Transgender Health最新文献

Purpose: In this article, we describe and illustrate the victimization experiences of transgender immigrants in the U.S. detention system.

Methods: We use two sources of data, (1) the 2015 U.S. Transgender Survey and (2) Immigration and Customs Enforcement government contracts and audit documentation, to gain a greater understanding of the experiences of transgender detainees in these facilities.

Results: By connecting what is evidenced in these two data sources, we observe a systemic pattern of victimization that includes physical and sexual assault, long-term solitary confinement, as well as the denial of lifesaving gender-affirming services.

Conclusion: Immigrant detention centers are often mismanaged entities in which the well-being of detainees is hardly procured. The conditions are even more precarious and downright dangerous for transgender detainees. We conclude by recommending stringent penalties to facilities that endanger the well-being of detainees as well as an overall reform of the immigration system.

Purpose: Epidemiologic studies suggest that the transgender population has a higher burden of cardiovascular (CV) disease. We aimed to assess CV risk and investigate the relationship between estradiol (E2) or ethinylestradiol (EE) use and carotid intima media thickness (cIMT) in transgender women.

Methods: This is a cross-sectional analysis nested into a transgender-specific cohort in Rio de Janeiro, Brazil, from August 2015 to February 2018. Increased cIMT was defined as a measurement above the 75th percentile. We tested the association of E2, EE, or both with cIMT. We calculated odds ratios (ORs) using adjusted logistic regression models to assess the association of current use (use in the last 30 days) and long-term use (using for at least 365 consecutive days) of the hormone categories with cIMT.

Results: We included 298 transgender women with a median age of 31 years (interquartile range [IQR]=25-38), 54.2% had human immunodeficiency virus (HIV) infection. Among transgender women currently on hormone therapy (44.9%), most were on estradiol (27.2%), a combination of E2/EE (12.7%), or EE alone (5.1%). Median cIMT was 0.57 mm (IQR=0.52-0.64). In the final adjusted models, current (OR=0.37; 95% confidence interval [95% CI]=0.14 to 0.93) and long-term (OR=0.20; 95% CI=0.04 to 0.7) E2 use was negatively associated with increased cIMT.

Conclusions: Both current- and long-term E2 use had a negative association with increased cIMT in a young population of transgender women. Follow-up studies are needed to confirm its safety and support hormone recommendations for transgender women.

Purpose: This study aims to assess the prevalence of intersex variations/differences in sex development (I/DSDs), associated adrenal conditions, and primary gonadal insufficiency in children with gender dysphoria.

Methods: We performed a comprehensive review of the medical records for individuals who carried the diagnostic codes for gender dysphoria in addition to intersex and/or other conditions associated with sex steroid variations among patients evaluated by pediatric endocrinologists from 2013 to 2022.

Results: We found that 9 of 612 (1.5%) transmasculine (TM) and 4 of 215 (1.9%) transfeminine patients had detectable I/DSDs. Although most patients were diagnosed with I/DSDs before evaluation of gender dysphoria, 4 of 13 (30.7%) were diagnosed with I/DSDs after being referred to endocrinology for gender dysphoria. In all cases, diagnoses were made by the endocrinologists evaluating for gender dysphoria. An additional 0.7% of TM patients were diagnosed with distinct hyperandrogenic adrenal conditions, and 1% of TM patients were diagnosed with primary ovarian insufficiency.

Conclusion: The low, but clinically relevant, prevalence of I/DSDs, distinct adrenal conditions, and primary gonadal insufficiency in this transgender population supports the need for access to individualized expert medical care. Specifically, multidisciplinary clinics with experience in endocrinology may provide specialized support for the transgender community.

Purpose: In trans people undergoing feminizing hormone therapy, optimal estradiol concentrations are unclear, and anecdotally, some individuals desire supraphysiologic estradiol concentrations. We aimed to assess associations between estradiol concentration and psychological distress, well-being, and dysphoria. Second, we aimed to explore relationships between estradiol concentration and the risk of medical conditions potentially associated with estradiol therapy.

Methods: This exploratory online cross-sectional study was conducted between June 2020 and March 2021, using a nonprobability snowball sampling method. Inclusion criteria included the following: (1) Currently living in Australia, (2) identification as transgender and using estradiol for gender affirmation purposes, and (3) 16 years of age or older. Estradiol concentrations were correlated with the Kessler Psychological Distress Scale (K10), the Personal Wellbeing Index (PWI-A), and gender dysphoria as measured by the Gender Congruence and Life Satisfaction Scale.

