Transgender And Gender Diverse Research Articles

Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population.

Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Clinicians in the Veterans Health Administration initiate gender-affirming hormone therapy in concordance with clinical guideline recommendations

BackgroundGender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies have examined how current GAHT initiation compares to recommended GAHT initiation.ObjectiveThis study assessed guideline concordance around feminizing and masculinizing GAHT initiation in the Veterans Health Administration (VHA).MethodsThe sample included 4,676 veterans with a gender identity disorder diagnosis who initiated feminizing (n=3,547) and masculinizing (n=1,129) GAHT between 2007 and 2018 in VHA. Demographics and health conditions on veterans receiving feminizing and masculinizing GAHT were assessed. Proportion of guideline concordant veterans on six VHA guidelines on feminizing and masculinizing GAHT initiation were determined.ResultsCompared to veterans receiving masculinizing GAHT, a higher proportion of veterans receiving feminizing GAHT were older (≥60 years: 23.7% vs. 6.3%), White non-Hispanic (83.5% vs. 57.6%), and had a higher number of comorbidities (≥7: 14.0% vs. 10.6%). A higher proportion of veterans receiving masculinizing GAHT were Black non-Hispanic (21.5% vs. 3.5%), had posttraumatic stress disorder (43.0% vs. 33.9%) and positive military sexual trauma (33.5% vs.16.8%; all p-values&amp;lt;0.001) than veterans receiving feminizing GAHT. Among veterans who started feminizing GAHT with estrogen, 97.0% were guideline concordant due to no documentation of contraindication, including venous thromboembolism, breast cancer, stroke, or myocardial infarction. Among veterans who started spironolactone as part of feminizing GAHT, 98.1% were guideline concordant as they had no documentation of contraindication, including hyperkalemia or acute renal failure. Among veterans starting masculinizing GAHT, 90.1% were guideline concordant due to no documentation of contraindications, such as breast or prostate cancer. Hematocrit had been measured in 91.8% of veterans before initiating masculinizing GAHT, with 96.5% not having an elevated hematocrit (&amp;gt;50%) prior to starting masculinizing GAHT. Among veterans initiating feminizing and masculinizing GAHT, 91.2% had documentation of a gender identity disorder diagnosis prior to GAHT initiation.ConclusionWe observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT. Findings suggest that VHA clinicians are initiating feminizing GAHT in concordance with clinical guidelines. Future work should assess guideline concordance on monitoring and management of GAHT in VHA.

Health Care Utilization During the First 5½ Years of Authorized Service by Transgender U.S. Service Members (2016-2021).

Purpose: This study examined the utilization of gender-affirming health care by active-duty service members during the initial 5½ years that transgender and gender-diverse (TGD) individuals were authorized to serve in the U.S. military. The aim of this study was to inform policy discussions regarding inclusion of TGD individuals in the military. Methods: We conducted a retrospective cohort study using administrative health care data from the Military Data Repository (MDR). We assessed the association of demographic factors with the utilization of gender-affirming medical and surgical care. We calculated the incidence rate of initial TGD-related encounters and new prescriptions for gender-affirming hormones among Defense Department Service members between July 2016 and December 2021. Results: We identified 2481 service members with an initial health care encounter with an associated TGD-related diagnosis. More than half (53%) of these service members started gender-affirming hormones, and 14% underwent gender-affirming surgery. Mastectomies and hysterectomies accounted for more than 70% of surgeries. Service members made 3.22 initial encounters with a TGD-related diagnosis per 10,000 service members per year, with an overrepresentation of service members who were designated female in the MDR (8.62), junior enlisted (4.98), and young (4.64). Individuals designated female in the MRD comprised 17% of all service members but accounted for 46% of initial encounters, 51% of new prescriptions, and 73% of surgeries. Conclusion: The study revealed a higher-than-expected number of service members seeking gender-affirming care, particularly among service members designated female in the MDR. Military Health System clinicians provided most of this care, which may mitigate the cost of delivering this essential medical care.

Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature

Objective. Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review. Materials and Methods. Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline. Results. The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies. Conclusion. There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.

Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research.

Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.

