Transgender Women Research Articles

Occupational Preferences, Childhood Behavior, and Openness: The Role of Sex, Sexual Orientation, and Gender Identity in Iran.

Previous research suggests that both same-sex attraction and the personality trait "openness" are associated with sex-atypical preferences and behaviors. Here, we examined the links between adulthood occupational preferences, childhood play behavior, and openness among Iranian cisgender gynephilic males (n = 228), cisgender ambiphilic males (n = 48), cisgender androphilic males (n = 178), transgender androphilic males (n = 58), cisgender androphilic females (n = 226), cisgender ambiphilic females (n = 94), cisgender gynephilic females (n = 31), and transgender gynephilic females (n = 121) from Iran. Cisgender and transgender same-sex attracted males and females exhibited sex-atypical occupational preferences with the latter group showing even more sex-atypicality than the former. The personality trait openness did not differ between cisgender groups. Transgender androphilic males had a significantly higher mean score for openness compared to cisgender androphilic females and transgender gynephilic females, whereas transgender gynephilic females had a significantly lower mean score compared to cisgender androphilic males. In both males and females, childhood sex-atypicality, same-sex attraction, and openness were associated with sex-atypical occupational preferences. Our findings from Iran provides cross-cultural support for interconnectedness of childhood and adulthood sex-atypicality, openness, and same-sex attraction in males and females who are cisgender and transgender.

Anorectal sexual function index: Development and validation of a health-related quality of life measure.

To assess the reliability and validity of measuring receptive anal intercourse (RAI) sensation and associated satisfaction and bother METHODS: Between July 2022 and January 2023, we conducted a survey on sensations during RAI among people with prostates (i.e. cisgender men and transgender women). The survey content was developed based on our previous qualitative study. We assessed internal reliability and consistency through time. Sensations experienced during RAI were correlated with health-related quality of life (HRQOL) measures to ensure construct validity. The final index contained four scales: pleasure (four items), pain (seven items), urinary (four items), and bowel (four items). Overall, 1084 individuals filled out the questionnaire. The internal consistency for all subscales was at or above 0.79. Scores tended to be stable across time with all test-retest coefficients at or above 0.72. Pleasure scores were inversely correlated with pain scores (r=-0.46). Pleasure was positively correlated with erections (r=0.36) and orgasms (r=0.44) during RAI, and sexual satisfaction (r=0.39). Notable positive correlations for pain scores were with bowel scores (r=0.49), internalized homophobia (r=0.35), and prostatitis symptoms (r=0.37). Urinary scores were moderately associated with IPSS scores (r=0.22). Bowel scores were positively correlated with GI symptoms (r=0.24), mental health symptoms (r=0.28), and chronic prostatitis symptoms (r=0.29). The results of the current study provide evidence that the ASFI is both reliable and valid. The ASFI may be a particularly useful HRQOL measure to assess outcomes regarding a host of urologic issues that may affect RAI.

Social Network Characteristics Associated with More Frequent HIV and STI Prevention Conversations: The N2 Cohort Study in Chicago.

Black cisgender sexually minoritized men (SMM) and transgender women (TW) are subgroups at highest risk of HIV and sexually transmitted infections (STIs) in the US. We sought to identify factors facilitating continued conversations - social reinforcement - surrounding HIV/STI prevention among this subgroup. Participants were recruited in Chicago from 2018 to 2019 from community health spaces. Participants provided information about themselves (level 2) and ⩽5 confidants (level 1). We used multinomial multilevel modeling to identify associations with HIV/STI prevention conversation frequency. A total of 370 participants provided information on 987 confidants (mean = 2.6). We found significantly positive associations between having biweekly or more often HIV/STI prevention conversations and a confidant being a kin family member, older by 15 years or more, racially homophilous, and emotionally close. Future interventions should harness social networks by including components that consider racial homophily, respect for elders, and strong ties, in addition to applying kin family systems interventions approaches and decreasing stigma surrounding HIV/STIs.

