Transgender And Gender Diverse Research Articles

Abstract 4137559: Assessing Veterans’ Risk of Cardiovascular Disease by Gender Identity

Background: Extant literature suggests that transgender and gender diverse (TGD) individuals experience a higher burden of CVD risk factors and psychosocial stressors than their cisgender (cis) peers. However, prior studies have been limited by self-reported outcomes or small samples. Aim: To determine whether TGD veterans have greater CVD (MI, ischemic stroke, cardiac revascularization) incidence than cis veterans using large, nationwide data. Methods: We used EHR data from the Veterans Healthcare Administration to identify veterans with >2 outpatient encounters in fiscal years 2010-2019. Veterans’ gender identity was classified using natural language processing in combination with gender-affirming hormone therapy (GAHT) and a previously validated algorithm for identifying TGD individuals using ICD codes and VHA data. Of 1,105,082 veterans without prior CVD, 42,149 were classified as TGD. We examined sample characteristics by gender identity and used Cox regression to assess the association of gender identity with incident CVD. Results: TGD veterans’ mean age (years) was 46 (cis females=40; cis males=53). Cis females had the fewest CVD risk factors, followed by TGD veterans and cis males. Adjusting for age, race, and Hispanic ethnicity, TGD veterans had 1.49 [1.42-1.56] and 0.93 [0.90-0.97] times the risk of CVD compared to cis females and cis males, respectively. Upon additional adjustment for other CVD risk factors, renal function, alcohol use disorder, depression, anxiety, and sexual minority status, results remained statistically significant. Significance also held in sensitivity analyses which matched each TGD veteran to cis female and male veterans on age within 2 years. In analyses stratified by gender identity, trans feminine (HR [95% CI]: 1.26 [1.14-1.40]) and uncategorized TGD veterans (HR [95% CI]: 1.29 [1.22-1.37]) were at higher CVD risk than cis female veterans; trans masculine (HR [95% CI]: 0.85 [0.77-0.93]) and trans feminine veterans (HR [95% CI]: 0.90 [0.82-0.99]) were at lower CVD risk than cis male veterans. Among TGD veterans, GAHT receipt was associated with an 11% decrease in CVD risk. Conclusion: TGD veterans’, particularly trans feminine and uncategorized TGD veterans’, CVD risk was greater than that of cis females. Contrary to prior findings, GAHT was associated with decreased CVD risk. These results invite further study into the mechanisms by which GAHT and other factors impact CV health across and within gender identities.

Deliberate Absence: Mapping the Presence of Indian Transgender and Gender Diverse (TGD) Youth in Social and Medical Rights-Based Work Initiatives for the Community

Background: Adolescence, the transitional phase between childhood and adulthood, involves significant biological, social, cognitive and emotional changes. In India, adolescents (10–18 years) form 21% of the population, increasing to 33% when including those aged 10–24 years, making India home to the world’s largest adolescent population. The concept of adolescence, unlike the biological process of puberty, is culturally determined and influenced by globalisation and changing societal values. Objectives: This article aims to (a) elucidate the barriers hindering transgender and gender diverse (TGD) youth in India from accessing gender affirmation, including familial rejection, constraining legal provisions and inadequate public health infrastructure; (b) underscore the impact of socio-cultural and political attitudes on health disparities faced by TGD youth, emphasising the need for comprehensive and individualised healthcare and socio-cultural support; (c) advocate for a socio-medical approach to address the unique challenges of Indian TGD youth, focusing on collaborative efforts among healthcare professionals, social institutions and policymakers; (d) propose strategies for improving access to early gender-affirmative care, including training healthcare providers, promoting comprehensive medical support and advocating for the rights of TGD youth. Methods: A blind review of literature was conducted using PUBMED/MEDLINE, Google Scholar, Web of Science, PsycINFO and SCOPUS with keywords such as ‘transgender youth’, ‘nonbinary and gender diverse youth’, ‘gender-affirming medical care in India’ and ‘youth mental health’. The search eventually included peer-reviewed publications, books, reviews, editorials, opinion pieces, feature stories and individual case reports. Articles were screened and thematically analysed to synthesise findings. Results: The review highlights significant barriers to gender-affirming care for TGD youth in India, including familial rejection, restrictive legal frameworks and inadequate public health infrastructure. Socio-cultural and political attitudes contribute to health disparities, necessitating comprehensive healthcare and socio-cultural support. Conclusions: Addressing the challenges faced by TGD youth in India requires a socio-medical approach, emphasising collaborative efforts among healthcare providers, social institutions and policymakers. Strategies for improvement include training healthcare providers, promoting comprehensive medical support and advocating for the rights of TGD youth to ensure early and effective gender-affirmative care.

