Health status of transgender people globally: A systematic review of research on disease burden and correlates

Patient care practices for LGBTQ+ individuals in clinical genetics: A scoping review

Individuals who are LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and/or have a sexual orientations and/or gender identity beyond cisheteronormative conceptions) face systemic barriers to healthcare, leading to significant health inequities. To address these challenges, genetic providers must better understand and inclusively address LGBTQ+ patient needs. This scoping review aims to map the current landscape of genetic care practices and their inclusivity toward LGBTQ+ individuals. We conducted a systematic search of databases, including Ovid MEDLINE, PsycINFO, and Web of Science, identifying 65 relevant articles focused on LGBTQ+ patient experiences and care practices within genetic healthcare services. Our thematic analysis of the articles highlights three major themes: exclusionary clinical environments and tools, provider biases and educational needs, and patient-reported barriers in accessing genetic services. Many articles underscored the importance of inclusive language and criticized the conflation of sex, sex chromosomes, and gender. A significant focus was on cancer care for transgender and gender-diverse individuals, revealing a need for more data on the effects of gender-affirming care on cancer risk assessment. Moreover, genetic counselors often report insufficient training in LGBTQ+ health needs, contributing to biases and knowledge gaps. Despite increased awareness among providers of the need for inclusive care, LGBTQ+ patients encounter substantial barriers, including medical distrust and limited family health history, which may deter them from disclosing their identities due to the risk of discrimination. This review calls for standardized data collection practices regarding sex-related variables, gender modality, and sexual orientation, alongside specialized training programs for providers. By emphasizing critical areas for research, policy changes, and education, we aim to promote equitable, patient-centered genetic services for LGBTQ+ communities.

A scoping review examining measurement of anti-transgender stigma in low- and middle-income countries

Globally, transgender and other gender diverse (trans) people experience widespread prejudice, discrimination, violence, and other forms of stigma, which contribute to negative health outcomes. Most anti-trans stigma research has been conducted in high-income countries. Measurement of anti-trans stigma in low- and middle-income countries (LMICs) is important for understanding and improving the health of trans populations globally. Accordingly, this scoping review explores the use of quantitative anti-trans stigma measures in LMICs. This scoping review follows the guidance of the PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist and examines empirical research with trans populations in LMICs published in English, Spanish, Arabic, and Russian between 2001-2024. Study eligibility criteria included: 1) trans study population, 2) LMIC study location, 3) quantitative or mixed-method study design, and 4) quantitative measurement of anti-trans stigma. The search yielded 82 articles (representing 65 unique studies) from 34 LMICs. Most articles were published since 2018. No articles focused exclusively on trans men. About 62% of articles included a primary focus on stigma; health outcomes primarily examined HIV and mental health. Nearly all articles (95%) measured enacted stigma; other forms of stigma (e.g., internalized and anticipated) were less commonly measured, and structural stigma was only measured in 4 articles. More than half of the articles (55%) measured stigma both broadly and within specific contexts (e.g., from family, in health care). More research exploring anti-trans stigma is needed, especially with trans-masculine and other gender diverse people, measuring outcomes beyond HIV and mental health, and measuring forms of stigma beyond enacted stigma. Expanding and improving measurement of anti-trans stigma in LMICs can improve our understanding of the mechanisms shaping health equity to inform context specific and tailored health interventions to support trans communities worldwide.

Phenotyping to Identify Mental Health Trends of Transgender Individuals Using Private Commercial Insurance Data in the United States

Purpose: We evaluated the performance of computational phenotypes (CPs) in commercial insurance claims for identifying transgender (TG) individuals and assessed trends in population size and depression and anxiety prevalence of the TG population. Methods: We compared two previously defined CPs by measuring their concordance. We combined CPs to establish a cohort of TG individuals from MerativeTM MarketScan® commercial insurance claims (2007-2021) to measure population and mental health trends using joinpoint regression. Results: Due to high levels of overlap between CPs, we combined CPs to reach our sample size of 67,809 unique individuals. TG-related International Classification of Diseases (ICD) diagnoses codes increased from 59% of TG claims in 2007 to 97% in 2021. We observed a sharp increase in the prevalence of TG-related claims in 2012 by 42.3% (95% confidence interval [CI] = 35.8-56.8) per year then by 17.0% per year (95% CI = 6.1-23.7) from 2017 to 2021. Among TG individuals there was a gradual increase in mental health-related claims from 2007 to 2015, which remained stable until there was a 10% decrease in 2021. Conclusion: The combined CP identified the largest TG population in commercial insurance claims to date. Most TG individuals were identified through TG-related ICD codes for both CPs. Increases over calendar time may represent an increased access to insurance-covered gender-affirming services. Persistently high depression and anxiety-related claims suggest an ongoing need to reduce the burden of psychiatric-related claims in this population.

