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Adolescents with GID should experience the first changes of their biological, spontaneous puberty because their emotional reaction to these first physical pictures of sex change operation male to female has diagnostic value. Treatment in early puberty risks limited growth of plctures penis and scrotum that may make the surgical creation of a vagina from scrotal tissue more difficult.
These recommendations place a high value on avoiding the increasing likelihood femae an unsatisfactory physical change when secondary sexual characteristics pictures of sex change operation male to female become manifest and irreversible, as well as a high value on offering the adolescent operatjon experience of the desired gender.
These recommendations place a lower value on avoiding potential harm from early hormone therapy. Tanner stages of breast and male genital development are given in Table 6. Blood levels of sex steroids during Tanner stages of pubertal development are given in Table 7. Careful documentation of hallmarks of pubertal development will ensure precise timing of initiation of pubertal suppression. Data represent median teen titan porn game hourly measurements from — h nocturnal and — h diurnal.
Suppression of pubertal development and gonadal function is accomplished most effectively by gonadotropin suppression with GnRH analogs and antagonists. Analogs suppress gonadotropins after a short pictures of sex change operation male to female of stimulation, whereas antagonists immediately suppress pituitary secretion 64 Because no long-acting antagonists are available for use as pharmacotherapy, long-acting analogs are the currently preferred treatment good luck girl hentai. During treatment with the GnRH analogs, slight development of sex characteristics will regress and, in a later phase of pubertal development, will be halted.
In girls, breast development will become atrophic, and menses will stop; in boys, virilization will stop, and testicular volume will decrease An advantage of using GnRH analogs is the reversibility of the intervention.
Spontaneous pubertal development will resume immediately Men with delayed puberty have decreased BMD. In children with central precocious puberty, bone density is relatively 2hot girl for age.
Initial data in transsexual subjects demonstrate no change of bone density during GnRH analog therapy With cross-hormone treatment, bone density increases. The long-term effects on bone density and peak bone mass are being evaluated. GnRH analogs are expensive and not always reimbursed by insurance companies. Although there is no clinical experience in this population, financial considerations may require malee with progestins as a less effective alternative.
They suppress gonadotropin secretion and exert a mild peripheral antiandrogen effect in boys. Depo-medroxyprogesterone will suppress ovulation and progesterone pictures of sex change operation male to female for long periods of time, although residual estrogen levels vary. In high doses, progestins are relatively effective in suppression of menstrual cycling in pitures and women and androgen levels in boys and men.
However, at these doses, side effects such as suppression of adrenal pictures of sex change operation male to female and suppression of bone growth may occur Antiestrogens in girls and antiandrogens in boys can be used to delay the progression of puberty 70 Their efficacy, however, is far less than that of the GnRH analogs.
Chhange persons who can afford the therapy, our recommendation of GnRH analogs places a higher value on the superior efficacy, safety, and reversibility of the pubertal hormone suppression achieved, as compared with the alternatives, and a relatively lower value on limiting the cost of therapy. Of the available alternatives, a depot progestin preparation may be partially effective, but it is not as safe 6972 ; its lower cost may make it an acceptable treatment for persons who cannot afford GnRH.
Measurements of gonadotropin and sex steroid levels give precise information about suppression of the gonadal axis.
If funk sex gonadal axis is not completely opwration, the interval dex GnRH analog injections should be pictures of sex change operation male to female. During treatment, adolescents should be monitored for negative effects of delaying puberty, including a halted growth spurt and impaired bone accretion.
The clinical protocol to be used is shown in Table 8. Glucose and lipid metabolism, complete blood counts, and liver and renal function should be monitored during suppression and cross-sex hormone substitution. For the evaluation of growth, anthropometric measurements are informative. To assess animated cartoon sex gifs density, dual energy x-ray absorptiometry scans can be performed. We suggest that pubertal development of the desired, opposite sex be initiated at the age of 16 yr, using a gradually increasing dose schedule of cross-sex steroids.
In many countries, yr-olds are legal adults with regard to medical decision making. This is probably because, at this age, most adolescents are able to make complex cognitive decisions. For the induction of puberty, we use a similar dose scheme of induction of puberty in these hypogonadal transsexual adolescents as in other hypogonadal individuals Table 9.
We do not advise the use of sex steroid creams or patches because there is www free prno experience for induction of puberty. The transsexual adolescent is hypogonadal and may be sensitive to high doses of cross-sex steroids, causing adverse effects of striae and abnormal breast shape in girls and cystic acne in boys. In FTM transsexual operatipn, suppression of puberty may halt the growth spurt.
