Graduation date: 2000

Transgender and nonbinary (TNB) people identify with a gender identity that differs from cultural expectations based on sex assigned at birth. Many TNB people pursue social and/or medical transition with the intent of affirming their gender identity to themselves and the world around them. Medical transition describes the process of utilizing one or more forms of gender-affirming medical care (e.g., hormone therapy, gender confirmation surgery, hair removal, breast augmentation, mastectomy) in order to change the physical body such that it is more congruent with an individual’s affirmed gender identity. Researchers suggest that many TNB individuals currently use or desire to use gender-affirming hormone therapy (GAHT), and that some TNB individuals desire or use nontraditional or non-standardized (e.g., low dose) hormone therapy regimens. Unfortunately, many TNB people encounter barriers in the process of accessing gender-affirming healthcare, especially individuals who are nonbinary and/or desire gender transition steps that are nontraditional or non-standardized (e.g., low-dose hormone therapy). In current research literature, little is currently known about the experiences and healthcare needs of TNB people who currently or desire to take nontraditional GAHT. To address this gap in the research literature, the present study was a qualitative study involving semi-structured interviews with 10 TNB people to explore their experiences connected to nontraditional GAHT. The grounded theory analysis revealed a core category: Nontraditional Gender Affirmation Model. The core category is comprised of five axial level categories: Social Processes, Medical Processes, Barriers to Accessing Medical Transition Care, Facilitators to Accessing Medical Transition Care, and Coping with Distress and Barriers. The five axial level categories are comprised of 30 open-coding level categories and 33 open-coding level subcategories. The grounded theory model developed depicts a framework of various phenomena involved in the process of gender affirmation for transgender and nonbinary individuals with nontraditional gender transition needs, including nontraditional approaches to GAHT. Implications for healthcare providers, psychological practice, and future research are discussed.

This investigation was conducted to determine the effect of estrogen replacement therapy (ERT) on vitamin B-6 status of postmenopausal women. Nineteen postmenopausal women served as subjects. Nine (54.7 + 4.7 years) were taking ERT (experimental group); ten (56.8 + 2.3 years) were not (control group). For three consecutive days, subjects recorded their dietary intake and collected their 24-hour urine specimens. On the fourth day, a fasting blood sample was drawn from the subjects. The dietary intake of vitamin B-6, as well as the concentration of total vitamin B-6 in plasma (PB6; and urine (UB6) were measured. PB6 and UB6 were determined by a microbiological method with Saccharomyces uvarum as the assay organism. The mean age, height, hematocrit and hemoglobin values were similar for the two groups. The experimental group was significantly heavier than the control group (p<0.05). The experimental group had a lower mean PB6 than the control group: 47.7 ± 19.7 nmol/L vs. 56.2 + 20.6 nmol/L. These means were not significantly different (p=0.05). PB6 was positively correlated with dietary vitamin B-6 intake (p=0.0001) and vitamin B-6 to protein ratio (p=0.0021). When the means were adjusted for dietary vitamin B-6 and the vitamin B-6 to protein ratio, the mean PB6 of the experimental group (42.7 nmol/L) was significantly lower than that of the control group (60.6 nmol/L) (p<0.05). PB6 was not positively correlated with either age (r=0.20) or the vitamin B-6 dietary history score (r=0.15). UB6 was similar for the two groups. UB6 correlated positively with daily dietary intake of vitamin B-6 (r=0.51, p<0.05) and the ratio of vitamin B-6 to protein (r=0.47, p<0.05), UB6 was not significantly correlated to urine volume (r=0.05). The mean daily intakes of vitamin B-6 and protein were similar for the two groups. One of the 19 subjects had a vitamin B-6 intake that was less than 67 percent of the RDA. Most subjects' (89%) intake of vitamin B-6 was adequate when the ratio of 0.016 mg of vitamin B-6 per g of protein was used as the standard. / Graduation date: 1990

Introduction: The risk factors involved in treating transgender individuals with hormone therapy have been documented, but a full understanding of them remains elusive. Much of the research performed in transgender medicine is old or being completed overseas. It is thus the responsibility of current providers and investigators to expand our current knowledge, so this often marginalized population can receive the best quality care. Methods: A group of 28 transgender men and women who received care from the Endocrinology Clinic at Boston Medical Center were randomly selected as part of a quality control project to evaluate the risk factors involved in hormone therapy. Analysis was two-fold. First, change in lab values associated with known risk factors over a two-year period were assessed in individual patients. Second, group analysis sought to correlate changing hormone levels with lab values associated with known risk factors. Results: The result of the analysis was the majority of the patients who were observed did not suffer from any of the risk factors commonly associated with hormone therapy, and if anything benefited from the consistent clinical care. Several correlations were calculated between hormone levels and the lab values associated with the risk factors, however further analysis must be completed to confirm any connection. Discussion: The goal of this project was to not only evaluate care at Boston Medical Center, but also to draw attention to transgender health. In doing so, we have given an example of safe and effective hormone therapy and shown additional avenues for future research.

