title: Priorities for transgender medical and healthcare research.
abstract: OBJECTIVE
  Transgender individuals experience unique health disparities but are the subject of little focused health research. This manuscript reviews current literature on transgender medical and mental health outcomes and proposes research priorities to address knowledge gaps.
  
  
  RESULTS
  Published research in transgender healthcare consists primarily of case reports, retrospective and cross-sectional studies, involving largely European settings. Challenges to US-based transgender health research include a diverse population where no single center has sufficient patient base to conduct clinical research with statistical rigor. Treatment regimens are heterogeneous and warrant study for best practices. Current research suggests increased mortality and depression in transgender individuals not receiving optimal care, and possibly a modest increase in cardiovascular risk related to hormone therapy. Current evidence does not support concerns for hormone-related malignancy risk.
  
  
  CONCLUSIONS
  The priorities for transgender medical outcomes research should be to determine health disparities and comorbid health conditions over the life span, along with the effects of mental health, medical, and surgical interventions on morbidity and mortality. Specific outcomes of interest based on frequency in the literature, potential severity of outcome, and patient-centered interest, include affective disorders, cardiovascular disease, malignancies, fertility, and time dose-related responses of specific interventions.
authors.affiliation: aDepartment of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota bDepartment of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Mountain Home VAMC, Johnson City, Tennessee cDepartment of Family and Community Medicine, University of California, San Francisco, California dProgram of Developmental Psychoendocrinology, Division of Gender, Sexuality, and Health, College of Physicians and Surgeons, Columbia University Medical Center and NYS Psychiatric Institute, New York City, New York eDepartment of Psychiatry, University of Texas, Medical Branch, Galveston, Texas fDepartment of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York City, New York gDivision of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia, USA hDepartment of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium iSection of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Feldman
authors.forename: George R
authors.initials: GR
authors.lastname: Brown
authors.forename: Madeline B
authors.initials: MB
authors.lastname: Deutsch
authors.forename: Wylie
authors.initials: W
authors.lastname: Hembree
authors.forename: Walter
authors.initials: W
authors.lastname: Meyer
authors.forename: Heino F L
authors.initials: HF
authors.lastname: Meyer-Bahlburg
authors.forename: Vin
authors.initials: V
authors.lastname: Tangpricha
authors.forename: Guy
authors.initials: G
authors.lastname: TʼSjoen
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Safer
mesh_terms: D035843:Biomedical Research; D015897:Comorbidity; D003695:Delivery of Health Care; D005260:Female; D006292:Health Priorities; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000523:psychology; D054525:Minority Health; D020380:Needs Assessment; D012307:Risk Factors; D057829:Gender-Affirming Procedures / Q000009:adverse effects; D063106:Transgender Persons / Q000523:psychology; D014189:Transsexualism / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*
references.citation: Eur J Endocrinol. 2011 Apr;164(4):635-42
references.pmid: 21266549
references.citation: Am J Public Health. 2014 Feb;104(2):e105-12
references.pmid: 24328665
references.citation: Can Urol Assoc J. 2013 Jul-Aug;7(7-8):E544-6
references.pmid: 24032068
references.citation: Eur J Endocrinol. 2015 Feb;172(2):163-71
references.pmid: 25550352
references.citation: Am J Public Health. 2013 Oct;103(10):e27-32
references.pmid: 23947310
references.citation: Psychoneuroendocrinology. 2014 Jan;39:65-73
references.pmid: 24275005
references.citation: Int J Endocrinol. 2010;2010:
references.pmid: 20706676
