Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for t...

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Objective Abnormalities in the morphology and function of two gray matter structures central to emotional processing, the perigenual anterior cingulate cortex (pACC) and amygdala, have consistently been reported in bipolar disorder (BD). Evidence implicates abnormalities in their connectivity in BD. This study investigates the potential disruptions in pACC-amygdala functional connectivity and associated abnormalities in white matter that provides structural connections between the two brain regions, in BD. Methods Thirty-three individuals with BD and 31 healthy comparison participants (HC) participated in a scanning session during which functional magnetic resonance imaging (fMRI) during processing of face stimuli and diffusion tensor imaging (DTI) were performed. The strength of pACC-amygdala functional connections was compared between BD and HC groups, and associations between these functional connectivity measures from the fMRI scans and regional fractional anisotropy (FA) from the DTI scans were assessed. Results Functional connectivity was decreased between the pACC and amygdala in the BD group, compared to HC group, during the processing of fearful and happy faces (p<0.005). Moreover, a significant positive association between pACC-amygdala functional coupling and FA in ventrofrontal white matter including the region of the uncinate fasciculus was identified (p<0.005). Conclusion This study provides evidence for abnormalities in pACC-amygdala functional connectivity during emotional processing in BD. The significant association between pACC-amygdala functional connectivity and the structural integrity of white matter that contains pACC-amygdala connections suggest that disruptions in white matter connectivity may contribute to disturbances in the coordinated responses of the pACC and amygdala during emotional processing in BD.

Objective-Abnormalities in the anterior interhemispheric connections provided by the corpus callosum (CC) have long been implicated in bipolar disorder (BD). In this study, we used complementary diffusion tensor imaging (DTI) methods to study the structural integrity of the CC and localization of potential abnormalities in BD. Methods-Subjects included 33 participants with BD and 40 healthy comparison participants.Fractional anisotropy (FA) measures were compared between groups using region of interest (ROI) methods to investigate the anterior, middle and posterior CC and voxel-based methods to further localize abnormalities.Results-In ROI-based analyses, FA was significantly decreased in the anterior and middle CC in the BD group (P<0.05). Voxel-based analyses similarly localized group differences to the genu, rostral body and anterior midbody of CC (P<0.05, corrected).Conclusion-The findings demonstrate abnormalities in the structural integrity of the anterior CC in BD which may contribute to altered inter-hemispheric connectivity in this disorder.The anterior corpus callosum (CC) has been implicated in bipolar disorder (BD) since at least 1903 when Starr described symptoms detected after anterior CC lesions similar to those of BD, such as "undue excitement, causeless laughter, unusual crying, great depression and a lack of harmony between the association of ideas and the state of feeling which they should awaken" (1). An early magnetic resonance imaging (MRI) study of cerebral morphology in BD detected mid-sagittal CC area decreases (2). Subsequent structural MRI studies provided further evidence for CC white matter abnormalities in BD including in volume, signal intensity Corresponding Author: Fei Wang, M.D., Ph.D. Department of Psychiatry, Yale University School of Medicine, Mailing Address: 300 George Street, Suite 901, New Haven, CT 06511, Phone: 203-785-6180, Fax: 203-737-2513, email: fei.wang@yale.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. and structural integrity (3-5), although reports varied in the CC subregions studied and regional differences detected. In this study, complementary diffusion tensor imaging (DTI) region of interest (ROI) and voxel-based methods were used to study the structural integrity of CC white matter in BD and assess the regional localization of differences. Anterior CC reductions in FA in BD were anticipated. Methods ParticipantsThe Structured Clinical Interview for DSM-IV Axis I Disorders Version 2.0 (SCID) (6) confirmed the presence or absence of Axis I Disorders and mood state at scanning for the 33 BD and 40 healt...