Transgender health最新文献

Purpose: Stigma and discrimination against transgender people can lead to their segregation. Fighting stigma and discrimination is a crucial strategy to expand access to health services. The goals of the present study were to develop and validate a transgender health care humanization scale (THcH scale) to evaluate the perception of humanization in health care for transgender individuals.

Methods: This cross-sectional study included 340 health care providers aged ≥18 years. Participants answered a structured questionnaire when attending HIV/AIDS scientific meetings or at their place of work. An exploratory factor analysis was conducted, using a polychoric matrix and robust diagonally weighted least squares extraction method. The number of retained factors was defined through the parallel analysis technique, with random permutation of the observed data and the use of Robust Promin rotation.

Results: The interpretability of correlation matrix items was suggested by the Bartlett's sphericity tests (1633.7, df=91; p<0.001) and Kaiser-Meyer-Olkin Test (0.875). The factor structure showed adequate adjustment indices (χ²=44,200, df=52; root mean square error of approximation p<0.05; comparative fit index=0.968; Tucker-Lewis index=0.945; goodness-of-fit index = 0.995). Only one factor was retained by parallel analysis, explained by 54.17% of the variance of the construct and confirmed by the following indices: unidimensional congruence=0.902, explained common variance=0.828, and mean of item residual absolute loadings=0.279. Good reliability was confirmed by Cronbach's alpha test (0.899).

Conclusion: The THcH scale showed good psychometric properties. This self-report questionnaire, which can be completed in 5 min, may be useful in scientific research and could guide health care providers in expansion of a Health Humanization Policy and in deconstructing prejudice against transgender people in health care settings.

Testosterone therapy prompts the development of male secondary sexual characteristics coupled with numerous physiological changes; however, the effect of prolonged androgen exposure on transgender men's fertility remains to be fully elucidated. Multiple clinical consensuses advise assisted reproduction before hormone treatment and state that fertility preservation following androgen therapy entails the suspension of testosterone administration. Although the desire for reproduction among transgender men is prevalent, the discontinuation of gender-affirming hormone therapy poses a major challenge due to the anxiety, unease, and gender dysphoria that follow androgen withdrawal. The present investigation aimed to explore the feasibility and outcomes of oocyte retrieval in adult transgender men undergoing testosterone administration before or during fertility preservation. Seven case reports, four cohort studies, and two cross-sectional studies were identified following a systematic literature search on the PubMed/Ovid MEDLINE, Scopus, and ScienceDirect databases. The findings gathered in this review disclose the viability of oocyte retrieval after prolonged androgen exposure and suggest the absence of a direct relationship between the duration of testosterone suspension and fertility preservation outcomes. Although the reports are limited, recent evidence shows that continuous testosterone administration and the use of aromatase inhibitors during ovarian stimulation could potentially reduce the distressing effects of hormonal ovulation induction. New approaches to fertility preservation in transgender men must be further explored to ensure interventions aligned both with the reproductive desire and avoidance of gender dysphoria exacerbation that follow hormone therapy suspension.

Purpose: Although HIV surveillance contains information on HIV outcomes among transgender persons with HIV (TPWH), it does not include other important data, for example, gender-affirming health care, which may influence viral suppression (VS). We describe TPWH accessing Medicaid and the association of gender-affirming surgery with VS.

Methods: Through matching Medicaid claims with HIV registry data, a cohort of previously identified TPWH in Medicaid was compared to cisgender women and men in terms of VS in 2013-2017 in New York City. Medicaid claims were used to identify TPWH who obtained gender-affirming surgery (e.g., chest, genital surgeries). We described the VS of those who had surgery and examined temporal trends in VS pre- and postsurgery and by surgery type.

Results: 1730 TPWH were enrolled in Medicaid and in HIV care in 2013-2017. Overall for VS at last laboratory, TPWH in Medicaid had lower VS (76.0%) than cisgender women (80.4%) and men (83.3%). The exception was the 185 TPWH who obtained gender-affirming surgery (86.5%). Among 160 TPWH in Medicaid who obtained gender-affirming surgery and achieved VS, VS increased presurgery (66.3% 2 years prior, 76.9% 1 year prior) and remained high 1 year after (86.3%) and 2 years after (87.7%) (the last percentage is only among those who had surgery before 2017, N=81).

Conclusion: Gender-affirming surgery may be an important motivator to becoming virally suppressed and was associated with sustained high VS, which can lead to improved survival and quality of life. Medicaid and other insurers should consider improving access to gender-affirming surgery among TPWH.

Purpose: To describe barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs).

Methods: We used longitudinal data from a prospective cohort of TNB youth seeking care at a multidisciplinary pediatric gender clinic between August 2017 and June 2018. We calculated the time between (i) initial clinic contact, (ii) phone intake, (iii) first medical appointment, and (iv) initiating PBs/GAHs. We estimated Kaplan-Meier curves for each time-to-care interval and used Cox regression models to estimate hazard ratios (HRs) for factors hypothesized to be barriers and facilitators of care.

