Transgender Health Research Articles

Substance use patterns among a global sample of transgender and non-binary people during the COVID-19 pandemic

BackgroundTransgender and non-binary (TNB) people are at high risk of substance misuse compared to cisgender individuals. Few studies have described substance use among non-binary people, and many studies have focused solely on samples from Western countries. In this global study of TNB people, we sought to identify intra-group differences, risk factors, and COVID-related changes in the use of tobacco, alcohol, and cannabis.MethodsWe used cross-sectional data from 926 TNB users of the Hornet app across 76 countries between October and November 2020. Participants self-reported the use of tobacco, alcohol, and cannabis in the past 6 months and any changes in use during the pandemic. We generated descriptive statistics and used logistic regression to assess substance use between TNB subgroups, identify risk factors for each substance by gender identity, and identify changes in substance use before and during the pandemic.ResultsMost TNB participants used tobacco (53.7%, n = 498) and alcohol (66.3%, n = 614). Non-binary participants had increased odds of using cannabis (adjusted odds ratio: 1.62, 95% CI 1.03, 2.55) compared to transfeminine participants. Participants’ geographic region of residence was most associated with higher substance use, compared to other potential factors. Most participants reported increases in at least one substance during COVID-19 (54.2%, n = 276 of 518 responses).ConclusionsIn this global TNB sample, we found that substance use varied by gender identity, and changes in substance use during the pandemic varied by TNB sub-groups. We join researchers calling for gender-specific tailoring of substance-related services for TNB clients and urge further studies with greater inclusion and disaggregation of non-binary and transmasculine individuals to support better-informed analysis of transgender health.

Diabetes Care And Transgender Health: Clinical Pearls.

Diabetes and other cardiometabolic diseases occur across the world, and do not discriminate between populations. This communication reviews the epidemiology and etiology of diabetes in the transgender population, and highlights clinical issues that must be kept in mind while evaluating and managing the condition. It adds value to existing literature by equipping health care professionals with specific skills designed to enhance diabetes care delivery, and results, in transgender individuals.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Community-Engaged Participatory Methods to Address Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Young People's Health Information Needs With a Resource Website: Participatory Design and Development Study.

Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people (aged 15 to 25 years) face unique health challenges and often lack resources to adequately address their health information needs related to gender and sexuality. Beyond information access issues, LGBTQ+ young people may need information resources to be designed and organized differently compared with their cisgender and heterosexual peers and, because of identity exploration, may have different information needs related to gender and sexuality than older people. The objective of our study was to work with a community partner to develop an inclusive and comprehensive new website to address LGBTQ+ young people's health information needs. To design this resource website using a community-engaged approach, our objective required working with and incorporating content and design recommendations from young LGBTQ+ participants. We conducted interviews (n=17) and participatory design sessions (n=11; total individual participants: n=25) with LGBTQ+ young people to understand their health information needs and elicit design recommendations for the new website. We involved our community partner in all aspects of the research and design process. We present participants' desired resources, health topics, and technical website features that can facilitate information seeking for LGBTQ+ young people exploring their sexuality and gender and looking for health resources. We describe how filters can allow people to find information related to intersecting marginalized identities and how dark mode can be a privacy measure to avoid unwanted identity disclosure. We reflect on our design process and situate the website development in previous critical reflections on participatory research with marginalized communities. We suggest recommendations for future LGBTQ+ health websites based on our research and design experiences and final website design, which can enable LGBTQ+ young people to access information, find the right information, and navigate identity disclosure concerns. These design recommendations include filters, a reduced number of links, conscientious choice of graphics, dark mode, and resources tailored to intersecting identities. Meaningful collaboration with community partners throughout the design process is vital for developing technological resources that meet community needs. We argue for community partner leadership rather than just involvement in community-based research endeavors at the intersection of human-computer interaction and health.