The Situated Vulnerabilities and Resiliencies Framework: a call for integrated strategies to address global HIV inequities for transgender, non-binary, and gender diverse populations

Transgender, non-binary, and gender diverse (trans) populations are burdened by the risk of HIV acquisition. Achieving global UNAIDS 95-95-95 targets by 2030 among trans populations requires conceptual frameworks to understand HIV epidemic drivers and optimise effective strategies to curb HIV inequities in trans populations. The Situated Vulnerabilities and Resiliencies Framework describes and explains HIV inequities in these populations. The HIV epidemic among trans populations is situated in multilevel biopsychosocial contexts, and these populations are made vulnerable to HIV through fundamental causes and conditions that render them at risk for risk. Key considerations include pathways that are linked to sex and gender, all-population and trans-specific exposures, developmental context, syndemic dynamics, and intersectionality. The framework highlights the need to deploy integrated strategies and interventions that are neutral to HIV status and grounded in health and human rights, work with trans communities, and use strengths-based approaches leveraging situated resiliencies (ie, salutogenic factors such as collective agency and trans kinships) to reduce pervasive stigma and advance HIV equity in trans populations.

Experiences of Transformation: The Challenges of Gender Transition for Transgender Women in Pakistan

In a historical development, the Pakistani parliament made significant strides toward recognizing the rights of the third gender by enacting the Transgender Protection of Rights Act in 2018. This legislation represents a pivotal milestone in acknowledging and safeguarding the rights of transgender individuals in Pakistan. The present study sought to investigate the barriers encountered by transgender women in accessing gender-affirmative treatment for the purpose of gender transition. Ten transgender women participated in semi-structured and in-depth interviews, employing the grounded theory method for analysis. Analysis uncovered a spectrum of medical, social, sexual, legal, religious, financial, and psychological barriers that participants faced during the transition process. These findings are contextualized within Pakistan's cultural milieu and examined in relation to existing literature. The outcomes of this research have the potential to enlighten clinicians, academics, policymakers, and other stakeholders about the unique challenges encountered by transgender women, thereby fostering greater awareness and understanding.

Community involvement and engagement in designing a social-media based educational intervention for oral and sexual health promotion in transgender women in Malaysia: a narrative summary

Patient and public involvement and engagement (PPIE) in health care research has been advocated to ensure that the research is relevant, acceptable and beneficial to the communities that it serves. However, there remains a significant gap in research projects incorporating PPIE among the transgender communities, particularly from the global South. In this narrative summary the authors describe the methodology of PPIE through a novel collaboration with community members for the design and development of a bilingual and culturally sensitive educational intervention that was tailor made for transgender women in Malaysia. The educational intervention named Ms Radiance was aimed at creating oral health awareness, improving oral health care utilization and promoting safe oral sex practices among transgender women. The PPIE team included local transgender community advocates and artists who played a pivotal role in making the educational content accessible, engaging and suitable for delivery through a popular social media platform, Instagram®. PPIE enhanced the intervention's relevance and effectiveness through community friendly, culturally appropriate content creation, delivery and trust-building. Instructional designs such as the ADDIE (analyse, design, develop, implement and evaluate) ensure that educational interventions are well-planned and effective. A structed PPIE approach in the research project was seamlessly integrated with the ADDIE instructional design that guided the effective planning and delivery of oral health and sexual health education The research highlights the impact of PPIE on the project and offers insights for future interventions in marginalized communities from the global South.

Gender-Affirming Hormone Therapy and Depressive Symptoms Among Transgender Adults

Importance

In the US, transgender, nonbinary, and gender diverse (TGD) adults have high rates of depression. Gender-affirming hormone therapy (GAHT) is associated with improved mental health outcomes, yet existing US studies have short follow ups and lack sample diversity.

