A prospective comparison study of subcutaneous and intramuscular testosterone injections in transgender male adolescents

OBJECTIVES

This prospective study compares testosterone injection type and effects on biochemical changes, clinical effects, and quality of life amongst transgender and gender diverse (TGD) adolescents assigned female at birth (AFAB) over the first 6 months of subcutaneous (SQ) vs. intramuscular (IM) testosterone injections as part of their gender affirming care.

METHODS

Subjects were testosterone-naïve transgender adolescents, AFAB, ages 14-18 years old. Subjects were either randomized to injection type or selected a preferred injection type. At enrollment, subjects completed baseline labs and PedsQL™ quality of life questionnaire. At 3 month and 6 month follow up, subjects completed peak and trough testosterone levels, PedsQL™, masculinizing effects, and medication experience questionnaires.

RESULTS

Twenty-six subjects participated with a median age 15.5 years. By 6-month follow up, trough testosterone levels were comparable between the two groups. Peak testosterone levels were higher in the IM group at 3-month follow up. Mild adverse effects were rare (12 %, all in SQ subjects) and limited to skin reaction only. Self-reported masculinization effects and quality of life were not statistically different between injection groups. A total of 92 % of participants was self-injecting by 3-month follow up.

CONCLUSIONS

In this prospective study, clinical and biochemical effects are similar between SQ and IM testosterone injections for transgender adolescents. Subjects expressed preference for both injection types. Both SQ and IM injection modalities are safe and effective for TGD youth initiating testosterone and both options should be offered to patients.

Exploring the Impact of Legislation Aiming to Ban Gender-Affirming Care on Pediatric Endocrine Providers: A Mixed-Methods Analysis

Context

Access to gender-affirming medical care is associated with better mental health outcomes in transgender and gender diverse youth. In 2021 and 2022, legislation aiming to ban gender-affirming medical care for youth was proposed in 24 states.

Objective

This study aimed to (1) assess the impact of this legislation on pediatric providers based on legislative status of their state of practice and (2) identify the themes of concerns reported by them.

Methods

A mixed-methods study was conducted via an anonymous survey distributed to pediatric endocrinology providers. Survey responses were stratified based on US state of practice, with attention to whether legislation aiming to ban gender-affirming care had been considered. Data were analyzed both quantitatively and qualitatively.

Results

Of 223 respondents, 125 (56.0%) were currently providing gender-affirming medical care. A total of 103 (45.7%) respondents practiced in a state where legislation aiming to ban gender-affirming care had been proposed and/or passed between January 2021 to June 2022. Practicing in legislation-affected states was associated with negative experiences for providers including (1) institutional pressure that would limit the ability to provide care, (2) threats to personal safety, (3) concerns about legal action being taken against them, (4) concerns about their career, and (5) institutional concerns about engagement with media. Major qualitative themes emerging for providers in legislation-affected states included safety concerns and the impact of laws on medical practice.

Conclusion

This study suggests that legislation aiming to ban health care for transgender youth may decrease access to qualified providers in affected states.

Multidimensional and Intersectional Gender Identity and Sexual Attraction Patterns of Adolescents for Quantitative Research

To identify and compare gender identity and sexual attraction (GISA) patterns using a latent class analysis (LCA), questionnaire data from a cross-sectional study on social resilience in adolescence was conducted in 2020, using a sample of 785 Swiss seventh grade high school students. Following McCall’s complex intersectionality approach, we applied an intracategorical and intersectional approach to reshape, differentiate, and critique the existing binary, heteronormative GISA categorization. To empirically validate the detected classes according to content, we measured the participants’ psychological characteristics with measures of self-esteem, social competence, symptoms of anxiety and depression, dissociation, social desirability, and emotional styles, and related these measures to the respective GISA patterns the LCA detected. The results of our multistep LCA endorsed that heteronormatively binary gender identities are far too simplistic to fully illustrate adolescents’ differences and similarities where gender is concerned. Out of the subsample of n = 785 adolescents (375 identified as “assigned females” and 410 “assigned males”), three significant subgroups of multidimensional GISA patterns emerged for both assigned females and males where differences within the identified GISA groups were larger than those between traditional “boys” and “girls” overall. The LCA demonstrated that the six classes with GISA indicators could be described as low GISA diverse (cis/heterosexual), intermediate GISA diverse (gender identity diverse and/or sexual diverse), high GISA diverse (gender diverse/sexual diverse) for both assigned males and females thus showing that GISA and the psychological state according to gender variance is greater within groups of assigned females and assigned males than between these groups.