Transgender Population Research Articles

Addressing the Health Needs of LGBTQ Persons in Medical Curricula: A Review of Educational Programs.

Given the vulnerability of and the importance of caring for the specific health care needs of the growing lesbian, gay, bisexual, transgender, and queer (LGBTQ) population, the authors attempted to identify all educational interventions in psychiatric settings with quantitative outcomes targeting medical students, residents, and physicians in postgraduate settings. To gain insight from other disciplines that have published research in this area, a second objective was to review studies in teaching in those other disciplines. The authors sought to describe the methods of selected studies. The authors searched the published English-language literature indexed in PubMed, EMBASE, and PsycINFO using key terms for health care education concerning LGBTQ populations. The authors described and critically appraised studies with quantitative outcomes designed to enhance knowledge, skills, and attitudes in treating the LGBTQ community. Of the 15 trials identified, 10 included medical students, 4 included internal medicine residents or medical school faculty, and 1 included oncologists. We did not find any randomized controlled trials or controlled nonrandomized trials of curricula dedicated to teaching learners in psychiatry. All of the studies included a presurvey, followed by an educational intervention and then a postsurvey assessment. The educational interventions, outcome measures, and quality of studies varied widely. Four studies enrolled self-identified members of the LGBTQ community as trainers and facilitators of the educational interventions. The lack of high-quality controlled studies indicates the need to develop evidence-based curricula to support the education of the psychiatric workforce to provide for the special needs of LGBTQ persons.

Prevalence of an Identity Crisis Within the Transgender Population of Pakistan

Prevalence of an Identity Crisis Within the Transgender Population of Pakistan

Sexual health in transgender and gender diverse people.

Sexual health and sexual function are critical to the wellbeing of cisgender, transgender, and gender diverse populations. To date, there has been only limited patient-focused evaluation of sexual function in transgender and gender diverse patients at several stages in their gender-affirming medical care. There remains a need to better understand the impact of gender affirming medical and surgical therapy on sexual health, and to develop evidence-based treatments to address sexual dysfunction when present. The impact of gender-affirming hormone therapy on sexual health is complex and evolves over time on treatment. Despite high incidences of complications, major genital gender-affirming surgeries such as vulvovaginoplasty and penile implant placement after phalloplasty yield high patient satisfaction. While treatments to preserve or restore erections and to improve vaginal lubrication have been trialed based upon literature in cisgender populations, there remains minimal evidence to guide medical treatment of sexual dysfunction ranging from erectile dysfunction to dyspareunia. There is a continued need for ongoing efforts to develop patient-reported outcome measures and rigorous investigation of sexual health preservation and restoration treatments in transgender and gender diverse populations.

Mental Health Challenges due to Health Care Discrimination among Transgender Youth: A Selective Review

Abstract: Background: Transgender youth face various difficulties including mental health due to discrimination in healthcare settings because of their gender orientation. This review investigates the mental health of transgender youth and health care discrimination leading to inadequate health care. Materials and Methods: The study complied with the latest publications using PRISMA reporting guidelines. For the selective review, 19 articles were selected over the last five years (between 2017 and 2022) which were primarily focused on mental health challenges and lack of health care due to health care discrimination among transgender youth. The study included publications at a global level, citing the global articles first, followed by Asia. The study only took into account biological and/or non-biological factors for the young transgender community, including both male and female factors. Result: All 19 articles confirmed the positive significance of the Mental Health of the transgender youth community due to discrimination meanwhile, 08 articles mainly indicated about lack of healthcare or unfair healthcare in settings due to being transgender along with mental health concerns. This review identified the differences in mental health and discrimination that the transgender population faces. Conclusion: As a reform, lower levels of depression and suicidality have been associated with social transition and having access to gender-affirming medical treatment. However, policies affecting this young transgender minority, who experience mental and social prejudice, must be changed. Multilevel intervention should also be advocated to address both of these severe issues. Keywords: Mental health, Transgender youth, Health care discrimination, Gender-affirming, Sexual assault, Stigma.