Objective

To evaluate the use of GAHT delivered in primary care as an intervention for moderate-to-severe depressive symptoms in diverse TGD adult patients.

Design, Setting, and Participants

LEGACY was an observational cohort study conducted in federally qualified community health centers in Boston and New York that followed up TGD patients (N = 3592) from calendar years 2016 to 2019 (48 months). Participants included individuals aged 18 years or older, gender identity different from sex at birth, a past 12-month medical visit, and signed patient consent form in the electronic health record (EHR).

Exposures

Prescriptions for GAHT obtained from EHR data, using the date of the first and last GAHT prescription in each calendar year of observation (GAHT within the year vs no GAHT during the year).

Main Outcomes and Measures

A binary outcome of patient-reported moderate-to-severe depressive symptoms was obtained using the validated Patient-Health Questionnaire (PHQ), scoring 10 or greater on the PHQ-9 or scoring 3 or greater on the PHQ-2. Following multiple imputation, generalized estimating equations (GEE) longitudinally modeled GAHT and moderate-to-severe depressive symptoms (n = 20 320 observations) and adjusted for age, gender identity, race and ethnicity, health insurance, federal poverty level, HIV serostatus, number of cohort years, and clinical site.

Results

The median age of the 3592 patients was 28 (IQR, 24-36) years. Race and ethnicity was diverse (1.3% Asian/Pacific Islander, 11.7% Black, 16.1% Hispanic/Latinx, 63.1% White, 6.8% multiracial, and 1.4% other). In addition, 18.9% were nonbinary, 52.1% lived below the federal poverty level, 34.2% were publicly insured, 4.1% were uninsured, and 5.1% were living with HIV. At baseline, 84.5% of the individuals were prescribed GAHT and 15.3% reported moderate-to-severe depressive symptoms. Patients prescribed GAHT had a statistically significantly lower risk of moderate-to-severe depressive symptoms over follow-up compared with those not prescribed GAHT (adjusted risk ratio, 0.85; 95% CI,  0.75-0.98).

Conclusions and Relevance

In this longitudinal observational cohort study, GAHT was associated with lower rates of moderate-to-severe depressive symptoms, highlighting the importance of gender-affirming primary care models for TGD patients.

Stratified analysis of health and gender-affirming care among Italian transgender and gender diverse adults

PURPOSE

This study aimed to provide the first comprehensive analysis of the health status of transgender and gender-diverse (TGD) adults in Italy, addressing disparities in physical and mental health and access to gender-affirming care. By combining self-reported health data with clinical evaluations and incorporating demographic and clinical variables, the research offers a robust and previously unavailable health profile of this population.

METHODS

An anonymous online survey targeting TGD adults across Italy was conducted from June 2020 to June 2021. The survey consisted of self-reported health assessments and clinician-conducted evaluations, collecting data on chronic physical conditions, mental health disorders, infectious diseases, and gender-affirming care. Statistical analyses, including chi-square tests and logistic regression, identified associations between demographics and health outcomes.

RESULTS

Among 959 participants, mental health disorders were prevalent, with over half experiencing depression and/or anxiety. Non-binary individuals reported poorer health compared to binary individuals. Chronic conditions such as thyroid disorders were more common in individuals assigned female at birth (AFAB), whereas those assigned male at birth (AMAB) had higher rates of osteoporosis and sexually transmitted infections. Key health predictors included age, education, employment, and engagement in gender-affirming hormone therapy.

CONCLUSION

The study reveals stark health disparities among TGD individuals in Italy, emphasizing the need for targeted health policies, expanded mental health services, and specialized healthcare provider training.

Towards Best-Practice Healthcare for Transgender Patients: Quality Improvement in United Kingdom General Practice

