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Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research

Author

Listed:
  • Tiffany F Ho
  • Brian Zenger
  • Bayarmaa Mark
  • Laurel Hiatt
  • Erika Sullivan
  • Benjamin A Steinberg
  • Ann Lyons
  • Adam M Spivak
  • Cori Agarwal
  • Marisa Adelman
  • James Hotaling
  • Bernadette Kiraly
  • Sharon Talboys

Abstract

Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003–2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.

Suggested Citation

  • Tiffany F Ho & Brian Zenger & Bayarmaa Mark & Laurel Hiatt & Erika Sullivan & Benjamin A Steinberg & Ann Lyons & Adam M Spivak & Cori Agarwal & Marisa Adelman & James Hotaling & Bernadette Kiraly & Sh, 2024. "Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research," PLOS ONE, Public Library of Science, vol. 19(5), pages 1-20, May.
    • Handle: RePEc:plo:pone00:0302895
    DOI: 10.1371/journal.pone.0302895
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    References listed on IDEAS

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    1. Sanchez, N.F. & Sanchez, J.P. & Danoff, A., 2009. "Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City," American Journal of Public Health, American Public Health Association, vol. 99(4), pages 713-719.
    2. repec:plo:pmed00:0040296 is not listed on IDEAS
    3. White Hughto, Jaclyn M. & Reisner, Sari L. & Pachankis, John E., 2015. "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions," Social Science & Medicine, Elsevier, vol. 147(C), pages 222-231.
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