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No description available.

There is no abstract available for this thesis. / Department of Biology

Resumo: O objetivo desta pesquisa foi avaliar a qualidade de vida de mulheres na pós-menopausa usuárias e não usuárias de terapia hormonal (TH) em Unidade Básica de Saúde (UBS) de Franca-SP. Foi conduzido estudo clínico transversal, com amostra de conveniência composta por 250 mulheres na pós-menopausa, idade entre 45 a 70 anos, atendidas em UBS de setembro de 2007 a agosto de 2008. As participantes foram divididas em dois grupos: usuárias de terapia hormonal (n=70) e não usuárias (controle, n=180). Foram excluídas aquelas com: doenças psiquiátricas, tireopatias não-controladas, doenças malignas, uso de antidepressivos, obesidade grau III, drogaditas e etilistas. Consideraram-se como usuárias de TH aquelas que faziam uso contínuo dessa terapia há pelo menos seis meses. Foram avaliadas as características sócio-demográficas e clínicas. Aplicou-se o Índice Menopausal de Blatt-Kupperman (IMBK) para avaliar a intensidade dos sintomas climatéricos e o Questionário de Saúde da Mulher (QSM) para a avaliação da qualidade de vida. A análise estatística foi realizada pelo teste do Qui-Quadrado ou exato de Fisher, teste de Mann-Whitney ou de Kruskal-Wallis. Os resultados não mostraram diferenças significativas na comparação entre os grupos quanto à idade, menarca, menopausa, paridade e índice massa corpórea. Observou-se que 67,2% eram casadas (168/250), 83,2% com ensino fundamental (208/250) e 53,2% se ocupavam com os trabalhos domésticos (133/250), não diferindo entre os grupos. As usuárias de TH relataram menor freqüência de sintomas climatéricos (IMBK) de intensidade moderada e acentuada, comparadas a não usuárias (p<0,001). Na avaliação do QSM, verificou-se entre as usuárias de TH, menor escore médio quanto ao déficit cognitivo (p<0,001), sintomas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This research aims at assessing the quality of life in postmenopausal women who were users and non-users of hormone therapy (HT) in public health care unit (HCU) of Franca- SP. This cross-sectional, clinical study was undertaken in a convenience sample consisting of 250 postmenopausal women, aged 45-70 years, followed up at the HCU from September 2007 to August 2008. The patients were divided in two groups: users of HT (n=70) and non-users of HT (control, n=180). Exclusion criteria: obesity, psychiatric disturbances, antidepressants use, uncontrolled thyroid diseases, drug addicts, alcohol addicts and malignant diseases carriers. Women considered HT users were those who had undergone this treatment for at least six months. Socio-demographics and clinical characteristics were assessed. The Blatt-Kupperman Menopausal Index (BKMI) was applied to rate the intensity of climacteric symptoms and the Women's Health Questionnaire (WHQ) was applied to assess women's quality of life. For data statistical analysis, a Qui-square tests, a Fisher's Exact Test, a Mann-Whitney Test and Kruskal- Wallis test were used. The results show that there is no significant difference between groups regarding age, menarche, menopause, parity and body mass index. At total 67.2% of women were married (168/250), 83.2% had received fundamental education (208/250) and 53.2% were busy with house chores (133/250), not differing among the group. HT users reported a lower frequency of moderate and severe climacteric symptoms (p<0.001). From WHQ, it was observed among the HT users lower average score of memory concentration (p<0.001), vasomotor symptoms (p=0.048), sleep problems (p<0.001) and attractiveness (p=0.024); however there were no differences between groups regarding the QSM total score. In conclusion, postmenopausal women who were users and nonusers of HT, followed up at a health care unit, not presented differences in global quality of life. / Orientador: Eliana Aguiar Petri Nahas / Coorientador: Jorge Nahas Neto / Banca: Lúcia Helena Simões Costa-Paiva / Banca: Paulo Traiman / Mestre

