Hormonal Prescription Research Articles

8768 Initiation of Exogenous Sex Hormones in a Pediatric Gender Clinic

Abstract Disclosure: C.M. Roberts: None. M.M. Knoll: None. G. Robertson: None. A. Egan: None. C. Moser: None. Introduction: The demographics of patients seeking care for gender dysphoria have changed significantly since care was started in 1987. The criteria for prescribing sex hormones have also evolved to allow a greater range of patients to receive gender-affirming hormones. We examined factors associated with prescription of gender-affirming hormones to patients presenting for gender-affirming care our clinic. Methods: Secondary analysis of sex hormone initiation as a minor among 14-17-year-old adolescents diagnosed with gender dysphoria, seen in the pediatric gender clinic between 2/19/2018 and 7/20/2022. We extracted demographic variables, appointment dates, and sex hormone prescription data from our electronic medical record. We collected patient reports of gender identity and suicidal behavior, and parent and adolescent reports of general adolescent well-being, months of gender dysphoria and social transition, and parental support for the adolescent’s gender identity from electronic clinic surveys. Results: We identified 273 adolescent-parent dyads with complete data. Most of our sample were assigned female at birth (74.4%), transgender male (59.3%), and white (83.5%) adolescents who lived in urban (86.4%) and lower-middle-income (64.5%) areas. The average age was 15.9+/-1.1 years. A minority of adolescents reported recent suicidal ideation 60/273 (22%), and prior suicide attempts 20/273 (7%). Parents reported a shorter duration of gender dysphoria (-16.7 months (95%CI: -22.0, -11.5)) and social transition (-4.7: -6.5, -3.0), and higher levels of parental support than adolescents. Approximately half, 146/273 (53.5%), of adolescents started sex hormones. The average age at initiation was 16.5 years +/- 0.9. Age at presentation, length of gender dysphoria or social transition, and the presence of suicidal ideation or attempts were not associated with initiation of sex hormones. Assigned males (OR:1.82:95%CI 1.04, 3.19), adolescents with higher parent-reported parental support for the adolescent’s identity (1.03:1.01, 1.04), and adolescents with private insurance rather than Medicaid (Blue Cross- 5.39:2.73, 10.64) were more likely to start sex hormones as a minor. Conclusion: Published criteria for the initiation of sex hormones among adolescents with gender dysphoria, including age, persistence of dysphoria, and the presence of suicidality, did not predict the prescription of sex hormones to minors in our clinic. Parent-reported support for the adolescent’s gender identity played a small role in predicting the prescription of hormones, but male sex assigned at birth and having private health insurance played larger roles. Further exploration of these findings is needed to ensure equity in the treatment of gender dysphoria. Presentation: 6/3/2024

The analysis of prescribing CDK4/6 inhibitors for patients with breast cancer in real clinical practice.

e13082 Background: The analysis of prescribing CDK4/6 inhibitors for patients with HR+/Her2neu- breast cancer was conducted at the St. Petersburg City Clinical Oncology Dispensary from April 2020 to October 2023. Patients in group 1 (n=365) received Palbociclib, and patients in group 2 (n=450) received Ribociclib. Methods: 99.45% of participants in the 1 group were female. In the 2 group all patients female. The average age of patients in both groups was 66 years. Results: In the first line of therapy, the clinical oncologist's choice more often leaned towards Ribociclib (p=0.0293). In later lines, Palbociclib was more frequently prescribed (p=0.0086). Ribociclib was significantly more often prescribed compared to Palbociclib in cases of primary hormone resistance (19.8%vs.13.9% (p=0.0288)). A higher "tumor burden" was documented at the start of therapy in patients receiving Ribociclib - 9.32% (5 or more loci of metastatic involvement). The frequency of overall response was significantly higher with Palbociclib (24.3%vs.11.7% (p=0.00001)), which is likely related to the higher incidence of primary hormone resistance and prescription in cases with a higher "tumor burden" in the Ribociclib group. The presence of PIK3CA mutations in patients of the Palbociclib group signifies a significant difference in response to therapy. The mPFS is 26(95% CI 16-29) when the mutation is present and 11(95% CI 9-14) when it is absent (p=0.0016). In the presence of metastatic liver impairment, significant differences in the mPFS assessment were in favor of Ribociclib (12 (95% CI 10-19) vs 11.0 (95% CI 9-15) (p<0.0001)). For the presence of a BRCA mutation, age, presence of bone metastases, brain metastases, visceral metastases (excluding liver), hormonal partner, there were no statistically significant differences between the groups for progression-free survival. The mPFS in both groups was comparable, and we didn't obtain statistically significant differences. In the 1st line the mPFS is not yet reached (p=0.602). In the 2nd line - in the Ribociclib group - 20, Palbociclib -22 (p=0.253). In the 3rd and later lines - the mPFS in the Ribocilib group - 19 (6.9-31.1), Palbociclib -14 (7.3-20.7) (p=0.775). The hematologic toxicity occurred significantly more often with Palbociclib (p=0.00001). As for Ribociclib, an undesirable event such as asthenia was prominent. The influence of dose-limiting toxicity on mPFS has been noted. In the presence of dose-limiting toxicity in the Palbociclib group, the mPFS has not been reached and is significantly different from the mPFS in patients who did not have a dose reduction. Conclusions: The analysis showed that Ribociclib is more often prescribed in the 1 line for patients with a higher 'tumor burden' and with primary hormone resistance. In relation to this, we observe a decrease in such an indicator as the frequency of overall response in this group of patients compared to Palbociclib.

