Determinants of and Barriers to Hormonal and Surgical Treatment Receipt Among Transgender People.
Purpose:Medical gender confirmation therapy (GCT) plays an important role in transgender health; however, its prevalence and determinants constitute an area of uncertainty.Methods:Data for this cross-sectional study were obtained from an online survey distributed from October 2012 through the end of 2013 among persons who visited the social media sites of a transgender education and social networking meeting. Eligible respondents (n=280) were persons whose gender identity was different from their sex assigned at birth and who responded to questions about previously received or planned hormonal therapy (HT), chest reconstruction, or genital surgery. Multivariable logistic regression models examined how receipt and plans to receive different GCT types were associated with participants' characteristics and gender identity.Results:The respective percentages of ever and current HT were 58% and 47% for transwomen and 63% and 57% for transmen. Genital surgery was reported by 11 participants; all transwomen. Relative to transmen, transwomen were thrice more likely to report plans to undergo genital surgery. By contrast, transmen were more than 10 times as likely as transwomen to have had or planned chest surgery. Older participants and those who were in a committed relationship were less likely to plan future GCT. Having health insurance was not associated with GCT receipt. Treatment cost was named as the main problem by 23% of transwomen and 29% of transmen. Accessing a qualified healthcare provider for transgender-related care was listed as the primary reason for not receiving surgery by 41% of transmen and 2% of transwomen.Conclusions:Prevalence of GCT differed across subgroups of participants and was lower than corresponding estimates reported elsewhere. The variability of results may reflect differences in recruitment procedures and response rates; however, it is also possible that it may be driven by geographic, socioeconomic, and health-related heterogeneity of the transgender population.
Rollins School of Public Health, Emory University, Atlanta, Georgia.; School of Medicine, Emory University, Atlanta, Georgia.
R Craig
RC
Sineath
Rollins School of Public Health, Emory University , Atlanta, Georgia .
Cory
C
Woodyatt
Rollins School of Public Health, Emory University , Atlanta, Georgia .
Travis
T
Sanchez
The Rockway Institute, Alliant International University , San Francisco, California.
Shawn
S
Giammattei
School of Medicine, Emory University, Atlanta, Georgia.; Atlanta VA Medical Center, Decatur, Georgia.
Theresa
T
Gillespie
Division of Research, Kaiser Permanente, Oakland, California.
Enid
E
Hunkeler
School of Public Health, Georgia State University , Atlanta, Georgia .
Ashli
A
Owen-Smith
Kaiser Permanente Southern California, Los Angeles, California.
Virginia P
VP
Quinn
School of Public Health, Georgia State University , Atlanta, Georgia .
Douglas
D
Roblin
School of Nursing University of Michigan , Detroit, Michigan.
Robert
R
Stephenson
Rollins School of Public Health, Emory University , Atlanta, Georgia .
Patrick S
PS
Sullivan
School of Medicine, Emory University, Atlanta, Georgia.; Atlanta VA Medical Center, Decatur, Georgia.
Vin
V
Tangpricha
Rollins School of Public Health, Emory University , Atlanta, Georgia .
Michael
M
Goodman
barriers to care; epidemiology; transgender
J Plast Reconstr Aesthet Surg. 2012 Jun;65(6):711-9
22189204
Am J Public Health. 2014 Nov;104(11):2191-8
24328655
Eur J Endocrinol. 2013 Sep 13;169(4):471-8
23904280
Arch Sex Behav. 2014 Nov;43(8):1491-501
25231821
Women Health. 2014;54(8):750-67
25190135
Psychol Med. 2005 Jan;35(1):89-99
15842032
J Urban Health. 2015 Feb;92(1):182-92
25476958
Psychoneuroendocrinology. 2012 May;37(5):662-70
21937168
Qual Life Res. 2006 Nov;15(9):1447-57
16758113
Nurs Forum. 2014 Apr-Jun;49(2):110-23
24387331
J Nerv Ment Dis. 2013 Nov;201(11):996-1000
24177489
JAMA. 2013 Feb 6;309(5):478-84
23385274
Nicotine Tob Res. 2016 Mar;18(3):306-13
25782458
LGBT Health. 2015 Dec;2(4):313-23
26788772
Clin Endocrinol (Oxf). 2010 Feb;72(2):214-31
19473181
Front Endocrinol (Lausanne). 2014 Jun 13;5:87
24982651
Milbank Q. 2015 Sep;93(3):484-515
26219197
Am J Public Health. 2009 Apr;99(4):713-9
19150911
Curr Opin Endocrinol Diabetes Obes. 2013 Dec;20(6):570-4
24468760
Br J Gen Pract. 1999 Dec;49(449):991-2
10824346
Surg Infect (Larchmt). 2014 Apr;15(2):99-104
24180342
Asian J Androl. 2013 Mar;15(2):280-5
23353716
Soc Sci Comput Rev. 2012 May 1;30(2):202-211
24031157
J Sex Med. 2012 Dec;9(12):3148-53
23035854
Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23 (2):198-207
26845331
J Sex Med. 2014 Dec;11(12):2995-3001
25213018
J Sex Med. 2012 Mar;9(3):743-50
22188877