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-18Bitstream added on 2014-06-13T18:39:58Z : No. of bitstreams: 1 martins_mad_me_botfm.pdf: 354151 bytes, checksum: fd9ef52802847e9f7bceaa3e8157d4f3 (MD5) / O objetivo desta pesquisa foi avaliar a qualidade de vida de mulheres na pós-menopausa usuárias e não usuárias de terapia hormonal (TH) em Unidade Básica de Saúde (UBS) de Franca-SP. Foi conduzido estudo clínico transversal, com amostra de conveniência composta por 250 mulheres na pós-menopausa, idade entre 45 a 70 anos, atendidas em UBS de setembro de 2007 a agosto de 2008. As participantes foram divididas em dois grupos: usuárias de terapia hormonal (n=70) e não usuárias (controle, n=180). Foram excluídas aquelas com: doenças psiquiátricas, tireopatias não-controladas, doenças malignas, uso de antidepressivos, obesidade grau III, drogaditas e etilistas. Consideraram-se como usuárias de TH aquelas que faziam uso contínuo dessa terapia há pelo menos seis meses. Foram avaliadas as características sócio-demográficas e clínicas. Aplicou-se o Índice Menopausal de Blatt-Kupperman (IMBK) para avaliar a intensidade dos sintomas climatéricos e o Questionário de Saúde da Mulher (QSM) para a avaliação da qualidade de vida. A análise estatística foi realizada pelo teste do Qui-Quadrado ou exato de Fisher, teste de Mann-Whitney ou de Kruskal-Wallis. Os resultados não mostraram diferenças significativas na comparação entre os grupos quanto à idade, menarca, menopausa, paridade e índice massa corpórea. Observou-se que 67,2% eram casadas (168/250), 83,2% com ensino fundamental (208/250) e 53,2% se ocupavam com os trabalhos domésticos (133/250), não diferindo entre os grupos. As usuárias de TH relataram menor freqüência de sintomas climatéricos (IMBK) de intensidade moderada e acentuada, comparadas a não usuárias (p<0,001). Na avaliação do QSM, verificou-se entre as usuárias de TH, menor escore médio quanto ao déficit cognitivo (p<0,001), sintomas... / This research aims at assessing the quality of life in postmenopausal women who were users and non-users of hormone therapy (HT) in public health care unit (HCU) of Franca- SP. This cross-sectional, clinical study was undertaken in a convenience sample consisting of 250 postmenopausal women, aged 45-70 years, followed up at the HCU from September 2007 to August 2008. The patients were divided in two groups: users of HT (n=70) and non-users of HT (control, n=180). Exclusion criteria: obesity, psychiatric disturbances, antidepressants use, uncontrolled thyroid diseases, drug addicts, alcohol addicts and malignant diseases carriers. Women considered HT users were those who had undergone this treatment for at least six months. Socio-demographics and clinical characteristics were assessed. The Blatt-Kupperman Menopausal Index (BKMI) was applied to rate the intensity of climacteric symptoms and the Women’s Health Questionnaire (WHQ) was applied to assess women’s quality of life. For data statistical analysis, a Qui-square tests, a Fisher’s Exact Test, a Mann-Whitney Test and Kruskal- Wallis test were used. The results show that there is no significant difference between groups regarding age, menarche, menopause, parity and body mass index. At total 67.2% of women were married (168/250), 83.2% had received fundamental education (208/250) and 53.2% were busy with house chores (133/250), not differing among the group. HT users reported a lower frequency of moderate and severe climacteric symptoms (p<0.001). From WHQ, it was observed among the HT users lower average score of memory concentration (p<0.001), vasomotor symptoms (p=0.048), sleep problems (p<0.001) and attractiveness (p=0.024); however there were no differences between groups regarding the QSM total score. In conclusion, postmenopausal women who were users and nonusers of HT, followed up at a health care unit, not presented differences in global quality of life.

The doctrine of informed consent, defined as respect for autonomy, is the tool used to govern the relationship between physicians and patients. Its framework relies on rights and duties that mark these relationships. The main purpose of informed consent is to promote human rights and dignity. Some researchers claim that informed consent has successfully replaced patients' historical predispositions to accept physicians' advice without much explicit resistance. Although the doctrine of informed consent promotes ideals worth pursuing, a successful implementation of these ideals in practice has yet to occur. What has happened in practice is that attorneys, physicians, and hospital administrators often use consent forms mainly to protect physicians and medical facilities from liability. Consequently, ethicists, legal theorists, and physicians need to do much more to explain how human rights and human dignity relate to the practice of medicine and how the professionals can promote them in practice. This is especially important because patients' vulnerability has increased just as the complexity and power of medical science and technology have increased. Certain health care practices can shed light on the difficulties of implementing the doctrine of informed consent and explain why it is insufficient to protect patients' rights and dignity. Defining a normal biological event as a disease, and routinely prescribing hormone drug therapy to menopausal women for all health conditions related to menopause, does not meet the standards of free informed consent. Clinicians provide insufficient disclosure about risks related to long-term use of hormone therapies and about the absence of solid evidence to support their bias toward hormone therapies as a treatment of choice for menopause related health conditions. The contributing problem is women's failure to act as autonomous agents because they either choose not to take an active part in their own therapy or because they fear to question physicians' medical authority. To insure that patients' autonomy and free choice are a part of every physician-patient interaction, physicians and patients need actively to promote them as values that are absolutely indispensable in physicians' offices, clinics, and hospitals.