Transgender Research Research Articles

Abstract C006: Understanding barriers to low HPV vaccination in the LGBTQ+ community in Los Angeles: Collecting neighborhood-level data at pride events

Abstract Background The uptake of the Human Papillomavirus vaccine and anal cancer screening remain low among LGBTQ+ communities, especially in Los Angeles County. The LA metropolitan area has the nation’s second largest LGBTQA+ community, with an estimated 523,000 persons representing intersectional identities including the racial and ethnic diversity within lesbian, gay, bisexual, transgender, non-binary and questioning. Significant barriers to vaccination and screening exist, including inadequate knowledge, reluctance to disclose personal information, fear of a cancer diagnosis, and conflicting messages. Methods Cedars Sinai Cancer Center Community Outreach and Engagement (COE) created the Transgender Research Advisory Committee (T-RAC), a subcommittee of our Community Advisory Board, and facilitated bi-directional engagement with the research team to ensure that voices of the community were included in each phase of designing an intervention to increase HPV vaccination. T-RAC has n=8 members representing LGBTQ+ patients, advocates, and community navigators and their roles include: (1) weigh in on all materials development for community audiences, recruitment and research implementation strategies; (2) review the progress of study; (3) provide guidance on developments in the community; (4) contribute to interpretation of study findings; and (5) participate in dissemination of study findings. Results With T-RAC’s advice, a needs assessment survey was developed, and data was collected at Long Beach Pride on May 2024 with N=205 survey respondents. While 82% have heard about HPV, only 48% were vaccinated with at least one dose and only 12% completed all three doses. Among those who have not completed the HPV vaccine series (n=177), 33% are in interested in getting the vaccine, 55% prefer a mobile health clinic, and 70% would be vaccinated at Pride events. Qualitative responses indicated the following barriers to getting screened: “not ready”, “need more information”, “prefer a health provider”, and “unsure about side effects”. For those interested, a mobile health clinic was available during Pride event and N=16 people were vaccinated. Conclusion More outreach, education and engagement are needed to address barriers and low uptake of the HPV vaccine among LGBTQ+. Further, this initiative has led to the application for Research Program Project Grants (P01) and plans to launch a health education initiative, EndHPV, along with continuing to make mobile health clinics available at Pride events throughout Los Angeles County. The role of T-RAC has been instrumental in catalyzing gender-affirming interventions that directly address the unique needs and challenges faced by the LGBTQ+ community and promote equitable access to services for all. Citation Format: Alex Caro, Victor Cristanto, Richard Zaldivar, Marc Goodman, Reener Balingit, Zul Surani. Understanding barriers to low HPV vaccination in the LGBTQ+ community in Los Angeles: Collecting neighborhood-level data at pride events [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C006.

Attitudes of Hematologists in the Midwestern United States Toward Evaluating and Managing Thrombosis Risk in Transgender Youth Starting Gender Affirming Hormone Therapy