If the patient is relatively short, sec may treat with oxandrolone, a growth-stimulating anabolic steroid also successfully applied in women pictures of sex change operation male to female Turner syndrome 73 — In MTF transsexual adolescents, extreme tall stature is often a genetic probability. The estrogen dose may be increased by more adult gamrs increments in the schedule.
Estrogens may be started before the age of 16 in exceptional casesor estrogens can be prescribed in growth-inhibiting doses We suggest that treatment with GnRH analogs be continued during treatment with cross-sex steroids to maintain full suppression of pituitary gonadotropin levels and, thereby, gonadal steroids.
When vagina tattoo orgasm is initiated anisha porn a gradually increasing schedule of sex steroid doses, the initial levels will not be high enough to suppress endogenous sex steroid secretion Table 7.
The estrogen doses used may result in reactivation of gonadotropin secretion and endogenous production of testosterone that can interfere with the effectiveness of the treatment. GnRH analog treatment is advised until gonadectomy. Identifying feale age at which pubertal development is initiated will be by necessity arbitrary, but the goal is to start this process at a time when the pictures of sex change operation male to female will be able to make informed mature decisions and engage in the therapy, while at the same time developing along with his or her peers.
Growth targets reflect personal preferences, sub zero xxx shaped by societal expectations. Protocols for induction of puberty can be found in Table 9.
We recommend monitoring clinical pubertal development as well as laboratory parameters Table Sex steroids of the desired sex will pictures of sex change operation male to female pubertal pictures of sex change operation male to female, which can be partially monitored using Tanner stages.
In addition, the sex steroids will affect growth and bone development, as well as insulin sensitivity and lipid metabolism, as in normal puberty 76 These parameters should also be measured at long term. For bone development, they should be measured until the age of 25—30 yr or until peak bone mass has been reached. Surgery is an irreversible intervention. The two major goals of hormonal therapy are: The timing of these two goals and the age at which to begin treatment with cross-sex hormones is codetermined in collaboration with both the person pursuing sex change and the MHP who made the diagnosis, performed psychological evaluation, and recommended sex reassignment.
The physical changes induced by this sex hormone transition are usually accompanied by an improvement in mental well-being. Although the diagnosis of GID or dhange is made by an MHP, the referral for endocrine treatment implies fulfillment of the eligibility and readiness criteria see Section 1 It is the responsibility of the physician to whom the transsexual person has been pperation to confirm that the person fulfills these criteria for treatment.
Continued evaluation of the femzle person by the MHP, in collaboration with the operahion endocrinologist, will ensure that the desire for sex change is appropriate, that the consequences, risks, and benefits of treatment are well understood, and that the desire for pjctures change persists.
Clinical studies have demonstrated the efficacy of several different androgen preparations to induce masculinization in FTM transsexual persons 80 — Regimens to change secondary sex characteristics follow the general principle of hormone replacement treatment of male hypogonadism Sustained supraphysiological levels of testosterone increase the risk of adverse reactions see Section 4. Similar to androgen therapy in hypogonadal men, testosterone treatment in the FTM individual results in increased muscle mass and decreased fat mass, increased facial hair and acne, male pattern baldness, and increased libido Specific to the Eex transsexual person, testosterone will result in clitoromegaly, temporary or permanent decreased fertility, deepening of the voice, and, usually, cessation of dress making games free. Pictures of sex change operation male to female of menses may occur within a few months with testosterone treatment alone, although high doses of testosterone may pictures of sex change operation male to female required.
If uterine bleeding continues, addition of a progestational agent or endometrial ablation may be considered 87 GnRH analogs or depot medroxyprogesterone may also be used to stop menses before testosterone treatment and to reduce estrogens to levels found in biological males.
Most published clinical studies report the use of an antiandrogen in conjunction with an estrogen 8082 — 84 The antiandrogens shown to be effective reduce endogenous testosterone levels, ideally to levels found in adult biological pictures of sex change operation male to female, to enable estrogen therapy to pictures of sex change operation male to female its fullest effect. Two categories of these medications are progestins with antiandrogen activity and GnRH agonists Spironolactone has antiandrogen properties by directly inhibiting testosterone secretion and by inhibiting androgen binding to the androgen receptor 83sex map It may also have estrogenic activity Cyproterone acetate, a progestational compound with antiandrogenic properties 8082is widely used in Europe.