Incidence and risk factors of hypothyroidism after treatment for early breast cancer: a population-based cohort study

PurposeAn increased incidence of hypothyroidism among breast cancer survivors has been observed in earlier studies. The impact of the postoperative treatment modalities and their potential interplay on hypothyroidism development needs to be studied.MethodsWe conducted a population- and registry-based study using the Breast Cancer Data Base Sweden (BCBaSe) including females diagnosed with breast cancer between 2006 and 2012. In total, 21,268 female patients diagnosed with early breast cancer between 2006 and 2012, with no previous prescription of thyroid hormones and no malignant diagnosis during the last ten years before breast cancer diagnosis, were included in the final analysis.ResultsDuring the follow-up (median follow-up time 7.9 years), 1212 patients (5.7%) developed hypothyroidism at a median time of 3.45 years from the index date. No association of the systemic oncological treatment in terms of either chemotherapy or endocrine therapy and hypothyroidism development could be identified. A higher risk (HR 1.68;95% CI 1.42–1.99) of hypothyroidism identified among patients treated with radiation treatment of the regional lymph nodes whereas no increased risk in patients treated only with radiation therapy to the breast/chest wall was found (HR 1.01; 95% CI 0.86–1.19). The risk of hypothyroidism in the cohort treated with radiotherapy of the regional lymph nodes was present irrespective of the use of adjuvant chemotherapy treatment.ConclusionsBased on the results of our study, the implementation of hypothyroidism surveillance among the breast cancer survivors treated with radiotherapy of the regional lymph nodes can be considered as reasonable in the follow-up program.

