Transgender Care Research Articles

Insights Into Facial Surgery Trends in the United States in the Setting of Gender Dysphoria: A National Analysis From 2012 to 2019.

Over the past decade, there has been an improvement in access to gender-affirming surgical care for the transgender population. Even with improvements, this population continues with a high level of inequity among access to specialized surgical care. While multiple studies have previously focused on trends among top and bottom surgery, this study provides trends specifically among facial gender affirmation surgery (FGAS) within the United States. The National Inpatient Sample (NIS) was utilized to identify patients who underwent FGAS from 2012 to 2019. The diagnostic codes for gender identity disorder and gender dysphoria were used to identify the desired patient population. CPT coding released in a medical policy for transgender care coverage was used to identify those who underwent FGAS. Frequency distributions from the patient population were analyzed to determine differences among characteristics. In total, 660 patients underwent FGAS from 2012 to 2019. The incidence of FGAS has increased by 1433%. Geographically, FGAS was more likely to be performed in the West and Northeast geographical regions (P<0.0001). There was a statistically significant difference in hospital length of stay and the total number of charges when stratified by race (P<0.0001 and P=0.0003), hospital location (P<0.0001 and <0.0001), and insurance type (P<0.0001 and <0.0001). The largest cohort of patients paid out-of-pocket (P<0.0001). FGAS is one of the fastest-growing GAS procedures. Currently, FGAS procedures are not equally distributed, with higher concentrations occurring among wealthier, white individuals in certain geographical regions. Future studies are warranted to understand further trends within FGAS.

Discrimination experiences of transgender individuals in healthcare: an interview study on the perspective of health professionals specializing in the treatment of transgender individuals

BackgroundExperiences of discrimination in healthcare lead to poorer mental and physical health for transgender individuals. There is evidence that trans-specialists, i.e. health professionals specializing in transgender care, are an important source of discrimination experienced by transgender individuals in healthcare. In this qualitative interview study, we explored the reasons for this possibly surprising finding by analyzing subjective views of trans-specialists on various issues related to discrimination of transgender individuals.MethodsWe conducted 20 semi-structured, qualitative, exploratory interviews with healthcare professionals specializing in transgender care. Interview questions were developed based on an extensive literature analysis and results of previous research on the topic. The interviews were conducted online, were digitally recorded and transcribed. Data analysis was conducted using the methods of content analysis and thematic analysis.ResultsThe interviewees had great difficulty giving a consistent definition of the concept of gender identity. Most of them saw it as a self-determination of a transgender individual. Although herewith emphasizing the autonomy of transgender individuals, most trans-specialists felt that they had to be convinced of their patient’s transsexuality to carry out treatment. Most trans-specialists reported having had doubts about whether some transgender individuals were suffering from gender incongruence or not. There was also ambiguity among interviewees about whether transsexuality is a mental illness.ConclusionsWe were able to identify specific topics that can cause discrimination experiences on the part of transgender individuals in their contact with trans-specialists. These include the vagueness of the construct of gender identity and the ambivalence between respect for the autonomy of transgender individuals and the validation of the diagnosis “transsexuality”. Also, uncertainties regarding the classification of transsexuality as a mental illness can lead to experiences of discrimination. Furthermore, our results imply that trans-specialists might remember own discriminatory behavior less than it actually took place. Our results can contribute to the development of specific measures to avoid discrimination experiences of transgender individuals in contact with trans-specialists. These should include a reflection on one’s own gender identity and training on mechanisms of discrimination.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Primary care provider beliefs and knowledge of prescribing gender-affirming hormone therapy to transgender and gender diverse patients

