Transgender Population Research Articles

Fractures in the Transgender Population: A Retrospective Study

Introduction. While data on the bone health of transgender individuals exist, less is known about related fractures. The authors aimed to compare the anatomic locations of and impact of co-morbidities on fractures between transgender and cisgender populations at a single institution. Methods. The authors conducted a retrospective chart review of patients with fractures at a single institution between January 2020 and January 2021. Demographics, fracture locations, and comorbidities were identified and compared between cisgender and transgender individuals. Statistical analyses included χ2 or Fisher exact tests for proportions and independent t-tests or Wilcoxon rank-sum tests for continuous measures. Results. Transgender patients, compared to cisgender patients, were younger (W=258823, p<0.001) and had a higher incidence of shoulder/upper arm fractures (10/26 [38%] vs 1,847/12,463 [15%], p=0.003) but no lumbar spine fractures. There were no other significant differences in fracture locations. The transgender group had a higher prevalence of depression (14/26 [54%] vs 2,696/12,463 [22%], p<0.001), while hypertension was more common in the cisgender population (6,211/12,463 [50%] vs 5/26 [19%], p=0.003). While most fractures in the transgender group were not due to high-energy trauma, none of the individuals had a history of bone mineral density disorders. Conclusions. Our findings show that there were no significant differences in fracture locations between transgender and cisgender patients, except at one site. Larger studies, including longitudinal prospective studies, are needed to better understand bone health and fracture risk among transgender patients, particularly regarding changes over time with gender-affirming treatment.

Structural discrimination and HIV-related health outcomes among Black transgender populations in the Southern United States: a scoping review

Background Transgender populations are disproportionately impacted by HIV with an overall HIV rate of 13.7%. Non-Hispanic Black/African Americans (44.2%) have the highest transgender HIV prevalence compared to Hispanics (25.8%) and White (6.7%). Moreover, Black transgender populations face debilitating structural level factors including: racism and discrimination, stigma, poverty, unemployment or underemployment, high rates of food insecurity, unstable housing, lack of insurance, criminalization, incarceration, and violence that negatively impact their health and well-being. Methods In this article, we conducted a scoping review to analyze the impact of structural discrimination on HIV prevention, care, and treatment among Black transgender people in the Southern United States. Results Of the 397 articles identified, twelve manuscripts eligible for full-text review were assessed based on the inclusion/exclusion criteria. A total of five articles with a combined total of 341 study participants met the eligibility criteria. All five studies included in this scoping review reported different yet interrelated structural discrimination factors. These were grouped into three categories: (a) socioeconomic factors, (b) access to healthcare, and (c) stigma and discrimination. Conclusions Black transgender populations face extreme structural discrimination creating barriers to access and adherence to HIV prevention, care, and treatment programs. There is an urgent need for additional research and the implementation of tailored, culturally-appropriate, multi-level interventions to address structural discrimination-related factors that increase HIV vulnerability for Black transgender populations.

Exploring the Incidence of Testicular Neoplasms in the Transgender Population: A Case Series.

The use of hormonal therapy and gender-affirming surgery in the transgender community has been rising during the last several years. Although it is generally safe, hormonal therapy's link to testicular cancer remains uncertain. To review the incidence of testicular cancer in specimens from gender-affirming orchiectomies at our institution and evaluate the tumors for histologic and genetic alterations. Pathology reports for gender-affirming orchiectomies (January 1, 2018, to August 1, 2023) were reviewed for testicular neoplasms, with additional analysis for chromosome 12 abnormalities. Incidence and chromosome variations were compared with those in the general population. Among 458 cases during 5.5 years, 5 germ cell neoplasms in 4 patients emerged. Our institution's annual incidence rate (159 per 100 000) is 26.5 times higher than the National Cancer Institute's previous report (6.0 per 100 000). Although they were morphologically no different from germ cell neoplasms in the general population, fluorescence in situ hybridization tests showed no i(12p) in 4 of 5 neoplasms (80%) in our cohort. The cause behind this rise in incidence remains uncertain but may be due to long term pretreatment with hormones or blockers. The lower isochromosome 12p frequency suggests an alternative mechanism driving tumor development, which requires more detailed molecular studies.

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.

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.

Data Improvement: A Strategy to Improve Understanding of Violence Against Transgender Populations.

Data Improvement: A Strategy to Improve Understanding of Violence Against Transgender Populations.

The Latent Risk of Prostatitis In Transgender Population.

The Latent Risk of Prostatitis In Transgender Population.

