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Glintborg D, Møller JJK, Rubin KH, Lidegaard Ø, T'Sjoen G, Larsen MLJØ, Hilden M, Andersen MS. Gender-Affirming Treatment and Employment Rate in 3812 Danish Transgender Persons and 38 120 Controls. J Clin Endocrinol Metab 2024; 109:3076-3086. [PMID: 38771642 DOI: 10.1210/clinem/dgae351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/20/2024] [Accepted: 05/20/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE Gender-affirming care could be associated with higher employment rate. We assessed employment rates in transgender persons compared to controls and demographic, health, and treatment-related factors associated with employment in transgender persons. METHODS National register-based cohort study in Danish persons with diagnosis code of gender dysphoria during year 2000-2021. Five age-matched controls of the same sex at birth and 5 age-matched controls of the other sex at birth were included. The date of study inclusion was the first date of transgender diagnosis. Employment was the primary study outcome. RESULTS The cohort included 3812 transgender persons and 38 120 cisgender controls. The median age (interquartile range) was 19 (15; 24) years for transgender men, n = 1993 and 23 (19; 33) years for transgender women, n = 1819. In transgender men compared to control cisgender women, the odds ratio (OR) (95% CI) for employment was 0.33 (0.29; 0.38) before study inclusion and 0.24 (0.20; 0.29) in the fifth calendar year after index; in transgender women compared to control cisgender men, corresponding ORs were 0.30 (0.70; 0.34) and 0.21 (0.18; 0.25). Similar findings were observed between transgender persons and cisgender controls of other sex. Use of gender-affirming hormone in transgender men increased probability of employment at all time points after 5 years (OR 1.61 [95% CI: 1.08; 2.42], P = .02). In transgender women, use of hormone treatment was not associated with changed employment rates at 5 years (OR 1.31 [0.94; 1.82], P = .11). CONCLUSION Masculinizing hormone treatment was associated with higher probability of employment.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense 5000, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
| | - Jens-Jakob Kjer Møller
- OPEN-Open Patient Data Explorative Network, Odense University Hospital, Odense 5000, Denmark
| | - Katrine Hass Rubin
- OPEN-Open Patient Data Explorative Network, Odense University Hospital, Odense 5000, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
| | - Øjvind Lidegaard
- Department of Gynaecology, Fertility and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent 9000, Belgium
| | - Mie-Louise Julie Ørsted Larsen
- Department of Gynaecology, Fertility and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Malene Hilden
- Department of Gynaecology, Fertility and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense 5000, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
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Henriques M, Pereira H. Psychosexual Health and Well-Being of Trans and Gender-Diverse Individuals in Portugal. SOCIETIES 2024; 14:144. [DOI: 10.3390/soc14080144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
This study aimed to explore and describe the perceptions of trans and gender-diverse individuals (TGD) in Portugal regarding the implications on their psychological, social, and psychosexual health. A qualitative investigation was conducted using an electronic interview answered by 32 participants. The data were examined through a thematic analysis, and the following themes were identified: experiences with healthcare services, social interaction, discrimination experiences, mental health, social support systems, self-esteem, social identity, sex and sexual health, quality of life, and sociopolitical enhancement strategy proposals. The analysis of these themes provides information on the perceptions and experiences of the participants and suggests factors that impact the well-being and quality of life of the individuals in the current sample.
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Affiliation(s)
- Mariana Henriques
- Department of Psychology and Education, Faculty of Social and Human Sciences, University of Beira Interior, Pólo IV, 6200-209 Covilhã, Portugal
| | - Henrique Pereira
- Department of Psychology and Education, Faculty of Social and Human Sciences, University of Beira Interior, Pólo IV, 6200-209 Covilhã, Portugal
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
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Almås EM, Benestad EEP, Bolstad SH, Karlsen TI, Giami A. Gender Identity Orientation and Sexual Activity-A Survey among Transgender and Gender-Diverse (TGD) Individuals in Norway. Healthcare (Basel) 2024; 12:482. [PMID: 38391857 PMCID: PMC10888209 DOI: 10.3390/healthcare12040482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The understanding and conceptualizing of gender and sexuality are continuously negotiated between individuals and cultures. Recently, new gender identity orientations have emerged, fighting pathologization and establishing new spaces and options for being sexually active gendered beings. OBJECTIVE To investigate variations in sexual activities across different gender identity orientations. METHOD A questionnaire used in France was adapted to the Norwegian context and implemented in this study. The participants were recruited through therapists, TGD organizations, and social media. RESULTS A total of 538 individuals responded to the questionnaire, of which 336 provided a written description of their gender identity. Based on an analysis of the degree of male gender identity orientation, the degree of female gender identity orientation, and the degree of nonbinary gender identity orientation, three clusters appeared and were used in the analyses of sexual activities and preferences. CONCLUSIONS Some findings could be attributed to lingering aspects of traditional gender roles, while others may be indicative of sexual expression stemming from societal acceptance of gender diversity and new identity orientations.
