Transgender Health Research Articles

Advancing 2S/LGBTQ+ Health Equity: A Call for Structural Action.

The social, mental, physical and sexual health of diverse Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations across Canada and globally is under threat. In Canada, we are not immune to the rise in divisive and regressive policies and rhetoric that is negatively impacting the lives of 2S/LGBTQ+ people in the US and across the world (HRC Staff 2023; United Nations 2022). Make no mistake, the threats to the human rights and health of 2S/LGBTQ+ communities are growing in Canada as well (Benchetrit 2023). Health systems leaders and scholars can play a critical role in learning about, addressing and advocating for health equity for 2S/LGBTQ+ communities. This themed issue focuses on the urgency of addressing the social and structural determinants of health inequity for 2S/LGBTQ+ communities in a context of political volatility.

Major MH disparities found among trans vs. cis youth

Despite broad improvements in attitudes toward gender minorities, a new study examining mental health disparities in transgender individuals compared to the cisgender population has found alarming increases over several years, prompting researchers to call for new policies to address the worsening mental health of transgender and gender nonconforming people in the United States.

Abuse in Chilean Trans and Non-Binary Health Care: Results from a Nationwide Survey

Abuse in health care (AHC) is an emerging concept used to describe healthcare practices and conduct that health services users find belittling and degrading. Such experiences, whose causes are not always voluntary but systematic and structural, have been described as one of the main barriers to the trans and non-binary population’s access to health care. To study this problem in Chile, the country’s first trans and non-binary health survey was conducted between January 2021 and June 2022 with the participation of 1116 people. Univariate statistical analyses were performed to calculate the frequencies (f) and percentages (%) of the different forms of AHC reported. Chi-squared tests (p < 0.01) and the Pearson correlation coefficients (r > 0.10) were used to identify statistically significant correlations between experiences of AHC, the health personnel reportedly involved, and participants’ responses to these experiences. About 84% of the participants who replied to questions on this subject said that they had experienced some form of AHC. The most frequently reported were inappropriate use of pronouns (65.9%) and stereotypical comments about genders (48.3%). These events occurred mostly in encounters with secretaries and receptionists, followed by psychologists and nurses. The most frequent response of participants to these situations was to change the medical staff responsible for their care, followed by ceasing to seek professional attention. A mainstreamed relational gender perspective is required to address the complexity of this problem.

Transgender Men and Non-Binary Individuals’ Right to Pregnancy

Transgender men and non-binary individuals’ rights to conceive and bear children remain unimaginable through dominant gender constructs. Social reproduction and structural violence reinforce the gender binary and restrict transgender men and non-binary individuals from exercising their right to conceive, parent, and receive proper health support. This gender expectation is reified in Canadian historical, socio-economic, and legal contexts, creating significant barriers in relation to accessing trans-reproductive healthcare. This paper brings attention to the paucity of research to understand better the rights of transmen and non-binary individuals when wanting to conceive and raise a family. It highlights the underutilization of the social work profession and their critical role to support affirmative reproductive trans healthcare.

"I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States.

Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.

Comprehending Health of the Transgender Population in India Through Bibliometric Analysis.

Objective: In India research on health issues of transgender populations are very recent and limited though transgenders are an important sub-group of the population. Hence, this study attempts to understand the state of transgender health research in India through a systematic review of literature. Methods: A systematic literature review was conducted using bibliometric analysis. Initially, 132 studies were identified, and only 37 articles meeting selection criteria were subsequently selected for review using PRISMA 2020 guidelines. The research landscape was examined with tools such as Biblioshiny, Arc-GIS (10.1), and Vos-Viewer. Results: The review highlights that existing literature on transgender health in India mainly focuses on sexual health while neglecting their overall health status. It also emphasises the skewed geographical coverage of these studies. Based on the analysis, the interdisciplinary nature of the subject is illustrated in a three-field plot and through term co-occurrence. These indicate the need for culture-specific gender-affirmative services promoting a holistic approach to comprehend the health of transgender populations in India. Conclusion: In India research on transgender health is lopsided and at an initial stage. There is a need to develop diverse research focus on various health issues of transgenders that should also be geographically representative. Future in-depth research on this subject will enable optimizing resource allocation, developing effective gender-inclusive policies, and support holistic planning for better health status of transgender people in India, and other countries with similar socio-cultural background.

