1
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Ong C, Monita M, Liu M. Gender-affirming hormone therapy and cardiovascular health in transgender adults. Climacteric 2024; 27:227-235. [PMID: 38597210 DOI: 10.1080/13697137.2024.2310518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/20/2024] [Indexed: 04/11/2024]
Abstract
A growing number of people identify as transgender and gender non-binary in the USA and worldwide. Concomitantly, an increasing number of patients are receiving gender-affirming hormone therapy (GAHT) to achieve gender congruence. GAHT has far-ranging effects on clinical and subclinical markers of cardiovascular risk. Transgender patients also appear to be at higher risk for cardiovascular diseases compared to their cisgender peers and the impact of gender-affirming therapy on cardiovascular health is unclear. Studies on the effect of GAHT on cardiovascular outcomes are confounded by differences in GAHT regimens and methodological challenges in a diverse and historically hard-to-reach population. Current cardiovascular guidelines do not incorporate gender identity and hormone status into risk stratification and clinical decision-making. In this review, we provide an overview on the cardiometabolic impact and clinical considerations of GAHT for cardiovascular risk in transgender patients.
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Affiliation(s)
- Caroline Ong
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Monique Monita
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Minghao Liu
- Department of Endocrinology, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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2
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Strenth CR, Smith M, Gonzalez L, Grant A, Thakur B, Levy Kamugisha EI. Mediational pathways exploring the link between adverse childhood experiences and physical health in a transgender population. Child Abuse Negl 2024; 149:106678. [PMID: 38309101 DOI: 10.1016/j.chiabu.2024.106678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) consist of instances of abuse, neglect, or household dysfunction occurring before adulthood. Prevalence rates of ACEs are higher among specific populations, including gender minorities. In addition to ACEs, transgender individuals (TG) face many personal, social, and structural factors that have the potential to negatively impact their physical health. OBJECTIVE This study examines exploratory mediational pathways between ACEs and two health outcomes (i.e., general health and days physically ill) in TG. Mediators include everyday discrimination, social support, gender non-affirmation, and mental distress. METHODS Cross-sectional data from the U.S. Transgender Population Health Survey (TransPop) was used to conduct a serial/parallel mediation analysis. The TransPop survey included a total of 274 TG. RESULTS For both outcome variables, the same three indirect pathways were significant. First, ACEs were associated with increased mental distress, which was associated with a decrease in general health and an increase in days physically ill. Second, ACEs were associated with increased discrimination, which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill. Finally, ACEs were associated with discrimination, which was associated with increased gender non-affirmation which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill. CONCLUSION Interventions focused on reducing discrimination, gender non-affirmation, and poor mental health may be vital to improving the health of TG and to mitigating the indirect role of ACEs on TG health.
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Affiliation(s)
- Chance R Strenth
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Margaret Smith
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Leo Gonzalez
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Abigail Grant
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Bhaskar Thakur
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Emily I Levy Kamugisha
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
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3
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Jordan SP. Compelling care: A grounded theory of transmasculine self-defense and collective protection at the clinic. Soc Sci Med 2024; 345:116638. [PMID: 38364718 DOI: 10.1016/j.socscimed.2024.116638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
Despite formidable inequities in health care systems, transgender people are accessing clinical services in record numbers and gaining recognition as a patient population. This article examines how transgender people are negotiating their care and, in so doing, challenging patterns of marginalization and exclusion. Interviews with twenty-six transmasculine adults were collected and analyzed in the context of a community-led initiative foregrounding low-income people and people of color in Los Angeles County using a constructivist grounded theory approach. Participants gained agency in clinical settings by compelling care, a grounded theory that explains how patients contest medical authority and shift power through everyday acts to defend themselves and future patients. Histories of mistreatment and unequal social power drive patients to engage with health care providers judiciously and with a sense of social responsibility. In tracing seemingly decentralized acts of self-defense (e.g., vetting providers, disrupting gender norms, directing treatment), the study shows how patients rely on community resources and marshal collective protection. The theory recasts patients as constitutive actors in a changing landscape of care and as integral to, and one of many fronts of, collective struggle. In turn, the study lends theoretical insights to anti-racist understandings of medical mistrust andoffers a depathologized framework toward the development of community-building health equity interventions.
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Affiliation(s)
- Sid P Jordan
- Portland State University, School of Social Work, 1800 SW 6th Ave, Portland, OR, 97201, USA.
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4
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Gilmore JP, Dainton M, McEvoy NL. Ethical considerations for the nursing care of Transgender patients in the Intensive Care Unit. Nurs Crit Care 2024. [PMID: 38380778 DOI: 10.1111/nicc.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
There is more discussion than ever surrounding the health and care needs of Transgender communities. However, there is limited research on the care of Transgender patients in the Intensive Care Unit which can contribute to knowledge gaps, inconsistencies and uncertainties surrounding health care practices. This article is not intended to address all of the specific needs of Transgender patients in ICU, but to explore the ethical considerations for caring for a Transgender woman in the ICU. In doing so, this article will explore some specific considerations around gender affirming care, challenging discrimination, physiological changes, and systems change to enhance care.
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Affiliation(s)
- John P Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marissa Dainton
- School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, UK
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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5
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Zarwell M, Bowling J, Gunn LH, Kissler N, McComas M, Patton A, Ragunathan R, Brown R. Collectives for Care: Perspectives of Providers and Community Members in Transgender Health Care in a Southern U.S. City. J Homosex 2024; 71:96-119. [PMID: 35969714 DOI: 10.1080/00918369.2022.2105674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Affirming and accessible health care may improve health outcomes for trans individuals in the U.S. We explored strategies to improve affirming care for trans individuals from the perspectives of providers and transgender and non-binary community members. Forty members of a collective group of gender-affirming providers (GAP) in the southern U.S. were recruited to participate in a brief online survey. A graphical LASSO undirected network analysis approach visualized associations across outcomes and explanatory variables. Multinomial ordered (or logistic, for binary outcomes) models explored associations between a common set of explanatory variables and outcomes. Strong partial correlations (network) and statistically significant explanatory variables (ordinal and logistic models) were identified. Additionally, we conducted three focus groups (FGs) audio-recorded over Zoom with 11 community members. Four study team members analyzed the transcripts using content analyses. Survey results indicated that higher frequency of attendance at monthly provider meetings, additional training, and provision of training and consultation were associated with greater perceived competence among GAP members. To improve services, FG participants suggested treating patients as experts, increasing diversity and representation among providers, and expanding the GAP group. These results highlight the critical need to design and implement community-identified interventions to improve gender-affirming services and enhance provider training.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Neha Kissler
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Megan McComas
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Alexandra Patton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Roshna Ragunathan
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Rhett Brown
- Novant Health, Charlotte, North Carolina, USA
- Advance Care Midtown, Charlotte, North Carolina, USA
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6
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Zubizarreta D, Trinh MH, Reisner SL. Quantitative approaches to measuring structural cisgenderism. Soc Sci Med 2024; 340:116437. [PMID: 38000173 DOI: 10.1016/j.socscimed.2023.116437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
There is rapidly growing interest in understanding the impacts of structural cisgenderism on health and health inequities for transgender and nonbinary populations. This growing interest has led to an influx of novel measures of structural cisgenderism. In this commentary, we discuss and identify gaps in existing measures and offer considerations for the development of future measures. Developing and utilizing valid measures of structural cisgenderism is crucial to quantify its impacts on health and health inequities, and to inform public health interventions, laws, and policies to eliminate gender identity and modality-based health inequities.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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7
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Weingartner LA, Combs RM, Bohnert CA, Decker HR, Noonan EJ. Epistemic Peerhood as a Model To Improve Gender-Affirming Care in Medical Education. Teach Learn Med 2024; 36:89-98. [PMID: 36314249 DOI: 10.1080/10401334.2022.2137169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Issue: Inadequate training around gender-affirming care is a critical gap in health care and medical education that causes disparities and leads to injury for transgender, nonbinary, and other gender-diverse patients. In contrast to this widespread provider knowledge gap, gender-diverse patients bring critical knowledge from their own experiences to health care. Embracing varied epistemologies, or sources of knowledge, within medical education has the potential to enhance gender-affirming care by intentionally placing value on the lived experiences and emphasizing the credibility of gender-diverse patients. Evidence: In this article, the authors endorse a model of epistemic peerhood in which the embodied knowledge of gender-diverse patients and the authoritative knowledge of providers are each valued for their contribution to care. The authors reflect on experiences developing gender-affirming healthcare curricula and how medical education has not yet adequately addressed gender-diverse care without embracing community knowledge. Implications: The authors identify three vital areas to integrate epistemic peerhood in medical training to address gaps in gender-affirming care: (1) collaborative student training methods that reflect embodied knowledge in the absence of, or in addition to, clinical expertise on gender-affirming care; (2) sustainable partnerships between academic programs and gender-diverse communities that foster continuous engagement from collaborators with lived experience; and (3) broad community input about best practices for representing gender diversity in patient simulation. Embracing epistemic peerhood in each of these areas would result in broader gender-diverse community representation and leadership in medical education, which would ultimately strengthen gender-affirming healthcare training.