Early Access to Testosterone Therapy in Transgender and Gender-Diverse Adults Seeking Masculinization

Testosterone treatment is a necessary component of care for some transgender and gender-diverse individuals. Observational studies have reported associations between commencement of gender-affirming hormone therapy and improvements in gender dysphoria and depression, but there is a lack of data from randomized clinical trials. To assess the effect of testosterone therapy compared with no treatment on gender dysphoria, depression, and suicidality in transgender and gender-diverse adults seeking masculinization. A 3-month open-label randomized clinical trial was conducted at endocrinology outpatient clinics and primary care clinics specializing in transgender and gender-diverse health in Melbourne, Australia, from November 1, 2021, to July 22, 2022. Participants included transgender and gender-diverse adults aged 18 to 70 years seeking initiation of testosterone therapy. Immediate initiation of testosterone commencement (intervention group) or no treatment (standard care waiting list of 3 months before commencement). This design ensured no individuals would be waiting longer than the time to standard care. The primary outcome was gender dysphoria, as measured by the Gender Preoccupation and Stability Questionnaire. Secondary outcomes included the Patient Health Questionnaire-9 (PHQ-9) to assess depression and the Suicidal Ideation Attributes Scale (SIDAS) to assess suicidality. Questionnaires were undertaken at 0 and 3 months. The evaluable cohort was analyzed. Sixty-four transgender and gender-diverse adults (median [IQR] age, 22.5 [20-27] years) were randomized. Compared with standard care, the intervention group had a decrease in gender dysphoria (mean difference, -7.2 points; 95% CI, -8.3 to -6.1 points; P < .001), a clinically significant decrease in depression (ie, change in score of 5 points on PHQ-9; mean difference, -5.6 points; 95% CI, -6.8 to -4.4 points; P < .001), and a significant decrease in suicidality (mean difference in SIDAS score, -6.5 points; 95% CI, -8.2 to -4.8 points; P < .001). Resolution of suicidality assessed by PHQ-9 item 9 occurred in 11 individuals (52%) with immediate testosterone commencement compared with 1 (5%) receiving standard care (P = .002). Seven individuals reported injection site pain/discomfort and 1 individual reported a transient headache 24 hours following intramuscular administration of testosterone undecanoate. No individual developed polycythemia. In this open-label randomized clinical trial of testosterone therapy in transgender and gender-diverse adults, immediate testosterone compared with no treatment significantly reduced gender dysphoria, depression, and suicidality in transgender and gender-diverse individuals desiring testosterone therapy. ANZCTR Identifier: ACTRN1262100016864.

TikTok in Transgender Health: Is it Really Useful for Plastic Surgeons?

TikTok in Transgender Health: Is it Really Useful for Plastic Surgeons?

Psychosocial impact of COVID-19 pandemic on mental health of transgender and transvestite people: integrative review

Resumo Este estudo objetivou identificar, analisar e integrar resultados de estudos que examinaram o impacto da pandemia de COVID-19 na saúde mental de pessoas transexuais e travestis. Foi realizada uma revisão integrativa da literatura, em conformidade com as diretrizes PRISMA. Conduziu-se uma busca sistemática dos estudos primários publicados em três bases de dados: PubMed/MEDLINE, LILACS e PsycINFO. Foram incluídos oito estudos que atenderam aos critérios de inclusão. A análise temática do material gerou seis categorias temáticas. Os estudos analisados apontaram que a situação de vulnerabilidade social ao qual as pessoas trans encontram-se submetidas no cotidiano foi ampliada durante a pandemia. A necessidade do distanciamento físico resultou no aumento de sintomas de ansiedade e depressão, agravamento das condições econômicas, dificuldades para acessar procedimentos e medicamentos que compõem o processo de afirmação de gênero, além de exacerbar conflitos familiares e manifestações de transfobia. Há necessidade de implementar políticas públicas e uma rede de proteção social para diminuir a vulnerabilidade e sofrimento psicossocial de pessoas trans.

Prevalence of and factors associated with the use of gender-affirming hormonal therapy outside the reference regimen among transgender people in a community-led clinic in Metro Manila, Philippines: a retrospective cross-sectional study

ObjectivesWe aimed to describe the gender-affirming hormonal therapy (GAHT) intake behaviour and regimen and the factors associated with the use of hormones inconsistent with reference GAHT regimen among transgender people...

