Transgender Population Research Articles

Implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa: a scoping review.

The transgender or trans population is one of the most marginalized social groups globally, frequently experiencing ill-treatment and discrimination. This is disproportionately higher in sub-Saharan Africa where trans people experience stigma even in healthcare settings. There is limited evidence concerning the implementation and outcomes of interventions to mitigate this stigma. Therefore, this scoping review aimed to describe interventions and determine their effectiveness in reducing transgender stigma in sub-Saharan Africa. Searches (completed November 01, 2021, and re-run May 2022) were conducted in MEDLINE (via PubMed), Cochrane Library including the Cochrane Central Register of Controlled Trials, EBSCOhost, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Web of science, clinicaltrials.gov, and online grey literature sources to identify publications that described interventions to reduce transgender stigma in sub-Saharan Africa. From 877 literature search results, 23 full-text articles were assessed. Data were extracted from the four (4) eligible papers. Only one study explicitly mentioned transgender people. Second, while two studies incorporated conceptual frameworks, they did not show how the frameworks guided the study. The four studies implemented unique interventions at various socio-ecological levels to address individual and interpersonal and structural stigma. Each study utilized a different methodological approach, and the interventions were all evaluated qualitatively. There is a paucity of transgender stigma reduction interventions implemented in Sub-Saharan Africa with limited evidence of interventions delivered to mitigate stigma at interpersonal and structural levels. Future anti-transgender stigma research should consider reporting details about the core components and descriptions of the interventions. Additionally, the use of validated measures of stigma and the evaluation of interventions for implementation outcomes would be helpful.

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

(Trans) Gender Identity in Sanjay Johri's Kinnar Ma

One of the first plays from the Uttar Pradesh hinterlands that ventured to challenge gender and sexual conventions was possibly Sanjay Jauhari's LGBTQ drama Kinnar Ma. A play by Sanjay Jauhari adds to and enhances the Parnassus in a world where sex is forbidden and sexual equality, acceptance, and dignity are trendy concepts right now. The play was written by the author "to write something about their wretched lives" out of pure charity and magnanimity. (Summary by Kinnar Ma) The current collection is an artistic homage to our society's transgender population. The play is about the trials and tribulations of a transgender named Lali who suffers the discrimination on account of being a transgender. A strong and significant work of literature, "Kinnar Ma," illuminates the difficulties faced by the transgender minority in India. It pushes for a more inclusive and equal environment for everyone, questions traditional standards, and highlights the value of acceptance and love. The tale serves as a reminder that everyone deserves to be treated with respect, decency, and compassion, regardless of their gender identification.

Transgender and Gender-Nonconforming Populations Experience Unique Challenges in Health Information Environment Developed for Heteronormative Audience

A Review of: Tenny, C. S., Surkan, K. J., Gerido, L. H., & Betts-Green, D. (2021). A crisis of erasure: Transgender and gender-nonconforming populations navigating breast cancer health information. The International Journal of Information, Diversity, & Inclusion, 5(4), 132–149. https://doi.org/10.33137/ijidi.v5i4.37406 Objective – To understand the lived experiences of transgender and gender-nonconforming populations in seeking health information about breast cancer. Design – Thematic literature review. Setting – Four English-language databases featuring clinical, patient engagement, and library and information sciences (LIS) research. Subjects – Twenty-one published articles. Methods – The researchers chose three concepts (trans, LGBTQ+, and breast cancer), identified related terms for each, and used these terms to conduct literature searches in four databases: PubMed, Web of Science, Library Literature & Information Science Full Text, and Library, Information, Science & Technology Abstracts. Search results were reviewed for relevance to the research objective. The researchers applied grounded theory to analyze the 21 selected articles through open, axial, and selective (thematic) coding. The qualitative research software NVivo was used to perform thematic analysis of each article, and a shared codebook was developed to ensure saturation of axial themes and consistency of coding amongst researchers. Main Results – Three overarching themes emerged from selective coding that exemplify experiences of transgender and gender-nonconforming persons seeking health information about breast cancer: access, erasure, and quality. Compared to their cisgender peers, these historically marginalized populations and their caregivers experience more difficulty accessing the already limited breast cancer information, healthcare, and support services suited to their needs. In particular, transgender and gender-nonconforming patients are often burdened with choosing between receiving health information and care designed for heteronormative persons and risking self-disclosure and possible discrimination by culturally incompetent health professionals. Conclusion – The researchers noted the alarmingly limited resources available for gender-nonconforming patients seeking information and support for health matters other than mental health or sexually transmitted diseases. The researchers also called for increased efforts by LIS curriculums and professionals to study and understand the needs of transgender and gender-nonconforming patrons, and to improve the quality and quantity of information resources specifically dedicated to these unique populations.

Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017.

The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk factors. Using 2009-2017 Medicare fee-for-service data, we implemented an algorithm that leverages diagnosis, procedure, and pharmacy claims to identify age-entitled transgender Medicare beneficiaries and stratify the sample by inferred gender: trans feminine and nonbinary (TFN), trans masculine and nonbinary (TMN), and unclassified. We selected a 5% random sample of cisgender individuals for comparison. We descriptively analyzed (means and frequencies) demographic characteristics (age, race/ethnicity, US census region, months of enrollment) and used chi-square and t-tests to determine between- (transgender vs. cisgender) and within-group gender differences (e.g., TMN, TFN, unclassified) difference in demographics (p<0.05). We then used logistic regression to estimate and examine within- and between-group gender differences in the predicted probability of 25 health conditions, controlling for age, race/ethnicity, enrollment length, and census region. The analytic sample included 9,975 transgender (TFN n=4,198; TMN n=2,762; unclassified n=3,015) and 2,961,636 cisgender (male n=1,294,690, female n=1,666,946) beneficiaries. The majority of the transgender and cisgender samples were between the ages of 65 and 69 and White, non-Hispanic. The largest proportion of transgender and cisgender beneficiaries were from the South. On average, transgender individuals had more months of enrollment than cisgender individuals. In adjusted models, aging TFN or TMN Medicare beneficiaries had the highest probability of each of the 25 health diagnoses studied relative to cisgender males or females. TFN beneficiaries had the highest burden of health diagnoses relative to all other groups. These findings document disparities in key health condition diagnoses among transgender Medicare beneficiaries relative to cisgender individuals. Future application of these methods will enable the study of rare and anatomy-specific conditions among hard-to-reach aging transgender populations and inform interventions and policies to address documented disparities.

A Single Center Review of COVID-19 Testing and Vaccination in the Transgender and Nonbinary Population.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected transgender and nonbinary (TGNB) persons. We evaluated COVID-19 testing and vaccination rates among TGNB patients at our institution. Methods: We compared COVID-19 testing and vaccination rates between TGNB patients and a cisgender population matched by age, race, and ethnicity. Data were collected through September 22, 2021. Demographic variables, testing rates, and vaccination rates were collected. Descriptive statistics were calculated, and regression was performed on outcomes of interest: any vaccination dose, at least one test, and at least one positive test. Gender modality was the exposure of interest. Results: There were 5050 patients: 1683 cisgender men, 1682 cisgender women, and 1685 TGNB individuals. TGNB patients were more likely to be on Medicaid/Medicare and more likely to be single. The number of patients with at least one test was similar between TGNB (n = 894, 53.1%) and cisgender (n = 1853, 55.1%) groups. The number of patients who had at least one positive test was higher among cisgender patients (n = 238, 7.1%) compared with TGNB patients (n = 73, 4.3%). Vaccination rates were significantly greater among TGNB patients. Compared with cisgender patients, TGNB patients had greater odds of vaccination (adjusted odds ratio [aOR] = 1.25 [95% confidence interval; CI 1.06-1.48]). Compared with cisgender patients, TGNB patients had lower odds of having at least one positive COVID-19 test (aOR = 0.51 [95% CI 0.36-0.72]). Conclusion: Our institutional experience found that vaccination rates for TGNB patients were higher and COVID-19 positivity lower than for cisgender patients.

