■性别确认激素疗法(GAHT)是跨性别和性别多样化(TGD)个体寻求的常见医疗干预措施。根据临床指南建议启动GAHT可确保提供高质量的护理。然而,之前没有研究检查当前的GAHT起始与推荐的GAHT起始相比如何.
■这项研究评估了退伍军人健康管理局(VHA)关于女性化和男性化GAHT启动的指南一致性。
■样本包括4,676名患有性别认同障碍的退伍军人,他们在2007年至2018年期间在VHA中开始女性化(n=3,547)和男性化(n=1,129)GAHT。评估了接受女性化和男性化GAHT的退伍军人的人口统计学和健康状况。确定了有关女性化和男性化GAHT启动的六个VHA指南中的指南一致退伍军人的比例。
■与接受男性化GAHT的退伍军人相比,接受女性化GAHT的退伍军人年龄较大(≥60岁:23.7%vs.6.3%),白人非西班牙裔(83.5%vs.57.6%),并有更多的合并症(≥7:14.0%vs.10.6%)。接受男性化GAHT的退伍军人比例较高的是黑人非西班牙裔(21.5%vs.3.5%),患有创伤后应激障碍(43.0%vs.33.9%)和积极的军事性创伤(33.5%vs.16.8%;所有p值<0.001)比接受女性化GAHT的退伍军人。在开始用雌激素使GAHT女性化的退伍军人中,由于没有禁忌症的记录,97.0%的人是指南一致的,包括静脉血栓栓塞,乳腺癌,中风,或者心肌梗塞.在开始螺内酯作为女性化GAHT的一部分的退伍军人中,98.1%是指南一致的,因为他们没有禁忌症的文件,包括高钾血症或急性肾功能衰竭。在开始将GAHT男性化的退伍军人中,由于没有禁忌症的记录,90.1%的人是指南一致的,如乳腺癌或前列腺癌。在开始男性化GAHT之前,已经在91.8%的退伍军人中测量了血细胞比容,96.5%的患者在开始男性化GAHT之前没有血细胞比容升高(>50%)。在发起女性化和男性化GAHT的退伍军人中,91.2%的人在GAHT开始之前有性别认同障碍诊断的记录。
■我们观察到VHA中当前的GAHT启动实践与指南之间的高度一致性,特别是女性化的GAHT。研究结果表明,VHA临床医生正在根据临床指南开始女性化GAHT。未来的工作应评估VHA中GAHT监测和管理的指南一致性。
UNASSIGNED: Gender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies have examined how current GAHT initiation compares to recommended GAHT initiation.
UNASSIGNED: This study assessed guideline concordance around feminizing and masculinizing GAHT initiation in the Veterans Health Administration (VHA).
UNASSIGNED: The sample included 4,676 veterans with a gender identity disorder diagnosis who initiated feminizing (n=3,547) and masculinizing (n=1,129) GAHT between 2007 and 2018 in VHA. Demographics and health conditions on veterans receiving feminizing and masculinizing GAHT were assessed. Proportion of
guideline concordant
veterans on six VHA
guidelines on feminizing and masculinizing GAHT initiation were determined.
UNASSIGNED: Compared to veterans receiving masculinizing GAHT, a higher proportion of veterans receiving feminizing GAHT were older (≥60 years: 23.7% vs. 6.3%), White non-Hispanic (83.5% vs. 57.6%), and had a higher number of comorbidities (≥7: 14.0% vs. 10.6%). A higher proportion of veterans receiving masculinizing GAHT were Black non-Hispanic (21.5% vs. 3.5%), had posttraumatic stress disorder (43.0% vs. 33.9%) and positive military sexual trauma (33.5% vs.16.8%; all p-values<0.001) than veterans receiving feminizing GAHT. Among
veterans who started feminizing GAHT with estrogen, 97.0% were
guideline concordant due to no documentation of contraindication, including venous thromboembolism, breast cancer, stroke, or myocardial infarction. Among
veterans who started spironolactone as part of feminizing GAHT, 98.1% were
guideline concordant as they had no documentation of contraindication, including hyperkalemia or acute renal failure. Among
veterans starting masculinizing GAHT, 90.1% were
guideline concordant due to no documentation of contraindications, such as breast or prostate cancer. Hematocrit had been measured in 91.8% of veterans before initiating masculinizing GAHT, with 96.5% not having an elevated hematocrit (>50%) prior to starting masculinizing GAHT. Among veterans initiating feminizing and masculinizing GAHT, 91.2% had documentation of a gender identity disorder diagnosis prior to GAHT initiation.
UNASSIGNED: We observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT. Findings suggest that VHA clinicians are initiating feminizing GAHT in concordance with clinical
guidelines. Future work should assess guideline concordance on monitoring and management of GAHT in VHA.