Transgender Men Research Articles

MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation.

Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community-informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term-at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth.

Same Place, Different Worlds: An Emergent Fit Analysis of the Experiences of Iranian Trans Women and Trans Men

Same Place, Different Worlds: An Emergent Fit Analysis of the Experiences of Iranian Trans Women and Trans Men

Strength, power and aerobic capacity of transgender athletes: a cross-sectional study

ObjectiveThe primary objective of this cross-sectional study was to compare standard laboratory performance metrics of transgender athletes to cisgender athletes.Methods19 cisgender men (CM) (mean±SD, age: 37±9 years), 12 transgender men...

Examining the Risks of Multiple Types of Interpersonal Victimization for Transgender and Gender Non-Conforming College Students.

Recent research has shown that transgender and gender non-conforming (TGNC) individuals are at risk of experiencing interpersonal violence, yet there may be differences within this group and across victimization types. The current study examined rates of seven types of interpersonal victimization based on six gender identities (cisgender women, cisgender men, trans women, trans men, nonbinary, and another identity) among a national study of college students. Data from the Spring 2021 American College Health Association's National College Health Assessment III (ACHA-NCHA III), a national-level study of U.S. college students, were used. We examined the association between gender identity and seven types of interpersonal violence victimization (violent victimization, sexual victimization, intimate partner violence victimization, stalking, bullying, microaggression, and discrimination) that occurred within the past 12 months. Logistic regression analyses were performed to examine if, when controlling for competing factors, gender identity was associated with an increase in the expected odds of victimization for each victimization type. Analyses revealed that TGNC college students reported experiencing a greater amount of all seven types of victimization compared to cisgender college students. These findings corroborate previous research indicating that rates of interpersonal violence are higher among TGNC college students compared to those who identify as cisgender, even after controlling for sexual orientation, related demographic factors, and substance use. Findings from the current study suggest that there are differences within individuals who identify as TGNC in terms of their risk for interpersonal victimization and that rates differ across victimization types. More work is needed to provide tailored prevention programming for TGNC college students.

Gender affirming treatment and employment rate in 3,812 Danish transgender persons and 38,120 controls.

Gender affirming care could be associated with higher employment rate. We assessed employment rates in transgender persons compared to controls and demographic, health and treatment-related factors associated with employment in transgender persons. National register-based cohort study in Danish persons with diagnosis code of gender dysphoria during year 2000-2021. Five age-matched controls of the same sex at birth and five age-matched controls of the other sex at birth were included. The date of study inclusion was the first date of transgender diagnosis. Employment was the primary study outcome. The cohort included 3,812 transgender persons and 38,120 cisgender controls. The median age (interquartile range) was 19 (15; 24) years for transgender men, n = 1,993 and 23 (19; 33) years for transgender women, n = 1,819. In transgender men compared to control cisgender women, the odds ratio (95% confidence interval) for employment was 0.33 (0.29; 0.38) before study inclusion and 0.24 (0.20; 0.29) in the fifth calendar year after index; in transgender women compared to control cisgender men, corresponding ORs were 0.30 (0.70; 0.34) and 0.21 (0.18; 0.25). Similar findings were found between transgender persons and cisgender controls of other sex. Use of gender affirming hormone in transgender men increased probability of employment at all time points with odds ratio after 5 years: 1.61 (1.08; 2.42), p = 0.02 (95% confidence interval). In transgender women, use of hormone treatment was not associated with changed employment rates, 5 years odds ratio 1.31 (0.94; 1.82), p = 0.11. Masculinizing hormone treatment was associated with higher probability of employment.

Being a good boy: pup play, body image, and the self for gay, bi, trans, and queer men

Puppy play is a kink activity, in which people dress as, take on the role of, and mimic the physical and emotional behaviours of young canines or pups. We explore how the pup identity, depicted in cellphilms by queer men who are part of the pup community, influences men’s body image perceptions using multimodal critical discourse analysis. Participants expressed feelings of dissonance, shame, and self-rejection when viewing themselves as humans, but conveyed excitement, pleasure, and self-celebration when viewing themselves as pups. Participants depicted their body images being transformed by way of puppy gear, puppy spaces, handlers, and playmates, which was said to foster more (self-)acceptance, playfulness, and freedom. This study highlights the potential for puppy play to provide a transformative experience for individuals, allowing participants to explore, re-signify, and embrace their bodies as pups.

