Patient Characteristics Associated with Receiving Gender-Affirming Hormone Therapy in the Veterans Health Administration

Wolfe, Hill L.; Vimalananda, Varsha G; Wong, Denise H.; Reisman, Joel I.; Rao, Sowmya R.; Shipherd, Jillian C.; Blosnich, John R.; Livingston, Nicholas A.; Jasuja, Guneet K.

doi:10.1089/trgh.2022.0040

Cited by 2 publications

(1 citation statement)

References 43 publications

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“…Therefore, as the Defense Health Agency and other civilian or Federal healthcare systems work to reduce inequities and improve healthcare operations, transgender and gender-diverse people must have positionality and agency in these efforts. Such work could be built in parallel to the work done within the Veterans Administration 39–41 …”

Section: Discussionmentioning

confidence: 99%

Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Klein,

Gonzalez,

Highland

et al. 2024

Medical Care

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Background: Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired. Objective: This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System. Research Design: This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository. Participants: A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code. Measures: Time-to-gender-affirming hormone initiation after diagnosis receipt. Results: A total of 2439 Service members were included (Mage 24 y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female (P<0.001), and Asian and Pacific Islander (P=0.02) and Black (P=0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis. Conclusion: The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.

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Section: Discussionmentioning

confidence: 99%

Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Klein,

Gonzalez,

Highland

et al. 2024

Medical Care

View full text Add to dashboard Cite

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Barriers and Facilitators to Gender-affirming Hormone Therapy in the Veterans Health Administration

Wolfe

Boyer

Shipherd

et al. 2023

Annals of Behavioral Medicine

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Background In 2011, the Veterans Health Administration (VHA) established a policy for the delivery of transition-related services, including gender-affirming hormone therapy (GAHT), for transgender and gender diverse (TGD) patients. In the decade since this policy’s implementation, limited research has investigated barriers and facilitators of VHA’s provision of this evidence-based therapy that can improve life satisfaction among TGD patients. Purpose This study provides a qualitative summary of barriers and facilitators to GAHT at the individual (e.g., knowledge, coping mechanisms), interpersonal (e.g., interactions with other individuals or groups), and structural (e.g., gender norms, policies) levels. Methods Transgender and gender diverse patients (n = 30) and VHA healthcare providers (n = 22) completed semi-structured, in-depth interviews in 2019 regarding barriers and facilitators to GAHT access and recommendations for overcoming perceived barriers. Two analysts used content analysis to code and analyze transcribed interview data and employed the Sexual and Gender Minority Health Disparities Research Framework to organize themes into multiple levels. Results Facilitators included having GAHT offered through primary care or TGD specialty clinics and knowledgeable providers, with patients adding supportive social networks and self-advocacy. Several barriers were identified, including a lack of providers trained or willing to prescribe GAHT, patient dissatisfaction with prescribing practices, and anticipated or enacted stigma. To overcome barriers, participants recommended increasing provider capacity, providing opportunities for continual education, and enhancing communication around VHA policy and training. Conclusions Multi-level system improvements within and outside the VHA are needed to ensure equitable and efficient access to GAHT.

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Patient Characteristics Associated with Receiving Gender-Affirming Hormone Therapy in the Veterans Health Administration

Cited by 2 publications

References 43 publications

Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Barriers and Facilitators to Gender-affirming Hormone Therapy in the Veterans Health Administration

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