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  • Thursday, February 2, 2017

    February 03, 2017 2:09 PM - February 03, 2017 2:22 PM


    • Michael Goodman, MD; MPH ;
    • Rebecca Nash, MD ;
    • Lee Cromwell, MS ;
    • Tracy Becerra-Culqui, MPH; PhD ;
    • Darios Getahun, MD; MPH; PhD ;
    • Enid Hunkeler, MA ;
    • Andrea Millman, MA ;
    • Virginia Quinn, PhD ;
    • Douglas Roblin, PhD ;
    • Michael Silverberg, PhD ;
    • Jennifer Slovis, MD ;
    • Dennis Tolsma, MPH ;
    • Vin Tangpricha, MD; PhD
    Purpose: The purpose of the present study was to determine the frequency, determinants and patterns of gender affirmation therapy among transgender and gender non-conforming members of three large integrated health care systems.
    Materials and Methods: Data were collected from electronic medical records (EMR) at Kaiser Permanente sites in Georgia (KPGA), Northern California (KPNC), and Southern California (KPSC). The candidates for inclusion were health plan members who had at least one relevant diagnostic code or at least one relevant keyword ("transgender", "transsexual", "transvestite", "gender identity", "gender dysphoria", or "gender reassignment") in electronic medical records. Two trained researchers reviewed up to three short keyword-containing text excerpts to confirm transgender status. Among transgender persons, treatment status was determined by linkage with EMR records of drug prescriptions, diagnostic and procedure codes reflecting gender affirmation therapies, and text strings electronically abstracted from progress notes. Gender affirmation therapies were classified by treatment type (e.g., hormonal therapy and "top" or "bottom" surgery).
    Results: Among 6,505 transgender persons, 54% were trans-feminine, 45% were trans-masculine and in 1% natal sex or gender identity could not be determined. Approximately 60% of these persons were receiving some type of gender affirmation therapy. The proportions of trans-masculine and trans-feminine participants receiving any type of treatment were similar, however trans-masculine individuals were more likely to have evidence of surgical treatment; and, trans-feminine individuals were more likely to have evidence of non-surgical hormonal treatment. Evidence of "top" surgery was more common in trans-masculine than trans-feminine individuals (25% v 5%). Individuals enrolled in KPNC were more likely than individuals enrolled in KPGA or KPSC to have any gender affirmation therapy (p<0.01). The proportion of individuals receiving any gender affirmation therapy increased with age and was highest for non-Hispanic whites compared to other racial/ethnic groups (p<0.01).
    Conclusion: The majority of transgender persons enrolled in these three integrated health care systems received gender affirmation therapy. Factors associated with receipt of gender affirmation therapy included natal sex, age, race, and geographic area of residence.
    Category: Primary Care