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence.

Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Pubertal Suppression in Early Puberty Followed by Testosterone Mildly Increases Final Height in Transmasculine Youth.

Treatment for transmasculine youth (TMY) can involve testosterone treatment and is sometimes preceded by gonadotropin-releasing hormone agonist (GnRHa) treatment for puberty blockade. GnRHas can increase final height in birth-assigned females with central precocious puberty. Maximizing final adult height (FAH) is an important outcome for many TMY. Our objective was to determine how GnRHa treatment before testosterone impacts FAH. Retrospective cohort study at 5 US transgender health clinics. Participants were 32 TMY treated with GnRHas in early to midpuberty before testosterone (GnRHa + T group) and 62 late/postpubertal TMY treated with testosterone only (T-only group). The difference between FAH minus midparental target height (MPTH) was +2.3 ± 5.7 cm and -2.2 ± 5.6 cm in the GnRHa + T and T-only groups, respectively (P < .01). In the GnRHa + T group, FAH was 1.8 ± 3.4 cm greater than predicted adult height (PAH) (P < .05) and FAH vs initial height (IH) z-score was 0.5 ± 1.2 vs 0.16 ± 1.0 (P < .05). After adjusting for patient characteristics, each additional month of GnRHa monotherapy increased FAH by 0.59 cm (95% CI 0.31, 0.9 cm), stage 3 breast development at start of GnRHa was associated with 6.5 cm lower FAH compared with stage 2 (95% CI -10.43, -2.55), and FAH was 7.95 cm greater in the GnRHa + T group than in T-only group (95% CI -10.85, -5.06). Treatment with GnRHa in TMY in early puberty before testosterone increases FAH compared with MPTH, PAH, IH, and TMY who only received testosterone in late/postpuberty. TMY considering GnRHas should be counseled that GnRHas may mildly increase their FAH if started early.

Gender affirming care for the minimally invasive gynecologic surgeon.

Given the current political climate and the release of an updated version of the World Professional Association for Transgender Health's guidelines, this review assesses recent updates in the care of transgender and gender diverse (TGD) patients, specifically related to care provided by gynecologists. The number of people identifying as TGD and pursuing gender affirming care is increasing. Contraception for these patients is underdiscussed and high rates of pelvic pain and irregular bleeding were identified. Rates of regret are low following gender affirming surgeries, and studies have repeatedly shown their benefits for gender dysphoria. A minimally invasive approach is recommended for gender affirming hysterectomy, and the decision to proceed with bilateral salpingo-oophorectomy should be based on shared decision making. Surgical techniques include ensuring an adequate margin when taking the infundibulopelvic ligament, and consideration for two-layer vaginal cuff closure. Gynecologists play a key role in the care of TGD patients. Recent reviews have found extensive gaps in our knowledge, including a lack of guidelines for cancer prevention, effects of testosterone on benign conditions, and the long-term effects of bilateral salpingo-oophorectomy on health outcomes for patients on testosterone.

Access Denied: A qualitative Study on transgender health policy in Egypt

For this paper, I conducted an interdisciplinary qualitative study to investigate transgender experiences accessing gender-affirming healthcare (GAH) in Egypt. I outline how the current health policy on GAH was developed and its negative impact, celebrating the resilience of transgender people in navigating the hostile anti-transgender environment, and conclude by offering some health policy recommendations to improve the GAH situation. Since 2003, Egypt has introduced an Islamic Sharia-influenced policy that banned accessing GAH for transgender people, placing professional and legal liability on healthcare providers. The policy created an anti-transgender medical environment, forcing transgender people to rely on Do-It-Yourself GAH or underground, risky, ill-equipped, and overpriced medical facilities. Other non-medical factors also impacted transgender people's ability to access GAH: social stigma, family rejection, state persecution, and economic insecurity. Despite this multilayered anti-transgender environment, transgender people proved to be innovative and resilient, creating ways to overcome these challenges and continue to exist. Transgender people created communal spaces online to guide each other in navigating the challenges of accessing GAH and used various means to challenge bans on GAH.Egypt, Gender-Affirming Health Care, Islam, Policy, DIY, Transgender, Law.