Background: Transgender and gender nonconforming (TG) youth who are at increased risk of thrombosis may be evaluated by a hematologist to discuss thromboprophylaxis prior to starting gender-affirming hormone therapy (GAHT). However, in the absence of guidelines to inform the delivery of hematologic care to such youth, variations in practice patterns may lead to suboptimal care for these individuals. Aim: Determine hematologists' recommendations about which TG youth should be considered at higher risk of thrombosis, laboratory evaluation and medical management of such youth, and which youth should be referred for hematologic evaluation prior to starting GAHT. Methods: From 6/2022-2/2023, we recruited hematologists caring for patients 13-22 years-old and practicing in the Midwestern U.S. for individual semi-structured interviews. Hematologists were recruited from the institutions in the footprint of the Midwest Transgender Research Collaborative. Interviews assessed demographics, practice characteristics, comfort recommending and prescribing thromboprophylaxis to TG youth, and recommendations for 1) which youth TG youth would be considered at higher risk of thrombosis; 2) laboratory evaluation; 3) recommended thromboprophylactic medication and duration; and 4) which TG youth should undergo hematologic evaluation prior to GAHT. Transcripts were analyzed using team-based framework analysis. The study was IRB approved; informed consent was obtained. Results: Eleven hematologists from 4 academic centers participated. Mean age was 50.5 years (SD 7.2); 9 participants identified as white; 2 were Latino/a. Ten participants had provided care to TG adolescents (13-17 years-old); all 11 had provided care to TG young adults (18-22 years-old). Participants reported on average 2.8 (SD 3.3) TG adolescents and 2.5 (SD 2.9) TG young adults in their practices. Ten participants reported comfort with recommending and prescribing thromboprophylaxis to patients at higher risk of thrombosis starting estrogen for GAHT; counseling about knowledge gaps and engaging in shared decision making were important elements in the process. One participant reported preference for non-medication interventions, such as compression stockings and using lower doses or transdermal formulations of estrogen. There was less consensus around attitudes toward prophylaxis for youth starting testosterone for GAHT: 4 participants reported lower likelihood of recommending thromboprophylaxis due to low risk of thrombosis with testosterone use; 3 participants discussed risk of erythrocytosis/polycythemia due to testosterone use (although there was no consensus on whether prophylaxis would be recommended); 3 participants reported comfort prescribing prophylaxis to youth starting testosterone; and 2 participants reported insufficient knowledge about the thrombotic risks of testosterone. Hematologists reported various factors that would lead to TG youth being considered high risk, as well as recommended lab testing (Table 1). If prophylaxis is needed, 10 participants would recommend a direct anticoagulant, while 1 would recommend aspirin. Five participants anticipated that long term prophylaxis would be needed for the duration of GAHT, while 6 reported duration would be individualized. Ten participants would not recommend against estrogen due to thrombosis risk, emphasizing the importance of gender care and the role of the hematologist in making GAHT as safe as possible. No participant would recommend against testosterone. Participants offered recommendations for which TG youth should be evaluated by a hematologist prior to starting GAHT (Table 2). Conclusion: Overall, hematologists voiced comfort with recommending and prescribing thromboprophylaxis to TG youth at higher risk of thrombosis starting estrogen. However, there was lack of consensus about evaluation of youth at higher risk of thrombosis starting testosterone and whether mitigation of risk would be needed. Developing guidance for gender care teams for which youth should be considered at higher risk of thrombosis and referred for hematologic evaluation would help optimize the safe delivery of gender-affirming hormone care. Additional data and guidance about the thrombosis risks associated with GAHT is needed to better inform hematologic care. Funding: NIH R01HL161153; Cincinnati Children's Hospital Medical Center Gap Funding

Transgender Research in Counseling Journals: A Content Analysis from 2007 to 2020

Transgender Research in Counseling Journals: A Content Analysis from 2007 to 2020

Seeing the unseen: how can we best identify transgender women within the Veterans Affairs healthcare system's electronic medical record?

One challenge in transgender research is reliably identifying patients through electronic medical records data, as there is no universal transgender International Classification of Diseases (ICD) code, but rather multiple ICD codes that can be used. To explore the sensitivity and specificity of 5 commonly used ICD codes to identify transgender patients overall and transgender women specifically (assigned male sex at birth) by using data from the Veterans Affairs (VA), the largest integrated health system in the United States. Patients aged ≥18 years were identified via ICD-9 codes 302.5 and 302.6 (Ninth Revision) and ICD-10 codes F64.0, F64.8, and F64.9 (Tenth Revision) using VA health records from 2000 to 2021 and stratified by bilateral orchiectomy status. Detailed chart review was performed on 32 randomly selected patients for each code (half with and half without orchiectomy) to confirm transgender status and to perform descriptive analyses. For each ICD code, rates of confirmed transgender status ranged from 88% to 100% for those with and without an orchiectomy, with the majority being transgender women (consistent with most veterans being assigned male sex at birth). Most transgender women (66%-100%) were undergoing estrogen gender-affirming therapy. The majority of provider-driven entries of transgender status took place from 2011 to 2020, with 75% of entries made from 2011 to 2020, consistent with increased recognition and societal acceptance of this population. False negatives were detected at a rate of 15%. Based upon these 5 ICD codes alone, we estimate that the VA has records for 9,449 to 10,738 transgender individuals. All 5 codes are very sensitive in identifying transgender patients, and the combination of these codes with orchiectomy is extremely sensitive in identifying transgender women, specifically. Major strengths of the study are the use of universal ICD codes and a large patient sample size that spans health records nationally and across multiple decades, potentially making our data more generalizable. The main limitation of this study is that subanalyses were performed on a limited number of patients, which prevented us from capturing all false positives and thus from calculating specificity for each code. Similarly, our true negatives were derived from a small, random subset of the population; as such, our calculation for specificity is an estimate. This study highlights a novel method to identify transgender women and paves the way for further research.