Introduction: The ongoing care of transgender patients in United Kingdom (UK) general practice (GP) is hampered by a lack of UK primary care guidelines regarding the monitoring of treatments, despite the key role that general practice has in holistic lifelong care. This quality improvement project aimed to audit the monitoring of treatments and health screening in a GP practice population, across two large practices in southwest England, in order to drive local improvement and to identify gaps in wider healthcare support for this population. Methods: This project updated a previously published audit instrument, incorporating a novel, pragmatic standard, based on up-to-date UK gender clinic guidelines and the UK population screening programmes. National Health Service (NHS) Health Research Authority and Medical Research Council processes were used to confirm that this quality improvement project did not require formal ethics committee approval. An audit against this standard was performed for 176 transgender and gender-minority patients, to provide data on the consistency of the monitoring of gender hormonal treatments and reminders for appropriate population health screening programmes. Results: A total of 16% of those undergoing hormonal treatments had received optimal monitoring; 20% were missing the most basic hormone level monitoring. Reminders regarding appropriate health screening were rare in patients who had changed the gender markers on their electronic record. Long waiting lists, the use of private clinics, confusion around responsibilities shared between primary and secondary care and growing complex co-morbidity were demonstrated. Conclusions: This project supports previous calls for consistent evidence-based guidelines, improved data systems and adequately resourced primary and secondary care services to support the safe and effective lifelong care of transgender patients.

The AFFIRM Framework for gender-affirming care: qualitative findings from the Transgender and Gender Diverse Health Equity Study

BACKGROUND

Transgender, nonbinary, and gender diverse (TGD) people experience stigma in healthcare settings impacting healthcare utilization, including avoidance of care due to anticipated discrimination. Gender-affirming care refers to care for medical gender affirmation, such as gender-affirming hormones and surgery, as well as general care that affirms and respects TGD patients. This study sought to explore the experiences of TGD adults to inform gender-affirming care delivery and develop an actionable framework for practice.

METHODS

Between May-October 2021, one-time individual in-depth interviews were conducted with 27 TGD adults receiving any healthcare in the greater Boston Massachusetts area to gather data about gender-affirming care. Interviews were semi-structured, explored prior and current experiences in healthcare and ideal gender-affirming care models, and conducted virtually via a secure Zoom platform. Analyses were conducted using immersion crystallization and reflexive thematic analysis; interview transcripts were double coded by two coders.

RESULTS

Participants had a mean age of 28.5, ranging 18-45 years, and were: 7 transgender men, 6 transgender women, 8 nonbinary, 3 genderqueer, 1 agender, and 2 gender not specified. Themes about gender-affirming care coalesced into the acronym AFFIRM: (1) Affirms in individual interactions: Participants called for affirmation of TGD identity, lived expertise, and competent TGD providers and staff. (2) Flexible and accessible: Participants expressed the need for gender-affirming care to be available beyond urban population-specific clinics, in a timely fashion without long wait lists, and in a community-centered manner such as offering non-traditional times and settings. (3) Fights systemic oppression: Participants emphasized the need for providers and health systems to eliminate gatekeeping practices for gender-affirming care and create care models that resist intersecting oppressive systems such as racism and cisgenderism. (4) Interacts with community: Patients desired intentional interaction with TGD community to holistically address health and unmet gender affirmation needs. (5) Retains patients in care: Patients shared the need to collaboratively identify and problem-solve obstacles to gender-affirming care with providers and healthcare systems to optimize TGD-specific retention strategies. (6) Multidisciplinary: Patients called for interdisciplinary teams with co-located services such as primary care and mental healthcare with letter-writing for surgical care, and incorporation of peer navigators to meet the broader social, health, and well-being needs of TGD people.

CONCLUSIONS

Findings from this study and the AFFIRM Framework which emerged from TGD patient narratives can be applied to improve current care and set benchmarks for high-quality gender-affirming care delivery and practice.

Hormones, Stress, and Heart Disease in Transgender Women with HIV in LITE Plus

INTRODUCTION

Cardiovascular disease (CVD) is a leading cause of death among transgender women and people with HIV. Exogenous estrogen and psychosocial stressors are known risk factors for CVD. Yet, few studies have used biomarkers to examine the role of stress in CVD risk among transgender women with HIV (TWHIV). This analysis examined whether stress moderates relationships between gender-affirming hormone therapy (GAHT) duration and CVD risk among TWHIV.

METHODS

This cross-sectional analysis of baseline data from an observational cohort of 108 Black and Latina TWHIV in Boston, New York, and Washington, DC, enrolled December 2020 to June 2022, measured sociodemographics, medical diagnoses, medications, smoking history, and perceived stress via interviewer-administered surveys. Physiological stress was measured with 14 biomarkers to calculate allostatic load indices (ALI). Forty participants provided saliva samples used to calculate cortisol awakening response and cortisol daily decline. The 2018 American College of Cardiology Revised Pooled Cohort Equation estimated 10-year CVD risk. Data were analyzed in 2024.