Risk of Venous Thromboembolic Events Among Obese Hormonal Contraceptive Users

Background: Obesity and hormonal contraception (HC) are independent risk factors for venous thromboembolism (VTE). Thirty eight percent of women in the United States (US) are obese, and the prevalence of childhood obesity in the US is among the highest in the world. Obesity (BMI>30 kg/m2), increases VTE risk via several mechanisms, and the VTE risk in obese individuals is 2.5 times higher than that of their non-obese peers. More than half of women aged 15-49 years use some form of contraception, and 14% report using oral contraceptive pills specifically. The overall VTE risk with combined hormonal contraception (CHC) is approximately two-fold higher than an individual's baseline risk, with further increase depending on the type/dose of progesterone and estrogen, and route of administration. To date case-control and cohort studies have demonstrated an increased VTE risk among obese contraceptive users. But these data do not include adolescents and were derived from populations with relatively low rates of obesity. This study aimed to assess and compare the VTE risk among obese females, age 10-44 years, who were prescribed HC compared to non-obese HC users and obese non-users utilizing a national electronic-medical record database. Using a large national database allowed the inclusion of females from diverse ethnic, economic, and geographic background. Methods: Population level data was collected from TriNETX, LLC, an administrative database that contains comprehensive inpatient and outpatient data from 56 tertiary care hospitals in US. Prevalence data regarding the type and dose of progesterone and estrogen and mode of administration was assessed. Data on females ages 10-44 years from 1/1/2000 to 12/30/2022, who received a new prescription for any HC as identified by the prescription name in pharmaceutical claims and procedure codes was analyzed. Recorded BMI was used to divide the cohort into obese and non-obese individuals as per CDC guidelines. VTE events were defined as presence of ≥1 ICD 9 or 10 codes for VTE diagnosis and presence of a prescription for an anticoagulant drug within the first year after hormonal prescription. Data was summarized descriptively and VTE rates were calculated. Results: Of the 97,026,002 females who met inclusion criteria, 1,370,481 were obese and 2,649,987 were non-obese. The overall rate of VTE for obese vs. non-obese users was 0.9% vs. 0.5% (p<-0.001) and obese HC users vs. obese non-users was 0.9 and 1.06% (p<0.05). VTE rates among obese users versus non-obese users was significantly higher for most progesterone only options (p<0.001), excluding drospirenone only pills and high dose norethindrone (Table 1). A similar pattern of higher VTE rates in obese vs non-obese users was observed for the majority of CHC preparations with few exceptions (p<0.001). (Table 1) In general, VTE rates were higher among obese non-users compared to obese users. However, the rate of VTE was significantly higher among obese users of oral norethindrone 5mg and all medroxyprogesterone acetate users (p<0.001). (Table 2) Discussion: Utilizing the data from a large inpatient/outpatient administrative database, our study shows that obese HC users have a higher VTE rate within one year of initiating HC when compared to non-obese HC users, for progesterone only options (excluding drospirenone, high dose norethindrone) and most CHCs. With few exceptions, obese HC non-users had a higher rate of VTE when compared to obese users. This observation is likely due to confounding by indication bias as prescribers may avoid HC in individuals with underlying risk factors for VTE. Applying propensity score analysis and examining different subcategories of obesity may help overcome this bias in future analysis. Our study highlights the utility of large databases to study healthcare outcomes of VTE risk in females with and without obesity and HC users and non-users. Although limited by the use of administrative claims data and acknowledging that all statistically significant results may not be clinically significant, our study suggests obesity as a VTE risk factor in females for most HCs.

A Cross-Sectional Analysis of Cardiovascular and Bone Health Care Utilization During Treatment With Thyroid Hormone.

Combination therapy with levothyroxine and liothyronine (LT4 + LT3) and desiccated thyroid extract (DTE) make up >10% of new thyroid hormone (TH) prescriptions in the United States. To assess health care utilization related to cardiovascular disease (CVD) and bone health (BH) events (atrial fibrillation [AF], heart failure [HF], myocardial infarction [MI], stroke, and osteoporosis/fractures [FX]) in participants taking LT4+LT3 or DTE surveyed in the Medical Expenditure Panel Survey database. Multi-year cross-sectional analysis examining 5437 participants (≥18 years old) treated with LT4, LT4+LT3, or DTE between 2016 and 2020. Health care utilization was assessed through outpatient, emergency, and hospital visits for AF, HF, MI, stroke, FX, and a composite index. A weighted analysis provided national estimates of health care utilization parameters. Utilization was re-analyzed following propensity score-based matching to balance sociodemographic and clinical covariates between treatment groups. Additionally, provider type and specialty data were obtained from visits associated with TH prescriptions. 5106 participants were treated with LT4 monotherapy, 252 with DTE, and 79 with LT4 + LT3. Prevalence of combined outpatient CVD and BH-related care utilization was lower among DTE/LT4+LT3 vs LT4 users (3.5% vs 7.7%; P = .008). There were no differences in emergency/hospital events. After covariate balancing, CVD and BH-related care utilization was similar between groups in outpatient and emergency/hospital settings. LT3 and DTE made up 7.6% of all TH prescriptions. For visits associated with DTE prescriptions, nurse practitioners and alternative medicine professionals were more likely to be identified as the primary provider type. No significant differences in CVD- and BH-related health care utilization were identified between LT4 and DTE/LT4+LT3 users after covariate balancing. Non-MD providers were more likely to prescribe DTE.

Validation of an administrative algorithm for transgender and gender diverse persons against self-report data in electronic health records.