The Current State of Transgender Health Curricula in Graduate Surgical Education: A Systematic Review of Survey Data

Transgender and gender diverse (TGD) individuals in the U.S. face significant healthcare disparities, which can be further exacerbated by providers' unfamiliarity with this population's specific needs. ACGME currently does not have requirements for gender-affirming surgery (GAS) in the residency programs of surgical specialties that are responsible for providing this care. This systematic review evaluates gender-affirming care (GAC) and GAS training in surgical residency programs in the U.S. through the analysis of survey respondent data. Six databases (PubMed, Embase, Web of Science and Scopus, Cochrane Library and Google Scholar) were searched in December 2022 and May 2023. The search process ultimately yielded 22 survey-based studies, published between 2015 and 2023, with responses from 3020 respondents (2582 trainees and/or attending physicians, 438 program directors). Six different surgical specialties were the focus of included studies, and common questions revolved around GAS training availability, comfort in treating TGD patients, and the importance of GAS in graduate surgical education (GSE). Less than half of trainees indicated that they received some form of previous GAC or GAS training, and less than half of program directors indicated that their residency or fellowship program offered such training. While comfort levels around treating TGD patients ranged, the studies indicated an overall perceived importance of GAS training. These findings highlight the need to incorporate GAS training into graduate surgical education to improve access to and quality of care for TGD patients.

The Limited Coverage of Facial Feminization Surgery in the United States: A Literature Review of Policy Constraints and Implications.

There is a literature gap regarding facial feminization surgery (FFS) access and coverage. Our goal is to compile information from previous studies and assess the current policy landscape for these surgeries in the US. We also explored why some policies do not cover them, identify states with better coverage, and determine the most covered procedures. PubMed, Medline, Embase, and Scopus were searched for studies that reviewed policies on FFS coverage. Studies on surgical techniques or other gender-affirming surgeries (GASs) that did not involve FFS were excluded. Seven studies were included for analysis. In 2014, the Department of Human Health Services (HHS) lifted the transgender exclusion policy, leading to an increase in policies regarding GASs for both private and state insurance. However, there are differences in medical necessity requirements among policies, which may not align with the World Professional Association for Transgender Health (WPATH) criteria. States that prohibit exclusion tend to offer better coverage for FFS. These states are mainly located in the western and northeast regions, whereas states in the southern and middle east regions have less coverage. Among the procedures, chondrolaryngoplasty is the most covered, while facial and cervical rhytidectomy are the least covered. To enhance transgender care, it is crucial to reach a consensus on how to offer coverage for facial feminization surgery. However, there is a lack of adequate research on this topic, and there is a need for resources and tools to assess the results of FFS procedures. One significant constraint of this study is that it does not provide a systematic review of the literature.

Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany

Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11–18 years, Mage = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% (n = 332) of the sample identified as binary and 10% (n = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.

An Investigation of Gender Representation and Collaboration in Academic Plastic Surgery Research

Background: Gender disparities in academic leadership positions may be influenced by several factors, including research productivity. We aimed to describe the publication gender gap in major plastic surgery journals, assess gender-related and gender-neutral research publications, and identify any potential gender disparities associated with publication characteristics. Methods: For this cross-sectional study, we reviewed all original research publications in Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery, and Aesthetic Surgery Journal from 2014 through 2018. Genderize.io was used to identify the gender of all authors. Each publication was classified as either gender-neutral, transgender health, women’s health, or men’s health-related based on the article's content. Results: Of the 12,718 authors across 2234 publications analysed, females were first authors in 30%, last authors in 17%, and all authors in 27%. Among the publications, 1782 (79.8%) were focused on gender-neutral, 419 (18.8%) on women's health, 18 (0.8%) on transgender health, and 15 (0.7%) on men's health. Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI] = 1.4 [1.1-1.8] and OR [95% CI] = 51.0 [47-55], p &lt; .001) and had a higher mean number of citations compared to gender-neutral articles ( p &lt; .001). Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI] = 1.4 [1.1–1.8] and OR [95% CI] = 51.0 [47–55], p &lt; .001) and had a higher mean number of citations compared to gender-neutral articles ( p &lt; .001). Conclusion: The publication gender gap persists in academic plastic surgery. The academic community should continue to prioritize addressing gender disparity from the perspective of research productivity.

Assessing Student Pharmacists' Perceptions and Knowledge of Transgender and Gender-Diverse Healthcare

Assessing Student Pharmacists' Perceptions and Knowledge of Transgender and Gender-Diverse Healthcare

"Why should other people be the judge": The codification of assessment criteria for gender-affirming care, 1970s-1990s.