BackgroundTransgender patients often cannot access a provider who is knowledgeable about providing gender-affirming hormone therapy (GAHT). This study evaluated primary care provider (PCP) comfort and experience with, opinions about, and knowledge of prescribing GAHT to adults.MethodsAn anonymous Qualtrics survey was distributed to PCPs in San Diego County. Fisher’s exact test assessed any association between age, years in practice, or practice setting and 1) comfort in prescribing GAHT and 2) favorable statements about learning about, providing, and benefitting from training in GAHT. T-tests determined relationship between age, years in practice, or practice type setting with number of correctly answered multiple choice knowledge-based questions out of 4.ResultsOut of 220 responses, median age was 41, 60% had practiced for ≤ 10 years, and 19% had practiced in an academic setting. Forty-two percent did not receive any education about transgender healthcare during medical training. The most commonly reported barrier to providing GAHT was lack of training (74%). PCPs age ≤ 41 (67% vs 49%, p = 0.009), PCPs practicing for ≤ 10 years (65% vs 51%, p = 0.037), and PCPs in non-academic settings (64% vs. 41%, p = 0.013) were more likely to report being comfortable with prescribing GAHT. PCPs age ≤ 41 (89% vs 62%, p < 0.001) and PCPs practicing for ≤ 10 years (86% vs 66%, p < 0.001) were more likely to show interest in learning about GAHT. PCPs age ≤ 41 (74% vs 46%, p < 0.001) and PCPs practicing for ≤ 10 years (70% vs 50%, p = 0.003) were more likely to show interest in prescribing GAHT. Knowledge scores were higher for PCPs age ≥42 (mean 1.7 vs 1.4, p = 0.033) and PCPs working in academic centers (mean 2.0 vs 1.4, p = 0.002).ConclusionYounger (age ≤ 41) and early career (practicing for ≤ 10 years) PCPs reported being more comfortable with prescribing GAHT and had more favorable opinions in learning about, providing, and benefitting from training in GAHT. They are interested in providing GAHT; however, few prescribe GAHT with most reporting lack of training as a major barrier. This was evident with overall low knowledge scores regardless of age, experience, or clinical setting and underscores the need for increased educational efforts in transgender care throughout medical training.

A transdisciplinary perspective is indispensable to address the increased demand for transgender care

A transdisciplinary perspective is indispensable to address the increased demand for transgender care

Impact of Estrogen Therapy on BRCA1-Associated Breast Cancer Progression in Transgender Women

The combination of hormone treatment and genetic liabilities in transgender women leads to a complicated situation for breast cancer growth particularly linked to BRCA1 mutations. Gender-affirming treatment relies heavily on estrogen and causes intense cell growth and differentiation in breast tissue driven by estrogen receptor mechanisms. Mutations in BRCA1 lead to weak DNA repair processes which enhance an individual's vulnerability to cancerous changes. Rodestrogens enhance the functioning of proliferative pathways like PI3K/AKT and MAPK pathways in cells with dysfunctional BRCA1. This collaborative action elevates the threats posed by benign growths such as fibroadenomas leading to invasive breast cancer. By affecting the expression of vital regulatory proteins linked to cell proliferation estrogen further compromises the genomic integrity in cells harboring BRCA1 mutations. The hormone environment influenced by exogenous estrogen therapy can shape the tumor microenvironment for better cancer progression and metastasis. Comprehending the relationship between estrogen signaling and pathways related to BRCA1 is important for identifying the enhanced risk of cancer in transgender women using hormone therapy. This detailed study aligns recent discoveries regarding genetic vulnerability and hormonal impacts with cell mechanisms to reveal a detailed insight into breast cancer progression in these individuals. The study emphasizes the necessity for custom-designed cancer screening methods and targeted treatments to help mitigate risks and support transgender care. Understanding these pathways greatly enriches our knowledge of hormone-induced carcinogenesis among those who carry certain genetic markers while also guiding the creation of personalized care for transgender women at enhanced risk of breast cancer.

12545 Transgender Healthcare Online Curriculum: A Partnership Between An Academic Medical Center And Corrections Facility

