Population Of Transgender Women Research Articles

A Contextualization of Transgender Women and Condom Use Using the HIV Syndemic Framework: Scoping Review

Objective: To contextualize condom use in the transgender women population utilizing the HIV syndemic framework. Methods: Studies reporting condom use frequency and syndemic factors associated with HIV risk in transgender women were systematically searched. We followed the Scoping Reviews (PRISMA-ScR) checklist. Results: Social factors have a proven relationship with using condoms and HIV among transgender women. Syndemic factors, defined as co-occurring adverse factors that interact to contribute to risk behaviors, deserve a specific analysis to develop strategies to face HIV among transgender women. Conclusions: A syndemic perspective allows to generate specific health intervention and prevention policies to protect transgender women.

Uso de múltiplas substâncias e fatores associados em mulheres trans e travestis: resultados do estudo TransOdara, Brasil

ABSTRACT Objective To estimate the prevalence of concomitant substance consumption and analyze associated risk factors in a non-probabilistic sample of the Brazilian population of transgender women and travestis. Methods A cross-sectional study was conducted with recruitment via respondent-driven sampling. The sample included transgender women and travestis residing in São Paulo, Porto Alegre, Salvador, Manaus, and Campo Grande, aged 18 years or older, between 2019 and 2021. The outcome was the concomitant use of licit and illicit substances. The association between sociodemographic/behavioral factors and the outcome was analyzed through Poisson regression with mixed effects. Adjusted prevalence ratios (confidence interval of 95% — 95%CI) were estimated. Results The prevalence in the last 12 months of multiple substance use was 49.3%, of which 65.5% were alcohol, 52.9% tobacco, and 40.1% marijuana. Transgender women and travestis who use multiple substances face more violence (1.71; 95%CI 1.14–2.55), unemployment (1.58; 95%CI 1.05–2.37) and pervasive unstable work status (1.52; 95%CI 1.08–2.14), transactional sex (1.51; 95%CI 1.21–1.88) which can be their sole option to make a living, and are aged 18 to 24 years (1.37; 95%CI 1.14–1.65). Conclusion The use of multiple substances may be an attempt to cope with distress and marginalization. Substance use has been associated with multiple harms and medical conditions. Comprehensive management and care should be provided, as defined by the key principles of the Brazilian Unified Health System. Health care should be integrated into structural interventions.

Estimate the population size of transgender women based on the capture-recapture method in Tianjin

Objective: To investigate the population size of transgender women (TGW) in Tianjin and analyze the characteristics of their sexual behaviors to provide a basis for AIDS prevention and control. Methods: To estimate the population size of TGW in Tianjin using the capture-recapture method. At the same time, an anonymous questionnaire was collected to conduct a multi-factor logistic analysis of the TGW population's sexual behavior. Results: A total of 213 TGW were investigated. Tianjin's estimated TGW population size was 599 (95%CI: 407-792). Multivariate logistic analysis of the use of condoms consistently showed that compared with TGW without regular sex partners, those with regular sex partners had a lower proportion of consistent condom use (aOR=0.44, 95%CI: 0.23-0.82) and had received HIV tests in the last year were more likely to adhere to condom use than those who had not been tested (aOR=2.73, 95%CI: 1.06-6.99). Conclusion: It is necessary to strengthen HIV mobilization testing among the TGW population and their regular sexual partners to improve condom use.

Strategies to increase HIV testing among men who have sex with men and transgender women: an integrative review

