Transgender Health

The study compared physician-based outpatient mental health care follow-up between transgender and gender diverse (TGD) individuals and the general population who had a mental health-related emergency department (ED) visit or hospitalization.

This retrospective population-based cohort study used linked health administrative data to examine all adult psychiatric patients discharged from an ED visit (ED cohort) or hospitalization (hospitalization cohort) between 2012 and 2018 in Ontario, Canada. TGD individuals were identified and their data linked with health administrative data. The primary outcome was the proportion of individuals with any outpatient physician visit for mental health reasons within 30 days of the index discharge. Multivariable logistic regression analyses examined follow-up outcomes, including by diagnostic category, with adjustment for sociodemographic and clinical factors.

There were 728 TGD and 581,708 general population individuals with a mental health-related ED visit, while 454 TGD and 217,507 general population individuals had a psychiatric hospitalization. TGD individuals had higher 30-day post-ED follow-up (adjusted risk ratio [aRR] =1.21; 95% confidence interval [CI]: 1.02–1.42), particularly with a psychiatrist (aRR = 1.27; 95% CI: 1.07–1.52) and for those with an anxiety and related disorder diagnosis (aRR = 1.63; 95% CI: 1.23–2.15). Meanwhile, TGD individuals had lower 30-day follow-up posthospitalization (aRR = 0.80; 95% CI: 0.66–0.98) after adjusting for covariates.

TGD individuals had greater rates of post-ED mental health follow-up, particularly with a psychiatrist, but lower rates of follow-up after a hospitalization. The higher follow-up after ED visits likely reflects greater clinical need. Lower follow-up after hospitalization is concerning given the risk of adverse outcomes and requires further research.

Gender-affirming surgery (GAS) improves both physical and mental health in transgender and gender-diverse individuals. However, access to GAS in the United States is hindered by unreliable insurance coverage and the geographically limited availability of gender-affirming surgeons. This study aimed to demonstrate the cost-effectiveness of gender-affirming mastectomy to encourage more routine insurance coverage.

A cost-effectiveness analysis was performed using a Markov model with a willingness-to-pay threshold of $50,000/quality-adjusted life year (QALY). The two main arms of the Markov model were access to, or lack of access to, mastectomy followed by additional sub-arms for negative or positive health events. Data on health event probability, quality of life, and cost were extracted from the 2015 US Transgender Survey Report, a large Midwest academic health system, and published literature.

Compared with no mastectomy ($14,195, 1.13 QALYs), gender-affirming mastectomy resulted in a greater annual cost and effectiveness ($22,438, 1.46 QALYs) with an incremental cost-effectiveness ratio (ICER) of $24,979/QALY in the second year. By the seventh year of the model and beyond, mastectomy was less costly while still remaining more effective than lack of surgery (ICER $-85/QALY).

Our findings indicate that gender-affirming mastectomy is cost-effective in the second-year post-surgery and modeled to save the health care system money seven years after surgery. These results imply that the provision of gender-affirming mastectomy services results in better outcomes at a lower cost, making the business case for public policymakers and private third-party payers to expand their coverage.

This study aimed to investigate the early impacts of masculinizing hormone therapy on body composition among testosterone-naive Thai transmasculine (TM) individuals, focusing on changes in fat and lean mass within the initial 3–6 months of treatment.

In total, 32 participants were enrolled in this prospective study, receiving a 6-month course of 250-mg intramuscular testosterone enanthate. The assessment included whole-body dual X-ray absorptiometry, alongside anthropometric and laboratory evaluations.

After 6 months of testosterone administration, a significant reduction in total fat mass (FM) was observed (−4.5%; 95% confidence interval [CI] −8.5 to −0.5). Concurrently, there was an increase in total fat-free mass (FFM) (7.0%; 95% CI 3.3 to 10.8). Stratifying participants based on the World Health Organization Asian obesity criteria (body mass index <23 kg/m² for normal and ≥23 kg/m² for overweight-obesity), an elevation in FFM was observed in both categories, with a significant FM reduction only among individuals with obesity. Additional findings included hemoconcentration, reduced high-density lipoprotein cholesterol (HDL-C), and a decline in sex hormone-binding globulin (SHBG).

Within a brief timeframe of testosterone therapy, a substantial decrease in FM and an increase in FFM were noted. Notably, this reduction in FM was more prominent in participants with obesity. Various alterations in laboratory parameters, such as hemoconcentration, reduced HDL-C, and diminished SHBG, were attributed to changes in hepatic metabolism and pituitary suppression induced by exogenous testosterone. These findings contribute valuable insights into the nuanced effects of hormone therapy on body composition among the TM population. Clinical Trial Registration Number—TCTR20241004001.

Mental illness is a significant public health issue among transgender female sex workers (FSW). A variety of factors inform the prevalence of mental illness among transgender FSW, including violence exposure and stigma. Mindfulness, the process of paying attention to the immediate experience with awareness and attentiveness in a nonjudgmental way, has been shown to improve mental health among stigmatized populations, including cisgender FSW living with HIV. This analysis examines the relationship between mindfulness and mental health among transgender FSW living with HIV in the Dominican Republic (DR) and investigates if mindfulness impacts the relationship between violence exposure and mental health.

One hundred transgender FSW living with HIV participated in a cross-sectional survey in Santo Domingo, DR, in 2019. We conducted multivariate linear regressions to assess the relationship between mindfulness and anxiety and depression, respectively, adjusting for covariates. We also conducted multivariate linear regression for the impact of violence exposure (a three-class latent variable) on each outcome, moderating for mindfulness and adjusting for covariates.

Mindfulness was associated with lower depression and anxiety scores and moderated the relationship between violence exposure and depression, but only for those in the mid-level violence exposure class.

This formative work creates a strong foundation for future implementation and evaluation of mindfulness-based interventions with this population to address their mental health needs. Future research should examine the relationships between mindfulness, social support, social cohesion, and social change.