Transgender Men Research Articles

Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy

Abstract Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy. Key messages • In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals. • The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.

Self-determination and self-affirmative paths of trans* and gender diverse people in Portugal: Diverse identities and healthcare

Abstract Background Trans* and gender diverse (TGD) people are very heterogeneous. While legal contexts and healthcare practices have been growingly endorsing self-determination and consent for gender affirmative care in some countries, gender affirmation trajectories need to be understood as unique and fluid processes, constructed and negotiated by each individual in a given social and cultural context. This study aimed to characterize diverse profiles of TGD people in Portugal, regarding individual choices and trajectories in social, legal, and medical gender affirmative processes. Methods A questionnaire, first developed in France and used in Brazil, Italy, Norway, and Chile, was adapted to the Portuguese context. The conducted survey is comprised of 120 questions, organized into six sections: 1) sociodemographic variables; 2) gender affirmation processes and medical and psychological care; 3) general health and sexual health; 4) mental health; 5) sexuality and sexual concerns; 6) experiences of discrimination and gender identity. Data were collected from a convenience sample of 115 adults who identified as TGD. Content analysis was performed on the written responses, and later categorized. Results Approximately 21% of people identified as men, 17% as trans men, 7% as women, 12% as trans women, 26% as non-binary persons, and 17% as agender or other identifications. Differences were calculated among profiles of TGD participants and their choices for affirmative care, social, and legal transition, revealing an association between the way people self-identify and the request for legal recognition of gender identity, as well as the choices of procedures (or aspirations) for medical affirmation (i.e., hormonal treatments, top surgery, bottom surgery). Conclusions The provision of health care practices consistent with the principles of self-determination requires training of health care professionals and adjustment of public policies, to allow for unique trajectories and profiles.

Early exposure to (hetero)sexism in medical settings: young patients’ experiences with gynaecology

Abstract Background Gynaecology is a highly gendered specialty where gender norms are particularly susceptible to shape patient-provider interactions. Consultations about contraceptive practices, reproductive choices, and sexual activity are fertile settings for the potential confrontation of different sets of gender-related expectations, and the expression of gender-based discrimination, i.e. sexism and heterosexism. We therefore investigated young patients’ first experiences with gynaecological care in Germany with a focus on their experiences of (hetero)sexism. Methods We conducted 15 qualitative interviews with a gender-inclusive sample of patients aged 16-25 who narrated their first consultations and experiences of gynaecological care. We analysed the data thematically. Results Cis-gender heterosexual women composed the majority of the sample; a trans man and two persons who reported being at some point in same-sex relationships were also included. The main reasons for a first consultation were painful periods and contraception. Participants narrated examples of gender-based discrimination, with providers making what was perceived as gender-insensitive, demeaning, or plainly homophobic remarks. Those were particularly present in relation to conversations about the contraceptive pill, with either providers refusing to prescribe it on the account that the patient didn’t have sex or “real sex” (i.e. heterosexual intercourse) or with providers pushing for use of the pill “just in case”, even when patients didn’t need nor want it. Additionally, sexist, unrequited arguments about how the pill could enhance a patient’s breast or skin occurred in several conversations. Conclusions Our study shows clear occurrences of (hetero)sexism on the part of gynaecologists, from demeaning comments to more subtle reminders of sexist gender norms. It highlights the need to implement more patient-centred, gender-sensitive gynaecological practise to support the promotion of respectful care. Key messages • Young patients are exposed to various forms of gender-based discrimination in gynaecological care in Germany, highlighting how entrenched traditional, (hetero)sexist gender norms are among providers. • Promoting more gender-sensitive, respectful care could start with a reflection on consultations around the contraceptive pill, as they often crystallise the manifestation of damaging gender norms.

Major financial problems, low mental well-being and reduced HIV/STI testing among sex workers in the Netherlands during the COVID-19 pandemic: a repeated cross-sectional survey

ObjectivesTo determine associations between the banning of sex work during the COVID-19 pandemic, and work, financial problems, mental well-being and HIV/sexually transmittable infection (STI) testing among sex workers in the...

Enacted and Anticipated Stigma Are Associated With Mental Ill-Health Among LGBT+ People in Malaysia: A Brief Report

