Access to health services among sexual minority people in the United States

Prostate Cancer Screening and Diagnoses in the Transfeminine Population

OBJECTIVE

To examine the frequency and rate at which transfeminine patients receive prostate-specific antigen testing compared to a matched cisgender cohort.

METHODS

Patients with prostates who had encounters in our health system, are currently age 46 or older, and who are alive were included in our study. Transfeminine patients were identified through diagnosis codes and chart review. A 1:5 matched cohort was created based on patient age, race, and area deprivation index. Conditional logistic regression was done to compare odds of receiving any testing and Poisson regression was done to compare the total tests.

RESULTS

A total of 275,112 patients were included in the study, of which 315 were confirmed to be transfeminine. A well-matched 1:5 propensity-matched cohort was created. Our results suggest that transfeminine patients were 0.28 (95% CI 0.20-0.38, P <.001) times as likely as cisgender patients to receive at least 1 PSA test at our institution and received only 32% (95% CI 27%-37%, P <.001) as many total PSA tests.

CONCLUSION

Until more is known about the best practices for PSA testing in the transfeminine population, these patients should receive PSA testing. However, our results suggest that transfeminine patients are significantly less likely to receive any testing and significantly fewer tests in their lifetimes, which may represent a significant healthcare disparity.

Depressive Symptoms Among Older Gay Men: What Are the Most Important Determinants?

Background: Studies have shown that gay men experience higher levels of depression and are more likely to report suicidal ideation, plans, and attempts over their lifetime compared to heterosexual men. However, most studies have been conducted with adolescents and young adults, while there is a lack of research focusing on older adults. The aims of this study are to assess the level of depressive symptoms among older gay men and examine the associations between five key factors-loneliness, internalized homophobia, self-esteem, ageism, health behavior-and depressive symptoms. Methods: The convenience sample included seventy-nine gay men living in the community. Prospective participants were recruited by facilitators of social and support groups, who either distributed the questionnaire directly to members on-site or forwarded a link to their emails. All study measures used were valid and reliable. Results: Participants' mean level of depression exceeded the scale's cutoff point for detecting depression, indicating mild depression. Four variables made a significant contribution to the explanation of depression, with loneliness having the largest contribution, followed by ageism, internalized homophobia, and health behavior. The regression model explained a very high percentage of the depression variance (83%). Conclusions: These four factors are central to understanding depression among older gays. Medical and social professionals should recognize their significance and incorporate them into the treatment provided to those in need. Further studies are needed to gain a deeper understanding of the factors associated with depression in this vulnerable population.

Prostate Cancer in Sexual Minorities: Epidemiology, Screening and Diagnosis, Treatment, and Quality of Life

Prostate cancer has the highest incidence among all cancers in men. Sexual minorities, including gay and bisexual men, as well as transgender, were previously a "hidden population" that experienced prostate cancer. Although there continues to remain a paucity of data in this population, analyses from studies do not reveal whether this population is more likely to endure prostate cancer. Nonetheless, several qualitative and quantitative studies have established worse quality-of-life outcomes for sexual minorities following prostate cancer treatment. Increased awareness of this previously "hidden population" among healthcare workers, as well as more research, is warranted to gain further understanding on potential disparities faced by this growing population.