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Affiliation(s)
- Elsa Mari Almås
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | | | - Silje-Håvard Bolstad
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | - Tor-Ivar Karlsen
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | - Alain Giami
- INSERM (National Institute of Health and Medical Research), 94807 Paris, France
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Casas-Ramírez M, Martínez-Linares JM, Cortés-Martín JJ, López-Entrambasaguas OM. Trans people perceptions of care received from healthcare professionals - A phenomenological study. Heliyon 2024; 10:e23328. [PMID: 38163130 PMCID: PMC10755318 DOI: 10.1016/j.heliyon.2023.e23328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Trans people have unique health needs and turn to the public health system to meet them. Offering them a more inclusive assistance requires health professionals to know these needs and work on cultural competence. Understanding trans people perceptions of service received will improve therapeutic relationships and the assistance provided to them. Objective To understand trans patients experiences with health care and their perception of care rendered by the Andalusian Public Health System. Design A qualitative phenomenological study according to Ricoeur's hermeneutic approach. Methodology 18 in-depth interviews were conducted between January and April 2022 with trans adult users of the Andalusian Public Health System. These interviews were audio recorded, transcribed and analyzed following the steps proposed by Tan. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study report. Results Three themes were generated from trans patients experiences in the Andalusian Public Health System related to the assistance provided to them: 1) Positive and negative feelings during their pass through the public health system, 2) The importance of being able to receive the care they need, and 3) Having the chosen identity in official documents in order to utterly complete their transition. Conclusion Care rendered by healthcare professionals to trans people was received as positive in mostly cases. However, trans people think these professionals need more training in order to avoid some behaviors they perceive as discriminatory and which they believe tends to pathologize gender identity. They also require more information about the treatments in particular they are about to receive and they demand to end drug shortages. Administrative procedures to change identity are also problematic. So the healthcare system must undergo some modifications in order to become more inclusive.
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Recognizing the diversity of the Portuguese transgender population: A cross-sectional study. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Suen YT, Chan RCH, Wong EMY. Heterogeneity in the Desire to Undergo Various Gender-Affirming Medical Interventions Among Transgender People in Hong Kong: Findings from a Community-Driven Survey and Implications for the Legal Gender Recognition Debate. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3613-3625. [PMID: 36121583 DOI: 10.1007/s10508-022-02352-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Previous estimates suggest that there are at least nine million transgender people in Asia-Pacific; however, in most countries, legal gender recognition has not been made possible or there are otherwise stringent eligibility criteria. The obligation of having undergone gender-affirming medical interventions as a basis for such recognition is being hotly debated. However, there has been little empirical evidence on the desire to undergo various gender-affirming medical interventions among transgender people. This study fills the research gap by studying Hong Kong, where a transgender person must produce medical evidence for "complete" sex reassignment surgery in order to change the sex entry on their identity card. A community-driven survey of 234 transgender people found that only 13.0% of the participants who were assigned male at birth could fit such a requirement. Strikingly, because none of the participants assigned female at birth had undergone construction of a penis or some form of a penis, all of them would be excluded from legal gender recognition. Financial reasons and reservations about surgical risks and/or techniques were the most commonly cited reasons for not undertaking the medical interventions. The findings suggest that an overwhelming majority of transgender people in Hong Kong are excluded from legal gender recognition, which fundamentally affects their civil, political, economic, social, and cultural rights. More generally, this study shows heterogeneity among transgender people in the desire for different gender-affirming medical interventions, and thus argues that the legal gender recognition debate needs to consider their concerns and self-determination.
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Affiliation(s)
- Yiu Tung Suen
- Gender Studies Programme, Faculty of Social Science, Chinese University of Hong Kong, Room 250, 2/F, Sino Building, Shatin, Hong Kong.
| | - Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Eliz Miu Yin Wong
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Barcelos TMR, Ferreira CHJ, Lerri MR, Brito LGO, de Sá MFS, de Sá ACS, da Silva Lara LA. Sexual function of transgender women after gender affirming surgery: A mini review. Clin Anat 2022; 35:560-570. [PMID: 35334140 DOI: 10.1002/ca.23863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/11/2022]
Abstract
A transgender person has a gender identity opposite to the sex assigned at birth. Transgender individuals may have altered sexual function (SF) due to psychosocial factors related to body image distortion, shame, and dissatisfaction with genital appearance, and these conditions can increase the risk of sexual dysfunction. This study aimed to characterize the SF of trans-women after gender affirming surgery (GAS). We reviewed the Pubmed database for studies published between January 2008 and December 2021. 17 studies were included, four were cross-sectional studies, one prospective study, four prospective cohort studies, five retrospective studies. The instruments used to evaluate the SF were female sexual function index, semistructured questionnaires, patients' opinion, Sexual Desire Inventory, Maudsley Marital Questionnaire-S, WHOQOL-100. The results of our review indicate there is weak evidence that GAS improves the SF of trans-women. We thus recommend that future studies use questionnaires that are validated for the assessment of the SF of trans-women to better determine the impact of genital surgery in this population.
