Purpose: The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status. Methods: The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5,117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000-2009 for 1,277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3,840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups. Results: Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years. Conclusion: The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses.

Bakgrund och problemformulering: Transpersoner är historiskt sett en utsatt grupp som avviker från normer och strukturer i samhället. Genom förnyade och nystiftade lagar arbetas det i Sverige för att transpersoner ska få den vård som krävs för en god hälsa. Utan god hälsa och vård kan lidande uppstå i form av skam och otrygghet. Kunskap är en förutsättning för god vård. Syfte: Syftet med studien är att belysa sjuksköterskans bemötande av transpersoner i vårdande kontext genom att beskriva sjuksköterskans attityder gentemot och kunskap om personer med transidentitet. Metod: För att få en uppfattning om rådande forskning gjordes en litteraturstudie där innehållet strukturerades för att kunna urskilja subkategorier och därefter huvudkategorier. Artiklarna som analyserades var både kvalitativa och kvantitativa. Resultat: Tre kategorier representerade studiens resultat och var följande: ”kunskap och förståelse”, ”attityder” samt ”bemötande”. Det framkom en omfattande okunskap om transpersoner hos sjuksköterskor. Attityderna varierade men var ganska genomgående ifrågasättande och negativa. Sjuksköterskor var ofta påverkade av normer, medvetet eller omedvetet, vilket tog sig uttryck genom ett diskriminerande, auktoritärt och stigmatiserande bemötande. Kategorierna visade sig ha tydliga samband, klinisk kunskap kunde exempelvis kopplas till mer positiva attityder. Det fanns därtill ofta en vilja hos sjuksköterskan att ge en god vård. Diskussion: Sjuksköterskans kunskap kan innebära skillnaden mellan god och diskriminerande vård. Utbildning om transpersoner brister vid många universitet, vilket speglas i en utbredd okunskap. Det är viktigt att teamarbete främjas för att en kompetent vård ska främjas. Diskriminering och stigmatisering kan motverkas genom att arbetsledare och sjuksköterskor tar sitt professionella ansvar.

Bakgrund: En transperson är en person som inte identifierar sig med sitt juridiska kön utan mer som det motsatta könet, som både man och kvinna eller inget kön alls. Processen att genomgå en könsbekräftande behandling är såväl social som medicinsk och juridisk. Sjuksköterskan bör sträva efter att behandla samtliga patienter på ett jämlikt sätt. Syfte: Syftet med denna studie var att beskriva sjuksköterskans erfarenheter av att möta transpersoner samt att genomföra en metodologisk granskning av de inkluderade artiklarna. Metod: Detta är en litteraturstudie med beskrivande design, vars resultat har sin grund i åtta kvalitativa och en kvantitativ artikel. Dessa hämtades från databaserna Cinahl och Medline via PubMed. I granskningen av artiklarna framkom två teman och fem underrubriker. Den metodologiska aspekten är undersökningsgrupp. Huvudresultat: Sjuksköterskorna hade bristande kunskaper om transpersoner och därför skapades osäkerhet att bemöta och vårda dessa. Flertalet sjuksköterskor kände rädsla att diskriminera trots att intentionen var att möta dessa personer med respekt och värdighet. Antalet sjuksköterskor som deltog i studierna i de inkuderade artiklarna var 400. Studierna var utförda i USA, Kanada och Australien. Slutsats: Otillräcklig kunskap och rädsla för att göra fel påverkar sjuksköterskan i vårdandet av transpersoner. Mer forskning behövs för att öka förståelsen hos vårdpersonal för att ge bättre förutsättningar till jämlik vård av transpersoner samt för att ge bättre stöd till de som genomgår könsbekräftande behandling. / Background: A transgender person is a person who does not identify themselves as the gender assigned at birth but more as the opposite gender, as both man and woman or as neither of them. The process undergoing sex reassignment is social as well as medical and legal. The nurse should strive to treat all patients equally. Aim: The purpose of this study was to describe nurses experience in meeting transgender persons and to conduct a methodological review of the included articles. Method: This is a literature review with a descriptive design in which the result is based on eight qualitative and one quantitative article. These were collected from the databases Cinahl and Medline through PubMed. In the research of the articles there emerged two themes with five subheadings. The methodological aspect is study group. Results: The nurses expressed low knowledge about transgender people and therefore was uncertain how to meet and nurse them. Most nurses felt fear of discriminating despite the intention to treat these people with respect and dignity. The number of nurses who participated in the studies of the included articles was 400. The studies were performed in the United States, Canada and Australia. Conclusion: Inadequate knowledge and fear of making mistakes affect the nurse in the care of transgender persons. More research is needed to increase understanding for all health care professional and to provide better conditions for equal treatment of transgender persons and to provide better support for those undergoing gender sex reassignment treatment.

