Transgender Health最新文献

Non-probability sampling methods utilize nonrandom research participant selection, which may generate study samples that are not representative of the general population. Non-probability sample studies are often regarded as inferior due to uncertainty about their generalizability and external validity. In reality, non-probability sampling offers advantages that make this method particularly valuable for minority health research. In this perspective article, we review the strengths and limitations of probability and non-probability samples, examining three landmark survey studies used to study transgender and gender diverse mental health. We conclude that both types of studies provide important and actionable data about mental health inequities experienced by minority populations.

Background: Transgender women (TGW) and cisgender men who have sex with men (cis-MSM) are often grouped together as key populations. We evaluated behavioral and other characteristics that may distinguish TGW from cis-MSM in Bangkok, Thailand.

Methods: We enrolled into an 18-month cohort cis-MSM and TGW 18-35 years of age without HIV, who reported anal intercourse plus condomless anal intercourse, multiple partners, transactional sex, and/or sexually transmitted infection. Robust multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and confidence intervals (95% CIs) for associations with being a TGW. Among TGW, logistic regression with generalized estimating equations was used to estimate adjusted odds ratios (aORs) and 95% CIs for associations with taking hormones and having undergone gender affirmation surgery (GAS).

Results: From 2017 to 2019, 660 cis-MSM and 348 TGW were enrolled. Compared to cis-MSM, TGW were more likely to be attracted to mostly/only men (aPR: 3.79, 95% CI: 1.57-9.13), have a higher monthly income (aPR: 1.25, 95% CI: 1.04-1.50), have lived in their current residence for <1 year (aPR: 1.21, 95% CI: 1.01-1.46), have engaged in sex work (aPR: 1.48, 95% CI: 1.23-1.77), and be less likely to have ever undergone HIV testing (aPR: 0.83, 95% CI: 0.70-0.98). Among TGW, 149 (42.8%) were taking hormones and 33 (9.5%) had undergone GAS. GAS was more common among TGW who ever used methamphetamines (aOR: 1.55, 95% CI: 1.00-2.41) and those >23 years (18-20-year olds aOR: 0.17, 95% CI: 0.05-0.55; 21-23-year olds aOR: 0.36, 95% CI: 0.20-0.65).

Conclusions: TGW and cis-MSM are unique populations; tailored, gender-affirming, differentiated models of HIV prevention and care are necessary to address vulnerabilities specific to each key population.

Purpose: Estrogen therapy is associated with an increased risk of venous thromboembolism (VTE). A large proportion of transfeminine patients use estrogen therapy before undergoing gender-affirming surgery. Many surgeons implement the discontinuation of hormone therapy before surgery. This study sought to evaluate the perioperative risk of VTE in transfeminine patients undergoing the procedure of facial feminization.

Methods: Retrospective chart reviews were performed of all patients who underwent facial feminization by a single surgeon at an urban academic institution from 2014 to 2020. Patient characteristics including comorbidities, Caprini score, VTE chemoprophylaxis, and perioperative hormone therapy management were reviewed. The incidences of VTE during perioperative hospital stay and within 1 week and 6 months after the surgical procedure were examined.

Results: There were 296 facial feminization procedures performed on 282 distinct patients who met criteria for inclusion in the study. Hormone therapy was prescribed to 83.6% of patients, 69.5% of whom reported that they held these medications before the procedure. Of those holding, 84.1% of patients reported they discontinued these medications between 2 and 4 weeks. No patients received VTE chemoprophylaxis. There were 0 VTE incidents during the patients' perioperative period up to 6 months postprocedure.

Conclusion: Our findings support that transfeminine patients who use estrogen hormone therapy are at a minimal risk to experience VTE when undergoing facial feminization procedures. Future directions include evaluating the psychologic effect of discontinuing hormone therapy to help guide perioperative decision making.

Although transgender and nonbinary (TNB) people can acquire human papillomavirus (HPV), research examining HPV vaccination in these populations is scarce. TNB individuals experience high levels of gender-related health care discrimination, which may undermine HPV vaccine uptake. Using data from a national online survey (N=716), we found a negative association between gender-related health care discrimination and HPV vaccination among transgender women and nonbinary individuals who were assigned male at birth (AMAB; odds ratio [OR]=0.52; 95% confidence interval [CI]: 0.29-0.93). Addressing gender-related health care discrimination may facilitate HPV vaccination and help prevent HPV-related cancers among transgender women and nonbinary AMAB individuals.

Increasingly, transgender and gender diverse (TGD) youth are seeking gender-affirming medical care. Most multidisciplinary gender-affirming pediatric clinics are located in academic facilities in urban areas. To improve access to care and advance the field, grassroots establishment-without targeted funding or explicitly trained gender health providers-of multidisciplinary gender health clinics in rural and community health care settings can increase care access and lay the foundation for dedicated funding, staff, and clinic space. In this perspective piece, we share our grassroots process of establishing a multidisciplinary gender health clinic in the community setting, highlighting critical turning points that facilitated our clinic's rapid growth. Our experience can provide important lessons learned for community health care systems seeking to establish programs that will serve TGD youth.

This study explored whether self-reported barriers to accessing a health care provider, gender-affirming procedures, and relevant psychosocial measures were related to experienced gender affirmation in a cross-sectional sample of trans individuals (N=101). Body image quality of life [b=0.181, t(4.277), p<0.001] and the number of gender-affirming procedures [b=0.084, t(2.904), p=0.005] were significant predictors of transgender congruence, a measure of gender affirmation, and accounted for 40% of the adjusted variance in transgender congruence scores F(2, 89)=31.363, p<0.001, R²=0.413. Results suggest that experiencing a barrier to gender-affirming health care is associated with anticipation of discrimination and provides further evidence that gender-affirming health care is associated with positive psychosocial outcomes.

