Transgender health最新文献

Recent U.S. government directives under the Trump administration have prioritized funding research on regret and detransition following gender-affirming care. Empirical evidence demonstrates that regret following gender-affirming care is exceedingly rare, occurring in less than 1% of recipients according to systematic reviews-with epidemiological evidence estimating approximately 1 in 1 million people. This disproportionate research focus violates health equity principles by diverting resources from well-documented health disparities affecting larger segments of transgender and nonbinary (trans) populations. Studying such rare outcomes also presents extremely significant methodological challenges. We argue that epidemiological-based research priorities, rather than ideologically driven agenda should inform trans health.

Purpose: The rate is on the rise of transgender women choosing to have a gender-affirming vaginoplasty in the United States of America, and little is documented on postoperative recommendations to decrease complications and maximize function. This review aimed to identify the indications to incorporate pelvic floor physical therapy into the process for transgender women completing a gender-affirming vaginoplasty.

Methods: Articles were gathered from CINAHL, SPORTDiscus, PubMed, and MEDLINE with keywords including "transgender," "transsexual," "gender affirmation surgery," "sex reassignment," "pelvic floor," "physical therapy," "male-to-female," and "complications." A total of 13 sources were found to be relevant to this study and included in the review.

Results: Results from this literature review found that transgender women frequently have complications of urinary incontinence, prolonged pelvic pain, and neovaginal stenosis after completing vaginoplasty surgery. A case study and two retrospective studies demonstrated positive outcomes from physical therapy related to pelvic pain, dilation protocol, and urinary and bowel function.

Conclusions: Minimal research shows positive outcomes following pelvic floor physical therapy program for transgender women following gender-affirming vaginoplasty. However, no true conclusions can be drawn due to lack of research comparing pelvic floor physical therapy following gender-affirming vaginoplasty with a control.

Purpose: Research suggests that gender-affirming medical care (GAMC) is associated with improved health outcomes; however, there are increasing efforts to limit access to this care for minors. Little prior research has explored transgender and nonbinary (TNB) adolescents' perspectives regarding the impact of accessing GAMC. The goal of this study was to understand the impact receiving GAMC as minors has had on the lives of TNB adolescents.

Methods: Adolescents ages 14-17 who reported having received GAMC were recruited in August 2023 via their electronic health record portal account to participate in an anonymous, qualitative study. Participants completed an electronic survey containing two open-ended questions about how accessing GAMC in adolescence had impacted their life. Free-text responses were reviewed to develop a de novo codebook. Each response was coded and themes were generated iteratively using an inductive thematic analysis framework.

Results: In total, 60 adolescents (82% White, 55% identified as a boy or man) completed the survey. Three themes and two subthemes were identified from participants (n = 60): (1) Congruence, involving ways accessing GAMC enhanced alignment between their gender identity and physical appearance and their ability to self-love, (2) Mental Health, describing how receiving GAMC impacted adolescents' mental health, and (3) Thriving, focusing on how GAMC impacted adolescents' ability to engage with others and become more future-oriented.

Conclusions: Findings from this study highlight the positive impact GAMC has on adolescent mental health and social well-being and thus add to our growing understanding of the impact of GAMC and the possible harms associated with limiting access.

Purpose: Transgender and gender diverse ("trans") people often face stigma and discrimination, leading to mental health challenges. Gender affirmation, including social, legal, and medical aspects, can alleviate these challenges. However, the mental health outcomes associated with legal gender recognition remain under-explored, particularly in an Australian context. Therefore, this study examines associations between different forms of gender affirmation and mental health outcomes among a large sample of Australian trans adults.

Methods: We analyzed data from 1,359 trans adults responding to a national survey conducted in late 2019 in Australia. Measures included demographics, gender affirming care access, hormone therapy, legal affirmation, psychological distress, suicidal ideation, suicide attempts, and gender euphoria. Logistic regressions assessed associations between gender affirmation factors and mental health outcomes, accounting for sociodemographic variables.

Results: Access to gender affirming care was associated with reduced psychological distress, decreased recent suicidal ideation, and increased gender euphoria. Legal gender affirmation was correlated with lower psychological distress and increased gender euphoria. Participants desiring hormone therapy but not accessing it reported higher psychological distress.

Conclusion: Our study highlights the positive impact of gender affirmation on the mental health of trans adults. Access to medical and legal gender affirmation were both associated with lower psychological distress and higher gender euphoria. These findings stress the importance of timely access to gender affirmation when desired. Further research should explore nuanced effects across affirmation pathways, informing inclusive health care and legal frameworks.