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Affiliation(s)
| | | | - Maria Rita Lerri
- Department of Gynecology and Obstetrics, Clinical Hospital of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Di Grazia M, Taverna C. Considerations on critical issues of categorizations of gender incongruence in epidemiologic research. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Kronk CA, Everhart AR, Ashley F, Thompson HM, Schall TE, Goetz TG, Hiatt L, Derrick Z, Queen R, Ram A, Guthman EM, Danforth OM, Lett E, Potter E, Sun SD, Marshall Z, Karnoski R. Transgender data collection in the electronic health record: Current concepts and issues. J Am Med Inform Assoc 2022; 29:271-284. [PMID: 34486655 PMCID: PMC8757312 DOI: 10.1093/jamia/ocab136] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/13/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
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Affiliation(s)
- Clair A Kronk
- Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Avery R Everhart
- Population, Health, and Place Program, Spatial Sciences Institute, University of Southern California, Los Angeles, California, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Florence Ashley
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Hale M Thompson
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, Illinois, USA
| | - Theodore E Schall
- Berman Institute of Bioethics, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Teddy G Goetz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurel Hiatt
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Zackary Derrick
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Roz Queen
- Health Information Science, School of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - A Ram
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
| | - E Mae Guthman
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, USA
| | - Olivia M Danforth
- Department of Family Medicine, Samaritan Health Services Geary St. Clinic, Albany, Oregon, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emery Potter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Simón(e) D Sun
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Center for Neural Science, New York University, New York, New York, USA
- Department of Neuroscience and Physiology, Neuroscience Institute, NYU Grossman Medical Center, New York, New York, USA
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Ryan Karnoski
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
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Mabire X, Robin-Radier S, Ferraz D, Preau M. FOREST protocol: a qualitative study exploring health and sexuality of transmasculine individuals in France. BMJ Open 2021; 11:e052748. [PMID: 34848520 PMCID: PMC8634350 DOI: 10.1136/bmjopen-2021-052748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION While current research on sexuality and health often explores sexual behaviours among heterosexual and gay cisgender individuals, little is known about the sexualities of transgender people, especially transmasculine people. When data are available, sexual health is often reduced to risk exposure, not considering in detail social context and determinants that could contribute to a more comprehensive approach, such as general health, class, race, exposure to violence or social representations. Recognising this gap, identified in both national (French) and international scientific literature, this study aims to explore the sexual health of transmasculine people, employing an intersectional approach and considering both positive and negative health determinants. METHODS This 2-year research based in the disciplinary field of social psychology, with a gender perspective, and will apply qualitative methods. We adopt a community-based research approach, integrating one university and one community-based organisation in the coordination of the study. In a triangulation perspective, two rounds of semistructured interviews will be performed with key informants (medical practitioners, community-based support services workers, etc) and with people self-identifying as transmasculine. Focus groups will complement data collection. ETHICS AND DISSEMINATION FOREST protocol was approved by the Comité d'Évaluation Éthique (CEEI) de l'Institut National de la Santé Et de la Recherche Médicale (CEEI/International Review Board 00003888). The research adopts the principles of open science, and findings will be published assuring participants' confidentiality. Informative flyers and videos will be elaborated to communicate study findings to participants, stakeholders and the transcommunities at large, and data will be stored in lasting archives.
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Affiliation(s)
- Xavier Mabire
- PHASE (Psychology of Health, Aging and Sport Examination), University of Lausanne Faculty of Social and Political Science, Lausanne, Vaud, Switzerland
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
| | - Suzanne Robin-Radier
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
- Community-Based Organization, OUTrans NGO, Paris, Île-de-France, France
| | - Dulce Ferraz
- PHASE (Psychology of Health, Aging and Sport Examination), University of Lausanne Faculty of Social and Political Science, Lausanne, Vaud, Switzerland
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Brazil
| | - Marie Preau
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
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Barrientos Delgado J, Saiz JL, Guzmán-González M, Bahamondes J, Gómez F, Castro MC, Espinoza-Tapia R, Saavedra LL, Giami AJ. Sociodemographic Characteristics, Gender Identification, and Gender Affirmation Pathways in Transgender People: A Survey Study in Chile. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3505-3516. [PMID: 34259985 DOI: 10.1007/s10508-021-01939-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 06/13/2023]
Abstract
Understanding the internal diversity of transgender communities is essential for developing optimal, inclusive policies and service provision. To date, research on this topic remains scarce in Chile. We conducted a survey study describing sociodemographic characteristics (age, sex assigned at birth, onset age, nationality, education, sex work, having a partner, having children, sexual orientation, religiousness, gender identification, and gender affirmation pathways). A snowball sample of 377 self-identified transgender adults living in Chile (Mage = 31.88, rangeage = 18-67) was collected for the purpose of this study. According to their sex assigned at birth, 139 participants were female and 238 male. Results revealed that sex assigned at birth was significantly associated with almost all the sociodemographic variables. Eight gender self-identification categories were obtained based on self-declaration. These gender identification categories varied according to sex assigned at birth. Finally, four patterns (clusters) of gender affirmative actions were identified among participants. These patterns indicated that the longer the gender affirmation pathway time, the greater the invasiveness level of the medical procedures used. Sex assigned at birth moderated the association between gender affirmation pathways and gender identity categories. Results were discussed highlighting the heterogeneity found in terms of sociodemographic characteristics, gender identification, and gender affirmation pathways.
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Affiliation(s)
- Jaime Barrientos Delgado
- Facultad de Psicología, Universidad Alberto Hurtado, Almirante Barroso 10, 8340575, Santiago, Chile.