Association of Recalled Childhood Sex-Typed Behavior with Sexual Orientation and Gender Identity in Iranian Adult Males and Females

ABSTRACT Same-sex sexual attraction in both males and females has been associated with childhood sex-atypical behavior. Gynephilic females recall behaving in a manner that is less female-typical and more male-typical compared to cisgender androphilic females, whereas androphilic males recall behaving in a manner that is less male-typical and more female-typical compared to cisgender gynephilic males. In addition, male and female ambiphilic individuals exhibit intermediate levels of childhood sex-atypicality. In this study, we examined recalled childhood sex-typed behavior among Iranian cisgender gynephilic males (n = 236), cisgender ambiphilic males (n = 51), cisgender androphilic males (n = 191), transgender androphilic males (n = 60), cisgender androphilic females (n = 243), cisgender ambiphilic females (n = 96), cisgender gynephilic females (n = 32), and transgender gynephilic females (n = 122). Both cisgender androphilic males and cisgender gynephilic females recalled elevated childhood sex-atypicality, scoring intermediate between cisgender gynephilic males and cisgender androphilic females. Male and female ambiphilic participants scored intermediate between their other- and same-sex attracted cisgender counterparts. Transgender androphilic males exhibited hyper-feminized childhood behavior, scoring even more female-typical than cisgender androphilic females. Transgender gynephilic females recalled behaving as male-typical as cisgender gynephilic males. Consistent with previous research, our findings from Iran – a non-Western, Middle Eastern culture – provide cross-cultural support for the universality of childhood sex-atypicality as a normative developmental precursor of monosexual or ambisexual same-sex attraction in both males and females who are cisgender and transgender.

Abstract PO1-10-02: Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience

Abstract Background: Estrogen exposure is a known risk factor for the development of breast cancer in women. Less clear is the risk posed by gender affirming hormone therapy (GAHT) in both transgender men and transgender women. We aimed to characterize the breast cancers that have arisen in our institution’s transgender patient population including biomarker profile, method of diagnosis, and stage at diagnosis. Methods: For this retrospective cohort study, patients from the Mount Sinai Health System were identified using the electronic medical record from 2016-2023. A cohort of transgender or non-binary patients with breast cancer was established by using ICD-10 codes for carcinoma in situ of breast (D-05) and malignant neoplasm of breast (C-50) and a diagnosis or medical history encompassing gender identity disorders (ICD-10-CM: F64) or a chief complaint related to transgender health. Chart review enabled selection of patients who have a history of GAHT. Patients with incomplete medical records were excluded from analysis. Results: 14 patients met criteria and were included for final analysis. Mean age at diagnosis was 51.7 (31-65) years and 86% (12/14) were at or above 40 years of age at diagnosis and eligible for routine screening mammography. The cohort encompassed six trans men (assigned female at birth), seven trans women (assigned male at birth), and one genderqueer person (assigned female at birth). Family history was not significant for most of the cohort. Two patients had a first-degree relative with a history of breast cancer; both were BRCA negative. Four patients (29%) were diagnosed via screening mammography; six patients (43%) were diagnosed after palpating a breast or axillary mass; and four patients (29%) had not undergone screening but were diagnosed via breast imaging mandated prior to planned chest masculinization surgery. At time of initial presentation, the diagnostic stage was DCIS in five patients (36%); LCIS in one patient (7%); stage 1 cancer in four patients (29%); stage 2 cancer in three patients (21%); and breast implant-associated anaplastic large cell lymphoma in one patient (7%). 50% (7/14) of patients had an active or past prescription for testosterone-based GAHT, and 50% (7/14) patients had an active or past prescription for estrogen-based GAHT. Mean duration of all GAHT prior to diagnosis was 16.6 years (mean duration of estrogen-based GAHT was 27.6 years and mean duration for testosterone-based GAHT was 5.7 years). Biomarker profiles were available for twelve patients; 8/12 (67%) patients were diagnosed with estrogen receptor (ER) positive cancer, four (33%) with ER negative cancers. Of patients on estrogen-based GAHT, three presented with ER+ and four presented with ER- cancers. 10/14 patients had bilateral mastectomies and 4/14 had lumpectomies. Discussion/Conclusion: The mode of cancer detection suggests that screening mammography is under-utilized among transgender and non-binary patients who use GAHT. This represents a health care disparity involving a vulnerable patient population. The biomarker profile among this population demonstrates that both estrogen-responsive and estrogen-nonresponsive cancers can arise in the setting of prior or ongoing gender affirming estrogen or testosterone. Citation Format: Nithya Krishnamurthy, Ethan Ravetch, Christina Weltz. Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-02.