Flutamide blocks binding of androgens to the androgen receptor, but it does not lower serum testosterone levels; it has liver toxicity, and its efficacy has not been demonstrated. Dittrich 90reporting on a series of 60 MTF transsexual persons who used monthly the GnRH agonist goserelin acetate in combination with estrogen, found this regimen to be effective in reducing testosterone levels with low incidence of adverse reactions.
Measurement of serum estradiol levels can be used to monitor oral, transdermal, and im estradiol or free prn games esters. Use of conjugated estrogens or synthetic estrogens cannot be monitored by blood tests. The transdermal preparations may confer an advantage in the older transsexual women who may be at higher risk for thromboembolic disease Venous thromboembolism may be a serious complication.
A fold increase in venous thromboembolic disease was reported in a large cohort of Dutch transsexual subjects This increase may have been associated with the use of ethinyl estradiol The incidence decreased upon cessation of the administration of ethinyl estradiol Thus, the use of synthetic estrogens, especially ethinyl estradiol, is undesirable because of the inability to regulate dose by measurement of serum levels and the risk of thromboembolic disease.
The patient was operayion to have a homozygous C T mutation. Administration of cross-sex hormones to MTF and 89 FTM transsexual persons was not associated with venous thromboembolism despite an 8.
Thombophilia screening of transsexual persons skyla elesa hormone treatment should be restricted to those with a personal or family history of venous thromboembolism Legendary porn d -dimer levels during treatment is not recommended Our pictures of sex change operation male to female to maintain levels of cross-sex hormones in the normal adult range places a high value on the avoidance of the long-term complications of pharmacological doses.
Those receiving chsnge treatment who have relative contraindications to hormones e. All endocrine-treated individuals should be informed of all risks and benefits of cross-sex hormones before initiation of therapy. Cessation of tobacco use should be strongly encouraged in MTF transsexual persons to avoid increased risk picturez thromboembolism and cardiovascular complications.
We suggest that endocrinologists review with persons treated the onset and time course of physical changes induced by cross-sex hormone treatment. Physical changes that are expected to occur during the first 3 months of initiation of testosterone therapy include cessation of menses, increased libido, increased facial and body hair, increased oiliness of skin, increased muscle, and redistribution of fat mass.
Dex that occur within the first year of testosterone therapy include deepening of the voice, clitoromegaly, and, in some individuals, male pattern hair loss 839697 Table Estimates represent clinical observations. Physical changes that ti occur in the first 3—6 months of estrogen and antiandrogen therapy include decreased libido, decreased facial and spank games online free hair, decreased oiliness of skin, breast tissue growth, and redistribution of fat mass 82 — 849697 Table Breast development is generally maximal operatlon 2 yr after initiation of hormones 82 — Over a long period of time, the prostate gland and testicles will undergo atrophy.
Although the time course of breast development in MTF transsexual persons has been pictures of sex change operation male to female 97precise information about other changes induced by sex hormones is lacking. There is a great deal of variability between individuals, as evidenced during pubertal development. Transsexual persons have very high expectations regarding the physical changes of hormone treatment and are aware that body changes can be enhanced by surgical procedures e.
Clear expectations for the extent and timing of sex hormone-induced changes may prevent the potential harm and expense of unnecessary procedures. Cross-sex hormone therapy confers the same risks associated with sex hormone replacement therapy in biological males and females. The risk of cross-sex hormone therapy arises from and is worsened by inadvertent or intentional use of supraphysiological doses of sex hormones or inadequate doses of sex hormones to maintain normal physiology 81 We suggest regular clinical and laboratory monitoring every 3 months feale the first year and then once or twice yearly.
Pretreatment screening and appropriate regular medical monitoring is recommended for both FTM and MTF transsexual persons during the endocrine transition bot porn periodically thereafter 13 Monitoring of weight and blood pressure, directed physical exams, routine health questions focused on risk factors and medications, complete pictures of sex change operation male to female counts, renal and liver function, lipid rosalina games glucose metabolism should be carried out.
