RESUMEN

The surgery of trans people is not apprehended by most of plastic surgeons as a simple surgery for the purpose of morphological transformation. At the same time, the French trans population does not benefit from adequate surgical coverage. Over the past few years, French regulations have simplified the process of reassignment surgeries. In addition, we have witnessed a fairly rapid increase in requests for transition surgery with accelerated and sometimes atypical courses. In recent years, a number of specialists have warned the medical community about the risks of slippage due to a lack of psychological monitoring of certain people beginning a transition process. Quite recently, hybrid transition paths have also appeared which, from a surgical point of view, are no longer limited to ensuring that a native assigned female patient can take on the most masculine appearance possible or the reverse. In this manuscript, we expose the biological, historical and societal place of transidentity and then address the reasons for the warnings of a certain category of the medical population while reassuring the surgical community on the benefits of reassignment surgeries in a controlled context. We end by proposing a few ways to improve the care course of trans people applicable in France.

RESUMEN

Thoracic reassignment surgeries are the most common gender reassignment surgeries. They represent the first and sometimes the only step in the reassignment process for transgender patients. Surgical techniques for thoracic reassignment derive from those used for the cisgender population and are accessible to plastic surgeons who do not usually treat transgender patients. On the other hand, there are some anatomical differences between men and women that they should understand, for instance, the positioning of the neo-NAC, the neo-inframammary fold and the scars. It is therefore important to understand these anatomical differences in order to optimize the cosmetic results of these surgeries so that they correspond to the expectations of these patients. In addition, the plastic surgeon will also have to be careful to adapt his approach to the relational level, with these patients, such as avoiding misgendering or using the "dead name". Finally, even if these operations are theoretically covered at 100% by the French health insurance, a request for prior agreement may be required in certain cases.

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RESUMEN

Our consultations are saturated by an influx of requests from young people - and very often from their parents - for whom the binarity of the boy/girl classification has been shattered, and whose only watchword is: "I choose my gender, my sexuality, my body, my way of being, of moving and representing myself, I want to become what I am". For them, anatomy is no longer a fatality: hormones, mutilating and restorative surgeries, increasingly sophisticated aesthetic techniques make it possible to adapt their body and their gender to their intimate aspirations. Psychological support must help these patients to explore their gender identity, and allow them to live it as well as possible in their social and family environment.

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RESUMEN

Support for trans teenagers and young adults is based on a comprehensive approach to care, taking into account the needs and desires of the individual and his or her environment. It involves welcoming their requests and listening to their questions, in order to help them assert themselves. The aim is to be particularly attentive to these young people, sometimes in vulnerable psychological, social and educational situations, as well as to their families, by welcoming them, listening to them and taking charge of them through multidisciplinary networks.

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RESUMEN

Gender identity is a concept that is both widespread and relatively abstract for most citizens. It seems important to define this notion in its dynamic perspective, by concretely exploring the administrative, legal, therapeutic, surgical and social components of a person's transition journey in France in 2023. The major role played by militant lesbian, gay, bisexual and transgender associations and the ethical issues raised by this change of identity must be highlighted.

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RESUMEN

In the light of sociological, anthropological and philosophical developments on gender issues, there is no longer any legitimate theory in Western society that can account for the process of identity development, the links between the biological realities and limits of the sexed body and the experience of gender. It's necessary to listen to everything that's said, not only by the young person but also by his or her parents, and even by the wider family, without any preconceived notions, judgments or normative criteria, but also to avoid the temptation to say "why" in favor of offering help. For some children and teenagers, it's possible to offer a transitional pathway.

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RESUMEN

Oftentimes ignored or infrequently expressed, some transgender persons harbor a desire for parenthood. Given the evolution of medical techniques and the enacting of legislative reforms, it is henceforth possible to propose fertility preservation strategies in the overall context of gender transidentity. During the "female to male" (FtM) transition pathway, androgen therapy has an impact on gonadic function, generally inducing blockage of the ovarian function, with amenorrhea. Even though these events may be reversed on cessation of treatment, the possible long-term effects on future fertility and on the health of children yet to be born are little known. Moreover, transition surgeries definitively compromise the possibility of pregnancy insofar as they involve bilateral adnexectomy and/or hysterectomy. Options for fertility preservation in the framework of FtM transition are premised on cryopreservation of oocytes and/or ovarian tissue. In a comparable manner, even though relevant documentation is lacking, hormonal treatments for persons transitioning from male to female (MtF) can have an impact on future fertility. In the event of surgery involving bilateral orchidectomy in which spermatozoid cryopreservation has not been carried out, fertility is definitively impossible. In both cases and under present-day legislation, numerous legal and regulatory barriers render highly problematic the reutilization of cryopreserved gametes. Given these different constraints, it is indispensable to closely supervise these types of treatment by proposing psychological support.

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RESUMEN

The issue of trans minors is becoming more and more important as a new issue of care, especially in the health field. The nursing world is no stranger to these requests for support, at school or in specialized centers. This is why, through this article, it seemed necessary to go back over some definitions and to deconstruct some prejudices concerning this population.

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RESUMEN

All methods of contraception used by a cisgender woman can theoretically be used by a transgender man. In practice, some contraceptives can aggravate gender dysphoria and should be discarded. On the other hand, contraceptives which make it possible to consolidate amenorrhea or to accentuate the virilization induced by taking testosterone will be better tolerated.