This brief report contributes crucial empirical evidence to the fledgling literature on mental health status and minority stressors among LGBT+ people in Malaysia, where LGBT+ identities remain criminalized by laws. Drawing data from the 2023 Kami Survey (n= 640), we explore the associations between enacted stigma (measured using the Experiences of Discrimination Scale [EDS]), proximal stressors including anticipated stigma (negative future expectations) and internalized LGBT-phobia, and mental health variables (depression, nonsuicidal self-injury [NSSI], suicidal ideation, and suicide attempts). Participants who were Malay or Indigenous in the Malay Peninsula (compared with Chinese), questioning sexual orientation (compared with gay or lesbian participants), trans men, trans women, or nonbinary participants (compared with cis men), and intersex individuals (compared with those without intersex characteristics) scored significantly higher on the EDS. Multivariate regression analyses, adjusting for demographic characteristics, revealed that enacted stigma predicted elevated risks of depressive symptoms, NSSI, and suicide attempts. Furthermore, negative future expectations were significantly associated with increased risks of NSSI and suicidal ideation. Our findings provide preliminary support for the minority stress model in Malaysia, emphasizing the need to eradicate systemic and institutional injustices promoting enacted stigma and stressful environments for LGBT+ people. Further longitudinal research is warranted to complement our cross-sectional findings by exploring the nuanced impacts of different forms of enacted stigma and proximal stressors on LGBT+ mental health, specifically within the LGBT-criminalization context of Malaysia and broader Southeast Asia.

Mind the Gap! LGBTQ + Population’s Perceptions of Discrimination and of Legal Innovation

Abstract Introduction Homosexuality was decriminalized in Portugal in 1982, and several legislative changes have emerged since the beginning of the twenty-first century. However, 2010 marked the beginning of the approval of fundamental laws for the life of LGBTQ + people, such as same-sex marriage, access to parenthood and the right to self-determination of gender identity. Despite these advances, discrimination is still present in Portuguese society. Methods The aim of this investigation is to study the processes and experiences of discrimination of LGBTQ + people in their daily lives, analyzing the perception of the discrepancy between legislation and the experiences of participants. Its aim is also to analyze the strategies suggested by the participants to reduce this discrepancy. To this end, semi-structured interviews were conducted with 21 LGBTQ + participants, of various sexual orientations (six gay men, three lesbian women, six bisexual persons, five pansexual individuals, and one who identified as “other”) and gender identities (six transgender participants, including two trans men, two non-binary persons, one trans woman, and one genderqueer participant). Results Content analysis of these interviews resulted in 828 units of analysis coded in 30 categories. The participants reported that they have gone through multiple experiences of discrimination in different contexts and that they recognize forces of resistance to legal innovation. Conclusion There is a gap between legal advances and the experiences of LGBTQ+ people in Portugal, who still report discrimination experiences in many domains of daily life. Policy Implications Implications for research and public policies are presented, particularly considering the need to inform and provide training to both strategic audiences and stakeholders and to inform the larger population to promote social change.

Self-care practices during the gender transition of Costa Rican transgender men

Relatively little is known about the unique needs and issues faced by transgender men and their self-care practices during gender transition. This study aimed to analyse self-care practices during gender transition through the life histories of a group of Costa Rican transgender men. A qualitative study with a sociohistorical design employing a thematic life history approach was conducted with fourteen participants between April and September 2022. Data were analysed using Content Analysis. Three categories were developed concerning self-care: (i) the shaping of self-care practices throughout different life stages; (ii) self-care practices related to masculinising the body; and (iii) self-care practices on the margins of a cisheteronormative society. The identified self-care practices took place with the goal of materialising men’s gender identity socially, legally and medically. While self-care plays a key role in supporting individuals throughout the transition process, it is limited in its capacity to ensure comprehensive well-being. The social prejudice and violence encountered by transgender men poses a challenge to achieving full well-being. External pressures and adversities limit the effectiveness of self-care practices, highlighting the need for broader systemic change to enhance the overall health and wellness of transgender men in Costa Rica.

Artificial intelligence evaluation of electrocardiographic characteristics and interval changes in transgender patients on gender-affirming hormone therapy

Abstract Aims Gender-affirming hormone therapy (GAHT) is used by some transgender individuals (TG), who comprise 1.4% of US population. However, the effects of GAHT on electrocardiogram (ECG) remain unknown. The objective is to assess the effects of GAHT on ECG changes in TG. Methods and results Twelve-lead ECGs of TG on GAHT at the Mayo Clinic were inspected using a validated artificial intelligence (AI) algorithm. The algorithm assigns a patient’s ECG male pattern probability on a scale of 0 (female) to 1 (male). In the primary analysis, done separately for transgender women (TGW) and transgender men (TGM), 12-lead ECGs were used to estimate the male pattern probability before and after GAHT. In a subanalysis, only patients with both pre- and post-GAHT EGCs were included. Further, the autopopulated PR, QRS, and QTc intervals were compared before and after GAHT. Among TGW (n = 86), the probability (mean ± SD) of an ECG male pattern was 0.84 ± 0.25 in the pre-GAHT group, and it was lowered to 0.59 ± 0.36 in the post-GAHT group (n = 173, P < 7.8 × 10−10). Conversely, among TGM, male pattern probability was 0.16 ± 0.28 (n = 47) in the pre-GAHT group, and it was higher at 0.41 ± 0.38 in the post-GAHT group (n = 53, P < 2.4×10−4). The trend persisted in the subanalysis. Furthermore, both the PR (P = 5.68 × 10−4) and QTc intervals (P = 6.65×10−6) prolonged among TGW. Among TGM, the QTc interval shortened (P = 4.8 × 10−2). Conclusion Among TG, GAHT is associated with ECG changes trending towards gender congruence, as determined by the AI algorithm and ECG intervals. Prospective studies are warranted to understand GAHT effects on cardiac structure and function.