Abstract Disclosure: E. Lamos: None. R. Malek: None. Introduction: The World Professional Association for Transgender Health Standards of Care (WPATH SOC-8) states that all recommendations be applied equally to individuals living in institutions​, including those incarcerated. Studies suggest correctional staff have little training in transgender care.​ To demonstrate a partnership between an academic medical center and a corrections facility and increase knowledge and comfort in transgender healthcare, academic faculty developed an online curriculum as an educational opportunity for state corrections facility staff and clinicians. Methods: There were 6 modules: Overview of Transgender Competent Care, Health Vulnerabilities, Creating an Inclusive Environment, Feminizing and Masculinizing Hormone Treatment, and Preventative Care of the Transgender Individual (Image). The Short Course (first 3 modules) was for staff or clinicians not providing hormone-affirming care and the Full Course (all 6 modules) for clinicians who provide hormone-affirming care. Each module included embedded knowledge assessments and post-module action items. An anonymous pre and post curriculum survey assessed module effectiveness. The project was considered non-human subject research by the Institutional Review Board. Result analysis used the Fisher Exact Test and unpaired t test. Results: 44 corrections staff and clinicians participated (2022-2023) with a 32% post survey response rate. 57% indicated zero prior hours of transgender education with 59% feeling somewhat or extremely comfortable with transgender healthcare. Most were interested in learning about transgender healthcare (Table 1). Participants had a statistical improvement in knowledge and their access to resources were good or excellent after completion (p &amp;lt;0.05, both) (Table 2). Also, for the Short Course, comfort in recognizing barriers to care significantly improved (p&amp;lt;0.05), 100% agreed both with the importance of what they were asked to learn and that knowledge and skills increased. Domains of comfort with transgender healthcare did not statistically change for participants of the Full Course. Participants positively reflected on curriculum content and bias discussion. Full Course respondents requested more therapeutics information. Inclusive interactions were the most frequent practice improvement strategy. Conclusion: This curriculum increased knowledge and improved resources for those providing healthcare to incarcerated transgender patients. The curriculum was inclusive of many diverse types of learner and allowed learners to choose the course that aligned with their clinical role. It meets WPATH SOC-8 recommendations that corrections staff and clinicians receive training in transgender care.​ It highlights the collaboration between an academic medical center and corrections facility, meeting the academic mission to serve marginalized groups. Presentation: 6/1/2024

'A void in our community': exploring the complexities of delivering and implementing primary care services for transgender individuals in Northern Ontario.

To understand how the implementation of primary care services for transgender individuals is undertaken and delivered by practitioners in Northern Ontario. Northern Ontario, Canada, has a shortage of primary care health practitioners, and of these, there are a limited number providing transgender primary care. Transgender people in Northern Ontario must also negotiate a lack of allied and specialty services related to transgender health and travel over long distances to access those services that do exist. A convergent mixed methods design was guided by normalization process theory (NPT) to explore transgender primary care delivery and implementation by nurses, nurse practitioners, physicians, social workers, and psychotherapists. A survey measuring implementation processes was elaborated through qualitative interviews with participants. Analysis of key themes emerging using the NPT framework informed understanding of primary care successes, barriers, and gaps in Northern Ontario. Key themes included the need for more education on transgender primary care practice, increased need for training and awareness on transgender resources, identification of unique gaps and barriers to access in Northern Ontario transgender care, and the benefits of embedding and normalizing transgender care in clinical practice to practitioners and transgender patients. These findings are key to understanding and improving access and eliminating healthcare barriers for transgender people in Northern Ontario.

Reproductive health in trans and gender diverse patients: Transgender medicine: contextual trans gynecology.

This manuscript aims to promote an understanding of the special needs of transgender and gender-diverse people by putting trans gynecology into context. By definition, medical interventions for transgender people are not different from the treatment of cisgender people but cannot be singled out as gender-affirmative treatment. Treatment is dedicated to an overarching goal beyond medicine, namely to enable and maintain social functioning under the signs of the social gender. It is therefore that this narrative overview intensively deals with the requirements of trans gynecology. Also, various gynecological disorders are touched upon, provided they are relevant to trans people. The different significance of gynecological symptoms for either trans men or trans women, and the effects of supraphysiological androgen treatment on hormone-sensitive tissue, are stressed. Transgender health care is not just gender-affirmative transitional care but is committed to a superior objective, often beyond a medical perspective: to create and maintain physical conditions for social functioning under the signs of the individually appropriate sex and to contribute to significantly reducing gender dysphoria. For these purposes, it is a prerequisite to have a distinct contextual understanding of the complex reality of transpeople and knowledge about the numerous facets of transgender healthcare. Gynecology for transgender and gender-diverse people does not differ greatly from gynecology for cisgender female patients except in goals and context. Relief from complaints derived from genital organs is, of course important, but for transpeople there always is an overarching gender dimension that sometimes complicates treatment and might give rise to misunderstandings. Also, minority stress caused by societal factors frequently impacts the mental and physical state of health negatively and needs to be considered. This paper focuses on the context of trans gynecology and addresses various contentual aspects for both transmale patients having left genital organs in situ and transfemale patients with gynecological demands. Gynecological topics are addressed, highlighting their relevance for transgender and gender-diverse people (TGD), including the effects of supra-physiological androgen exposure on ovaries and uterus, vaginal bleeding, pelvic pain under testosterone treatment, screening policies, and benign gynecological disorders as clinical manifestations may appear differently and treatment may be more burdensome.