The ‘Real’ Transgender Citizen: Diagnostic Practices of Gender Dysphoria and Citizenship Eligibility in Pakistan

ABSTRACT Emergent meanings of gender dysphoria in medical consultations between transgender people and psychiatrists in Pakistan attempt to answer the question- who is genuinely transgender? The use of biomedical models to investigate the ‘realness’ of trans experience has orchestrated complexities of care as psychiatric evidence of gender dysphoria becomes the gateway to citizenship. Psychiatrists become accessories of state bureaucracy as assessors of legitimate citizenship claims in relation to the Transgender Persons (Protection of Rights) Act 2018. I follow the developing meanings of gender dysphoria as it becomes socially imbricated with Sunni Muslim medical ethics regarding the ‘natural’ body. Even as gender variant citizens discover their selves as political participants, their bodies need to correspond with biopsychological truths of citizenship in an infrastructure of suspicion. How does the sociality of the medical encounter make space for proving or denying gender dysphoria as a genuine psychic state? This paper looks at the varied ways in which doctor-patient interactions become a place of evidence production to satisfy state legislative demands of citizen psychology. Using an interdisciplinary approach that draws on legal literature and medical anthropology, I explore diagnostic practices and expectations of gender dysphoria to explicate the meaning of transgender health within psychiatric care.

Concurrent Gender Dysphoria/Incongruence and Autism Spectrum Disorder, a literature review

IntroductionSeveral studies have found that ASD (Autism Spectrum Disorder) and GD (Gender Dysphoria by DSM-V)/GI (Gender Incongruence by ICD-11) tend to co-occur, and in recent years the interest and publications on this comorbidity has increased rapidly.ObjectivesTo review the prevalence of ASD in individual with a diagnosis of GD/GI.To better tailor and improve care offered in the National Health Service (NHS) Gender Identity Clinics (GICs) throughout the UK.MethodsSystematic literature review was conducted via Pub Med, MEDLINE and PsycINFO by the author, for all English-language articles published between 2018 and 2023, containing keywords as ASD, GD (Gender Dysphoria), GI (Gender Incongruence), transgender, autistic traits, autism, gender diversity, gender variance.ResultsRate of people with ASD appear to be higher in people accessing Gender Identity Clinics (GICs) than in the general population. Results from this literature review show increased prevalence of GD and GI in ASD population.ConclusionsThis comorbidity has highlighted the importance of better tailor transgender healthcare services for people with neurodevelopmental conditions and neurodiversity, to avoid delay in ASD individuals accessing care and gender affirming medical treatments. Services should strive to provide an effective and equitable service. It is also important to better identify potential barriers for ASD people in accessing gender care. Literature also shows the people with ASD have more difficulties in communicating and describing their gender narrative and to express their wishes for gender treatments. Symptoms including problems in communications and social skills, obsession and rigidity can also impact their assessment of GD/GI in gender identity services. Some studies showed that for individuals who have concurrent ASD and GD/GI, assessment in GICs may be extended to better review their wishes for gender identity and for gender affirming treatment. Further research is needed to better investigate and understand factors explaining the relationship between ASD and gender diversity. There is still limited research in the real life experiences of gender diverse and autistic people. There is also a need to improve Gender reassignment protocol nationally to better care for individual with ASD and GD/GI throughout GICs in the UK.Disclosure of InterestNone Declared

What parents know: Informing a wider landscape of support for trans and gender diverse children and adolescents

The childhood and adolescence of transgender and gender diverse children and young people (trans children) is contested in many areas, such as media, education, health, and increasingly in the political sphere. Parents and carers of trans children navigate services and societal relations in their journey to affirm their children, from happy childhood to trans adults. This paper reports on the accounts of parents of trans children in Australia. Semi-structured interviews with 18 parents of 15 trans children in four states were analysed to understand the journey holistically, and interactions with services and institutions on this journey. Children ranged in current age from 8 to 21 years, and were 2 to 16 years when they first expressed their trans identity. These journeys highlight moments of gender euphoria, and points of both positive and negative interactions with a range of services such as GPs, specialist healthcare, trans healthcare, schools, foster care, government records, and sporting environments. This research demonstrates that parents have a collective body of knowledge on supporting and affirming trans children that should be drawn on to inform child and youth services.