I ett historiskt perspektiv har transpersoner varit en icke accepterad grupp och heteronormativa antaganden har varit det synsätt som präglat det svenska samhället. I Sverige finns idag lagar som styr vården för att alla ska få vård på lika villkor. Unga transpersoner är fortfarande i dagens samhälle en utsatt grupp, inte minst inom vården där man ser att bemötande och kunskap om dessa individer är viktiga aspekter för att öka chansen till en jämlik vård. Syftet med studien är att ur ett patientperspektiv beskriva unga transpersoners upplevelse av bemötande vid vårdkontakt. Vi har valt att göra en litteraturstudie för att sammanfatta dagens kunskap kring ämnet. Det finns få vetenskapliga artiklar publicerade inom ämnet. De kvalitativa och kvantitativa artiklarna som vi valt utifrån vårt intresseområde har analyserats och tolkats. Resultatet av analysen beskrivs i tre teman: bemötande, upplevelse av utsatthet i vårdmiljö och att mötas av okunskap. Resultatet visar att vården inte är anpassad för unga transpersoner. Det finns brister i bemötandet vilket skapar frustration och transpersoner upplever att de får undervisa vårdpersonalen i transrelaterad vård. Vidare belyses att transpersoner förväntas passa in i ett heteronormativt system, att de ofta känner sig i underläge samt är beroende av vårdaren och tvingas svara på obekväma frågor för att få vård. Vår tolkning av resultatet är att det finns en kunskapsbrist bland vårdpersonal och att de normer som finns inom vården idag behöver medvetandegöras. All vårdpersonal har ett ansvar att motverka diskriminering och stigmatisering inom sjukvården.

Bakgrund: Transpersoner och icke-binära är en stigmatiserad grupp i samhället. Många lever i en känsla av utanförskap och denna grupp är enligt statistik överrepresenterad inom psykisk ohälsa. Det finns kunskapsbrist om hur sjuksköterskan som tillhandahåller vård i dessa situationer på hur ett korrekt sätt kan bemöta transpersoner och icke-binära inom hälso-och sjukvård. Syfte: Syftet med denna studie var att beskriva transpersoners och icke-binäras erfarenheter och upplevelser av hälso-och sjukvården. Metod: Detta är en litteraturstudie med beskrivande design. Studiens databassökning identifierade tio kvalitativa artiklar som överensstämde med studiens syfte och inklusionskriterier. Resultatet som analyserades presenterades i två huvudteman och sju underteman.  Huvudresultat: Resultatet visade att majoriteten av transpersoner och icke-binära någon gång känt sig kränkta inom hälso- och sjukvården. Personer som identifierade sig som icke-binär kände ofta att de var tvungna att passa in i en mall som de ej var bekväma med. Resultatet visade att språket som användes av hälso- och sjukvårdspersonal var viktigt i mötet med transpersoner och icke-binära. Genom att använda korrekt språk och pronomen i mötet gav det en känsla av acceptans.  Slutsats: På grund av den okunskap som fanns kunde sjuksköterskor ha svårigheter att veta hur de skulle bemöta transpersoner och icke-binära. Det framgick att brist på kunskap oavsiktligt kunde påverkade mötet negativt för personer med könsöverskridande identitet. Därför bör utbildning om denna urvalsgrupp vara mer tillgänglig för hälso- och sjukvårdspersonal. / Background: Transgender and non-binary people are a stigmatized group within the society. Members of this group often experience a deep sense of exclusion, and are statistically over-representeded in mental healthcare. However, there is a lack of knowledge about how nurses providing care in these situations should appropriately behave and interact in meetings with transgender and non-binary people in healthcare. Aim: The purpose of this study was to describe the lived experiences of transgender and non-binary people in meetings with healthcare providers. Method: The study is based on a literature review with a descriptive design. Literature searches identified ten qualitative studies that met the study’s inclusion criteria. Findings from an analysis of the relevant literature are grouped into two overarching themes and seven further sub-themes. Main results: The findings of this study showed that the majority of transgender