Gender Marker Laws and Access to Emergency Rental Assistance for Transgender Renters in the United States During COVID-19

Barriers to changing gender markers on identification documents (IDs) create many economic challenges for transgender and gender nonconforming individuals. In the United States, each state has different laws and processes for changing the gender marker on a state ID. Using Household Pulse Survey data, this paper investigates whether transgender renters residing in states with several hurdles to changing gender on a driver’s license had a more difficult time accessing emergency rental assistance during the COVID-19 pandemic. Descriptive results from baseline logistic regression models suggest that among transgender individuals, residing in states that require proof of sex-change surgery, a court order, or an amended birth certificate to change gender on a driver’s license was associated with a lower likelihood of receiving emergency rental assistance after applying. Gender marker laws have deep consequences for housing policy: state-level considerations for the transgender population should be included in housing policy design.

Characteristics and Outcomes Among US Commercially Insured Transgender Adults With Cirrhosis: A National Cohort Study.

The National Institute on Minority Health and Health Disparities has noted that transgender individuals experience unique health disparities. We sought to describe the landscape of transgender patients with cirrhosis. We identified all transgender and cisgender adults in Optum's deidentified Clinformatics Data Mart Database between 2007 and 2022 using validated billing codes and calculating age-standardized prevalence of cirrhosis among cisgender vs transgender adults. Among those with incident cirrhosis diagnoses, we calculated age-standardized incidence densities of liver-related outcomes (decompensation, transplantation, hepatocellular carcinoma) and all-cause mortality. We examined 5-year survival using inverse probability treatment weighting to balance transgender and cisgender populations on demographic and clinical characteristics. Among 64,615,316 adults, 42,471 (0.07%) were transgender. Among 329,251 adults with cirrhosis, 293 (0.09%) were transgender. Trans- (vs cis-) genders had higher prevalence of cirrhosis (1,285 [95% confidence interval (CI) 1,136-1,449] per 100,000 vs 561 [559-563] per 100,000). Among adults with cirrhosis, trans- (vs cis-) genders had higher proportions of anxiety (70.7% [56.9-86.9] vs 43.2% [42.7-43.8]), depression (66.4% [53.3-81.7] vs 38.4% [37.9-38.9]), HIV/AIDS (8.5% [3.9-16.1] vs 1.6% [1.5-1.7]), and alcohol (57.5% [46.0-71.1] vs 51.0% [50.5-51.6]) and viral (30.5% [22.8-39.8] vs 24.2% [23.9-24.5]) etiologies, although etiologies had overlapping CIs. Trans- (vs cis-) genders had similar incidence densities of death (12.0 [95% CI 8.8-15.3] vs 14.0 [13.9-14.2] per 100 person-years), decompensation (15.7 [10.9-20.5] vs 14.1 [14.0-14.3]), and liver transplantation (0.3 [0.0-0.8] vs 0.3 [0.3-0.4]). In inverse probability treatment weighting survival analysis, transgender and cisgender individuals had similar 5-year survival probabilities (63.4% [56.6-71.1] vs 59.1% [58.7-59.4]). Trans- (vs cis-) gender adults have double the prevalence of cirrhosis, and the majority have a diagnosis of anxiety and/or depression. These results are informative for researchers, policymakers, and clinicians to advance equitable care for transgender individuals.

Teaching and Learning About the Transgender Population: Student Reflections.

Decreasing the disparities in health care for transgender people requires nursing to expand its knowledge base about the population. There is limited research and information about curricula integration inclusive of this population, yet much is written about the gap in nursing knowledge and education. There may be insufficient opportunities to expose students to the population as patients; therefore, creative education strategies are necessary. An innovative multimodal education process was implemented in an urban university setting to expose undergraduate nursing students to the population. Lecture, video, live testimonial, and panel discussion were used. Class reflections and survey data revealed three qualitative narrative reflections. Students reported awareness of how to improve their interactions with this population, appreciation for the experience, and meaningfulness of the experience. The experience brought students closer to understanding the need in providing equitable and appropriate care. Multiple modes of teaching were successful in the affective learning domain. More research in ways to enhance nursing education is necessary. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Pre-exposure Prophylaxis Awareness and Use Among Transgender and Nonbinary Individuals in Canada.