Sex- and species-specific contribution of CD99 to T cell costimulation during multiple sclerosis

BackgroundDifferences in immune responses between women and men are leading to a strong sex bias in the incidence of autoimmune diseases that predominantly affect women, such as multiple sclerosis (MS). MS manifests in more than twice as many women, making sex one of the most important risk factor. However, it is incompletely understood which genes contribute to sex differences in autoimmune incidence. To address that, we conducted a gene expression analysis in female and male human spleen and identified the transmembrane protein CD99 as one of the most significantly differentially expressed genes with marked increase in men. CD99 has been reported to participate in immune cell transmigration and T cell regulation, but sex-specific implications have not been comprehensively investigated.MethodsIn this study, we conducted a gene expression analysis in female and male human spleen using the Genotype-Tissue Expression (GTEx) project dataset to identify differentially expressed genes between women and men. After successful validation on protein level of human immune cell subsets, we assessed hormonal regulation of CD99 as well as its implication on T cell regulation in primary human T cells and Jurkat T cells. In addition, we performed in vivo assays in wildtype mice and in Cd99-deficient mice to further analyze functional consequences of differential CD99 expression.ResultsHere, we found higher CD99 gene expression in male human spleens compared to females and confirmed this expression difference on protein level on the surface of T cells and pDCs. Androgens are likely dispensable as the cause shown by in vitro assays and ex vivo analysis of trans men samples. In cerebrospinal fluid, CD99 was higher on T cells compared to blood. Of note, male MS patients had lower CD99 levels on CD4+ T cells in the CSF, unlike controls. By contrast, both sexes had similar CD99 expression in mice and Cd99-deficient mice showed equal susceptibility to experimental autoimmune encephalomyelitis compared to wildtypes. Functionally, CD99 increased upon human T cell activation and inhibited T cell proliferation after blockade. Accordingly, CD99-deficient Jurkat T cells showed decreased cell proliferation and cluster formation, rescued by CD99 reintroduction.ConclusionsOur results demonstrate that CD99 is sex-specifically regulated in healthy individuals and MS patients and that it is involved in T cell costimulation in humans but not in mice. CD99 could potentially contribute to MS incidence and susceptibility in a sex-specific manner.

History of Rectal Product Use and Country of Residence Influence Preference for Rectal Microbicide Dosage Forms Among Young Sexual and Gender Minorities: A Multi-country Trial Comparing Placebo Douche, Suppository, and Insert Products.

The DESIRE Study (MTN-035) explored product preference among three placebo rectal microbicide (RM) formulations, a rectal douche(RD), a suppository, and an insert, among 210 sexually active transgender people and men who have sex with men in five counties: the United States, Peru, Thailand, South Africa, and Malawi. Participants used each product prior to receptive anal sex (RAS) for 1month, following a randomly assigned sequence, then selected their preferred product via computer assisted self-interview. In-depth interviews examined reasons for preference. We compared product preference and prior product use by country to explore whether geographic location and experience with the similar products impacted preference. A majority in the United States (56%) and Peru (58%) and nearly half in South Africa (48%) preferred the douche. Most in Malawi (59%) preferred the suppository, while half in Thailand (50%) and nearly half in South Africa (47%) preferred the insert. Participants who preferred the douche described it as quick and easy, already routinized, and serving a dual purpose of cleansing and protecting. Those who preferred the insert found it small, portable, discreet, with quick dissolution. Those who preferred the suppository found the size and shape acceptable and liked the added lubrication it provided. Experience with product use varied by country. Participants with RD experience were significantly more likely to prefer the douche (p = 0.03). Diversifying availability of multiple RM dosage forms can increase uptake and improve HIV prevention efforts globally.

Psychosocial factors associated with non-suicidal self-injury attempts among people in the transmasculine and non-binary spectrum from Argentina

ABSTRACT Transmasculine and non-binary individuals frequently experience stigma related to their gender identity, which leads to higher rates of mental health problems in comparison with the cisgender population. This study describes the prevalence of non-suicidal self-injury (NSSI) attempts and explores its association with indicators of violence, discrimination, and gender affirmation among people who self-identify within the transmasculine and non-binary spectrum from Argentina. Between May and September 2019, 415 participants completed an online survey. The median age was 23 years (IQR = 19–27). Most of the sample (84.6%) self-identified as transmasculine (e.g. trans man or male) and 15.4% as non-binary. The prevalence of NSSI attempts was high (74.6%). The first attempt frequently occurred during adolescence. NSSI attempts were negatively associated with indicators of psychological, medical, and legal gender affirmation only at the bivariate level. In the final multivariable model, NSSI attempts remained associated with younger age, bullying at school, violence from family members, and sexual abuse. Prevalence of NSSI attempts among transmasculine and non-binary people from Argentina is disproportionately elevated. It is critical to prioritise this population in policies and interventions to prevent this problem from an early age. Such interventions should address discrimination and violence against this community, since these are the factors primarily associated with occurrence of NSSI attempts.