and non-binary people have experienced, on at least one occasion, being met with ignorance in healthcare situations. Those self-identifying as non-binary often reported feeling as though they are required to fit into categories they are uncomfortable with. Evidence also suggests that the kind of language used by healthcare providers played an important determining role in how meetings were experienced by transgender and non-binary people. Use of appropriate pronouns and terminology by staff appears to help make feel more accepted. Conclusion: Due to the widespread lack of knowledge, healthcare providers often found it difficult to know how to behave and interact in meetings with transgender and non-binary people. Problems rooted in the lack of understanding contributed to negatively affect people’s experience with the healthcare system. Therefore education about transgender and non-binary people should be more available for healthcareproviders

Bakgrund: Transpersoner har betraktats som en marginaliserad och utsatt grupp i samhället. Det har framkommit exempel på diskriminering och stigmatisering från samhällsstrukturer och normer. Både från omgivningen och internaliserat. Vidare har det visat sig leda till att transpersoner löper ökad risk för psykisk ohälsa och missbruk utöver deras transspecifika omvårdnadsbehov. Syfte: Litteraturstudien beskrev transpersoners erfarenheter av bemötandet i hälso- och sjukvården. Metod: Studien var en beskrivande litteraturstudie. Huvudresultat: De mest framträdande fynden i resultatet innefattade kommunikationen mellan vårdgivare och transpersoner. Negativa upplevelser av vårdmöten karaktäriserades av när transpersonerna blev bemötta respektlöst utifrån affirmerat pronomen och identitet. Negativa upplevelser präglades även av vårdpersonalens egna värderingar, där transfobi beskrevs, eller en skillnad i kunskap mellan vårdgivare och transpersonen gällande transhälsa. Resultatet av respektlösheten kunde i sin tur leda till att vården fick minskad kvalité eller uteblev. Goda upplevelser i möten präglades av respekt för individen, kunskap om transhälsa samt acceptans och förståelse. Slutsats: Hur transpersoner bemötts inom hälso- och sjukvården har präglats av positiva och negativa erfarenheter. Att vårdpersonalen haft transhälsorelevanta kunskaper och förmåga att möta transpersonen med ett holistiskt och personcentrerat förhållningssätt har potential att kunna bidra till att öka hälsa och förebygga ohälsa. / Background: Transgender people have been seen as a marginalized and vulnerable group in society. Examples of discrimination and stigmatization have emerged from societal structures and norms. Both from the environment and internalized. Furthermore, it has been shown that transgender people are at increased risk of mental illness and substance abuse in addition to their trans-specific nursing needs. Aim: The literature study described transgender persons experiences of professional-patient relations in health care. Method: The study was a descriptive literature review. Main results: The most prominent findings included communication between caregivers and transgender people. Negative experiences of care meetings were characterized by when the transgender people were treated disrespectfully by not referring to their affirmed pronoun and identity. Negative experiences were also characterized by the care staff's own values, where transphobia was described, as well as a difference in knowledge between caregivers and the transperson regarding transhealth. The result of this disrespect could in turn lead to quality of care being reduced or care being not available. Good experiences in meetings were characterized by respect for the individual, knowledge of transhealth as well as acceptance and understanding. Conclusion: How transgender people have been treated in health care has been characterized by positive and negative experiences. The fact that healthcare staff have had transhealth-relevant knowledge and the ability to meet the transgender person with a holistic and person-centered approach has the potential to contribute to increasing health and preventing ill health.