To adapt and validate an algorithm to ascertain transgender and gender diverse (TGD) patients within electronic health record (EHR) data. Using a previously unvalidated algorithm of identifying TGD persons within administrative claims data in a multistep, hierarchical process, we validated this algorithm in an EHR data set with self-reported gender identity. Within an EHR data set of 52746 adults with self-reported gender identity (gold standard) a previously unvalidated algorithm to identify TGD persons via TGD-related diagnosis and procedure codes, and gender-affirming hormone therapy prescription data had a sensitivity of 87.3% (95% confidence interval [CI] 86.4-88.2), specificity of 98.7% (95% CI 98.6-98.8), positive predictive value (PPV) of 88.7% (95% CI 87.9-89.4), and negative predictive value (NPV) of 98.5% (95% CI 98.4-98.6). The area under the curve (AUC) was 0.930 (95% CI 0.925-0.935). Steps to further categorize patients as presumably TGD men versus women based on prescription data performed well: sensitivity of 97.6%, specificity of 92.7%, PPV of 93.2%, and NPV of 97.4%. The AUC was 0.95 (95% CI 0.94-0.96). In the absence of self-reported gender identity data, an algorithm to identify TGD patients in administrative data using TGD-related diagnosis and procedure codes, and gender-affirming hormone prescriptions performs well.

Transgender and gender diverse consumers on navigating the stigmatized process of gender affirmation in the Central Plains USA

Purpose Transgender and gender diverse (TGD) individuals who choose to begin a gender affirmation journey often find the experience challenging. This can be a highly stigmatized process, and TGD consumers must strategically interact with brands and products to successfully construct authentic identities. Therefore, the purpose of this study was to obtain a better understanding of the TGD individual’s identity transformation within the consumption context. Design/methodology/approach Interviews were conducted with 27 TGD individuals about their gender affirmation journeys. The process of in vivo coding and thematic coding were applied for inductive analysis. Through subsequent analysis, parities with concepts from stigma management theory and Alvesson’s (2010) self-identity metaphors were identified. Findings The results of this study illustrated seven themes of TGD consumption patterns in relation to the gender affirmation journey. Awakening marks the watershed realization of a TGD identity, a cessation of some consumption habits and an emergence of new ones. Exhibiting is a form of information control and often transpired with new clothing purchases. Shifting one’s name and pronouns on identification documents is a means of covering. Remaking typically involves the procurement of medical services such as hormonal prescriptions and/or surgical procedures. Disclosing to individuals in one’s reference groups is a method of assessing (and maintaining) the wise, the curious and the oblivious. Rebelling against the stereotypes of masculinity and femininity in media portrayals and leisure activities is a technique to express one’s eccentricity and quirkiness. Finally, releasing describes the potentially waning TGD label and a somewhat stabilizing pattern of consumption. A model of TGD consumers is presented, and key assertions are discussed. Originality The variety and complexity of consumer purchases associated with gender affirmation journeys were investigated, and it was revealed that many of these consumption choices aided in the TGD individual’s stigma management as well. The key assertions presented here progress the literature on gender affirmation journeys by predicting patterns of consumption.

Barriers and facilitators for accessing and prescribing hormone therapy in primary care for transgender adults: a scoping review protocol.

The objective of this scoping review is to understand the extent and type of evidence in relation to barriers and facilitators experienced by transgender adults in accessing hormone therapy. It will also explore the experiences of primary care practitioners in prescribing hormone therapy in primary care. Providing care to transgender patients is a rapidly growing area of primary care. Despite the existence of clinical practice guidelines that support the prescription of gender-affirming hormone therapy in primary care, only a small number of primary care providers are offering this care. This review will seek to advance research on this topic by examining the barriers and facilitators of hormone prescription for transgender adults in primary care. This review will consider research on primary care practitioners who prescribe hormone therapy to transgender adults. It will also focus on transgender adults who seek hormone therapy in primary care. Only studies that examine barriers and facilitators in primary care will be included. The review will include qualitative, quantitative, and mixed methods studies, in addition to systematic reviews and meta-analyses. The search will include MEDLINE, CINAHL, EmCare, and Nursing and Allied Health Premium. No date limits will be applied to the search. Only articles written in English will be eligible for inclusion. Articles will be reviewed and data extracted by 2 independent reviewers. The results of the extracted data will be presented in a narrative summary with accompanying tables.

Gender dysphoria: An overview for orthodontists.

