Health of transgender men in low-income and middle-income countries: a scoping review

Abstract

IntroductionDespite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men’s health in low-income and middle-income countries (LMICs).MethodsThe review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.ResultsWe included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).ConclusionGreater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men’s health in LMIC.

“Existimos”: Health and social needs of transgender men in Lima, Peru

“…Consistent with prior research [ 1 , 7 ], trans men in this study reported avoidance of healthcare and limited use of health services. Rather than exposing themselves to discriminatory treatment in healthcare settings, uninformed or misinformed healthcare providers, and potential ridicule and humiliation from others (e.g., healthcare administrators, fellow patients), trans men reported disengagement from healthcare, a finding which corroborates prior research globally [ 7 , 23 ]. Avoidance of healthcare poses a critical threat to the health of trans men.…”

“…Trans men in the current study commonly reported experiences of depression, suicidal ideation, anxiety, guilt, fear, isolation, and shame, consistent with research demonstrating high rates of mental health morbidity for transgender people globally [1,7]. Gender socialization [30] and transgression of gender norms were strong determinants of mental health and wellbeing for trans men in this study.…”

“…While research in transgender health is expanding, trans men continue to be underrepresented in the global health literature [1,7]. This erasure can be traced to the lack of HIV funding for trans men communities, the historical source and health catalyst of much transgender research, largely focused in transgender women [8][9][10][11].…”

“…This erasure can be traced to the lack of HIV funding for trans men communities, the historical source and health catalyst of much transgender research, largely focused in transgender women [8][9][10][11]. A recent scoping review of research in low-income and middle-income countries about trans men identified 53 studies, only 1 of which was in Peru, and described avoidance of care due to negative experiences, stigma from healthcare providers, and barriers to gender-affirming care (e.g., lack of qualified and willing providers, high cost, restrictive gatekeeping in assessment for hormones and surgery) as common themes [7]. Trans men's disengagement in healthcare may have serious health-related consequences including increased morbidity and mortality [12].…”

Characterising the impact of COVID-19 environment on mental health, gender affirming services and socioeconomic loss in a global sample of transgender and non-binary people: a structural equation modelling

“…Prior to COVID-19, research has documented global health inequities and lack of access to healthcare services and competent providers, be it services specific to primary care, gender affirming services or mental health counselling and therapy services among trans people across low-income, middle-income and high-income countries. [14][15][16] These health inequities stem from a multitude of systematic social and economic marginalisation, violence, stigma and discrimination across societial domains, particularly in healthcare settings. 17 Thus, the urgency of COVID-19related healthcare needs may have deprioritised gender affirming services and further exacerbate already existing social and structural inequities even further.…”