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Round R, Gokool N, Manica G, Paschall L, Foulcer S. Improving access for and experience of transgender and non-binary patients in clinical research: Insights from a transgender patient focus group and targeted literature reviews. Contemp Clin Trials 2023; 131:107243. [PMID: 37245727 DOI: 10.1016/j.cct.2023.107243] [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: 04/05/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The transgender and non-binary communities make up a significant, growing proportion of the population, but, to date, few clinical trials report including transgender and non-binary individuals. METHODS As part of a mixed-method approach, multiple literature searches for articles published from January 2018 to July 2022 and a Patient Advisory Council (a semi-structured patient focus group) meeting were conducted to identify challenges faced by the transgender and non-binary communities when accessing healthcare and participating in clinical research. A set of guidelines to promote inclusivity in clinical research was developed using these findings. RESULTS During this time period, only 107 (0.08%) of 141,661 published articles of clinical trials reported participation of transgender or non-binary patients. A targeted search identified only 48 articles reporting specific barriers to inclusion in clinical research, while an expanded search identified 290 articles reporting barriers to healthcare access for transgender and non-binary patients. Several key considerations to promote study inclusivity emerged from the literature searches and Patient Advisory Council: adjust clinical protocols, informed consent documents, and data collection forms to distinguish sex assigned at birth from gender identity; involve members of the transgender and non-binary communities in research whenever possible; provide communication training to personnel involved in clinical research; and maximize accessibility for potential participants. CONCLUSION Future research on investigational drug dosing and drug interactions in transgender and non-binary patients, along with regulatory guidance, are recommended to ensure clinical trials' processes, designs, systems, and technologies are transgender and non-binary patient-friendly, inclusive, and welcoming.
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Nguyen TT, Do AL, Nguyen LH, Vu GT, Dam VAT, Latkin CA, Hall BJ, Ho CSH, Zhang MWB, Ho RCM. Scholarly literature in HIV-related lesbian, gay, bisexual, and transgender studies: A bibliometric analysis. Front Psychol 2023; 14:1028771. [PMID: 36844310 PMCID: PMC9945527 DOI: 10.3389/fpsyg.2023.1028771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Lesbian, gay, bisexual, and transgendered (LGBT) people are marginalized and understudied. Analyzing research activity worldwide is vital to better understand their needs in confronting the HIV epidemic. This study aimed to evaluate the global literature to identify the research collaboration, content, and tendency in HIV-related issues among the LGBT populations. Methods Peer-reviewed original articles and reviews were achieved from the Web of Science Core Collection database. Country's collaborations and co-occurrence of most frequent terms were illustrated by VOSviewer software. The Latent Dirichlet Allocation (LDA) and the linear regression model were utilized to uncover the hidden topics and examine the research trend. Results From 1990 to 2019, a total of 13,096 publications were found. Stigma, sexual risk behaviors and HIV testing were the major topics in the LGBT research during the study period. Among 15 topics, topics about HIV/Sexually transmitted infections (STIs) prevalence, Outcomes of HIV/AIDS care and treatment, and Opportunistic infections in HIV-positive LGBT people showed decreasing attention over years, while other topics had a slight to moderate increase. Discussion Our study underlined the exponential growth of publications on the LGBT population in HIV research, and suggested the importance of performing regional collaborations in improving research capacity. Moreover, further research should focus on examining the manner to increase the coverage of HIV testing and treatment, as well as implement HIV-interventions with low cost and easy to scale-up.
