Evaluation of healthcare for transgender veterans

Abstract

PurposeTo identify the cohort of veterans diagnosed with gender dysphoria obtaining care through VA Northern California Healthcare System (VANCHCS), and evaluate their care. MethodsUsing ICD-10 criteria, we identified veterans with a diagnosis of gender dysphoria. We stratified these individuals by self-identified gender, and evaluated their medical records for gender affirming-hormone therapy and access to behavioral health, endocrine, speech pathology, and dermatology resources. ResultsOf the 148 Veterans found, 95 identified as transwomen, 43 as transmen, and 10 as non-binary. Non-binary Veterans were excluded from further analysis. Transmen were significantly younger than transwomen (42±13.7 vs 51.5±15.9 yrs., p< 0.001 by t-test). Transwomen were more likely to be Air Force Veterans than transmen (21.1% vs 17.1%), and less likely to be Army Veterans (38.9% vs 43.9%), but were more likely to see a Endocrinologist (83.2% vs 72.1%) and Speech Therapist (44.2% vs. 25.6%). Gender affirming hormone therapy for transwomen included combinations of gonadotropin-releasing hormone analogs, spironolactone, finasteride, estradiol, and progesterone, whereas for transmen, testosterone was the sole therapy. The majority of our Veterans (65 transwomen (68.4%) and 38 transmen (88.4%) had not undergone gender-affirming surgery. Only 59 transwomen (62%) had measurements of prostate-specific antigen (PSA). Both groups were followed comparably in Behavioral Health Clinics (87.4% for transwomen, 90.7% for transmen). Only 35 transwomen (36.8%) were seen in Dermatology clinics for gender specific needs. ConclusionOur patients and their management were diverse. We conclude that care for transgender Veterans could be enhanced by a more consistent, team-based approach to therapy.