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Lorello GR, Tewari A, Sivagurunathan M, Potter E, Krakowsky Y, Du Mont J, Urbach DR. The lived experiences of transgender and gender-diverse people in accessing publicly funded penile-inversion vaginoplasty in Canada. CMAJ 2024; 196:E816-E825. [PMID: 38955411 PMCID: PMC11230671 DOI: 10.1503/cmaj.231250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. METHODS We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. RESULTS We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). INTERPRETATION Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.
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Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont.
| | - Aradhana Tewari
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont
| | - Marudan Sivagurunathan
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont
| | - Emery Potter
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont
| | - Yonah Krakowsky
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont
| | - Janice Du Mont
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont
| | - David R Urbach
- Department of Anesthesia and Pain Management (Lorello), Toronto Western Hospital - University Health Network; Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; The Wilson Centre (Lorello); Women's College Research Institute (Lorello, Tewari, Sivagurunathan, Du Mont, Urbach); Women's College Hospital (Potter); Division of Urology (Krakowsky), Department of Surgery, and Dalla Lana School of Public Health (Du Mont), and Department of Surgery (Urbach), University of Toronto, Toronto, Ont
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Kearns S, Hardie P, O’Shea D, Neff K. Instruments used to assess gender-affirming healthcare access: A scoping review. PLoS One 2024; 19:e0298821. [PMID: 38829881 PMCID: PMC11146745 DOI: 10.1371/journal.pone.0298821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE The overall aim of this scoping review was to identify, explore and map the existing literature pertaining to healthcare access for transgender and non-binary individuals. DESIGN The scoping review followed Arksey and O'Malley's methodological framework, and the reporting adhered to the guidelines provided by the PRISMA Extension for Scoping Reviews. METHODS To gather relevant articles, a comprehensive search strategy was employed across four electronic databases, with the assistance of a university librarian. In addition, manual and internet searches were conducted for grey literature. From the initial search, a pool of 2,452 potentially relevant articles was retrieved, which was supplemented by an additional 23 articles from the supplemental search. After an independent review by two researchers, 93 articles were assessed, resulting in the inclusion of 41 articles in the review. RESULTS The literature highlights the identification of barriers and enablers, spanning across 32 individual data sets that affect healthcare accessibility for transgender and non-binary individuals. Leveque's five dimensions of healthcare access, namely approachability, acceptability, availability and accommodation, affordability, and appropriateness, were utilized to categorise these 42 factors. Some of the key themes that emerged in these dimensions include challenges in accessing information about services, concerns about acceptance from family and peers, past experiences of discrimination in healthcare settings, considerations related to cost and insurance, and the difficulty in finding appropriately trained competent providers. CONCLUSIONS The review focused on the most commonly researched aspects of healthcare access and identified gaps in research and opportunities for future studies. The findings provide recommendations for policy and practice, which could guide the development of interventions aimed at addressing the barriers faced by transgender individuals seeking gender-affirming care.
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Affiliation(s)
- Seán Kearns
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
| | - Philip Hardie
- Nursing Programme, Hibernia College, Dublin, Ireland
| | - Donal O’Shea
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
| | - Karl Neff
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
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3
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Tople TL, Calderon T, Johnson SL. Epidemiology of Gender Diversity. Oral Maxillofac Surg Clin North Am 2024; 36:137-142. [PMID: 38216350 DOI: 10.1016/j.coms.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
In the United States, approximately 1.6 million individuals identify as transgender and gender diverse (TGD), encompassing a wide range of identities and experiences. Despite progress in visibility and acceptance, TGD people continue to face health care and societal disparities, especially affecting racial minorities. Although legal advancements have been achieved, the key to addressing these persistent health care disparities lies in implementing comprehensive and culturally sensitive health care practices and supportive policies. With a growing number of TGD people seeking gender-affirming care, it is imperative that health care practitioners understand the unique challenges faced by this community and provide tailored services with sensitivity and expertise.
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Affiliation(s)
- Tannon L Tople
- Department of Medicine, University of Minnesota Twin Cities Medical School, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
| | - Thais Calderon
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, 325 9th Avenue, Box 359796, Seattle, WA 98104, USA
| | - Sean L Johnson
- Office of Healthcare Equity, University of Washington School of Medicine, 1959 Northeast Pacific Street, F-Wing, Seattle, WA, USA
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Wolfe HL, Vimalananda VG, Wong DH, Reisman JI, Rao SR, Shipherd JC, Blosnich JR, Livingston NA, Jasuja GK. Patient Characteristics Associated with Receiving Gender-Affirming Hormone Therapy in the Veterans Health Administration. Transgend Health 2024; 9:151-161. [PMID: 38694620 PMCID: PMC11059777 DOI: 10.1089/trgh.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to examine patient characteristics associated with receipt of gender-affirming hormone therapy in the Veterans Health Administration (VHA). Methods This cross-sectional study included a national cohort of 9555 transgender and gender diverse (TGD) patients with TGD-related diagnosis codes who received care in the VHA from 2006 to 2018. Logistic regression models were used to determine the association of health conditions and documented social stressors with receipt of gender affirming hormone therapy. Results Of the 9555 TGD patients, 57.4% received gender-affirming hormone therapy in the VHA. In fully adjusted models, patients who had following characteristics were less likely to obtain gender-affirming hormones in the VHA: Black, non-Hispanic versus white (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.52-0.72), living in the Northeast versus the West (aOR: 0.72; 95% CI: 0.62-0.84), a documented drug use disorder (aOR: 0.56; 95% CI: 0.47-0.68), ≥3 versus no comorbidities (aOR: 0.44; 95% CI: 0.34-0.57), and ≥3 versus no social stressors (aOR: 0.42; 95% CI: 0.30-0.58; all p<0.001). Younger patients aged 21-29 years were almost 3 times more likely to receive gender affirming hormone therapy in the VHA than those aged ≥60 (aOR: 2.98; 95% CI: 2.55-3.47; p<0.001). Conclusion TGD individuals who were older, Black, non-Hispanic, and had more comorbidities and documented social stressors were less likely to receive gender-affirming hormone therapy in the VHA. Further understanding of patient preferences in addition to clinician- and site-level determinants that may impact access to gender-affirming hormone therapy for TGD individuals in the VHA is needed.
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Affiliation(s)
- Hill L. Wolfe
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Denise H. Wong
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Joel I. Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Sowmya R. Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jillian C. Shipherd
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- LGBTQ+ Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - John R. Blosnich
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Nicholas A. Livingston
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Guneet K. Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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Menon R, Lockie P. Roux-en-Y gastric bypass in a transgender patient: a case report. J Surg Case Rep 2024; 2024:rjae168. [PMID: 38505332 PMCID: PMC10948746 DOI: 10.1093/jscr/rjae168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
The frequency of transgender individuals seeking gender affirming care is increasing over the last decade. Transgender patients suffer from obesity and psychiatric illness at elevated levels compared with the general population. A 54-year-old male-to-female transition patient presented with morbid obesity, hyperlipidaemia, and weight gain 2 years after their gender-transition and hormonal therapy. She received a Roux-en-Y gastric bypass (RYGB). At 7 months postoperatively, the patient has experienced 49% excess body weight loss, her body dissatisfaction had resolved and has completed further plastic surgery. The RYGB is an effective method for weight loss as well as benefits from cardiovascular disease, cancer, metabolic related conditions, and psychosocial wellbeing. Holistic treatment in conjunction with dietetic and psychology services can help maintain long-term weight management. Bariatric surgery combined with a multidisciplinary care team addressing medical and psychiatric concerns is integral to achieving and maintaining weight loss and gender identity.