BackgroundMen who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV, with much higher incidence and prevalence rates than in the general population in different countries. There are several barriers to testing among MSM and TGW, such as low risk perception, anticipation of HIV-related stigma, discrimination of sexual orientation, in addition to difficulties related to care and access to health services. Therefore, analyzing the available evidence of the effectiveness of strategies for scaling up HIV testing among key populations is essential to point out potential knowledge gaps which may need to be addressed and develop public health policies to promote testing and early diagnosis of HIV infection.MethodsAn integrative review was carried out to evaluate strategies for scaling up HIV testing in these populations. Search strategy was performed on eight electronic databases, without language restriction. We included clinical trials, quasi-experimental studies, and non-randomized studies. Study selection and data extraction were both performed independently by pairs and disagreements were solved by a third revisor. The screening of the studies was carried out through the selection of titles/abstracts and the reading of the full texts of the pre-selected studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data extraction was performed using a structured form.ResultsThirty-seven publications referring to 35 studies were included, mostly being carried out in the United States of America and Australia. No studies were found evaluating disaggregated data on TGW. The studies were grouped into four types of intervention strategies: self-test distribution system (n = 10), organization of health services (n = 9), peer education (n = 6), and social marketing campaign (n = 10). Strategies that focused on the first three groups, combined or not, were more effective in increasing HIV testing among MSM.ConclusionsConsidering the diversity of interventions and the methodological heterogeneity of the included studies, strategies especially involving self-test distribution systems, associated with new information and communication technologies, should be evaluated in different communities and social contexts. Research evaluating specific studies on TGW population is still needed.

PD20-04 TRENDS IN PROSTATE CANCER DIAGNOSIS IN TRANSGENDER WOMEN: A NATIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023PD20-04 TRENDS IN PROSTATE CANCER DIAGNOSIS IN TRANSGENDER WOMEN: A NATIONAL STUDY Farnoosh Nik-Ahd, Amanda De Hoedt, Christi Butler, Jennifer T. Anger, Peter R. Carroll, Matthew R. Cooperberg, and Stephen J. Freedland Farnoosh Nik-AhdFarnoosh Nik-Ahd More articles by this author , Amanda De HoedtAmanda De Hoedt More articles by this author , Christi ButlerChristi Butler More articles by this author , Jennifer T. AngerJennifer T. Anger More articles by this author , Peter R. CarrollPeter R. Carroll More articles by this author , Matthew R. CooperbergMatthew R. Cooperberg More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about prostate cancer (CaP) screening and diagnosis in transgender women (TW). To date, only 10 case reports have been published on CaP in this population. In this study, we sought to understand the clinical characteristics and CaP screening history at prostate cancer diagnosis among TW. METHODS: This is a retrospective study of all patients ages 18 and older across the entire Veterans Affairs Health System (VAHS) in the United States from January 2000-February 2022 with both an ICD code for CaP and at least one ICD code related to transgender identity. Detailed chart review was performed to stratify patients by gender-affirming hormone usage. Data abstracted included PSA at diagnosis, consistency of PSA screening, clinical stage, bilateral orchiectomy status, biopsy grade group, and primary treatment modality. Consistent PSA screening was defined as screening at least every 2 years between ages 55-69, as per American Urological Association screening guidelines. RESULTS: After detailed chart review, 133 TW with CaP were identified. After stratification by use of estrogen for gender-affirming hormone therapy, 99 had no prior estrogen use, 15 were formerly on estrogen but had stopped prior to diagnosis, and 19 were actively on estrogen at diagnosis. Only 25-33% of TW were undergoing consistent guideline-based PSA screening regardless of estrogen usage. Median duration of estrogen use was 44 months and 11 months, respectively, for those formerly on estrogen and those actively on estrogen at diagnosis. Among all patients, PSA, PSA density, and grade group were highest among those on estrogen at diagnosis followed by those formerly on estrogen. CONCLUSIONS: This is the largest study of CaP in TW to date. Nonetheless, our study population of 133 CaP patients was much lower than expected given the estimated TW population within the VAHS. The degree to which this represents the effects of estrogen therapy on CaP diagnosis and/or dramatic underdiagnosis due to limited guideline-based PSA screening even among those with CaP requires further study. Future work should aim to understand the incidence and long-term outcomes of CaP in this population and establish guidelines for CaP screening for those on gender-affirming hormone therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e584 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farnoosh Nik-Ahd More articles by this author Amanda De Hoedt More articles by this author Christi Butler More articles by this author Jennifer T. Anger More articles by this author Peter R. Carroll More articles by this author Matthew R. Cooperberg More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

Implementation of unassisted and community-based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A demonstration study in Metro Manila, Philippines.