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Affiliation(s)
- Laura A Weingartner
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Ryan M Combs
- Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Carrie A Bohnert
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Hallie R Decker
- Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Emily J Noonan
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
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8
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Agénor M, Lett E, Ramanayake N, Zubizarreta D, Murchison GR, Eiduson R, Gordon AR. Racial/Ethnic Differences in Sexually Transmitted Infection Testing Among Transgender Men and Nonbinary Assigned Female at Birth Young Adults in the United States: a National Study. J Racial Ethn Health Disparities 2023; 10:2900-2910. [PMID: 36469284 DOI: 10.1007/s40615-022-01467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) cause a major burden of disease in the United States (US)-especially among structurally marginalized populations, including transgender and nonbinary people, individuals assigned female at birth (AFAB), Black and Latinx/e individuals, and young adults. Although screening can help detect and prevent STIs, research on STI testing among populations at diverse intersections of multiple forms of structural marginalization, including Black, Latinx/e, and other racially/ethnically minoritized transgender men and nonbinary AFAB US young adults, is extremely scarce. METHODS We conducted a national cross-sectional online survey of transgender and nonbinary US young adults from February to July 2019. Using Poisson regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the associations between race/ethnicity-which we conceptualized as a system of structural inequality that shapes individuals' and groups' exposure to racism-and lifetime and past-year STI testing among transgender men and nonbinary AFAB US young adults aged 18-30 years with at least one-lifetime sexual partner (N = 378). RESULTS Approximately 74% of participants had received an STI test in their lifetime, and, among those, 72% with a past-year sexual partner had been tested for an STI in the last 12 months. We observed no statistically significant association between race/ethnicity and lifetime STI testing among transgender and nonbinary AFAB young adults with a lifetime sexual partner. In contrast, Black (PR = 1.32; 95%: 1.03, 1.68) and Latinx/e (PR = 1.39; 95% CI: 1.11, 1.75) transgender men and nonbinary AFAB young adults who ever received an STI test and had a past-year sexual partner were significantly more likely to have received an STI test in the last 12 months relative to their White counterparts, adjusting for demographic factors. Further adjustment for lifetime STI diagnosis and health insurance status did not appreciably attenuate these observed adjusted differences; however, the adjusted difference in the prevalence of past-year STI testing between Black (but not Latinx/e) and White transgender men and nonbinary AFAB young adults was no longer statistically significant upon further adjustment for educational attainment and employment status, possibly due to small sample sizes. CONCLUSION The higher adjusted prevalence of past-year STI testing among Black and Latinx/e compared to White transgender men and nonbinary AFAB US young adults may reflect racist and xenophobic sexual stereotypes about Black and Latinx/e people among health care providers and institutions, the history of hyper-surveillance of Black and Latinx/e people by public health institutions in the context of infectious disease containment, and/or agency and resistance among Black and Latinx/e transgender men and nonbinary AFAB young adults with regard to sexual health promotion in the face of multiple compounding systems of oppression.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Applied Transgender Studies, Chicago, IL, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | | | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gabriel R Murchison
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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9
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Chaum M, Grossi S, Chen J, Hu V, Ray E, Giuliano A, Bose S. Masculinizing hormone therapy effect on breast tissue: Changes in estrogen and androgen receptors in transgender female-to-male mastectomies. Breast 2023; 72:103596. [PMID: 37951051 PMCID: PMC10665694 DOI: 10.1016/j.breast.2023.103596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/03/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE Almost two percent of individuals in the United States identify as gender non-conforming. In the female-to-male (FTM) transgender population, masculinizing hormone therapy with testosterone is commonly prescribed in gender transition. To date, the effects of exogenous androgens on breast tissue and its roles in altering breast cancer risk are poorly understood. This study examines the histopathologic findings in gender affirming mastectomy (GAM) in transgender FTM patients and the effects of exogenous androgens on estrogen receptors (ER) and androgen receptors (AR). METHODS A retrospective review of pathology specimens obtained between 2017 and 2020 was performed comparing androgen exposed breast tissue with breast tissue without androgen exposure. Breast specimens were obtained from patients who underwent FTM GAM with recorded exogenous androgen exposure. Control breast specimens were obtained from reduction mammoplasty (RM) procedures in cisgender women which were aged matched to the GAM cohort, as well as postmenopausal women with benign/prophylactic mastectomy procedures; all controls were without androgen exposure. The histopathologic findings were assessed. Immunohistochemistry for AR and ER was performed and the score interpreted by digital image analysis. RESULTS Androgen-exposed breast tissue revealed dense fibrotic stroma, lobular atrophy, thickened lobular basement membranes, and gynecomastoid changes. Longer duration of androgen exposure resulted in a more pronounced effect. The incidence of atypia or cancer was lower in GAM than RM cohort. ER and AR expression was highest in transgender male breast tissue with intermediate duration of exogenous androgen exposure. CONCLUSION Increased androgen exposure is associated with lobular atrophy and gynecomastoid changes in breast parenchyma. Overall, ER and AR are expressed strongly in lobular epithelium in patients with prolonged androgen exposure. Exogenous testosterone does not appear to increase risk for breast cancer. Additional studies are needed to investigate the mechanism responsible for these changes at a cellular level and its role in cancer development.
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Affiliation(s)
- Manita Chaum
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Sara Grossi
- Saul and Joyce Brandman Breast Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Surgery, University of California San Diego, San Diego, CA, United States.
| | - Jiaxi Chen
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Vivian Hu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Surgery, University of California San Diego, San Diego, CA, United States
| | - Edward Ray
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Armando Giuliano
- Saul and Joyce Brandman Breast Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Shikha Bose
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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10
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Maffucci F, Clark J, Jun M, Douglass L. A Urologist's Guide to Caring for Transgender and Gender Diverse Patients. Urol Clin North Am 2023; 50:577-585. [PMID: 37775216 DOI: 10.1016/j.ucl.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Urologists are experts in the fields of genital and pelvic anatomy, sexual health and reproductive medicine. As such, a working understanding of urologic conditions relevant to transgender and gender diverse patients should be expected within their scope of practice. Herein, we describe an introductory framework for general urologists to grow their knowledge of the appropriate terminology, anatomy, and basic tenets of gender-affirming care to better manage the urologic needs of transgender and gender diverse patients.
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Affiliation(s)
- Fenizia Maffucci
- Department of Urology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Jessica Clark
- Department of Urology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Min Jun
- Crane Center for Transgender Surgery, 575 Sir Francis Drake Boulevard, Suite 1, Greenbrae, CA 94904, USA
| | - Laura Douglass
- Department of Urology, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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11
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Sterling J, Carbonella J, Jones T, Hanchuk S, Kelly P, Garcia MM. Cancer Screening for Transgender Individuals: Guidelines, Best Practices, and a Proposed Care Model. Urol Clin North Am 2023; 50:563-576. [PMID: 37775215 DOI: 10.1016/j.ucl.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Few transgender-specific cancer screening recommendations exist. This review aims to cover current guidelines and practice patterns of cancer screening in transgender patients and, where evidence-based data are lacking, to draw from cisgender screening guidelines to suggest best practices for transgender patients based on anatomic inventory. Sufficient evidence does not exist to determine the long-term effects of gender-affirming hormone therapy on cancer risk. In the future, cancer screening and prevention should be focused on anatomic inventory and high-risk behaviors.
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Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Tashzna Jones
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Urology, University of California San Francisco, San Francisco, CA, USA; Department of Anatomy, University of California San Francisco, San Francisco, CA, USA; Department of Urology, Cedars-Sinai Transgender Surgery and Health Program, Gender Affirming Genital Surgery and Sexual Medicine, Cedars-Sinai Medical Center, Los Angeles, 8631 West Third Street, Suite 1070W, Los Angeles, CA 90048, USA.