Understanding daily and momentary drinking motives among transgender and gender diverse adults

Background Transgender and gender diverse (TGD) adults may be at increased risk for alcohol use due to gender minority stress (GMS) and specific drinking motives. Aim The current study evaluated the relations between GMS and resilience, drinking motives, and alcohol outcomes among TGD adults. Methods Twenty-five primarily White TGD adults (7 transgender men, 7 transgender women, and 11 gender diverse) who were 19 years of age or older (mean: 32.60; SD: 10.82), lived in Canada, and drank regularly were prompted to complete surveys multiple times per day indexing drinking motives, GMS and resilience factors, contexts, and alcohol use and craving. Multilevel models examined predictors of each drinking motive and relations between drinking motives and alcohol outcomes at the daily and momentary levels. Results Days with increased GMS corresponded with increased social (p<.05) and conformity motives (p<.01). Days with increased resilience also corresponded with elevated social (p<.01) and conformity (p<.05) motives. Days with higher enhancement and social motives predicted increased alcohol use (ps<.01). All momentary motives were elevated when participants reported higher momentary resilience (p<.001). Significant associations between drinking motives, contexts, and alcohol craving were also evident. Discussion GMS and certain drinking motives may contribute to increased alcohol use and craving among TGD adults. Findings encourage the development of gender-inclusive interventions that address GMS and specific drinking motives to support a reduction in this population’s alcohol use.

Body composition changes and satisfaction associated with gender-affirming hormone therapy in transgender men

Body composition changes and satisfaction associated with gender-affirming hormone therapy in transgender men

The impact of testosterone on TLR expression in transgender men

The impact of testosterone on TLR expression in transgender men

Gender-affirming hormone therapy and its impact on myocardial mass and cardiac function: a prospective magnetic resonance study on transgender men and women

Gender-affirming hormone therapy and its impact on myocardial mass and cardiac function: a prospective magnetic resonance study on transgender men and women

Beyond barks and bodies: Pup play and body image in gay, bi, trans, and queer men through a Deleuzian lens

Body image is a complex issue that affects individuals from all genders and sexual orientations. Within the queer community pup play is a BDSM-related activity where participants take on the role of a pup/dog, complete with barking, crawling, and other canine behaviors. In this research, we explored how identifying as a pup shapes the body image of gay, bisexual, queer, and trans (GBQT) men using a Deleuzian approach. The process of cellphilming included attendance of three online workshops and the creation of a short cellphilm about their body image. Seventeen participants across five groups completed the workshops and submitted a cellphilm. Data was analyzed through discourse analysis, and while our analysis includes workshop quotes and film excerpts, the true depth of the films, capturing elements like lighting and sound, goes beyond the transcribed words. Three overarching discursive considerations are reported: (i) reinforcing body standards for GBTQ men, (ii) capacity for changing feelings about bodies, and (iii) becoming a pup. Participants suggested that although the pup community is more accepting of diverse bodies, hegemonic body standards for GBTQ men still apply. However, participants also described how identifying as a pup and connecting with others in the pup community was a way to navigate body image tensions.

