Implementing a Patient-Reported Outcomes Survey for Transgender and Gender-Diverse Patients at a Gender Health Clinic...

Approximately 1.6 million Americans identify as transgender and gender diverse (TGD), yet health outcomes research focused on TGD patients is lacking. This gap persists despite significant health disparities experienced by TGD patients, including high rates of depression and suicidality. In clinical settings, patient-reported outcomes surveys (PROS) can pinpoint immediate clinical needs for individual patients while also generating health outcomes data. This project describes early outcomes and the implementation of PROS for TGD patients being seen at a gender health clinic (GHC) in Birmingham, Alabama.

A REDCap-based PROS was implemented at a GHC in Birmingham, Alabama from June 2023 to May 2024, including validated tools for depression (Patient Health Questionnaire-2 and -9), gender dysphoria (Utrecht Gender Dysphoria Scale), alcohol use (Alcohol Use Disorders Identification Test-C), and substance use (Alcohol, Smoking, and Substance Involvement Screening Test). Acceptability, appropriateness, and feasibility metrics also were collected.

In total, 51 patients completed the PROS, including transwomen (n = 21), transmen (n = 21), nonbinary (n = 10), genderqueer (n = 3), and gender nonconforming (n = 3) patients. Among those patients, 40% screened positive for depressive symptoms and 45% reported tobacco use. The mean gender dysphoria score was 56.81 (standard deviation 9.91) out of 70, and the mean gender affirmation score was 18.13 (standard deviation 2.22) out of 20. Patients found the PROS highly acceptable (86%), appropriate (98%), and feasible (94%). Several challenges were encountered during implementation, including REDCap technical issues, staffing and workflow complexities, and occasional patient difficulty with independent PROS completion.

This project demonstrates the feasibility and value of implementing a PROS in a GHC, particularly in a medically underserved region like the southeastern United States. Addressing implementation challenges is critical, however.