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12
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Abesamis LEA. Contending with precarity: Digital pathways to sexual and reproductive healthcare among transgender Filipinos during the COVID-19 pandemic. Soc Sci Med 2023; 336:116284. [PMID: 37820496 DOI: 10.1016/j.socscimed.2023.116284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/17/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Stringent lockdowns during the COVID-19 pandemic and the cisnormative framing of sexual and reproductive health (SRH) in the Philippines cultivated precarious access to SRH systems among transgender (trans) communities during the public health crisis. With the shift toward digital health initiatives, this study aimed to explore the experiences of the local trans community in using digital health initiatives (DHIs) to access SRH care and gender-affirming services, information, and providers during the COVID-19 pandemic. Online interviews with 13 self-identified trans Filipinos living in the Philippines during the pandemic were conducted and analyzed using interpretative phenomenological analysis. First, the narratives of trans Filipinos illustrate how DHIs can address discontinuities of care that emerged during the COVID-19 pandemic. However, because of long-standing geographic, economic, and social barriers to trans-responsive healthcare in the Philippines, local trans communities navigate alternative pathways to care established within digital spaces (e.g., social media) by trans individuals and groups. These online communities of care not only connect trans Filipinos to culturally competent and affordable care but also foster a sense of belongingness and support. Taken together, this study underscores the need to go beyond technical access to care to ensure that trans-inclusive and trans-responsive sources and providers of care are made available throughout the healthcare system. As the narratives of trans Filipinos illustrate, the narratives, experiences, and practices within their online communities of care may be the key to actualizing such a healthcare system not only in the Philippines but all over the world.
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Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University Manila, Manila, Philippines; Department of Behavioral Sciences, University of the Philippines Manila, Manila, Philippines.
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13
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Voultsos P, Papana A, Alexandri S, Zymvragou CE. Transgender Attitudes and Beliefs Scale-Greek (TABS-Gr) version: translation and initial evaluation of psychometric properties among medical students. BMC Med Educ 2023; 23:704. [PMID: 37759217 PMCID: PMC10523621 DOI: 10.1186/s12909-023-04666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Transgender people face significantly greater discrimination and health disparities in health care settings than cisgender people. The role of education in eliminating this phenomenon has been increasingly recognized by many medical schools. However, transgender health content is sparse or lacking in the medical curricula of many countries. METHOD This study was designed to validate the Greek version of the Transgender Attitudes and Beliefs Scale (TABS-Gr). The study adopted a cross-sectional, comparative-descriptive research design. Participants (N = 203) were contacted through online recruitment and invited to complete an anonymous web-based survey. The data were collected between December 2022 and February 2023. RESULTS The overall reliability of the TABS-Gr questionnaire was high (Cronbach's α = 0.961, p. from Hotelling's T-squared test < 0.000). High Cronbach's alpha values were estimated for the three subscales, with α = 0.958 for Interpersonal Comfort, α = 0.906 for Gender Beliefs, and α = 0.952 for Human Values. Hotelling's T-squared test confirmed that all items on the scale had the same mean (p < 0.001 for all subgroups). Explanatory factor analysis (EFA) demonstrated adequate fit. Convergent and discriminant validity were validated based on the estimated correlations. The three-factor structure of the Greek TABS version was confirmed. The mean total score was 155.95 (SD = 30.63), indicating that medical students had a moderately positive attitude towards transgender people. Participants showed significantly less biased (more tolerant, positive) attitudes towards transgender people on the Interpersonal Comfort (IC) and Human Value (HV) subscales than on the Sex/Gender Beliefs (SGB) subscale. A demographic comparison was conducted and demonstrated a correlation between scores and sociodemographics, except for place of origin. A statistically significant increase in the total mean score was estimated for women compared to men. CONCLUSION The overall psychometric findings provide some evidence to support the validity of the Greek version of the TABS. However, we call for further validation research in Greek medical schools. Since our claims for validity are based in part on an exploratory factor analysis, a future confirmatory factor analysis (CFA) is part of our call for further validation research. While the results of this study are mostly in line with the results of previous research, some nuances were identified. These results may inform educators, medical school curricula and education policy-makers.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece.
| | - Angeliki Papana
- School of Mathematics, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
| | - Stella Alexandri
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
| | - Christina-Erato Zymvragou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Thessaloniki, GR 54124, Greece
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Zamudio-Haas S, Koester K, Venegas L, Salinas A, Herrera C, Gutierrez-Mock L, Welborn L, Deutsch MB, Sevelius J. "Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas. BMC Health Serv Res 2023; 23:1013. [PMID: 37730598 PMCID: PMC10510224 DOI: 10.1186/s12913-023-09707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.
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Affiliation(s)
- Sophia Zamudio-Haas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA.
| | - Kim Koester
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luz Venegas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Ariana Salinas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Cinthya Herrera
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luis Gutierrez-Mock
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Layla Welborn
- La Clinica de La Raza, 3451 East 12th Street, CA, 94601, Oakland, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Jae Sevelius
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
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15
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Koehler A, Strauß B, Briken P, Fisch M, Riechardt S, Nieder TO. (De-)centralized health care delivery, surgical outcome, and psychosocial health of transgender and gender-diverse people undergoing vaginoplasty: results of a retrospective, single-center study. World J Urol 2023; 41:1775-1783. [PMID: 36961526 PMCID: PMC10352146 DOI: 10.1007/s00345-023-04348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Previous research on genital gender-affirming surgery lacked to build a framework that took various surrounding factors into account. E.g., transgender health care services are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). The present study investigated the effects of different structural and clinical aspects of gender-affirming genital surgery on psychosocial outcomes. METHODS We surveyed former transgender and gender-diverse people who completed a vaginoplasty between 2014 and 2018. 45 participants were included in the study. We calculated hierarchical linear regression analyses to assess the relationship between psychosocial outcome measures (gender congruence, mental health, quality of life) and different aspects of gender-affirming genital surgery (e.g., setting of service delivery). To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identify predictors that are actually related to the outcomes. RESULTS A non-responder analysis revealed no systematic bias in the recruitment procedure. Treatment satisfaction was a significant predictor for gender congruence. Moreover, we found the setting of service delivery (centralized, decentralized) to predict psychological health and the physical health dimension of quality of life. The effect sizes of our models were moderate to high, and models explained up to 26% of the total variance with a power up to 0.83. CONCLUSION The present study is an exploratory attempt into the manifold relationships between treatment-related factors (e.g., aesthetic outcome), the setting of service delivery, and their effects on gender-affirming genital surgery.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy, and Psycho-Oncology, University Hospital Jena, Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Riechardt
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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16
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Tillewein H, Becker J, Kruse-Diehr A. Institutional Barriers to Healthcare Services Among Transgender Individuals in the Rural Midwest. J Homosex 2023:1-17. [PMID: 37289135 DOI: 10.1080/00918369.2023.2222204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Often the barriers that arise in healthcare are due to healthcare professionals lack of education, exposure, and transphobia. Another potential barrier is due to geographical location of living in a rural area where there is a lack of healthcare services. This phenomenological study investigated barriers faced by transgender individuals who were transitioning in a rural area, focusing particularly on institutional barriers present in the healthcare system. Transgender individuals were recruited using convenience and snowball sampling. Data were collected via in-depth, face-to-face interviews in a rural area of the Midwest in the United States (n = 8). Transgender participants discussed themes of discrimination among healthcare providers based on gender. Participants reported gender markers as a barrier for healthcare services, such as inappropriate or incomplete response options on billing and medical forms. Participants perceived discrimination among gynecology, psychiatry, and medical emergency staff, and pharmacists. Overall, transgender individuals experienced mistreatment while transitioning in a rural area which created issues with participants' progress in transitioning. This study shows that education for all types of healthcare providers is needed regarding transgender health. Particularly in rural areas-many of which continue to lack essential healthcare services for the general population-the transgender population might not receive the culturally sensitive and appropriate attention they require.
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Affiliation(s)
- Heather Tillewein
- Department of Health and Human Performance, Austin Peay State University, Clarksville, Tennessee, USA
| | - Jennifer Becker
- Department of Public Health, Southern Illinois University, Carbondale, Illinois, USA
| | - Aaron Kruse-Diehr
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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17
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Knudson GA, Feldman J, Neira P, Fraser L. Closing the gap in education: Raising medical professionals' knowledge and attitudes in transgender health. Best Pract Res Clin Obstet Gynaecol 2023; 89:102339. [PMID: 37295317 DOI: 10.1016/j.bpobgyn.2023.102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 04/08/2023] [Indexed: 06/12/2023]
Abstract
Transgender and gender diverse (TGD) health is a rapidly evolving, underserviced, and underresearched healthcare field. This chapter will provide a brief review of the research in TGD health and medical education and offer further areas of research and curriculum design.