Clinical Care of Acne Vulgaris for Transgender and Gender Diverse Youth

Abstract Primary care providers have reported feeling ill-equipped to care for transgender and gender diverse (TGD) patients because of lack of training, and their treatment of acne has been shown to be variable and not standardized. This is an important practice gap, as TGD youth represent a historically underserved population in medicine, despite data suggesting that up to 9.2% of high school–age adolescents identify as TGD. Although needs and expectations for quality health-care in TGD youth do not necessarily differ from their cisgender peers, TGD adolescents have unique considerations in their care and are at risk for negative social and emotional outcomes secondary to minority stress, discrimination, and rejection by peers and family. Acne is estimated to affect approximately 85% of adolescents and is associated with negative mental health outcomes, including suicidal ideation, low self-esteem, and depression. As such, knowledgeable and culturally informed care of acne in TGD adolescents has important implications for quality of life for patients who desire effective treatment. This review article addresses these practice gaps by summarizing an approach to acne evaluation and management with an emphasis on appropriate regimens for TGD youth, and the unique psychosocial and medical considerations for this population.

Exploring Perspectives on HIV Vulnerability Communication among Transgender and Gender Diverse Patients and Primary Care Providers.

Transgender and gender diverse (TGD) individuals represent a population with a heavy burden of HIV. Multi-level stigma encountered by TGD individuals can create significant barriers to discussing topics related to HIV prevention; however, research on communication between TGD patients and primary care providers (PCPs) about HIV vulnerability and prevention remains limited. This study used in-depth qualitative interviews with 25 TGD patients and 15 PCPs conducted in 2022 to explore perspectives on HIV vulnerability communication during primary care encounters. Overall, 14 of the TGD patients were nonbinary, genderqueer, or another gender identity; all but two participants identified as a sexual minority. The majority of PCPs (n = 11) were physicians. The range of years practicing medicine was between two and 39years. Thematic analysis was used to organize codes and establish themes. Three broad themes regarding factors that facilitate communication regarding HIV vulnerability were identified: (1) focusing on behaviors over identities, (2) conveying impartiality, and (3) acknowledging individuality among TGD patients. Findings corroborate earlier research that identified strengths in providers refraining from behavior-based assumptions tied to a patient's gender identity and sexual orientation and conveying impartial and nonjudgmental attitudes when discussing behaviors that can increase HIV vulnerability. Additionally, these findings underscore the significance of recognizing that, within the TGD community, all persons have unique circumstances, preferences, and needs. Future work should continue to explore the dynamics of HIV vulnerability and prevention discussions, especially among TGD individuals from diverse backgrounds and regions, to identify strategies for strengthening patient-provider communication and reducing vulnerability to HIV.

Clinical Characteristics and Care Trajectories of Transgender and Gender Diverse Patients With Cancer Seen in a Pediatric Gender Clinic.