“Rediscovering what I need to do to give myself pleasure.” Trans women’s experiences of their sexualities during gender transition: An interpretative phenomenological analysis.

“Rediscovering what I need to do to give myself pleasure.” Trans women’s experiences of their sexualities during gender transition: An interpretative phenomenological analysis.

Urine tenofovir testing for real-time PrEP adherence feedback: a qualitative study involving transgender women in Uganda.

Adherence counselling with point-of-care (POC) drug-level feedback using a novel tenofovir assay may support pre-exposure prophylaxis (PrEP) adherence; however, perceptions of urine testing and its impact on adherence are not well studied. We qualitatively examined how POC tenofovir testing was experienced by transgender women (TGW) in Uganda. Within a cluster randomized trial of peer-delivered HIV self-testing, self-sampling for sexually transmitted infections and PrEP among HIV-negative TGW showing overall low PrEP prevention-effective adherence (NCT04328025), we conducted a nested qualitative sub-study of the urine POC assay among a random sample of 30 TGW (August 2021-February 2022). TGW interviews explored: (1) experiences with POC urine tenofovir testing and (2) perceptions of PrEP adherence counselling with drug-level feedback. We used an inductive content analytic approach for analysis. Median age was 21 years (interquartile range 20-24), and 70% engaged in sex work. Four content categories describe how TGW experienced POC urine tenofovir testing: (1) Urine tenofovir testing was initially met with scepticism: Testing urine to detect PrEP initially induced anxiety, with some perceptions of being intrusive and unwarranted. With counselling, however, participants found POC testing acceptable and beneficial. (2) Alignment of urine test results and adherence behaviours: Drug-level feedback aligned with what TGW knew about their adherence. Concurrence between pill taking and tenofovir detection in urine reinforced confidence in test accuracy. (3) Interpretation of urine tenofovir results: TGW familiar with the interpretation of oral-fluid HIV self-tests knew that two lines on the test device signified positivity (presence of HIV). However, two lines on the urine test strip indicated a positive result for non-adherence (absence of tenofovir), causing confusion. Research nurses explained the difference in test interpretation to participants' satisfaction. (4) White coat dosing: Some TGW deliberately chose not to attend scheduled clinic appointments to avoid detecting their PrEP non-adherence during urine testing. They restarted PrEP before returning to clinic, a behaviour called "white coat dosing." Incorporating POC urine testing into routine PrEP adherence counselling was acceptable and potentially beneficial for TGW but required attention to context. Additional research is needed to identify effective strategies for optimizing adherence monitoring and counselling for this population.

Prevalence and incidence of anal high-grade squamous intraepithelial lesions in a cohort of cisgender men and transgender women who have sex with men diagnosed and treated during acute HIV acquisition in Bangkok, Thailand.

Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored. Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits. A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03-18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57-29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27-14.14), syphilis infection (aHR 4.67, 95% CI 1.10-19.90) and CD4 count <350 cells/mm3 (aHR 3.09, 95% CI 1.28-7.48). With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.