Gender-affirming orchiectomy in transgender and non-binary individuals: A large cohort study with middle- to long-term follow-up

Introduction Some transgender individuals opt for gender-affirming orchiectomy. Data on postoperative outcomes in the transgender population are scarce. Methods All individuals who underwent gender-affirming orchiectomy between 01-2010 and 01-2024 were retrospectively identified at two centers that provide surgical transgender care. Individual demographics, motivations, intra- and postoperative complications, reoperations and postoperative regret were recorded. Surgical risk factors were identified using logistic regression analysis. Results A total of 119 individuals were retrospectively identified with a median clinical follow-up of 2.3 years (range 0.3–9.4). A total of 109 identified as transgender woman, eight as non-binary and two as agender. 18 (15%) individuals opted for sperm cryopreservation before surgery. The postoperative course was without complications in 102 (86%) individuals. Complications comprised hemorrhage (n = 5, 4%, Clavien-Dindo 3b) and abscess formation (n = 7, 6%, Clavien-Dindo 2), (n = 1), 3a (n = 3) and 3b (n = 3))). In the follow-up time, seven individuals underwent vaginoplasty, two vulvoplasty and two were on the waiting list for vaginoplasty. There were no cases of regret. A BMI >35 was identified as risk factor for infectious complications (p = .045, OR 9.8, 95% CI 1.0–99.3). Discussion Gender-affirming orchiectomy is a simple and safe procedure. It can be performed as standalone gender-affirming surgical procedure, or as bridge to another gender-affirming procedure.

Virtual reality versus webinar trans healthcare training for emergency medicine residents: a feasibility study

Introduction Transgender and gender non-binary (TGNB) patient care is not routinely taught in medical training. As a result, clinicians frequently lack knowledge regarding gender-affirming practices, surgeries and medications. TGNB-specific health knowledge and care delivery are further negatively impacted by pervasive societal transphobia. Virtual reality (VR)-based instruction may provide learners with opportunities for perspective taking, empathy building and attitudinal shifting to improve care delivery to TGNB patients. Methods This was a feasibility trial that compared passive VR and webinar in changing learner attitudes, knowledge and medical decision-making (MDM). Residents were recruited from five US emergency medicine (EM) residencies and were randomized to either VR or webinar educational intervention arm. Pre- and post-intervention assessments were matched using a unique identifier. Participants provided feedback about platform usability. Results From August 2020 to October 2021, 206 resident participants were randomized into a case-based VR experience or webinar intervention on TGNB-specific EM medicine; 52 residents completed all three steps of the study. Webinar participants demonstrated more changes in attitudinal statements than VR participants. No improvements in knowledge or MDM were appreciated in either intervention arm. Participants in both arms shared positive and critical feedback about the intervention they accessed, with convenience and ease of use being valued for asynchronous webinar learning. Discussion The webinar arm demonstrated a higher increase in empathy or change in attitude compared to VR learners. As VR becomes more technologically agile, accessible and reliable, more work is needed to see if this novel format is an educational tool that closely approximates the standardized patient encounter.

The Importance of Fertility Preservation in the Transgender Population

ObjectiveTo call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. MethodsSixteen genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Their physicians were aware of fertility struggles after undergoing hormone therapy and therefore referred to urology. Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. ResultsUnder IRB approval, 15 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (aged years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. ConclusionsWith more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development.

Medical care for transgender individuals at a hospital in southern Brazil: why do they drop out from our service?