"I'm not getting paid to give you a TED talk on how my trans body works". Experiences of hysterectomy gender affirming surgery: A qualitative study.

To explore the experiences of care surrounding hysterectomy as part of gender affirming surgery. An in-depth reflexive thematic analysis from accounts by 10 out of 12 people was undertaken. Experiences were then mapped to the surgery journey as a template for developing system responsiveness. No one person's experience of the procedure was affirmed across the entire surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. The physical care environment influenced the experience, for example, the waiting room was marginalizing (intimidating), with a gendered clinic name and toilets. Some participants took a female support person/partner so that "people looking would assume that I was there supporting her, not the other way around." Communication misalignments were evident around information provided/understood about fertility and ovarian preservation. Participants were also placed in the position of both receiving care and providing education: "I also shouldn't have to be going in there for treatment, and then being expected to educate the medical professional that's meant to be helping me… I'm not getting paid to give you a TED talk on how my trans body works." The experiences mapped across the surgery journey highlighted multiple levels of service provision development needed to foster inclusive practice, for example, from workforce education to healthcare policy. Healthcare for transgender people can be unsafe and inequitable. Increasing transgender health responsiveness across the surgery journey will facilitate better alignments in communication and uphold bodily autonomy, leading to safer and inclusive practice.

Understanding harms associated with gender identity conversion efforts among transgender and nonbinary individuals: The role of preexisting mental well-being

Background: Affirmation of gender identity is critical for the mental health and overall well-being of transgender and nonbinary (TNB) persons. Gender identity conversion efforts (GICE), an outlawed practice for licensed professionals in numerous U.S. jurisdictions, have been associated with negative mental health and substance use outcomes. Limited previous literature examining GICE exposure has been criticized for failing to distinguish mental well-being for TNB persons before or after GICE. Our study builds on current literature by examining differences in TNB persons’ psychosocial risk indicators based on their GICE exposure, accounting for pre-GICE mental well-being. Methods: We conducted a secondary data analysis using the 2015 U.S. Transgender Survey (N = 25,810), the largest available national survey aimed at understanding TNB persons’ experiences. Using logistic regression models, we examined how GICE exposure (disaggregated by temporal precedence of initial suicide attempts) is related to health (psychological distress, extra-medical prescription use, healthcare avoidance), socio-structural (public restroom avoidance, housing instability), and interpersonal outcomes (sexual assault, emotional and physical intimate partner violence (IPV)). Results and conclusions: Initiating a suicide attempt post-GICE or in the absence of GICE were the only consistently significant predictors of poor outcomes across all domains compared to participants who never experienced GICE or attempted suicide. Findings suggest, however, that a combination of GICE with a history of suicide attempts (pre- or post-GICE) was indicative of the highest risk across outcomes, highlighting the particularly hazardous nature of combining poor mental well-being and GICE exposures. Our study adds much-needed complexity to our understanding of how GICE exposure’s role in the well-being of TNB persons may differ related to their pre-GICE mental health. Our findings add further credence to previous studies identifying harms associated with GICE exposure, regardless of pre-GICE mental well-being.

Transgender and non-binary patient simulations can foster cultural sensitivity and knowledge among internal medicine residents: a pilot study