Purpose: Hormone treatment (HT) is a cornerstone of gender-affirming therapy in transgender and gender nonconforming people. Nonbinary and genderqueer (NBGQ) people, individuals identifying outside the male to female binary, are increasingly recognized. Not all trans people and NBGQ individuals seek full HT. Current guidelines for HT of transgender and gender nonconforming people do not include specific regimens for NBGQ people who seek tailored treatment. We aimed to compare HT prescribed to NBGQ and binary trans people.

Methods: We performed a retrospective study in 602 applicants for gender care in 2013-2015 at a referral clinic for gender dysphoria. GenderQueer Identity questionnaires at entry were used to categorize people as NBGQ or binary transgender (BT). Medical records were assessed until the end of 2019 with regard to HT.

Results: A total of 113 individuals identified as nonbinary and 489 as BT before the start of HT. NBGQ persons were less likely to receive conventional HT (82% vs. 92%, p=0.004) and more likely to be prescribed tailored HT than BT people (11% vs. 4.7%, p=0.02). None of the NBGQ individuals who received tailored HT had undergone gonadectomy. A subgroup of NBGQ individuals assigned male at birth using exclusively estradiol had similar estradiol and higher testosterone serum concentrations compared with NBGQ individuals using conventional HT.

Conclusion: NBGQ individuals more often receive tailored HT compared with BT people. In the future, individualized endocrine counseling may further shape customized HT regimens for NBGQ individuals. For these purposes, qualitative and prospective studies are needed.

Purpose: Tobacco use is prevalent among sexual and gender minorities (SGM), yet few studies have examined the specific drivers of tobacco use among trans women. The purpose of this study is to examine the impact of proximal, distal, and structural stressors associated with tobacco use among trans women.

Methods: This study is based on a cross-sectional sample of trans women (n=162) living in Chicago and Atlanta. Analyses were conducted to examine the association between stressors, protective factors, and tobacco use using a structural equation modeling framework. Proximal stressors (transgender roles scale, transgender congruence scale, internalized stigma, and internalized moral acceptability) were operationalized as a higher order latent factor, while distal stressors were operationalized as observed variables (discrimination, intimate partner violence, sex work, rape, child sexual abuse, HIV, and violence). Protective factors included social support, trans-related family support, and trans-related peer support. All analyses adjusted for sociodemographic variables (age, race/ethnicity, education, homelessness and health insurance).

Results: The prevalence of smoking among trans women in this study was 42.9%. In the final model, homelessness (odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.97, 7.25), intimate partner violence (OR: 2.14; 95% CI: 1.07, 4.28), and commercial sex work (OR: 2.22; 95% CI: 1.09, 4.56) were all associated with tobacco use. There was no association between proximal stressors and tobacco use.

Conclusion: Among trans women, tobacco use prevalence was high. Tobacco use was associated with homelessness, intimate partner violence, and commercial sex work. Targeted tobacco cessation programs should account for the co-occurring stressors that trans women face.

Objective: Transgender individuals report negative experiences in emergency department settings, but little is known about emergency clinicians' barriers to treating transgender patients. The purpose of this study was to explore emergency clinicians' experiences with transgender patients to better understand their comfort with caring for this population.

Methods: We conducted a cross-sectional survey of emergency clinicians in an integrated health system in the Midwest. To assess the relationship between each independent variable and the outcome variables (i.e., comfort level generally and comfort level asking transgender patients about their body parts specifically), Mann-Whitney U test or Kruskal-Wallis analysis of variance was conducted for categorical independent variables and Pearson correlations were conducted for continuous independent variables.

Results: Most participants (90.1%) were comfortable caring for transgender patients, whereas two-thirds (67.9%) were comfortable asking transgender patients about body parts. Although none of the independent variables was associated with increased clinician comfort level caring for transgender patients in general, White clinicians and those who were unsure how to ask patients about their gender identity or transgender-specific care they had received were less comfortable asking about body parts.

Conclusion: Having skills to communicate with transgender patients was associated with emergency clinicians' comfort levels. In addition to offering traditional classroom-based didactics about transgender health care, providing opportunities for clinical rotations that allow clinicians-in-training to treat, and perhaps more importantly, learn from transgender patients will likely be higher yield in bolstering clinician confidence in serving this patient population.

Purpose: Transgender people experience discrimination in health care, including reports of avoiding or delaying emergency department (ED) care due to prior negative experiences, fear of discrimination, poor accommodations, and inappropriate staff behavior. Emergency physicians receive minimal training on transgender care. This study sought to understand the experience of transgender patients when visiting EDs in the Portland metro area, and the knowledge and training experience of Oregon Health & Science University (OHSU) ED staff.

Methods: Two populations were examined via survey: (1) Transgender people who accessed, or felt they should access, ED care in Portland, Oregon, in the past 5 years; and (2) OHSU ED patient-facing staff. Data were analyzed to identify trends in ED experiences, and predictors of positive experiences. Potential relationships between self-reported proficiency in transgender care and formal training experience, professional role, and duration of practice were also assessed.

Results: Of the predictors assessed, only the opportunity to provide pronouns at check-in was associated with better perceived experiences (p<0.01). The differences between reported best and worst ED experiences were significant in all domains of perceived experiences but one (p<0.01). ED providers who had formal training were more likely to rate themselves as proficient (p<0.01). There was no relationship found between self-reported proficiency and length of practice.

Conclusion: This study demonstrated that there are significant differences between reported best and worst ED experiences by transgender patients, and thus areas for ED improvement. It is our recommendation that EDs provide the opportunity for patients to supply their pronouns, and offer trainings in transgender health care for employees.