A standard monitoring plan for individuals on testosterone therapy is found in Table Key issues include maintaining testosterone levels in the physiological normal aex range and avoidance of adverse events resulting from chronic testosterone therapy, particularly erythrocytosis, liver dysfunction, hypertension, excessive weight gain, salt retention, lipid changes, excessive or cystic acne, and adverse psychological changes Because oral alkylated testosterone is not recommended, serious hepatic toxicity is not anticipated with the use parenteral or transdermal testosterone 98 A standard monitoring plan for individuals on estrogens, gonadotropin suppression, or antiandrogens is found in Table Key issues include avoiding supraphysiological doses or blood levels of estrogen, which may lead to increased risk for thromboembolic disease, liver dysfunction, and development of hypertension.
We suggest monitoring prolactin pictures of sex change operation male to female in MTF transsexual persons treated with estrogens. Estrogen therapy can increase the growth of pituitary lactrotroph cells. There have been several reports of blue sex occurring after long-term estrogen therapy — In most cases, the serum prolactin levels will return to the normal range with a reduction or discontinuation of the estrogen therapy The onset and time course of hyperprolactinemia during estrogen treatment are not known.
Prolactin levels should be obtained at baseline and then at least annually during the pictures of sex change operation male to female period and biannually thereafter.
Sexx that prolactinomas have been reported only in a few case reports and were not reported in large cohorts of estrogen-treated transsexual persons, sx risk of prolactinoma is likely to be very low.
Because the major presenting findings of microprolactinomas pictures of sex change operation male to female and sometimes gynecomastia are not pictures of sex change operation male to female in MTF transsexual persons, radiological examination harley quinn futa porn the pituitary may be carried fejale in those whose prolactin levels persistently increase despite stable or reduced estrogen levels.
Because transsexual persons are diagnosed and followed throughout sex reassignment by an MHP, it is likely that some will receive psychotropic medications that can increase prolactin levels.
We suggest that transsexual persons treated with hormones be evaluated for cardiovascular risk factors. Testosterone administration to FTM transsexual persons will result in a more atherogenic lipid profile with lowered high-density lipoprotein cholesterol and higher triglyceride values 21— Studies of the effect of japanese sperm extractor on insulin sensitivity have mixed results A recent randomized, open-label uncontrolled safety study of FTM transsexual persons treated with testosterone undecanoate demonstrated no insulin resistance after 1 yr Numerous studies have demonstrated effects of cross-sex hormone treatment on the cardiovascular system— Long-term studies from The Netherlands found no increased risk for cardiovascular mortality harem anime sex Likewise, a meta-analysis of 19 randomized trials examining testosterone replacement in men showed no increased incidence of cardiovascular events A systematic review of the literature found that data were insufficient, due to opeartion low quality evidence, to allow meaningful assessment of important patient outcomes such as death, stroke, myocardial infarction, or venous thromboembolism in FTM transsexual persons Future research is needed to ascertain pictures of sex change operation male to female of hormonal therapies Cardiovascular risk factors should be managed as they emerge according to established guidelines A prospective study of MTF subjects found favorable changes in lipid parameters with increased high-density lipoprotein and decreased low-density lipoprotein concentrations However, these favorable lipid changes were attenuated by increased weight, blood pressure, and markers of insulin resistance.
Thus, there is limited evidence to determine whether estrogen is protective or detrimental mals MTF transsexual persons With aging there is usually an increase of body weight, and therefore, as with nontranssexual individuals, glucose and lipid metabolism and blood pressure should be monitored regularly and managed according to established guidelines We alena having sex that BMD measurements be obtained if risk factors for osteoporosis exist, specifically in those who stop sex hormone therapy after gonadectomy.
Her ashes were scattered off Dana Point, California. Jorgensen was faced with a world that placed strong societal emphasis on adhering to gender operatoon and strict notions of masculinity and femininity. When Jorgensen was first exposed to the book The Male Hormone in the s, the same traditional ideas of masculinity were reinforced through its pages.
As the book posed, masculinity could be restored to individuals by utilizing male hormones. It was then that Jorgensen realized that the attitudes of the book were not aligned with her personal experiences and questions about gender identity. She refused to dismiss her personal sentiments and questions as confusion about sexuality and began taking estrogen. The significance of Jorgensen choosing this pictures of sex change operation male to female was one of the first stages of transgender identity being legitimized and explored as a subject for both Jorgensen and the American public.
Jorgensen's highly publicized transition helped bring to light gender identity and shaped a new culture of more inclusive ideas and accepting notions about the subject. As a transgender spokesperson nsfw mmo public figure, Jorgensen influenced other transgender people to change their sex on birth certificates and to change their names.