Dignity in Diversity: Navigating End-of-Life Care for a Transgender Woman in an Inpatient Hospice Unit

Dignity in Diversity: Navigating End-of-Life Care for a Transgender Woman in an Inpatient Hospice Unit

Health care: life stories by trans women in Colombia

BackgroundIn Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia.MethodsA qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research.ResultsThis research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes.ConclusionParticipants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

Concepts and Contexts: Towards a Theory of “Hermeneutical Bastardization”

Abstract This paper theorizes and defends a process I term “hermeneutical bastardization.” This concept tracks the way in which some hermeneutical injustices arise not from a gap in a shared pool of hermeneutical resources, but from the decontextualization of an advantageous hermeneutical resource into another (typically dominant) hermeneutical domain. This decontextualization bastardizes hermeneutical resources by severing the concept from its original meaning and significance. I focus on the term “trans woman” and examine the way in which dominant epistemic agents rewrite and redefine the concept according to prominent and prevalent pernicious representations. Specifically, once decontextualized, the term “trans woman” denotes an individual who is thoroughly erotic and sexual in nature. Hermeneutical bastardization can illuminate how hermeneutically marginalized groups are reconstructed by other dominant epistemic agents according to these pernicious representations and can be silenced whilst their concepts, or rather their terms, are being utilized in sets of dominant hermeneutical resources in ways that severely diverge from their original intra-communal conceptualization. This type of hermeneutical injustice does not arise from a lacuna in our set of resources, but instead depends on the uptake of a concept's term and its subsequent decontextualization.

Determinants of antiretroviral therapy adherence among transgender women in South Africa.

Transgender women bear a huge burden of human immunodeficiency virus (HIV) in South Africa. However, they are not fully engaged in healthcare across the HIV continuum of care. In addition, transgender women face multiple facets of stigma and discrimination as well as socio-economic inequalities, which all have a negative impact on antiretroviral therapy (ART) adherence. The study aimed at exploring and describing the experiences of ART adherence of transgender women living with HIV in the Buffalo City Metro Municipality. The study employed an interpretative phenomenological analysis (IPA) design. Twelve participants were enrolled using a snowballing sampling technique. Data were collected using semi-structured interviews and analysed using an IPA framework. While exploring determinants to ART adherence among transgender women living with HIV in Buffalo City Metro, two superordinate themes emerged: enablers to ART adherence and psychosocial factors promoting adherence. The study found that factors such as differentiated ART service delivery, ARV medicines-related factors, motivators for taking treatment and support systems facilitated ART adherence. Emerging from this study is the need to scale up differentiated, person-centred ART service deliveries that will enhance access and adherence to treatment for transgender women.Contribution:This study provides unique insights on factors enhancing ART adherence among transgender women. There is a paucity of literature on access to HIV care services for key and vulnerable populations, and these findings will be shared in the country and in the region.

A Look at Human Trafficking and the Anti-Trafficking Apparatus in Mexico through the Experience of Victoria, a Trans Woman

In this article, we discuss the experience of Victoria, a trans woman who was trafficked in the context of the criminal war in Mexico. Drawing on anthropological and feminist perspectives that privilege the dialogue of knowledge, Victoria’s experience allows us to problematise two central elements of the phenomenon of human trafficking in Mexico: first, the relationship between organised crime groups and human trafficking, and its effects on daily life in local contexts in Mexico, specifically in the experience of a trans woman. And second, the functioning of the Mexican anti-trafficking apparatus which, by focusing on the rescue of victims of sexual exploitation in places where independent sex work occurs, overlooks the identification of other forms of trafficking, such as trafficking for labour exploitation and servitude, both experienced by Victoria at the hands of organised crime groups.

Cardiometabolic impacts of gender-affirming hormone therapy in transgender persons: a systematic review