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Affiliation(s)
- Rahul Menon
- General Surgery Department, Ipswich Hospital, Ipswich QLD 4305, Australia
| | - Phil Lockie
- General Surgery Department, Ipswich Hospital, Ipswich QLD 4305, Australia
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Zhang TR, Harel D, Rivera A, Shahnawaz S, Qian Y, Berry C, Zhao LC, Radix A, Bluebond-Langner R, Mmonu NA. Incidence, Complications, and Long-term Outcomes of Gender-affirming Phalloplasty: Analysis of a Large Statewide Population-based Dataset. Urology 2024; 185:27-33. [PMID: 38340965 DOI: 10.1016/j.urology.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To evaluate the incidence of gender-affirming phalloplasty and postoperative complications in a large population-based dataset. METHODS Retrospective cohort study was done using the California Department of Health Care Access and Information datasets which include patient-level data from all licensed hospitals, emergency departments, and ambulatory surgery facilities in California. Adult patients 18 years or older undergoing gender-affirming phalloplasty in California from January 1, 2009 to December 31, 2019 were included. We examined phalloplasty-related complications using International Classification of Disease diagnosis and procedure codes and Current Procedural Terminology codes. Unique record linkage number identifiers were used to follow patients longitudinally. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS We identified 766 patients who underwent gender-affirming phalloplasty in 23 facilities. Of 475 patients with record linkage numbers, 253 (55.3%) had subsequent re-presentations to the inpatient, emergency department, and ambulatory surgery settings related to phalloplasty complications. Survival analysis indicated that 50% of patients re-presented by 1year post-phalloplasty. Asian/Pacific Islander patients had lower risk of complications, and California residents had higher risk of complications. CONCLUSION This population-based study confirms that gender-affirming phalloplasty has a high complication rate, and demonstrates for the first time an association with high rates of return to hospitals, emergency departments, and ambulatory surgery centers. These findings provide additional higher-level evidence that may aid patient counseling, shared surgical decision-making, and institutional and government policy.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NYU Langone Medical Center, New York, NY; Department of Urology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY
| | - Adrian Rivera
- Department of Biostatistics, New York University, New York, NY
| | - Samia Shahnawaz
- Department of Biostatistics, New York University, New York, NY
| | - Yingzhi Qian
- Department of Biostatistics, New York University, New York, NY
| | - Carolyn Berry
- Department of Population Health, NYU Langone Medical Center, New York, NY
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, New York, NY
| | - Asa Radix
- Department of Medicine, NYU Langone Medical Center, New York, NY; Callen-Lorde Community Health Center, New York, NY
| | | | - Nnenaya A Mmonu
- Department of Urology, NYU Langone Medical Center, New York, NY; Department of Population Health, NYU Langone Medical Center, New York, NY.
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Ha A, Garoosi K, Hale E, Higuchi T, Winocour J, Mathes DW, Kaoutzanis C. Trends in Gender-Affirming Surgeries in the United States from 2010 to 2021. Indian J Plast Surg 2024; 57:47-53. [PMID: 38450014 PMCID: PMC10914541 DOI: 10.1055/s-0043-1778096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Introduction: In 2017, an estimated 1.6 million adults and 150,000 teenagers identified as transgender in the United States. With ever-changing legislative developments regarding health care benefits for this population and the increasing number of patients presenting for gender-affirming surgery (GAS), there is a scarcity of literature on the temporal trends within the past decade. The objective of this study was to examine the temporal trends of the utilization of GAS. Methods: We conducted a cross-sectional study using TriNetX, a federated research network containing deidentified aggregate patient data. Using International Code of Disease (ICD) and Current Procedural Terminology (CPT) codes, we identified patients with a diagnosis of gender dysphoria who underwent GAS from 2010 to 2021. Basic demographic information and complications were analyzed. Complications of interest included site failure, infection, and systemic complications. Results: We identified a total of 8,403 patients who underwent GAS between January 2010 and December 2021. The number of procedures per year increased nearly 500% between 2016 and 2021 from 421 procedures to 2,224 procedures. Our demographic results were consistent with previous survey-based studies. The average age of patients who underwent masculinizing surgeries was consistently younger than those who underwent feminizing surgeries. Most patients undergoing GAS were of white race. The overall complication rate was 4.7%. Conclusion: In conclusion, our study reveals a significant and rapid rise in the utilization of GAS in the United States, with a fivefold increase in procedures between 2016 and 2021. The demographic characteristics and low complication rates observed highlight the evolving landscape of health care for transgender individuals and the need for ongoing assessment and support in this field.
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Affiliation(s)
- Ally Ha
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
| | - Kassra Garoosi
- University of Colorado School of Medicine, Aurora, Colorado
| | - Elijah Hale
- University of Colorado School of Medicine, Aurora, Colorado
| | - Ty Higuchi
- Department of Surgery, Division of Urology, Anschutz Medical Campus, Aurora, Colorado
| | - Julian Winocour
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
| | - David W. Mathes
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
| | - Christodoulos Kaoutzanis
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
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Torres Perez-Iglesias CA, Heyman A, Koh DJ, Medina N, Roh DS, Slama J. Technical and Clinical Differences Between Transgender and Cisgender Females Undergoing Breast Augmentation. Ann Plast Surg 2023; 91:534-539. [PMID: 37823620 DOI: 10.1097/sap.0000000000003706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Gender-affirming surgery is a quickly expanding field. However, it is facing a shortage of specialized surgeons for a population exceeding 1.4 million individuals. Many studies comparing outcomes between cisgender and transgender patients fail to describe the technical differences of the operation. Breast augmentation in the transgender female patient involves important anatomical, technical, and clinical features that differ from the cisgender female. In this study, we aimed to describe and compare these characteristics between these 2 groups to better inform the new generation of gender-affirming surgeons. METHODS A retrospective cohort study of patients who underwent primary breast augmentation between 2009 and 2019 at a specialized tertiary center for transgender care was performed. Mastopexy, secondary augmentation, and reconstructive procedures were excluded. Demographic, operative, and clinical data were collected from medical records. All patients had a minimum of 1 year of follow-up after the initial surgery. Bivariate analysis was performed. RESULTS A total of 250 cisgender females and 153 transgender females were included. The transgender group showed higher rates of smoking ( P < 0.0001), immunosuppression ( P < 0.0001), obesity ( P < 0.0001), mental health disorders ( P < 0.0001), and hypertension ( P = 0.002). Median base width ( P < 0.0001), sternal notch to nipple distance ( P < 0.0001), and implant size (500 mL [interquartile range, 425-600 mL] vs 350 mL [interquartile range, 325-385 mL]; P < 0.0001) were larger in transgender patients. Transgender patients also demonstrated a stronger correlation between implant size and body surface area ( r = 0.71, P < 0.0001). Readmission, reoperation, and complication rates were similar between the groups; however, transgender females had a higher incidence of surgical site infections (3.9% vs 0.4%, P < 0.013). Capsular contracture was the most common complication and indication for reoperation in both groups. CONCLUSIONS There are important anatomical, clinical, and technical differences between reconstructive gender-affirming breast augmentation in transgender female patients and cosmetic breast augmentation in the cisgender female. The gender-affirming surgeon must know these differences to provide the best quality of care and help patients achieve better congruence between their gender identity and body image.