Results: Our cohort included 104 youth aged 13-20 years. The median time from contacting the clinic to initiating PBs/GAHs was 307 days (range, 54-807). Lower income level, Medicaid insurance, and lack of family support were associated with longer times from contacting the clinic to completing the first medical appointment. In addition, older youth experienced longer times to first medical appointment relative to youth aged 13-14 years. Youth younger than 18 years of age who did not complete a mental health assessment before their first medical appointment experienced delays from first medical appointment to initiating PBs/GAHs (HR=0.44, 95% confidence interval, 0.22-0.88).

Conclusion: Certain subsets of youth disproportionately experienced delays in receiving gender-affirming medications, and these factors varied by stage of care engagement. Given the association between gender-affirming care and improved mental health, identifying sociostructural and clinic-level barriers to care is critically important to facilitating more equitable access.

Purpose: We report a novel case of a transgender woman who experienced excess mucosal secretion leading to symptomatic skin irritation after her colonic vaginoplasty successfully treated with glycopyrrolate.

Methods: This is a case report of a 47-year-old transgender woman with symptomatic excess mucosal secretion and skin irritation from colonic vaginoplasty, and we describe her treatment course and responses. Patient consent was obtained for publication.

Results: The patient's chronic neovaginal discharge improved with glycopyrrolate.

Conclusions: Anticholinergic drugs may be helpful in treating patients who experience chronic neovaginal discharge following colonic vaginoplasty.

Body mass index (BMI) is defined as weight (kg)/height² (m²). Differences in BMI percentiles between sexes confound the diagnosis of weight-related disorders in transgender youth because choosing the appropriate chart is challenging. Data on BMI measures are needed for transgender youth, but there are no guidelines on how to collect or report this data. We use two theoretical cases to assert that health care providers and researchers should consider use of both male and female growth charts for transgender youth, particularly for individuals at the extremes of weight.

Background: Transgender/nonbinary (trans/NB) patients face stigma in health care settings. Health care professionals' training on trans/NB issues has historically been lacking. Interprofessional education (IPE) provides an opportunity to improve knowledge and attitudes across health care professions. The purpose of this study was to: (a) describe the development and implementation of an IPE workshop on gender-affirming care through a trans/NB community-academic partnership and (b) examine the impact of the workshop on student knowledge and attitudes. Methods: The workshop included a slide presentation on basic terminology and concepts, video clips of trans/NB patient-provider interactions, facilitated discussions of affirming practices, and a trans/NB panel. Nonparametric statistical analysis of pre- and post-survey data from 58 workshop participants measured changes in student knowledge and attitudes. Findings: Students demonstrated statistically significant improvements in knowledge (t=-12.72; p<0.01) and interpersonal comfort (t=-2.06; p<0.05) as well as sex and gender beliefs (t=-3.06; p<0.05) on subscales from the Transgender Attitudes & Beliefs Scale. The results demonstrated no differences on the human value subscale (t=-0.69; p=0.49) or on health care professional questions (t=-1.23; p=0.23). Conclusions: A community-academic partnership developed and implemented this brief interactive educational intervention, which can improve both knowledge and attitudes about trans/NB individuals' health among health professional students.

Purpose: Emerging literature suggests there may be important differences in the demographic characteristics and health profiles of nonbinary transgender youth compared to binary transgender youth. Methods: Between June 2017 and June 2018, 202 transgender youth aged 15-24 years were recruited into a randomized trial of home HIV testing, Project Moxie. This analysis compares demographic and health risk behavior characteristics between youth reporting nonbinary and binary transgender identities in baseline surveys. Results: Nonbinary youth were significantly less likely to have accessed medical interventions to affirm their gender than binary youth (8.4% vs. 46.2%), and less likely to be living currently as the gender that most affirms them (80.7% vs. 91.6%). While there were no significant differences in the low levels of resilience reported across the sample, nonbinary youth reported significantly higher levels of stress. Health risk behaviors were generally high across nonbinary and binary participants, with no significant differences in sexual partner count, condomless sex, alcohol use, tobacco, marijuana, or other drug use. Conclusion: Findings affirmed many similarities, and key disparities, between nonbinary and binary transgender youth. Research and interventions dedicated to the unique needs and experiences of nonbinary transgender youth to address high levels of health risk behaviors and stress are critical.

Introduction: This systematic review assessed the impact of race/ethnicity, education, and income on transgender individual's lifetime experience of suicidal thoughts and behaviors (SITB) in gray and published literature (1997-2017). Methods: Sixty four research projects (108 articles) were identified in WorldCat, PubMed, and Google Scholar. Articles were included if they were published in Canada or the United States, included original quantifiable data on transgender SITBs, and had ≥5 participants, at least 51% of whom were ≥18 years. Results: Across all projects suicide ideation averaged 46.55% and attempts averaged 27.19%. The majority of participants were Caucasian, whereas the highest rate of suicide attempts (55.31%) was among First Nations, who accounted for <1.5% of participants. Caucasians, by contrast, had the lowest attempt rate (36.80%). More participants obtained a bachelor's degree and fewer an associate or technical degree than any other level of education. Suicide attempts were highest among those with ≤some high school (50.70%) and lowest among those with an advanced degree (30.25%). More participants made an income of $20-$50,000/year and less $10-$20,000 than any other income bracket. Conclusion: SITBs, among the transgender population, are both universally high and impacted by race/ethnicity, educational attainment, and income. These findings may be useful in creating culturally and factually informed interventions for transgender individuals experiencing SITBs and in informing future research on this topic.