Reply to Editorial Comment on "The Importance of Fertility Preservation in the Transgender Population"

Reply to Editorial Comment on "The Importance of Fertility Preservation in the Transgender Population"

Evaluation of Gender-Identity Inclusive Language Used in U.S. Hospital Breastfeeding Education Materials.

Purpose: To assess the use of gender-identity inclusive language in breastfeeding education materials publicly available on U.S. Hospital websites. Methods: Hospitals were identified through the American College of Obstetricians and Gynecologists website. Breastfeeding education materials were searched online at each hospital. The first breastfeeding material on each website was used for our evaluation. Gender-identity inclusive versus traditional sexed language terms were curated a priori by referencing the National Institutes of Health and American Psychological Associations' guidelines. Education materials were categorized into: (1) "gender-identity inclusive language," (2) "mix of inclusive and traditional sexed language," or (3) "traditional sexed language." Frequencies of the type of language and specific gender-related terms were calculated. Results: In total, n = 112 hospitals with publicly available breastfeeding education materials were included. Most hospitals used both traditional sexed and inclusive language (69%, n = 77), followed by only traditional language (31%, n = 35). None of the hospitals used solely gender-identity inclusive language. One hospital provided material "intended for LGBTQI+" populations. Conclusion: Education materials provided by hospitals for breastfeeding do not utilize gender-identity inclusive language As such, there remains uncertainty and hesitancy on how to provide appropriate breastfeeding education for all persons who identify as transgender and/or non-binary, yet choose or are able to breastfeed. Further research in this area could ascertain the impacts of using gender-identity inclusive language in breastfeeding education materials for the general, transgender, or non-binary populations.

HIV epidemic among key populations in Nigeria: results of the integrated biological and behavioural surveillance survey (IBBSS), 2020–2021

IntroductionNigeria has the fastest-growing HIV epidemic in West and Central Africa and key populations (KPs) bear a higher burden of HIV. This integrated biological and behavioural surveillance survey was conducted...

Drug-drug interactions between gender-affirming hormone therapy and antiretrovirals for treatment/prevention of HIV.

Transgender persons face a greater burden of HIV compared to cisgender counterparts. Concerns around drug-drug interactions (DDIs) have been cited as reasons for lower engagement in HIV care and lower pre-exposure prophylaxis (PrEP) uptake among transgender populations. It is therefore imperative for hormone therapy, PrEP and antiretroviral therapy providers to understand the DDI potential between these therapies. Studies of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) PrEP with feminizing hormone therapies (FHTs) show reduced plasma tenofovir concentrations, but intracellular concentrations of tenofovir-diphosphate are not reduced. Efficacy of PrEP is expected to be maintained despite this interaction. Masculinizing hormone therapies have no effect on tenofovir concentrations but may increase FTC to a nonclinically relevant extent. No interactions between FHT and cabotegravir or tenofovir alafenamide have been demonstrated. Administration of TDF/FTC PrEP has no effect on hormone levels in transmen or transwomen. PrEP is expected to be effective and safe in transpersons and should be provided to high-risk individuals regardless of gender affirming hormone use. Enzyme inducing/inhibiting antiretroviral therapy may decrease or increase, respectively, the concentrations of FHT and masculinizing hormone therapy. Unboosted integrase inhibitors or enzyme neutral non-nucleoside reverse transcriptase inhibitors are not expected to affect and are not affected by gender affirming hormones and can be considered in transmen and transwomen. Overlapping toxicities including weight gain, dyslipidaemia, cardiovascular disease and bone density effects should be considered, and antiretroviral modifications can be made to minimize toxicities. Interactions between supportive care medications should be assessed to avoid chelation interactions and hyperkalaemia.

Editorial Comment on “The Importance of Fertility Preservation in the Transgender Population”

Editorial Comment on “The Importance of Fertility Preservation in the Transgender Population”

Income Inequality Among Transgender Individuals In India: With Data Evidence And Case Study From Chandigarh Tri-City

This research paper explores the Income Inequality experienced by transgender individuals in India. Despite legal recognition and progressive reforms, the transgender community continues to be victimised due to socioeconomic marginalization. This paper examines income inequality within the transgender population in Chandigarh Tri-City through primary data collection and analysis. The research explores factors such as educational attainment, employment opportunities, and access to social services that contribute to income inequality. By identifying these issues, the research aims to provide a comprehensive understanding of how economic inequalities exist and what measures are needed to bring inclusivity and equality for transgender individuals

Trends in psychosocial research on LGBTIQ+ populations in Latin America: Findings, challenges, and concerns