Queering Public Health: A Critical Examination of Healthcare Access and Gender Expression among Trans, Nonbinary, and Other Gender Nonconforming People during COVID-19

Research documenting the impact of COVID-19 on Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) populations in Canada is limited. Our objectives were to investigate the impact of COVID-19 lockdown measures on the lives of trans, nonbinary, and other gender nonconforming (TGNC) people. Engage COVID-19 is a mixed methods study examining the impact of COVID-19 on gay, bisexual, queer, and other men who have sex with men (GBQM) living in Vancouver, Toronto, and Montreal, Canada. Using purposive sampling, we conducted in-depth qualitative interviews (between November 2020–February 2021 and June–October 2021) with 93 participants who discussed the impact of COVID-19 on their lives. Seventeen participants were identified as TGNC. TGNC participants reported barriers to trans healthcare during the initial months of the COVID-19 pandemic. Several participants indicated that some public health interventions during COVID-19 (i.e., lockdowns) eased the pressure to “perform” gender due to fewer in-person interactions. During lockdowns, TGNC participants increasingly cultivated community networks online. Nevertheless, participants reported longing for the social support that was available to them during pre-COVID. Lack of access to community spaces during lockdowns had a negative impact on participants’ mental health, despite reduced pressure to perform gender and opportunities for social engagement in online spaces.

State-Level Policies and Health Outcomes in U.S. Transgender Adolescents: Findings from the 2019 Youth Risk Behavior Survey.

Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a sample of transgender adolescents. Methods: Our analytic sample consisted of adolescents residing in 14 states that used the 2019 Youth Risk Behavior Survey's optional gender identity question in their surveys (n = 107,558). Chi-square analyses were performed to examine differences between transgender and cisgender adolescents in demographic variables and suicidal ideation, depression status, cigarette use, binge drinking, grades in school, and perceptions of school safety. Multivariable logistic regression models were run for transgender adolescents only to examine associations between policies and health outcomes, adjusting for demographics. Results: Transgender adolescents comprised 1.7% (n = 1790) of our sample. Compared with cisgender adolescents, transgender adolescents were more likely to experience adverse health outcomes in chi-square analyses. Multivariable models indicated that transgender adolescents who lived in a state that had explicit transgender guidance in their antidiscrimination laws were less likely to experience depressive symptoms, and those who lived in a state with positive or neutral athlete guidance were less likely to report past 30-day cigarette use. Conclusion: Our study is one of the first to show protective associations between affirming transgender-specific policies and health outcomes in transgender adolescents. Findings could have important implications for policymakers and school administrators.

Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study.