Abstract PO1-10-02: Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience

Abstract Background: Estrogen exposure is a known risk factor for the development of breast cancer in women. Less clear is the risk posed by gender affirming hormone therapy (GAHT) in both transgender men and transgender women. We aimed to characterize the breast cancers that have arisen in our institution’s transgender patient population including biomarker profile, method of diagnosis, and stage at diagnosis. Methods: For this retrospective cohort study, patients from the Mount Sinai Health System were identified using the electronic medical record from 2016-2023. A cohort of transgender or non-binary patients with breast cancer was established by using ICD-10 codes for carcinoma in situ of breast (D-05) and malignant neoplasm of breast (C-50) and a diagnosis or medical history encompassing gender identity disorders (ICD-10-CM: F64) or a chief complaint related to transgender health. Chart review enabled selection of patients who have a history of GAHT. Patients with incomplete medical records were excluded from analysis. Results: 14 patients met criteria and were included for final analysis. Mean age at diagnosis was 51.7 (31-65) years and 86% (12/14) were at or above 40 years of age at diagnosis and eligible for routine screening mammography. The cohort encompassed six trans men (assigned female at birth), seven trans women (assigned male at birth), and one genderqueer person (assigned female at birth). Family history was not significant for most of the cohort. Two patients had a first-degree relative with a history of breast cancer; both were BRCA negative. Four patients (29%) were diagnosed via screening mammography; six patients (43%) were diagnosed after palpating a breast or axillary mass; and four patients (29%) had not undergone screening but were diagnosed via breast imaging mandated prior to planned chest masculinization surgery. At time of initial presentation, the diagnostic stage was DCIS in five patients (36%); LCIS in one patient (7%); stage 1 cancer in four patients (29%); stage 2 cancer in three patients (21%); and breast implant-associated anaplastic large cell lymphoma in one patient (7%). 50% (7/14) of patients had an active or past prescription for testosterone-based GAHT, and 50% (7/14) patients had an active or past prescription for estrogen-based GAHT. Mean duration of all GAHT prior to diagnosis was 16.6 years (mean duration of estrogen-based GAHT was 27.6 years and mean duration for testosterone-based GAHT was 5.7 years). Biomarker profiles were available for twelve patients; 8/12 (67%) patients were diagnosed with estrogen receptor (ER) positive cancer, four (33%) with ER negative cancers. Of patients on estrogen-based GAHT, three presented with ER+ and four presented with ER- cancers. 10/14 patients had bilateral mastectomies and 4/14 had lumpectomies. Discussion/Conclusion: The mode of cancer detection suggests that screening mammography is under-utilized among transgender and non-binary patients who use GAHT. This represents a health care disparity involving a vulnerable patient population. The biomarker profile among this population demonstrates that both estrogen-responsive and estrogen-nonresponsive cancers can arise in the setting of prior or ongoing gender affirming estrogen or testosterone. Citation Format: Nithya Krishnamurthy, Ethan Ravetch, Christina Weltz. Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-02.

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for Gender Affirmation [ID 2683658

INTRODUCTION: The process of transitioning from female to male in transgender persons usually includes medical treatment as well as surgical interventions, including removal of the uterus and ovaries. Nulliparity and prolonged exposure of the vaginal mucosa to testosterone, which are common among transgender men, may present challenges to perform a vaginal hysterectomy with salpingo-oophorectomy. The aim of this study is to describe outcomes of vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) approach to perform hysterectomy among transgender men as part of their gender-affirming care. METHODS: This is a case series observational study conducted at single tertiary medical center including all patients undergoing hysterectomy with bilateral salpingo-oophorectomy by vNOTES approach for gender-affirming care between February 2022 and April 2023. Primary outcome was defined as compound complication rate including intraoperative and postoperative. Patients' demographic and clinical charectaristics were collected from the electronic medical files. Pain at postoperative follow-up was evaluated using visual analog scores, which ranges from 0 (no pain) to 10 (worst pain possible). RESULTS: The study population included eight transgender men, all of whom were nulliparous and had undergone testosterone treatment for more than a year. Median age at surgery was 24 years and median body mass index was 30 kg/m2. Mean operative time of the surgery was 111 minutes (range: 91–143 minutes) and none required converting from vNOTES to an alternative approach. No extensive bleeding or organ damage was reported. For one patient, there was one small vaginal laceration requiring suture. All but one patient was discharged the same day. The patient requiring next-day discharge was complicated by postoperative urinary retention. On postoperative follow-up, median pain score was 3 (range: 1–5). CONCLUSION: Outcomes from this case series suggest that a vNOTES approach to hysterectomy among transgender men can be performed without surgical complications and with low self-reported pain.

Fertility Preservation in the Transgender and Nonbinary Population: A Survey Study [ID 2683653

INTRODUCTION: To date, there are little data discussing fertility preservation desires of transgender and nonbinary adults. This study seeks to examine the demographic characteristics of transgender and nonbinary adults interested in or who have pursued fertility preservation as well as assess the barriers these adults face when interested in fertility preservation. METHODS: An online survey was designed by a team of researchers at an academic medical center. It was assessed for readability by an expert in survey design and reviewed for relevance by members of the transgender and nonbinary communities. It was distributed to an international audience. Participants were 18+, English-speaking, identified as non-cisgender, and had interest or previous experience in completing fertility preservation. The survey was distributed online from November 2022 to May 2023. Results were analyzed using REDCap Stats &amp; Charts software. RESULTS: In total, 102 participants initiated the survey. Fifty-three participants met inclusion criteria for analysis. The majority of participants identified either as transgender woman (43.3%; 23) or nonbinary (32.1%; 17), with 18.9% (10) identifying as transgender man. 17 (32.1%) participants had previously preserved eggs, sperm, or embryos, and 36 (67.9%) were interested in, but had not yet pursued, fertility preservation. Of participants who had completed preservation, 94.1% (16) were assigned male at birth. Of those interested in fertility preservation, 61.8% (21) were assigned female at birth. In terms of barriers to preservation, 63.8% (23) quoted cost as a barrier, despite 91.4% (32) having insurance. CONCLUSION: This survey demonstrates that transgender and nonbinary adults are both interested in and have pursued fertility preservation. In our study sample, only transgender women had been able to complete fertility preservation, which may be illustrative of the more arduous and costly process of preserving oocytes versus sperm. Our results demonstrate, as anticipated, cost continues to be the most common barrier to fertility preservation.