Among non-gender conforming populations, there is a subgroup of individuals who experience significant distress associated with their gender incongruity, commonly referred to as gender dysphoria (GD). In the UK, there is a recognised pathway for individuals experiencing GD. This has traditionally been initiated by a referral to the Gender Identity Development Service (GIDS) for children and adolescents or to a Gender Identity Clinic (GIC) for adults. This pathway can potentially involve several specialties and treatment modalities, including the prescription of various hormones. It is important for orthodontists to have an understanding of this field, as well as the potential treatment modalities, so that they can support this often marginalised patient group. Inherent differences between male and female facial features may also lead patients with GD to present to orthodontists, wishing to change their facial appearance. This article highlights the current national pathway for GD and the orthodontic considerations for these individuals.

Reoperation and Pain-Related Health Services Utilization After Hysterectomy for Endometriosis with Bilateral, Unilateral or No Oophorectomy

To evaluate pain-related health services use after hysterectomy for endometriosis with or without unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy (BSO), with respect to rates and types of reoperation, physician visits, and subsequent opioid and hormone prescriptions.

Hormone Prescription and HIV Screening/Preventive Practices Among Clinicians Providing Care for Transgender Individuals.

Through a survey-based approach, we sought to investigate regional differences in gender-affirming hormone therapy (GAHT) prescribing practices, as well as HIV screening and prevention practices among clinicians providing care to transgender individuals. Our survey was disseminated between December 2019 and January 2021 to clinicians who prescribe GAHT within New England (United States). Between-group differences in GAHT prescribing and HIV screening/prevention practices were evaluated by practice setting and subspecialty. Of the 20 survey respondents, 55% practiced in health care settings affiliated with an academic institution, 45% practiced in a community-based health care setting, and 30% were Endocrinologists. Clinicians in community-based health care settings reported more frequently prescribing oral 17β-estradiol (p=0.02) and spironolactone (p=0.007) for feminizing GAHT compared with clinicians in health care settings affiliated with an academic institution, who reported more frequently prescribing leuprolide (p=0.03). For masculinizing GAHT, clinicians from health care settings affiliated with an academic institution reported more frequently prescribing topical testosterone (p=0.03). There were no significant between-group differences in reported barriers to initiation or reasons for stopping GAHT. While non-Endocrinologists reported "often" or "always" offering HIV screening, most Endocrinologists reported "rarely" or "never" offering HIV screening and "rarely" or "never" offering pre-exposure or postexposure prophylaxis to their transgender patients. Regional GAHT prescribing practices varied by setting. Additional research is needed to better understand whether these differences translate to differences in GAHT efficacy and side-effects. Further, HIV screening/prevention practices varied by subspecialty. Integrated GAHT and HIV screening/prevention across subspecialties could help reduce the disproportionate burden of HIV faced by the transgender community.

Treating hypothyroidism is not always easy: When to treat subclinical hypothyroidism, TSH goals in the elderly, and alternatives to levothyroxine monotherapy.

The majority of patients with hypothyroidism feel better when levothyroxine treatment restores thyroid-stimulating hormone (TSH) concentrations to normal. Increasingly, a significant minority of patients remain symptomatic and are dissatisfied with their treatment. Overzealous treatment of symptomatic patients with subclinical hypothyroidism may contribute to dissatisfaction among hypothyroidism patients, as potential hypothyroid symptoms in patients with minimal hypothyroidism rarely respond to treatment. Thyroid hormone prescriptions have increased by 30% in the United States in the last decade. The diagnosis of subclinical hypothyroidism should be confirmed by repeat thyroid function tests ideally obtained at least 2months later, as 62% of elevated TSH levels may revert to normal spontaneously. Generally, treatment is not necessary unless the TSH exceeds 7.0-10mIU/L. In double-blinded randomized controlled trials, treatment does not improve symptoms or cognitive function if the TSH is less than 10mIU/L. While cardiovascular events may be reduced in patients under age 65 with subclinical hypothyroidism who are treated with levothyroxine, treatment may be harmful in elderly patients with subclinical hypothyroidism. TSH goals are age dependent, with a 97.5percentile (upper limit of normal) of 3.6mIU/L for patients under age 40, and 7.5mIU/L for patients over age 80. In some hypothyroid patients who are dissatisfied with treatment, especially those with a polymorphism in type 2 deiodinase, combined treatment with levothyroxine and liothyronine may be preferred.

Patterns of Thyroid Hormone Prescription in Patients with Bipolar or Schizoaffective Disorder: Findings from the LiSIE Retrospective Cohort Study.