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RESUMEN

In France, the health of trans minors remains a sensitive and too often invisible subject, leaving a population marked by great vulnerability on the margins of health services. It is therefore particularly interesting to highlight the medical issues related to this population, the psychological risks related to transphobia and the questions related to hormonal treatments at the heart of current controversies.

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RESUMEN

Today, more and more young people are questioning the fixations of identity. They claim the right to invent themselves and invite adults to deconstruct the boundaries between masculine and feminine, between heterosexuality and homosexuality. Parents are often disconcerted by this, especially when they are confronted with transgender issues in their child or adolescent. They react in different ways, from guilt to rejection, from resignation to support. The work of professionals, especially psychiatrists, does not consist so much in identifying the sources of gender issues as in creating a space for listening and supporting young people who are at particular risk of suicide.

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RESUMEN

Gender transitions have been taking place in France for more than fifty years. Recently, case law has come to fruition and has further strengthened the rights of transgender people. However, the issues related to being transgender, including in the medical field, remain too often unknown. This article reports on the specificities and non-specificities of the transidentitarian experience.

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RESUMEN

Transgender people should be patients like any other. However, many testimonies describe how difficult, even painful, access to care is for them. Some health care providers react with incomprehension, rejection and discrimination, which can be perceived as violence towards transgender patients. A change in health policies and the implementation of training are fundamental to ending these inequalities in care.

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RESUMEN

In addition to the Code of Ethics, the legal framework protecting transgender people in their medical care is very limited. The conclusions of different reports or opinions, notably from the National Consultative Commission on Human Rights, show that transgender individuals are often faced with a great lack of understanding on the part of health care providers. This ultimately leads to discrimination, and therefore to abuse. Improving their care is important in order to limit this discrimination and, consequently, the factors of over-victimization.

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RESUMEN

The evolution of medical techniques as well as legislative changes currently allow to propose fertility preservation strategies in the context of transidentity. During "female to male" transition, androgen therapy has an impact on gonadal function since it usually induces a blockage of ovulation with amenorrhea. Although this effect is reversible when treatment is stopped, the possible long-term effects of testosterone treatment on future fertility or health of future children are poorly known. In addition, transitional surgeries definitely compromise fecundity when they include bilateral ovariectomy and/or hysterectomy. Yet, although long ignored or poorly expressed, the desire for parenthood is a reality in transgender men. Fertility preservation options in FtM transition rely on oocyte or ovarian tissue cryopreservation. The purpose of this review is to provide an overview of the literature regarding fertility preservation in transgender men. Although series remain limited, the increase in the number of recently published articles reflects the interest in improving the management of fertility issues in transgender men.

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Transgender patients are at increased risk of cancer, sexually transmitted diseases, short- and long-term postoperative complications in patients with vaginoplasty, but also unwanted pregnancy in non-hysterectomized trans men. However, access to care is often difficult for these patients, who often do not benefit from appropriate gynecological monitoring, especially for fear of judgment or discrimination. In view of the health risks of these patients, it is essential to be able to offer them specific and adapted gynecological follow-up. To date, there are no clear recommendations regarding the gynecological follow-up of transgender patients. We relied on the recommendations of the World Professional Association of Transgender Health (W-PATH) and the Endocrine Society Guideline and performed a literature review. We carried out several searches via pubmed in order to explore one by one the different aspects of gynecological follow-up, in particular of non-hysterectomized transgender men and transgender women with a vaginoplasty. It emerges from this a lack of follow-up of transgender people, with a reluctance to consult a gynecologist, associated with the lack of knowledge and experience of health professionals. Due to the risks identical to those of the general population, added to those specific to transgender people, it is important to be able to offer these patients specialized and personalized gynecological follow-up, and to raise awareness and train health professionals on the importance of and the specificities of the gynecological follow-up of these patients.

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Many health care professionals are dealing with the issue of transgender people in their medical practice. In the field of reproduction, Trans people can benefit from fertility preservation before the introduction of hormonal treatment or surgery altering their fertility. This article, which is the result of a collaborative work of several reproductive professionals involved in the health of Trans people, provides an overview of the possibilities of fertility preservation and medically assisted reproduction techniques in France for Trans people.

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RESUMEN

Since the end of the 1990s, the management of transgender adolescents has developed in many countries following the Dutch Approach initiated in the Netherlands. Dedicated consultations have been developed in France since 2013, welcoming a growing number of children and adolescents. What kind of support is offered to children and their families?

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Becoming a father is a process that covers different situations. In addition to the well-known situations of traditional conception and sperm donation, there are others that need to be considered. These situations concern in particular access to parenthood for transgender men who have made a social transition.

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RESUMEN

The evolution of medical care for transgender people currently makes it possible to propose fertility preservation. Fertility preservation should be initiated before the start of hormonal treatments and/or surgical procedures. The "reproductive" aspect and the desire for parenthood among transgender people have long been ignored. However, these aspects are important to consider and fertility preservation should be discussed before the start of the physical transition. The aim of this review is to assess the literature on fertility preservation for transgender women ("male to female"). Many uncertainties remain regarding the impact of hormonal treatments on the reproductive functions of transgender women and their reversibility. However, the significant increase in the number of recently published articles is evidence of the improvement in the conditions of access to these procedures for women starting a transition process. Nevertheless, there are still a number of barriers that can prevent or delay this process.

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