A literature analysis of scientific research on gender incongruence in Muslim nations

This study aims to chart and review the unexplored transgender research portfolio of Muslim countries using bibliometric method. Data retrieved from the Scopus database were analyzed using CiteSpace, VOSviewer, Biblioshiny, and ScientoPy software. It was found that barring Turkey and Iran, transgender research has been minimal in most Muslim countries. The collective productivity is gradually but surely rising. Around 84% of the publications have been collaborative efforts. The keyword analysis revealed that gender dysphoria, human immunodeficiency virus, LGBT, and vaginoplasty were the most frequently used keywords. The socio-economic circumstances of the transgender community are generally deplorable in most Muslim nations. Overall, there is a dire need for high-quality multifaceted transgender research in the Muslim world to raise general awareness. Resolving disputes on gender dysphoria or sex reassignment surgeries and reinstating the social rights of the transgender community should be the utmost priority of future research in Muslim countries.

Institutional transphobia: barriers to transgender research in early years education

ABSTRACT This paper develops and applies the emergent concept of institutional transphobia to explore the barriers to transgender research in early years education. It argues that institutional processes embed and disguise the logic of transphobia by drawing on dominant, taken-for-granted claims of the inappropriateness or irrelevance of gender-focused education interventions that challenge cis-normativity and heteronormativity. Drawing on the barriers and difficulties experienced through a PhD journey, the paper explores how institutional transphobia was evident in the seemingly neutral reasons for denying site access and ethics approvals, divergent institutional ethics requirements, the tensions between individual support and institutional processes, and the expectations on research higher degree students. The paper concludes that current processes and priorities must be challenged and replaced with an institutional mandate that explicitly values and welcomes transgender research as a priority.

Visualizing patterns and gaps in transgender sexual and reproductive health: A bibliometric and content analysis of literature (1990–2020)

Background Transgender people face numerous obstacles to accessing adequate, affordable, and appropriate sexual and reproductive health (SRH) services as outlined by the UN’s Sustainable Development Goal 3.7 target of achieving universal access to SRH services by 2030. However, transgender SRH sits as a poorly researched area within public health that makes it difficult to understand the current dilemmas facing transgender SRH. This article reports the findings of a study aimed at taking stock of global research in transgender SRH. Methods A bibliometric analysis, used to gain insights from the retrieved literature’s metadata, alongside a content analysis were utilized to examine the growth, impact, and content of retrieved articles. Results Nine hundred fourteen journal articles were retrieved, predominately in English (884; 96.7%). These involved 3653 authors from 46 affiliated countries. Most frequent keywords included HIV, PrEP, and gender identity; corresponding to the SRH issues studied, namely HIV/AIDs and gender reassignment. Top cited and overall articles originated heavily from US affiliated authors. Content analysis outlined the articles’ inclusion of the transgender community to largely have a mixed focus with cisgender people in research, these articles largely disease-focused and conducted within cities in the United States. Conclusions Growth in transgender SRH research was minimal until the early-2010s, after which a steep rise can be observed. Research retrieved has a disproportionate clinical and biomedical focus around HIV and related STI issues suggesting a failure to engage with reproductive justice and more comprehensive rights-based understanding of SRH. The sustained use of derogative language suggests a need for greater inclusion and awareness of trans identities within research and publishing. The dominance of the United States in authorship and as a site of research establishes the need for more geographically diverse research, trans, and LMIC-led research enquiry and creating greater opportunities for cross-cultural, comparative, and collaborative scholarly work.

Nothing about us, without us: Are we asking the right questions in transgender research?

Nothing about us, without us: Are we asking the right questions in transgender research?