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18
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Kline NS, Webb NJ, Johnson KC, Yording HD, Griner SB, Brunell DJ. Mapping transgender policies in the US 2017-2021: The role of geography and implications for health equity. Health Place 2023; 80:102985. [PMID: 36804680 DOI: 10.1016/j.healthplace.2023.102985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
Transgender individuals globally face varying policy contexts that can influence their health. In the United States (US), a patchwork of exclusionary and inclusive policies exists, creating potentially different social and political contexts that shape transgender health depending on the state. In this article, we consider how recent legislation introduced in US states focused on transgender people may be a political determinant of health and affect health equity goals. To advance this aim, we employed the perspective of legal epidemiology to systematically search a US legal database (Westlaw) for policies focused on transgender individuals proposed between January of 2017 and September of 2021.698 policies were analyzed as affirming or exclusionary of transgender identities and categorized by content. We calculated a ratio of affirming versus exclusionary bills to create "exclusionary density" and "affirming density" measures. Those measures were used to calculate an inclusivity score and corresponding maps of inclusivity and exclusionary contexts by US state. Exclusionary and affirming density measures showed deeply polarized policy responses to transgender individuals depending on US state. Further, we observed differences in magnitude regarding the laws being proposed. Exclusionary laws largely focused on criminalization while inclusionary laws focused on representation in government agencies. These findings highlight that transgender individuals in the US can experience vastly different political contexts depending on where they live.
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Affiliation(s)
- Nolan S Kline
- University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
| | - Nathaniel J Webb
- University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Kaeli C Johnson
- University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Hayley D Yording
- University of North Texas Health Science Center, Gibson D. Lewis Library, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - Stacey B Griner
- University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
| | - David J Brunell
- University of North Texas Health Science Center, School of Public Health, Department of Health Behavior and Health Systems, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA
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19
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Green R, Eckstrand KL, Faeder M, Tilstra S, Ufomata E. Affirming Care for Transgender Patients. Med Clin North Am 2023; 107:371-384. [PMID: 36759103 DOI: 10.1016/j.mcna.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Gender identity is a deeply felt internal sense of self, which may correspond (cisgender) or not correspond (transgender) with the person's assigned sex at birth. Transgender, nonbinary, and gender diverse people may choose to affirm their gender in any number of ways including medical gender affirmation. This is a primer on the medical care of transgender individuals which covers an introduction to understanding a common language, history of transgender medical care, creating a welcoming environment, hormone therapy, surgical therapies, fertility considerations, and cancer screening in transgender people.
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Affiliation(s)
- Rebecca Green
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Kristen L Eckstrand
- Department of Psychiatry, University of Pittsburgh School of Medicine, Loeffler Building #301, 121 Meyran Avenue, Pittsburgh, PA 15213, USA
| | - Morgan Faeder
- University of Pittsburgh School of Medicine, UPMC Psychiatry CL, 3600 Forbes Avenue, Suite 306, Pittsburgh, PA 15213, USA
| | - Sarah Tilstra
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Eloho Ufomata
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Defreyne J, Vander Stichele C, Iwamoto SJ, T'Sjoen G. Gender-affirming hormonal therapy for transgender and gender-diverse people-A narrative review. Best Pract Res Clin Obstet Gynaecol 2023; 86:102296. [PMID: 36596713 DOI: 10.1016/j.bpobgyn.2022.102296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
As the number of transgender and gender-diverse (TGD) people accessing gender-affirming care increases, the need for healthcare professionals (HCPs) providing gender-affirming hormonal therapy (GAHT) also increases. This chapter provides an overview of the HCPs interested in getting involved in providing GAHT.
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Affiliation(s)
- J Defreyne
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
| | - Clara Vander Stichele
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, and Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
| | - G T'Sjoen
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
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21
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Karmouta R, Tsui I, Khitri M. Familial Exudative Vitreoretinopathy Initially Diagnosed as Incontinentia Pigmenti in an Asymptomatic Teenager: A Case Report. Case Rep Ophthalmol 2023; 14:640-646. [PMID: 38023608 PMCID: PMC10673348 DOI: 10.1159/000533632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
In this case report, we aim to illustrate a presentation of familial exudative vitreoretinopathy (FEVR) that closely resembles incontinentia pigmenti (IP) and the role of genetic testing that is of no cost to the patient in providing the correct diagnosis. We present a case of an 11-year-old female-to-male transgender patient with a history of hypodontia and skin hypopigmentation who was incidentally found to have a retinal lesion on ultra-widefield fundus imaging during routine screening. Ultra-widefield fluorescein angiography confirmed bilateral peripheral ischemic retinopathy that was successfully treated with laser. The patient was presumed to have IP; however, genetic testing was negative. Due to cost, further genetic testing was declined by the family, and the patient had no further ocular complaints. At age 16, genetic testing became available to the patient, and the patient was found to have FEVR with LRP5 mutation. The patient began screening for comorbidities associated with LRP5 mutation. This case highlights how the ophthalmologic findings of FEVR can present identically to those of IP, and genetic testing is an invaluable tool in distinguishing between these two pathologies. Correct diagnosis of FEVR is vital in assessing other comorbidities of the disease, including osteoporosis. Furthermore, increased use of ultra-widefield fundus imaging in routine eye screening may be of great benefit for community screening of retinal disease, and ultra-widefield fluorescein angiography is of significant use in the diagnosis of FEVR.
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Affiliation(s)
- Reem Karmouta
- David Geffen School of Medicine, Stein Eye Institute, Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
| | - Irena Tsui
- David Geffen School of Medicine, Stein Eye Institute, Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
| | - Monica Khitri
- David Geffen School of Medicine, Stein Eye Institute, Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
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22
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Cossío-Aranda JE, Jain V, Figueiras-Graillet LM, Arias-Mendoza A, López-Cuéllar J, Betancourt-Alvara AB, Sosa-Liprandi Á, Pinto F, Eiselé JL, Pineiro D. Toward a better understanding of cardiovascular risk in the transgender and gender-diverse community: a supplement to the Tijuana Declaration. Arch Cardiol Mex 2023; 93:1-4. [PMID: 37992703 PMCID: PMC10665105 DOI: 10.24875/acme.m23000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023] Open
Abstract
On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a communication regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender-diverse (TGD) individuals. This document, called the Tijuana Declaration, urged the global cardiovascular community to work toward understanding and mitigating this problem. This article aims to unpack the numerous factors that lead to it. An example is the social stigma faced by members of the TGD community, which leads to increased stress and risk for cardiovascular complications. TGD patients are also more likely to have insufficient access to health care, and those that do receive care are often faced with providers that are not adequately educated about the unique needs of their community. Finally, there is some evidence to suggest that gender-affirming hormone therapies have an impact on cardiovascular health, but studies on this subject often have methodological concerns and contradictory findings. Decreasing the incidence of adverse cardiovascular events in this community requires interventions such as educational reform in the medical community, an increase in research studies on this topic, and broader social initiatives intended to reduce the stigma faced by TGD individuals.
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Affiliation(s)
- Jorge E. Cossío-Aranda
- Mexican Society of Cardiology, Juan Badiano 1, Col. Section XVI, Tlalpan, Mexico City, Mexico
| | | | | | - Alexandra Arias-Mendoza
- Mexican Society of Cardiology, Juan Badiano 1, Col. Section XVI, Tlalpan, Mexico City, Mexico
| | - Julio López-Cuéllar
- Mexican Society of Cardiology, Juan Badiano 1, Col. Section XVI, Tlalpan, Mexico City, Mexico
| | | | - Álvaro Sosa-Liprandi
- Inter-American Society of Cardiology, Juan Badiano 1, Col. Section XVI, Mexico City, Mexico
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Zamantakis A, Li DH, Benbow N, Smith JD, Mustanski B. Determinants of Pre-exposure Prophylaxis (PrEP) Implementation in Transgender Populations: A Qualitative Scoping Review. AIDS Behav 2022;:1-19. [PMID: 36520334 DOI: 10.1007/s10461-022-03943-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
We conducted a scoping review of contextual factors impeding uptake and adherence to pre-exposure prophylaxis in transgender communities as an in-depth analysis of the transgender population within a previously published systematic review. Using a machine learning screening process, title and abstract screening, and full-text review, the initial systematic review identified 353 articles for analysis. These articles were peer-reviewed, implementation-related studies of PrEP in the U.S. published after 2000. Twenty-two articles were identified in this search as transgender related. An additional eleven articles were identified through citations of these twenty-two articles, resulting in thirty-three articles in the current analysis. These thirty-three articles were qualitatively coded in NVivo using adapted constructs from the Consolidated Framework for Implementation Research as individual codes. Codes were thematically assessed. We point to barriers of implementing PrEP, including lack of intentional dissemination efforts and patience assistance, structural factors, including sex work, racism, and access to gender affirming health care, and lack of provider training. Finally, over 60% of articles lumped cisgender men who have sex with men with trans women. Such articles included sub-samples of transgender individuals that were not representative. We point to areas of growth for the field in this regard.