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Affiliation(s)
- Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam,*Correspondence: Tham Thi Nguyen, ✉
| | - Anh Linh Do
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Giang Thu Vu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Vu Anh Trong Dam
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Brian J. Hall
- School of Global Public Health, New York University, New York, NY, United States
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melvyn W. B. Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Hall JP, Kurth NK, Ipsen C, Myers A, Goddard K. Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy. Health Aff (Millwood) 2022; 41:1433-1441. [DOI: 10.1377/hlthaff.2022.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jean P. Hall
- Jean P. Hall , University of Kansas, Lawrence, Kansas
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Ghorbanian A, Aiello B, Staples J. Under-Representation of Transgender Identities in Research: The Limitations of Traditional Quantitative Survey Data. Transgend Health 2022; 7:261-269. [PMID: 36643059 PMCID: PMC9829119 DOI: 10.1089/trgh.2020.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Research indicates that the portrayal and representation of transgender individuals within society, or lack thereof, impact the way in which they are able to reconcile their gender identity. Quantitative research methodology often requires that participants select one identity label from a limited list for each identity characteristic (e.g., race, sexual orientation, and relationship status). The process of choosing from limited items that do not represent one's identities limits our understanding of the nuances of identity and may create minority stress for the participant. Methods This study included 325 diverse transgender adults who participated in a national anonymous online survey as part of a broader study focused on minority stress and mental health. Participants answered questions about gender, sexual orientation, relationship status, race, and religion, and were given the option to select multiple response options and to write in additional identities that were not listed. Results Descriptive results indicated that 95 unique gender identities written in were not captured by the 14 gender labels provided, over 43% of participants selected multiple sexual orientations, and participants wrote in additional options for every identity variable. Conclusion The nuance of transgender identities may not be adequately captured by standard demographic research methodologies and research would benefit from ongoing revision of demographic response options informed by the literature. Through the process of acknowledging and validating less visible identities, transgender individuals will be better represented and understood by researchers.
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Affiliation(s)
- Ariann Ghorbanian
- California School of Professional Psychology, Alliant International University, San Diego, California, USA.,Address correspondence to: Ariann Ghorbanian, MA, California School of Professional Psychology, Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA,
| | - Bridget Aiello
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Jennifer Staples
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
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Tabler J, Snyder JA, Schmitz RM, Geist C, Gonzales CM. Embracing Complexity: Variation in Faculty's Attitudes toward Inclusive Measures of Gender and Sexuality in Social and Health Sciences Research. JOURNAL OF HOMOSEXUALITY 2022:1-23. [PMID: 35452368 DOI: 10.1080/00918369.2022.2059967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the absence of adequate measurement efforts, expansive gender and sexual identities will remain underexplored in quantitative social science and health research. We use primary survey data (N = 309) to identify factors associated with U.S.based social and health science faculty's attitudes toward inclusive gender and sexuality measures in participant-based research. Results suggest that political science faculty rated expansive gender and sexuality measures as less important to their own research, relative to psychology, sociology, and health sciences faculty. In addition, cisgender/heterosexual women and LGBTQ+ identifying faculty rate and apply these measures more positively compared to faculy who identify as cisgender/heterosexual men. Finally, faculty engaging in predominantly quantitative research, or in teaching-focused positions, had lower ratings of the importance of gender expansive measurement. Results suggest that while individual characteristics shape faculty's attitudes toward and use of inclusive gender and sexuality measures, disciplinary and academic contexts also matter.
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Affiliation(s)
- Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, Wyoming, USA
| | - Jamie A Snyder
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, Wyoming, USA
| | - Rachel M Schmitz
- Department of Sociology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Claudia Geist
- Department of Sociology and Division of Gender Studies, University of Utah, Salt Lake City, Utah, USA
| | - Carlos M Gonzales
- Department of Sociology and Criminology, Pennsylvania State University, Pennsylvania, USA
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Thangthaeng N, Hillard MA, Cayford M, Barrett S, Ducar D, Larkin ME. Promoting a gender-affirming environment in research: implications for research nurses. J Res Nurs 2022; 27:157-165. [PMID: 35392208 PMCID: PMC8980582 DOI: 10.1177/17449871211068647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Approximately 25 million people around the world identify as transgender, and the numbers are growing. While visibility of transgender communities has increased, significant healthcare disparities remain. Transgender individuals report being less inclined to share their sex assigned at birth due to fear of stigmatization and mistrust of the medical community. The mistrust and inequity experienced by transgender individuals are not limited to clinical care and may extend to clinical research as well. Aim and method: The aim of this paper is to start a conversation about barriers to participating in research and the role of research staff, specifically the Clinical Research Nurse, in promoting engagement of transgender individuals in clinical research trials. Discussion and conclusions: A discussion of safety considerations, data integrity, and implications for data management is included. Because disparities may result in large part from lack of education and knowledge on best practices for providing care for this population, recommendations for fostering a culture of competence and gender-affirming care among research professionals featuring the role of the research nurse will be discussed.