There is very little information on the experiences of transgender and gender diverse (TGD) youth with cancer. To examine clinical characteristics and care trajectories of TGD youth a history of cancer. This case series reviewed records of 2790 pediatric gender clinic patients seen between 2007 and 2022 to identify 14 with a history of cancer diagnosis. Demographics, clinical characteristics, disclosure of gender identity to oncology teams, oncology teams' use of correct names and pronouns, documented interprofessional communication between gender health and oncology teams, and course of medical gender affirmation were reviewed. Of 14 TGD youth with a history of cancer, 11 (78.6%) were diagnosed prior to presenting to the gender clinic (mean [SD]=8.2 [4.7] years), three following initial gender care (mean [SD]=1.1 [0.2] years). Six (42.9%) patients were engaged in annual survivorship care when presenting, and 8 (57.1%) were seen concurrently by both clinics. Nine (64.3%) patients had documented communication between teams. Three-quarters of patients who were seen concurrently by both clinics had documented interprofessional communication. Eight (57.1%) patients received gender affirming hormones, after cancer treatment concluded. TGD youth with cancer experiences present for gender affirming care and merit clinical attention. There was variability in (1) patients' and families' disclosure of TGD identities to oncology teams, (2) whether oncology documentation consistently used patients' correct name and pronouns, and (3) whether there was documented interprofessional consultation between teams. There is need for ongoing improvement in research and clinical protocols for TGD youth with cancer.

Menstrual management in transgender and gender diverse individuals: psychiatric and psychosocial considerations.

Transgender and gender-diverse (TGD) menstruators are individuals assigned female at birth (AFAB)*, who retain the capacity to menstruate and have a gender identity that differs from their natal sex. Reports indicate up to 1.6 million individuals in the US identify as TGD. Until recently, the mainstream menstrual discourse has failed to capture the experience of transmenstruators. However, a better understanding of the menstrual experiences of TGD-AFAB will allow for more individualized patient-centered care. In this review, we provide the relevant data necessary to inform the psychiatric management of menstruation in TGD-AFAB individuals, including experiences of menstruation, preferences for menstrual management, and the impact on mental health. Our review indicates that menstrual care in TGD patients must be tailored to the individual; clinicians should remain open-minded to the unique experience of transmenstruators; gender-affirming menstrual care is necessary to reduce psychological burden. It should not be assumed that TGD-AFAB menstruators are utilizing appropriate contraceptive methods and should receive contraceptive and fertility preservation counseling. We highlight the importance of having these conversations early in the reproductive arch, even before puberty onset. Keeping in mind the gender minority stress model, in the upcoming sections, we discuss the limited body of literature on mood disorders in TGD-AFAB individuals who menstruate, undergo menstrual suppression, or continue to ovulate. The psychological impact of hormonal therapies is also reviewed.

Systematic review of ethical/methodological issues in transgender youth participative research

Abstract Background Understanding the experiences of transgender and gender-diverse (TGD) youth is essential for developing appropriate support services. However, studies focusing on TGD youth under 18 outside clinical settings are scarce, limiting effective support development. The requirement for parental consent in participatory research poses ethical and logistical challenges, impacting the safety, well-being, and privacy of adolescent participants. This dynamic complicates the balance between adolescents’ rights to autonomy and privacy and parental duties to protect their children. This review aims to illuminate the ethical and methodological challenges in participatory research with TGD youth. Methods A systematic review of bibliometric databases from 2006 to 2022 was conducted, focusing on transgender and gender non-conforming identities, adolescence, qualitative and participatory research methods, and consent issues. This review was registered with PROSPERO in November 2022 (CRD42022368360). Results Of 3,794 articles initially identified, 291 met the inclusion criteria, and 48 were extensively reviewed. Research with TGD youth commonly faces ethical tensions including parental inclusion in the consent process, safeguarding participant safety and privacy, ensuring confidentiality, and creating environments that allow TGD youth to express themselves and feel empowered. Methodological challenges include engaging public and stakeholders, recruiting participants, data collection, and maintaining research integrity. Conclusion & Implications The literature on participatory research with young transgender and gender-diverse individuals reveals intricate and often conflicting issues related to consent procedures, power dynamics, and the researcher’s role. These findings are applicable in various legal and geographical contexts, providing insights that can guide practices globally. Key messages • Research reveals ethical dilemmas in participatory research with transgender young people, highlighting difficulties around consent and the need for tailored support. • Understanding the complexities of research ethics enables better support for transgender and gender-diverse young people during research.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

Sex Work Patterns Among Transgender and Gender Diverse People: A Latent Class Analysis