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Czimbalmos M, Rask S. (Dis)advantaged positions in accessing gender-affirming healthcare in Finland: an intersectional qualitative study of foreign-origin transgender people. BMC Health Serv Res 2022; 22:1287. [PMID: 36284312 PMCID: PMC9597978 DOI: 10.1186/s12913-022-08654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background An increasing body of scholarship focuses on transgender individuals’ experiences when accessing gender-affirming healthcare. However, the experiences of transgender individuals who identify as being of foreign-origin in Finland have rarely been studied. This study aims to fill the gap in research and contribute to the understanding of the experiences of transgender individuals who also identify as belonging to the foreign-origin populations in Finland. Methods Fourteen semi-structured qualitative interviews were conducted and analyzed with reflexive thematic analysis (RTA), through the framework of intersectionality. The interviews were part of a broader sample of qualitative data, collected about the experiences of sexual and gender minorities among the foreign-origin populations in Finland. Results The analysis showed two main interconnected themes. Firstly, perceived barriers when accessing gender-affirming care. In this theme, the intersections of transgender identity, foreign background, class, and age affected the experiences of the individuals. Secondly, the necessity of “performing identities:” the intersections of class, transgender identity, nativity, and race affected those. Conclusion The findings of the current study suggest that the intersectional aspects of individual identities create structural inequalities in the Finnish gender-affirming healthcare system. To tackle these inequalities, further research is needed on the healthcare experiences of gender minorities in Finland both within and outside the scope of transgender-specific healthcare.
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Affiliation(s)
- Mercédesz Czimbalmos
- grid.14758.3f0000 0001 1013 0499The Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Shadia Rask
- grid.14758.3f0000 0001 1013 0499The Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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25
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Mattelin E, Fröberg F, Korhonen L, Khanolkar AR. Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden. EClinicalMedicine 2022; 52:101641. [PMID: 36313143 PMCID: PMC9596319 DOI: 10.1016/j.eclinm.2022.101641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers. METHODS The study included 168,952 individuals (aged 16-84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level. FINDINGS Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44-4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49-2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94-38·40) and exposure to physical violence (7·46, 2·97-18·70). INTERPRETATION In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities. FUNDING We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.
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Affiliation(s)
- Erica Mattelin
- Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Corresponding author.
| | - Frida Fröberg
- Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amal R. Khanolkar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, United Kingdom
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Gibson AF, Drysdale K, Botfield J, Mooney-Somers J, Cook T, Newman CE. Navigating trans visibilities, trauma and trust in a new cervical screening clinic. Cult Health Sex 2022; 24:1366-1379. [PMID: 34506266 DOI: 10.1080/13691058.2021.1952307] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
Trans and gender diverse people are globally recognised as being under-served in clinical services, with significant implications for their health. During a national reorientation of the Australian cervical screening programme - from Papanicolaou smears to human papillomavirus screening - we conducted interviews with 12 key informants in cancer policy, sexual and reproductive health and trans health advocacy to understand how trans people's needs and experiences were being accounted for and addressed in health policy and practice. Themes captured the complexities of increasing visibility for trans people, including men and non-binary people with a cervix. These complexities reflect the extensive system and cultural change required in asking policymakers and practitioners to think differently about who is at risk of a disease typically associated with cisgender women. Informants drew on the language of trauma to explain the resistance many trans people feel when engaging with clinical services, particularly relating to sexual and reproductive health. In doing so, they argued for increasing resources and processes to elicit trans people's willingness to put their trust in such services. Thinking critically about the relationship between the politics of trans visibilities, trauma and trust can support effective and inclusive approaches to transgender health.
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Affiliation(s)
- Alexandra F Gibson
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jessica Botfield
- Family Planning New South Wales, Ashfield, NSW, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Abesamis LEA. Intersectionality and the invisibility of transgender health in the Philippines. Glob Health Res Policy 2022; 7:35. [PMID: 36175930 PMCID: PMC9522541 DOI: 10.1186/s41256-022-00269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Transgender (trans) Filipinos are disproportionately vulnerable to health problems because of the inaccessibility of essential healthcare services resulting from the invisibility and exclusion of trans health in Philippine health and related social institutions. Because of the institutional prejudice and discrimination against trans Filipinos in Philippine society, an intersectional approach presents an opportunity to analyze the invisibility and potentially elucidate the unique health needs of trans Filipinos. This article elucidates how the invisibility of trans Filipinos in health is a product of co-existing and interacting prejudiced and discriminatory institutions, such as the law, education, and medicine, where the historical experiences of colonization, the hegemony of cisgenderism, and the impact of capitalism remain salient. By elucidating these co-existing and interacting structures and forces, this article highlights the gaps in the Philippine healthcare system, such as the lack of affirming and protective policies for trans health and the limited cultural competence of healthcare providers. In light of these, future research and policy work must work towards integrating gender-specific and gender-inclusive approaches, centering the voices of trans Filipinos in health discourses, and decolonizing and expanding the local understanding of trans health among Filipinos.
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Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University, 2401 Taft Avenue, Manila, 1004, Metro Manila, Philippines.
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28
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Compton ML, Taylor SS, Weeks AG, Weiss VL, Hogan MM, Wang H, Ely KA. Cytology and LGBT+ health: establishing inclusive cancer screening programs. J Am Soc Cytopathol 2022; 11:241-252. [PMID: 35840516 PMCID: PMC10132263 DOI: 10.1016/j.jasc.2022.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022]
Abstract
There are substantial disparities in cancer screening for sexual minorities and gender non-conforming patients. In additional to patients having trauma due to negative experiences with the healthcare system, disparities may be heightened due to heteronormative and cisnormative design of screening programs and electronic medical record systems. Furthermore, there are morphologic challenges specific to certain specimen types from the LGBT + population, such as anal cytology samples, cervical cytology from transgender men taking testosterone, and neovaginal cytology samples. Men who have sex with men are at increased risk for anal cancer compared with the general population. While early detection of anal dysplasia decreases the risk of invasive carcinoma, screening programs are not widespread. Cervical cancer screening may be psychologically and physically challenging for transgender men and non-binary patients. The use of exogenous testosterone therapy causes atrophic changes in cervical cytology samples which mimic high-grade dysplasia. The rate of unsatisfactory samples are also increased in this population. Although HPV driven cancers have been reported in patients with neovaginas, there are currently no guidelines about appropriate screening for transgender women and intersex patients who have neovaginas. Cytopathologists can optimize the health of LGBT + patients in many ways including advocating for inclusive screening guidelines, validating self-collection for HPV and cytology samples, updating requisition forms to better capture the spectrum of gender expression, and recognizing the morphologic changes in cytology samples due to exogenous hormone use.
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Affiliation(s)
- Margaret L Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Shayne S Taylor
- Vanderbilt University Medical Center for Transgender Health, Nashville, Tennessee
| | - Amy G Weeks
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa M Hogan
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Huiying Wang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Lee SA, O'Brien OF, Turner MJ, Kennelly MM. Implementing Medical Student Teaching on Gynaecological Healthcare of Transgender Patients. Ir Med J 2022; 115:632. [PMID: 36300707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Introduction Transgender people have specific healthcare needs and experience difficulty in accessing health services. Medical students should receive teaching on general and gynaecological healthcare issues in this population. Our aim was to assess medical students' knowledge of healthcare needs of transgender people before and after a newly implemented teaching session on transgender healthcare. Method A mixed-method study was carried out over a three month period in a university obstetric and gynaecology hospital in Dublin. A one-hour teaching session was developed and delivered to final year medical students. Students completed a survey before and after receiving the lecture. Results Seventy-one students completed the pre-lecture survey and forty-three completed the post-lecture survey. Pre-lecture, 64 students (90%) reported some-to-no understanding of healthcare issues of transgender people, and only 13 (18%) reported understanding gynaecological issues faced by transgender people. Post-lecture, 41 (95%) had a better understanding of health issues faced by this population and 40 (93%) had a better understanding of gynaecological health issues faced. Most students (81%) wanted further teaching on the topic. Conclusion A one-hour teaching session was effective at improving student knowledge of care of transgender people. This teaching could be expanded to all Irish medical schools. Going forward, the teaching could be adapted for post-graduate obstetric and gynaecology teaching.