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Affiliation(s)
| | | | | | - Nilton Medina
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Daniel S Roh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Jaromir Slama
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA
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Riddle MC, Safer JD. Medical considerations in the care of transgender and gender diverse patients with eating disorders. J Eat Disord 2022; 10:178. [PMID: 36414965 PMCID: PMC9682795 DOI: 10.1186/s40337-022-00699-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
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Affiliation(s)
- Megan C Riddle
- Eating Recovery Center, 1231 116Th Ave NE, Bellevue, WA, 98004, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA.
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, 275 7Th Ave 12Th Floor, New York, NY, 10001, USA
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Smith JR, Pakvasa M, Oostrom LA, Gottlieb LJ, Motley DN, Hill BJ. Transgender gender-affirming surgery consultation among patients seeking care in the Midwestern United States. Medicine (Baltimore) 2022; 101:e31319. [PMID: 36397321 PMCID: PMC9666111 DOI: 10.1097/md.0000000000031319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Gender-affirming surgery (GAS) is among the most rapidly growing and expanding subfields in plastic surgery due to increased awareness, decreased stigma, rising demand, and improved access for transgender and gender non-conforming individuals (TGNC). In order to address potential barriers and facilitators in GAS education and training, there is a need to explore the experiences of TGNC individuals. The purpose of this study was to qualitatively explore the factors that influence TGNC patient experiences in surgical consultation for GAS. Targeted recruitment was used to recruit and enroll participants who identified as TGNC and who had undergone consultation with a surgeon to discuss GAS. Semi-structured interviews were used to explore patient experiences with GAS. Recorded audio from these interviews was later transcribed verbatim. Open coding of these transcripts was then performed independently by 3 individual members of the research team using the consensual qualitative coding methods. Fifteen interviews were conducted (transmale, n = 7; transfemale, n = 4; gender non-conforming/non-binary, n = 4). Participants frequently expressed worry and frustration over insurance coverage and exorbitant out-of-pocket expense, whether actual or perceived. Logistical barriers were the most frequently cited category of barriers. The majority of participants made at least 1 reference to relying on others during the process of insurance pre-authorization. The majority of participants described their interactions with surgeons as positive, indicating that they felt comfortable during consultation and that their surgeons ensured their understanding. Our findings provide important insight into this often stressful and challenging process. Ensuring a welcoming, safe, and gender-affirming environment and experience for these individuals is essential. These findings may help to guide future education for medical students, trainees, clinic staff, and surgeons, as well as to direct changes necessary to improve the patient experience in clinics and hospitals for TGNC individuals undergoing consultation for GAS.
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Affiliation(s)
- Jesse R. Smith
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Mikhail Pakvasa
- Pritzker School of Medicine, University of Chicago Biological Sciences Division, Chicago, IL
| | - Leonie A. Oostrom
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lawrence J. Gottlieb
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Darnell N. Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago Medicine & Biological Sciences, Chicago, IL
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Brandon J. Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago Medicine & Biological Sciences, Chicago, IL
- Planned Parenthood Great Plains, Overland Park, KS
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Recognizing the diversity of the Portuguese transgender population: A cross-sectional study. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Clark KD, Sherman AD, Flentje A. Health Insurance Prevalence Among Gender Minority People: A Systematic Review and Meta-Analysis. Transgend Health 2022; 7:292-302. [PMID: 36033215 PMCID: PMC9398476 DOI: 10.1089/trgh.2020.0182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act. Methods Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using a Q-test and I 2 measure. Results Of 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71-0.79; p<0.001). Subgroup analysis by gender determined 70% of transgender women (95% CI: 0.64-0.76; p<0.001; I 2=97.16%) and 80% of transgender men (95% CI: 0.77-0.83; p=0.01; I 2=54.51%) were insured. Too few studies provided health insurance prevalence data for gender-expansive participants (GM people who do not identify as solely man or woman) to conduct analysis. Conclusion The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.
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Affiliation(s)
- Kristen D. Clark
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Athena D.F. Sherman
- Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, Georgia, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, UCSF, San Francisco, California, USA
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Eustaquio PC, Castelo AV, Araña YS, Corciega JOL, Rosadiño JDT, Pagtakhan RG, Regencia ZJG, Baja ES. Prevalence and Factors Associated With Gender-Affirming Surgery Among Transgender Women & Transgender Men in a Community-Based Clinic in Metro Manila, Philippines: A Retrospective Study. Sex Med 2022; 10:100497. [PMID: 35247792 PMCID: PMC9023245 DOI: 10.1016/j.esxm.2022.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background More information is needed about gender-affirming surgery (GAS) in the Philippines because of many self- or peer-prescribed gender-affirming procedures among transgender people. Aim To assess the desire of transgender adults for GAS, determined the prevalence, and evaluated factors associated with the desire. Methods We did a retrospective study of medical charts of 339 transgender men (TGM) and 186 transgender women (TGW) who attended clinical services at Victoria by LoveYourself, a transgender-led community-based clinic in Metro Manila, from March 2017 to December 2019. The medical charts were reviewed to ascertain data on gender dysphoria (GD), clinical and sociodemographic characteristics, health-seeking behaviors, and gender-affirmation-related practices, including the use of gender-affirming hormone therapy (GAHT). We also estimated the prevalence and explored factors associated with the desire for GAS using generalized linear models with a Poisson distribution, log link function, and a robust variance. Main Outcome Measures Our primary outcome was the self-reported desire for GAS. Results Almost half were already on GAHT, of whom 93% were self-medicating. Our study's prevalence of GD is 95% and nearly 3 in 4 desire GAS. The prevalence of desiring GAS was related to the specific surgical procedure chosen. Transgender adults opting for breast surgery and genital surgeries have 8.06 [adjusted prevalence ratio, (aPR): 8.06; 95% Confidence Interval, (CI): 5.22–12.45; P value < .001] and 1.19 (aPR: 1.19; 95% CI: 1.11–1.28; P value < .001) times higher prevalence of GAS desire, respectively, compared with otherwise not opting for those procedures. Moreover, the prevalence of GAS desire was higher among patients with GD (aPR 1.09; 95% CI: 1.01–1.18; P value = .03) than individuals without GD. Clinical Translation Providers' awareness of patients’ desires, values, and health-seeking preferences could facilitate differentiated guidance on their gender affirmation. Strengths and Limitations This quantitative study is the first to explore gender-affirming practices among transgender adults in the Philippines and provide significant insights into their healthcare needs. Our study focused only on TGM and TGW and did not reflect the other issues of transgender people outside of Metro Manila, Philippines. Furthermore, our retrospective study design may have missed essential predictors or factors not captured in the medical charts; hence, our study could never dismiss confounding factor bias due to unmeasured or residual confounding factors. Conclusions There is a high prevalence of self- and peer-led attempts from TGM and TGW to facilitate the gender transition, with the desire for GAS being significantly associated with GD and by which specific surgical procedure is chosen. Eustaquio PC, Castelo AV, Araña YS et al. Prevalence and Factors Associated With Gender-Affirming Surgery Among Transgender Women & Transgender Men in a Community-Based Clinic in Metro Manila, Philippines: A Retrospective Study. Sex Med 2022;10:100497.