AbstractPsychosocial research on lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) populations from Latin America is relatively recent. Initially, research focused mainly on prejudice, using qualitative techniques. Studies on LGBTIQ+ populations, using more sophisticated psychosocial theories such as those of Herek or Meyer, began in the mid‐1990s. This study deals with surveys and scales based on non‐probabilistic samples, LGBTIQ+ populations being the first studied. In the early 2000s, queer and/or LGBTIQ+ theories were introduced, and research has been much more interdisciplinary. This paper describes the theoretical frameworks used in LGBTIQ+ research in Latin America and examines distinctions in the findings from Mexico, Colombia, Chile, Argentina, and Brazil. Future research must involve cross‐cultural studies, systematic or scoping reviews, and studies on non‐binary populations. Finally, the conditions for reimaging LGBTIQ+ research in Latin America are discussed.

Medical students' knowledge and attitudes towards breast cancer screening strategies for the transgender population.

179 Background: Transgender patients (TP) are less likely to seek medical attention, including breast cancer screening (BCS) . Approximately half of TP perceive healthcare workers as uneducated, and face intersecting disparities when accessing healthcare. Despite an increased risk of BC while hormonal gender reassignment treatment, only 0.6% adhere to BCS recommendations. Most medical schools do not include transgender health training in their curricula, leading to an inadequacy in preparing professionals to deliver comprehensive high-quality care. Our group previously demonstrated an important gap in knowledge from specialists on BCS in TP (Barragan-Carrillo et. al. ASCO, 2022). We seek to evaluate the state of knowledge of BCS in TP in Medical Students. Methods: We conducted a validated 14-item online survey exploring the knowledge and attitudes of medical students regarding BCS strategies in TP. 6 questions assessed attitudes and 8 knowledge. Participants were invited in July 2022 through social media to complete the survey. Descriptive statistics were employed for data analysis and chi square was used to asses for associations between demographic data with knowledge. Results: 104 participants completed the survey, 75 (72.1%) identified as female, 28 (26.9%) as men, and 1 (1%) as transgender. 17 (16.3%) self-identified as a sexual minority. Median age was 22 (range 18-30) years. 69 (66.3%) were enrolled in private institutions, and 35 (33.7%) in public. Most (65%) were 4 th -7 th year, and 36 (35%) 1 st -3 rd year students. 32 (30.7%) expressed confidence in their knowledge to address BCS needs for TP. 15% considered medical schools provide good understanding of transgender health needs,86%) believe understanding these needs should be mandatory in in the medical school curricula, and 103 (99.0%) stated they would benefit from more training the subject. Regarding knowledge evaluation, the average score was 46.7% (SD 19.3), with only 11.5% identifying the correct age to start BCS and only 22% the correct interval for it. Only 9 students (8.6%) had a score higher than 75%, and 0 participants got a score of 100%. On chi-square testing we did not find any associations between demographics and knowledge. Conclusions: Most medical students believe they lack capacity to address transgender health issues and would benefit from additional education and training. Our findings support that the current medical school curricular do not support sufficient training on this subject, and bolster the need for a more inclusive curricula. The described deficiencies in future physicians’ knowledge emphasize the importance of incorporating these topics into academia.

Comparison of machine learning models for the prediction of hypertension in transgender patients undergoing gynecologic surgery.

Transgender patients face a higher burden of cardiovascular morbidity due to structural and biological stressors, particularly in low-resource settings. No studies exist comparing machine learning model development strategies for this unique patient cohort and limited literature exists comparing data/outcomes between transgender and cisgender populations. We compare machine learning models trained solely on transgender patients against models developed on a size-matched and ratio-matched cohort of cisgender patients and a 300-fold larger, ratio-matched cohort of cisgender patients undergoing obstetric/gynecologic procedures in the National Surgical Quality Improvement Program from January 1, 2005 through December 31, 2019. All models were developed to predict the outcome of hypertension. Statistical significance between models was calculated using 5-by-2 fold cross validation hypothesis testing. Among 626,102 patients having an obstetric/gynecologic surgery, there are 1959 transgender patients of which 85,405 (13.7%) have hypertension requiring medication. Saliently, the logistic regression machine learning models trained selectively on the transgender cohort have an AUC of 0.865 (95% CI: 0.83-0.90), with an accuracy of 85% (95% CI: 0.80-0.87) compared to (p < 0.05) the logistic regression model trained on the 300-fold larger combined cohort which has an AUC of 0.861 (95% CI: 0.82-0.90), with an accuracy of 83% (95% CI: 0.80-0.87). Machine learning models can be trained on smaller, selectively transgender populations and may perform similarly or better to predict cardiovascular outcomes in transgender patients, than models developed on predominantly cisgender patients; this can be useful in lower-resource settings with smaller-volume transgender patients.