Transgender and nonbinary populations are disproportionately affected by HIV and face barriers to accessing HIV-related services. Pre-exposure prophylaxis (PrEP) may benefit those at risk of HIV acquisition. However, PrEP awareness and uptake, along with potential barriers and facilitators, have not been investigated among transgender and nonbinary individuals living in Canada. This study analyzed data from 1965 participants of the 2019 Trans PULSE Canada survey, a national convenience sampling survey of transgender and nonbinary individuals in Canada. Data were analyzed to estimate levels of PrEP awareness and uptake and to identify predictors of PrEP awareness among the study population. Prevalence ratios estimated from block-wise modified Poisson regression models were used to assess predictors of PrEP awareness. PrEP awareness, lifetime PrEP use, and current PrEP use were estimated to be 71.0%, 2.2%, and 0.9%, respectively, among the full sample, and 82.3%, 7.3%, and 3.8% among those with indications for PrEP use. Respondents who were aged 45 years or older, transfeminine, Indigenous, living in Atlantic Canada or Quebec, and had high school education or less were significantly less likely to be aware of PrEP. Lifetime sex work, past-year HIV/STI testing, being single or in a nonmonogamous relationship, and higher levels of emotional social support were positively associated with PrEP awareness. There is a need to improve PrEP awareness and particularly uptake among transgender and nonbinary individuals in Canada. This study revealed inequities in PrEP awareness within this population, which may serve as targets for future public health initiatives.

Phantom sensation in genital gender-affirming surgery: a narrative review.

To review findings related to phantom genital sensation, emphasizing phantom sensation in the transgender and gender diverse (TGD) population. We discuss prevalence, presentation and potential implications for sensory outcomes in genital gender-affirming surgery. There is a high prevalence of phantom genital sensations in the TGD population. The prevalence varies by body part, approaching 50% in the most frequently reported transgender phantom - the phantom penis. Unlike genital phantoms that occur after trauma or surgery which are often painful, transgender phantoms are typically neutral and often erogenous in experience. Phantom sensation in the TGD population can be an affirming experience and important part of sexual well being and embodiment. Recent studies have begun to characterize the prevalence and presentations of phantom genital sensations in TGD people, informing our evolving understanding of the sensory experiences of the transgender and gender diverse population. Targeting integration of these centrally-mediated phantom genital sensations with the peripherally generated sensation from genital stimulation may represent one potential avenue to improve sensation and embodiment following genital gender-affirming surgical procedures. Additionally, emerging techniques in modern peripheral nerve surgery targeting phantom pain may offer potential treatment options for painful phantom sensation seen after cases of genital surgery or trauma.

Determinants of Repeating an HIV Test Among Gay, Bisexual, and Other Men Who have Sex with Men, and Transgender People Who Use an Online-Requested Self-Sampling Program and Attending Community-Based Testing Venues in Spain (2018-2021).

Our aims were: (1) to characterize gay, bisexual and other men who have sex with men (GBMSM) and transgender (TG) populations using internet-based self-sampling services in the TESTATE project or attending community-based STI/HIV voluntary counselling and testing (CBVCT) services as alternative strategies to formal HIV testing within the Spanish national health system, and (2) to identify factors associated with repeat use of the same screening strategy from November 2018 to December 2021. Demographic, health, and behavioral characteristics of users using complementary strategies were analyzed. We developed a cross-sectional study, with descriptive analysis, HIV cascade, and a multivariate logistic model to identify factors associated with participants' repeated use of the same screening strategy. We included 9939 users, of whom 94.1% were GBMSM (n = 9348) and 5.9% TG (n = 580), with a high representation of migrants. Reactive results were 3.4% (n = 340), with 3.0% in GBMSM (n = 277/9348) and 10.7% in TG (n = 63/591). 73.8% (n = 251) were confirmed HIV positive and 76.7% (n = 194) were linked to health services. Users repeated the online screening strategy more than CBVCT (44.3% vs. 31.8%), but TG population used face-to-face community services more (8.4% vs. 0.6%). Factors influencing the repetition of the online self-sampling strategy included older age, non-migrant status, and recent HIV testing. In the CBVCT strategy, factors included older age, TG identity, non-migrant status, condom use during the last sexual encounter, and recent HIV testing. In conclusion, both CBVCT and online-requested self-sampling at home are important alternatives to the health system for the provision of HIV testing to GBMSM and TG.