Effects of gender-affirming hormone therapy on lower urinary tract symptoms and sexual function among transgender individuals.

Gender-affirming hormone therapy (GAHT) includes estrogen preparations and androgen inhibitors for transgender women, and testosterone preparations for transgender men. The aim of the study was to investigate possible effects of GAHT on lower urinary tract symptoms (LUTS) and sexual function among transgender individuals. Fifty-one transgender men and 47 transgender women were prospectively recruited. Four validated female questionnaires (Bristol Female Lower Urinary Tract Symptoms [BFLUTS] questionnaire, the Medical, Epidemiologic, and Social aspects of Aging [MESA] questionnaire, Urgency, the Severity and Impact Questionnaire [USIQ], and the Female Sexual Function Index [FSFI]) and two validated male questionnaires (International Prostate Symptom Score [IPSS], and the International Index of Erectile Function [IIEF]) were used to assess LUTS and sexual function among transgender men and women, respectively, before and during GAHT. Follow-up was performed over a period of 3-12 months. Thirty-four transgender men (mean age 24.4 ± 7.6 years) and 31 transgender women (mean age 29 ± 8.7 years) completed all questionnaires, before and during GAHT. Testosterone treatment was associated with a statistically significant improvement in sexual desire among transgender men, as reflected in the FSFI questionnaire (4.5 ± 1.2 vs. 3.6 ± 1.3, P = 0.002). None of the three LUTS questionnaires showed statistically significant changes during the treatment with testosterone preparations. Estrogen treatment was associated with a statistically significant decrease in erectile function among transgender women, as reflected by the IIEF questionnaire (9.0 ± 7.2 vs. 14.1 ± 11.1, P = 0.012). No significant changes were found in LUTS during the treatment with estrogen preparations, except for a slight worsening of nocturia (2.1 ± 1.8 vs. 1.1 ± 1.4, P = 0.009). GAHT was not found to be associated with significant LUTS in both transgender men and women. Nevertheless, some effects on sexual function were observed, mainly a decrease in erectile function among transgender women and an increase in sexual desire among transgender men.

Language and terminology to describe transgender communities; Perspectives from people with lived experience

Background There is no consensus over the meaning of “transgender,” “trans and gender diverse,” and other terminology used to describe people with a gender different from the gender presumed or recorded for them at birth. We aimed to survey transgender (trans) individuals to understand lived experience perspectives on terminology. Methods An online cross-sectional survey of trans people currently living in Australia and aged ≥16 was conducted from June 2021 to April 2022. Demographic data and terminology preferences were ascertained through fixed-option and free-text questions. Results Of 1023 respondents with a median age of 30 years (IQR 24, 41), 37.1% were trans women, 34.9% were trans men, 27.6% were non-binary, and 0.4% had a culturally specific identity. There was no consensus regarding community-level terminology, with “trans/transgender and gender diverse” the most preferred term (21.9%), followed by “trans/transgender” (19.3%), and “gender diverse” (15.1%). The term “trans/transgender” was more preferred by trans women (27.9%), trans men (19.0%), respondents who had a history of or wanted gender-affirming hormone therapy (GAHT; 20.7%), and gender-affirming surgery (GAS; 20.9%), compared to non-binary respondents (8.2%), and respondents who did not want GAHT (4.9%) or GAS (13.9%). Three themes emerged from free-text responses regarding term preference: (1) Inclusivity, (2) Trans as a binary and medicalized experience, and (3) Societal understanding, accessibility, and destigmatization. Conclusion From Australian trans communities’ perspectives, the term “trans/transgender and gender diverse” was the most preferred community-level terminology to collectively describe people with a gender different from the gender presumed or recorded for them at birth. Further perspectives are needed from other cohorts internationally.

The experiences and perspectives of abortion seekers who travel for care: a qualitative evidence synthesis.

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This QES aims to address the following question: What are the lived experiences and perceptions of abortion seekers (i.e. pregnant women, transgender men, and non-binary people of any gender) traveling to obtain care? The review objectives are to: synthesize the qualitative evidence to address the review question; identify factors that influence abortion travel experiences and perspectives, which may include the specific abortion regulatory and care delivery context (e.g. legal restrictions, unavailability) and abortion seekers' personal circumstances (e.g. age, race/ethnicity, gender, partnership status, gestational duration, social/family support, income/wealth).