The study aimed to demonstrate the feasibility of an unassisted and community-based HIV self-testing (HIVST) distribution model and to evaluate its acceptability among men-having-sex-with-men (MSM) and transgender women (TGW). Our demonstration study focused on implementing the HIVST distribution model in Metro Manila, Philippines. Convenience sampling was done with the following inclusion criteria: MSM or TGW, at least 18 years old, and had no previous HIV diagnosis. Individuals taking HIV pre-exposure prophylaxis, on antiretroviral therapy, or female sex at birth were excluded. The implementation of the study was done online using a virtual assistant and a delivery system via courier due to COVID-19-related lockdowns. Feasibility was measured by the number of HIVST kits successfully delivered and utilized and the HIV point prevalence. Moreover, acceptability was evaluated by a 10-item system usability scale (SUS). HIV prevalence was estimated with linkage to care prioritized for reactive participants. Out of 1,690 kits distributed, only 953 (56.4%) participants reported their results. Overall, HIV point prevalence was 9.8%, with 56 (60.2%) reactive participants linked to further testing. Furthermore, 261 (27.4%) of respondents self-reported, and 35 (13.4%) of the reactive participants were first-time testers. The HIVST service had an overall median and interquartile range (IQR) SUS score of 82.5 (IQR: 75.0, 90.0), rendering the HIVST kits very acceptable. Our study suggests the acceptability and feasibility of HIVST among the MSM and TGW in Metro Manila, Philippines, regardless of their age or HIV testing experience. In addition, other platforms of information dissemination and service delivery of HIVST should be explored, including access to online instructional videos and printed materials, which may facilitate easier use and interpretation of results. Furthermore, due to our study's limited number of TGW respondents, a more targeted implementation strategy to reach the TGW population is warranted to increase their access and uptake of HIVST.

Anti-Androgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial

Spironolactone and cyproterone acetate are commonly used in feminizing hormone therapy to achieve the goal of female range testosterone level; however, the data on the efficacy comparing between these two anti-androgens are scarce. To compare the anti-androgenic effects between spironolactone and cyproterone acetate as the component of feminizing hormone therapy among transgender women population. The study was single-blinded randomized controlled trial involved 52 transgender women from two transgender health clinics. Each participant received oral estradiol valerate 4 mg/day combined with anti-androgen, spironolactone 100 mg/day or cyproterone acetate 25 mg/day, depending on which group they were randomized to. Clinical and biochemical variables were obtained at baseline and at 12 weeks of feminizing hormone therapy. The change of testosterone level from baseline. Other changes including free testosterone, estradiol, prolactin and lipid profile after the therapy. After a 12 weeks of feminizing hormone therapy, the change of testosterone level in the cyproterone acetate group [558.0 ng/dL (IQR 352.0 to 783.3)] was significantly higher than the spironolactone group [226.2 ng/dL (IQR,-4.3 to 480.1)](p value <0.001). Testosterone and calculated free testosterone in the cyproterone acetate group were significantly lower than the spironolactone group. Consequently, a proportion of the participants who achieved the female range testosterone (<50 ng/dL) was significantly higher in cyproterone acetate group (90%) compared to the spironolactone group (19%). Serious adverse effects observed in cyproterone acetate users were drug-induced liver injury and asymptomatic hyperprolactinemia. The data on the differences between the two anti-androgen could be benefit for the transgender health-care providers in medication selection and adverse-effects counseling. The study design was randomized controlled trial and controlled the estrogen component by prescribed the same type and dose for each participant. However, the study was suffered from the confound feminizing effects from previous hormone therapy and the high drop-out rate. For feminizing hormone therapy, cyproterone acetate had a higher testosterone suppression efficacy than spironolactone. Burinkul S, Panyakhamlerd K, Suwan A, et al. Anti-Andorgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial. J Sex Med 2021;18:1299-1307.

Characterisation of testicular function and spermatogenesis in transgender women.