Introduction: Transgender persons with gender dysphoria can be treated using hormones based on estradiol and testosterone. The long-term cardiovascular effects of these therapies are not fully known. Objective: To verify the impact of gender-affirming hormone therapy on risk factors for cardiovascular events (lipid profile, glucose, and blood pressure) and cardiovascular events (acute myocardial infarction [AMI], stroke, and venous thromboembolism [VTE]) in transgender persons. Methods: A systematic review of scientific articles was performed using the PubMed/MEDLINE, Scopus, Embase, and Web of Science platforms. Results and Discussion: The search resulted in 1040 articles, of which 154 duplicates were discarded. Of the remaining 886, 837 articles were excluded, leaving 49, which were read in full. Among these, after confrontation of two researchers, 14 were selected for interpretation and final data extraction. Regarding the data obtained, 11 articles considered transgender women (TW), resulting in a population of 7154 people, with a mean age of 29 years. When interpreting the results, there was an increase in VTE and stroke events in TW compared to cis men and women. The cardiovascular risk factors did not show significant changes in the evaluated studies. Twelve studies were considered for transgender men (TM), generating a population of 4393 people, with a mean age of 26 years. A worsening of the lipid profile in TM and an increase in AMI were observed in comparison with cis women. Conclusion: Review data showed that transgender persons have a risk of increased cardiovascular outcomes and may require early intervention as a preventive measure.

Navigating secondary school: A perspective from trans and non‐binary activists

AbstractGender expansive youth, including trans and non‐binary (TNB) individuals, encounter unique challenges in educational contexts, often marked by hostility, exclusion, and discrimination. This research, adopting the social justice youth development (SJYD) framework, aims to investigate the challenges experienced in Italian secondary schools, amplifying the voices of TNB activists. A total of 15 activists (average age 23.8), comprising 5 trans men, 2 trans women and 8 non‐binary individuals, were recruited. Most identified as White Italian, with one of Italian‐African descent and one multiracial. Interviews collected participants' perceptions of barriers and areas for improvement in school contexts. Reflexive thematic analysis confirmed schools as challenging contexts for TNB identities, highlighting critical flaws in the educational system, such as macro‐ and micro‐aggressions, insufficient knowledge among teachers and staff to support gender expansive students, and a tendency to systematically exclude LGBTQIA+ culture‐related content from curricula. Participants reported engaging in individual and collective activism, striving to adapt and transform educational environments into inclusive spaces for gender identity exploration. Activism stemmed from a sense of responsibility to enhance the well‐being and recognition of the TNB community. Practical implications for school community practices and policies, informed by the SJYD framework in dialogue with participants' experiences, are proposed. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Speaking Bitterly, Desirably and Queerly: The Jinxing Show as Queer Chinese TV

ABSTRACT This article examines one of the most sensational (and controversial) Chinese talk shows of the post-2010 years, The Jinxing Show (TJS; 2015–2017), known for its host, Jin Xing, China’s first transgender woman celebrity. I explore how the transculturally situated aesthetics, talk themes and presentation styles of TJS contributed to Jin’s on-screen presence as a form of ‘uneventful queer’ (McCarthy 2001) TV culture in a supposedly LGBTQ-censoring China. My televisual-discourse analyses of TJS reveal a ‘post-trans’, cosmopolitan-neoliberal rhetoric through which Jin promoted ‘proper’ Chinese womanhood and ‘desirable’ Chinese cultural citizenship in her unique ‘bitter-speaking’ style on the show. Meanwhile, I demonstrate that TJS crystalised certain queer-promising transcultural flows and encounters which were often endorsed by (or in fact dovetailed with) the government’s nationalistic-patriotic self-imaginary in an age of globalisation. Diverging from the scholarly criticism of Jin’s public persona as epitomic of Chinese-specific neoliberal tenets, this study emphasises the dual ‘post-trans’ and queer subjectivities generated through TJS and sheds light on the ‘Chinese-specific’ queer presences, desires, lives and possibilities that have been paradoxically enlarged and publicised through Jin’s on-TV advocacy for the state’s ideological-political projects.