Assessing the Influence of Long-Term Gender-Affirming Hormone Therapy on Cardiovascular Risk in Transgender Men through Carotid Intima-Media Thickness.

Background: Transgender men use exogenous androgen for male pattern virilization. Hysterectomy and bilateral salpingo-oophorectomy (HBSO) is performed to stop the endogenous estrogen secretion. Cardiovascular disease (CVD) risk has been shown to increase with long-term use of androgens and the removal of estrogen. We aimed to investigate the CVD risk in these individuals by measuring internal and common carotid artery intima-media thicknesses (CIMT). Methods: In this cohort study, data were collected from transgender men who had undergone HBSO and used androgens for at least two years (median treatment duration was 5 years in our research). Cisgender women in the same age range were selected as the control group. Demographics, vital signs, and hematological values of transgender patients and cisgender women subjects in the control group were noted. CVD markers were compared with sonographically measured CIMT values. Results: The mean age and body mass index (BMI) of the study group were 32.6 and 25.3, respectively. Weight, systolic-diastolic blood pressure, hemoglobin, hematocrit, low-density lipoprotein (LDL), serum triglyceride (TG), HbA1c levels, internal CIMT, and common CIMT values of the study group were higher, while the high-density lipoprotein (HDL) level was significantly lower compared the control group (p1 = 0.025, p2 = 0.010, p3 = 0.002, p4 = 0.001, p5 = 0.001, p6 = 0.012, p7 = 0.008, p8 = 0.007, p9 = 0.013, and p10 = 0.001). There was also an increase in the body weight, BMI, LDL, and TG levels of the study group after the testosterone treatment (p1 = 0.025, p2 = 0.019, p3 = 0.001, p4 = 0.001, and p5 = 0.001). Conclusions: We demonstrated that the use of testosterone therapy in transgender men is associated with higher CIMT values. While further investigation is needed to assess morbidity and mortality rates, we recommend that regular clinical and radiological examinations be performed in these individuals to accurately evaluate the risk of CVD.

8314 Masculinizing Hormone Therapy and Gynecological Neoplasm: a Single Institution Cohort

Abstract Disclosure: S. Korpaisarn: None. T. Ngaothepphurktharam: None. Y. Tingthanatikul: None. Background: Gynecological neoplasm/malignancy is one of the concerned areas among transgender men on masculinizing hormone therapy (MHT). Long-term MHT and gynecological neoplasm/malignancy remain unclear. Methods: A retrospective cohort chart review was done on all transgender men (TM) who underwent hysterectomy with or without oophorectomy between January 2014 and October 2022. Intraoperative findings and pathological results of genital organs, including the cervix, endometrium, myometrium, and fallopian tubes, were extracted. The pathological results were classified as benign, precancerous, and malignant. Descriptive statistical analysis was used to demonstrate the prevalence of gynecological neoplasm and malignancy. Results: A total of 30 TM underwent hysterectomy with oophorectomy. Twenty-eight (93%) had bilateral oophorectomy, and 7% had unilateral oophorectomy due to gynecological conditions. The mean age when TM underwent surgery was 32.1 ± 5.1 years, and the mean age of gender-affirming hormone initiation was 28.7± 5.1 years. The median duration of MHT before gynecological surgery was 32 months (IQR 22-59). Most TM (73%) used testosterone enanthate, 17% testosterone undecanoate, and 2 transgender men did not start MHT before genital surgery. All TM who used GHT became amenorrheic before surgery. The median preoperative testosterone level was 561.5 ng/dL (IQR 776-1189). Intraoperative findings revealed that most TM (86.7%) had unremarkable uterus size, and 13% showed enlarged uterus size. In the latter, all were from myoma uteri. Most intraoperative findings of ovaries showed 93% unremarkable. One TM had intraoperative polycystic ovarian morphology, and one showed a unilateral ovarian cyst. Cervical pathological reports showed unremarkable results in 67%. Five TM (17%) had chronic cervical inflammation. There was 1 TM (3%) who showed low-grade squamous intraepithelial lesion (LSIL) with squamous metaplasia. Regarding endometrial pathology, the mean endometrial thickness was 0.13 ± 0.08 cm. Most endometrial reports (66%) were in a proliferative phase, 27% were in an atrophic or inactive endometrium, and 7% were in the secretory phase. Regarding pathological reports of ovaries, 80% had cystic ovaries. None of the TM showed precancerous or malignant conditions of endometrium, ovaries, and fallopian tubes. PAP smear was available in 27 TM; all were negative for intraepithelial lesions or malignancy. Conclusion: Among a cohort of TM who received MHT for 32 months, there is no evidence of precancerous or malignant pathology of the endometrium, ovaries, and fallopian tubes. Most of them had thin endometrium with cystic ovaries. One TM showed LSIL with squamous metaplasia of the cervix. Healthcare providers should follow local gynecological cancer screening guidelines developed for cisgender women in their clinical practice. Presentation: 6/2/2024

