Opportunities for incorporating intersectionality into biomedical informatics.

Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy.

Technology for transgender healthcare: Access, precarity & community care.

While much of the transgender health literature has focused on poor health outcomes, less research has examined how trans people find reliable information on, and actually go about accessing, gender-affirming healthcare. Through qualitative interviews with creators of trans technologies, that is, technologies designed to address problems that trans people face, we found that digital technologies have become important tools for proliferating access to gender-affirming care and related health information. We found that technologists often employed different processes for creating their technologies, but they coalesced around the goal of enabling and increasing access to gender-affirming care.

How Do Prescribing Clinicians Obtain Consent to Initiate Gender-Affirming Hormones?

Purpose: Multiple consent models exist for initiating gender-affirming hormone therapy (GAHT). Our study aim was to examine the variety of approaches utilized by clinicians.

Methods: Online and in-person recruitment of clinicians involved in gender-affirming care was undertaken from June 2019 through March 2020.

Measuring Geographic Access to Transgender Hormone Therapy in Texas: A Three-step Floating Catchment Area Analysis.

While the extant literature has established that transgender people face significant barriers to accessing healthcare, no studies to date have offered an explicitly spatial analysis of their access to trans-specific care. This study aims to fill that gap by providing a spatial analysis of access to gender-affirming hormone therapy (GAHT) using Texas as a case study. We used the three-step floating catchment area method, which relies on census tract-level population data and location data for healthcare facilities to quantify spatial access to healthcare within a specific drive-time window, in our case 120 min.

Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations.

Purpose Of Review: Pre-exposure prophylaxis (PrEP) represents one of the most effective methods of prevention for HIV, but remains inequitable, leaving many transgender and nonbinary (trans) individuals unable to benefit from this resource. Deploying community-engaged PrEP implementation strategies for trans populations will be crucial for ending the HIV epidemic.

Recent Findings: While most PrEP studies have progressed in addressing pertinent research questions about gender-affirming care and PrEP at the biomedical and clinical levels, research on how to best implement gender-affirming PrEP systems at the social, community, and structural levels remains outstanding.

Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults.

Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less.

Construction and validation of a spatial database of providers of transgender hormone therapy in the US.

What little data on transgender healthcare is available often focuses on transgender people's negative experiences in accessing healthcare. However, no research has been conducted that illustrates where gender-affirming hormone therapy, one part of transgender-specific medical care, is available. Without these data, large scale research to discern patterns of availability of and access to gender-affirming medical care is nearly impossible.

Ethnoracial inequities in access to gender-affirming mental health care and psychological distress among transgender adults.

Purpose: Transgender people face known barriers to accessing mental health care generally, and gender-affirming care in particular. However, little research has been done to evaluate the impact of systemic racism on access to gender-affirming mental health care (GAMHC) among transgender people of color (TPOC).

Methods: We conducted a cross-sectional, secondary analysis of data on 20,967 respondents to the 2015 United States Transgender Survey who reported a desire for GAMHC services related to their gender transition.

'I'm not interested in research; i'm interested in services': How to better health and social services for transgender women living with and affected by HIV.

This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services.

Considerations for transgender population health research based on US national surveys.

Transgender identities and health are highly politicized in the United States leading to restrictions on relevant data collection in national health surveillance systems. This has serious implications on transgender population health research; an urgent area of study given the systemic discrimination faced by transgender individuals and the resultant social and health inequities. In this precarious political climate, obtaining high-quality data for research is challenging and in recent years, two data sources have formed the foundation of transgender health research in the United States, namely the 2015 United States Transgender Study and the Behavioral Risk Factor Surveillance System after the launch of the optional Sexual Orientation and Gender Identity Module in 2014.

Transgender data collection in the electronic health record: Current concepts and issues.

There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies.

"In transition: ensuring the sexual and reproductive health and rights of transgender populations." A roundtable discussion.

This roundtable discussion is the result of a research symposium entitled In Transition: Gender [Identity], Law & Global Health where participants took up the challenge to engage with the question: What will it take to ensure the sexual and reproductive health and rights (SRHR) of transgender populations across the globe? The barriers to overcome are fierce, and include not only lack of access to health services and insurance but also stigma and discrimination, harassment, violence, and violations of rights at every turn. Transgender people must of course lead any sort of initiatives to improve their lives, even as partnerships are needed to build capacity, translate lived experience into usable data, and to make strategic decisions. The SRHR of transgender people can only be addressed with attention to the social, cultural, legal, historical, and political contexts in which people are situated, with social, psychological, medical, and legal gender affirmation as a key priority shaping any intervention.