| | - José L Saiz
- Departamento de Psicología, Universidad de La Frontera, Temuco, Chile
| | | | - Joaquín Bahamondes
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Fabiola Gómez
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | | | - Alain J Giami
- INSERM-CESP Institut National de la Santé et de la Recherche Médicale, Villejuif, France
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Bray G, Giami A. Prises en charge médicales et psychologiques de la vie sexuelle des femmes trans : revue de la littérature internationale. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Glintborg D, Rubin KH, Kristensen SBM, Lidegaard Ø, T’Sjoen G, Burgwal A, Hilden M, Andersen MS. Socioeconomic status in Danish transgender persons: a nationwide register-based cohort study. Endocr Connect 2021; 10:1155-1166. [PMID: 34414901 PMCID: PMC8494405 DOI: 10.1530/ec-21-0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gender dysphoria could be associated with low socioeconomic status (SES). SES could be modified by age, ethnic background, and medical morbidity. AIM To determine SES in a national study population including transgender persons in Denmark. METHODS National register-based cohort study in Danish transgender persons and age-matched controls. The transgender study cohort included persons with ICD-10 diagnosis code of 'gender identity disorder' and/or persons with legal sex change and persons who fulfiled the inclusion criteria during 2000-2018. The main outcome measure was SES including personal income, occupational status, and education. RESULTS The cohort included 2770 transgender persons and 27,700 controls. In the transgender study cohort, 1437 were assigned male at birth (AMAB), median age (interquartile range, IQR) 26.0 (17.3) years, and 1333 were assigned female at birth (AFAB), median age 22.5 (10.3) years. Adjusting for age and sex, the relative risk ratio (RRR) of low vs high personal income was 5.6 (95% CI: 4.9; 6.3) in transgender persons compared to controls. The RRR of low vs high income was 6.9 (5.8; 8.3) in persons AMAB compared to control males and 4.7 (3.9; 5.6) in persons AFAB compared to control females. The RRR of low vs high income was 3.7 (3.2; 4.3) in transgender persons of Danish origin compared to controls. The Charlson comorbidity index was comparable in transgender persons vs controls. CONCLUSIONS Being transgender was negatively associated with SES. In transgender persons, the risk of low vs high income could be more pronounced in transgender persons of foreign origin.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence should be addressed to D Glintborg:
| | - Katrine Hass Rubin
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Simon Bang Mohr Kristensen
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guy T’Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Aisa Burgwal
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Gender Identity, Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Di Grazia M, Sammartano F, Taverna C, Knowles A, Trombetta C, Barbone F. Epidemiologic considerations on gender incongruence in adults, adolescents and children and mental health issues: A review of the literature. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Di Grazia M, Sammartano F, Taverna C, Knowles A, Trombetta C, Barbone F. Considérations épidémiologiques sur l’incongruence de genre chez les adultes, les adolescents et les enfants et les questions de santé mentale : une revue de la littérature. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Condat A, Mamou G, Lagrange C, Mendes N, Wielart J, Poirier F, Medjkane F, Brunelle J, Drouineaud V, Rosenblum O, Gründler N, Ansermet F, Wolf JP, Falissard B, Cohen D. Transgender fathering: Children's psychological and family outcomes. PLoS One 2020; 15:e0241214. [PMID: 33211742 PMCID: PMC7676740 DOI: 10.1371/journal.pone.0241214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
Medical advances in assisted reproductive technology have created new ways for transgender persons to become parents outside the context of adoption. The limited empirical data does not support the idea that trans-parenthood negatively impacts children’s development. However, the question has led to lively societal debates making the need for evidence-based studies urgent. We aimed to compare cognitive development, mental health, gender identity, quality of life and family dynamics using standardized instruments and experimental protocols in 32 children who were conceived by donor sperm insemination (DSI) in French couples with a cisgender woman and a transgender man, the transition occurring before conception. We constituted two control groups matched for age, gender and family status. We found no significant difference between groups regarding cognitive development, mental health, and gender identity, meaning that neither the transgender fatherhood nor the use of DSI had any impact on these characteristics. The results of the descriptive analysis showed positive psycho-emotional development. Additionally, when we asked raters to differentiate the family drawings of the group of children of trans-fathers from those who were naturally conceived, no rater was able to differentiate the groups above chance levels, meaning that what children expressed through family drawing did not indicate cues related to trans-fatherhood. However, when we assessed mothers and fathers with the Five-Minute Speech Sample, we found that the emotions expressed by transgender fathers were higher than those of cisgender fathers who conceived by sex or by DSI. We conclude that the first empirical data regarding child development in the context of trans-parenthood are reassuring. We believe that this research will also improve transgender couple care and that of their children in a society where access to care remains difficult in this population. However, further research is needed with adolescents and young adults.
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Affiliation(s)
- Agnès Condat
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- CESP INSERM 1018, ED3C, Université Paris Descartes, Paris, France
- * E-mail:
| | - Grégor Mamou
- Clinique Dupré, Fondation Santé des Etudiants de France, Sceaux, France
| | - Chrystelle Lagrange
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Nicolas Mendes
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Service Biologie de la Reproduction–CECOS, Hôpital Cochin, AP-HP, Paris, France
| | - Joy Wielart
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Fanny Poirier
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - François Medjkane
- Service de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Lille, Lille, France
| | - Julie Brunelle
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Ouriel Rosenblum
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Service Biologie de la Reproduction–CECOS, Hôpital Cochin, AP-HP, Paris, France
| | - Nouria Gründler
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Service Biologie de la Reproduction–CECOS, Hôpital Cochin, AP-HP, Paris, France
| | - François Ansermet
- Service de Psychiatrie de l’enfant et de l’adolescent, Département de l’enfant et de l’adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jean-Philippe Wolf
- Service Biologie de la Reproduction–CECOS, Hôpital Cochin, AP-HP, Paris, France
- Université Paris Descartes, Paris, France
| | | | - David Cohen
- Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
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Rowniak S, Bolt L, Sharifi C. Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review. ACTA ACUST UNITED AC 2020; 17:1826-1854. [PMID: 31021971 DOI: 10.11124/jbisrir-2017-003869] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals. INTRODUCTION Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic. INCLUSION CRITERIA Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. METHODS A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools. RESULTS Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. CONCLUSIONS Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.
