Human immunodeficiency virus (HIV) prevention and treatment remain critically important to outpatient care among transgender and gender-nonbinary individuals. Epidemiologically, trans men and trans women are significantly more likely to have HIV compared with all adults of reproductive age. Here, we provide an overview of unique primary care considerations affecting transgender and gender-nonbinary individuals, including screening and treatment of HIV and other sexually transmitted infections as well as cancer screening and fertility preservation options. We also seek to review current literature and clinical practice guidelines related to drug-drug interactions between antiretroviral therapy (ART) and gender-affirming hormonal therapy (GAHT). In short, integrase strand transfer inhibitor-based therapy is not expected to have significant drug interactions with most GAHT and is preferred in most transgender individuals, including those on GAHT. Clinicians should also remain aware of current GAHT regimens and consider tailoring ART and GAHT to reduce cardiovascular and other risk factors.
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| http://dx.doi.org/10.1093/ofid/ofac091 | DOI Listing |
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The increase in access to facial gender-affirming surgery has resulted in an increase in facial feminization procedures for transfeminine and gender nonbinary populations. However, refined execution of facial masculinization is challenged by the lack of defined measurements for facial augmentation, the lack of long-term predictability in autologous bone grafting in augmentation procedures, and the lack of precision in traditional facial augmentation procedures with generic alloplastic implants. The authors describe an innovation in facial masculinization surgery using modern reconstructive craniofacial surgical techniques with preoperative virtual modeling and the fabrication of 3-dimensionally printed, patient-specific custom implants.
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Article Synopsis
- Current cancer screening guidelines for transgender individuals are mainly based on expert opinions and adapted from guidelines for cisgender populations, which may not fully address the unique risks faced by transgender individuals.
- A study of 192 transgender and gender-nonbinary individuals found that adherence to recommended cancer screenings, including breast, cervical, prostate, and colon cancer, was significantly lower than national rates for cisgender individuals.
- Key predictors of increased screening adherence included having gender-affirming surgery and coming out as transgender at a younger age, whereas being HIV positive was linked to lower adherence rates, highlighting the need for improved healthcare access for TGNB individuals.
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