The objective of the study was to investigate dropout rates and discern potential factors contributing to the discontinuation of treatment provided to transgender individuals by the Transdisciplinary Gender Identity Program at the Hospital de Clínicas de Porto Alegre (PROTIG). This study employs a descriptive, cross-sectional, retrospective design to analyze socio-demographic and clinical data obtained from medical records of patients treated at PROTIG between 2000 and 2018. A structured form, devised by PROTIG's professional team, was utilized to extract and evaluate several variables including: age, gender, education level, diagnosis of F64 according to the International Classification of Diseases (ICD-10: Version: 2010), clinical comorbidities (coded by ICD-10), laboratory diagnosis of sexually transmitted infections, distance between patients' residence and the hospital, and year of entry into PROTIG. The patient cohort was stratified into two categories based on their duration of attendance: dropout (defined as attendance for up to 365 days) and non-dropout (attendance exceeding 365 days). Categorical variables between dropout and non-dropout groups were compared using Pearson's chi-square test. Additionally, Poisson regression analysis was utilized, employing a 95% confidence interval (CI) and setting the significance level at 0.05. The study included a total of 888 patients accessing PROTIG, with 275 (31%) classified in the dropout group. Of the patient population, 65.5% (n = 582) self-identified as transgender women, while 34.5% (n = 306) identified as transgender men. Significant differences were noted between the dropout and non-dropout groups. Specifically, differences were noted among transgender women (p < 0.001), individuals with lower levels of education (p < 0.001), those with fewer diagnoses classified under ICD-10 as F64 (p < 0.001), individuals exhibiting fewer clinical comorbidities recorded in ICD-10 (p < 0.001), and those who commenced inclusion in PROTIG after 2010 (p < 0.001). There exists a notable rate of treatment discontinuation among individuals receiving care at PROTIG, with statistically significant variances observed between groups. We posit potential rationales for this discontinuation, informed by care experiences and feedback from group attendees: Increased accessibility to outpatient services in our jurisdiction for Transgender Care, along with heightened societal awareness of gender identity fostering diverse gender expression avenues devoid of reliance on gender-affirming surgical interventions.

Transgender and Gender Diverse Health Care in the US Military: What Dermatologists Need to Know.

The US Military has made considerable strides in providing quality health care to transgender and gender diverse service members (TSMs). Current policies ensure continued military readiness and allow TSMs to receive gender-affirming care while continuing to serve. Dermatologists play an important role in the multidisciplinary medical team required for medical gender transition; however, there is considerable discord between medically necessary procedures for dermatologic gender-affirming care and insurance-covered benefits. Within the scope of dermatology, many of the available procedures currently are not covered by insurance. This article seeks to discuss how military and civilian dermatologists can contribute to gender-affirming care. We also review existing disparities in health care and identify potential areas of improvement.

Referrals For Gender-Affirming Hormone Treatment in Croatia's National Network for Transgender Healthcare.

A network of healthcare professionals specializing in transgender care was established in Croatia in 2011, and legal advancements were subsequently made in 2014. Both achievements made gender transition more transparent and thus more attainable in Croatia. This observational study was conducted to assess the number of transgender individuals initiating gender-affirming hormone treatment (GAHT) in Croatia and describes trends in age and sex assigned at birth. Between 2011 and 2022, a total of 111 transgender individuals initiated GAHT. Within the cohort, 52 were assigned male at birth (AMAB) and 59 were assigned female at birth (AFAB). The overall annual incidence rate of transgender individuals initiating GAHT was 0.52 per 100,000 age-adjusted individuals. There was a statistically significant increase (p < 0.01) in transgender individuals commencing GAHT before the COVID-19 pandemic. Furthermore, a rising trend toward masculinizing rather than feminizing treatment was identified (p < 0.05), particularly among younger transgender individuals. The COVID-19 pandemic disrupted these trends in 2020, except for the trend of initiating therapy at a younger age (p < 0.01). The annual incidence and age distribution trends of transgender individuals initiating GAHT in Croatia closely mirrored those in other European countries, with a higher prevalence of individuals assigned female at birth. The study underscores a significant rise in the number of individuals initiating gender-affirming hormone treatment, emphasizing the need for proper legal regulation and healthcare system response.

Transgender health care in the United States: legal, ethical and practical concerns for gastroenterologists in a changing landscape.

Transgender health care in the United States: legal, ethical and practical concerns for gastroenterologists in a changing landscape.