Breastfeeding is essential for the growth and development of all infants. Despite the large transgender and gender-diverse population size, there is no comprehensive research of breastfeeding or chestfeeding practices in this group. This study was designed aimed to investigate the status of breastfeeding or chestfeeding practices in transgender and gender-diverse parents and to explore the possible influencing factors. A cross-sectional study was conducted between January 27 2022 and February 15 2022 online in China. A representative sample of 647 transgender and gender-diverse parents was enrolled. Validated questionnaires were used to investigate breastfeeding or chestfeeding practices and its associated factors, including physical factors, psychological factors and socio-environmental factors. The exclusive breastfeeding or chestfeeding rate was 33.5% (214) and only 41.3% (244) of infants could be continuously fed until 6 months. Accepting hormonotherapy after having this child (adjusted odds ratio (AOR)=1.664, 95% confidential interval (CI)=1.014∼2.738) and receiving feeding education (AOR=2.161, 95% CI=1.363∼3.508) were associated with a higher exclusive breastfeeding or chestfeeding rate, while higher gender dysphoria scores (37-47: AOR=0.549, 95% CI=0.364∼0.827; >47: AOR=0.474, 95% CI=0.286∼0.778), experiencing family violence (15-35: AOR=0.388, 95% CI=0.257∼0.583; >35: AOR=0.335; 95% CI=0.203∼0.545), experiencing partner violence (≥30: AOR=0.541, 95% CI=0.334∼0.867), using artificial insemination (AOR=0.269, 95% CI=0.12∼0.541), or surrogacy (AOR=0.406, 95% CI=0.199∼0.776) and being discriminated against during seeking of childbearing health care (AOR=0.402, 95% CI=0.28∼0.576), are significantly associated with a lower exclusive breastfeeding or chestfeeding rate. Participants who had feeding education were more likely to feed their child with human milk as the first food intake (AOR = 1.644, 95% CI = 1.015∼2.632), while those who had suffered from family violence (>35: AOR=0.47; 95% CI=0.259∼0.84), discrimination (AOR=0.457, 95% CI=0.284∼0.721) and chose artificial insemination (AOR=0.304, 95% CI=0.168∼0.56) or surrogacy (AOR=0.264, 95% CI=0.144∼0.489), were less likely to give their child human milk as first food intake. Besides, discrimination is also related to a shorter breastfeeding or chestfeeding duration (AOR=0.535, 95% CI=0.375∼0.761). Breastfeeding or chestfeeding are neglected health problems in the transgender and gender-diverse population and many socio-demographic factors, transgender and gender-diverse-related factors, and family environment are correlated with it. Better social and family support is necessary to improve breastfeeding or chestfeeding practices. There are no funding sources to declare.

Introduction to healthcare for transgender and gender-diverse people.

This editorial provides a broad introduction to transgender health for transgender and gender-diverse people. Following a brief description of the history of transgender and gender-diverse people, the development of medical treatment is discussed, together with the use of appropriate terminology and language. The content largely draws attention to the guidance in the Standards of Care for the Health of Transgender and Gender Diverse People Version 8 developed by the World Professional Association for Transgender Health (WPATH) and published in 2022. Further key areas addressed are as follows. • The use of names and pronouns. • Population estimates of transgender and gender diverse people. • Diagnostic classification systems in transgender health. • A wide range of gender-affirming medical interventions, including hormones and surgeries. • Ethical considerations for research with transgender and gender diverse populations.

Gender-Affirming Voice Surgery: Considerations for Surgical Intervention.

The purpose of this article is to provide an overview of the current state and available evidence surrounding surgical voice care for the transgender and/or gender expansive population. The term "gender expansive" has been proposed as an inclusive term to classify those who do not identify with traditional gender roles but are otherwise not confined to one gender narrative or experience. We aim to review indications and candidacy for surgery, surgical procedure options for altering vocal pitch, and typical postoperative expectations. The role of voice therapy and considerations for perioperative care will also be discussed.

BreatheOut: Development and implementation of a pharmacist-led, culturally tailored smoking cessation program for transgender and gender diverse patients

BackgroundThe transgender population has disparities and predictors of smoking unique from the general population. Although culturally tailored smoking cessation programs have been created for minority populations with increased burden of tobacco use, there are no such pharmacist-led smoking cessation interventions for transgender patients. ObjectivesThe objective is to describe the development and implementation of a culturally tailored smoking cessation program for transgender and gender diverse patients and highlight an opportunity for pharmacist involvement in the interdisciplinary health care team for trans patients. MethodsThe BreatheOut program was devised as a pharmacist-led smoking cessation program for transgender and gender diverse patients. The program was designed based on the PEN-3 model for centering cultural identity in behavior change and was administered in an ambulatory care setting at a community health center with integrated clinical pharmacists. Patients are offered pharmacotherapy for treatment of smoking cessation in accordance with guideline-directed therapy. ResultsPreliminary evaluation of this program was conducted through a prospective, observational study. To assess long-term feasibility of the program, time spent at each visit was tracked to calculate cost using a pharmacy resident versus a clinical pharmacist to provide the service. The program was financially feasible when the cost of personnel time was compared with medical billing and pharmacy revenue. ConclusionThis culturally tailored smoking cessation program for a population with a high burden of smoking was found to be feasible when administered by a pharmacy resident or clinical pharmacist. Preliminary data support expansion of this program and the use of a culturally tailored approach to smoking cessation in this population.