Does gender-affirming treatment prevent full spermatogenesis in transgender women (TW)? Adequate hormonal therapy (HT) leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained. Gender-affirming treatment in transgender individuals may involve gender-affirming HT. The effects on spermatogenesis in TW remain unclear. In order to add information from a referral centre for transgender care, we wish to compare results of earlier studies with our population of TW who received a standard hormone treatment. This was a prospective cohort study part of the European Network for the Investigation of Gender Incongruence (ENIGI), conducted between 15 February 2010 and 30 September 2015. There were 162 TW were included in the ENIGI study at the Ghent University Hospital in Belgium. Participants are included in ENIGI when they first start HT, and follow-up visits occur over the next 3 years. The study included 97 TW who initiated HT with cyproterone acetate (CPA) plus oestrogens and proceeded with gonadectomy at the Ghent University Hospital. Testicular tissue retrieved during gonadectomy was processed and stained for four different germ cell markers by the Biology of the Testis lab at the Vrije Universiteit Brussel. Subsequent immunohistochemical staining was performed for melanoma-associated antigen A4 (MAGE-A4, marker for spermatogonia and early spermatocytes), boule homologue, RNA-binding protein (BOLL, marker for secondary spermatocytes and round spermatids), cAMP-responsive element modulator (CREM, marker for round spermatids) and acrosin (marker for acrosome visualization). Serum levels of sex steroids were measured prior to surgery. Suppressed testosterone levels (<50 ng/dl) were found in 92% of the participants prior to surgery. The mean time between initiation of HT and surgery was 685 days. In 88% (85/97) of the sections, MAGE-A4 staining was positive. Further staining could not reveal complete spermatogenesis in any participant. Testicular function of the participants prior to initiation of HT was not assessed, although all participants presented with cisgender male serum testosterone values before initiation of HT. The current study only reports on people using CPA at a fixed dose and may therefore not be applicable to all TW. HT leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained. Serum testosterone levels are associated with the sperm maturation rate. It is important to discuss sperm preservation before the start of hormone therapy. If serum testosterone levels remain higher, spermatogenesis may still occur. D.V.S. is a post-doctoral fellow of the Fonds Wetenschappelijk Onderzoek (FWO; 12M2819N). Processing of the testis specimens was funded by the Biology of The Testes (BITE) research group (Department of Reproduction, Genetics and Regenerative medicine at Vrije Universiteit Brussel (VUB)). There are no competing interests. N/A.

Fracture risk assessment in an Italian group of transgender women after gender-confirming surgery.

Bone health is a critical issue in transgender women (TW) health care. Conflicting results have been reported on bone status after gender-confirming surgery (GCS). No recent data in Italian TW are available. The aim of this cross-sectional study was to evaluate fracture risk, lumbar spine BMD and 25OH vitamin D (25OHD) levels in a population of TW on estrogen replacement therapy (ERT) after GCS. We retrospectively analyzed a group of 57 TW, aged 45.3 ± 11.3years, referred to our Gender Dysphoria Clinic, at least 2years after GCS. Anthropometric parameters, patient compliance to ERT, biochemical and hormonal assessment, lumbar spine BMD and fracture risk were evaluated. Prevalence of low bone mass (Z-score ≤ -2) was 40% according to the natal gender. In this group, 17β-estradiol levels were significantly lower (median 21pg/ml [25th-75th percentile 10.6-48.5] vs 63pg/ml [38.5-99.5]; p < 0.001) and a higher prevalence of low compliance to ERT was recorded (83% vs 29%; p < 0.0001) compared to those with higher bone mass. An intermediate-high fracture risk was found in 14% of the sample. A high percentage (93%) of hypovitaminosis D was present. TW on ERT have a high prevalence of low bone mass, significantly associated with low estradiol levels and low compliance to ERT. A high prevalence of hypovitaminosis D was highlighted. Considering that one out of seven TW showed an intermediate-high 10-year fracture risk, such risk assessment may be considered to prevent and manage osteoporosis in this clinical setting.

HIV Prevalence and Factors Related to HIV Infection Among Transgender Women in Vietnam: A Respondent Driven Sampling Approach.