Exploring Decisional Conflict Experienced by Individuals Considering Metoidioplasty and Phalloplasty Gender-affirming Surgery.

Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS. We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed. Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict. In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.

A Qualitative Study of Transgender and Nonbinary Perspectives Regarding the Desired Properties of a Peer Support Intervention for the Initiation of Gender-Affirming Hormone Therapy [ID 2683451

INTRODUCTION: Transgender and nonbinary (TNB) people experience significant mental health disparities and challenges accessing gender-affirming care. Peer support interventions have been shown to improve mental health in other populations and contexts but have not been uniquely tailored to the initiation of gender-affirming hormones. This study aims to identify the desired properties of a peer support intervention for TNB people initiating gender-affirming hormones. METHODS: We conducted semistructured interviews with TNB adults who had initiated or attempted to initiate gender-affirming hormones (IRB: HUM00203630: approved/exempt; gender-affirmation: off-label). Participants were selected by snowball and purposive sampling methods. Interview questions focused on the participants' experiences with peer support and their vision for ideal peer support while initiating hormones. Interviews were transcribed and analyzed using reflective thematic analysis with inductive and deductive coding. A TNB community advisory board collaborated in the study design and interviews were conducted by TNB research team members. RESULTS: The ages of the participants ranged from 20 to 52 years (mean=32); 8/18 identified as men or trans men; 4/18 identified as nonbinary; 3/18 identified as women or trans women; 3/18 identified as genderqueer or genderfluid; 10/18 identified as a person of color. Themes include the importance of 1) trans community knowledge in guiding hormone therapy decisions, 2) having support structures attend to intersectional identities, and 3) recognizing barriers to peer engagement, including anxieties about fitting in and internalized transphobia. CONCLUSION: Centering TNB voices is essential in designing a peer support intervention for hormone initiation. Our participants offered nuanced approaches for how to share information about hormones, attend to intersectional identities, and navigate barriers to peer engagement.

Gender-Affirming Hysterectomies: Analysis of Temporal Trends and Characteristics Pre- and Post-Expansion of Health Care Coverage at a Large Integrated California Health Care System [ID 2683540

INTRODUCTION: Despite expansion of gender-affirming health care coverage in 2013, few studies have investigated temporal trends in gender-affirming surgeries (GAS) including hysterectomies. Our study aims to investigate the temporal trends of hysterectomies for transgender men and gender-diverse persons (TGD) compared to cisgender women between 2010–2012 and 2013–2019, and annually from 2010 to 2019. METHODS: We conducted an observational retrospective cohort study on TGD and cisgendered patients, aged 18 and older, within Kaiser Permanente Northern California (KPNC) between 2010 and 2019. Data on demographics, surgical characteristics, concurrent procedures, and postoperative complications were extracted from electronic medical records. Bivariate comparisons were performed using chi-squared analysis for categorical variables and t-tests for continuous variables. RESULTS: This study included 41,341 hysterectomies performed within KPNC between 2010 and 2019. Among all hysterectomies, 461 (1.1%) were for TGD. TGD who underwent hysterectomies were more likely to be younger, White, and nulliparous compared to their cisgender counterparts (P&lt;.05). The incidence of hysterectomies remained similar in cisgender women—from 3,750 (99.7%) in 2010 to 4,361 (98.4%) in 2019. For TGD, the incidence of hysterectomies increased gradually—from 10 (0.3%) in 2010 to 70 (1.6%) in 2019, with the largest increase occurring from 40 (1.0%) hysterectomies in 2014 to 62 (1.5%) in 2015. After expansion of GAS coverage, hysterectomy rates increased eightfold from 55 (0.5%) in 2010–2012 to 406 (1.4%) in 2013–2019. CONCLUSION: Gender-affirming hysterectomies have increased substantially because of changes in GAS policies. Future data will evaluate trends of ovarian conservation during concurrent GAS hysterectomy.