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Affiliation(s)
| | | | | | | | - John Danvic T Rosadiño
- LoveYourself Inc., Mandaluyong City, Philippines; Faculty of Management and Development Studies, University of the Philippines - Open University, Los Baños, Laguna, Philippines
| | | | - Zypher Jude G Regencia
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Emmanuel S Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
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Reported Pain in Cisgender Female and Transmasculine Patients Seeking Benign Breast Surgery. Plast Reconstr Surg Glob Open 2022; 10:e4140. [PMID: 35198357 PMCID: PMC8856122 DOI: 10.1097/gox.0000000000004140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Benign breast surgery aims to treat the physical and psychological discomfort that may be associated with excess breast tissue. In this investigation, we present the first systematic examination and comparison of the determinants of pain and related symptomology in cisgender women and transmasculine individuals presenting for benign breast surgery. METHODS To complete this study, we abstracted the intake forms of 128 transmasculine and 62 cisgender female patients who presented for benign breast surgery between August 2016 and July 2020. RESULTS Increasing chest size was associated with significantly increased odds of reporting rash (OR 1.10 95% CI [1.01-1.10], P < 0.03), difficulty playing sports (OR 1.19 95% CI [1.09-1.29], P < 0.001), and difficulty finding clothes that fit (OR 1.21, 95% CI [1.11-1.33], P < 0.001). For individuals who bound their chests, size was also associated with difficulty exercising in a binder (OR 1.14 [1.01-1.29], P < 0.03). Looking separately at the two populations, the only factors that remained associated with pain in multivariate models were BMI (β = 0.10 [0.01-0.18], P < 0.03) for cisgender women and history of binding (β = 1.95 [0.37-3.52], P < 0.02) for transmasculine people. CONCLUSIONS Pain does not seem to be associated with chest size in either cisgender female or transmasculine patients seeking benign breast surgery. The association between chest binding and pain in transmasculine people supports the provision of gender-affirming chest surgery to eliminate the need to bind and reduce both physical and psychological distress.
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Javier C, Crimston CR, Barlow FK. Surgical satisfaction and quality of life outcomes reported by transgender men and women at least one year post gender-affirming surgery: A systematic literature review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:255-273. [PMID: 35799954 PMCID: PMC9255096 DOI: 10.1080/26895269.2022.2038334] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Many transgender women and men undergo gender-affirming surgeries. Existing work shows that early surgery outcomes are generally positive, suggesting high surgical satisfaction and positive quality of life outcomes. Less work, however, examines these outcomes in the longer-term. AIMS To conduct a systematic literature review into the longer-term (i.e., ≥ 1 year) surgical satisfaction and quality of outcomes following various forms of gender-affirming surgery in transgender populations. Specifically, we aim to examine research on such outcomes at least one-year post gender-affirming chest, genital, facial, vocal cord, and Adam's apple removal surgeries. METHODS Studies were identified through Google Scholar, PsycINFO, Scopus, and PubMed databases, as well as through Google Scholar search alerts. We considered all studies published until October 2021. Two reviewers extracted data from suitable studies using Covidence. Both reviewers also independently assessed the identified studies' risk of bias and strength of evidence. RESULTS Seventy-nine low quality (e.g., small sample sizes, lack of control/comparison groups) studies suggest that most transgender patients are satisfied with surgical outcomes when assessed at least one-year post-surgery. Low quality research also indicates that transgender women and men typically report positive psychological and sexual wellbeing post-surgery, and similar wellbeing outcomes as those who have not had surgery. DISCUSSION To the best of our knowledge, this literature review is the first to critically summarize and evaluate all published studies on the longer-term quality of life outcomes following chest, genital, facial, voice and Adam's apple removal surgeries for transgender women and men. While the results suggest promising surgical satisfaction and quality of life outcomes following surgery, many studies only draw on small samples, and most studies do not allow for causal conclusions. Further, few studies have compared surgical outcomes between transgender women and men. We conclude by offering concrete suggestions for future research.
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Affiliation(s)
- Christienne Javier
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
- CONTACT Christienne Javier School of Psychology, The University of Queensland, St Lucia, Queensland4072, Australia
| | - Charlie R. Crimston
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Fiona Kate Barlow
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
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16
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Sherman ADF, Balthazar M, Klepper M, Febres-Cordero S, Valmeekanathan A, Prakash D, Cimino AN, Wharton W, Allure K, Kelly U. Approach and avoidant coping among black transgender women who have experienced violence: A qualitative analysis. Psychol Serv 2022; 19:45-61. [PMID: 34460276 PMCID: PMC9891319 DOI: 10.1037/ser0000581] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Black transgender women face nearly universal exposure to violence. Coping behaviors among cisgender women who have survived violence are well delineated; however, there are relatively few studies examining coping strategies for transgender women. The purpose of this qualitative study was to identify and characterize coping behaviors employed by Black transgender women (from Baltimore, MD and Washington, DC metropolitan areas) following an experience of violence. Secondary qualitative data analysis was conducted using framework analysis to explore narratives of 19 Black transgender women. Themes regarding avoidant and approach coping behaviors were developed within the context of existing literature. Approach coping behavior themes included: Help-Seeking, Seeking Guidance and Support, Self-Protecting Behavior, Positive Reappraisal, Self-Affirmation, Self-Care, Connection to a Higher Power, and Acceptance. Avoidant coping behavior themes included: Cognitive Avoidance, Substance, Alcohol, and Tobacco Use, Emotional Discharge, and Seeking Alternative Rewards. Participants employed similar coping behaviors as seen among cisgender women survivors of violence. However, several unique applications of approach coping mechanisms were identified including self-protecting behavior and self-affirming behavior. Culturally informed application of the identified coping behaviors can be taught and integrated into trauma-informed mental health interventions to promote strength and resilience among Black transgender women. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Monique Balthazar
- The Nell Hodgson Woodruff School of Nursing, Emory University,Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University
| | - Meredith Klepper
- The Johns Hopkins University School of Nursing, Johns Hopkins University
| | | | | | - Diane Prakash
- The Nell Hodgson Woodruff School of Nursing, Emory University
| | - Andrea N. Cimino
- Danger Assessment Training and Technical Assistance Center, Johns Hopkins School of Nursing
| | - Whitney Wharton
- The Nell Hodgson Woodruff School of Nursing, Emory University
| | - Kisha Allure
- Casa Ruby, Washington, District of Columbia, United States
| | - Ursula Kelly
- The Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta VA Health Care System, Atlanta, Georgia, United States
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Sineath RC, Blasdel G, Dy GW. Addressing urologic health disparities in sexual and gender minority communities through patient-centered outcomes research. Urology 2021; 166:66-75. [PMID: 34774931 DOI: 10.1016/j.urology.2021.08.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 10/19/2022]
Abstract
Sexual and gender minority (SGM) communities face stigma and discrimination that impact all aspects of health. To better understand and improve their urologic health outcomes, we must study SGM patients as a distinct population and pursue research on outcomes identified as priorities to SGM communities. Patient-centered outcomes research (PCOR) is a methodology which is increasingly familiar to urologists and is crucial to adequately addressing SGM health in future urological research. We review existing literature focused on urologic outcomes of SGM populations and highlight specific PCOR initiatives built on SGM community engagement.
