Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study

A Descriptive Study of Transgender Active Duty Service Members in the U.S. Military

Purpose: Department of Defense policy prohibits, with limited exceptions, transgender individuals from serving in their affirmed gender in the U.S. Military, citing potential impact on unit cohesion and military readiness. To date, however, little is known about the sociodemographic profile and health of transgender military personnel. Methods: U.S. Military personnel who self-identified as transgender completed anonymous online measures of demographics and military service. Participants also completed measures of health, mood, eating pathology, and risk behaviors. Results: One hundred ninety-five service members (mean age: 28.9±7.2 years, 48.7% transmale, 70.3% non-Hispanic White, 7.83±5.9 years in service) completed the survey. The majority of respondents first identified as transgender before military accession. Most had disclosed their gender identity to their command and providers, and had undertaken steps toward gender affirmation. The sample as a whole reported above average physical health, with mood symptoms within normal ranges and few reported risk behaviors. Analyses of covariance indicated that transmales reported significantly better mental health and psychosocial functioning compared with transfemales. Conclusion: In light of current policy that precludes, with limited exceptions, transgender individuals from serving in the U.S. Military in their affirmed gender, the current study provides an initial sociodemographic profile of this understudied population and indicates that transgender service members report above average physical health and few risk behaviors. Preliminary analyses indicated that transfemales in the military may be at higher risk for mental health concerns, compared with transmales. Additional research is needed to elucidate risk and protective factors among transgender service members.

Increased prevalence of depression, anxiety, and adjustment and somatoform disorders in transsexual individuals

BACKGROUND

The aim of this study was to explore rates of depression, anxiety, and adjustment and somatoform disorders in a large sample of transsexual individuals (TSI), compared with matched non-TSI cohorts from general practices in Germany.

METHODS

Individuals initially documented as transsexual (index date) between January 2010 and December 2018 were identified in 468 general practices (GP) from the IMS Disease Analyzer database (IQVIA). Non-transsexual women (NTSW) and men (NTSM) were matched (1:1) with transsexual individuals by age, index year, and physician. The main outcome measure was the prevalence of depression, anxiety, and adjustment and somatoform disorders among TSI compared to NTSW and NTSM.

RESULTS

A total of 535 TSI, 535 NTSW, and 535 NTSM were analyzed (mean age in each group was 35 years). Depression was documented in 20% of TSI versus 7.7% of NTSW and 5.5% of NTSM (p < 0.001), reaction to severe stress and adjustment disorders in 10% of TSI versus 4.3% of NTSW and 2.9% of NTSM (p < 0.001), somatoform disorders in 9.7% of TSI versus 5.8% of NTSW and 5.8% of NTSM (p 0.016), and anxiety disorders in 5.8% of TSI versus 1.9% of NTSW and 1.6% of NTSM, (p < 0.001).

CONCLUSION

Our findings indicate a need to promote TSI mental health. Furthermore, primary care physicians and psychiatrists should be aware of the importance of detecting and treating mental disorders in TSI and thereby improve their quality of life.

Characteristics of Transgender Patient Cases Managed by a Toxicologist: an Analysis of the Toxicology Investigator's Consortium (ToxIC) Registry: January 2017-June 2019

INTRODUCTION

The Toxicology Investigators Consortium (ToxIC) database, created in 2010 by the American College of Medical Toxicology (ACMT), compiles data recorded by medical toxicologists. In January 2017, the data field for transgender (and if transgender, male-to-female or female-to-male) was added to the ToxIC form. Little is known regarding trends in poisonings among transgender patients. We sought to review consultations managed by a bedside toxicologist and provide descriptive data in trends among types of exposures within the transgender demographic.

METHODS

A retrospective ToxIC database evaluation of cases in which the patient identified as transgender were reviewed from January 2017-June 2019 and descriptive demographics reported.

RESULTS

The registry contained 113 cases that involved transgender patients. Of those with complete data, 41 (36.6%) were male-to-female, 68 (60.7%) were female-to-male, and 3 (2.7%) identified as gender non-conforming. Of those with complete data, the most common reason for encounter was intentional use of a pharmaceutical drug (N = 97, 85.8%), of which 85 (87.6%) were classified as intentional pharmaceutical use intended for self-harm. Analgesics were the most common class of drugs used out of those reported (N = 24, 22%). Forty-six (90.2%) patients aged 13-18 with complete data were identified as encounters due to self-harm. Attempt at self-harm was the most common reason for intentional pharmaceutical encounter among the sample of transgender patients with complete data (N = 85, 87.6%); with female-to-male patients having an N = 53 (77.9%).

CONCLUSION

Among transgender patients in the ToxIC registry, the most common primary reason for the encounter was intentional use of a pharmaceutical drug intended for self-harm. In this small cohort, there were some age and transition differences in prevalence. These findings may inform poisoning prevention practices as well as sex- and gender-based management of patients in this vulnerable population.

Transgender pediatric surgical patients-Important perioperative considerations

Transgender describes a variety of identities in which an individual's gender identity is different from expected based on the sex assigned at birth. In the United States, it is estimated that over 1 million adults and 150 000 youth identify as transgender, with increasing numbers being seen in healthcare and surgical settings. These numbers will continue to rise as visibility and acceptance grow. Current guidelines recommend transition-related surgeries be reserved for older adolescents and adults. However, this is not the only circumstance in which the pediatric anesthesiologist may find themselves caring for a transgender patient. In order to provide the safest and most affirming care, it is crucial that the pediatric anesthesiologist develop a working knowledge of this unique and vulnerable population, including the potential impacts of gender-affirming treatment on their perioperative care.