Transgender and nonbinary patients face unique healthcare challenges, such as harassment, discrimination, and/or prejudice, at higher rates than their cisgender counterparts. These experiences, or even the fear of these experiences, may push patients to delay or forego medical treatment, thus compounding any existing conditions. Such extraneous issues can be combatted through cultural sensitivity. The authors designed blended education consisting of an online module followed by a live simulation to educate and promote sensitivity. Internal medicine (IM) residents (n = 94) completed the module, which introduced them to transgender community terminology and medical disparities, and ways to incorporate affirming behaviors into their practice. Afterward, they engaged in a simulation with true transgender-simulated patients (SPs) — either trans-masculine, trans-feminine, or non-binary. Residents were expected to conduct a patient interview mirroring an intake appointment. Residents then engaged in a debriefing session with the lead investigator and the SP to reflect on the experience, receive feedback and constructive criticism, and ask questions. After the education, the residents’ knowledge significantly increased, t(66) = 3.69, p ≤ 0.00, d = 0.45, and their attitude toward members of the transgender community also increased significantly, t(62) = 7.57, p ≤ 0.00, d = 0.95. Furthermore, nearly all residents (99%) reported the training allowed them to practice relevant skills and was a worthy investment of their time. Nearly half (45%) of the residents who listed changes they will make to their practice pledged to ask patients for their preferred name and pronouns. Most comments were positive (75%), praising the education’s effectiveness, expressing gratitude, and reporting increased confidence. Results provided evidence that the education was effective in increasing IM residents’ knowledge and attitudes. Further research is needed to investigate the longitudinal effects of this education and to extend the education to a broader audience. The investigators plan to adapt and expand the research to other specialties such as gynecology and emergency medicine.

The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children

Background Since 2016 trans people in the UK, and particularly trans children, have experienced a sustained and escalating campaign to roll back trans freedoms, rights and access to healthcare. A series of legislative, politicized and media-driven campaigns have resulted in the year-by-year worsening of access to affirmative healthcare for trans children in the UK. Aim This study examines publications from the NHS-commissioned ‘Cass Review’ into children’s gender services, seeking to better understand what is happening in trans children’s healthcare in the UK. Methods Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children’s healthcare published between January 2020 and May 2023. Results Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being. Discussion The Cass Review itself can be understood as an example of cis-supremacy, within a cis-dominant healthcare system lacking accountability to trans communities. These findings draw attention to systemic barriers to effective healthcare policy, with relevance for trans healthcare across and beyond the UK.

(039) Challenges in Transgender Care Through a Qualitative Lens: Provisional Results About Sexual Medicine Professionals´ Opinions

Abstract Introduction Transgender people’s health and healthcare have become one of the most important challenges in healthcare settings and policy making. The perspectives of transgender consumers are important to inform policymaking and the development of measures to diminish barriers to accessing and maintaining health care. However, the perspective of healthcare providers, namely clinicians, is less known and is important to take a comprehensive and collaborative stance to deliver the best healthcare. Objective To highlight the perspective of sexual medicine practitioners/sexologists involved in transgender healthcare on the challenges faced in providing transgender healthcare. Methods Following an initiative by the Portuguese Society for Clinical Sexology, we used a participatory research design involving experienced sexual medicine clinicians/sexologists and activists for transgender care to develop a study to collect sexologists' perceptions of the challenges they faced when providing health care to transgender people. After IRB approval, we used a cross-sectional qualitative design and disseminated an online survey among professional associations (e.g., the Portuguese Society of Andrology, Sexual Medicine and Reproduction). A total of 25 complete answers were collected from clinicians who act in transgender healthcare and whose professional background included: Clinical Psychology, Pediatric Psychiatry, Psychiatry, Endocrinology, Urology, Gynecology and Anesthesiology. Participants were, on average, 46 years old (SD = 12.38), had an average of 13 years (SD = 11.25) experience in Sexual Medicine/Clinical sexology and 11 years on average (SD = 10.38) of experience with transgender healthcare. Sociodemographic data was collected between January and June 2023, and four open questions were presented. The current study will report preliminary content analysis concerning the open question: “Which challenges have you encountered in your experience as a health professional acting clinically with transgender people?”. Results The preliminary content analysis revealed 6 main categories, each representing distinct and interrelated subcategories aggregating different codes. The main categories were: 1. Formal Institutional Challenges (e.g., lack of formal education concerning transgender care, lack of specific guidelines for primary care; long waiting lists); 2. Informal Institutional Challenges (e.g., lack of updated knowledge from other clinicians not directly involved in transgender care; non-responsiveness from colleagues, translating policies and international guidelines into practices); 3. Social Challenges (e.g., family stigma; social discrimination); 4. Patient’s Challenges (e.g., lack of compliance; hostility or negative expectations towards health professionals); 5. Personal limits (e.g., perseverative thinking about the timing and patients’ internalisation of information about surgery risks; feelings of strangeness towards non-binary bodies); 6. Clinical Challenges (e.g., presence of emotional disorders/psychopathology; establishing differential diagnosis). Conclusions The current preliminary and provisional results highlight that clinical sexologists involved in transgender healthcare face different challenges regarding their role. The interrelated themes and subthemes reveal that clinical sexologists acting in transgender care have a critical stance towards policy making, service management and the quality of professional education provided to clinicians. Stigmatisation by their colleagues towards transgender people is a focus of concern. Still, they also feel they experience patients’ hostility and clinical and ethical challenges when trying to provide the best standards of care with a lack of resources. Disclosure No.