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Affiliation(s)
- Stefan Rowniak
- School of Nursing and Health Professionals, University of San Francisco, San Francisco, USA
| | - Lindsay Bolt
- Institute for Nursing Excellence, University of California, San Francisco (UCSF) Health, San Francisco, USA.,UCSF Centre for Evidence Synthesis & Implementation: a Joanna Briggs Institute Centre of Excellence
| | - Claire Sharifi
- University of San Francisco Gleeson Library, Geschke Center, University of San Francisco, San Francisco, USA
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18
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Carrara S, Hernandez JDG, Uziel AP, Conceição GMSD, Panjo H, Baldanzi ACDO, Queiroz JP, D'Angelo LB, Balthazar AMSE, Silva Junior ALD, Giami A. Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil. CAD SAUDE PUBLICA 2019; 35:e00110618. [PMID: 30994742 DOI: 10.1590/0102-311x00110618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] Open
Abstract
The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey's main objectives were to gauge the trans/travesti population's diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers' social networks. For defining respondents' gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.
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Affiliation(s)
- Sérgio Carrara
- Laboratório de Diversidade Sexual e de Gênero, Políticas e Direitos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Jimena de Garay Hernandez
- Laboratório de Diversidade Sexual e de Gênero, Políticas e Direitos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Anna Paula Uziel
- Laboratório de Diversidade Sexual e de Gênero, Políticas e Direitos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Henri Panjo
- Centre de Recherche en Épidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale, University Paris Saclay - F- 94807 Villejuif, Paris, France
| | | | - João Pedro Queiroz
- Instituto de Psicologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Luisa Bertrami D'Angelo
- Programa de Pós-graduação em Psicologia Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Adriana Maria Shad E Balthazar
- Laboratório de Diversidade Sexual e de Gênero, Políticas e Direitos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Aureliano Lopes da Silva Junior
- Laboratório de Diversidade Sexual e de Gênero, Políticas e Direitos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Alain Giami
- Centre de Recherche en Épidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale, University Paris Saclay - F- 94807 Villejuif, Paris, France
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19
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Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People. J Immigr Minor Health 2019; 20:115-123. [PMID: 27804013 DOI: 10.1007/s10903-016-0527-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.
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20
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Nikolavsky D, Hughes M, Zhao LC. Urologic Complications After Phalloplasty or Metoidioplasty. Clin Plast Surg 2018; 45:425-435. [PMID: 29908632 DOI: 10.1016/j.cps.2018.03.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the past decade, issues facing transgender individuals have come to the forefront of popular culture, political discourse, and medical study. The evaluating physician should have knowledge of the reconstructed anatomy, as well as potential postoperative complications. This knowledge will aid in providing appropriate care and recognizing issues that may require specialized urologic care. Transgender anatomic definitions and a synopsis of common urologic complications specific to transmen, including urethrocutaneous fistulae, neourethral strictures, and persistent vaginal cavities are discussed.
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Affiliation(s)
- Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA.
| | - Michael Hughes
- Department of Urology, SUNY Upstate Medical University, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Lee C Zhao
- Department of Urology, New York University School of Medicine, 50 East 32nd, Street, 2nd Floor, New York, NY 10016, USA
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21
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Getahun D, Nash R, Flanders WD, Baird TC, Becerra-Culqui TA, Cromwell L, Hunkeler E, Lash TL, Millman A, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Safer J, Slovis J, Tangpricha V, Goodman M. Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med 2018; 169:205-213. [PMID: 29987313 PMCID: PMC6636681 DOI: 10.7326/m17-2785] [Citation(s) in RCA: 293] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use. OBJECTIVE To examine the incidence of these events in a cohort of transgender persons. DESIGN Electronic medical record-based cohort study of transgender members of integrated health care systems who had an index date (first evidence of transgender status) from 2006 through 2014. Ten male and 10 female cisgender enrollees were matched to each transgender participant by year of birth, race/ethnicity, study site, and index date enrollment. SETTING Kaiser Permanente in Georgia and northern and southern California. PATIENTS 2842 transfeminine and 2118 transmasculine members with a mean follow-up of 4.0 and 3.6 years, respectively, matched to 48 686 cisgender men and 48 775 cisgender women. MEASUREMENTS VTE, ischemic stroke, and myocardial infarction events ascertained from diagnostic codes through the end of 2016 in transgender and reference cohorts. RESULTS Transfeminine participants had a higher incidence of VTE, with 2- and 8-year risk differences of 4.1 (95% CI, 1.6 to 6.7) and 16.7 (CI, 6.4 to 27.5) per 1000 persons relative to cisgender men and 3.4 (CI, 1.1 to 5.6) and 13.7 (CI, 4.1 to 22.7) relative to cisgender women. The overall analyses for ischemic stroke and myocardial infarction demonstrated similar incidence across groups. More pronounced differences for VTE and ischemic stroke were observed among transfeminine participants who initiated hormone therapy during follow-up. The evidence was insufficient to allow conclusions regarding risk among transmasculine participants. LIMITATION Inability to determine which transgender members received hormones elsewhere. CONCLUSION The patterns of increases in VTE and ischemic stroke rates among transfeminine persons are not consistent with those observed in cisgender women. These results may indicate the need for long-term vigilance in identifying vascular side effects of cross-sex estrogen. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute and Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- Darios Getahun
- Kaiser Permanente Southern California, Pasadena, California (D.G., T.A.B., V.P.Q.)
| | - Rebecca Nash
- Emory University, Atlanta, Georgia (R.N., W.D.F., T.L.L., M.G.)
| | - W Dana Flanders
- Emory University, Atlanta, Georgia (R.N., W.D.F., T.L.L., M.G.)
| | - Tisha C Baird
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California (T.C.B.)