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Affiliation(s)
- R Craig Sineath
- Department of Urology, Oregon Health & Science University, Portland, Oregon.
| | - Gaines Blasdel
- Department of Urology, New York University Grossman School of Medicine, New York, New York
| | - Geolani W Dy
- Department of Urology, Oregon Health & Science University, Portland, Oregon
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Tristani-Firouzi B, Veith J, Simpson A, Hoerger K, Rivera A, Agarwal C. Preferences for and barriers to gender affirming surgeries in transgender and non-binary individuals. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 23:458-471. [PMID: 36324882 PMCID: PMC9621289 DOI: 10.1080/26895269.2021.1926391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: The transgender/non-binary community continues to be an underserved population in medicine, and our understanding of their interests, disinterests, and barriers to transition-related healthcare is quite limited, especially among the diverse gender identities within the transgender/non-binary umbrella. Aim: To determine the interests, disinterests and barriers to gender affirming surgeries for transgender men, transgender women and non-binary individuals of any birth-assigned sex. Methods: An anonymous, online survey using REDcap was applied across all 50 states and advertised through social media, healthcare organization websites and flyers. The responses of individuals greater than 18 years of age who identified as transgender or non-binary were analyzed. Results: Compared to the 2015 US Transgender Survey, interest in gender affirming surgeries was higher across all gender identities surveyed and for all procedures, by an average of 38%. Interest overall in gender affirming procedures varied greatly among gender identity groups as well as with age differences. Barriers were found to be a mixture of lack of resources for recovery, financial, and a fear of complications. Discussion: Our results highlight that a desire for these procedures is unique for each individual and should never be assumed for transgender/non-binary patients. In order to better aid this underserved population, the medical community must further work to mitigate the barriers to gender affirming procedures by decreasing cost, investigating ways to increase access to resources for recovery, and improving outcomes for each of the gender affirming surgeries.
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Affiliation(s)
| | - Jacob Veith
- Division of Plastic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Andrew Simpson
- Division of Plastic Surgery, Western University, London, Ontario, Canada
| | - Kelly Hoerger
- Division of Plastic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Andy Rivera
- Division of Plastic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Cori A. Agarwal
- Division of Plastic Surgery, University of Utah, Salt Lake City, Utah, USA
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Jahromi AH, Horen SR, Dorafshar AH, Seu ML, Radix A, Anderson E, Green J, Fraser L, Johannesson L, Testa G, Schechter LSM, Schechter L. Uterine transplantation and donation in transgender individuals; proof of concept. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:349-359. [PMID: 37808528 PMCID: PMC10553376 DOI: 10.1080/26895269.2021.1915635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Loren Schechter
- Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
- The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at, Chicago, IL, USA
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20
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Aubrey C, Saad N, Köbel M, Mattatall F, Nelson G, Glaze S. Implications for management of ovarian cancer in a transgender man: Impact of androgens and androgen receptor status. Gynecol Oncol 2021; 161:342-346. [PMID: 33663874 DOI: 10.1016/j.ygyno.2021.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 36-year-old transgender man (assigned female at birth) on exogenous testosterone therapy was found to have stage IIA ovarian endometrioid carcinoma, and underwent adjuvant chemotherapy. Diffuse androgen receptor expression in the tumor initiated a multidisciplinary discussion regarding the safety of continuing exogenous testosterone as gender-affirming hormone therapy.
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Affiliation(s)
- Christa Aubrey
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Canada
| | - Nathalie Saad
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Fiona Mattatall
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Oncology, Division of Gynecologic Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | - Sarah Glaze
- Department of Oncology, Division of Gynecologic Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada.
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21
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Meyer G, Boczek U, Bojunga J. Hormonal Gender Reassignment Treatment for Gender Dysphoria. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:725-732. [PMID: 33559593 DOI: 10.3238/arztebl.2020.0725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/16/2020] [Accepted: 06/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND No data are available at present on the prevalence of gender dysphoria (trans-identity) in Germany. On the basis of estimates from the Netherlands, it can be calculated that approximately 15 000 to 25 000 persons in Germany are affected. Persons suffering from gender dysphoria often experience significant distress and have a strong desire for gender reassignment treatment. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed database employing the searching terms "transsexualism," "transgender," "gender incongruence," "gender identity disorder," "gender-affirming hormone therapy," and "gender dysphoria." RESULTS In view of its far-reaching consequences, some of which are irreversible, hormonal gender reassignment treatment should only be initiated after meticulous individual consideration, with the approval of the treating psychiatrist/psychotherapist and after extensive information of the patient by an experienced endo - crinologist. Before the treatment is begun, the patient must be extensively screened for risk factors. The contraindications include severe preexisting thromboembolic diseases (mainly if untreated), hormone-sensitive tumors, and uncontrolled pre - existing chronic diseases such as arterial hypertension and epilepsy. Finding an appropriate individual solution is the main objective even if contraindications are present. Male-to-female treatment is carried out with 17β-estradiol or 17β-estradiol valerate in combination with cyproterone acetate or spironolactone as an antiandrogen, female-to-male treatment with transdermal or intramuscular testosterone preparations. The treatment must be monitored permanently with clinical and laboratory follow-up as well as with gynecological and urological early-detection screening studies. Prospective studies and a meta-analysis (based on low-level evidence) have documented an improvement in the quality of life after gender reassignment treatment. Female-to-male gender-incongruent persons often have difficulty being accepted in a gynecological practice as a male patient. CONCLUZION Further prospective studies for the quantification of the risks and benefits of hormonal treatment would be desirable. Potential interactions of the hormone preparations with other medications must always be considered.
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Affiliation(s)
- Gesine Meyer
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology, Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
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Health and well-being of trans and non-binary participants in a community-based survey of gay, bisexual, and queer men, and non-binary and Two-Spirit people across Canada. PLoS One 2021; 16:e0246525. [PMID: 33571252 PMCID: PMC7877578 DOI: 10.1371/journal.pone.0246525] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
There is a paucity of population health data on the experiences of transgender, non-binary, and other gender minority gay, bisexual, and queer men, and Two-Spirit people in Canada. To address this gap, this article presents a socio-demographic and health profile of trans and non-binary participants from the community-based bilingual 2018 Sex Now Survey. Participants were recruited in-person from Pride festivals in 15 communities to self-complete an anonymous paper-and-pen questionnaire. To be eligible, participants needed to be at least 15 years old, live in Canada, either report a non-heterosexual sexual identity or report sex with a man in the past 5 years, and not report gender identity as a woman. Through community consultations the survey was inclusive of trans men, non-binary people, and Two-Spirit people. Three gender groups (cisgender, transgender, and non-binary) were created, and trans and non-binary participants were compared with their cisgender peers across a variety of demographic, mental health, sexual health, and general health indicators. Odds ratios were calculated to determine initial significance for categorical variables, and adjusted odds ratios were calculated to control for five possible confounders (age, ethnoracial identity, country of birth, sexual identity, and financial strain). Significant differences emerged across all sets of indicators, with many of these findings remaining significant after adjusting for confounding variables, including significantly higher reported rates of mental health challenges and sexual health service barriers for trans and non-binary participants compared to the cisgender group. Trans and non-binary participants were also more likely to be in polyamorous relationships. Collectively, our findings demonstrate that trans and non-binary people experience significant disadvantages compared with cisgender sexual minority men. Improved educational supports and employment protections, access to queer and gender affirming healthcare, and trauma-informed mental health services are needed to improve the health wellbeing of trans and non-binary people in Canada.
