Evaluation of healthcare for transgender veterans

Agron, Rachel; Gale, Scott; Neavins, Tara M.; Stassinos, Martha G.; Tarro-Zylema, Rachel E.; Volpp, Bryan D.; Wilson, Machelle; Swislocki, Arthur L

doi:10.1016/j.endmts.2020.100072

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Although we used validated ICD-9 and ICD-10 codes to identify transgender patients, some clinicians document transgender-related medical visits using nonspecific ICD diagnostic codes that are not validated for identifying transgender patients in the electronic medical record (eg, E34.9 endocrine disorder, unspecified). 30 We did not have access to clinic notes and were unable to comment on our cohort’s self-reported gender identity. Our analyzable sample was small, limiting our ability to control for potential confounding factors (eg, concomitant medication orders).…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of Creatinine-Based Kidney Function With and Without Sex Assigned at Birth Among Transgender Adults

et al. 2021

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Background Clinicians use sex-based kidney function estimating equations, but the appropriate sex modifier for transgender adults undergoing hormone therapy (HT) is undetermined. Objectives Compare median estimated creatinine clearance (eCrCL; Cockcroft-Gault) and estimated glomerular filtration rates (eGFRs; Modification of Diet in Renal Disease [MDRD] and Chronic Kidney Disease Epidemiology Study [CKD-EPI]) before and during HT when estimated with and without sex assigned at birth. Methods Single-system retrospective cohort study of transgender adults (2007-2017) prescribed ≥90 days HT (index date = first order) and measured serum creatinine ≤6 months pre-index date (baseline) and ≤12 months post-index date. We grouped patients based on testosterone or estrogen treatment and compared eCrCL and eGFRs at baseline up to 6-12 months post-index date using equations based on sex assigned at birth (female or male modifier in testosterone or estrogen groups, respectively) or gender identity (male or female modifier in testosterone or estrogen groups, respectively). We used Wilcoxon signed-rank tests (Bonferroni correction) for all comparisons. Results In total, 29 (median age 26 years, follow-up 259 days) and 41 patients (29 years, 250 days) were prescribed testosterone or estrogen, respectively. In the testosterone group, the maximum eCrCL and eGFR changes based on sex assigned at birth were −14%, P = 0.0181; −18%; P = 0.0009, respectively, and based on gender identity were +5%, P > 0.025 and +11%, P = 0.0094, respectively. In the estrogen group, eCrCL or eGFRs based on sex assigned at birth did not change from baseline but based on gender identity were −17%, P < 0.0001 and −26%, P < 0.0001, respectively. Conclusion and Relevance Female-based equations may underestimate kidney function in transgender adults undergoing testosterone or estrogen treatment. Prospective cohort studies are needed to confirm the clinical significance of these findings.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of Creatinine-Based Kidney Function With and Without Sex Assigned at Birth Among Transgender Adults

et al. 2021

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“…Potential participants were identified using ICD codes as proxy measures for identities, as done in previous research (Agron et al, 2021; Blosnich et al, 2014; Kauth et al, 2014). Using the last 3 months of service as a time frame and the ICD codes in three facilities, a total of 54 potential TGD participants were identified and mailed opt-out letters.…”

Section: Methodsmentioning

confidence: 99%

“…Historically, the International Classification of Diseases ( ICD ) codes (e.g., gender dysphoria) have been used as proxy measures for identifying transgender veterans in VHA research (Agron et al, 2021; Blosnich et al, 2014; Kauth et al, 2014). It is important to note that these codes are proxy measures and not an exact measure of identifying TGD veterans.…”

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confidence: 99%

Recruitment tools for transgender and gender diverse veterans in health care research.

Singh,

Landes,

Abraham

et al. 2024

Psychological Services

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Transgender and gender diverse (TGD) veterans in the Veterans Health Administration experience health and health care disparities, and research with this population is needed to improve gender-affirming care in Veterans Health Administration. However, TGD veterans may experience hesitancy to participate in research. We must address barriers to participation through feasible and acceptable methods. Opt-out letters are an effective tool used to recruit veterans in mental health research. The present study examined the feasibility and acceptability of opt-out letters modified for TGD veterans. Opt-out letters were sent to 54 potential TGD participants at three sites. The letters stated the research team would begin contacting

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“…[188][189][190][191] This may be due to a history (and current reality) of health insurance denials for trans persons, meaning that providers adapted to using non-trans-related codes to avoid treatments being flagged as trans care. [192] To find out which patients were transgender men, transgender women, or nonbinary persons was difficult as it required manual full review of all patients' charts. No nonbinary persons were detected, but this could reflect patient discomfort disclosing their identity or the decision to report a binary trans identity to ease access to desired care.…”

Section: From the Clinical Perspectivementioning

confidence: 99%

Transgender Data Collection in the Electronic Health Record (EHR): Current Concepts and Issues

Kronk¹,

Everhart²,

Ashley³

et al. 2021

Preprint

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There are over one million transgender people living in the United States and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.

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Evaluation of healthcare for transgender veterans

Cited by 5 publications

References 18 publications

A Retrospective Analysis of Creatinine-Based Kidney Function With and Without Sex Assigned at Birth Among Transgender Adults

A Retrospective Analysis of Creatinine-Based Kidney Function With and Without Sex Assigned at Birth Among Transgender Adults

Recruitment tools for transgender and gender diverse veterans in health care research.

Transgender Data Collection in the Electronic Health Record (EHR): Current Concepts and Issues

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