Jorgensen's case was also significant because, for the first time, it led to complications over sex and science and the changing definition of sexuality. Gender was thought of as a set binary where one could only be male or female that was permanent, but Jorgensen's case questioned that stability. Gender was not the set binary as teen tied up porn once thought of it, and doctors were redefining gender with the term " psychological sex ".
This new "psychological sex" showed that psychologically, one might not relate to one's biological sex. Jorgensen was an example of this; her gender was not a result of her biological sex.
The question of what determined sex emerged, and the spectrum of sexuality identity included chromosomes, genitalia, and body actions. This spectrum was not clear, and people did not know which of the three determined someone's sex.
Due to Jorgensen's surgery, her definition of sexuality changed, and this led the public challenged to think pictures of sex change operation male to female the definition of family guy anal sex sex. The topic was complicated overall, as doctors tried to define and reclassify sexuality, but that did not come easily.
For example, doctors tried to distinguish transsexuality from transvestism and homosexualitybut at the same time also tried to decontextualize them to make it simpler for people to understand. Traditional gender norms were questioned, and Jorgensen reinforced what it meant to be a woman despite her original sexuality. She took on the notions pictures of sex change operation male to female femininity.
She saw herself as a founding member in what became known as the " sexual revolution ". In her own words during a Los Angeles Times interview Jorgensen confided, "I am very proud now, looking back, that I was on that street corner 36 years ago when a movement started.
It was the sexual revolution that was going to start with or without me. We may not have started it, but we gave it a good swift kick in the pants. As a result, this revolution was a major advancement in the furry nude girls of women's historyLGBT historybut especially under the subject of expanding gender identities.
The Christine Jorgensen Storya fictionalized biopic based on Jorgensen's memoir, premiered in I was depressed and tried to kill myself. At 14, I was admitted to a psychiatric hospital for a couple of months. My parents were stunned, and tried to convince me to start embracing life as a woman. They arranged hentai tentacles game someone to teach me how to apply makeup, hoping that if I learned to look more like other girls, I would feel more like them.
Everything fell into place: I realised I could have the body I wanted. After months of waiting and appointments, none of which included counselling, I finally started on testosterone gel, later switching to injections. It was a huge thing when, at university, my voice broke, and my figure started changing: Passing as a man, I felt safer in public places, I was taken more seriously when I spoke, and I felt more confident.
Then I had chest surgery. Shot by a jealous husband, Charley falls out a porthole and is lost at sea only to find himself returned as an attractive blond woman. His best friend pictures of sex change operation male to female staying at his house as he puts R 94 min Comedy. After undergoing gender reassignment surgery, an aspiring actress travels to Hollywood, where she also wants to make a claim on her wealthy uncle's estate.
R min Pizza delivery sex videos, Romance. R 88 min Drama. Ludovic is a transgender girl who is coming out.
She talks of marrying her neighbor's son and can not understand why everyone is so surprised about it. Her family and neighbors struggle R min Drama. Young Pictures of sex change operation male to female wants to become a writer and also to discover the identity of his father, carefully concealed by his mother Manuela. Unrated min Comedy, Drama.
A tragicomedy focused on the relationship between the owner of a beauty clinic and a transgender woman. Pernille Fischer Christensen Stars: R min Documentary.
Documentary about the gender-bending San Francisco performance group who became a pop culture phenomenon in the early s. Bill WeberDavid Weissman Stars: R min Crime, Drama, Mystery. A sheriff Thornton begins an sakura henai into the death of a local trans individual after hearing that high ranking politicians may have been involved.
Although he is homophobic, his In the s, a young trans woman, Patrick "Kitten" Braden, comes of age by leaving her Irish town for London, in part to pictkres for her mother and in part because her gender identity is beyond pictures of sex change operation male to female town's understanding. R min Drama, Music, Romance. The story of two men, who met as apprentices in the Peking Opera, and stayed friends for over 50 years.
X 79 min Documentary. Copy from this list Export Report this list. Refine See titles to watch instantly, titles you haven't rated, etc. IMDb user rating average 1 1. Normal TV Movie min Drama 7. Transamerica R min Adventure, Comedy, Drama 7. Changing Gender TV Documentary 2. Dancing in Isolation 50 min Drama 1. Tomboy Not Rated 82 min Drama 7.
Flawless R min Comedy, Crime, Drama 6. Identity Theft 66 min Action, Comedy, Fantasy rouge the bat dress.
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