This study was conducted through in-depth interviews to examine potential differences between binary-aligned transgender individuals and non-binary individuals in regards to media usage when learning about, articulating, and explaining their gender identity. Results showed numerous differences between transgender people with binary-aligned and non-binary gender identifications in regards to social media preferences and differences in perceived media importance and effects. Additional information was found in regards to the age at which gender identity is articulated and the importance of individuality in comparison to one's gender identity.

Introdução: O homem transexual (HT) é um indivíduo de sexo genético feminino, com fenótipo feminino normal, que deseja viver e ser aceito como um membro do sexo masculino. O tratamento hormonal que é realizado no processo de redesignação sexual nesses pacientes consiste na administração de testosterona nas suas diversas apresentações, mais comumente ésteres de testosterona de curta ou longa ação. O tratamento hormonal visa induzir virilização, através da produção de um padrão masculino de crescimento dos pelos faciais e corporais, aumento da massa muscular e interrupção dos ciclos menstruais. O efeito da terapia androgênica na saúde cardiovascular de HT é pouco conhecido, principalmente em relação às repercussões em longo prazo. O HT representa um modelo ideal e único para a avaliação das ações da testosterona exógena administrada em doses suprafisiológicas em um organismo geneticamente feminino. Alguns estudos de farmacogenética demonstraram a influência da repetição CAG do gene do receptor androgênico (RA) nos efeitos observados durante terapia com testosterona em homens hipogonádicos e a maioria dos estudos confirmou a modulação desses polimorfismos sobre fatores de risco cardiovascular. Objetivos: avaliar em HT em tratamento androgênico a prevalência de fatores clássicos de risco cardiovascular e as propriedades estruturais e funcionais dos vasos arteriais; correlacionar a distribuição alélica do microssatélite CAG RA com a ocorrência de comorbidades e com as propriedades estruturais e funcionais dos vasos arteriais; comparar os valores das propriedades estruturais e funcionais dos vasos arteriais de HT com uma população controle (feminina e masculina). Pacientes: 46 pacientes com diagnóstico de HT (faixa etária 42 ± 10 anos) acompanhados no Ambulatório da Unidade de Disforia de Gênero do HCFMUSP e em tratamento com ésteres de testosterona há pelo menos um ano (variação de 1 a 38 anos) foram selecionados para o estudo. Métodos: Parâmetros clínicos (IMC, circunferência abdominal, relação cintura quadril, pressão arterial e pressão de pulso, composição corporal por bioimpedância), a presença de comorbidades (hipertensão arterial, dislipidemia, diabetes mellitus, obesidade) e vícios (tabagismo, etilismo e uso de drogas ilícitas), dados laboratoriais (hematócrito, glicemia de jejum, insulina, índice HOMA IR, hemoglobina glicada, colesterol total, HDL colesterol, LDL colesterol, triglicerídeos e creatinina) e parâmetros vasculares (espessura íntima média da carótida, diâmetro da carótida, percentual da variação sisto-diastólica da carótida e velocidade de onda de pulso dos vasos arteriais) foram avaliados no grupo de HT. Os mesmos parâmetros vasculares também foram avaliados em controles saudáveis masculinos e femininos pareados para idade e IMC com os HT. A distribuição alélica do microssatélite CAG RA foi avaliada em 44 HT através da análise do produto amplificado da região de repetições CAG do exon 1 do gene do RA, utilizando o software GeneMapper. Resultados e Conclusões: Neste grupo de HT em terapia com ésteres de testosterona observamos uma prevalência de dislipidemia de 42%, hipertensão arterial sistêmica de 35%, obesidade de 30%, diabetes de 4% e tabagismo de 20%. HT em tratamento androgênico apresentaram maior velocidade de onda de pulso carotídeo-femoral do que controles masculinos, mas não do que controles femininos, embora no subgrupo >= 42 anos os HT tenham apresentado maior VOP do que