An Historical Case Study of Trans Exclusion and Empowerment: Implications for Transgender Older Adults and Aging

ABSTRACT Transgender older adults have a long history of exclusion that shapes current experiences with social services. However, scant gerontological research uses archival data, which can provide critical context for service providers. Moreover, sparse research examines how exclusion can be a catalyst for change that social workers could leverage. Empowerment theory provides a theoretical tool to explain how this is possible. This multidisciplinary case study blends community member interviews and archival data to answer this question: How did exclusion shape empowerment and social change for transgender Americans? This study focuses on the events before and after the Compton’s Cafeteria Riot, one of the first acts of LGBTQIA+ collective resistance that led to new services for and by transgender Americans. Data reveal how exclusion facilitated the emergence of collective empowerment among transgender women and queer youth in San Francisco. Archival data shows how exclusion preceded self-efficacy, critical consciousness, involvement with similar others, acquisition of new skills, and ultimately action to eliminate social, economic, and political barriers and power imbalances. This study provides both empirical and theoretical tools to contribute new data and perspectives on trans exclusion and empowerment and its implications for social workers serving transgender older adults.

Safety and Community Context: Exploring a Transfeminist Approach to Sapphic Relationship Platforms

Relationship platforms (e.g., dating apps) are crucial tools for sapphics (trans women, cisgender women, and nonbinary people who are attracted to other sapphics). However, current platforms are not designed in a way that accounts for sapphic lived experience, especially the lived experience of sapphics who hold multiple marginalized identity characteristics. Even on platforms that do exist for sapphics, transgender women and nonbinary people are often subject to discrimination, fetishization, and stigmatization. To aid in the design of platforms that better serve the needs of multiply marginalized sapphics, we engaged a diverse group of 25 sapphics in six rounds of community discussion on key topics for relationship platform design. Based on participant discussions, we identify key challenges when designing for multiply marginalized sapphics around relationship structures, gender and sexuality classification, and safety priorities for interaction. We present two design priorities alongside community-sourced design directions which can help future designers address these challenges: identity-centric safety and community-based information formats.

Adverse childhood experiences among black sexually minoritized men and Black transgender women in Chicago

BackgroundAdverse childhood experiences (ACE) are important predictors of mental health outcomes in adulthood. However, commonly used ACE measures such as the Behavioural Risk Factor Surveillance System (BRFSS) have not been validated among Black sexually minoritized men (SMM) nor transgender women (TW), whom are known to have higher rates of ACE and poorer mental health outcomes. Assessing the psychometric properties of the measure is important for health equity research, as measurements that are not valid for some populations will render uninterpretable results.MethodsData are drawn from the Neighborhoods and Networks (N2) study, a longitudinal cohort of Black SMM and TW living in Southern Chicago. We conducted confirmatory factor analysis, correlation analysis and a two-parameter Item Response Theory (IRT) on the BRFSS ACE measure, an 11-item measure with 8 domains of ACE.ResultsOne hundred forty seven participants (85% cisgender male) completed the BRFSS ACE measurement in the N2 study with age ranges from 16–34. The cohort were from a low socioeconomic background: about 40% of the cohort were housing insecure and made than $10,000 or less annually. They also have a high number of ACEs; 34% had endorsed 4 or more ACE domains. The three-factor structure fit the BRFSS ACE measure best; the measurement consisted of three subscales: of “Household Dysfunction”, “Emotional / Physical”, and “Sexual Abuse” (CFI = 0.975, TLI = 0.967, and RMSEA = 0.051). When the 8 domains of ACE were summed to one score, the total score was is correlated with depressive symptoms and anxiety scores, establishing concurrent validity. Item Response Theory model indicated that the “parental separation” domain had a low discrimination (slope) parameter, suggesting that this domain does not distinguish well between those with and without high ACE.ConclusionsThe BRFFS ACE measure had adequate reliability, a well-replicated structure and some moderate evidence of concurrent validity among Black SMM and TW. The parental separation domain does not discriminate between those with high and low ACE experiences in this population. With changing population demographics and trends in marriage, further examination of this item beyond the current study is warranted to improve health equity research for all.

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

BackgroundHealth inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals. MethodsWe analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016–December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation. ResultsThe mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00–1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37–2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12–1.59) and mental (PR = 1.49; 95 %CI = 1.33–1.66) health days. ConclusionHCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.