ABSTRACT Sex work is a diverse profession encompassing a broad range of people, and services. Though overrepresented in sex work communities, transgender and gender diverse (TGD) individuals are underrepresented in sex work literature. Further, sex work literature continues to underrepresent the heterogeneity evident in the sex work community and the practices that occur within it. The present study utilized data from the 2015 United States Transgender Survey (USTS) to conduct a latent class analysis (LCA) to identify patterns of different types of sex work among TGD adults (N = 2,153) and understand the demographic characteristics associated with engagement in different types of sex work. Conceptual and statistical fit indices indicated an ideal 5-class model. Classes include (1) High Online Primary, (2) Low Online Primary, (3) Varied Sex Work, (4) Erotic Dancer, and (5) Street Primary. Results also revealed multiple differences in class membership based on demographic variables including gender identity, race/ethnicity, and sexual orientation. For example, individuals in Class 5 were significantly more likely to report no income, or income below $10,000, compared to all other classes. Taken together, the current findings highlight the varied and diverse settings, activities, and circumstances of TGD sex workers. Findings also point to a continued need to acknowledge, account for, and value the voices of sex workers across the industry when conducting research, health services, and advocacy.

Health-Related Experiences of Transgender and Gender-Diverse Coloradans: A Scoping Review of the Literature.

Extant literature on transgender and gender-diverse (TGD) people living in the United States is centered on bicoastal metropolitan cities. Little is known about the health status and health-related barriers among TGD people living in the middle of the country. Minority Stress Theory (MST) provides a framework for understanding how TGD people experience stressors that shape their health-related experiences. To describe health-related experiences of TGD people living in Colorado using the MST framework. The scoping review was limited to peer-reviewed, English-language studies published between January 2018 and November 2023. Data abstraction and synthesis were performed using Thomas and Harden's approach to thematic synthesis. Twenty-one articles were included in the review. Seventeen (80.9%) articles were quantitative studies, two (9.5%) were qualitative, and two (9.5%) were mixed methods. Most of the participants were transfeminine and 18 years old or younger. Three themes emerged (1) TGD Coloradans experience multiple health-related stressors, (2) these stressors contribute to poor health outcomes, and (3) overcome with coping strategies and/or social support. TGD Coloradans experience multiple stressors related to their TGD identity that shape their health-related experiences. Nurses play a critical role in intervening in these stressors and addressing care disparities.

Nutrition and Training Recommendations for Transgender and Gender-Diverse Athletes Involved in Strength Sports and Resistance Training: A Case Series of Nine Athletes Assigned Female at Birth.

Transgender and gender diverse (TGGD) athletes have distinct nutrition and training considerations. Guidance for nutrition and sport professionals working with TGGD athletes is lacking, especially when addressing sex-specific data. The purpose of this case series was to depict nutrition and training assessment approaches and recommendations for TGGD athletes involved in strength sports or resistance training. Six types of data informed each case presentation, including: demographic, anthropometric, health history, and survey data (Eating Competence Scale, Exercise Benefits and Barriers Scale); a 3-day food and physical activity record; and an in-depth interview. Nine TGGD athletes assigned female at birth (AFAB) presented with a range of gender identities, experiences, sport involvement, and transition journeys. Most athletes consumed inadequate energy and fiber, adequate or marginally high levels of saturated fat and added sugars, and high levels of sodium. Most athletes scored low on the Eating Competence Scale and high on the Exercise Benefits and Barriers Scale. Nutrition and sports professionals can individualize the care they provide for TGGD athletes when addressing sex-specific data and help athletes ensure they are meeting their nutrient needs.

"I Needed to be That Voice": A Multi-Party Study of the Healthcare and Social Service Experiences and Needs of Transgender and Gender-diverse Older Adults in Canada.