controles masculinos e femininos. Não houve diferença de diâmetro, distensão relativa e espessura íntima média carotídea entre HT e controles. Maior diâmetro, maior espessura íntima média e menor distensão relativa da carótida foram observados em HT obesos e hipertensos; e maior velocidade de onda de pulso aórtica em HT hipertensos. Os parâmetros correlacionados à medida funcional da artéria aorta foram a idade, o tempo de tratamento androgênico e a relação cintura-quadril, enquanto que as propriedades estruturais e funcionais da carótida se correlacionaram com idade, parâmetros antropométricos e glicêmicos. Não houve influência do trato CAG RA na comparação entre os HT com e sem comorbidades metabólicas. Repetições CAG RA curtas se associaram com níveis significativamente mais elevados de glicemia de jejum, insulina basal e HOMA IR. Em relação aos parâmetros antropométricos, pressóricos, lipídicos e arteriais, não foi identificada associação com o número de repetições CAG RA. Estes achados sugerem um potencial efeito deletério da terapia androgênica prolongada sobre os vasos arteriais e a necessidade de medidas preventivas em HT / Introduction: Transgender men (TM) are 46, XX individuals, with normal female phenotype, who desire to live and be accepted as a male member. Testosterone esters are used in sex reassignment therapy to induce virilization and to adapt the body to the male identity. The effects of androgen therapy on TM cardiovascular function are poorly known, particularly with regard to long-term androgen treatment. TM represents a good model for evaluation of high-dose exogenous testosterone action in biological women. Pharmacogenetic studies have demonstrated the influence of CAG polymorphic tract of the androgen receptor gene (AR) on the androgenic effects observed during testosterone therapy in hypogonadal men, and most studies confirmed the modulation of these polymorphisms on cardiovascular risk factors. Objective: to evaluate the prevalence of cardiovascular risk factors and the structural and functional properties of large arteries in TM on long-term cross sex hormone therapy compared to a male and female healthy control group; to correlate the allelic distribution of CAG AR polymorphic tract with the cardiovascular comorbidities and the structural and functional properties of large arteries in TM. Patients: Forty-six patients with a diagnosis of TM (42 ± 10 years old), followed at the Gender Dysphoria Unit-HCFMUSP, receiving cross-sex hormone treatment with testosterone esters for at least one year (ranging from 1 to 38 years) were selected for the study. Methods: Clinical parameters (BMI, waist circumference, waist-to-hip ratio, blood pressure, pulse pressure, body fat percentage), the presence of cardiovascular comorbidities (hypertension, dyslipidemia, diabetes mellitus, obesity) and addictions (smoking, alcohol and drug abuse), laboratory parameters (hematocrit, fasting plasma glucose, basal insulin, HOMA IR index, glycated hemoglobin, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and creatinine) and vascular parameters (carotid intima-media thickness, carotid diameter, carotid relative distensibility and aortic pulse wave velocity - PWV) were evaluated in the TM group. The same vascular parameters were also evaluated in healthy male and female control group, matched for age and BMI. The allelic distribution of the CAG AR polymorphic tract was evaluated in 44 TM using the GeneMapper software. Results and Conclusions: In the TM group, we observed dyslipidemia in 42%, hypertension in 35%, obesity in 30%, diabetes in 4% and smoking habit in 20%. The mean aortic PWV values in TM was higher than in male healthy controls (p=0.005), but not than in female controls (p=0.640). When categorized by age, considering the median age, TM >= 42 years had higher aortic PWV measures than male (p < 0.001) and female (p = 0.024) controls, regardless of their arterial blood pressure values. There was no difference in carotid diameter, carotid relative distensibility and carotid intima-media thickness between TM and controls. Obese