| | | | - Lee Cromwell
- Kaiser Permanente Georgia, Atlanta, Georgia (L.C., B.R.)
| | - Enid Hunkeler
- Kaiser Permanente Northern California, Oakland, California (E.H., A.M., M.J.S., J.S.)
| | - Timothy L Lash
- Emory University, Atlanta, Georgia (R.N., W.D.F., T.L.L., M.G.)
| | - Andrea Millman
- Kaiser Permanente Northern California, Oakland, California (E.H., A.M., M.J.S., J.S.)
| | - Virginia P Quinn
- Kaiser Permanente Southern California, Pasadena, California (D.G., T.A.B., V.P.Q.)
| | | | - Douglas Roblin
- Kaiser Permanente Mid-Atlantic States, Rockville, Maryland (D.R.)
| | - Michael J Silverberg
- Kaiser Permanente Northern California, Oakland, California (E.H., A.M., M.J.S., J.S.)
| | - Joshua Safer
- Icahn School of Medicine at Mount Sinai, New York, New York (J.S.)
| | - Jennifer Slovis
- Kaiser Permanente Northern California, Oakland, California (E.H., A.M., M.J.S., J.S.)
| | - Vin Tangpricha
- Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia (V.T.)
| | - Michael Goodman
- Emory University, Atlanta, Georgia (R.N., W.D.F., T.L.L., M.G.)
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22
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Girard G, Doré V. Thirty Years of Research on Gay Men and HIV Prevention in France: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1341-1349. [PMID: 29417262 DOI: 10.1007/s10508-018-1163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/16/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
Research on homosexuality and HIV/AIDS in the social sciences has evolved into a vast and multiform field of study since the beginning of the epidemic in the Global North. Studies from France in this domain have remained relatively unknown at the international level. This article offers a narrative review of publications that resulted from research on homosexuality and HIV/AIDS, from 1985 to 2016. It offers an analysis of how the constitution of a field of research conditions the ways scientific questions are asked (and answered). This epistemological concern is addressed through a sociohistorical contextualization of the main issues surrounding prevention and how they have been addressed by researchers in France. A review of French publications on HIV prevention among gay men reveals certain specificities. In terms of the social science disciplines, psychology and psychoanalysis are much less present in this domain, whereas epidemiology, sociology, and anthropology are the most represented. The works analyzed in this article also reveal the circulation and local adaptations of risk categories imported from the English-speaking world, such as "relapse" and "bareback." Regardless, research on HIV prevention in France largely evolved contemporaneously in the same way that it did elsewhere.
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Affiliation(s)
- Gabriel Girard
- Institut de Recherche en Santé Publique de l, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
| | - Véronique Doré
- Agence Nationale de Recherche sur le Sida et les hépatites virales, Paris, France
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23
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Prunas A, Bandini E, Fisher AD, Maggi M, Pace V, Quagliarella L, Todarello O, Bini M. Experiences of Discrimination, Harassment, and Violence in a Sample of Italian Transsexuals Who Have Undergone Sex-Reassignment Surgery. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:2225-2240. [PMID: 26763285 DOI: 10.1177/0886260515624233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present study aims to provide an overview of experiences of discrimination, harassment, and violence in a sample of Italian transsexuals who have undergone sex-reassignment surgery (SRS). Lack of support for gender transition from family members was also assessed, before and after SRS. Data were collected in the context of a multicentric study (Milan, Florence, and Bari) on SRS outcome. Patients who underwent SRS were contacted and asked to fill out a questionnaire concerning experiences of discrimination, harassment, violence, and crime they might have experienced in previous years. Seventy-two participants took part in the research: 46 were male-to-female (MtF; 64%) and 26 were female-to-male (FtM; 36%). Thirty-six percent of the total sample (with no differences between MtF and FtM) experienced at least one episode of harassment, violence, or discrimination. The workplace was reported to be the social area with the highest risk of discrimination and harassment (22% of participants). Reports of more than one incident of discrimination, harassment, and violence characterized the majority of participants in the MtF sample. Compared with previous studies carried out in other countries, a much larger proportion of participants could count on a supportive family environment before and after transition. Our results show that Italian society at large is prejudiced against transsexuals, but at a more "micro" level, having a trans person as a family member might result in a protective and tolerant attitude.
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Affiliation(s)
- Antonio Prunas
- 1 University of Milano-Bicocca, Italy
- 2 Associazione Italiana Sessuologia e Psicologia Applicata, Milan, Italy
- 3 Ospedale Niguarda-Ca' Granda, Milano, Italy
| | | | | | - Mario Maggi
- 4 Careggi University Hospital, Florence, Italy
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24
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Quinn VP, Nash R, Hunkeler E, Contreras R, Cromwell L, Becerra-Culqui TA, Getahun D, Giammattei S, Lash TL, Millman A, Robinson B, Roblin D, Silverberg MJ, Slovis J, Tangpricha V, Tolsma D, Valentine C, Ward K, Winter S, Goodman M. Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people. BMJ Open 2017; 7:e018121. [PMID: 29284718 PMCID: PMC5770907 DOI: 10.1136/bmjopen-2017-018121] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/11/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. PARTICIPANTS A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. FINDINGS TO DATE About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. FUTURE PLANS STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to gender affirmation therapy.