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Affiliation(s)
- Nopporn Thangthaeng
- Nopporn Thangthaeng, PhD, BSN, RN, Diabetes Research Center, Massachusetts General Hospital, 50 Staniford St, Ste 301, Boston, MA 02114, USA.
| | - Mallory A Hillard
- Nurse Practitioner, Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA
| | - Melody Cayford
- Research Study Nurse, Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA
| | - Sophia Barrett
- Research Intern, Transhealth Northampton, Florence, MA, USA
| | - Dallas Ducar
- Founding Chief Executive Officer, Transhealth Northampton, Florence, MA, USA
| | - Mary E Larkin
- Nurse Director, Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA
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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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Portz KJ, Burns A. Utilizing Mixed Methodology to Increase Cultural Competency in Research with Transgender and Gender Nonconforming Individuals. Transgend Health 2020; 5:69-73. [PMID: 32322690 PMCID: PMC7173686 DOI: 10.1089/trgh.2019.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transgender and gender nonconforming (TGNC) individuals experience increased risk to mental and physical health concerns based on minority stress variables, including discrimination, internalized stigma, and expectations of violence. Research in this area displays a disconnect between provider and TGNC individuals seeking care. This study sought to improve cultural competency in research with TGNC individuals, with the ultimate goal to further explore cultural competency factors in work with TGNC individuals in research and clinically. Mixed methods research was conducted with trans masculine, trans feminine, and nonbinary identifying individuals to pilot survey measures before administration in a larger study.
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Affiliation(s)
- Kaitlin J. Portz
- Siteman Psychology Service, Siteman Cancer Center, Barnes-Jewish Hospital, St. Louis, Missouri
- Address correspondence to: Kaitlin J. Portz, PhD, Siteman Psychology Service, Siteman Cancer Center, Barnes-Jewish Hospital, 4921 Parkview Place, MS 90-35-703, St. Louis, Missouri 63110
| | - Anna Burns
- Department of Social Work, Psychology, and Counseling, Alabama A&M University, Normal, Alabama
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Hafford-Letchfield T, Cocker C, Rutter D, Tinarwo M, McCormack K, Manning R. What do we know about transgender parenting?: Findings from a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1111-1125. [PMID: 30983067 DOI: 10.1111/hsc.12759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/11/2019] [Accepted: 03/11/2019] [Indexed: 05/12/2023]
Abstract
Transgender issues are under-explored and marginalised within mainstream social work and social care professional practice. The experience of gender transition has a profound impact on the individuals who have diverse gender identities and their family members. We present findings from a systematic review of studies concerning the experiences of transgender parenting conducted during January-September 2017. We took a life course approach, examining the research studies that investigated the experience of people identifying as transgender, who were already parents at the time of their transition or who wished to be parents following transition. The review evaluated existing findings from empirical research on transgender parenting and grandparenting to establish how trans people negotiate their relationships with children following transition, and sought to consider the implications for professional practice with trans people in relation to how best to support them with their family caring roles. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Empirical studies published from 1 January 1990 to 31 April 2017 in the English language, and which had transgender parenting as a significant focus, were included in the review. Twenty-six studies met the criteria. Key themes reported are: how trans people negotiate their relationships with children following disclosure and transition; the impact of parental transitioning on children; relationships with wider families; trans people's desires to be parents; and the role of professional practice to support trans families. We discuss how the material from the review can inform social work education and practice, including to help identify future research, education and practice priorities in this area.