"Single center experience of laparoscopic hysteroannessiectomy and histopathological outcomes in transgender men".

This article presents a retrospective descriptive analysis about female-to-male (FtM) gender-affirmation nongenital surgical procedures involving the gynecological team at the CIDIGeM (Centro Interdipartimentale Disturbi di Identità di Genere Molinette) Center in Turin. From 2004 to 2019, seventy FtM transsexual patients underwent hysteroannessiectomy: the chosen surgical technique involved a Total Laparoscopic Hysterectomy. The patients presented a median age of 30.5 years (range 21-53). No patients presented intraoperative complications, the median of surgery time was 80 min (range 40-150) and the hospital stay median was 5 days (range: 2-25). Histopathological examinations were negative for cancer in all patients except for one unknown case of grade 3 cervical intraepithelial neoplasia. Total Laparoscopic Hysterectomy is confirmed to be the method of choice in the group of FtM transsexuals: this approach has several advantages over abdominal hysterectomy, including more rapid recovery, fewer wound or abdominal wall infections; moreover, it has enabled us to preserve the vital structures needed for reconstruction of external genitalia. Cancer risk is still considered an area of priority in transgender research; thus, we underline the importance of performing a histopathological examination of the surgical specimen.

Oral Sex Knowledge and Experience of Transgender Youth: An Opportunity for Dental Education.

Recent evidence suggests that, when compared to their cisgender counterparts, transgender youth exhibit more unsafe sexual behavior that may elevate their risk for sexually transmitted infections. The aim of this study was to better understand what transgender youth know about oral sex, related consequences, and mechanisms of protection and where they obtained this information. The findings can be helpful in preparing oral health providers to play a role in meeting this public health need. The study took place at a U.S. academic pediatric medical center in 2017. Participants were recruited at a Transgender Research Day and during Transgender Clinic sessions. English-speaking transgender adolescents ages 14 to 24 were invited to participate in a previously validated survey about their knowledge and behaviors related to oral sex. Of the 138 transgender youth invited to participate, 57 completed the surveys, for a 41% response rate. Most respondents reported feeling they understood the necessity of protection and consequences of oral sex but did not use protection. Over half of the participants (58%) said they had not had a physician, dentist, or parent speak to them about oral sex. Given the lack of standardized, evidence-based sex education, it is imperative that adolescents, particularly in highly vulnerable populations like transgender youth, receive accurate information about oral sexual contact. Dental schools should prepare future practitioners to address these issues with youth using a culturally competent, evidence-based approach.

Motivation for Parenthood among LGBTIQ People in Croatia: Reasons for (not) Becoming a Parent

Parenting desires, intentions, and the underlying motivation for parenthood are well documented in the context of heterosexual couple parenthood, while among lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) people research is limited. The main goal of this study was to explore parenting desire and different reasons to become a parent or remain childfree among LGBTIQ people in Croatia. 486 childless LGBTIQ people participated in an on-line survey. In the quantitative part of the study, parenting desire and reasons for and against parenthood were measured, while the qualitative part analysed the answers to open-ended questions about additional reasons that influence the desire to want or not to want children. The results showed that 46% of the participants want to become parents, 35% did not know, and 19% reported they do not want to have children. The main reasons for parenthood among the participants who want children were internal – the desire to give love, share knowledge, and develop a special bond with a child. The participants who do not want to have children also stressed internal reasons against parenthood, such as restricted personal freedom, high responsibility, and the amount of workload they perceive as a part of parenthood. Several additional reasons for and against parenthood emerged from the qualitative data. Some reasons reflected universal issues unrelated to sexual orientation or gender identity, while others conveyed concerns related to social and legal barriers that LGBTIQ people face when it comes to parenthood.

What is "Nonbinary" and What Do I Need to Know? A Primer for Surgeons Providing Chest Surgery for Transgender Patients.

