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Advancing methods for US transgender health research.

Sari L Reisner1, Madeline B Deutsch, Shalender Bhasin

  • 1aThe Fenway Institute, Fenway Health bDepartment of Epidemiology, Harvard T.H. Chan School of Public Health cDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts dDepartment of Family and Community Medicine, University of California, San Francisco, California eResearch Program in Men's Health: Aging and Metabolism Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts fLGBT Health Initiative, New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York City, New York gQuillen College of Medicine, East Tennessee State University, Johnson City, Tennessee hDepartment of Family Medicine and Community Health, University of Minnesota, School of Medicine, Minneapolis, Minnesota iDepartment of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA jCenter of Expertise on Gender Dysphoria, Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands kCallen-Lorde Community Health Center, New York City, New York lSection of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine, Boston, Massachusetts mDivision of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta nThe Atlanta VA Medical Center, Decatur, Georgia, USA oDepartment of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium pDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

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Summary

Transgender health research in the US faces significant methodological challenges. Addressing these gaps through standardized methods and diverse study designs is crucial for advancing evidence-based care for transgender individuals.

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Area of Science:

  • Transgender Health
  • Health Services Research
  • Medical Research Methodology

Background:

  • Current transgender health research is hampered by a lack of large-scale prospective studies and intervention trials.
  • Limited data exists on the risks and benefits associated with sex affirmation treatments, including hormones and surgical interventions.
  • Inconsistent definitions and methodologies across studies impede the development of evidence-based care for transgender populations.

Purpose of the Study:

  • To describe the methodological challenges, research gaps, and opportunities within US transgender health research.
  • To highlight the need for improved study designs and data collection to support evidence-based care.
  • To identify strategies for enhancing the rigor and reach of transgender health research.

Main Methods:

  • Review of existing literature on methodological issues in transgender health research.
  • Discussion of various study designs (population-based, health systems-based, clinic-based, venue-based, hybrid) applicable to transgender health research.
  • Emphasis on the need for harmonization of research efforts and standardization of definitions and measurements.

Main Results:

  • Key challenges include the lack of prospective studies, insufficient data on sex affirmation interventions, and inconsistent terminology.
  • Various research designs can be employed, but harmonization and standardization are essential for robust findings.
  • Recruitment and follow-up of diverse transgender populations across different demographics are critical for comprehensive research.

Conclusions:

  • Standardizing lexicon, population definitions, study designs, sampling, measurement, outcome ascertainment, and sample size are critical for advancing transgender health research.
  • Applying existing and novel methods is necessary to fill research gaps and improve scientific rigor.
  • Enhanced research will inform evidence-based prevention and care for the underserved transgender population.