and hypertensive TM presented significantly higher values of carotid diameter and carotid intima-media thickness, and lower values of carotid relative distensibility than healthy transgenders. Hypertensive TM showed higher aortic PWV values than non-hypertensive TM. The aortic stiffness correlated significantly and positively with age, androgen treatment duration and waist-to-hip ratio in TM. Properties of the carotid artery correlated with age, anthropometric parameters and glycemic parameters in TM. Shorter CAG polymorphic tracts of TM were associated with higher levels of fasting plasma glucose, basal insulin and HOMA IR index. There was no influence of the CAG polymorphic tract of TM on the presence of cardiovascular comorbidities, anthropometric, pressure, lipid and arterial parameters. These findings suggest a potential deleterious effect of the long-term testosterone therapy on vessels and the need for preventive measures in TM

Introdução: O homem transexual (HT) é um indivíduo de sexo genético feminino, com fenótipo feminino normal, que deseja viver e ser aceito como um membro do sexo masculino. O tratamento hormonal que é realizado no processo de redesignação sexual nesses pacientes consiste na administração de testosterona nas suas diversas apresentações, mais comumente ésteres de testosterona de curta ou longa ação. O tratamento hormonal visa induzir virilização, através da produção de um padrão masculino de crescimento dos pelos faciais e corporais, aumento da massa muscular e interrupção dos ciclos menstruais. O efeito da terapia androgênica na saúde cardiovascular de HT é pouco conhecido, principalmente em relação às repercussões em longo prazo. O HT representa um modelo ideal e único para a avaliação das ações da testosterona exógena administrada em doses suprafisiológicas em um organismo geneticamente feminino. Alguns estudos de farmacogenética demonstraram a influência da repetição CAG do gene do receptor androgênico (RA) nos efeitos observados durante terapia com testosterona em homens hipogonádicos e a maioria dos estudos confirmou a modulação desses polimorfismos sobre fatores de risco cardiovascular. Objetivos: avaliar em HT em tratamento androgênico a prevalência de fatores clássicos de risco cardiovascular e as propriedades estruturais e funcionais dos vasos arteriais; correlacionar a distribuição alélica do microssatélite CAG RA com a ocorrência de comorbidades e com as propriedades estruturais e funcionais dos vasos arteriais; comparar os valores das propriedades estruturais e funcionais dos vasos arteriais de HT com uma população controle (feminina e masculina). Pacientes: 46 pacientes com diagnóstico de HT (faixa etária 42 ± 10 anos) acompanhados no Ambulatório da Unidade de Disforia de Gênero do HCFMUSP e em tratamento com ésteres de testosterona há pelo menos um ano (variação de 1 a 38 anos) foram selecionados para o estudo. Métodos: Parâmetros clínicos (IMC, circunferência abdominal, relação cintura quadril, pressão arterial e pressão de pulso, composição corporal por bioimpedância), a presença de comorbidades (hipertensão arterial, dislipidemia, diabetes mellitus, obesidade) e vícios (tabagismo, etilismo e uso de drogas ilícitas), dados laboratoriais (hematócrito, glicemia de jejum, insulina, índice HOMA IR, hemoglobina glicada, colesterol total, HDL colesterol, LDL colesterol, triglicerídeos e creatinina) e parâmetros vasculares (espessura íntima média da carótida, diâmetro da carótida, percentual da variação sisto-diastólica da carótida e velocidade de onda de pulso dos vasos arteriais) foram avaliados no grupo de HT. Os mesmos parâmetros vasculares também foram avaliados em controles saudáveis masculinos e femininos pareados para idade e IMC com os HT. A distribuição alélica do microssatélite CAG RA foi avaliada em 44 HT através da análise do produto amplificado da região de repetições CAG do exon 1 do gene do RA, utilizando o software GeneMapper. Resultados e Conclusões: Neste grupo de HT em terapia com ésteres de testosterona observamos uma prevalência de dislipidemia de 42%, hipertensão arterial sistêmica