Transgender women are at higher risk of HIV infection, however, there is a lack of information about HIV infection and related factors among transgender women in Vietnam. From February 2018 to June 2018, 456 transgender women were recruited in the study using Respondent-Driven Sampling technique. Participants completed the computer-based questionnaire and were tested for HIV serostatus. Multivariable logistic regression was used to identify factors related to HIV infection. The prevalence of HIV infection was 77 (16.5%), of which 19 (24.7%) were not aware of their HIV-positive status prior to the study. Factors associated with HIV infection included popper use (aOR 2.01, p = 0.044) and having regular male partner(s) (aOR 0.42, p = 0.006). More efforts are needed to reduce the high prevalence of HIV infection, such as expanding the reach of HIV screening and prevention programs to the transgender women population, particularly for substance users.Electronic supplementary materialThe online version of this article (10.1007/s10461-020-02867-5) contains supplementary material, which is available to authorized users.

Estimating the population size of transgender women in San Francisco using multiple methods, 2013

ABSTRACTPurpose: To estimate the number of adult transgender women (TGW) in San Francisco and to provide an example of how estimation can be conducted.Methods: Using nine different services accessed by the TGW population, the service multiplier, integrated into a respondent-driven sampling (RDS) survey of TGW, was used to calculate nine estimates of the TGW population in San Francisco. Both the successive sampling method, also integrated into the RDS survey of TGW, and a population proportion from the literature each calculated an additional estimate of the TGW population. The median of all 11 estimates was calculated to present a single estimate of the TGW population in San Francisco.Results: The median of estimates was 978 TGW in San Francisco (plausibility bounds 635 – 1,400). This estimate is consistent with known cases of HIV among TGW and surveys on the prevalence of infection in the TGW population.Conclusion: Using multiple methods, we estimate the TGW population size to be 0.13% of the San Francisco population. Despite small numbers, TGW bear a disproportionate burden of HIV infection in San Francisco. TGW are a priority for HIV care and prevention services.

HIV Risk Perception, HIV Knowledge, and Sexual Risk Behaviors among Transgender Women in South Florida.

Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk.

Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol

IntroductionOne of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate. AimTo estimate the incidence of VTE from the standard feminizing CSHTs used in the United States. MethodsA retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed. Main Outcome MeasureThe primary outcomes of interest were deep vein thrombosis or pulmonary emboli. ResultsFrom January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years. ConclusionThere was a low incidence of VTE in this population of transgender women receiving oral estradiol.

Construction and Validation of a Subjective Scale of Stigma and Discrimination (SISD) for the Gay Men and Transgender Women Population in Chile

Recent studies in Chile provide encouraging data on the attitude of the Chilean society toward sexual minorities, although other studies reveal that new ways to express stigma and discrimination toward sexual minorities have emerged. The objective of this study was the construction and validation of a measure to describe and characterize stigma and discrimination toward the gay men and transgender women population in Chile. Two studies were conducted. In study 1, the initial version of a scale, consisting of 147 items, was constructed in a process involving three phases: (a) a theoretical phase, (b) a qualitative phase, and (c) a phase using the original version of our scale. This original version was administered to a non-probabilistic snowball-type sample of 100 gay men (pilot study). After several analyses, the items were selected for the abbreviated version of the scale (SISD). Thus, the scale finally contained 23 items in six dimensions. In study 2, the SISD was administered to a type of RDS for gay men and a non-probabilistic snowball-type sample for transgender women. This study included 437 subjects aged 18–75 years (M = 32.22, SD = 10.22), 325 gay men (74.4 %), and 112 transgender women (25.6 %). The reliability coefficient was 0.89 for the SISD. In addition, there were statistically significant differences in the SISD scores between gay men and transgender women (t (435) = −2.48, p < 0.05, d = 0.26). Moreover, statistically significant differences were found between gay men and transgender women in three dimensions of the scale: disadvantages in the presence of authorities (t (435) = −2.83, p < 0.005, d = 0.31); discrimination at work (t (435) = −3.78, p < 0.005, d = 0.40); and institutional exclusion (t (434) = −4.25, p < 0.001, d = 0.46). A high percentage of individuals from each group reported victimization and discrimination events due to their condition as gay men and transgender women. Therefore, the SISD is a reliable and valid instrument to measure stigma and discrimination toward the gay men and transgender women population in Chile.