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Affiliation(s)
- Virginia P Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Enid Hunkeler
- Division of Research, Kaiser Permanente Northern California (emerita), Oakland, California, USA
| | - Richard Contreras
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Tracy A Becerra-Culqui
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Shawn Giammattei
- The Rockway Institute, Alliant International University, San Francisco, California, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Douglas Roblin
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Slovis
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, Georgia, USA
- The Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Cadence Valentine
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Savannah Winter
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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25
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Beckwith N, Reisner SL, Zaslow S, Mayer KH, Keuroghlian AS. Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults. Transgend Health 2017; 2:156-164. [PMID: 29159310 PMCID: PMC5685205 DOI: 10.1089/trgh.2017.0028] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults. Methods: We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of gender-affirming surgery and of age of hormone therapy initiation. Results: Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD=11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist. Conclusion: This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients.
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Affiliation(s)
- Noor Beckwith
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sari L. Reisner
- Harvard Medical School, Boston, Massachusetts
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shayne Zaslow
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Sociology, University of Virginia, Charlottesville, Virginia
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alex S. Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Address correspondence to: Alex S. Keuroghlian, MD, MPH, Division of Education and Training, The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, E-mail:
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Vitelli R, Scandurra C, Pacifico R, Selvino M, Picariello S, Amodeo A, Valerio P, Giami A. Trans identities and medical practice in Italy: Self-positioning towards gender affirmation surgery. SEXOLOGIES 2017. [DOI: 10.1016/j.sexol.2017.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vitelli R, Scandurra C, Pacifico R, Selvino M, Picariello S, Amodeo A, Valerio P, Giami A. Identifications de genre trans et pratiques médicales en Italie : positionnement personnel envers les formes de chirurgie de confirmation de genre. SEXOLOGIES 2017. [DOI: 10.1016/j.sexol.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kailas M, Lu HMS, Rothman EF, Safer JD. PREVALENCE AND TYPES OF GENDER-AFFIRMING SURGERY AMONG A SAMPLE OF TRANSGENDER ENDOCRINOLOGY PATIENTS PRIOR TO STATE EXPANSION OF INSURANCE COVERAGE. Endocr Pract 2017; 23:780-786. [PMID: 28448757 DOI: 10.4158/ep161727.or] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Transgender individuals now have many options for medical intervention, including gender-affirmation surgeries. However, it is unknown how common it is for transgender individuals to undergo these surgeries. The purpose of this cross-sectional study was to assess the prevalence of gender-affirming surgeries among transgender patients in 2015, which was immediately prior to insurance changes that made gender-affirming surgery more affordable for Massachusetts residents. METHODS A retrospective chart review of 99 transgender patients was performed at the Endocrinology Clinic at Boston Medical Center, an urban safety net hospital. The records for 99 transgender subjects who received treatment between 2004-2015, including 28 transmen and 71 transwomen, were examined. The outcome measures were the types of medical interventions chosen by transgender patients, which included hormone therapy, chest surgery, gonadectomy, genital surgery, and facial surgery. RESULTS Thirty-five percent of subjects had undergone at least one gender-affirming surgery. Transmen were more likely to have had surgery than transwomen (54% vs. 28%). Twenty-five percent of patients had chest surgery, 13% had genital surgery or gonadectomy, and 8% had facial surgery. CONCLUSION In 2015, a majority of transgender endocrinology clinic patients had not undergone any type of gender-affirmation surgery. Among those who did elect to have a surgery, genital surgery or gonadectomy were uncommon. The low rate of surgery among this sample of transgender patients may be attributable to the financial cost, lack of interest in surgery, or that genital surgery is not a high priority for transgender individuals relative to surgery to change visible features such as face and chest. Abbreviation: HT = hormone therapy.
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Parkinson P. Gender dysphoria and the controversy over the Safe Schools program. Sex Health 2017; 14:417-422. [DOI: 10.1071/sh17014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022]
Abstract
The Safe Schools program has attracted great controversy. On one end of the spectrum, it is defended as an anti-bullying program for young people who identify themselves as gay or lesbian, or have issues concerning their gender identity. On the other end of the spectrum, it is regarded as social engineering. This article seeks to promote a discussion of the way in which gender identity issues are addressed in the Safe Schools program. It is argued that the information in this program to Principals, teachers and young people is inaccurate and misleading. The program, as presently designed, may actually cause harm to children and young people who experience gender identity issues because it promotes gender transitioning without expert medical advice. The Safe Schools materials do not acknowledge that the great majority of children resolve gender dysphoria issues around the time of puberty. It may be much more difficult for a child to accept his or her gender at puberty if he or she has already changed name and gender identity in primary school. These deficits need to be addressed if the program is to continue.
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Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev 2017; 39:93-107. [PMID: 28486701 PMCID: PMC5868281 DOI: 10.1093/epirev/mxw003] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022] Open
Abstract
Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.