The prescription of thyroid hormone replacement therapy (THRT) has increased in the general population; the thyroid stimulating hormone (TSH) threshold to initiate THRT has decreased. It remains unclear whether a similar trend has occurred in patients with bipolar disorder (BD). In this work we explore patterns and trends of prescribing THRT in patients with BD or schizoaffective disorder (SZD) with an observational study and time-trend analysis in the framework of the LiSIE (Lithium—Study into Effects and Side Effects) retrospective cohort study. In most patients, THRT was initiated for subclinical hypothyroidism. The median TSH at which THRT was started was 6.0 (IQR 4.0) mIU/L and the median free serum thyroxine (fT4) at which THRT was started was 11.8 (IQR 3.9) pmol/L. The median TSH concentration at the start of THRT decreased annually with 0.10 mIU/L (p = 0.047) and was higher in patients treated with lithium than in patients treated with other mood stabilisers (p = 0.02). In conclusion, THRT was typically initiated in the context of mild or absent alterations of thyroid function tests with a decreasing TSH threshold. As THRT is rarely reversed once initiated, clinicians need to weigh up potential benefits and risks when prescribing THRT for subclinical hypothyroidism in patients with BD or SZD.

Care of Transgender Patients: A General Practice Quality Improvement Approach

Background: With increasing numbers of gender minority/ trans patients, primary care must ensure high quality lifelong care is offered. Aim: To improve the quality of medical care for gender minority/ trans patients. Design and Setting: Initiation of a quality improvement project using population census, patient cohort and audit of standards in a single general practice. Method: Retrospective notes review against an audit standard. Results: One practice has 68 trans patients (population prevalence of 337/100 000). Monitoring guidelines from multiple private and NHS gender identity clinics (GICs) were found to be inconsistent. It was not possible to use an appropriate primary care audit standard as no UK-wide guidance was identified. Initial audit against an international secondary care guideline which was developed following a recognised process suggests health monitoring of transgender patients may be substandard in nearly two thirds (62%) of cases. Patients with gender dysphoria are experiencing long waits for NHS GICs (mean 26 months) and frequently self refer to private services. They receive a mean 2.7 assessment appointments prior to treatment, which consists of 85% hormone prescription uptake. 20% of patients stopped hormone treatment, of which half detransitioned. All detransition has occurred in the last three years. Conclusion: There is a need to develop consistent, national evidence-based primary care guidance that includes standards for monitoring and dealing with complications, including detransition. Funding: None to declare. Declaration of Interest: None to declare. Ethics Approval Statement: The study went through IRAS process, but formal ethics committee permission was not required for a quality improvement retrospective review of notes auditing against standards.

Interfering Medications in Older Adults on Thyroid Hormone Replacement: Who Is at Risk?

Background: Thyroid hormone prescriptions have steadily increased in the past few years with levothyroxine being one of the most frequently prescribed medications in the United States. Population-based studies have shown that older age is a significant predictor for thyroid hormone initiation, with use continuing long-term. Thyroid hormone management in older adults is complicated by the presence of comorbidities and polypharmacy, particularly due to medications that can interfere with thyroid function tests. However, the prevalence of concurrent use of thyroid hormone and interfering medications in older adults and patient characteristics associated with this practice remain unknown. Methods: We conducted a population-based, retrospective cohort study of 538,137 thyroid hormone users aged ≥65 years from the Corporate Data Warehouse of the Veterans Health Administration (2004-2017). First, we described the prevalence of concurrent use of thyroid hormone and medications that commonly interfere with thyroid function tests (i.e., prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, amiodarone, lithium, interferon-alpha, tamoxifen). Then, we performed a multivariable logistic regression analysis to determine patient characteristics associated with concurrent use of thyroid hormone and at least one interfering medication during the study period. Covariates included in the model were patient age, sex, race, ethnicity and number of comorbidities. Results: Overall, 170,261 (31.6%) of patients were on at least one interfering medication while on thyroid hormone during the study period (median follow up 56 months). Non-white race [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.15-1.21], compared to white race), Hispanic ethnicity (OR 1.11, 95% CI 1.08-1.14, compared to non-Hispanic), female sex (OR 1.12, 95% CI 1.08-1.15, compared to male sex), and presence of comorbidities (e.g. Charlson-Deyo Comorbidity Score ≥2, OR 2.47, 95% CI 2.43-2.52, compared to zero) were more likely to be associated with concurrent use of thyroid hormone and interfering medications. Older age (e.g., ≥85 years, OR 0.47, 95% CI 0.46 - 0.48, compared to age 65-74 years) was less likely to be associated with concurrent use of thyroid hormone and interfering medications. Conclusions: Almost one-third of older adults on thyroid hormone were taking medications that have been known to interfere with thyroid function tests. Our study highlights the complexity of managing thyroid hormone replacement in older patients, many of whom are at risk for adverse effects in the context of polypharmacy and comorbidities.