Transgender and Gender-Diverse Child and Parent Close Relationships

Transgender and Gender-Diverse Child and Parent Close Relationships

Considerations in Gender-Affirming Hormone Therapy in Transgender and Gender Diverse Patients Undergoing Liver Transplantation

Liver transplantation is lifesaving for patients with end stage liver disease. Similar to the role of transplantation for patients with end stage liver disease, gender affirming hormone therapy (GAHT) can be lifesaving for transgender and gender diverse (TGGD) patients who experience gender dysphoria. However, management of such hormone therapy during the perioperative period is unknown and without clear guidelines. Profound strides can be made in improving care for TGGD patients through gender affirming care and appropriate management of GAHT in liver transplantation. In this article, we call for the transplant community to acknowledge the integral role of GAHT in the care of TGGD liver transplant candidates and recipients. We review the current literature and describe how the transplant community is ethically obligated to address this healthcare gap. We suggest tangible steps that clinicians may take to improve health outcomes for this minoritized patient population.

Practical guide to implementing patient-reported outcome measures in gender-affirming care: evaluating acceptability, appropriateness and feasibility

ObjectiveAssess acceptability, appropriateness and feasibility of the Practical Guide to Implementing patient-reported outcome measures (PROMs) in Gender-Affirming Care (PG-PROM-GAC) from a sample of patients and healthcare professionals.DesignCross-sectional study conducted August–October...

The association of gender-affirming hormone therapy duration and body mass index on bone mineral density in gender diverse adults

IntroductionFeminizing and masculinizing gender-affirming hormone therapy (fGAHT, mGAHT) results in bone mineral density (BMD) maintenance or improvement over time in transgender and gender diverse (TGD) adults. Mostly European TGD studies have explored GAHT’s impact on BMD, but the association of BMI and BMD in TGD adults deserves further study. ObjectiveTo determine whether GAHT duration or BMI are associated with BMD and Z-scores among TGD young adults. MethodsCross-sectional study of nonsmoking TGD adults aged 18–40 years without prior gonadectomy or gonadotropin-releasing hormone agonist (GnRHa) therapy taking GAHT for > 1 year. BMD and Z-scores were collected from dual-energy x-ray absorptiometry. Associations between femoral neck, total hip, and lumbar spine BMDs and Z-scores and the predictors, GAHT duration and BMI, were estimated using linear regression. ResultsAmong 15 fGAHT and 15 mGAHT, mean BMIs were 27.6 +/- standard deviation (SD) 6.4 kg/m2 and 25.3 +/- 5.9 kg/m2, respectively. Both groups had mean BMDs and Z-scores within expected male and female reference ranges at all three sites. Higher BMI among mGAHT was associated with higher femoral neck and total hip BMDs (femoral neck: β = 0.019 +/- standard error [SE] 0.007 g/cm2, total hip: β = 0.017 +/- 0.006 g/cm2; both p < 0.05) and Z-scores using male and female references. GAHT duration was not associated with BMDs or Z-scores for either group. ConclusionsZ-scores in young, nonsmoking TGD adults taking GAHT for > 1 year, without prior gonadectomy or GnRHa, and with mean BMIs in the overweight range, were reassuringly within the expected ranges for age based on male and female references. Higher BMI, but not longer GAHT duration, was associated with higher femoral neck and total hip BMDs and Z-scores among mGAHT. Larger, prospective studies are needed to understand how body composition changes, normal or low BMIs, and gonadectomy affect bone density in TGD adults.

The time-lagged impact of microaggressions at work on the emotional exhaustion of transgender and gender diverse employees

Background Despite the widespread adoption of workplace protections for transgender and gender diverse (TGD) individuals, past research has suggested that microaggressions still occur. Previous literature indicates that microaggressions have a deleterious and cumulative impact on mental health. However, little is known about how microaggressions affect TGD employees over time. Method Using a longitudinal design with lagged measures over a period of three months, we explored the current forms of workplace microaggressions against TGD individuals, as well as their prospective impact on emotional exhaustion. We also examined perceived social support, identity centrality, and identity pride as moderators of the effects of microaggressions on emotional exhaustion as these may inform us of potential mitigating factors and targets for interventions. Results TGD employees chronically experience various types of microaggressions which, in turn, lead to emotional exhaustion over time. None of the hypothesized factors moderated the time-lagged relationship of microaggressions on emotional exhaustion, but direct effects of perceived social support and identity pride on exhaustion were found. Conclusion The findings highlight the urgency to develop strategies that directly reduce microaggressions in organizational settings. In order to provide a safe space for gender minorities in the workplace, we recommend that organizations address microaggressions directly and explicitly within their human resource management policies in an authentic non-tokenistic way. In doing so, organizations should incorporate the experiences of various gender identities and gender expressions, while also defining clear processes for assessment and monitoring, corrective action, and best practice sharing.

