quality of life (QoL), sleep quality (SQ), and anxiety levels in patients with Type 2 diabetes mellitus (T2DM)

The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly

PurposeTo investigate the effects of preoperative somatostatin analogue (SSA) treatment on the annual cost of all acromegaly treatment modalities and on remission rates.MethodsThe medical records of 135 patients with acromegaly who were followed at endocrinology clinic of Cerrahpasa Medical Faculty for at least 2years after surgery between 2009 and 2016 were reviewed.ResultsThe mean follow-up time was 50.925.7months. Early remission was defined according to 3rd month values in patients who didn't achieve remission, and 6th month values in patients who achieved remission at the 3rd month after surgery. The early and late remission rates of the entire study population were 40% and 80.7%, respectively. The early remission of the preoperative SSA-treated group (61.5%) was significantly higher than SSA-untreated group (31.2%) (p=0.002). The early remission of the preoperative SSA-treated patients with macroadenomas (52.2%) was also significantly higher than the SSA-untreated group (23.5%) (p=0.02). In the subgroup analysis; this difference was much more pronounced in invasive macroadenomas (p=0.002). There were no differences between the groups in terms of late remission.The median annual cost of all acromegaly treatment modalities in study population was Euro3788.4; the cost for macroadenomas was significantly higher than for microadenomas (Euro4125.0 vs. Euro3226.5, respectively; p=0.03). Preoperative SSA use in both microadenomas and macroadenomas didn't alter the cost of treatment. The increase in the duration of preoperative medical treatment had no effect on early or late remissions (p=0.09; p=0.8).Conclusions Preoperative medical treatment had no effect on the costs of acromegaly treatment. There was a benefical effect of pre-operative SSA use on early remission in patients with macroadenomas; however, this effect didn't persist long term