Mental Health and Endocrine Telemedicine Consultations in Transgender Subjects During the COVID-19 Outbreak in Italy: A Cross-Sectional Web-Based Survey

Transgender people are a vulnerable group with a higher incidence of mental health issues and, during the COVID-19 outbreak, they may have faced psychological, physical and social obstacles. To evaluate the impact of the pandemic and the access to health care services during the COVID-19 pandemic on the mental health of the transgender people living in Italy. An anonymous web-based survey was conducted among transgender people living in Italy. The survey consisted of 41 questions (to address socio-demographic and COVID-19 related variables, general health problems and trans-related health issues) and three validated questionnaires (the Impact of Event Scale [IES], the Beck Depression Inventory [BDI-II] and the SF-12. In total 108 respondents were included in the analysis, of these 73.1% were transmen and 26.9% transwomen. The mean age was 34.3 ± 11.7 years with 88.9% undergoing gender affirming hormonal treatment (GAHT). Of these respondents 55.6% were not working during the COVID-19 pandemic, mainly because they lost their jobs due to the lockdown (30.5%) or because they were otherwise unemployed (25.0%). Only four subjects were quarantined at home because of a positive COVID-19 swab. The mean total IES score was 21.1 ± 14.9 with 24.1% of subjects scoring over the cut-off score of 26 thereby suggesting a moderate-to-severe impact of the pandemic event. Mean BDI score was 8.6 ± 8.4. SF-12 total mean score was 96.1 ± 11.9 with a Mental Component Summary (MCS) score of 42.8 ± 9.1. Access to endocrinological consultations for hormonal prescription via telemedicine services was associated with better IES total scores (P=.01). Our results highlight the impact of the pandemic on the mental health of this particular population and how telemedicine services may serve to mitigate negative psychological effects. Internet-based surveys may select a group of people not necessary representative of the whole population. The self-reporting bias should also be considered. Those who responded to our survey were mainly from northern Italy were COVID-19 has had a greater impact. Vulnerable groups such as the transgender population should receive more consideration also during pandemic events and their access to health services especially for endocrine and mental health care should be improved. A nationwide plan for the extended use of telemedicine should be established with targeted intervention to reduce psychological distress. Gava G, Fisher AD, Alvisi S, etal. Mental Health and Endocrine Telemedicine Consultations in Transgender Subjects During the COVID-19 Outbreak in Italy: A Cross-Sectional Web-Based Survey. J Sex Med 2021;18:900-907.

Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults

Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location. This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location. SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female). In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]). In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.

Long‐term effects of hormone replacement therapy on hepatocellular carcinoma risk and overall survival rate in women with chronic hepatitis C: A population‐based cohort study in Taiwan

AbstractThe relationship between hormone replacement therapy (HRT) and hepatocellular carcinoma (HCC) was discussed for several decades. However, the long‐term effects of HRT on female patients with hepatitis C during nature postmenopausal periods are unclear. This study aimed at investigating the effect of HRT on HCC risk and overall survival. We conducted a retrospective population‐based cohort study using data from Taiwan's National Health Insurance Research Database from January 1, 2000 to December 31, 2013. The treated cohort, consisting of 1022 patients with hepatitis C who received hormone analog therapy for at least 90 days (treated cohort), was matched with the control cohort, consisting of 1022 untreated patients with hepatitis C (controls) who had never received a hormone prescription, through propensity score adjustment; furthermore, cumulative incidence was calculated, and multivariable analyses were performed. The treated and control cohorts were followed up for mean periods of 7.47 and 6.64 years, respectively. The treated cohort had a significantly lower crude hazard ratio (HR) of HCC of 0.43 (95% confidence interval [CI]: 0.30‐0.61, P &lt; .001), with an adjusted HR of 0.49 (95% CI 0.31‐0.76, P = .001). After adjustment for other confounders and comorbidities, the hormone analog treatment was associated with a reduced risk of HCC. Subgroup analyses provided estimates of the strength of the associations between HRT and reduced HCC risk in different age categories. Our retrospective population study in Taiwan revealed that using hormone analog reduces the risk of HCC and mortality in patients with hepatitis C virus infection who are receiving HRT, such as menopausal women.