A thematic analysis of the experiences of prepubertal transgender and gender-diverse children in Sweden

Knowledge of prepubertal transgender and gender diverse (TGD) children is limited. This study fills a gap in the research literature by exploring the lived experiences of prepubertal TGD children related to gender identity, centering their voices. Interviews with 10 TGD Swedish children 4–12 years old were analyzed through Thematic Analysis. The analysis resulted in two main themes: (1) “The journey of gender exploration,” with subthemes Discovering me and The joys, and challenges of being me; (2) “Meeting the outside world,” with subthemes Can I belong? and Staying me: my tips, tricks and help from others. The children’s evolving gender identity was traced, emphasizing emotional aspects and pivotal milestones like affirmed names. Even though the children had supportive environments, challenges of misgendering and the need for continual self-assertion were exposed. Despite struggles for recognition, the study highlights TGD children’s resilient coping and well-being. Still, cisgender norms were observed to challenge their prevalent pride and positive self-images, emphasizing the need for enhanced knowledge of gender diversity for a broader societal change. This study expands the literature on TGD children’s gender identity development, informs professionals and a broad audience and provides an enhanced understanding of TGD prepubertal children through their own words.

Moving Beyond International Classification of Diseases Codes for the Retrospective Identification of Gender Diverse Veterans.

Purpose: The Veterans Health Administration (VHA) systematically asks Veterans to self-report gender identity for documentation in their electronic health record. Veterans with transgender and gender diverse (TGD) identities experience higher rates of several health conditions compared to Veterans without minoritized gender identities. Historically, cohorts of TGD Veterans were built with International Classification of Diseases Version 10 (ICD-10) codes assigned during clinical encounters. We examined concordance between self-reported gender identity and relevant ICD-10 codes in VHA health records to inform use of these indicators for examining the health needs of TGD Veterans. Methods: TGD-related ICD-10 codes were compared to self-reported gender identity from more than 1.5 million Veterans (2019-2022). Results: Only 34% of TGD Veterans included through self-report had an ICD-10 code associated with transgender care. ICD-10 codes had low sensitivity and high specificity compared to self-reported gender. Conclusion: These findings suggest ICD-10 codes alone undercount the larger population of TGD Veterans in the VHA.

No observed bidirectional effect between tenofovir diphosphate concentrations and gender-affirming hormone concentrations among transgender persons switching from tenofovir disoproxil fumarate/emtricitabine to tenofovir alafenamide/emtricitabine for HIV pre-exposure prophylaxis.

Many transgender and gender diverse (TGD) individuals have expressed concerns about the potential for oral pre-exposure prophylaxis to affect hormonal concentrations achieved from taking gender-affirming hormone therapy (GAHT). The purpose of this study was to understand the bidirectional effects between hormone and intraerythrocytic tenofovir diphosphate concentrations when switching from tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) to tenofovir alafenamide/emtricitabine (TAF/FTC) in TGD users/nonusers of GAHT. The study evaluated stored blood samples and dried blood spot cards from TGD adults without HIV who took ≥12 weeks of TDF/FTC and then switched to ≥12 weeks of TAF/FTC for pre-exposure prophylaxis. Thirty-nine individuals met the study inclusion criteria. Regardless of sex assigned at birth and the use of GAHT, there were no significant differences in hormone concentrations when individuals taking GAHT were taking TDF/FTC and then switched to TAF/FTC. Further, there was no significant difference in intraerythrocytic tenofovir diphosphate concentrations between users and nonusers of GAHT. There are no bidirectional effects between hormone and intraerythocytic tenofovir diphosphate concentrations when switching from TDF/FTC to TAF/FTC in TGD users/nonusers of GAHT.

Qualitative Metasummary: Transgender and Gender Diverse Children’s Experiences of Parental Responses

This qualitative metasummary literature review study explores transgender and gender diverse (TGD) children’s experiences of parents responding to their gender identities. In data collection for this study, we identified 31 peer-reviewed articles addressing this research topic. Studies included qualitative data collected from TGD children. Data analysis yielded three themes, six subthemes, and 35 findings. The primary three themes highlight TGD children’s experiences of supportive, unsupportive, and intermediate parental responses to their gender identities. In this paper, we provide examples of study findings and implications that healthcare providers may consider when offering gender-affirming care to TGD children with accompanying parents.

Sameness across Difference: A Postcolonial Feminist Analysis of Gender-Affirming Health Care in Thailand and the United States.