Most transgender research focuses on patients who identify within the gender binary of either trans-male or trans-female. This largely omits understanding of the "nonbinary" gender identity as it pertains to surgical care. We sought to describe a single-institution experience of chest-affirming procedures performed in nonbinary patients, including patient characteristics, surgical techniques, practice pearls, and outcomes. This was an observational study of nonbinary patients who underwent "chest-affirming surgery" from 2012 to 2017. Demographic and surgical data were collected. A postoperative questionnaire assessing quality of life and body image outcomes was administered. A total of 458 patients with gender dysphoria underwent chest surgery; 58 (13%) patients were nonbinary. All nonbinary patients indicated female sex was assigned at their birth (100%). The most commonly performed procedure was the double incision technique with nipple grafts (72%), followed by the double incision technique without nipple grafts (19%). On a Likert scale, patients reported improved quality of life (4.88, SD ± 0.34), comfort with exercise (4.07, SD ± 0.98), sex life (4.02, SD ± 0.92), and comfort with physical appearance with (4.97, SD ± 0.18) and without clothes (4.69, SD ± 0.47). Chest surgery for nonbinary patients comprises a considerable proportion of transgender surgery practice, and surgeons who provide affirming care should be familiar with the unique characteristics and treatment options for this population.

Open Availability of Patient Medical Photographs in Google Images Search Results: Cross-Sectional Study of Transgender Research.

BackgroundThis paper focuses on the collision of three factors: a growing emphasis on sharing research through open access publication, an increasing awareness of big data and its potential uses, and an engaged public interested in the privacy and confidentiality of their personal health information. One conceptual space where this collision is brought into sharp relief is with the open availability of patient medical photographs from peer-reviewed journal articles in the search results of online image databases such as Google Images.ObjectiveThe aim of this study was to assess the availability of patient medical photographs from published journal articles in Google Images search results and the factors impacting this availability.MethodsWe conducted a cross-sectional study using data from an evidence map of research with transgender, gender non-binary, and other gender diverse (trans) participants. For the original evidence map, a comprehensive search of 15 academic databases was developed in collaboration with a health sciences librarian. Initial search results produced 25,230 references after duplicates were removed. Eligibility criteria were established to include empirical research of any design that included trans participants or their personal information and that was published in English in peer-reviewed journals. We identified all articles published between 2008 and 2015 with medical photographs of trans participants. For each reference, images were individually numbered in order to track the total number of medical photographs. We used odds ratios (OR) to assess the association between availability of the clinical photograph on Google Images and the following factors: whether the article was openly available online (open access, Researchgate.net, or Academia.edu), whether the article included genital images, if the photographs were published in color, and whether the photographs were located on the journal article landing page.ResultsWe identified 94 articles with medical photographs of trans participants, including a total of 605 photographs. Of the 94 publications, 35 (37%) included at least one medical photograph that was found on Google Images. The ability to locate the article freely online contributes to the availability of at least one image from the article on Google Images (OR 2.99, 95% CI 1.20-7.45).ConclusionsThis is the first study to document the existence of medical photographs from peer-reviewed journals appearing in Google Images search results. Almost all of the images we searched for included sensitive photographs of patient genitals, chests, or breasts. Given that it is unlikely that patients consented to sharing their personal health information in these ways, this constitutes a risk to patient privacy. Based on the impact of current practices, revisions to informed consent policies and guidelines are required.

Brain activity elicited by viewing pictures of the own virtually amputated body predicts xenomelia

BackgroundXenomelia is a rare condition characterized by the persistent desire for the amputation of physically healthy limbs. Prior studies highlighted the importance of superior and inferior parietal lobuli (SPL/IPL) and other sensorimotor regions as key brain structures associated with xenomelia. We expected activity differences in these areas in response to pictures showing the desired body state, i.e. that of an amputee in xenomelia. MethodsFunctional magnetic resonance images were acquired in 12 xenomelia individuals and 11 controls while they viewed pictures of their own real and virtually amputated body. Pictures were rated on several dimensions. Multivariate statistics using machine learning was performed on imaging data. ResultsBrain activity when viewing pictures of one's own virtually amputated body predicted group membership accurately with a balanced accuracy of 82.58% (p = 0.002), sensitivity of 83.33% (p = 0.018), specificity of 81.82% (p = 0.015) and an area under the ROC curve of 0.77. Among the highest predictive brain regions were bilateral SPL, IPL, and caudate nucleus, other limb representing areas, but also occipital regions. Pleasantness and attractiveness ratings were higher for amputated bodies in xenomelia. ConclusionsFindings show that neuronal processing in response to pictures of one's own desired body state is different in xenomelia compared with controls and might represent a neuronal substrate of the xenomelia complaints that become behaviourally relevant, at least when rating the pleasantness and attractiveness of one's own body. Our findings converge with structural peculiarities reported in xenomelia and partially overlap in task and results with that of anorexia and transgender research.

Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective.

Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals.

Promoting resilience and emotional well-being of transgender young people: research at the intersections of gender and sexuality

ABSTRACTWithin lesbian, gay, bisexual and transgender (LGBT) research there is increasing health-related scholarship on trans lives, with a growing awareness of the impact of health inequalities on trans well-being. The aim of the paper is to provide greater understanding of transgender young people’s views of what is needed to promote their emotional well-being and resilience by undertaking specific analysis of data collected as part of wider research with young people (n = 97). The study utilised participatory qualitative methods with a cross sectional design generating data via a focus group with trans youth (n = 5), followed by thematic analysis. Findings suggest that both individual and collective capacities or resources enable and sustain resilience and well-being for trans young people. The adversity trans youth face is present in school, the community and in healthcare, but they are able to find places where they feel safe and connected to others. Practitioners, teachers and school nurses are well positioned to facilitate structural change in alliance with trans youth to promote resilience. Research results were utilised to inform health improvement, commissioning and service delivery.

Transgender sexual health in China: a cross-sectional online survey in China

ObjectiveTransgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men...

Archives Behaving Badly

The archive has been theorized as unstable and even fever-ridden, but what might it mean to deploy it in ways that counter its logic or to activate it in ways that we might call queer? Using the example of Leah DeVun's photographic exploration of the ONE National Gay and Lesbian Archives (the world's largest lesbian, gay, bisexual, and transgender research collection), this essay traces the manners in which an archive, as a repository of information, might always shore up certain histories while delimiting others. In contrast, the authors imagine using the archive badly—that is, not as a historian would but through interpolation and anachronism, focusing on the archive's feel and “mere” form. Rather than reconstruct the ways that archival materials inhabit a discrete historical period, this essay explores what it means to focus on the human agents that pull archival objects from circulation, as well as how such objects might circulate again. Ultimately, the authors consider an archive as an accretive space that continues to build up, and as a history in which we might live, rather than as a document of an already finished time.

The Rights and Responsibilities of Gay Social Parents and the Potential Implications for Children's Well-Being

As more gay couples become parents, there is a greater likelihood that some of these parents will face unique legal consequences if their relationships dissolve. In these cases, judges must determine whether social parents possess legal parental rights and responsibilities. A mixed-methods approach was adopted to assess judges’ rulings and justifications in 43 parental status cases involving gay disputants. The results verified a typology of five overarching legal themes, or rationales, that judges relied on in their decisions. The data also reveal that nearly half of the rulings in the sample were against conferring parental rights or responsibilities to social parents. These trends in judicial rulings call attention to potential adverse consequences for children's well-being, as prior research has linked disruptions in parent-child relationships to negative psychosocial outcomes. Implications for gay, lesbian, bisexual, and transgender (GLBT) research, policy, and the family legal system are discussed.

Transgender Health: A Review and Guidance for Future Research—Proceedings from the Summer Institute at the Center for Research on Health and Sexual Orientation, University of Pittsburgh

ABSTRACT This article reports on the outcome of the Summer Institute on Transgender Health Research held July 24–26, 2008, at the University of Pittsburgh, Pennsylvania. The institute attendees included a panel of experts in the field of transgender research. The goals of the institute were to provide an opportunity to learn more about transgender health research, to foster a dialogue among experts on transgender health issues, and to come to a consensus on what is needed to move the field forward. The scope of existing research on the transgender population is limited. While more research is needed on the known health problems of HIV/AIDS, substance use, and mental health, there is also a need to focus on other health issues, such as cardiovascular health, that are important to trans/gender-variant people. Participants identified a need to examine how societal discrimination can create a syndemic process that will affect multiple health disparities.