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Affiliation(s)
- S A Lee
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - O F O'Brien
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - M J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - M M Kennelly
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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van Heesewijk J, Kent A, van de Grift TC, Harleman A, Muntinga M. Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators. Adv Health Sci Educ Theory Pract 2022; 27:817-846. [PMID: 35412095 PMCID: PMC9374605 DOI: 10.1007/s10459-022-10112-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
Health disparities faced by transgender people are partly explained by barriers to trans-inclusive healthcare, which in turn are linked to a lack of transgender health education in medical school curricula. We carried out a theory-driven systematic review with the aim to (1) provide an overview of key characteristics of training initiatives and pedagogical features, and (2) analyze barriers and facilitators to implementing this training in medical education. We used queer theory to contextualize our findings. We searched the PubMed/Ovid MEDLINE database (October 2009 to December 2021) for original studies that reported on transgender content within medical schools and residency programs (N = 46). We performed a thematic analysis to identify training characteristics, pedagogical features, barriers and facilitators. Most training consisted of single-session interventions, with varying modes of delivery. Most interventions were facilitated by instructors with a range of professional experience and half covered general LGBT+-content. Thematic analysis highlighted barriers including lack of educational materials, lack of faculty expertise, time/costs constraints, and challenges in recruiting and compensating transgender guest speakers. Facilitators included scaffolding learning throughout the curriculum, drawing on expertise of transgender people and engaging learners in skills-based training. Sustainable implementation of transgender-health objectives in medical education faces persistent institutional barriers. These barriers are rooted in normative biases inherent to biomedical knowledge production, and an understanding of categories of sex and gender as uncomplicated. Medical schools should facilitate trans-inclusive educational strategies to combat transgender-health inequities, which should include a critical stance toward binary conceptualizations of sex and gender throughout the curriculum.
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Affiliation(s)
- Jason van Heesewijk
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1131, 1081 HX, Amsterdam, The Netherlands.
| | - Alex Kent
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Tim C van de Grift
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1131, 1081 HX, Amsterdam, The Netherlands
- Departments of Plastic, Reconstructive and Hand Surgery and of Psychosomatic Gynecology and Sexology, Amsterdam University Medical Center, Location VUmc and AMC, Amsterdam, The Netherlands
| | - Alex Harleman
- Centre for Sexual Health, GGD Amsterdam, Amsterdam, The Netherlands
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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Ong C, Liu M, Thermidor S, Eid M, Gianos E. Transgender Cardiovascular Health: Practical Management for the Clinician. Curr Atheroscler Rep 2022; 24:721-730. [PMID: 35767118 DOI: 10.1007/s11883-022-01047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Transgender individuals represent a growing part of our population with current trends indicating that clinicians will be treating more transgender patients in both the inpatient and outpatient setting. Current cardiovascular guidelines lack recommendations for transgender care secondary to limited data in this population. As we await future guideline recommendations, we provide a comprehensive review of the literature and practical management strategies related to transgender cardiovascular health. RECENT FINDINGS Transgender individuals are at higher risk for some cardiovascular diseases compared to their cisgender counterparts. Gender-affirming hormone therapy, concomitant health conditions, lifestyle habits, access to services, and quality of care all contribute to this finding. While it is likely both safe and appropriate to apply current CVD guidelines to the care of transgender men and women, clinicians should consider additional factors in risk assessment and address unique aspects of care at every visit.
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Affiliation(s)
- Caroline Ong
- Division of Cardiology, Northwell Health, Lenox Hill Hospital, New York, NY, USA. .,Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Minghao Liu
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Endocrinology, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Sadiya Thermidor
- Division of Cardiology, Northwell Health, Lenox Hill Hospital, New York, NY, USA.,Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Marwen Eid
- Division of Cardiology, Northwell Health, Lenox Hill Hospital, New York, NY, USA.,Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eugenia Gianos
- Division of Cardiology, Northwell Health, Lenox Hill Hospital, New York, NY, USA.,Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Agénor M, Geffen SR, Zubizarreta D, Jones R, Giraldo S, McGuirk A, Caballero M, Gordon AR. Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color. BMC Health Serv Res 2022; 22:369. [PMID: 35307008 PMCID: PMC8935683 DOI: 10.1186/s12913-022-07729-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/03/2022] [Indexed: 12/09/2023] Open
Abstract
Background Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited. Methods Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience—and resist—multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18–25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants’ experiences of health care discrimination were clustered into themes and sub-themes. Results Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination—both independently and simultaneously—in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks. Discussion Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07729-5.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA. .,Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Sophia R Geffen
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Raquel Jones
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Shane Giraldo
- Department of Sociology, Simmons University, Boston, MA, USA.,Youth Community Advisory Board, Tufts University, Medford, MA, USA
| | - Allison McGuirk
- Department of Counseling Psychology, University of Wisconsin Madison, Madison, WI, USA
| | - Mateo Caballero
- Youth Community Advisory Board, Tufts University, Medford, MA, USA.,Department of Communication Studies, Northeastern University, Boston, MA, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Everhart AR, Boska H, Sinai-Glazer H, Wilson-Yang JQ, Burke NB, LeBlanc G, Persad Y, Ortigoza E, Scheim AI, Marshall Z. 'I'm not interested in research; i'm interested in services': How to better health and social services for transgender women living with and affected by HIV. Soc Sci Med 2021; 292:114610. [PMID: 34923191 DOI: 10.1016/j.socscimed.2021.114610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022]
Abstract
This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services. Respondents offered simple, yet creative ways to address barriers to vital services based on their individual and collective experiences. Notably, participants stressed the need for 1) trans-friendly and trans-specific services, 2) integrated health services, and aid in navigating complex, overlapping systems, and 3) comprehensive community-based services. They also suggest employing trans women as care coordinators or case managers in order to foster more trans-friendly environments and empower community members. We identify concrete ways to improve health and social services at the level of service delivery and program design, as well as recommendations for future participatory research. We close with an interrogation of trans people, and trans women living with and affected by HIV in particular, as 'hard to reach' populations.
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Szücs D, Köhler A, Holthaus MM, Güldenring A, Balk L, Motmans J, Nieder TO. [ Transgender health and healthcare during the COVID‑19 pandemic: a cross-sectional online survey in German-speaking countries]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1452-1462. [PMID: 34622306 PMCID: PMC8496616 DOI: 10.1007/s00103-021-03432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/09/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Since spring of 2020, the COVID‑19 pandemic has disrupted our day-to-day lives and led to negative consequences in various areas of life, including mental and physical wellbeing. In this article, we take a closer look at the situation of trans people, who - due to experiences with discrimination and marginalization as well as their specific health-related interests - could be characterized by a particular vulnerability. METHODS Using an online cross-sectional survey, which we designed collaboratively with experts from the trans community, we investigated the mental and physical health of trans people from German-speaking countries and their access to trans-related healthcare during the COVID‑19 pandemic in the period from 1 May 2020 to 31 January 2021. RESULTS Since the beginning of the COVID‑19 pandemic, trans people have experienced barriers in access to gender-affirming treatments, mental health services, and COVID‑19-related medical care. At the same time, trans people reported being affected by chronic diseases disproportionately more often than the general population, including those leading to a higher risk for poorer outcomes of a COVID‑19 infection. Moreover, the participants reported being exposed to many risk factors associated with higher mental distress (e.g., having a chronic illness, belonging to a minority based on a non-heterosexual orientation, or having a low income). DISCUSSION The results of this survey indicate that prior vulnerabilities with regards to health problems and the restricted access to an informed and qualified transgender healthcare were exacerbated by the COVID‑19 pandemic.
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Affiliation(s)
- Daria Szücs
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Interdisziplinäres Transgender Versorgungscentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Andreas Köhler
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Interdisziplinäres Transgender Versorgungscentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Mika M Holthaus
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Interdisziplinäres Transgender Versorgungscentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Annette Güldenring
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Westküstenklinikum Heide, Heide, Deutschland
- BVT* e. V. (Bundesverband Trans* e. V.), Schiffbauerdamm 8, 10117, Berlin, Deutschland
| | - Lena Balk
- dgti e. V. (Deutsche Gesellschaft für Transidentität und Intersexualität e. V.), Braunschweig, Deutschland
| | - Joz Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgien
| | - Timo O Nieder
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Interdisziplinäres Transgender Versorgungscentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Abstract
Transgender people may choose to affirm their gender identity with gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS). The effects of GAHT and GAS on sexual health in transgender people have not been well elucidated. This systematic review aimed to appraise the current scientific literature regarding sexual desire, arousal, orgasm, pain, and satisfaction in transmen and transwomen before, during, and after gender transition. Overall, sexual dysfunction is common in both transmen and transwomen. GAHT and GAS may help to improve sexual satisfaction. More studies that focus on sexual health in the transgender population are urgently needed.
