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Epidemiology: - despite high risk for HIV1 infection, screening for HIV1 is low [2] Laboratory: - adult transgender laboratory testing [7] Complications: - transgender adolescents more likely to report long-term physical health problems (25 vs 15%) & mental health problems (59 vs 17%) than cisgender adolescents [3,6] - transgender adults who use estrogen therapy might face increased risk for venous thromboembolism & stroke [4] - transgender women retain prostate after gender-affirmation surgery & remain at risk of prostate cancer, regardless of estrogen use [8] Management: - screening & preventive medicince based on anatomy [5] - gender-affirming hormone therapy - commonly sought - does not require management by subspecialty care - indications: persistent, well-documented gender dysphoria - contraindications: - unable to make informed decisions - underage - uncontrolled medical disease or psychatric disease

Related

gender-affirming hormone therapy lesbian, gay, bisexual, transgender, or questioning their sexual orientation or gender identity (LGBTQ) transgender surgery

References

  1. Judge C, Sofair A, Chavey WE. "Socially Transitioned" Prepubescent Transgender Kids Have Similar Mental Health to Their Peers. Physician's First Watch, Feb 26, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Olson KR, Durwood L, DeMeules M, McLaughlin KA Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics Mar 2016 PMID: 26921285 http://pediatrics.aappublications.org/content/early/recent
  2. Pitasi MA et al HIV Testing Among Transgender Women and Men - 27 States and Guam, 2014-15. MMWR Morb Mortal Wkly Rep 2017;66:883-887 https://www.cdc.gov/mmwr/volumes/66/wr/mm6633a3.htm
  3. Rider GN, McMorris BJ, Gower AL et al Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study. Pediatrics. February 2018 PMID: 28736148 http://pediatrics.aappublications.org/content/early/2018/02/01/peds.2017-1683
  4. Getahun D, Nash R, Flanders WD et al Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med. 2018. July 10. PMID: 29987313 http://annals.org/aim/article-abstract/2687653/cross-sex-hormones-acute-cardiovascular-events-transgender-persons-cohort-study
  5. Medical Knowledge Self Assessment Program (MKSAP) 18, 19 American College of Physicians, Philadelphia 2018, 2022
  6. Baker KE. Findings from the behavioral risk factor surveillance system on health-related quality of life among U.S. transgender adults, 2014-2017, JAMA Intern Med 2019 Apr 22 PMID: 31009042 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2730765
  7. ARUP Consult: Adult Transgender Laboratory Testing The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/adult-transgender-laboratory-testing
  8. Nik-Ahd F, De Hoedt A, Butler C et al Prostate Cancer in Transgender Women in the Veterans Affairs Health System, 2000-2022. JAMA. Published online April 29, 2023. PMID: 37119522 https://jamanetwork.com/journals/jama/fullarticle/2804566