Publications by authors named "Randi Ettner"

Gender incongruence describes a condition in which an individual's gender identity does not align with their sex assigned at birth based on anatomic characteristics. Individuals with gender incongruence may request surgical interventions, and gender-affirmation surgery plays an important role for these individuals. The basis of care derives from principles elucidated in the Standards of Care, international guidelines that help inform clinical decision-making.

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Background: A rare, but consequential, risk of gender affirming surgery (GAS) is post-operative regret resulting in a request for surgical reversal. Studies on regret and surgical reversal are scarce, and there is no standard terminology regarding either etiology and/or classification of the various forms of regret. This study includes a survey of surgeons' experience with patient regret and requests for reversal surgery, a literature review on the topic of regret, and expert, consensus opinion designed to establish a classification system for the etiology and types of regret experienced by some patients.

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The requests for medically necessary surgical interventions for transgender individuals have steadily increased over the past several years. So too has the recognition of the diverse nature of this population. The surgeon relies heavily on the mental health provider to assess the readiness and eligibility of the patient to undergo surgery, which the mental health provider documents in a referral letter to the surgeon.

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Importance: In 2014, the US Department of Health and Human Services decided that its 1981 exclusion of transsexual surgical treatments from Medicare coverage was based on outdated, incomplete, and biased science and did not reflect current evidence or standards of care, and the exclusion was therefore lifted. As a direct result of this decision, surgeons nationwide are seeing an increase in consultations for surgical therapy to help transgender and gender-nonconforming individuals. Although some clinicians may have the technical training for such surgical procedures, in many cases, they may not have a full understanding of the complex and comprehensive care required to provide optimal health care for transgender individuals.

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Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient-provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed.

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Purpose Of Review: Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research.

Recent Findings: Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being.

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Care of the elderly transgender patient.

Curr Opin Endocrinol Diabetes Obes

December 2013

Purpose Of Review: This review examines recent developments regarding the care of the elderly transgender patient. There is scant clinical or other relevant information related to this topic, as the phenomenon of gender incongruity has been largely misunderstood and underreported. It is important that guidelines for appropriate and sensitive care be established, as this population is proliferating due to media attention and greater access to care.

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Several forces conspire to make the later decades a climacteric for transgendered persons. This paper will examine the social, emotional, and hormonal influences that entwine and challenge the stability of the elderly transgendered person. Case studies and therapeutic interventions will be addressed.

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Literature supporting a relationship between emotions and regulation of blood pressure dates back to the early 1900s. Theoretical explanations of the pathophysiology of the correlation have centered on several possible trajectories, the most likely being cardiovascular reactivity to stress. Prospective studies have demonstrated that chronic stress and enduring traits such as defensiveness and anxiety, impacts the development of hypertension.

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It is a relatively uncommon event that children find themselves in a situation with a parent who undergoes a transition from one sex to another. Unlike situations of divorce or a parent with a medical or major psychiatric disorder, it is unlikely that the children will know of other children who encounter similar situations. There is very little literature that describes the adjustment of these children and the nature of their relationships with their parents and peers.

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