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Hughto JMW, Quinn EK, Dunbar MS, Rose AJ, Shireman TI, Jasuja GK. Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults. JAMA Netw Open 2021; 4:e2036512. [PMID: 33538824 PMCID: PMC7862992 DOI: 10.1001/jamanetworkopen.2020.36512] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. OBJECTIVES To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location. MAIN OUTCOMES AND MEASURES SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female). RESULTS In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]). CONCLUSIONS AND RELEVANCE In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.
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Affiliation(s)
- Jaclyn M. W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Health Promotion and Health Equity, Brown School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Emily K. Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | | | - Adam J. Rose
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Guneet K. Jasuja
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
- OptumLabs, Eden Prairie, Minnesota
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Prince JCJ, Safer JD. Endocrine treatment of transgender individuals: current guidelines and strategies. Expert Rev Endocrinol Metab 2020; 15:395-403. [PMID: 32990485 DOI: 10.1080/17446651.2020.1825075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This review summarizes gender affirming medical and surgical care available to transgender individuals, along with proposals to improve medically and culturally appropriate care. AREAS COVERED Transgender individuals are those whose gender identity differs from that recorded at birth (usually based on visualization of external sexual anatomy). In order to align the body with the patient's gender identity, clinicians can provide hormone therapy (HT) to bring sex hormone levels to the range associated with the patient's gender identity. At steady state, monitoring for maintenance of levels, as well as for known risks and complications, is required. Treating clinicians should have knowledge of trans assessment criteria, hormone therapy, surgical options, primary care, and mental health needs of transgender patients. A narrative literature review was conducted using Pubmed and EMBASE with articles then selected for relevance. The initial search terms were: androgen suppression, antiandrogen, breast development, chest reconstruction, cisgender, estrogen, fertility preservation, gender-affirming surgery, gender identity, gender incongruence, genital reconstruction, hormone replacement, hyperlipidemia, orchiectomy, prolactin, prostate atrophy, spermatogenesis, spironolactone, testosterone, thrombogenesis, transgender, and virilization. EXPERT OPINION Although guidelines exist and examples of training are available, systematic formal training must be implemented to truly mainstream high-quality gender-affirming health care .
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Affiliation(s)
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai , New York, NY, USA
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Tabaac AR, Jolly D, Boskey ER, Ganor O. Barriers to Gender-affirming Surgery Consultations in a Sample of Transmasculine Patients in Boston, Mass. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3008. [PMID: 32983769 PMCID: PMC7489736 DOI: 10.1097/gox.0000000000003008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
Gender diverse people are increasingly pursuing gender-affirming surgery, but little is known about their experiences on accessing care. As part of the baseline assessment for an ongoing longitudinal study, we examined the types of barriers and self-reported out-of-pocket costs associated with gender-affirming surgery most commonly endorsed by transmasculine chest (top) and genital (bottom) surgery patients at their initial surgical consultation. METHODS A brief survey was administered to a clinical sample of transmasculine patients (n = 160; age ≥15 years) seeking a gender-affirming surgery at the Center for Gender Surgery in Boston, Mass. from April 2018 to February 2020. RESULTS The barriers most commonly endorsed by top surgery patients were insurance coverage and age. For bottom surgery patients, the most commonly endorsed barriers were getting mental health letters and readiness for surgery. Bottom surgery patients were also more likely to report barriers of readiness for surgery and cost of/access to hair removal, than top surgery patients (Ps < 0.05). Bottom surgery patients were more likely to report out-of-pocket costs related to hair removal, surgical consultation, and surgery (Ps < 0.05), whereas top surgery patients were more likely to report hormone treatment costs (P = 0.01). Average out-of-pocket costs were high (mean = 2148.31) and significantly higher for bottom surgery patients (b = 4140.30; β = 0.64; 95% confidence interval, 3064.6-5216.0). CONCLUSIONS Transmasculine patients experience a variety of barriers when seeking gender-affirming surgery. Presurgical requirements, insurance access, and high out-of-pocket costs may hinder access to care for many transmasculine people seeking bottom surgery.
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Affiliation(s)
- Ariella R. Tabaac
- From the Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
| | - Divya Jolly
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
| | - Oren Ganor
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
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Affiliation(s)
- Joshua D Safer
- From the Center for Transgender Medicine and Surgery, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York (J.D.S.); and the Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, and the Atlanta Veterans Affairs Medical Center - both in Atlanta (V.T.)
| | - Vin Tangpricha
- From the Center for Transgender Medicine and Surgery, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York (J.D.S.); and the Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, and the Atlanta Veterans Affairs Medical Center - both in Atlanta (V.T.)
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Barcelos CA. 'Bye-bye boobies': normativity, deservingness and medicalisation in transgender medical crowdfunding. CULTURE, HEALTH & SEXUALITY 2019; 21:1394-1408. [PMID: 30762488 DOI: 10.1080/13691058.2019.1566971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/29/2018] [Indexed: 06/09/2023]
Abstract
Transgender individuals experience multiple barriers to accessing care related to medical transition, including a shortage of providers as well as health insurance programmes that categorically exclude the provision of gender-affirming hormones and surgery. Like people seeking financial support for health care related to illness or injury, many transgender people utilise web-based crowdfunding to help pay for medical transition costs. Although a growing body of research finds that medical crowdfunding individualises the effects of health inequalities, little of this research has focused specifically on trans crowdfunding. A dataset of 410 crowdfunding campaigns for medical transition was created. The majority of online campaigns were used to fund chest surgeries among young, white, binary-identified trans men in the USA. On average, campaigns raise only about 25% of their fundraising goal. Using thematic narrative analysis, I find that campaign narratives exhibit several main themes: trans 101, biological essentialism, insurance access, deservingness, normative transition and notions of progress. These themes illustrate how transgender medical crowdfunding is a response to inequalities but also has the effect of reproducing them.
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Affiliation(s)
- Chris A Barcelos
- Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
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Abstract
The transgender and nonbinary (TGNB) population is a significant minority, comprising at least 0.6% of the population. Visibility is growing rapidly, especially in younger generations. Gender affirming health care must adapt to this population's needs. Demographic data regarding TGNB health care are limited, but several disparities are clear, stemming from sociopolitical factors, such as external discrimination and insensitive and/or uninformed care. Most self-identifying TGNB patients receive some type of nonsurgical care, including hormonal and/or mental health. Gender-affirming surgery is highly prevalent as well, with at least one-quarter of TGNB people having had some combination of the procedures in this category.
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Abstract
Transgender persons are a diverse group whose gender identity differs from their sex recorded at birth. Some choose to undergo medical treatment to align their physical appearance with their gender identity. Barriers to accessing appropriate and culturally competent care contribute to health disparities in transgender persons, such as increased rates of certain types of cancer, substance abuse, mental health conditions, infections, and chronic diseases. Thus, it is important that clinicians understand the specific medical issues that are relevant to this population.
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Affiliation(s)
- Joshua D Safer
- Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York (J.D.S.)
| | - Vin Tangpricha
- Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia (V.T.)