de 35%, obesidade de 30%, diabetes de 4% e tabagismo de 20%. HT em tratamento androgênico apresentaram maior velocidade de onda de pulso carotídeo-femoral do que controles masculinos, mas não do que controles femininos, embora no subgrupo >= 42 anos os HT tenham apresentado maior VOP do que controles masculinos e femininos. Não houve diferença de diâmetro, distensão relativa e espessura íntima média carotídea entre HT e controles. Maior diâmetro, maior espessura íntima média e menor distensão relativa da carótida foram observados em HT obesos e hipertensos; e maior velocidade de onda de pulso aórtica em HT hipertensos. Os parâmetros correlacionados à medida funcional da artéria aorta foram a idade, o tempo de tratamento androgênico e a relação cintura-quadril, enquanto que as propriedades estruturais e funcionais da carótida se correlacionaram com idade, parâmetros antropométricos e glicêmicos. Não houve influência do trato CAG RA na comparação entre os HT com e sem comorbidades metabólicas. Repetições CAG RA curtas se associaram com níveis significativamente mais elevados de glicemia de jejum, insulina basal e HOMA IR. Em relação aos parâmetros antropométricos, pressóricos, lipídicos e arteriais, não foi identificada associação com o número de repetições CAG RA. Estes achados sugerem um potencial efeito deletério da terapia androgênica prolongada sobre os vasos arteriais e a necessidade de medidas preventivas em HT / Introduction: Transgender men (TM) are 46, XX individuals, with normal female phenotype, who desire to live and be accepted as a male member. Testosterone esters are used in sex reassignment therapy to induce virilization and to adapt the body to the male identity. The effects of androgen therapy on TM cardiovascular function are poorly known, particularly with regard to long-term androgen treatment. TM represents a good model for evaluation of high-dose exogenous testosterone action in biological women. Pharmacogenetic studies have demonstrated the influence of CAG polymorphic tract of the androgen receptor gene (AR) on the androgenic effects observed during testosterone therapy in hypogonadal men, and most studies confirmed the modulation of these polymorphisms on cardiovascular risk factors. Objective: to evaluate the prevalence of cardiovascular risk factors and the structural and functional properties of large arteries in TM on long-term cross sex hormone therapy compared to a male and female healthy control group; to correlate the allelic distribution of CAG AR polymorphic tract with the cardiovascular comorbidities and the structural and functional properties of large arteries in TM. Patients: Forty-six patients with a diagnosis of TM (42 ± 10 years old), followed at the Gender Dysphoria Unit-HCFMUSP, receiving cross-sex hormone treatment with testosterone esters for at least one year (ranging from 1 to 38 years) were selected for the study. Methods: Clinical parameters (BMI, waist circumference, waist-to-hip ratio, blood pressure, pulse pressure, body fat percentage), the presence of cardiovascular comorbidities (hypertension, dyslipidemia, diabetes mellitus, obesity) and addictions (smoking, alcohol and drug abuse), laboratory parameters (hematocrit, fasting plasma glucose, basal insulin, HOMA IR index, glycated hemoglobin, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and creatinine) and vascular parameters (carotid intima-media thickness, carotid diameter, carotid relative distensibility and aortic pulse wave velocity - PWV) were evaluated in the TM group. The same vascular parameters were also evaluated in healthy male and female control group, matched for age and BMI. The allelic distribution of the CAG AR polymorphic tract was evaluated in 44 TM using the GeneMapper software. Results and Conclusions: In the TM group, we observed dyslipidemia in 42%, hypertension in 35%, obesity in 30%, diabetes in 4% and smoking habit in 20%. The mean aortic PWV values in TM was higher than in male healthy controls (p=0.005), but not than in female controls (p=0.640). When categorized by age, considering the median age, TM >= 42 years had higher aortic PWV measures than male (p < 0.001) and female (p = 0.024) controls, regardless of their arterial blood pressure values. There was no difference in carotid diameter, carotid relative distensibility and carotid intima-media thickness between TM and controls. Obese and hypertensive TM presented significantly higher values of carotid diameter and carotid intima-media thickness, and lower values of carotid relative distensibility than healthy transgenders. Hypertensive TM showed higher aortic PWV values than non-hypertensive TM. The aortic stiffness correlated significantly and positively with age, androgen treatment duration and waist-to-hip ratio in TM. Properties of the carotid artery correlated with age, anthropometric parameters and glycemic parameters in TM. Shorter CAG polymorphic tracts of TM were associated with higher levels of fasting plasma glucose, basal insulin and HOMA IR index. There was no influence of the CAG polymorphic tract of TM on the presence of cardiovascular comorbidities, anthropometric, pressure, lipid and arterial parameters. These findings suggest a potential deleterious effect of the long-term testosterone therapy on vessels and the need for preventive measures in TM

Bakgrund: Transpersoner lider i högre utsträckning av psykisk ohälsa i jämförelse med övrig befolkning. I enlighet med lagar och konventioner har alla människor rätt till jämlik och adekvat vård. Sjuksköterskor behöver bred kompetens för att kunna ge hälsofrämjande och likvärdig vård. Trots det upplevs svårigheter att behandla transpersoner på grund av otillräcklig utbildning och kunskap. Syfte: Syftet var att beskriva transpersoners upplevelser av mötet med vårdpersonal. Metod: En litteraturöversikt baserad på tolv kvalitativa vetenskapliga originalartiklar. Litteratursökningarna genomfördes i databaserna Cinahl Complete och PubMed. Resultat: I resultatet framkom fyra kategorier; att bli felkönad, människa inte vara transperson, betydelsen av kunskap eller okunskap hos vårdpersonal och vårdmiljöns betydelse. Transpersoner upplevde att deras könsidentitet var dominerande i mötet med vårdpersonal oavsett sökorsak. Upplevelsen av att inte få adekvat vård eller bemötande på grund av kompetensbrist var också tydlig. Sammanfattning: Bemötande har stor betydelse för hur transpersoner upplever sin vård. Positiva upplevelser av mötet med vårdpersonal var trygghetsingivande och stärkande medan negativa upplevelser var diskriminerande och icke hälsofrämjande. En ytterligare påverkande faktor var vårdmiljön. / Background: Transgender people suffer to a greater extent from mental illness in comparison to the rest of the population. In accordance with laws and conventions, everyone has the right to equal and adequate care. Nurses need broad competence to be able to provide health-promting and equivalent care. Despite that, difficulties are experienced in treating transgender people due to insufficient education and knowledge. Aim: The aim was to describe transgender persons experiences of healthcare encounters. Method: A litterature review based on twelve original qualitative scientific articles. The litterature search was carried out in the databases Cinahl Complete and PubMed. Results: Four categories emerged in the results; to be misgendered, human not just a transgender person, the importance of knowledge or lack of knowledge of healthcare staff and the importance of the healtcare environment. Transgender people felt that their gender identity was dominant in the encounter with healthcare professionals, regardless of the reason for seeking health care. The experience of not receiving adequate care or treatment due to lack of knowledge was also clear. Summary: The healthcare encounter has a great significance for how transgender people experience their care. Positive experiences of the encounter with healthcare personnel were reassuring and empowering, while negative experiences were discriminatory and did not promote transgender persons health. An additional factor that influenced the impression was the health care enviroment.