The social contexts of transgender and gender-diverse (TGD) older adults remain under-examined. In this qualitative study, which involved six virtual focus groups with a total of 21 participants inclusive of TGD adults ages 50+, service providers, and community advocates, we sought to examine the healthcare and social service experiences and needs of TGD older adults in Canada. Drawing theoretically on critical gerontology and intersectionality, and methodologically on interpretive description, we examined the perspectives of different participant groups to develop insight into TGD older adults' issues and priorities in the context of their engagements with systems of care. Our findings revealed the role of histories of marginalization, precarity, contemporary sources of intersectional oppression, and resistance in shaping the experiences of this population, while also highlighting community-driven ground-up activities to address evolving needs. Drawing on this conceptualization, we explored the implications of our research for ongoing inquiry, policy, and practice.

Does every transgender person want gender affirming surgery? A survey of transgender individuals in the Midwestern United States.

Gender-affirming surgery (GAS) is a highly personalized decision for transgender and gender diverse (TGD) individuals. However, the proportion of TGD individuals who desire GAS is unknown. A questionnaire was created after identifying themes surrounding experiences with gender-affirming medical care by community focus groups. Respondents who reported medically transitioning and who had undergone GAS were compared to those without prior GAS. From 88 completed surveys, 18 (20.5%) individuals did not wish to undergo GAS. Of those medically transitioning and desiring GAS, 15.2% (9/59) desired GAS but had not received it yet, with 6.7% (6/9) identifying as non-binary. Individuals who had not had GAS were more likely to earn under $15,000 annually, compared to $25,000-49,000 in the GAS group (p = 0.01). There was no significant difference in educational level (p = 0.32) or insurance status (p = 0.33). Of TGD individuals who desire GAS, out-of-pocket expenses such as hair removal, opaque insurance policies, lack of social support, and access to gender-affirming providers can hinder the transition process. Understanding barriers and rationales for pursuing GAS can provide targets for improving healthcare delivery to this diverse population.

Examining Daily Self-Efficacy, Minority Stressors, and Alcohol and Other Drug Use Among Trauma-Exposed Sexual Minority Women and Transgender and Gender-Diverse People.

This study aimed to develop and test a novel model integrating social-learning and self-medication frameworks by examining the association between self-efficacy to resist alcohol and other drug (AOD) use and daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We examined whether minority stressors moderated these associations. Data were from 57 trauma-exposed SMW and TGD people who participated in a 14-day daily diary study. Multilevel binary logistic models and ordinal logistic models were employed to examine associations between self-efficacy to resist AOD use and daily AOD use and unhealthy drinking risk at within- and between-person levels. We assessed same- and cross-level interactions between daily self-efficacy to resist AOD use and minority stressors in predicting AOD use and unhealthy drinking risk within the same 24-hour period (i.e., standardized as 6 pm to 6 pm; hereafter referred to as "same-day"). Self-efficacy to resist AOD use was associated with lower AOD use and unhealthy drinking risk. Minority stressors were associated with daily AOD use. Among those who experienced higher (vs. lower) average sexual minority stressors over the 2-week daily diary period, higher-than-usual self-efficacy to resist AOD use was less protective in decreasing risk of same-day unhealthy drinking. Interventions aiming to mitigate AOD use and unhealthy drinking risk by bolstering self-efficacy to resist AOD use should consider the impact of recent cumulative exposure to sexual minority stressors in this population. Further, policy efforts are needed to reduce perpetuation of stigma.

The Perceived Inclusivity of Sex Education Scale – 2: Sex Education Inclusivity and Health Outcomes Among Gender Diverse Individuals

Past research has documented a relationship between sex education inclusivity and health outcomes among sexually diverse youth (e.g., lesbian, gay, bisexual, queer). However, despite transgender and gender diverse (TGD) individuals also being regularly excluded from sex education, little research has explored this relationship among TGD people. In the current study, the Perceived Inclusivity of Sex Education Scale − 2 (PISES-2) was developed to better understand the associations between perceived sex education climate and both mental and behavioral health outcomes. TGD individuals (N = 162) were recruited to participate in an online survey to examine these associations. Results suggested that greater levels of perceived inclusivity of sex education were associated with lower levels of depression, anxiety, and suicidality in high school and post-high school. Additionally, greater levels of inclusivity of sex education were associated with increased sexual behaviors and less hesitancy toward sex in TGD individuals in high school and post-high school. These conclusions add to the growing literature highlighting the critical importance of inclusive and affirming sex education for the safety and well-being of TGD individuals.