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Affiliation(s)
- Hayley Braun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Janice Brockman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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Sineath RC, Woodyatt C, Sanchez T, Giammattei S, Gillespie T, Hunkeler E, Owen-Smith A, Quinn VP, Roblin D, Stephenson R, Sullivan PS, Tangpricha V, Goodman M. Determinants of and Barriers to Hormonal and Surgical Treatment Receipt Among Transgender People. Transgend Health 2016; 1:129-136. [PMID: 27689139 PMCID: PMC5012371 DOI: 10.1089/trgh.2016.0013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose: Medical gender confirmation therapy (GCT) plays an important role in transgender health; however, its prevalence and determinants constitute an area of uncertainty. Methods: Data for this cross-sectional study were obtained from an online survey distributed from October 2012 through the end of 2013 among persons who visited the social media sites of a transgender education and social networking meeting. Eligible respondents (n=280) were persons whose gender identity was different from their sex assigned at birth and who responded to questions about previously received or planned hormonal therapy (HT), chest reconstruction, or genital surgery. Multivariable logistic regression models examined how receipt and plans to receive different GCT types were associated with participants' characteristics and gender identity. Results: The respective percentages of ever and current HT were 58% and 47% for transwomen and 63% and 57% for transmen. Genital surgery was reported by 11 participants; all transwomen. Relative to transmen, transwomen were thrice more likely to report plans to undergo genital surgery. By contrast, transmen were more than 10 times as likely as transwomen to have had or planned chest surgery. Older participants and those who were in a committed relationship were less likely to plan future GCT. Having health insurance was not associated with GCT receipt. Treatment cost was named as the main problem by 23% of transwomen and 29% of transmen. Accessing a qualified healthcare provider for transgender-related care was listed as the primary reason for not receiving surgery by 41% of transmen and 2% of transwomen. Conclusions: Prevalence of GCT differed across subgroups of participants and was lower than corresponding estimates reported elsewhere. The variability of results may reflect differences in recruitment procedures and response rates; however, it is also possible that it may be driven by geographic, socioeconomic, and health-related heterogeneity of the transgender population.
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Affiliation(s)
- R Craig Sineath
- Rollins School of Public Health, Emory University, Atlanta, Georgia.; School of Medicine, Emory University, Atlanta, Georgia
| | - Cory Woodyatt
- Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Travis Sanchez
- Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Shawn Giammattei
- The Rockway Institute, Alliant International University , San Francisco, California
| | - Theresa Gillespie
- School of Medicine, Emory University, Atlanta, Georgia.; Atlanta VA Medical Center, Decatur, Georgia
| | - Enid Hunkeler
- Division of Research, Kaiser Permanente, Oakland, California
| | - Ashli Owen-Smith
- School of Public Health, Georgia State University , Atlanta, Georgia
| | | | - Douglas Roblin
- School of Public Health, Georgia State University , Atlanta, Georgia
| | | | | | - Vin Tangpricha
- School of Medicine, Emory University, Atlanta, Georgia.; Atlanta VA Medical Center, Decatur, Georgia
| | - Michael Goodman
- Rollins School of Public Health, Emory University , Atlanta, Georgia
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Roblin D, Barzilay J, Tolsma D, Robinson B, Schild L, Cromwell L, Braun H, Nash R, Gerth J, Hunkeler E, Quinn VP, Tangpricha V, Goodman M. A novel method for estimating transgender status using electronic medical records. Ann Epidemiol 2016; 26:198-203. [PMID: 26907539 PMCID: PMC4772142 DOI: 10.1016/j.annepidem.2016.01.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records of an integrated health system. METHODS A computer program scanned Kaiser Permanente Georgia electronic medical records from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., "transgender" or "transsexual") in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second program and another round of text string reviews. RESULTS Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the 185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%, 95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. CONCLUSIONS The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems.
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Affiliation(s)
- Douglas Roblin
- School of Public Health, Georgia State University, Atlanta; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Joshua Barzilay
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Laura Schild
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Hayley Braun
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rebecca Nash
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Enid Hunkeler
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Vin Tangpricha
- Emory University, School of Medicine, Atlanta, GA; The Atlanta VA Medical Center, Atlanta, GA
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, GA.
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Roblin D, Barzilay J, Tolsma D, Robinson B, Schild L, Cromwell L, Braun H, Nash R, Gerth J, Hunkeler E, Quinn VP, Tangpricha V, Goodman M. A novel method for estimating transgender status using electronic medical records. Ann Epidemiol 2016. [PMID: 26907539 DOI: 10.1016/j.annepidem.2016.01.004.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records of an integrated health system. METHODS A computer program scanned Kaiser Permanente Georgia electronic medical records from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., "transgender" or "transsexual") in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second program and another round of text string reviews. RESULTS Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the 185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%, 95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. CONCLUSIONS The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems.
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Affiliation(s)
- Douglas Roblin
- School of Public Health, Georgia State University, Atlanta; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Joshua Barzilay
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Laura Schild
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Hayley Braun
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rebecca Nash
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Enid Hunkeler
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Vin Tangpricha
- Emory University, School of Medicine, Atlanta, GA; The Atlanta VA Medical Center, Atlanta, GA
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, GA.
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Abstract
In the DSM-5, there has been a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent. The Workgroup for Sexual and Gender Identity Disorders, chaired by Kenneth J. Zucker, was employed by the American Psychiatric Association (APA) to update the DSM-5's GID diagnosis reflecting contemporary scientific knowledge. Additionally, in a pre-publication report to the APA, members of the Workgroup suggested that they would also be concerned with the destigmatization of transpeople while preserving a diagnosis that medical insurance companies would accept for issuing payments for transitioning treatments (Drescher, 2013). The aims of this article are, firstly, to question whether changing the diagnosis lessens the stigmatization of transpeople. I will suggest that the semantic change from GID to GD marks "inverted" gendered expressions as pathological and, thus, continues to stigmatize transpeople. Secondly, the article explores the development of the GD diagnosis, and illustrates how the scientific data this were founded on are contentious. The article then demonstrates how the trans anti-pathologization movement has challenged the perceived pathologizing effects of the DSM-5 classification of GD. The article examines a selection of Western transgender community advocates' websites, forums, and blogs. From these sources, the article then explores the different narratives of transpeople and political groups who offer details of their praxis, and evidences how the trans anti-pathologization advocates use the available science and human rights discourses to contest the role of psychiatry in the treatment of transpeople.
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Affiliation(s)
- Zowie Davy
- School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK,
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