Patterns of gender identity data within electronic health record databases can be used as a tool for identifying and estimating the prevalence of gender-expansive people

Abstract

Objective Electronic health records (EHRs) within the United States increasingly include sexual orientation and gender identity (SOGI) fields. We assess how well SOGI fields, along with International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes and medication records, identify gender-expansive patients. Materials and Methods The study used a data set of all patients that had in-person inpatient or outpatient encounters at an academic medical center in a rural state between December 1, 2018 and February 17, 2022. Chart review was performed for all patients meeting at least one of the following criteria: differences between legal sex, sex assigned at birth, and gender identity (excluding blank fields) in the EHR SOGI fields; ICD-10 codes related to gender dysphoria or unspecified endocrine disorder; prescription for estradiol or testosterone suggesting use of gender-affirming hormones. Results Out of 123 441 total unique patients with in-person encounters, we identified a total of 2236 patients identifying as gender-expansive, with 1506 taking gender-affirming hormones. SOGI field differences or ICD-10 codes related to gender dysphoria or both were found in 2219 of 2236 (99.2%) patients who identify as gender-expansive, and 1500 of 1506 (99.6%) taking gender-affirming hormones. For the gender-expansive population, assigned female at birth was more common in the 12–29 year age range, while assigned male at birth was more common for those 40 years and older. Conclusions SOGI fields and ICD-10 codes identify a high percentage of gender-expansive patients at an academic medical center.

Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy

“…This trend has also been observed in other gender identity clinics such as Amsterdam ( 18 ) and Valencia ( 37 ), albeit less pronounced than in Finland, where an AMAB to AFAB ratio of 1:5.2 was described in 2017 ( 29 ). A US-based study looking at gender identity data in an electronic health record database in Iowa described an AMAB to AFAB ratio of 1:5 in 12-17 year-old TGD individuals ( 38 ). A 2022 investigation based on a survey conducted across 16 states found AMAB to AFAB ratios of 1:1.5 to 1:2 in TGD US-American adolescents ( 39 ).…”