(136) LABIA MINORA: A COMPREHENSIVE REVIEW

Abstract Introduction The labia minora (LM) is a part of the external female genitalia that varies greatly in form and appearance, and changes at each developmental stage of a woman. Its highly neurovascular nature and proximity to the clitoris allows it to play a vital role in sexual function. Along with the labia majora, it helps to protect the opening of the urethra and vagina. The perception of a normal LM is dependent on cultural and social context and influences the kinds of procedures that are done on the LM. Objective This study aims to comprehensively review labial anatomy, development, pathology, its role in sexual function, perceptions of labial appearance, and labial procedures. The goal is to understand the mechanism and purpose of the evolution of the LM and its effects on anatomical and sexual function. Methods We reviewed journal articles from 1988 to 2023 concerning labial anatomy, physiology, pathology, piercings, tattoos, and labial procedures such as labiaplasty, genital mutilation, episiotomies. We also reviewed cultural perceptions of its structure, its role in sexual function and its composition and function in the transgender population. Results The LM is highly neurovascular and engorges with blood with sexual stimulation. The structural changes are influenced by hormone levels. Perception of normal appearance varies by cultural and societal norms, influencing procedures performed in the area. Due to the histological composition of the LM, it has many manifestations of dermatological diseases. The LM is also susceptible to infectious, neoplastic, drug-induced, inflammatory, autoimmune and other systemic diseases. Limited information exists on LM piercing and tattoos. The size discrepancies of the LM may cause psychological distress, with conflicting research on its impact on sexual sensitivity or function. Labial procedures such as labiaplasty may enhance sexual satisfaction while female genital mutilation may reduce sexual satisfaction. There is a lack of comprehensive documentation of techniques of LM creation in transgender women and a lack of long-term follow-up studies post-vaginoplasty. The lymphatic structure within the LM is poorly understood, emphasizing the need for further research. Conclusions The labia minora is important for arousal and sexual function and its changes over time is dependent on hormone levels. The appearance and structure drive the kinds of labial procedures that are conducted and significantly affects sexual health. There is a need for further studies of the labia minora to understand its complexities and evolution. Disclosure No.

(033) ABSENCE OF GENDER-AFFIRMING HYSTERECTOMIES FROM HYSTERECTOMY SEXUAL FUNCTION OUTCOMES LITERATURE

Abstract Introduction Gender affirming healthcare is a multidisciplinary field that includes (but is not limited to) the following interventions: hormonal therapy and gender affirming surgery (chest surgery, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, etc.). Gender-affirming hormone therapy has been shown to positively impact orgasm duration and satisfaction level among both transgender men and women. Research on sexual wellbeing after gender affirming surgery (GAS) indicates positive effects on sexual health outcomes; however, the literature lacks sufficient studies to make evidence-based recommendations. Objective To synthesize and review the current state of literature on sexual outcomes following gender affirming hysterectomies as background to inform a planned study on this topic. Methods This project is a literature review of peer-reviewed journal articles on sexual function and pleasure outcomes following hysterectomies, with a particular focus on gender affirming hysterectomies. We considered various cohort studies, systematic reviews, position statements, and meta-analyses in our review. Results No research currently exists on sexual function or orgasm experience after gender affirming hysterectomy. Current literature exploring sexual function post-hysterectomy only includes cisgender populations (indications typically include cancer risk reduction, pelvic pain, and/or abnormal uterine bleeding). Studies have found mixed results regarding sexual function in cisgender women post-hysterectomy and/or oophorectomy, including changes to anxiety and depression, sexual health and wellness, both in a positive and negative direction. Other analyses found no significant change in sexual function post-hysterectomy in cisgender women. Based on these findings, hysterectomies have mixed effects on sexual satisfaction & function in cisgender populations but there is no data to guide transgender populations. Conclusions More research is needed on sexual health outcomes (i.e., sexual pleasure, arousal, and orgasm) after gender affirming surgery, as very few studies examine the role of sexual function, including desire, arousal, pain and orgasm in patients’ lives post-GAS. No studies investigate sexual satisfaction post-gender affirming hysterectomy despite it being an important GAS for transgender men. Research on this procedure in this specific population will inform evidence-based practices and recommendations, elucidate sex outcomes when the main indication for a hysterectomy is gender affirmation, and advance our understanding of sexual pleasure overall. This author team is initiating a study to address this critical question. Disclosure No.

ASO Author Reflections: Opportunities to Mitigate Cancer Disparities in Transgender and Gender-Diverse Populations.

ASO Author Reflections: Opportunities to Mitigate Cancer Disparities in Transgender and Gender-Diverse Populations.