references.citation: J Voice. 2013 May;27(3):321-34
references.pmid: 23159032
references.citation: Clin Endocrinol (Oxf). 2003 May;58(5):562-71
references.pmid: 12699437
references.citation: J Assoc Nurses AIDS Care. 2014 Nov-Dec;25(6):657-63
references.pmid: 24880490
references.citation: J Sex Med. 2014 Dec;11(12):3002-11
references.pmid: 25250780
references.citation: J Urban Health. 2015 Jun;92(3):584-92
references.pmid: 25779756
references.citation: Breast Cancer Res Treat. 2015 Jan;149(1):191-8
references.pmid: 25428790
references.citation: J Voice. 2013 May;27(3):335-47
references.pmid: 23084812
references.citation: Eur J Endocrinol. 2014 Jun;170(6):809-19
references.pmid: 24616414
references.citation: Am J Public Health. 2013 May;103(5):943-51
references.pmid: 23488522
references.citation: Andrologia. 2015 Aug;47(6):680-4
references.pmid: 25059808
references.citation: Lupus. 2013 Nov;22(13):1399-402
references.pmid: 23897544
references.citation: LGBT Health. 2015 Dec;2(4):313-23
references.pmid: 26788772
references.citation: Cereb Cortex. 2013 Dec;23(12):2855-62
references.pmid: 22941717
references.citation: Am J Obstet Gynecol. 2011 May;204(5):e9-e12
references.pmid: 21354550
references.citation: Endocrinol Nutr. 2013 May;60(5):264-7
references.pmid: 23022362
references.citation: J Sex Med. 2014 May;11(5):1248-61
references.pmid: 24617977
references.citation: LGBT Health. 2016 Apr;3(2):122-31
references.pmid: 26674598
references.citation: J Sex Med. 2012 Oct;9(10):2641-51
references.pmid: 22906135
references.citation: LGBT Health. 2015 Mar;2(1):77-80
references.pmid: 26790021
references.citation: J Clin Transl Endocrinol. 2015 Jun;2(2):55-60
references.pmid: 28090436
references.citation: J Clin Endocrinol Metab. 2012 Jul;97(7):2503-11
references.pmid: 22564669
references.citation: Andrologia. 2014 Dec;46(10):1156-60
references.pmid: 24329588
references.citation: J Sex Med. 2014 Jul;11(7):1835-47
references.pmid: 24697986
references.citation: Clin Endocrinol (Oxf). 2010 Jan;72(1):1-10
references.pmid: 19473174
references.citation: J Sex Med. 2014 Dec;11(12):2995-3001
references.pmid: 25213018
references.citation: Laryngoscope. 2014 Jun;124(6):1409-14
references.pmid: 24155064
references.citation: Bone. 2013 May;54(1):92-7
references.pmid: 23369987
references.citation: Obstet Gynecol. 2015 Mar;125(3):605-610
references.pmid: 25730222
references.citation: J Sex Med. 2015 Jun;12(6):1499-512
references.pmid: 25817066
references.citation: Int Braz J Urol. 2012 Jan-Feb;38(1):97-107
references.pmid: 22397771
references.citation: PLoS One. 2011 Feb 22;6(2):e16885
references.pmid: 21364939
references.citation: J Womens Health (Larchmt). 2015 Feb;24(2):114-8
references.pmid: 25525682
references.citation: Br J Psychiatry. 2014 Feb;204(2):151-6
references.pmid: 23869030
references.citation: J Sex Med. 2013 Dec;10(12):3129-34
references.pmid: 24010586
references.citation: J Sex Marital Ther. 2013;39(4):321-35
references.pmid: 23470169
references.citation: Menopause. 2011 Oct;18(10):1052-9
references.pmid: 21775912
references.citation: BJU Int. 2008 Jan;101(2):259; author reply 259-60
references.pmid: 18173830
references.citation: J Psychosom Res. 2015 Apr;78(4):399-406
references.pmid: 25691225
references.citation: Andrologia. 2014 Sep;46(7):791-5
references.pmid: 23944849
references.citation: Eur J Endocrinol. 2008 Sep;159(3):197-202
references.pmid: 18567667
references.citation: LGBT Health. 2014 Dec;1(4):269-76
references.pmid: 26789855
references.citation: J Clin Endocrinol Metab. 2007 Sep;92(9):3470-5
references.pmid: 17579193
references.citation: Clin Endocrinol (Oxf). 2010 Feb;72(2):214-31
references.pmid: 19473181
references.citation: J Sex Med. 2014 Aug;11(8):1999-2011
references.pmid: 24828032
references.citation: Eur J Endocrinol. 2013 Sep 13;169(4):471-8
references.pmid: 23904280
references.citation: Psychoneuroendocrinology. 2012 May;37(5):662-70
references.pmid: 21937168
references.citation: Clin Endocrinol (Oxf). 1998 Mar;48(3):347-54
references.pmid: 9578826
references.citation: Circulation. 2007 Feb 20;115(7):840-5
references.pmid: 17309934
references.citation: J Sex Med. 2011 Aug;8(8):2361-9
references.pmid: 21595834