Results: There were 172 participants, and the median estradiol concentration was 420 pmol/L (interquartile range 269-614). No clinically significant association was found between estradiol concentration with psychological distress, wellbeing, or gender dysphoria. While there was a statistically significant lower K10 score and higher PWI-A General Life Satisfaction score with higher estradiol concentrations, the order of magnitude was small and not clinically significant. There was no association between estradiol concentration and thrombosis, malignancy, stroke, myocardial infarction, migraine, or hypertension.

Conclusions: Given no clear association between higher estradiol concentrations, psychological distress, wellbeing, or dysphoria, approaches to estradiol hormone therapy should be individualized. Further prospective research, with larger sample sizes, is required to more thoroughly investigate optimal feminizing hormone therapy regimens.

Purpose: Transgender-based discrimination is associated with poor mental health, unemployment, and poverty. Travestis and transgender women (trans women) frequently experience transgender-based discrimination, but associated factors are understudied. Our objective was to identify the factors associated with transgender-based discrimination among trans women from Brazil.

Methods: We used data from Transcendendo, a clinic-based cohort of trans women in Rio de Janeiro, Brazil. Eligible participants were ≥18 years old, assigned male sex at birth, and self-identified as travestis, transgender women, or other trans feminine identities. We analyzed baseline data for participants enrolled from August 2015 to March 2020. Face-to-face questionnaires collected data on socio-demographics, gender identity and expression, and transgender-based discrimination experience. Factors associated with transgender-based discrimination were evaluated through multivariable linear regression.

Results: Out of the 587 participants, 559 (95%) were included (28 excluded due to missing data). Mean age was 33 years, the majority identified as transgender women (40%), 71% reported current or past sex work, and 43% self-reported as living with HIV. In multivariable regression models, factors significantly associated with transgender-based discrimination included having no supporting or one supporting parental figure (vs. support from both parents), living in poverty (vs. not), and current and past sex work (vs. never).

Conclusions: Trans women without family support, who engaged in sex work or were economically deprived were more prone to transgender-based discrimination. A lack of parental support, the strongest independent predictor of transgender-based discrimination experiences, likely contributes to emotional and structural vulnerabilities.

Purpose: Borderline personality disorder (BPD) is a severe form of psychopathology associated with a host of negative outcomes. Some literature suggests elevated prevalence among transgender and gender diverse (TGD) samples. Elevated BPD prevalence among TGD populations could be due to factors other than BPD-specific psychopathology. Studies of TGD samples typically omit assessment of BPD, making it difficult to understand elevated BPD diagnosis. The current study explored (1) differences in BPD diagnosis among TGD patients versus cisgender patients, (2) if differences were explained by BPD-specific pathology, and (3) if BPD diagnostic disparities existed based on assessment modality.

Methods: Data from TGD (n=74) and cisgender heterosexual (n=920) patients who presented for treatment at one partial hospitalization program from 2014 to 2019 were compared to investigate differences in the frequency of BPD diagnosis.

Results: A larger proportion of TGD patients were diagnosed with BPD than cisgender patients (odds ratio [OR]=4.05, p<0.001). The disparity in diagnosis persisted even after controlling for BPD-specific personality pathology (OR=2.98, p<0.001). BPD diagnostic disparity occurred when assessed using structured (OR=4.78, p<0.001) and unstructured (OR=3.61, p<0.001) interview methods. There was no disparity, however, when BPD was diagnosed using an algorithm based on BPD-specific personality pathology purported to underlie the diagnosis.

Conclusions: Clinical providers appear inclined to assign a BPD diagnosis to TGD patients that may not correspond with group differences in underlying personality pathology. That some BPD symptoms might be more likely in TGD samples, future research can examine criterion-level biases in BPD diagnosis among TGD individuals.

Purpose: There are no standardized chest binding guidelines available to health care providers serving transgender and nonbinary individuals, exacerbating the significant health disparities affecting this community. Our study aimed to demonstrate the need for further evidence-based investigations into the association between chest binder type and health outcomes.

Methods: For this cross-sectional observational study, a community-engaged online survey evaluating individuals' experiences with their current or most recent chest binder was distributed to LGBTQ+ community centers, online forums, and clinics from July to November 2021. Participants rated their frequency of health outcomes in terms of both positive and negative changes, and the average score was calculated.