RESULTS

GAHT duration was positively associated with CVD risk scores in bivariate regression. In multivariable linear regression models (adjusting for age, income, education), only age and ALI remained significantly associated with CVD risk scores (β 1.13, CI: 1.05, 1.21). No stress measure significantly interacted with GAHT duration to affect CVD risk scores. In visual plots, GAHT duration increased CVD risk scores only for TWHIV experiencing the highest ALI.

CONCLUSIONS

Stress plays an important role in CVD in TWHIV. More research is needed on non-GAHT factors, which influence CVD health among transgender women.

A Trans and Queer Discursive Approach to Gender Diversity and Misgendering in the Transgender and Gender Diverse Population: Queering a Study for ICD-11

Producing knowledge about transgender and gender-diverse (TGD) individuals is a core public health strategy challenge. Yet several systemic limitations arise, notably the exclusion or exploitation of TGD individuals by research systems reproducing systemic discrimination by embedding social norms as self-evident facts of nature. This is particularly worrying in biomedical research, and contributes to the invisibilization of participants' gender diversity. This trans research illustrates methodological challenges through queering an earlier study by focusing on misgendering as a discursive element. We based our work on discursive materials reported by TGD participants in an ICD-11 study on gender incongruence. We used network analyses to illustrate potential differences between declared gender identity and discourse practices. Our results highlight a gap between declared gender identity and discourse practices, bringing the number of non-binary participants in the sample from 15 (20.8%) to 36 (50.0%). Moreover, misgendering and the use of derogatory terms are more common toward gender-diverse individuals. Sexual orientation shows a similar trend. This study reveals the reproduction of social norms within research processes and medical knowledge, as well as how, from an individual perspective, their non-compliance seems to be a key factor in TGD individuals' experience. By providing this simple methodological example, we hope to promote better integration of gender and its various dimensions into biomedical and public health research.

"Encouraged to be Your True Self": An Interpretative Phenomenological Study of Medical Students' Experiences of Role Models in Shaping Sexual Minority Identity in Medical School

Phenomenon: Sexual and gender minority (SGM) identifying individuals experience worse health outcomes compared to non-SGM identifying counterparts. Representation of SGM individuals within medical schools may improve the delivery of more equitable healthcare through reducing biases and normalizing SGM presence within healthcare spaces. Approach: Our initial aim was to explore the extent to which role models may influence personal SGM identities within medical schools in the United Kingdom, using an interpretative phenomenological approach. This methodology allowed us to develop meaning from, and give voice to participants' relationship with their bespoke experiences, respecting differing narratives within the broad 'SGM' umbrella, rather than attempting to establish commonalities. Semi-structured interviews were conducted with five medical students and three medical school faculty within three medical schools, who identified as SGM. Due to a lack of gender minority identifying participants, we unfortunately could not adequately speak to their experiences, and therefore narrowed our eventual focus to sexual minority (SM) individuals. Findings: The developed themes followed a cyclical process of: (1) role model identification; (2) role model selection, influenced by matched wider identities including generation, hierarchy and power; (3) trait assimilation, particularly where identity deficits were perceived; and (4) identity projection, where students used role models to both emulate comfortable SM identity projection, and become advocatory role models themselves. Throughout, participants described role models as multifaceted in their direction (vertical and horizontal), influence (positive and negative) and locus of effect (as individuals, and as part of a collective). Unexpectedly, identity, power, and hierarchy-matching meant peer-to-peer role modeling was often experienced more positively than vertical faculty-to-student role modeling. However, as expected, heteronormativity exerted an inhibitory effect on this process. Insights: We built upon existing social cognitive paradigms to develop a 'double-funnel' model to represent how social contexts can map onto individual SM identities and vice versa, mediated by role models. The triangulation of these three aspects in relation to medical education presents novel understandings to the field. Greater explicit institutional support of student-led SM societies, and facilitation of the presence and discussion of SM symbols and personal identities within professional spaces, may go a long way in redefining 'normativity' in medical schools.

Psychological interventions for depression in people with diabetes mellitus

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus.