Waiting for transgender care and its effects on health and equality: a mixed-methods population study in the Netherlands

Access to gender-affirming medical care has life-saving effects on transgender and gender diverse (TGD) individuals. An increasing number of TGD individuals seek care which led to waiting times of years. We assessed the duration and effects of excessive waiting for gender-affirming care. In this mixed-methods cross-sectional population study, conducted in the Netherlands between June and August 2019, all TGD individuals with experiences with receiving/applying for gender-affirming medical care could participate. Data of participants waiting for care was primarily analyzed. Demographic characteristics and requested care (multiple-choice questions) and the effects of waiting on health were surveyed (open-ended questions). Descriptive statistics were calculated per treatment, and differences in participant characteristics between those waiting for and already in care were assessed through Chi squared tests and post-hoc testing of residuals. Open text answers were thematically analyzed. Of all 975 participants, 431 (44.2%) waited for gender-affirming medical care. For 10 out of 20 treatment modalities, the median waiting period was more than a year. Participants already in care were on average higher educated and less-frequently non-binary. Subjective effects of waiting were (very) negative for most treatments. Qualitative findings showed that long waiting was associated with a range of psychosocial distress, poorer health, increasing healthcare consumption, and increased inequality between TGD individuals. Findings confirm that TGD individuals encounter long waiting times in multiple stages of their gender-affirming medical care. Waiting affects both physical and psychosocial health. Individual resilience and resources can mitigate these experiences, which increase inequality within this already marginalized group. Ministry of Health, Welfare and Sport of the Netherlands and Zorgverzekeraars Nederland (Healthcare Insurers Netherlands).

Developing a transgender primary care service: the Bridge at Southwark

Developing a transgender primary care service: the Bridge at Southwark

Body Mass Index Distributions and Obesity Prevalence in a Transgender Youth Cohort – A Retrospective Analysis

PurposeTo evaluate differences in auxological parameters between transgender and cisgender adolescents. MethodsRetrospective analysis of auxological data of 269 transgender and gender diverse patients (75% assigned female at birth or AFAB, 25% assigned male at birth or AMAB) at the outpatient clinic for Pediatric Endocrinology at the Vienna General Hospital. All were treatment naïve at initial measurement. Height and weight data were compared to current World Health Organization (WHO) standards, defining a standard deviation score (SDS) of ≥ 1 ≤ 2 as overweight and > 2 as obese. ResultsIn our untreated transgender population (mean age 15.7 years), 20% were overweight and 17% obese. Mean BMI was 0.64 SDS above the WHO average (p < .001). This result was more pronounced in the AFAB subgroup (+0.73 SDS, p < .001) than in the AMAB group (+0.37 SDS, p = .07). The AMAB group showed markedly higher BMI variance compared to WHO standards (p < .001) and to the AFAB group (p = .03), due to a higher relative number of underweight observations. When correcting for psychiatric diagnosis, transgender patients were still significantly overweight (p < .001). In patients for whom data both pregender-affirming hormone therapy and during gender-affirming hormone therapy was available (n = 133), BMI SDS did not change significantly over time (p = .22). DiscussionWe observed significantly higher rates of overweight and obesity in our adolescent transgender cohort. The reasons are likely complex and multifactorial. This makes eating and exercise behaviors central in both transgender care and future research.

Perceptions and Understanding of Transgender Patient Care: A Survey of Practicing Facial Plastic Surgeons.

Transgender individuals face significant health disparities including deficiencies in physician education, knowledge, and comfort with care. The objective of this study was to determine the perceptions, practice patterns, and familiarity of facial plastic surgeons with transgender health care. An anonymous questionnaire was sent to facial plastic surgeons within the American Academy of Facial Plastic and Reconstructive Surgery list-serve. Primary datapoints included participant characteristics, transgender-related experience, and educational goals. Of the 66 facial plastic surgeons surveyed, 49% had treated 1 to 10 transgender patients during their career, and 70% were actively treating at least 1 transgender patient. The number of patients treated and surgeries performed was significantly associated with self-perceived competence, comfort counseling on gender-affirming surgeries, discussing gender identity, asking preferred pronouns, and a desire to learn more about transgender care. Most participants (61%) obtained transgender care training through real-world experience, with only 18% receiving formal training in residency or fellowship. In total, 50% of respondents believe transgender care training among facial plastic surgeons is inadequate and 60% support its incorporation into residency/fellowship curricula. Increased awareness is needed to address the disparities experienced by transgender patients. Many facial plastic surgeons desire to learn more and support incorporating transgender care into training. Understanding the current state of transgender care can assist the facial plastic community in promoting education that strengthens physicians' ability to deliver competent care that addresses the inequities faced by this diverse group.