Results: Of 197 participants, 80% reported using commercial binders as their current or most recent binder type. Users of commercial binders reported significantly more positive mental health changes than noncommercial binders (p=0.043). There was no statistically significant association between negative outcomes and the binder category (p=0.595). Musculoskeletal complaints were more frequent with commercial binders. The frequency of skin changes was higher with noncommercial binders; however, acne was higher with commercial binders.

Conclusions: Our results suggest that the positive mental health changes associated with chest binding outweigh the negative side effects. However, the contrariety of adverse effects among binding methods suggests that chest binding must be evaluated by individual binder type rather than as a general practice. These findings will help providers guide conversations to identify which binder is best for each unique patient, as well as encourage future research in chest binding best practices.

Purpose: This study describes Thai transfeminine individuals' exogenous hormone use.

Methods: During the period May-July 2017, a survey was conducted among Thai transfeminine adults (N=181) who reported their exogenous hormone use, age at onset of use, brands used, where they obtained hormones, and discontinuation of use.

Results: Most participants (86.74%) used exogenous hormones. The mean (standard deviation) age of onset of use was 16.59 (3.79) years. A range of 1-15 brands with varying chemical composition were used. Hormones were typically procured from pharmacies (91.39%) and seldom physician prescribed (8.61%). Discontinuing use for 6 or more months was common (59.62%).

Conclusions: Gender-affirming health care beginning in adolescence for Thai transfeminine individuals is needed.

Purpose: Using a community-engaged approach, we adapted a human immunodeficiency virus (HIV) prevention smartphone app, Transpire, to meet the HIV and sexually transmitted infection (STI) prevention needs of transgender men and other transmasculine people. We conducted a pilot study to assess the feasibility and acceptability of the app among participants in two cities in the southeastern United States.

Methods: Participants were recruited online and through community partners. Eligible and consenting participants used the Transpire app for 3 months and completed surveys at the beginning and end of the follow-up period. Transpire gave participants access to HIV and STI prevention information; the ability to order HIV and STI at-home self-test kits, condoms, and lube; and mental health and substance use resources. The primary feasibility outcome was the System Usability Scale (SUS), which measures the usability of technology-based products.

Results: Sixty participants were enrolled. Most were 18-24 years old (n=33, 55%) and identified as non-Hispanic white (n=46, 77%). The mean SUS score was 72.4, which meets established criteria for acceptability. Fifteen (32%) participants conducted an HIV test during the 3-month follow-up period and 2 (4%) initiated pre-exposure prophylaxis.

Conclusions: Following a community-engaged adaptation process, the Transpire app was found to be acceptable in a pilot study conducted among transmasculine participants. These pilot data indicate that app-based interventions have the potential to increase awareness of and access to sexual health resources for transmasculine people. Additional studies will be needed to assess the efficacy of Transpire or similar apps to improve sexual health outcomes.

Purpose: The goal of this study was to assess possible psychosocial contributors to delayed coronavirus disease 2019 (COVID-19) vaccination within a sample of transgender and gender diverse (TGD) individuals.

Methods: TGD participants (N=385) were recruited from Prolific.co. Survey items assessed COVID-19 vaccination status, experiences of discrimination in health care settings, medical mistrust, COVID-19 mistrust, and perceived barriers to vaccination. Logistic regressions were conducted using SPSS version 27 to assess whether demographic variables, medical mistrust, experiences of discrimination in health care, and COVID-19 mistrust predicted vaccination behaviors. A PATH model was developed using AMOS 21.0 to assess the relationship among experiences of discrimination, general medical mistrust, COVID-19 mistrust, and barriers to vaccination in predicting receipt of a booster at the time of the study.

Results: Results from the logistic regressions indicated a binary TGD identity and higher COVID-19 mistrust predicted experiencing a delayed first dose of a COVID-19 vaccination and receipt of a booster at the time of the study over and above racial identity, experiences of discrimination, and general medical mistrust. Results from a PATH model indicated an association among experiences of discrimination in health care, medical mistrust, COVID-19 mistrust, barriers to vaccination, and having not received a booster at the time of the study.

Conclusion: These findings support prior research demonstrating that vaccination rates among TGD individuals do not differ from other groups. However, TGD individuals with a binary gender may have experienced or anticipated experiencing barriers to COVID-19 vaccination and/or receipt of a booster. Public health and clinical implications for these findings are discussed.