Pride and body image among transgender and nonbinary adults: the mediating role of body appreciation between gender identity pride and intuitive eating

ABSTRACT Studies exploring disordered eating among transgender and nonbinary populations have primarily focused on minority stressors with a dearth of research examining the role of gender identity pride on body appreciation and intuitive eating. To address this gap in the literature, the present study, comprised of 148 transgender and nonbinary adults (M age = 24.68, SD = 6.64), tested the associations among gender identity pride, body appreciation, and intuitive eating, controlling for demographics and minority stress variables. The study also tested body appreciation as a mediator in the cross-sectional association between gender identity pride and intuitive eating. Regression models indicated that greater gender identity pride was significantly associated with greater body appreciation, but not intuitive eating. Greater body appreciation was a significant mediator in the positive association between gender identity pride and intuitive eating. Findings support the significant role and relevance of examining gender identity pride as related to body appreciation and intuitive eating. Future research may determine the causal impact of gender identity pride on body image and eating behaviors in transgender and nonbinary populations. Clinicians may consider the positive role of gender identity pride when addressing body image and eating behaviors with their transgender and nonbinary clients.

Childhood Parental Neglect, Abuse and Rejection Among Transgender Women: A Cross-Sectional Study in Rio de Janeiro, Brazil.

We aimed to estimate the proportions of childhood parental neglect, abuse, and rejection and to evaluate the co-occurrence of these experiences among transgender women in Rio de Janeiro, Brazil. This was a cross-sectional study with a convenience sample enrolled between July 2019 and March 2020, using an adapted version of the Childhood Trauma Questionnaire. Proportions and corresponding confidence intervals (CI) were calculated. Kendall correlation with Tau-b estimator was used in the bivariate analyses. We gathered data from 139 participants. The most prevalent types of childhood traumas were emotional abuse (60.43%, 95% CI [51.79, 68.62]), physical abuse (57.55%, 95% CI [48.90, 65.89]) and sexual abuse (44.60%, 95% CI [36.18, 53.27]). Severe to extreme physical and emotional abuse occurred among 40.29% (95% CI [32.06, 48.93]) and 5.75% (95% CI [2.51, 11.02]) of participants, respectively. The proportion of parental rejection (eviction) was 32.37% (95% CI [25.04, 40.69]) and occurred with the other forms of abuse, except sexual abuse. Multiple types of childhood abuse, neglect, and parental rejection were observed among transgender women in our sample. The harmful effects of childhood abuse on the mental and physical health of people in the transgender population are of concern, particularly considering the cumulative effect produced by the co-occurrence of such events and their harmful lifetime effects. It is urgently necessary to debate and formulate public policies to ensure the right to gender expression from childhood.

Analysis of single nucleotide polymorphisms of the metabotropic glutamate receptors in a transgender population.

Gender incongruence (GI) is characterized by a marked incongruence between an individual's experienced/expressed gender and the assigned sex at birth. It includes strong displeasure about his or her sexual anatomy and secondary sex characteristics. In some people, this condition produces a strong distress with anxiety and depression named gender dysphoria (GD). This condition appears to be associated with genetic, epigenetics, hormonal as well as social factors. Given that L-glutamate is the major excitatory neurotransmitter in the central nervous system, also associated with male sexual behavior as well as depression, we aimed to determine whether metabotropic glutamate receptors are involved in GD. We analyzed 74 single nucleotide polymorphisms located at the metabotropic glutamate receptors (mGluR1, mGluR3, mGluR4, mGluR5, mGluR7 and mGluR8) in 94 transgender versus 94 cisgender people. The allele and genotype frequencies were analyzed by c2 test contrasting male and female cisgender and transgender populations. The strength of the associations was measured by binary logistic regression, estimating the odds ratio (OR) for each genotype. Measurement of linkage disequilibrium, and subsequent measurement of haplotype frequencies were also performed considering three levels of significance: P ≤ 0.05, P ≤ 0.005 and P ≤ 0.0005. Furthermore, false positives were controlled with the Bonferroni correction (P ≤ 0.05/74 = 0.00067). After analysis of allele and genotypic frequencies, we found twenty-five polymorphisms with significant differences at level P ≤ 0.05, five at P ≤ 0.005 and two at P ≤ 0.0005. Furthermore, the only two polymorphisms (rs9838094 and rs1818033) that passed the Bonferroni correction were both related to the metabotropic glutamate receptor 7 (mGluR7) and showed significant differences for multiple patterns of inheritance. Moreover, the haplotype T/G [OR=0.34 (0.19-0.62); P<0.0004] had a lower representation in the transgender population than in the cisgender population, with no evidence of sex cross-interaction. We provide genetic evidence that the mGluR7, and therefore glutamatergic neurotransmission, may be involved in GI and GD.