(040) Anterolateral Thigh Flap Phalloplasty: Outcomes Following Genital Gender Affirmation Surgery

Abstract Introduction Genital gender affirmation surgery (gGAS) is a key part of the management of patients with gender dysphoria. The anterolateral thigh (ALT) free flap was proposed as an alternative to the more common radial forearm free flap (RFFP) phalloplasty due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap offers greater security of vascular supply for suitable patients, and if suitable and desired the flap can be formed with an integrated urethra, facilitating voiding while standing. Objective The aim of the study is to report the contemporary surgical and functional outcomes of ALT phalloplasty. Methods All individuals undergoing ALT flap phalloplasty for genital gender affirmation surgery (GAS) between 2009 and 2023 nationwide were included. Individuals were managed in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care version 7. Data were extracted from a prospectively collected single surgeon database and medical records. Functional outcomes were assessed by non-validated questionnaire. Statistical analysis included Mann-Whitney, chi-squared, Fisher’s exact and unpaired T tests. Results Surgical outcomes: A total of 87 patients were included in the study. More than half (45, 51.7%) had an integrated urethra. The median length of stay following surgery was six days (IQR 6-7). Eleven patients (12.6%) had a 30-day Clavien-Dindo 3b complication or greater. Three patients (3.4%) experienced total flap loss. A further three patients (3.4%) had partial flap loss. Three patients (3.4%) required a salvage phalloplasty later. Thirteen patients (out of 42, 31.0%) without an integrated urethra went onto have a free flap urethroplasty. Functional outcomes: Thirty-nine individuals (44.8%) completed the patient reported outcomes questionnaire. Most patients (77%) were generally satisfied with their phalloplasty. More than half (56%) with an erectile device used their phallus for penetrative intercourse, while one in five reported experiencing orgasm using their phallus alone. Following urethral lengthening, all respondents were able to void standing. There was no significant difference in mean satisfaction scores for those with an integrated urethra compared to those without (4.18/5 vs 3.82/5, p=.45), as well as between those with or without an erectile device, respectively (3.78/5 vs 4.10/5, p=.26). Conclusions This study is one of the largest single centre cohorts of ALT flap phalloplasty reported to date. It further supports the use of the ALT flap as one of the main genital GAS options for transmen. Over half of the patients studied had an integrated urethra, the gold standard for urethral lengthening. Patient reported functional outcomes were promising, with similar scores regardless of urethral lengthening or erectile device insertion. Disclosure No.

A Gender-Affirming Approach to Contraceptive Care for Transgender and Gender-Diverse Patients

Transgender and gender-diverse (TGD) reproductive health care is a field with an abundance of misinformation and a paucity of quality literature available for both health care professionals and their patients. Clinicians often receive limited education and training in this area, and TGD individuals face many barriers to reproductive health care, including the lack of gender-affirming, inclusive, and knowledgeable clinicians as well as concerns about gender biases. As such, TGD individuals often feel uncomfortable discussing their reproductive health with their health care professionals and are deterred from seeking the appropriate care they need. Contraceptive counseling is a key component of reproductive health care but is often neglected in discussions between TGD patients and their health care professionals. Clinicians must strive to meet the contraceptive health care needs and desires of TGD patients in a gender-affirming manner within a safe and accepting space. Here, we summarize the current reproductive health care landscape and provide contemporary perspectives on how to improve contraceptive care for TGD individuals.