Abstract B011: Changes in prescriptions for breast cancer medications after Medicaid expansion

Abstract As of summer 2018, 34 states have expanded Medicaid eligibility under the Affordable Care Act. While the Medicaid expansions decreased rates of being uninsured among women with breast cancer and increased early breast cancer detection, it is unknown whether expansions increased receipt of medications used to prevent and treat breast cancer. This study examines differences over time in receipt of two types of breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) and associated payments for these medications in states that did vs. did not expand Medicaid during the period 2011-2017. The study's data source is the Medicaid State Drug Utilization Database (SDUD). This data set, compiled by the Centers for Medicaid and Medicare (CMS), is administrative data submitted by state Medicaid programs. The data comprise outpatient prescription medications that are covered under the Medicaid Drug Rebate Program for which Medicaid serves as a third-party payer; this includes aggregate numbers of prescriptions and associated payments for individuals enrolled in both fee for service and managed-care Medicaid programs. Both branded and generic prescriptions for three aromatase inhibitors (anastrozole, exemestane, and letrozole) were included in the study's analyses. Analyses used differences-in-differences and event study models (controlling for state characteristics) to compare changes in Medicaid expansion states to changes in nonexpansion states before vs. after expansion. Initial regression analyses indicate that prescriptions for all hormonal therapy medications increased by 22% (p&amp;lt;0.05) and prescriptions for aromatase inhibitors (branded and generics combined) increased by 26% (p&amp;lt;0.05) in expansion states relative to nonexpansion states. While prescriptions for tamoxifen and for generic aromatase inhibitors alone also increased in expansion states, these changes were not statistically significant. Post-expansion, both total payments and Medicaid payments for all hormonal therapies increased by 13% (p&amp;lt;0.01) in expansion states relative to nonexpansion states. The similar increases for total and Medicaid payments suggest that state Medicaid programs, not patients, financed the increased hormonal therapy prescription payments. Our findings indicate that states that expanded Medicaid with the ACA experienced increased prescriptions for breast cancer hormonal therapies relative to states that did not expand Medicaid; this effect of Medicaid expansion increased over time. The increased prescriptions were financed by Medicaid, not by patients. Citation Format: Catherine Maclean, Michael T. Halpern, Steven C. Hill, Michael Pesko. Changes in prescriptions for breast cancer medications after Medicaid expansion [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B011.

Thyroid Hormone Use in the United States, 1997-2016.

Thyroid disorders are among the most commonly treated conditions by the United States health care system. The number of patients reporting thyroid hormone use has increased in recent years, but it is unknown if there have been differential increases in the number of treated individuals within different demographic groups. Previous research has also not evaluated how expenditures for different thyroid hormone medications have changed in recent years. Using data from the 1997 through 2016 Medical Expenditure Panel Survey, we calculated the proportion of adults reporting thyroid hormone prescriptions by 3 demographic variables (age, sex, and race) and determined expenditures from thyroid hormone prescriptions by medication type (overall, generic, Synthroid or Cytomel, and other brand). Between 1997 and 2016, the proportion of adults who reported thyroid hormone use increased from 4.1% (95% CI, 3.7-4.4) to 8.0% (95% CI, 7.5-8.5). Most of the growth in thyroid hormone use occurred among adults aged >65, and use was also more common among females and non-Hispanic whites. Expenditures from thyroid hormones increased from $1.1 billion (95% CI, 0.9-1.3) in 1997 to $3.2 billion dollars (95% CI, 2.9-3.6) in 2016. Generic thyroid hormone prescriptions comprised 18.1% of all thyroid hormone prescriptions in 2004 (95% CI, 15.8-20.4) and 80.8% of all thyroid hormone prescriptions (95% CI, 78.4-83.2) in 2016. Thyroid hormone use nearly doubled over the last 20 years, and increased use was associated with being older, female, and non-Hispanic white. During the same time period, thyroid hormone expenditures almost tripled.