8125 Long-term Effects of Gender Affirming Hormone Therapy (GAHT) on Lipid Profile

Abstract Disclosure: G. Le: None. S. Pinkson: None. J. Trejo: None. D. Tripathy: None. Long-term Effects of Gender Affirming Hormone Therapy (GAHT) on Lipid Profile There is differential effect of long-term Estrogen and Testosterone therapy on lipid profile. While oral estradiol therapy in post-menopausal women has been associated with increased serum triglyceride and HDL, testosterone therapy in hypogonadal men decreases total cholesterol, LDL and HDL cholesterol. However, the long-term effects of Estrogen and Testosterone on lipid profile in transgender patients are not clear. We conducted a retrospective study to analyze the long-term effects of GAHT in transgender men and women followed in Endocrinology Clinic at Veterans Affairs Hospital. 36 transgender men (age 38 ± 2 years, on IM Testosterone cypionate) and 54 transgender women (age 46 ± 2 years, 36 on E2 tablet, 12 on patch, 6 on IM) were followed for 46 ± 5 months and 61 ± 5 months, respectively. Total cholesterol, triglyceride, HDL, LDL cholesterol, systolic and diastolic blood pressures, and BMI were compared before and after initiation of therapy. As expected, following GAHT, total testosterone was higher (546 ± 48 vs. 35 ± 9 ng/dL, P<0.001) in transgender men; in transgender women, serum E2 was higher (110 ± 9 vs. 26 ± 2 pg/dL, P<0.001) and total testosterone was suppressed (444 ± 29 ng/dL vs. 66 ± 13 ng/dL). In transgender men, after a follow-up period of approximately 4 years, there were no significant changes in lipid profile (total cholesterol 178 ± 8 vs. 175 ± 8 mg/dL, triglyceride 121 ± 4 vs 134 ± 12 mg/dL, HDL 47 ± 2 vs. 44 ± 2 mg/dL, LDL 107 ± 7 vs. 106 ± 8 mg/dL, all p=NS). Similarly in transgender women, no difference in lipid profile (total cholesterol 170 ± 5 vs. 175 ± 4 mg/dL, triglyceride 118 ± 7 vs 140 ± 9 mg/dL, HDL 49 ± 2 vs. 53 ± 3 mg/dL, LDL 99 ± 4 vs. 97 ± 4 mg/dL, all p=NS) was observed after 5 years of GAHT. There were no differences in lipid profile regardless of E2 tablet, patch or IM therapy. In transgender men, there was an increase in diastolic blood pressure (72 ± 3 vs. 76 ± 2 mmHg, P<0.05) while in transgender women there was decrease in systolic blood pressure (124 ± 2 vs. 118 ± 2 mmHg, p<0.005), and slight increase in BMI (28 ± 0.9 vs. 30 ± 1 kg.m2, P<0.005). In conclusion, long-term testosterone therapy in transgender men and estrogen therapy in transgender women was not associated with worsening lipid profile. Estrogen therapy was associated with lower BP in transgender women and testosterone therapy led to higher BP in transgender men. Presentation: 6/2/2024

8125 Long-term Effects of Gender Affirming Hormone Therapy (GAHT) on Lipid Profile

Abstract Disclosure: G. Le: None. S. Pinkson: None. J. Trejo: None. D. Tripathy: None. There is differential effect of long-term Estrogen and Testosterone therapy on lipid profile. While oral estradiol therapy in post-menopausal women has been associated with increased serum triglyceride and HDL, testosterone therapy in hypogonadal men decreases total cholesterol, LDL and HDL cholesterol. However, the long-term effects of Estrogen and Testosterone on lipid profile in transgender patients are not clear. We conducted a retrospective study to analyze the long-term effects of GAHT in transgender men and women followed in Endocrinology Clinic at Veterans Affairs Hospital. 36 transgender men (age 38 ± 2 years, on IM Testosterone cypionate) and 54 transgender women (age 46 ± 2 years, 36 on E2 tablet, 12 on patch, 6 on IM) were followed for 46 ± 5 months and 61 ± 5 months, respectively. Total cholesterol, triglyceride, HDL, LDL cholesterol, systolic and diastolic blood pressures, and BMI were compared before and after initiation of therapy. As expected, following GAHT, total testosterone was higher (546 ± 48 vs. 35 ± 9 ng/dL, P<0.001) in transgender men; in transgender women, serum E2 was higher (110 ± 9 vs. 26 ± 2 pg/dL, P<0.001) and total testosterone was suppressed (444 ± 29 ng/dL vs. 66 ± 13 ng/dL). In transgender men, after a follow-up period of approximately 4 years, there were no significant changes in lipid profile (total cholesterol 178 ± 8 vs. 175 ± 8 mg/dL, triglyceride 121 ± 4 vs 134 ± 12 mg/dL, HDL 47 ± 2 vs. 44 ± 2 mg/dL, LDL 107 ± 7 vs. 106 ± 8 mg/dL, all p=NS). Similarly in transgender women, no difference in lipid profile (total cholesterol 170 ± 5 vs. 175 ± 4 mg/dL, triglyceride 118 ± 7 vs 140 ± 9 mg/dL, HDL 49 ± 2 vs. 53 ± 3 mg/dL, LDL 99 ± 4 vs. 97 ± 4 mg/dL, all p=NS) was observed after 5 years of GAHT. There were no differences in lipid profile regardless of E2 tablet, patch or IM therapy. In transgender men, there was an increase in diastolic blood pressure (72 ± 3 vs. 76 ± 2 mmHg, P<0.05) while in transgender women there was decrease in systolic blood pressure (124 ± 2 vs. 118 ± 2 mmHg, p<0.005), and slight increase in BMI (28 ± 0.9 vs. 30 ± 1 kg.m2, P<0.005). In conclusion, long-term testosterone therapy in transgender men and estrogen therapy in transgender women was not associated with worsening lipid profile. Estrogen therapy was associated with lower BP in transgender women and testosterone therapy led to higher BP in transgender men. Presentation: 6/2/2024