Purpose: Transgender women have some of the highest rates of HIV globally. Sub-Saharan Africa is one of the more impacted regions, reflecting a higher underlying prevalence of HIV as well as greater social marginalization and criminalization of transgender women. While very little research has been conducted among transgender women in Nigeria, their risk for HIV infection is estimated to be much greater than the general population. In this study, we sought to determine both interest and adaptability of LifeSkills, an evidence-based intervention created by and for young transgender women in the United States, to reduce HIV-related risk among transgender women in Nigeria.

Methods: Two focus groups were conducted in Ibadan, Nigeria, and data were analyzed using a content analysis approach.

Results: A total of 15 transgender women participated in two focus groups with a mean age of 24.6 (standard deviation = 6.4). Echoing studies of transgender women globally, participants reported that the basic human need for kinship, acceptance, and support are undermined by harassment and violence. In addition to the personal and social harm of these experiences, they promote sexual risk, as described by focus group participants, by limiting options for basic HIV-related education, social support, access to preventive care, housing, and employment, all of which are a core focus of the LifeSkills curriculum. Interest in an empowerment approach focused on safety, support, and HIV prevention skill building, delivered in a group-based format was appealing to participants.

Conclusion: The LifeSkills intervention elicited interest and may be adaptable to the needs of transgender women in Nigeria.

Purpose: This study aimed to explore the use of serum free testosterone concentrations in transmasculine patients as a more reliable indicator of gender-affirming testosterone therapy than total testosterone concentration. Total testosterone values, recommended by current guidelines, may be impacted by obesity. In addition, this study aimed to characterize the impact of testosterone concentrations on hematocrit and the risk of polycythemia.

Methods: A retrospective study was conducted of transmasculine patients seen at Boston Children's Hospital Gender Multispecialty Service from 2007 to 2020. Sixty-eight birth-assigned female adolescents who were receiving gender-affirming testosterone therapy and had total and free testosterone concentrations were included. The aims were to determine the fidelity of total and free testosterone concentrations with body mass index (BMI) and to characterize the association of testosterone concentrations with erythrocytosis.

Results: Of 68 subjects, 23% were overweight and 40% had obesity. Compared with the group with a healthy BMI, patients with obesity had significantly lower total testosterone concentrations. Free testosterone concentrations did not vary based on BMI category. BMI z-score was inversely correlated with total testosterone, sex hormone-binding globulin, and albumin concentrations but not with free testosterone concentrations. Four percent of subjects developed erythrocytosis (e.g., hematocrit >50%). Neither BMI nor testosterone concentrations were correlated with hematocrit.

Conclusions: Free testosterone concentrations are an adjunctive tool in the monitoring of gender-affirming testosterone therapy. In addition, the development of erythrocytosis is independent of serum testosterone concentration and warrants further study to understand factors that may predispose patients to developing secondary polycythemia.

An electronic survey of transgender and nonbinary (TNB) adolescents was administered between June and August 2023 to identify potential facilitators of gender-affirming medical care (GAMC). Results indicated the most important facilitator was being able to access GAMC from their regular doctor. Accessing care via school-based health centers, a telemedicine visit with a gender specialist, and sharing videos about GAMC with parents were more important to those who had not been seen in a clinic that provides GAMC. Overall, this study offers important insights into how to improve access to GAMC for TNB adolescents who want but are not receiving this care.

Purpose: The purpose of this study was to compare the clinical acceptability of testosterone levels, time to treatment, and postinstruction questions/problems between in-person and telehealth injection teaching for adolescents and young adults (AYA) initiating gender-affirming testosterone therapy.

Methods: A retrospective cohort study was conducted using electronic medical record data from a large pediatric gender health clinic. Patients who received subcutaneous testosterone prescriptions between March 15, 2018, and March 14, 2022, were included. The study compared patients receiving in-person versus telehealth injection teaching. Data were collected on demographics, testosterone levels at 3 and 6 months, time from prescription to treatment, and post-instruction contacts. Statistical analyses included t-tests, chi-square tests, logistic regression, linear regression, and zero-inflated negative binomial.

Results: The study included 278 patients, with 136 (48.9%) receiving in-person teaching and 142 (51.1%) receiving telehealth teaching. There were no significant differences in baseline characteristics between groups. Clinical effectiveness, indicated by testosterone levels at 3 and 6 months, revealed no significant difference between instruction methods (p = 0.768 and p = 0.350). Time to treatment initiation was comparable (in-person: 15.34 days; telehealth: 18.02 days), with no significant difference in adjusted analysis (p = 0.204). Post-instruction contacts were slightly higher in the telehealth group (2.87 vs. 2.42, p = 0.040), but injection-related questions were rare and similar between groups (p = 0.650).

Conclusion: Telehealth instruction for testosterone injection is as effective as in-person teaching methods for AYA initiating gender-affirming care. The findings support the continued use of telehealth to enhance access to gender-affirming care, particularly in light of its clinical efficacy and patient acceptability.