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Affiliation(s)
- Natnita Mattawanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Chiang Mai 50200, Thailand.
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Chiang Mai 50200, Thailand
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle NE-WRMB1301, Atlanta, GA 30322, USA; Atlanta VA Medical Center, Decatur, GA, USA
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Abstract
The medical profession is deeply involved in designating and amending the sex designations on legal records that themselves are not used clinically. The assumptions inherent in the current legal sex designation system and the criteria for amending such are being reexamined. The harms of the current legal sex designation system, especially for transgender people, have become increasingly recognized. Consequently, the appropriateness of the health care professional's participation in recording legal sex designations has been called into question. Herein, we describe the medicolegal challenges surrounding legal sex designations and their potential solutions.
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Affiliation(s)
- Vadim M Shteyler
- University of California San Francisco, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, California.
| | - Eli Y Adashi
- Medicine and Biological Sciences, the Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Denby KJ, Cho L, Toljan K, Patil M, Ferrando CA. Assessment of Cardiovascular Risk in Transgender Patients Presenting for Gender-Affirming Care. Am J Med 2021; 134:1002-8. [PMID: 33895118 DOI: 10.1016/j.amjmed.2021.02.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The transgender population is rapidly growing in the United States and abroad. Transgender men and women are marginalized as a result of their transgender status, with resultant health repercussions. This and other factors such as increased substance use, mental health disorders, violence, and chronic stress may place transgender individuals at higher risk for cardiovascular disease. Additionally, many transgender patients pursue gender-affirming hormone therapy, which has been linked to increased rates of some cardiovascular events such as metabolic syndrome, venous thromboembolism, and stroke. Despite the likelihood of elevated cardiovascular risk in this population, there is a paucity of published data about the cardiovascular risk of this population. METHODS We present baseline cardiovascular data from a transgender population at a large tertiary care center prior to the initiation of hormone therapy. RESULTS The described transgender population had much higher rates of mental health disorders and substance use than the general population. Furthermore, there were high rates of undiagnosed and untreated comorbidities, such as hypertension and dyslipidemia, that increase risk for cardiovascular disease. Baseline risk assessment using the ASCVD (Atherosclerotic Cardiovascular Disease) and QRISK3 calculators showed higher-than-expected cardiovascular risk, particularly given the young age of our patient population. CONCLUSIONS Transgender individuals are at high baseline cardiovascular risk. These data help fill some important knowledge gaps in this patient subgroup, and provide us with much-needed data to help guide our management and counseling of individuals seeking this type of care.
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Abstract
BACKGROUND Transgender individuals can have complex health needs, in both trans and non-trans related health, experiencing higher levels of discrimination and disadvantages in accessing health care. The health needs of the transgender community are not consistent with the wider population, so individuals are often required to research services to meet their needs which can contribute to a reluctance in accessing health care. AIM To analyse existing literature on transgender patients experiences of health care. METHOD A search was performed of online databases (CINAHL, Medline, AMED, PubMed, ASSIA, PsychINFO, Web of Science and Scopus) and six studies were reviewed and analysed. FINDINGS Three main themes emerged: health professionals' knowledge and attitudes, navigating the system, and vulnerability and avoidance of health care. CONCLUSION The literature suggests that few encounters with health professionals were positive and that a lack of healthcare knowledge on trans-related issues and discrimination were the leading causes for dissatisfaction when accessing health services.
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Affiliation(s)
- Kirk Hobster
- Was a Staff Nurse, Critical Care, Nottingham University Hospital, at the time of writing. He is now a master of public health student, School of Medicine, University of Nottingham
| | - John McLuskey
- Associate Professor, School of Health Sciences, University of Nottingham
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Swartz JA, Ducheny K, Holloway T, Stokes L, Willis S, Kuhns LM. A Latent Class Analysis of Chronic Health Conditions Among HIV-Positive Transgender Women of Color. AIDS Behav 2021; 25:52-63. [PMID: 31144132 DOI: 10.1007/s10461-019-02543-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Research on the health of transgender people has focused on the risk for and health consequences of HIV and other sexually transmitted infections with little known about the prevalence of a broader range of medical conditions experienced by transgender people. This study used latent class (LC) analysis to examine a range of chronic medical conditions among 223 HIV-positive transgender women of color receiving primary care and psychosocial services in Chicago. The best-fitting model had 2 classes: low and moderate/high multimorbidity with 26% of participants classified in the moderate/high multimorbidity LC. Age group (i.e., under 35 vs 35 and older; AOR 13.8, p < 0.001), ever having AIDS (AOR 4.0, p < 0.05) and psychological distress (AOR 5.1, p < 0.05) were associated with increased probability of moderate/high multimorbidity class membership. The results suggest focusing on HIV-related care or hormonal treatment and potential cardiovascular issues could result in sub-optimal treatment for a population dis-engaged from primary care but which has a broad spectrum of largely untreated medical conditions.
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Koziara K, Mijas ME, Wycisk J, Pliczko MP, Grabski B. Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals. J Sex Med 2021; 18:1110-21. [PMID: 34108108 DOI: 10.1016/j.jsxm.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gender diverse individuals constitute a substantial yet still understudied population. Particularly little is known about gender non-binary people whose health needs have only recently gained attention from clinicians. AIM To investigate needs for gender-affirming interventions, selected health indicators and determinants in Polish gender non-binary individuals as compared to transgender men and transgender women. METHODS We analyzed a subset of data from an online study on health in members of the Polish LGBTQ community. The sample consisted of 53 persons who self-identified as non-binary and 45 transgender men and transgender women. The uptake and the desire for gender-affirming medical interventions as well as selected health indicators were compared in non-binary and transgender persons. Additionally, regression models were conducted for depression, self-esteem and somatic symptoms severity as dependent variables, age as a covariate, and perceived stigma exposure, resilience and discomfort associated with current gender expression as predictors. OUTCOMES Outcomes such as desire for gender-affirming medical interventions and legal gender reassignment, symptoms of depression, resilience, physical symptoms severity, and perceived stigma exposure were captured in self-reported questionnaires. RESULTS Compared to the transgender men and transgender women, the non-binary participants of the study significantly less often pursued or desired gender-affirming medical interventions and legal gender reassignment. The non-binary participants also felt significantly more discomfort with their current gender expression. They were also characterized by increased expectations of rejection, vicarious trauma associated with being an LGBTQ person, and by decreased resilience compared to the transgender men and transgender women. Non-binary identity and individual resilience predicted higher self-esteem and decreased depression in the sample. The severity of physical symptoms was predicted by perceived stigma exposure (positively) and by resilience (negatively). CLINICAL IMPLICATIONS Polish non-binary individuals may constitute a vulnerable population in terms of greater perceived exposure to stigma and decreased individual resilience. Both transgender and non-binary individuals seek gender-affirming interventions and legal gender reassignment; the latter group, however, does so significantly less often. STRENGTHS & LIMITATIONS We analyzed the data from a unique and understudied Polish population. By exploring the diversity within the transgender and non-binary community, we add to the ongoing discussion on transgender and non-binary health. The major limitations of the study are convenience sampling, cross-sectional design, and limited sample size. CONCLUSION Non-binary individuals constitute a distinct population in terms of psychosocial and health-related characteristics. Clinicians should be aware of their needs and the challenges they face in association with living in a predominantly gender binary-oriented society. Koziara K, Mijas M. Wycisk J, et al. Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals. J Sex Med 2021;18:1110-1121.