8425 Cancer Risk in Transgender Veterans Undergoing Gender-Affirming Hormone Therapy in a Single Medical Center

Abstract Disclosure: A. Vanasco: None. A. Chitnavis: None. K.L. Vinales: None. R.R. Correa: None. Background: The risk of cancer in the transgender patients while on Gender Affirming Therapy is still a source of safety concern among healthcare professionals. We aimed to assess the cancer incidence and potential risk factors in this population. Methods: An initial cohort of 428 charts within the Phoenix VA Healthcare System from January 1990 through October 2023 were identified using ICD codes consistent with a diagnosis of gender dysphoria. From this initial cohort, we completed a chart review of 94 patients who received GAHT through the endocrinology department. The collected information included type of cancer diagnosis, self-reported GAHT start date if not at the Phoenix VA, and risk factors for cancer (HPV, HIV, smoking history) along with recommended cancer screening, like latest mammogram, pap smear, and colonoscopy. Results: We identified 67 transgender women and 27 transgender men, 53.8± 16.0 and 43.8 years ± 12.6 years-old, with an average of 10 years of GAHT (10.1±7.4 years for estradiol therapy and 10.2±4.4 years for testosterone therapy, range 0.5-44 years of use). Cancer was diagnosed in 18 (27.7%) transgender women, including 8 skin, 3 lung, 2 prostate, 2 tongue, 1 thyroid, 1 musculoskeletal, 1 sinus, 1 bladder cancer. Among our transgender women, 37% were current and 33% were prior smokers. Two (3.0%) were HPV positive and both had cancer diagnoses, while two (3.0%) were HIV positive and neither had a cancer diagnosis. 19 (28.4%) underwent colonoscopies with benign results and 48 (71.6%) were untested. 21 (31.3%) underwent mammograms with benign findings, 1 (1.5%) had a mastectomy and reconstruction, and 45 (67.2%) were untested. Cancer was diagnosed in 3 (10.3%) transgender men, and included 2 skin, 1 breast, 1 cervical cancer. 4 (14.8%) were HPV positive, none of which had cancer. Forty percent of the transgender men were active smokers and an additional 30% were prior smokers. None were HIV positive. 8 (29.6%) underwent colonoscopy, 7 of which were benign and 1 pending results, and 19 (70.1%) were untested. Three (11.1%) underwent mammograms with benign findings, 16 (59.3%) had bilateral mastectomies, and 8 (29.6%) were untested. Eleven (40.7%) had pap smears with 10 benign findings and 1 ASCUS, 11 (40.7%) had hysterectomies, and 5 (18.5%) were untested. Conclusion: Our study sheds light on cancer incidence in transgender veterans undergoing GAHT. Incidence of cancer was higher in transgender women than transgender men, and the leading type of cancer for both groups was of the skin, not considered a GAHT risk. Significant numbers of both transgender men and women did not receive recommended health screenings, highlighting the need for improved education of screening importance. Presentation: 6/2/2024

