Impact of Sexual Orientation Identity on Medical Morbidities in Male-to-Female Transgender Patients

Abstract

Purpose: We aim to describe the relationship between sexual orientation identity and medical morbidities in a large sample of male-to-female (MTF) transgender patients. Methods: We reviewed medical records of patients presenting for MTF sex reassignment surgery (SRS) by a single, high-volume surgeon from 2011 to 2015. Sexual attraction to men (heterosexual), women (lesbian), or both (bisexual) was asked of each patient. We examined 16 medical morbidities for this analysis. Results: During the study period, 330 MTF transgender patients presented for SRS. The average age at the time of surgery was 38.9 (range 18-76). One hundred and one patients (32%) reported being heterosexual, 110 patients (34%) reported being lesbian, and 108 patients (34%) reported being bisexual. Lesbian patients presented for SRS at older ages (mean = 43 years old) compared with heterosexual patients (mean = 36 years old) and bisexual patients (mean = 37), P < 0.01. No differences were found in the majority of coexisting medical morbidities by sexual orientation identity. Lesbian patients had greater odds of having a history of depression, ageadjusted odds ratio (aOR) = 2.36, 95% confidence interval (CI) 1.26-4.40, compared with heterosexual patients. Lesbian patients had higher odds of being married or partnered, aOR = 2.31, 95% CI (1.27-4.19), compared with heterosexual patients. Heterosexual patients had higher odds of having human immunodeficiency virus (HIV), aOR = 9.07, 95% CI (1.08-76.5) compared with lesbian patients. Conclusions: Sexual orientation identity in MTF transgender patients is variable. The majority of medical morbidities are not associated with sexual orientation identity. Although HIV and depression are common morbidities among MTF patients seeking SRS, the prevalence of these morbidities differs by sexual orientation identity, but these findings need replication. Counseling and future research initiatives in transgender care should incorporate sexual orientation identity and associated risk behavior.

Age-Related Differences for Male-to-Female Transgender Patients Undergoing Gender-Affirming Surgery

“…We demonstrated, for example, that our patients were more frequently sexually attracted to women or bisexual, if they belonged to the older cohort (Table 3). These findings are consistent with those of Gaither et al, 24 who reported that gynephilic MtFs presenting for GAS were significantly older than heterosexual or bisexual controls. A study reporting on a consecutive series of predominantly young MtF patients in Spain with a mean age of 29.4 years at their day of surgery showed that 89.9% were sexually interested in men 27 .…”

“…Advocates of this 2-population model suggest that the 2 groups can be further distinguished on demographic criteria and clinical presentation 9, 23. Those who endorse this taxonomy have suggested, for example, that androphilic MtF individuals generally seek GAS earlier than those in the gynephilia group 24 . They have also suggested that individuals in the androphilic group are less likely to have a history of being married to women and to have fathered children.…”

Initial Clinical Needs Among Transgender and Non-binary Individuals in a Large, Urban Gender Health Program

“…13 Medical comorbidities, such as HIV or depression, may differ among transgender women who identify as straight, lesbian, or bisexual. 14 Measurement of sexual orientation in this population is complicated for many reasons, however, not the least of which is the contingency of common labels for sexual orientation on the subject's own gender. Identities may change over timethe relationship between development of gender and sexual orientation identities are complex, interrelated, and not fully understood but evidence suggests that gender-affirming care may alter individuals' perceptions of their own sexuality.…”

Perceived Barriers to HIV Prevention Services for Transgender Youth

“…Transgender adults and adolescents endorse multiple sexual orientation identities to describe attraction across gender lines. [32][33][34][35][36] As such, accurate assessment of transgender individuals' sexual health requires an understanding of both their sexual orientation and gender identity, the sexual behaviors in which they are engaging, and the people with whom they are having sex. However, information on how to take routine sexual histories of transgender patients is sparse.…”