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Boskey ER, Johnson JA, Harrison C, Marron JM, Abecassis L, Scobie-Carroll A, Willard J, Diamond DA, Taghinia AH, Ganor O. Ethical Issues Considered When Establishing a Pediatrics Gender Surgery Center. Pediatrics 2019; 143:peds.2018-3053. [PMID: 31085738 DOI: 10.1542/peds.2018-3053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
As part of establishing a gender surgery center at a pediatric academic hospital, we undertook a process of identifying key ethical, legal, and contextual issues through collaboration among clinical providers, review by hospital leadership, discussions with key staff and hospital support services, consultation with the hospital's ethics committee, outreach to other institutions providing transgender health care, and meetings with hospital legal counsel. This process allowed the center to identify key issues, formulate approaches to resolving those issues, and develop policies and procedures addressing stakeholder concerns. Key issues identified during the process included the appropriateness of providing gender-affirming surgeries to adolescents and adults, given the hospital's mission and emphasis on pediatric services; the need for education on the clinical basis for offered procedures; methods for obtaining adequate informed consent and assent; the lower and upper acceptable age limits for various procedures; the role of psychological assessments in determining surgical eligibility; the need for coordinated, multidisciplinary patient care; and the importance of addressing historical access inequities affecting transgender patients. The process also facilitated the development of policies addressing the identified issues, articulation of a guiding mission statement, institution of ongoing educational opportunities for hospital staff, beginning outreach to the community, and guidance as to future avenues of research and policy development. Given the sensitive nature of the center's services and the significant clinical, ethical, and legal issues involved, we recommend such a process when a establishing a program for gender surgery in a pediatric institution.
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Affiliation(s)
- Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | | | | | - Jonathan M Marron
- Ethics Advisory Committee.,Office of Ethics, and.,Division of Hematology/Oncology.,Center for Bioethics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Julian Willard
- Center for Bioethics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - David A Diamond
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | - Amir H Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
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Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol 2019; 8:184-190. [PMID: 31380225 PMCID: PMC6626314 DOI: 10.21037/tau.2019.04.09] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/23/2019] [Indexed: 11/06/2022] Open
Abstract
Transgender and gender non-binary (TGNB) individuals are a growing demographic with unique healthcare needs. Amid changes in public and private insurance coverage of gender confirming surgeries (GCS), utilization of these procedures is increasing. Meanwhile, systemic barriers continue to limit access to gender confirming care and perpetuate health disparities among TGNB individuals. Studies on the prevalence of TGNB identities and utilization of GCS are limited by a lack of gender identity data in population-based surveys and electronic medical records. However, data collection on gender identity is improving, and will be essential for characterizing the healthcare practices and needs of TGNB individuals.
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Affiliation(s)
- Ian T. Nolan
- School of Medicine, New York University, New York, NY, USA
| | | | - Geolani W. Dy
- Department of Urology, New York University, New York, NY, USA
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Abstract
Purpose: An emerging body of research analyzes the scope, ethics, and inequalities of web-based crowdfunding to raise money for medical expenses related to illness or injury. To date, little research has investigated how transgender communities utilize crowdfunding expenses related to gender affirming medical care. Methods: Using GoFundMe.com, we created a data set of 391 crowdfunding campaigns for gender-affirming care created from 2012 to 2016. In addition to descriptive statistics of recipient demographics and campaign financials, we conducted hierarchical multiple regression analyses to determine the factors associated with financial outcomes of fundraising for medical expenses. Results: Findings indicate that the majority of campaigns were used to fund chest surgeries among young, white, binary-identified trans men in the United States. Few campaigns met their fundraising goal. Being a trans man whose Facebook community shares the crowdfunding campaign is predictive of meeting a higher percentage of the fundraising goal, whereas being a trans woman whose Facebook community shares the campaign is predictive of raising more money. Conclusion: The use of crowdfunding for gender affirming highlights the difficulties that transgender persons face with using private and public health care programs to fund medically necessary care. Health care providers should exercise caution in recommending crowdfunding as a viable strategy to raise money for out-of-pocket costs.
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Affiliation(s)
- Chris A. Barcelos
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, Wisconsin
- Address correspondence to: Chris A. Barcelos, PhD, MPPA, Department of Gender and Women's Studies, University of Wisconsin-Madison, 475 N. Charter Street, Madison, WI 53706,
| | - Stephanie L. Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin
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Barcelos CA. Go fund inequality: the politics of crowdfunding transgender medical care. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1575947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Chris A. Barcelos
- Department of Gender and Women’s Studies, University of Wisconsin-Madison, Madison, WI, USA
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Zayhowski K, Park J, Boehmer U, Gabriel C, Berro T, Campion M. Cancer genetic counselors' experiences with transgender patients: A qualitative study. J Genet Couns 2019; 28:641-653. [DOI: 10.1002/jgc4.1092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/23/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Kimberly Zayhowski
- Department of Genetics Stanford University School of Medicine Stanford California
| | - Jessica Park
- Department of Genetics Stanford University School of Medicine Stanford California
| | - Ulrike Boehmer
- Department of Community Health Sciences Boston University School of Public Health Boston Massachusetts
| | - Camila Gabriel
- Center for Cancer Genetics and Prevention, Dana Farber Cancer Institute Boston Massachusetts
| | - Tala Berro
- Division of Graduate Medical Sciences Boston University School of Medicine Boston Massachusetts
| | - MaryAnn Campion
- Department of Genetics Stanford University School of Medicine Stanford California
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Gerth J, Becerra-Culqui T, Bradlyn A, Getahun D, Hunkeler EM, Lash TL, Millman A, Nash R, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Agreement between medical records and self-reports: Implications for transgender health research. Rev Endocr Metab Disord 2018; 19:263-269. [PMID: 30219985 PMCID: PMC6438197 DOI: 10.1007/s11154-018-9461-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A key priority of transgender health research is the evaluation of long-term effects of gender affirmation treatment. Thus, accurate assessment of treatment receipt is critical. The data for this analysis came from an electronic medical records (EMR) based cohort of transgender individuals. A subset of cohort members were also asked to complete a self-administered survey. Information from the EMR was compared with survey responses to assess the extent of agreement regarding transmasculine (TM)/transfeminine (TF) status, hormone therapy receipt, and type of surgery performed. Logistic regression models were used to assess whether participant characteristics were associated with disagreement between data sources. Agreement between EMR and survey-derived information was high regarding TM/TF status (99%) and hormone therapy receipt (97%). Lower agreement was observed for chest reconstruction surgery (72%) and genital reconstruction surgery (84%). Using survey responses as the "gold standard", both chest and genital reconstruction surgeries had high specificity (95 and 93%, respectively), but the corresponding sensitivities were low (49 and 68%, respectively). A lower proportion of TM had concordant results for chest reconstruction surgery (64% versus 79% for TF) while genital reconstruction surgery concordance was lower among TF (79% versus 89% for TM). For both surgery types, agreement was highest among the youngest participants. Our findings offer assurance that EMR-based data appropriately classify cohort participants with respect to their TM/TF status or hormone therapy receipt. However, current EMR data may not capture the complete history of gender affirmation surgeries. This information is useful in future studies of outcomes related to gender affirming therapy.