Glucose Homeostasis, Diabetes Mellitus, and Gender-Affirming Treatment

The transgender (trans) population includes individuals with gender identities more fittingly aligned with the opposite sex or with an alternative that transcends the classical dipole of male/female. Hormonal treatment in transgender individuals aims to suppress the secretion of endogenous sex steroids and replace them with the steroids of the desired gender. The mainstay of gender-affirming treatment in transgender males is testosterone, whereas for transgender females it is estrogen, usually combined with an anti-androgen or a gonadotropin-releasing hormone agonist if testes are present. Testosterone and estrogen are involved in carbohydrate metabolism via direct effects on skeletal muscle, liver, adipose tissue, and immune cells and indirectly through changes in body fat mass and distribution. The effect of transgender treatment on glucose tolerance is not clear. The provided conflicting results demonstrate a positive, neutral, or even negative association between exogenous testosterone and insulin sensitivity in trans men. Studies show that feminizing hormonal therapy of trans women has mainly an aggravating effect on insulin sensitivity. The existing evidence is not robust and further research is needed to investigate the relationships between body fat distributions, muscle mass, and glycemia/insulin resistance in transgender people under hormonal therapy.

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Barriers to uptake of PrEP across the continuum among transgender women: A global scoping review.

Although preexposure prophylaxis (PrEP) has demonstrated high efficacy for HIV prevention, rates of PrEP uptake remain low among the transgender population, especially in transgender women (TGW). We conducted this scoping review to assess and characterize barriers to PrEP use along the PrEP care continuum among TGW. We conducted this scoping review by searching studies in Embase, PubMed, Scopus, and Web of Science. Eligibility criteria included: reporting a PrEP related quantitative result among TGW; peer-reviewed and published in English between 2010-2021. Globally, high willingness (80%) to use PrEP was found, yet uptake and adherence (35.4%) were low. TGW experiencing hardship, including poverty, incarceration, and substance use, were associated with higher odds of PrEP awareness but lower odds of PrEP use. Structural and social barriers such as stigma, medical mistrust, and perceived racism can be important barriers for PrEP continuation. High social cohesion and hormone replacement therapy were associated with greater odds of awareness. In addition, our study confirmed prior research showing that PrEP does not lower feminizing hormone levels in TGW. Significant demographic factors among TGW that are associated with PrEP engagement. It is imperative to focus on TGW as a population with independent needs, requiring specific PrEP care guidelines and tailored resource allocation, that fully considers individual-, provider-, and community/structural-level barriers and facilitators. The present review also indicates that combining PrEP care with GAHT or broader gender-affirmation care may facilitate PrEP use.

LGBT+ Youth Perspectives on Sexual Orientation and Gender Identity Questions in the Growing Up in Ireland Survey: A Qualitative Study

The increasing importance of identifying lesbian, gay, bisexual and transgender (LGBT+) populations is a key driver in changes to demographic data collection in representative surveys of youth. While such population-based data are rare, Growing Up in Ireland (GUI), an Irish, government-funded, longitudinal survey, includes sexual orientation and gender identity (SOGI) measurements. This qualitative study responds to a query from the GUI study team and aims to identify how best to collect SOGI data in future waves of GUI. A university Human Research Ethics Committee granted approval for online consultations with LGBT+ youth (n = 6) with experiential expertise in policy making. The research is underpinned by rights-based public patient involvement (PPI) with recorded discussions, which were transcribed and imported into NVivo 12, generating the theme “recognition in research, policy and society”. This co-created article, with the LGBT+ young PPI Panel members, commends the inclusion of SOGI data in GUI and recommends changes in question placement and phrasing. Aligning with best practice, the PPI members provide a template for wording on consecutive sex and gender questions, expanded sexual orientation identity categories and maintaining the existing well-phrased transgender question from GUI. This offers potential to improve the quality of the SOGI data collected and the experience of those completing the questionnaire. These findings extend beyond GUI, with relevance for surveys with youth populations. This paper underscores the potential and benefits of participatory approaches to research with youth and views their role beyond simply as sources of data.

Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study

BackgroundAndrogenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. ObjectiveWe examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. MethodsRetrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. ResultsTGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LimitationsInability to determine causation and limited generalizability. ConclusionTGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.

Implications of testosterone therapy on wound healing and operative outcomes of gender-affirming chest masculinization surgery

The increased awareness of the transgender population and their medical needs has given rise to a wide array of gender-affirming surgeries and hormonal therapies. To better understand the implication of testosterone therapy on female-to-male gender-affirming mastectomies, we conducted a retrospective cohort study based on the medical histories of 170 transgender males operated on by a single surgeon over 18 years. One hundred and one (59.4%) patients received hormonal therapy. The average age of patients in the testosterone treatment group was 20.6±5.3 (range 14-49) years. The median weight of resected breast tissue was 318g (IQR 221-515) and 311.5g (IQR 223-480) in patients treated with testosterone, compared to 380g (IQR 225-735) and 370g (IQR 240-700) in patients without testosterone treatment (for the right and left breast, respectively). Supplementary liposuction was performed in 35 patients, of whom 23 (64%) were treated with testosterone. Fifty-four patients (31.7%) experienced surgical complications, and 55.6% of complications were recorded in the group treated with testosterone. Forty-nine patients (28.8%) recorded their satisfaction using the Likert satisfaction scale; the average satisfaction was 4.86±0.35 in the non-testosterone group and 4.63±0.69 in the testosterone group. Opposing previous cohorts, we did not find a statistically significant association between testosterone and increased surgical complications in gender-affirming mastectomies. Possible explanations include our practice of avoiding testosterone therapy several weeks before the operation and vigorous hemostasis methods.

Hepatitis C Virus Testing and Care Cascade Among Transgender and Gender Diverse Individuals

Hepatitis C virus (HCV) prevalence among transgender and gender-diverse individuals ranges from 1.8% to 15.7% versus 1% in the general population. Previous HCV studies inclusive of transgender and gender-diverse individuals primarily rely on convenience-based sampling methods or are geographically restricted. The purpose of this study is to compare the prevalence of HCV diagnoses, testing, and care engagement between transgender and gender-diverse and cisgender individuals. Using Optum's de-identified Clinformatics® Data Mart Database, in 2022, the unadjusted prevalence of HCV testing among all adults and people who inject drugs from January 2001 to December 2019 was measured. Multivariable logistic regression was used to compare the adjusted odds of HCV diagnoses and care engagement by gender subgroup. The overall unadjusted frequency of HCV diagnoses among transgender and gender-diverse individuals was approximately 3 times that of cisgender individuals (1.06% vs 0.38%, p<0.001), including among people who inject drugs (6.36% vs 2.36%, p=0.007). Compared with cisgender women, transfeminine/nonbinary individuals had over 5 times the adjusted odds of a HCV diagnosis and approximately 3.5 times the odds of being tested for HCV. In addition, compared with cisgender women, transfeminine/nonbinary individuals had significantly increased odds of having a HCV‒related procedure (e.g., abdominal ultrasounds, liver biopsies, Fibroscans). Cisgender men had significantly increased odds of receiving HCV medication compared with cisgender women. Although testing was higher among transgender and gender-diverse individuals, the higher overall frequency of HCV diagnoses among transgender and gender-diverse than among cisgender individuals signals persistent health disparities. Interventions are warranted to prevent HCV and increase ongoing testing and treatment uptake among transgender and gender-diverse populations.

Sex &amp; relationships in trans people

Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.