Joining a growing body of research calling for the integration of social analysis and postcolonial theory, recent work in medical sociology has analyzed health, illness, and medicine from a postcolonial lens. In this article, I argue for a postcolonial feminist approach to medical sociology that builds on this extant work while challenging methodological nationalism and cultural essentialism. Based on an analysis of gender-affirming health care for transgender and gender diverse (TGD) people in Thailand and the United States, I propose "sameness across difference" as a framework to analyze commonalities in the health care experiences of marginalized populations across nations as the products of imperial legacies. Drawing on 83 interviews with health care providers, TGD patients, and TGD activists, I demonstrate the role of imperialism in sustaining barriers to gender-affirming health care through the uneven geographic distribution of care across rural and urban areas and the reinforcement of racial and class hierarchies within cities.

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

BackgroundHealth inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals. MethodsWe analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016–December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation. ResultsThe mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00–1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37–2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12–1.59) and mental (PR = 1.49; 95 %CI = 1.33–1.66) health days. ConclusionHCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.

Dermatologic needs of transgender and gender diverse youth: A retrospective cohort study.

Several dermatologic concerns are known to disproportionally affect transgender and gender-diverse (TGD) adults, but little is known about dermatologic conditions in TGD youth. This study assesses the prevalence of acne, androgenic alopecia, scarring from gender-affirming procedures, and eczema in pediatric TGD patients seen at Boston Children's Hospital between April 2021 and April 2022. The results demonstrate that, for TGD youth, the studied dermatologic concerns are common, referral rates to dermatology are low, and acne is significantly associated with testosterone use. Future studies should examine additional dermatologic concerns and barriers to accessing dermatologic care for this historically underserved population.

Campus Sexual Violence and the Cost of Protecting Institutions: Carceral Systems and Trans Student Experience

Transgender and gender diverse (TGD) students on university campuses experience high rates of sexual violence relative to their cisgender peers and are less likely to utilize campus resources. Despite this, TGD students’ voices are often left out of conversations about campus sexual violence. To learn about TGD students’ experiences of university sexual violence prevention and response infrastructure, we conducted focus groups with 21 TGD students at a large university in the northeastern United States. Informed by abolition feminism and critical trans politics, we undertook this thematic analysis to examine the limits of current systems to respond to TGD students’ needs and reduce their victimization. Our findings highlight how carceral logic contributes to TGD students’ exclusion from and distrust of university systems to address sexual violence. Further, our findings illustrate how TGD students’ visions for healing-oriented approaches to sexual violence on campuses align with transformative justice principles. These findings suggest that feminist social work must support the development of campus sexual violence prevention and response infrastructure that moves away from a reliance on carceral logic and toward approaches developed by community-led transformative justice organizations to inform inclusive, intersectional, campus sexual violence prevention, and response efforts.

Daily and Momentary Associations Between Gender Minority Stress and Resilience With Alcohol Outcomes.

Minority stressors have been linked with alcohol use among transgender and gender diverse (TGD); however, no ecological momentary assessment studies have examined daily links between minority stress and alcohol use specifically among TGD. This study examined gender minority stressors and resilience as predictors of same-day or momentary alcohol-related outcomes. Feasibility and acceptability of procedures were evaluated. Twenty-five TGD adults (mean age = 32.60, SD = 10.82; 88% White) were recruited Canada-wide and participated remotely. They completed 21 days of ecological momentary assessment with daily morning and random surveys (assessing alcohol outcomes, risk processes, gender minority stressors, resilience), and an exit interview eliciting feedback. Gender minority stress had significant and positive within-person relationships with same-day alcohol use (incidence risk ratio (IRR) = 1.12, 95% confidence interval [CI] [1.02, 1.23]), alcohol-related harms (IRR = 1.14, 95% CI [1.02, 1.28]), and coping motives (IRR = 1.06, 95% CI [1.03, 1.08]), as well as momentary (past 30-min) alcohol craving (IRR = 1.32, 95% CI [1.18, 1.47]), coping motives (IRR = 1.35, 95% CI [1.21, 1.51]), and negative affect (IRR = 1.28, 95% CI [1.20, 1.36]). Gender minority stress indirectly predicted same-day drinking via coping motives (ab = 0.04, 95% CI [0.02, 0.08]). Resilience was positively associated with same-day alcohol use (IRR = 1.25, 95% CI [1.03, 1.51]) but not harms. TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support adaptive coping strategies.

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.