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Affiliation(s)
- Joseph Gerth
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA
| | - Tracy Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Andrew Bradlyn
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Enid M Hunkeler
- Emerita, Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | | | - Vin Tangpricha
- School of Medicine, Emory University, Atlanta, GA, USA
- The Atlanta VA Medical Center, Atlanta, GA, USA
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA.
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Hadj-Moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery. Sex Med Rev 2018; 7:141-155. [PMID: 30122339 DOI: 10.1016/j.sxmr.2018.06.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This article is the third in a 3-part series focused on the comprehensive treatment of gender dysphoria. Multidisciplinary gender dysphoria care may involve a combination of counseling, social gender transition, hormone therapy, and gender confirmation surgery (GCS) to maximize physical characteristics congruent with a patient's gender identity. Nonoperative management of gender dysphoria was covered in part 1. The focus of part 2 was feminizing GCS. In part 3, surgical considerations for masculinizing GCS are summarized, including a review of different phalloplasty techniques. This installment also includes information about adjunctive procedures, therapies, and products used by transgender men and women to express their gender identity. AIM To provide an overview of both genital and nongenital masculinizing gender confirmation procedures. To review phalloplasty techniques, preoperative considerations, complications, and outcomes. To summarize ancillary services and procedures available to transgender patients to facilitate their gender presentation. METHODS A review of relevant literature through May 2017 was performed via PubMed. MAIN OUTCOME MEASURES To summarize ancillary products and services used by transgender patients and to review surgical considerations for masculinizing genitoplasty. RESULTS A variety of nonsurgical ancillary services exist for transgender patients to aid their transition. A variety of phalloplasty procedures have been developed for transgender men who seek genital GCS. Most surgeons prefer radial forearm phalloplasty, including the authors whose surgical technique is described. Each phalloplasty approach is associated with its own benefits, drawbacks, and complications. CONCLUSION A variety of ancillary services and procedures that help transgender men and women communicate their gender identity in society is available and is an important adjunct to medical or surgical treatment of gender dysphoria. Pre-operative, intra-operative, and post-operative considerations of masculinizing genital gender confirmation procedures were reviewed. Hadj-Moussa M, Agarwal S, Ohl DA, et al. Masculinizing Genital Gender Confirmation Surgery. Sex Med Rev 2019;7:141-155.
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Affiliation(s)
| | - Shailesh Agarwal
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Ohl
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - William M Kuzon
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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Quinn VP, Nash R, Hunkeler E, Contreras R, Cromwell L, Becerra-Culqui TA, Getahun D, Giammattei S, Lash TL, Millman A, Robinson B, Roblin D, Silverberg MJ, Slovis J, Tangpricha V, Tolsma D, Valentine C, Ward K, Winter S, Goodman M. Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people. BMJ Open 2017; 7:e018121. [PMID: 29284718 PMCID: PMC5770907 DOI: 10.1136/bmjopen-2017-018121] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/11/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. PARTICIPANTS A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. FINDINGS TO DATE About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. FUTURE PLANS STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to gender affirmation therapy.
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Affiliation(s)
- Virginia P Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Enid Hunkeler
- Division of Research, Kaiser Permanente Northern California (emerita), Oakland, California, USA
| | - Richard Contreras
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Tracy A Becerra-Culqui
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Shawn Giammattei
- The Rockway Institute, Alliant International University, San Francisco, California, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Douglas Roblin
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Slovis
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, Georgia, USA
- The Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Cadence Valentine
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Savannah Winter
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Beckwith N, Reisner SL, Zaslow S, Mayer KH, Keuroghlian AS. Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults. Transgend Health 2017; 2:156-164. [PMID: 29159310 PMCID: PMC5685205 DOI: 10.1089/trgh.2017.0028] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults. Methods: We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of gender-affirming surgery and of age of hormone therapy initiation. Results: Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD=11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist. Conclusion: This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients.
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Affiliation(s)
- Noor Beckwith
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sari L. Reisner
- Harvard Medical School, Boston, Massachusetts
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shayne Zaslow
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Sociology, University of Virginia, Charlottesville, Virginia
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alex S. Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts
- Address correspondence to: Alex S. Keuroghlian, MD, MPH, Division of Education and Training, The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, E-mail:
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Lee EJ, Gurr D, Van Wye G. An Evaluation of New York City's 2015 Birth Certificate Gender Marker Regulation. LGBT Health 2017; 4:320-327. [PMID: 28937934 DOI: 10.1089/lgbt.2017.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE In 1971, the New York City (NYC) Department of Health and Mental Hygiene amended Section 207.05 of the NYC Health Code to allow individuals who had undergone "convertive surgery" (interpreted by the code to mean genital surgery) to amend the gender on their birth certificates. This surgery requirement was removed in 2015. In a survey evaluating the regulation change, we sought to characterize the transgender population newly eligible to obtain a gender-congruent NYC birth certificate by comparing respondents with and without genital surgery. METHODS We mailed a 42-question survey with each newly issued birth certificate. We compared respondents across current gender identity, race, Hispanic ethnicity, age, insurance status, income, current general health status, other transition-related care obtained, and healthcare access, stigma, and discrimination. RESULTS Of 642 applicants, 219 responded and were thus enrolled in our 5-year study (34.1%). Most (n = 158 out of 203 who answered, 77.8%) had not received genital surgery. Compared to respondents with genital surgery, respondents without surgery were significantly more likely to be transgender men (50.0% vs. 20.0%); younger (median age 32 vs. 56.5); on Medicaid (31.6% vs. 11.1%); identify as Hispanic (28.5% vs. 8.9%); and live in households making <$20,000 annually (35.3% vs. 12.8%). CONCLUSIONS Removing a genital surgery requirement more equitably enables transgender men and those with limited resources to obtain a gender-congruent birth certificate. Jurisdictions with such requirements should consider similar regulation changes to address the inequities that this requirement likely imposes in accessing birth certificates.
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Affiliation(s)
- Erica J Lee
- Bureau of Vital Statistics , Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Danielle Gurr
- Bureau of Vital Statistics , Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Gretchen Van Wye
- Bureau of Vital Statistics , Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
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Abstract
PURPOSE OF REVIEW To explore the medical and surgical clinical dilemmas in the management of trans (transgender) men, a growing population receiving more attention than in the past. RECENT FINDINGS Testosterone therapy is commonly prescribed to trans men for masculinization. Nonetheless, the optimal formulations and doses of testosterone therapy for trans men have not been well established. Testosterone therapy has been associated with increased levels of hemoglobin and triglycerides, as well as diabetes. Periodic monitoring of hemoglobin, cholesterol, and fasting glucose is therefore recommended. As compared to non-transgender women, trans men have lower age-specific rates of breast cancer and cervical cancer which can be attributed, in part, to surgeries such as bilateral mastectomies and hysterectomies. The frequency in which to recommend mammograms and Pap smears (in patients with intact cervices) is uncertain in this population because of a lack of evidence-based data. Many trans men desire and undergo bilateral mastectomies with much fewer undergoing metoidioplasty or phalloplasty. SUMMARY For trans men, most clinicians target serum testosterone concentrations in the normal male reference range. The frequency of screening for breast and cervical cancer should be individualized based upon anatomy, patient age, age of initiation of testosterone therapy, and other factors.
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Affiliation(s)
- Michael S Irwig
- Center for Andrology and Division of Endocrinology, The George Washington University, Washington, DC, USA
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