Eight-year follow-up on postoperative improvement protocol in extensive metoidioplasty transgenders:A case series

Background:This study aimed to evaluate the long-term penile size among patients who underwent extensive metoidioplasty.Methods:An evaluation was conducted on 7 out of 14 patients(mean age:29.71±13.76 years)who participated in a 2015 study that introduced a postoperative protocol to improve penile size after extensive metoidioplasty.Five transsexual females(46XX karyotype)and two patients with 5-alpha reductase deficiency were retrospectively followed up in 2023 to assess the long-term efficacy of the protocol at a specialized clinic in a general hospital in Tehran,Iran.All participants were informed about the study and consented to participate.Results:Five patients achieved increased penile size from their 2015 measurements(mean,29.00±13.34 mm).Five patients requested a larger sized penile traction device to continue the protocol.Conclusion:The long-term implementation of this protocol can result in increased penile size.We advise highly motivated patients to continue practicing the protocol to achieve better results.

Testosterone decreases adiponectin levels in female to male transsexuals

Aim： To evaluate the effect of testosterone （T） on adiponectin serum levels in transsexual female patients. Methods： We measured adiponectin, leptin, luteinizing hormone and follicle stimulating hormone, T, estradiol, lipid profile, biochemical parameters and body composition in 16 transsexual female patients at baseline and after 6 months of T treatment （100 mg Testoviron Depot/10 days, i.m.）. Results： Adiponectin levels were 16.9 ± 7.3 mg/mL at baseline and 13.5 ± 7.4 mg/mL at month 6 of T treatment （P 〈 0.05）. Leptin and high-density lipoprotein cholesterol decreased significantly, whereas body mass index, waist circumference and lean body mass increased significantly after 6 months of T treatment. No changes in insulin or Homeostasis Model Assessment were detected. Conclusion： T can significantly reduce adiponectin serum levels in transsexual female patients.

Polymicrogyria of the Unilateral Temporal Lobe in a Transsexual Patient—Case Report

Introduction: Polymicrogyria, the appearance of irregular small and over numbered gyri on the surface of the brain, has been reported as the most frequent finding, when exists, on the temporal lobe. Case Presentation: A patient, male, age of 35, came to the regular head and brain MRI scan due to psychiatric and hormonal treatment within transsexualism. There were no data of epilepsy in a patient’s history. MRI scans were acquired with a 1.5 T Siemens Magnetom system with a standard head coil. Three-dimensional 3D RAGE, contiguous 1.0 mm slice, and 1 acquisition sequence underwent final 3D rendering and subsequent volumetry. On the definitive 3D image, we have revealed an unusual gyrisation on the left temporal lobe which had a picture of partial polymicrogyria. Conclusion: This is a unique finding, to our knowledge, of the unilateral temporal polymicrogyria in a person with transsexualism. Although polymicrogyria is mostly related to epileptifom attacks, its impact on the transsexualism appearance is opened to be examined.

Penile reconstruction

During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.

Penile prosthesis implantation in a transsexual neophallus

Reconstruction surgery for a female to male transsexual usually involves mastectomy, hysterectomy and creating anaesthetically appealing neophallus. We have successfiflly inserted an inflatable prosthesis using the AMS CX prosthesisin a 45 year old transsexual, who had a large bulky neophallus constructed from the anterior abdominal subcutaneousfat, about 9 years ago. The single cylinder CX prosthesis was well anchored to the symphysis pubis using a dacronwindsock tubing, the activation pump was placed in the dependent pouch of the right labium and the reservior in theusual perivesical space. The patient subsequently had debulking procedure using liposuction to create a more aestheticand functional phallus. To date, the inflatable neophallus prosthesis is functioning well. (Asian J Androl 2000 Dec;2: 304-306)

Daniel Paul Schreber’s Homosexuality and Schizophrenia

Daniel Paul Schreber(1842-1911)was once the Presiding Judge in the Saxon Court of Appeal and a doctor of law in Germany,until he was afflicted with a severe mental illness in 1884.He was given the diagnosis of paranoid schizophrenia.His delusional systems involved intimate contact with God and the overwhelming desire to become a woman and to be impregnated by God.He repressed his homosexuality throughout his life.He published an autobiographical account of his mental illness in 1903 in a book entitled Denkwürdigkeiten eines Nervenkranken(Memoirs of a Nervous Illness),which soon became a classic of psychiatric literature commented on by Sigmund Freud,Carl Jung and other psychoanalysts.

Prefabricated Anterolateral Thigh Flaps for Phalloplasty in Female-to-Male Transsexuals

Background Phalloplasty is still a challenging operation because of the high urethral complication rate.Several options regarding different flaps can be chosen,but there is still no perfect solution for phalloplasty in female-to-male(FTM)transgender patients.Our group tried to use prefabricated anterolateral thigh(ALT)flaps for phalloplasty to overcome the urethral complications.Methods A total of 21 transgender patients were included from 2010 to 2019.A twostage operation was performed to reconstruct the phallus.The vaginal mucosa was prefabricated as neourethra at the first stage,and the shaft of the phallus was reconstructed at the second stage.Results All reconstructed phallus survived completely in our study,and the satisfaction rate was 76.2%.The total complication rate was 57.1%.The occurrence of fistula and strictures after the operation was 52.4%and 5.8%,respectively Conclusion Prefabricated ALT flaps with vaginal mucosa have a lower stricture rate.This technique provides a simple,effective surgical option in FTM transsexuals.