No abstract

The Department of Veterans Affairs has a policy of welcoming LGBTQ Veterans, and has established working groups to coordinate care for Veterans in this population. We wished to evaluate the care provided to gender-dysphoric Veterans in VANCHCS. Using ICD-10 criteria, we identified a population of 148 Veterans as of May 31, 2018. We stratified these individuals by preferred gender, regardless of “official” records, and further evaluated their medical records for cross-sex hormone therapy and access to mental health, endocrine, speech pathology, and dermatology resources. Of the 148 Veterans, 10 were non-binary, 43 were transmen, and 95 were transwomen. Because of small numbers, we excluded non-binary Veterans from further analysis. The transmen were significantly younger than transwomen (42±13.7 vs. 51.5±15.9 yrs., p< 0.001 by t-test). Transwomen were more likely to be Air Force Veterans than transmen (21.1% vs. 17.1%), and less likely to be Army Veterans (38.9% vs. 43.9%). Transwomen were more likely to see an Endocrinologist (83.2% vs. 72.1%), and Speech Therapy (44.2% vs. 25.6%) than transmen. Cross-sex hormone therapy for transwomen included multiple combinations including gonadotropin-releasing hormone analogs, spironolactone, finasteride, estradiol, and progesterone, whereas for transmen, testosterone was the sole therapy. The majority of our Veterans (65 transwomen (68.4%) and 38 transmen (88.4%) had not undergone gender-affirming surgery Only 59 transwomen (62%) had measurements of prostate-specific antigen (PSA). Both groups were followed comparably in Mental Health Clinics (87.4% for transwomen, 90.7% for transmen). Only 35 transwomen (36.8%) were seen in Dermatology clinics for gender identity issues. In summary, our populations represented diverse backgrounds and received a variety of treatments. We conclude that care for these Veterans could be enhanced by a more consistent, team-based approach to therapy.