Design and pilot evaluation of a brief intervention to reduce transphobia and improve attitudes of government officials to address legal gender affirmation needs of transgender people in Peru

Legal gender affirmation - legal name and gender marker change - is an important health-promoting health determinant for transgender people. In Peru, the state's failure to universally recognize transgender people's legal identity limits standardized legal affirmation procedures, including the paucity of government officials trained in gender affirmation strategies. This project, in partnership with Registro Nacional de Identificación y Estado Civil (RENIEC) and transgender communities, designed and piloted a group-based intervention to sensitize government officers to the importance of gender-concordant identity documents. Between August 2017 and February 2018, three in-person group intervention sessions were held (each 3-4 hours) with 51 government officers. Guided by Gender Affirmation and Structural Violence Frameworks, the intervention utilized Adult Learning Theory and applied storytelling and testimonials as pedagogy. Pre-/post-test surveys were administered (19 true/false items, summed to create an index score measuring knowledge and attitudes toward transgender people). Within-person changes in pre-/post-intervention scores were evaluated using paired t-tests. Pre-/post-test data were available for 41 participants. After the intervention, there were improvements in knowledge and more favorable attitudes toward transgender people (pre-test mean = 14.09, SD = 2.33 vs. post-test mean = 15.62, SD = 1.82; difference = 1.53, 95% CL = 0.60, 2.67; t-test = 3.30 [df = 46]; p = 0.002). The intervention was feasible to conduct and garnered high acceptability. The results suggest the promise of this brief intervention for future research and testing before potential later implementation and scale-up to increase the capacity of government officers to address legal gender affirmation for transgender people in Peru.

Androgen receptor expression in recurrent granulosa cell tumor of the ovary: Clinical considerations of treatment and surveillance in a transgender male

Granulosa cell tumors (GCT) represent a rare subtype of ovarian cancers. A majority of these tumors express androgen receptor (AR), making them hormonally sensitive. AR positivity not only suggests a potential role of anti-androgen therapy in treating these tumors but also poses a cause for concern: female to male (FTM) transgender patients undergoing exogenous testosterone therapy may be at risk for recurrence, progression, or even incidence of this type of cancer. Although treatment of GCT in transgender individuals has not been well-described, the impact of exogenous hormone use on cancer physiology and treatment should be considered, while also addressing gender dysphoria throughout treatment and in surveillance. Here, we describe a FTM transgender patient with recurrent AR-positive adult granulosa cell tumor after starting testosterone supplementation, along with a literature review to explore the current knowledge of ovarian changes observed following FTM gender transition and subsequent risk of ovarian cancer.

The experiences of oppression among transgender and gender expansive young people in Australia: An interpretative phenomenological study

Background: Transgender and gender expansive (TGE) people experience poorer mental health outcomes compared to their cisgender counterparts. There is limited research on understanding the experiences of TGE school-aged young people from an Australian perspective. Since each country and state has different cultures, laws, and access to gender-affirming care research considering these differences is imperative.Methods: To address this gap, we used a qualitative design to explore the oppression of Australian TGE young people. Sixteen TGE participants (aged 14-17) completed individual semi-structured interviews. Data were analysed using interpretive phenomenological analysis.Results: Three superordinate themes were identified: (1) oppression within the education system; (2) oppression within the medical and allied health system; and (3) oppression within the family system. The findings highlight the various settings and contexts of oppression young people encounter. We identified what must change for a more equitable society and advocate for the implementation of gender-affirming change.Discussion and conclusion: This study contributes to the dearth of TGE adolescents's experiences and provides practical implications for society, especially in relation to the education, medical, and family systems. The implications include advocacy for more research in Australia and the inclusion of adolescents in policy reform. Limitations of this study and future directions are discussed.

Oral health status among the transgender population of India: A systematic review and meta-analysis

BACKGROUND

The invisibility of the transgender population within official records, combined with other socio-economic factors, impacts oral health status among transgender people. Hence, our systematic review and meta-analysis aim to generate a pooled estimate of the oral health status of the transgender community in India.

MATERIAL AND METHODS

A systematic search was performed across four databases. The studies included a quantitative research design conducted in India and involved self-identified transgender individuals. The pooled prevalence was determined at a 95% confidence interval (CI). Q-statistics and the I2 test were utilized to evaluate the source of heterogeneity. Leave-one-out analysis and Baujat plots were used to detect outliers within the studies. A Doi plot and LFK index were employed to assess the publication bias.