12456 Changes In High-sensitivity Cardiac Troponin I After 12 Months Of Gender Affirming Hormone Therapy

Abstract Disclosure: A.S. Cheung: None. I. Bretherton: None. S. Perera: None. L. Singh: None. C.Y. Chiang: None. Background: Due to differences in cardiac size and physiology between cisgender men and women, sex-specific reference cut-offs are recommended for Abbott high-sensitivity cardiac troponin I (hsTnI) to improve diagnostic accuracy of acute coronary syndrome. There are no prospective studies which examine the impact of gender affirming hormone therapy on hsTnI. We aimed to prospectively evaluate the change in hsTnI in transgender men and women newly commencing gender affirming hormone therapy (GAHT) compared to cisgender men and cisgender women over 12 months. Methods: Transgender men (TM) and transgender women (TW) aged >18 years newly commencing GAHT were recruited from outpatient endocrine clinics. Cisgender men (CM) and cisgender women (CW) were recruited from local community advertisements. Fasting serum collected at baseline and 12 months was frozen at - 80 degrees with batch analysis on the Abbott ARCHITECT i2000 hsTnI assay. One-way ANOVA analysis was performed on age, baseline hsTnI, repeat hsTnI, and change in hsTnI over 12 months between the 4 groups. Chi-square was used to analyze categorical status of detectable hsTnI using a Limit of Quantitation of < 2 ng/L. Data are presented as mean (standard deviation). P value < 0.05 is defined as significant. Results: Baseline samples were available for 263 participants, and 103 had paired baseline and repeat hsTnI samples. The mean age of participants was 31 years ± 12.4 and none had renal impairment. The TM group was younger (n=58, 25.7 ± 6.2 years old, p < 0.005) compared to the other 3 groups (TW n=56, 33.8 ± 15.7 years, CM n=70, 32.7 ± 13.8 years, CF n=79, 31.2 ± 10.7 years). At baseline, CM (2.1 ± 2.4 ng/L) had comparable hsTnI to TW (1.8 ± 2.1, p = 0.9), but higher hsTnI compared to CF (0.8 ±1.1, p < 0.001) and TM (1.1 ± 1.8, p = 0.03). At 12 months follow-up, CM (2.5 ± 2.8ng/L) had higher hsTnI compared to TW (0.9 ± 0.9, p = 0.004), CF (0.6 ±0.6, p < 0.001) and TM (0.9 ± 0.5, p = 0.002). There was a significant decrease in hsTnI after 12 months in TW (-1.4 ± 2.2) compared with CM (0.6 ± 1.9, p = 0.013). Detectable baseline hsTnI became undetectable (<2ng/L) in 73% (8/11) of TW compared to 13% (1/8) CM subjects (p = 0.03). Conclusions: After 12 months of GAHT, hsTnI in transgender women reduced and became comparable to cisgender women and transgender men. Our data supports the use of the cisgender female hsTnI reference cut-off in transgender women and transgender men. Data suggests a possible reduction in cardiac muscle mass or improvement in cardiac physiology occurs after 12 months of GAHT in transgender women. Presentation: 6/1/2024

6590 Androgen Derived Hepatocellular Adenoma And Reinitiation Of Gender Affirming Hormone Therapy

Abstract Disclosure: A.L. McKenna: None. Y. Huang: None. L. Yang: None. N. Loo: None. C. Ritchie: None. A. Metcalfe: None. R. Nakhleh: None. M. Krishna: None. S. Thota-Kammili: None. J. Eleazer: None. A.Y. Chang: None. Hepatocellular adenomas (HCA) are uncommon, benign epithelial tumors of the liver. Risk factors include exogenous estrogen or androgen use, and genetic and metabolic syndromes. Management of HCA is delineated by sex assigned at birth; Observation is recommended in an HCA less than 5 cm in an individual assigned female at birth, while resection of an HCA in an individual assigned male at birth is recommended no matter the size due to risk of malignant transformation. What is not known is whether risk is different for individuals with gender incongruence on gender affirming hormone therapy (GAHT). There is limited data on the risk of HCA in this population. One case report of a transgender man who continued GAHT after diagnosis of an HCA though no follow-up information was available. We present follow-up on a transgender man assigned female at birth with multiple hemorrhagic HCA that was re-initiated on GAHT after stabilization of adenomas off GAHT. Unlike prior cases, the molecular profile showed ß-catenin negative, estrogen and androgen receptors positive. This is the first case report to our knowledge reporting detailed follow-up after restarting masculinizing GAHT after diagnosis of HCA. A 24-year-old transgender man presented to the emergency department with right upper quadrant pain. Initial labs were notable for ALT of 239 units per liter (U/L) and AST 165 U/L. Magnetic resonance imaging (MRI) of the abdomen and liver elastogram revealed multiple bilobar hepatic masses, the largest measuring 9.9 cm concerning for hemorrhagic HCA which was subsequently confirmed on liver biopsy. Immunostains were positive for estrogen and androgen receptors. The patient had no history of alcohol or illicit drug use, tattoos, or family history of liver disease. The patient had been treated with 100 mg of intramuscular testosterone cypionate weekly for the past six years for gender incongruence locally. No testosterone concentrations were available from prior to or during acute presentation. Discontinuation of hormone therapy was recommended along with conservative management with frequent MRI. Over the next 19 months, monitoring revealed improvement/resolution of the auto infarcting adenomas with the last MRI noting two stable HCA measuring 2.1 cm and 0.8 cm without new or enlarging liver lesions. Due to gender dysphoria off GAHT, reinitiation of hormone therapy with low dose AndroGel 1.62% topically was prescribed at 18 months after presentation. The patient has been monitored with labs monthly and plans to obtain MRI abdomen every three months. To date, the patient has tolerated reinitiation of therapy. This case demonstrates that patients on masculinizing GAHT who develop HCA can be conservatively managed and monitored based on pathology and that testosterone does not necessarily explain sex differences in the presentation/malignant transformation of HCA cisgender men as opposed to cisgender women. Presentation: 6/3/2024