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Affiliation(s)
- Trish Hafford-Letchfield
- Department of Mental Health and Social Work, School of Health and Education, Middlesex University, London, UK
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Staples JM, Neilson EC, George WH, Flaherty BP, Davis KC. A descriptive analysis of alcohol behaviors across gender subgroups within a sample of transgender adults. Addict Behav 2018; 76:355-362. [PMID: 28903090 DOI: 10.1016/j.addbeh.2017.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/10/2017] [Accepted: 08/17/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Transgender (trans) adults are identified as an at-risk group for problem alcohol use. Descriptive empirical data examining alcohol behaviors among trans adults is limited. The present study investigates alcohol behaviors - quantity, frequency, alcohol-related problems, and drinking to cope motives - across sex assigned at birth, gender expression, and gender identity subgroups within a sample of trans adults. METHOD A total of 317 trans participants were recruited to complete a cross-sectional battery of online measures assessing alcohol use behaviors, alcohol-related problems, and drinking to cope. Gender identity was assessed through two methods: (1) an open-ended question in which participants wrote-in their primary gender identity; and (2) participants rated the extent to which they identified with 14 gender identity categories. RESULTS This sample had high rates of alcohol use, alcohol-related problems, and drinking to cope motives relative to the general population. Significant and meaningful differences in drinking frequency, alcohol-related problems and drinking motives were found according to gender expression, but not sex assigned at birth or gender identity. CONCLUSIONS Future work should examine alcohol behaviors among trans individuals, including investigation of predictors and causal pathways, to inform prevention and intervention work aimed at reducing trans people's risk for alcohol-related problems.
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Affiliation(s)
- Jennifer M Staples
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - Elizabeth C Neilson
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - William H George
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - Brian P Flaherty
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - Kelly Cue Davis
- College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004, United States.
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Nieder TO, Köhler A, Eyssel J, Briken P. [Quality development within interdisciplinary transgender healthcare : Results and implications of a participatory research project]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:999-1008. [PMID: 28762122 DOI: 10.1007/s00103-017-2599-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Both internationally and nationally, the objective has been set to offer specialized, coordinated, and interdisciplinary treatment to individuals with rare clinical needs, such as trans individuals (e. g., transsexual, transgender). The Interdisciplinary Transgender Health Care Center Hamburg (ITHCCH) is the first and only center in Germany to integrate all disciplines relevant to trans healthcare (THC).The research project seeks to generate valid information to support quality development and assure high-quality treatment at the ITHCCH. This was done by (a) investigating needs and concerns of trans individuals regarding interdisciplinary THC, and (b) analyzing attitudes and interests of key stakeholders.Using a participatory approach involving a work group (representatives of trans support groups and local THC professionals), researchers developed an online survey focusing on trans individuals' needs and concerns. Data from N = 415 trans-identified participants were analyzed using quantitative and qualitative methods. In addition, a short survey was used to record key stakeholders' attitudes and interests towards the ITHCCH.Healthcare offers accessed by trans individuals as part of transition related treatment vary in focus and number. For example, take-up numbers of genital surgery differ between binary and non-binary trans individuals. Crucial aspects impacting on THC quality are structural characteristics, communication/social aspects, individuality, and professionalism/quality.To ensure successful, high-quality interdisciplinary THC, feedback from (potential) patients and stakeholders is crucial. In addition, both structural development and optimizing individuality and flexibility throughout the treatment process are key. This poses a considerable challenge to the sector of THC provision.
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Affiliation(s)
- Timo O Nieder
- Interdisziplinäres Transgender Versorgungscentrum Hamburg, Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Andreas Köhler
- Interdisziplinäres Transgender Versorgungscentrum Hamburg, Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Jana Eyssel
- Interdisziplinäres Transgender Versorgungscentrum Hamburg, Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Peer Briken
- Interdisziplinäres Transgender Versorgungscentrum Hamburg, Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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