Caring for Transgender and Gender Diverse Prehospital Patients: a NAEMSP Position Statement and Resource Document

ABSTRACT Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care–especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient’s identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals’ right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers. NAEMSP Recommends: EMS clinicians should maintain basic cultural competency regarding TGD populations, including familiarity with TGD-related health and health care disparities, consideration of TGD populations as underserved, and understanding the centrality of stigma and transphobia in creating disparities and other challenges which complicate daily life for TGD people. EMS clinicians should demonstrate cultural humility towards the TGD community, which includes self-assessment of knowledge gaps, as well as openness to new or unfamiliar ideas, information, and advice from those with different lived experiences. EMS clinicians should understand basic TGD-specific terminology and use appropriate language–including patient-identified name and pronouns–during direct patient care, in handoffs, and in documentation. EMS clinicians should treat a patient’s TGD status as sensitive health information and take care not to inadvertently disclose this information without the patient’s express permission. EMS clinicians should have a basic understanding of social transitioning and of gender-affirming medical and surgical treatments. EMS clinicians should employ a trauma-informed approach when caring for TGD patients. EMS education and training should incorporate learning domains that address comprehensive care for TGD patients, with educational content providing the specific knowledge and skills required to promote equitable care. EMS workplaces should implement policies to improve recruitment and retention of TGD personnel, covering harassment protection, non-discrimination practices, inclusive working environments, equal advancement opportunity and tailored employee benefits. Future EMS research should focus on elucidating the disparities in and barriers to prehospital care of the TGD patient population with emphasis on patient experience and education of prehospital clinicians.

Self-harm, suicidal ideation, depression and peer relationships in transgender and gender diverse adolescents accessing specialist mental health services.

There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%-2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK. This cross-sectional study explored data from 170 young people participating in the Beating Adolescent Self-Harm (BASH) trial. Baseline data about self-harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152). In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression. Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers.

5066 Evolution And Evaluation Of A Longitudinal ECHO Program In Transgender Health

Abstract Disclosure: M.S. Rothman: None. A. Chippone: None. A. Clark: None. D. Saxon: None. D. Miller: None. K. Young: None. S.J. Iwamoto: None. Background: Providers often report a lack of training in the care of transgender and gender diverse(TGD) patients. Extension for Community Healthcare Outcomes(ECHO) programs have been developed around the world as a form of tele-mentoring. As gender-affirming care bans rise in the US, it is crucial for providers to have access to education in TGD patient health. ECHO Colorado(CO) launched “Comprehensive Care for Transgender Patients” in 2020 as an ongoing live monthly series for providers interested in improving care for TGD patients. Design/Methods: 40 sessions were held between 2/2020-9/2023. Topics spanned mental health, medical, and surgical care with didactic presentations followed by case discussions. Demographic data was collected at registration via Connect, an online portal, and evaluations were conducted quarterly using Qualtrics. Not all questions were required. Participants attending at least one session in the quarter were eligible to complete the survey. With multiple responses, the most recent survey was used in the analysis. Results: 257 individuals participated in at least one session. 164/255 (64.3%) respondents identified as clinical health care providers. The majority of the remainder identified as: behavior health professional(n=28), other(n=23) or health outreach/admin(n=17). Most participants (79.4%) practice in CO and the majority provide direct care for underserved populations. 110 attendees responded to at least one survey. 96% of all participants reported improved understanding of the subject matter. Of the prescribing providers, 80%(60/75) rated themselves as comfortable with continuing and 68%(51/75) were comfortable with initiating hormone therapy. In the most recent quarter, participants were asked to self-report levels of professional isolation before and after the series. 30%(8/27) reported feeling very or extremely isolated prior, while none(0/27) reported this since participating. Common barriers reported were obstacles to implementing care and scheduling conflicts preventing attendance. Conclusion: Participants with a variety of backgrounds are highly satisfied with this longitudinal program. ECHO learning may combat feelings of professional isolation. The majority of providers report comfort with initiating and providing hormone therapy, but future efforts should seek ways to improve comfort, competency and examine asynchronous educational opportunities. Interest from attendees outside of CO supports a need for a national collaborative of TGD focused ECHOs. Presentation: 6/1/2024