In order to access gender-affirming care, transgender individuals were historically required by international guidelines to undergo mental health provider assessment (Coleman et al., 2012). This requirement for universal mental health provider involvement, initially formulated via professional expert opinion, has not been retained in the most recent World Professional Association for Transgender Health Standards of Care (WPATH SOC 8; Coleman et al., 2022). In the present analysis, I sought to examine the historical and cultural contexts of these expert opinions codified in the first version of the WPATH SOC released in 1979. Foucauldian genealogy and qualitative thematic analysis guided data collection and analysis. Study themes of debate, codification, and change outline the codification of early gender identity research criteria in SOC. These themes examine the historical context of the codification of mental health assessment for access to gender-affirming care. Historical perspectives from trans individuals themselves on assessment criteria are represented in the analysis, including the notable impacts of an individual's race, class, and sexual orientation on attitudes towards assessment practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Experiences ofLGBTQ Healthcare Professionals within Military Medical Culture.

Creating a positive workplace culture affects patient outcomes and force readiness. An inclusive workplace culture is especially important for lesbian, gay, bisexual, transgender, and queer (LGBTQ) military healthcare professionals, who have historically faced discrimination within the United States military. While research has examined LGBTQ service members' experiences in the military as a whole, there is a gap in the professional literature regarding LGBTQ healthcare workers' experiences within military medicine. This qualitative phenomenological study explored the experiences of ten LGBTQ military healthcare professionals. We interviewed each participant for one hour. Our research team then coded each interview and came to a consensus on how to organize these codes into emerging themes. We used reflexivity and member checking to increase the credibility of our results. Four themes emerged from our data analysis: (1) implicit bias; (2) explicit bias; (3) response to discrimination; and (4) recommendations for improving workplace culture. The participants described both the underlying and outright discrimination they faced at work. They made recommendations for reducing this discrimination through education, training, and increased leadership representation. Our results revealed that LGBTQ healthcare professionals continue to face discrimination in the workplace. This discrimination must be addressed to create an inclusive workplace environment within military medicine, which will enhance force readiness.

Occupational Therapy’s Role for Gender Affirming Surgeries: Vaginoplasty and Vulvoplasty

This article explores the new surgical population of gender affirming surgery, specifically vaginal surgeries for transgender and gender diverse people. There are established perioperative rehabilitation guidelines for nearly all other surgeries. A growing population of people is seeking gender affirming healthcare which includes vaginal surgery. This article reviews the guidelines set forth by the World Professional Association for Transgender Health Standards of Care (Version 8), explores the occupational needs of this population, as well as provides suggestions for future versions of official documents of the American Occupational Therapy Association to provide more inclusive language for the unique needs of this population following surgery.

Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students.

Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim. Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation. Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01). Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.

Development of a Mission-Driven Research Agenda to Support Efforts to End Epidemics.

New York State continues efforts to end the AIDS and hepatitis C epidemics and reduce new infections of sexually transmitted infections. In 2022, the New York State Department of Health AIDS Institute released its first-ever Research Agenda. This Research Agenda was systematically developed following input from internal and external research and community stakeholders. We used a participatory and iterative process to prioritize research knowledge gaps related to HIV/AIDS; sexual health and sexually transmitted infections; hepatitis C; lesbian, gay, bisexual, transgender health; drug user health; health equity; and emerging issues such as COVID-19. Questions were prioritized on the basis of the alignment with the following 5 criteria: magnitude of impact; funding and resources; feasibility of conducting research; translatability; and addresses an internal priority area. Findings are anticipated to generate actionable results that can be readily translatable into programs, policies, and practices. This Research Agenda includes 79 research and program evaluation questions prioritized for internally led and collaborative research. Efforts on 35 of the 61 internally led questions and funding of 11 collaborative research projects related to Research Agenda priorities began in 2022. An evaluation survey was conducted among all stakeholders involved in the prioritization process. All were satisfied or very satisfied with the process, and results yielded recommendations for future processes including weighting of questions relative to one another within each focus area and other suggestions to streamline the process. In year 1, 10 of the 35 questions were completed. Lessons learned include use of a participatory process to facilitate support and completion of Research Agenda, prioritize research questions to maximize impact and translatability, streamline the prioritization process by restricting proposed questions to those with clear potential for innovative research, emphasize anticipated resources necessary to implement the Research Agenda to set a realistic and actionable plan, and adaptability toward shifting priorities.

Images: Irregular sleep-wake rhythm disorder in transgender individuals.

Kokash A, Vendrame M. Images: irregular sleep-wake rhythm disorder in transgender individuals. J Clin Sleep Med. 2023;19(11):1981-1984.

Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework.

Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population. We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course. We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions. Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care. Teaching LGBTQ+ Health improved participants' knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added.