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Whitney C, Greene MZ, Dudek A. Getting it right after getting it wrong: Using the AQUERY tool in conversation with transgender nursing students. Nurse Educ Today 2020; 94:104560. [PMID: 32932057 DOI: 10.1016/j.nedt.2020.104560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Clare Whitney
- Stony Brook University, School of Nursing, United States of America.
| | - Madelyne Z Greene
- University of Wisconsin-Madison, School of Nursing, United States of America
| | - Alex Dudek
- University of Wisconsin-Madison, School of Nursing, United States of America
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Millington K, Schulmeister C, Finlayson C, Grabert R, Olson-Kennedy J, Garofalo R, Rosenthal SM, Chan YM. Physiological and Metabolic Characteristics of a Cohort of Transgender and Gender-Diverse Youth in the United States. J Adolesc Health 2020; 67:376-383. [PMID: 32417098 PMCID: PMC7483238 DOI: 10.1016/j.jadohealth.2020.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to describe baseline physical and laboratory characteristics of participants in the largest prospective study of transgender and gender-diverse (TGD) youth in the United States. METHODS Participants were recruited from four clinics which specialize in the care of TGD youth before starting either GnRH analogs for pubertal suppression or gender-affirming hormone treatment. Anthropometric and laboratory measurements were abstracted from the medical chart. Baseline characteristics including height, weight, body mass index, blood pressure, and laboratory measurements were compared with those of age-matched National Health and Nutritional Examination Survey comparison group. RESULTS Seventy-eight TGD youth with a median age of 11 years (range 8-14 years) were recruited before pubertal suppression, of whom 41 (53%) were designated male at birth, and 296 participants with a median age of 16 years (range 12-20 years) were recruited before beginning gender-affirming hormones, of whom 99 (33%) were designated male at birth. The mean high-density lipoprotein cholesterol was lower in the study participants when compared with that of National Health and Nutritional Examination Survey participants (50.6 ± 12.3 mg/dL vs. 53.3 ± 13.3 mg/dL, p = .001). Otherwise, the study cohorts were similar in terms of body mass index, proportion of overweight and obesity, blood pressure, and baseline laboratory variables. CONCLUSIONS Before starting gender-affirming treatment, TGD youth are physiologically similar to the general population of children and adolescents in the United States, with the exception of slightly lower high-density lipoprotein cholesterol. Evaluation of this cohort over time will define the physiological effects of pubertal blockade and gender-affirming hormone treatment.
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Affiliation(s)
- Kate Millington
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.
| | - Caroline Schulmeister
- Division of Pediatric Endocrinology, Benioff Children's Hospital, University of California at San Francisco, San Francisco, California
| | - Courtney Finlayson
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Ren Grabert
- Division of Adolescent Medicine, Lurie Children's Hospital, Chicago, Illinois
| | | | - Robert Garofalo
- Division of Adolescent Medicine, Lurie Children's Hospital, Chicago, Illinois
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Benioff Children's Hospital, University of California at San Francisco, San Francisco, California
| | - Yee-Ming Chan
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW The goal of this paper was to identify areas of importance in modern urology education that are not currently emphasized in current urological curricula. RECENT FINDINGS We identified curricular deficits in robotic surgical simulation, transgender health, leadership, business management, and social media training. Few practicing urologists feel comfortable managing transgender-specific needs, and most training programs do not adequately address transgender health. Urology programs also do not sufficiently emphasize topics in leadership, business management, or appropriate social media usage. With respect to simulation, while it is currently included in the Accreditation Council for Graduate Medical Education (ACGME) program requirements, it is currently under-utilized for training in robotic surgery. It is important for urologists to receive adequate training for the modern practice landscape. Where knowledge gaps among early practicing urologists arise, programs should adapt their curricula to address them.
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Hanssmann C. Epidemiological rage: Population, biography, and state responsibility in trans- health activism. Soc Sci Med 2020; 247:112808. [PMID: 32007767 DOI: 10.1016/j.socscimed.2020.112808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
This article examines how social movements reconceptualized trans-health in Buenos Aires, Argentina. Looking ethnographically to medical and activist practice, the article analyzes "epidemiological biographies", or activist-produced community-based studies blending quantitative and narrative data. It draws on population health, feminist science studies, transgender studies, and social theory to discuss the circulation and implications of these publications. Specifically, it describes how epidemiological biographies disputed health behavioral models by defining state violence and criminalization as primary conditions endangering health and life expectancy among travestis and trans-people. The article analyzes how activist researchers made state violence legible through logics of population health, even as the concept of "population" also emerged from techniques of state control. In contrast with models that place individual behavior at the locus of health interventions, activists instead advanced interventions that contested state securitization and shifted resource distribution. Epidemiological biographies had a considerable effect on national trans-health politics, providing an evidentiary basis for several regulatory shifts. These studies emerged in part through collective political action that reformulated dominant modes of statistical aggregation. This statistical turn-which I call "statistical collectivization"-produced contradictory effects. At one level, it obscured differential conditions of criminalization and violence. At another, it directed attention to the markedly racialized, sexualized, classed, and gendered forms of subjugation that materialize in landscapes of trans-health, and prioritized materially distributive regulation over and above civil protections. Through these contradictory actions, social movements reformulated dominant notions of health by challenging state securitization and contesting state power.
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Affiliation(s)
- Christoph Hanssmann
- San Francisco State University, Humanities Building, Room 315, 1600 Holloway Ave, San Francisco, CA, 94132, United States.
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Kattari SK, Atteberry-Ash B, Kinney MK, Walls NE, Kattari L. One size does not fit all: differential transgender health experiences. Soc Work Health Care 2019; 58:899-917. [PMID: 31618117 DOI: 10.1080/00981389.2019.1677279] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/05/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
Transgender and nonbinary (TNB) adults face a multitude of challenges when attempting to access general health care. Issues include fear of discrimination and encounters with providers who are not familiar with treating the needs of this population. These challenges may result in the delay or denial of medically necessary care. This study explores nuanced experiences of gender identity and sexual orientation around accessing health care. Using a statewide sample of TNB individuals (N = 417), analyses include descriptive statistics and logistic regressions predicting delayed care due to fear of discrimination and having any medical intervention to understand the importance of transgender-inclusive care and other experiences across identities. Findings indicate differential experiences across gender identity, sexual orientation, and age. Access to a trans-inclusive primary care provider was one of the strongest indicators both for not delaying care due to fear of discrimination and having had a medical intervention. Providers should be provided with more nuanced training about being culturally responsive and aware of differences across sexual orientation within the TNB community. This will move toward ensuring not only increased access to needed care and medical interventions, but toward potentially lowering the rate of those who delay access to care due to fear of discrimination.
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Affiliation(s)
- Shanna K Kattari
- University of Michigan School of Social Work , Ann Arbor , Michigan , USA
| | | | - M Killian Kinney
- University of Indiana School of Social Work , Indianapolis , Indiana , USA
| | - N Eugene Walls
- University of Denver Graduate School of Social Work , Denver , Colorado , USA
| | - Leonardo Kattari
- University of Michigan School of Social Work , Ann Arbor , Michigan , USA
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Howell J, Maguire R. Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland. INT J TRANSGENDERISM 2019; 20:421-433. [PMID: 32999627 PMCID: PMC6913671 DOI: 10.1080/15532739.2019.1658145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group. Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables. Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions. Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors. Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.
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Affiliation(s)
- Jamie Howell
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
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Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A. A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery. Urol Clin North Am 2019; 46:475-86. [PMID: 31582022 DOI: 10.1016/j.ucl.2019.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For individuals with gender dysphoria, gender-affirming surgeries (GAS) are one means of reducing the significant distress associated with primary and secondary sex characteristics misaligned with their gender identity. This article uses a systematic review to examine the existing literature on the psychological benefits of GAS. Findings from this review indicate that GAS can lead to multiple, significant improvements in psychological functioning. Methodological differences in the literature demonstrate the need for additional research to draw more definitive conclusions about the psychological benefits of GAS.
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Abstract
Gender dysphoria, or the incongruence between gender identification and sex assigned at birth with associated discomfort or distress, manifests in transgender patients, whose multifaceted care includes puberty suppression, cross-sex hormonal therapy, and gender-affirming surgery. Discussion of fertility preservation (FP) is paramount because many treatments compromise future fertility, and although transgender patients demonstrate desire for children, use of FP remains low for a plethora of reasons. In transgender women, established FP options include ejaculated sperm cryopreservation, electroejaculation, or testicular sperm extraction. Further research is needed regarding reproductive health and FP in transgender patients.
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Affiliation(s)
- Wen Liu
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA
| | - Michael L Schulster
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA
| | - Joseph P Alukal
- Department of Urology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Bobby B Najari
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA; Department of Population Health, NYU Langone Medical Center, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA.
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D’Avanzo PA, Bass SB, Brajuha J, Gutierrez-Mock L, Ventriglia N, Wellington C, Sevelius J. Medical Mistrust and PrEP Perceptions Among Transgender Women: A Cluster Analysis. Behav Med 2019; 45:143-152. [PMID: 31343968 PMCID: PMC6943929 DOI: 10.1080/08964289.2019.1585325] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023]
Abstract
Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0-10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.
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Affiliation(s)
- Paul A. D’Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health
| | - Luis Gutierrez-Mock
- Center of Excellence for Transgender Health, University of California, San Francisco
| | - Nicole Ventriglia
- Risk Communication Laboratory, Temple University College of Public Health
| | - Carine Wellington
- Risk Communication Laboratory, Temple University College of Public Health
| | - Jae Sevelius
- Center of Excellence for Transgender Health, University of California, San Francisco
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco
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