7275 Diverse Reasons for Discontinuing Gender Affirming Hormone Therapy

Abstract Disclosure: A. Jain: None. M.S. Irwig: None. Many Transgender and Gender Diverse (TGD) individuals take Gender Affirming Hormone Therapy (GAHT). A study that included 264 adults [67% assigned male at birth (AMAB)] in Georgia found that 2% (n=5) discontinued GAHT over a follow-up period of 64 months. Reasons identified were change in gender identity (n=2), financial barriers (n=2) and venous thrombosis (n=1). Discontinuation was temporary for 2 and permanent for 2. Here we describe the reasons why four TGD individuals discontinued GAHT. Case Descriptions: Patient 1, AMAB, came out as gay as a teenager. In his mid 30s he became unhappy which he attributed to a conflict between religion and his sexual orientation and failed relationships. He thought that changing his sex would solve his problems. He took injectable estrogen for 3-4 years. He subsequently underwent multiple gender-affirmation surgeries including facial feminization surgery, breast implants, an orchiectomy and vaginoplasty. Immediately following the breast implant surgery he had regrets and wanted them removed. He also regretted the vaginoplasty. He stopped estrogen following the bottom surgery. In his 40s he stated that he would like to detransition as he sees himself "as a fake" when looking in the mirror. Patient 2 was assigned female at birth. Puberty was associated with discomfort from having a large chest. In his late 20s he began injectable testosterone which he took for three years. He then decided to take a two year break as he was frustrated that he had not achieved the desired results and because he was still not able to pass as a man. He resumed testosterone two years ago and underwent top surgery. Patient 3, AMAB, knew from a young age that he was transgender. He took estrogen and an antiandrogen for > 5 years and underwent an orchiectomy and vaginoplasty. He was pleased with the results from the GAHT and surgeries. He presented as a woman for many years. A few years ago, however, he awoke one day with the thought that God wanted him to be a man. He decided to detransition and presented to the endocrinology clinic to start testosterone therapy. Patient 4, AMAB, began GAHT in her late 30s. She discontinued GAHT 4 years later due to lack of results (feminization, larger breasts, wider hips and a more curvy figure). She presented to the endocrinology clinic 2 years later, wanting to resume GAHT. Conclusion: In addition to the reasons identified by Gupta et al for discontinuation of GAHT, we also identified unrealistic expectations, not achieving the desired results and perceived conflict between religion and gender identity. Endocrinologists should be aware of the possibility of discontinuation of GAHT and know how to manage any potential complications such as hypogonadism that may arise. Reference: Gupta P et al. J Clin Endocrinol Metab. 2023. Presentation: 6/2/2024

Identifying the ways in which tobacco cessation interventions have been tailored for sexual and gender minority individuals: A systematic review.

Sexual and gender minority (SGM) individuals smoke at higher rates than their heterosexual and cisgender peers. SGM persons, especially transgender and gender diverse (TGD) individuals, face unique, adverse health effects associated with smoking. As such, SGM individuals may benefit from smoking cessation interventions that are tailored to meet their needs. This systematic review aims to describe the ways in which these interventions have been tailored for SGM individuals and summarize available acceptability and efficacy data. Four databases were searched to identify smoking cessation interventions adapted for SGM populations. Thirteen articles were identified, with tailored aspects focusing on culturally tailored references, SGM-specific psychoeducation, and intra-community support strategies. No clear patterns of efficacy were identified, and only one study included bioverified abstinence. Preliminary evidence suggests that smoking cessation interventions can be acceptably tailored to SGM individuals, however, additional research is needed to determine if SGM-tailored interventions are more efficacious than non-tailored approaches.