Sex and Gender Variables in Data Set Creation and Data Cleaning for Inclusive and Accurate Reproductive Health Research and Quality Improvement.

Existing data is often used for reproductive research and quality improvement. Electronic health records (EHRs) with a single data field for sex and gender conflate sex assigned at birth, genotype, gender identity, and the presence of anatomic tissue and organs. This is problematic for inclusion of transgender and gender-diverse populations in research. This article discusses considerations with a single-item sex and gender variable drawn from EHR records and describes an audit to determine variable validity as a criterion for inclusion or exclusion in perinatal research. Individuals with a live birth at a large academic medical center from 2010 to 2022 were identified via electronic query, and records with male demographic information were reviewed to validate (1) the patient's date of birth and delivery date in the EHR matched the medical record number, (2) male sex and gender demographic information, and (3) male gender terms in EHR notes. All health records of male birthing individuals (n = 8) had EHR evidence of giving birth within the health system during the timeframe, and the date of birth matched the medical record number of the EHR. All had male gender in the EHR demographic information. Six patients did not have any male gender terms in available EHR notes, only female gender terms. Two records had recent notes using male gender terms. Current EHRs may not have reliable data on the gender and sex of gender-diverse individuals. A single sex and gender variable drawn from EHRs should not be used as inclusion or exclusion criteria for health research or quality improvement without additional record review. EHRs can be updated to collect more data on sex, gender identity, and other relevant variables to improve research and quality improvement.

The burden of chronic pain in transgender and gender diverse populations: Evidence from a large US clinical database

AbstractBackgroundChronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain.MethodsThe study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age‐adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain‐associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without.ResultsWe observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain.ConclusionThis study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations.Significance StatementOur study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, and research into hormone therapy's impact on pain. These insights aim to foster more effective, personalized healthcare, enhancing the well‐being and quality of life for the TGD community.

"They're not my daughter, and yet…they're also not my son": Parents negotiating their adult child's nonbinary gender identity.

Scholars are increasingly recognizing that substantial gender heterogeneity exists among transgender populations; that is, gender identities that defy the ubiquitous binary categories of male and female. However, the developing research base on the families of transgender adults focuses almost exclusively on the family members of transgender persons with binary gender identities, a noteworthy shortcoming considering the prevalence of nonbinary gender identities among transgender populations and the pervasive assumption that only two genders exist. To address this gap, the current study sought to uncover how the parents of transgender adults with nonbinary gender identities come to understand, make sense of, and negotiate nonbinary gender identities in their families. Fourteen parents-12 mothers and 2 fathers-completed in-depth, semi-structured interviews, and the collected data were analyzed using reflexive thematic analysis. Analyses generated three broad themes that best-described these parents' experience with their child's gender, which was heavily shaped by the pervasiveness of cisnormativity: (a) varied attempts to understand nonbinary gender; (b) a nonbinary "double-edged sword"; and (c) familial resilience. Directions for future research, clinical practice, and policy change are discussed, including the therapeutic benefit of dialectical thinking and the need for legislation that legally affirms and protects nonbinary persons.

Sexual Assault Nurse Examiner Knowledge and Confidence in Providing Care for Transgender Patients Following Sexual Assault.

The transgender population experiences disproportionate rates of sexual assault (SA) compared with the cisgender population. Sexual assault nurse examiners (SANEs) have specialized education to provide care to victims of SA across the lifespan; however, training related to the care of transgender individuals following sexual assault is not always represented in SANE education. This leads to a lack of knowledge and confidence in providing care to transgender victims and can result in inequitable care and poor outcomes. To explore forensic nurses' knowledge and confidence in the care of the transgender population following SA, a descriptive, cross-sectional survey design was employed and distributed to two professional forensic nursing organizations. A total of 240 survey responses were received. The majority of participants reported that content related to transgender sexual assault (TGSA) was not part of their SA education. Nearly 60% perceived their knowledge and confidence in providing TGSA care as "beginner" or "developing" and almost all "agree" or "strongly agree" that additional TGSA education would be beneficial to them. As over half of participants have provided care to a TGSA patient and more than 80% expect to provide care in the future, it is imperative include standardized content related to TGSA care as part of core SANE curriculum and to offer continuing education to address the gap in current SANE TGSA knowledge and practice.