RESULTS

A total of 12 studies comprising 1566 transgender participants were included. The pooled prevalence of toothbrush use among transgenders in India was found at 83% (95% CI: 0.73-0.91), smoking = 12% (CI: 0.03-0.26), smokeless tobacco = 53% (CI = 0.38-0.68), dental caries = 78% (CI: 67%-88%), calculus = 65% (CI: 0.4-0.86), and bleeding 18% (CI:0.08-0.32).

CONCLUSION

Oral health disparities among Indian transgender individuals are evident in the low toothbrush usage, an elevated prevalence of tobacco use, and dental disorders such as calculus, cavities, and bleeding. Tailored dental health programs that include inclusive healthcare services and awareness are essential.

PROSPERO REGISTRATION

CRD42023468872.

Enhancing brain health in the Global South through sex and gender lens

Gender inequality substantially impacts society, disproportionately disadvantaging women, especially in the Global South. This inequality correlates with brain health outcomes for women, including a higher risk of cognitive decline and dementia. This perspective highlights how sex-linked biology and gender disparities affect women's brain health in the Global South through various pathways, such as differential exposome, health behaviors, and gender biases in research and healthcare systems. Alzheimer's disease and other brain health conditions exemplify how sex-specific risk factors and gender-related health barriers interact to influence brain health. We advocate for incorporating sex/gender considerations in research, policy, and clinical practice to improve brain health interventions in the Global South. Additionally, we propose using the patient and public involvement framework to effectively tailor health strategies that address these factors.

Characterization of the literature informing health care of transgender and gender-diverse persons: A bibliometric analysis

BACKGROUND AND OBJECTIVE

Transgender and gender-diverse (TGD) persons experience health inequities compared to their cisgender peers, which is in part related to limited evidence informing their care. Thus, we aimed to describe the literature informing care provision of TGD individuals.

DATA SOURCE, ELIGIBILITY CRITERIA, AND SYNTHESIS METHODS

Literature cited by the World Professional Association of Transgender Health Standards of Care Version 8 was reviewed. Original research articles, excluding systematic reviews (n = 74), were assessed (n = 1809). Studies where the population of interest were only caregivers, providers, siblings, partners, or children of TGD individuals were excluded (n = 7). Results were synthesized in a descriptive manner.

RESULTS

Of 1809 citations, 696 studies met the inclusion criteria. TGD-only populations were represented in 65% of studies. White (38%) participants and young adults (18 to 29 years old, 64%) were the most well-represented study populations. Almost half of studies (45%) were cross-sectional, and approximately a third were longitudinal in nature (37%). Overall, the median number of TGD participants (median [IQR]: 104 [32, 356]) included in each study was approximately one third of included cisgender participants (271 [47, 15405]). In studies where both TGD and cisgender individuals were included (n = 74), the proportion of TGD to cisgender participants was 1:2 [1:20, 1:1]. Less than a third of studies stratified results by sex (32%) or gender (28%), and even fewer included sex (4%) or gender (3%) as a covariate in the analysis. The proportion of studies with populations including both TGD and cisgender participants increased between 1969 and 2023, while the proportion of studies with study populations of unspecified gender identity decreased over the same time period.

CONCLUSIONS

While TGD participant-only studies make up most of the literature informing care of this population, longitudinal studies including a diversity of TGD individuals across life stages are required to improve the quality of evidence.

Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals

BACKGROUND

Limited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroids on gut microbiota taxonomy and function, addressing this gap. We prospectively analyzed gut metagenome changes associated with 12 weeks of GAHT in trans women and trans men, examining both taxonomic and functional shifts.

METHODS

Thirty-six transgender individuals (17 trans women, 19 trans men) provided pre- and post-GAHT stool samples. Shotgun metagenomic sequencing was used to assess the changes in gut microbiota structure and potential function following GAHT.

RESULTS

While alpha and beta diversity remained unchanged during transition, specific species, including Parabacteroides goldsteinii and Escherichia coli, exhibited significant abundance shifts aligned with affirmed gender. Overall functional metagenome analysis showed a statistically significant effect of gender and transition (R2 = 4.1%, P = 0.0115), emphasizing transitions aligned with affirmed gender, particularly in fatty acid-related metabolism.

CONCLUSIONS

This study provides compelling evidence of distinct taxonomic and functional profiles in the gut microbiota between trans men and women. GAHT induces androgenization in trans men and feminization in trans women, potentially impacting physiological and health-related outcomes.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02185274.