7609 Androgen Receptor Positive DCIS in a Transmasculine Individual on Testosterone Therapy

Abstract Disclosure: J. Kelly: None. B. Cohen: None. Introduction: The rate of breast cancer in transgender men is lower than in cisgender women, perhaps due to lower estrogen levels in the setting of suppression from exogenous testosterone, lack of clear guidelines on screening after top surgery, and increase in mastectomies. However, the impact of testosterone therapy on existing breast cancer is not known. Concerns regarding use of testosterone in patients with breast cancer include the potential for conversion of testosterone to estradiol, as well as direct androgen receptor (AR) stimulation. However, for some patients, hormone therapy is lifesaving and stopping gender affirming hormone therapy (GAHT) will negatively impact patient well-being. This creates a challenging clinical scenario when transgender patients on testosterone are diagnosed with breast cancer.Case Presentation: We present a case of a 29-year-old self-identified transmasculine nonbinary individual (assigned female at birth) who underwent chest reconstruction surgery after several months on daily transdermal testosterone therapy. A 4 cm DCIS ER+/AR+ with possible micro invasion was incidentally noted on pathology. They had no family history of breast cancer. The patient underwent chest MRI which was negative for persistent disease. The treating oncologist did not recommend Tamoxifen. The patient chose to discontinue testosterone therapy due to uncertainty regarding future breast cancer risk. However, due to worsening depression and fatigue, the patient chose to resume GAHT after receiving counseling of possible risk, though likely low, of cancer recurrence. Given that they had undergone bilateral mastectomy which, unlike chest reconstruction surgery where some breast tissue is left for contouring, all breast tissue was removed and given that chest MRI was negative for disease, cancer recurrence was felt to be low. Furthermore, though AR positivity was noted, the clinical implications are unclear and it is not known whether testosterone would stimulate tumor growth or potentially have antagonistic effects on ER signaling. Additionally, any stimulatory effects of AR signaling may be balanced by androgen suppression of gonadotroph production and reduction in estrogen production; this is more clearly associated with stimulatory effects on cancer growth. And finally, the potential risks of therapy must be weighed against the benefits provided to the patient’s well-being and mental health. Ultimately, the patient resumed testosterone therapy and has been doing well.Teaching Point: This case illustrates the uncertainties regarding the management of gender affirming testosterone therapy in patients with DCIS or breast cancer. It also highlights the need for a patient centered approach to decisions regarding changes to GAHT, to appropriately weigh the risks and benefits of continuing therapy. Presentation: 6/2/2024

7467 Supplement Use Among Transgender Patients: Case Reports and Literature Review

Abstract Disclosure: H. Cunningham: None. Q. Jones: None. C. Kelley: None. The barriers to initiating gender affirming medical treatment are innumerable and increasing in the wake of wide-sweeping anti-trans legislation, leading many transgender individuals to utilize more accessible means of transitioning. We provide examples of patient-initiated supplement use at a gender medicine clinic in the Southeast. We describe a 60-year-old transgender woman who was unable to establish care due to lack of affirming providers in her region and insurance approval delays. She began taking Pueraria mirifica, along with saw palmetto and fenugreek, for feminization. Subsequently, her breast size increased from an A to B cup, and she noticed fat redistribution to her hips. When finally seen one year later, labs demonstrated suppressed luteinizing and follicle stimulating hormones and increased sex hormone binding globulin, with an associated decrease in estradiol and testosterone levels. Cessation of supplements resulted in lab normalization. Our second case describes masculinizing effects, including voice deepening, experienced by a transgender man using a supplement that contained "orchic extract.” Supplements used for gender affirmation can also have more adverse effects, including polycythemia in the setting of trenbolone, an illicit steroidogenic performance enhancing supplement used for masculinization by some patients assigned female at birth. Patients without access to gender affirming hormones through a medical provider, or who do not feel comfortable accessing health care, may be more likely to use supplements purchased online without a prescription. Considering this, we must create more safe spaces for gender affirming care and ask all transgender patients about supplement use. Providers should consider supplement use as a possible explanation for unexpected lab results. The literature on supplement use for gender-affirming effects is sparse; this presentation provides a summary of and contributes to the current literature on this topic. Presentation: 6/2/2024