Sociodemographic Factors Associated with Suicide Outcomes in Transgender and Gender Diverse Young Adults

Objective Transgender and gender diverse (TGD) populations have a higher prevalence of suicide outcomes compared to cisgender peers. Further, among TGD groups, young adults frequently demonstrate a higher risk compared to other age cohorts. While evidence supports sociodemographic differences in suicide risk, these relationships are not well-established for TGD young adults. Method A secondary data analysis of the young adult (18–24 years) subpopulation of the 2015 U.S. Transgender Survey was conducted. Predicted probabilities of 12-month and lifetime suicide outcomes by gender identity, sexual orientation, race/ethnicity, homelessness, and poverty were estimated comparing fully adjusted models. Results Gender identity, race/ethnicity, and homelessness were significantly associated with all suicide outcomes. Comparisons of gender identities were significant for all outcomes and varied based on the outcome. American Indian/Alaska Native TGD young adults had the highest predicted probabilities compared to other race/ethnicity groups. Further, having a heterosexual/straight sexual identity was among the lowest predicted probabilities for suicide outcomes and significantly differed from several of the other sexual identities. Conclusions Findings underscore the importance of heterogeneity among TGD young adults and the need for intersectional research within this population. Elucidating sociodemographic characteristics that contribute to differential suicide risk is necessary for effective intervention strategies and policy advocacy.

Toward transgender health: Analysis of current barriers and theorizing interventions.

In the fields of medical and behavioral health care, there is a demonstrable scarcity of providers who possess the necessary levels of clinical and cultural competency required to serve transgender patients. As a result of this deficiency, many members of the transgender community engage in an avoidance of care. Among providers, there are observed deficiencies in awareness regarding specific acute and chronic health disparities experienced by members of the transgender population. We aim to demonstrate the unique and intersectional health disparities experienced by this community, to empower providers serving this community. Additionally, we endeavor to propose a range of potential clinical and political interventions and options for mobilization that providers can engage in. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Present State of Housing and Treatment of Transgender Incarcerated Persons.

The care and housing of transgender (TGD) incarcerated persons is a complex concern that is growing because of the increased recognition and diagnosis of gender dysphoria in society. To remain current in this evolving landscape, there have been updates to federal manuals and state guidelines regarding the medical care and housing of the TGD population. Since the publication by Glezer and colleagues in 2013, there has not been a comprehensive overview of current federal and state guidelines, and legal and other considerations on this topic. We provide an update with special consideration given to housing practices, safety, and access to care. A review of the literature shows that the World Professional Association for Transgender Health (WPATH) standards and Prison Rape Elimination Act (PREA) requirements are not uniformly implemented and enforced on a state level. In fact, some states have policies that are in direct conflict with federal requirements. The safety and equitable treatment of both TGD and cisgender populations is an important topic that merits attention. As new challenges emerge, an increase in federal enforcement and consistency is needed to ensure the humane treatment and protection of TGD inmates.

Posttraumatic stress disorder mediating associations between child sexual abuse and substance use among transgender adults in the United States.

Transgender people experience an excess burden of child sexual abuse (CSA), mental health concerns, and substance use compared to cisgender populations. Posttraumatic stress disorder (PTSD) has been found to mediate the association between CSA and substance use behaviors in cisgender populations, but this dynamic has not been previously examined among transgender adults. The aim of this study is to test if PTSD may mediate a relationship between CSA and substance use among transgender adults. Data were analyzed from the U.S. Transgender Population Health Survey (2016-2018), a national probability sample of transgender adults (N = 274). CSA was measured using the Adverse Childhood Experiences subsection for sexual abuse. Past-month PTSD was measured using the Primary Care-PTSD Diagnostic and Statistical Manual of Mental Disorders, fourth edition screening tool. Substance use was determined by lifetime binge drinking, polydrug use, and the Drug Use Disorders Identification Test. Baron and Kenny's approach was used to assess PTSD as a mediator between CSA and substance use. Within our sample, nearly half (45%) of the transgender adults experienced CSA. Lifetime binge drinking (40%), polydrug use (20%), and indications of drug-use-related problems (Drug Use Disorders Identification Test x¯ = 4.52) were frequently reported. Transgender adults who have experienced CSA had increased risk of PTSD and substance use, and PTSD was a mediator in all models. Results suggest that adult transgender CSA survivors are at increased risk of drug and alcohol use, and that PTSD may be an important contextual factor for substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).