Incident diabetes risk is not increased in transgender individuals using hormone therapy

Background In trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may alter the risk of developing type 2 diabetes in trans women and trans men. We aimed to compare the incidence of type 2 diabetes of adult trans women and trans men during hormone therapy with rates from their birth sex in the general population. Methods Retrospective data from the Amsterdam Cohort of Gender Dysphoria with transgender individuals on hormone therapy between 1972 and 2018 were linked to a nationwide health data registry. Because no central registry of diabetes is available, the occurrence of diabetes was inferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with the same birth sex from the general population. Results Compared to their birth sex in the general population, no difference in the incidence of type 2 diabetes mellitus was observed in trans women (N=2585, 90 cases, SIR 0.94 95%CI 0.76–1.14) or trans men (N=1514, 32 cases, SIR 1.40 95%CI 0.96–1.92). Conclusion Despite studies reporting an increase in insulin resistance in feminizing hormone therapy and a decrease in insulin resistance in masculinizing hormone therapy, the incidence of diabetes in transgender individuals after initiation of hormone therapy was not different compared to the general population.

Barriers in Access to Healthcare for Kenyan Queer Womxn and Trans Men: Findings of a Cross-Sectional Online Survey and Interviews

BackgroundIn many African countries, including Kenya, sexual behaviour between consenting adults of the same sex/ gender is illegal, which results in limited availability and access to health services and information for sexual and gender minorities. This results in unmet health issues for sexual and gender minorities who have a higher burden of STD/STI and HIV, STI-related cancers, and mental ill-health and trauma.MethodsWe conducted an online survey among 335 Kenyan queer womxn and trans men over the age of 18 who had at least one self-identified female sexual partner, collecting data on health service utilisation and barriers to accessing healthcare. ResultsWe identified gaps in all four areas that comprise standard of health – availability, accessibility, acceptability, and quality of care, exacerbated by the restrictive law and policy landscape in Kenya. Queer womxn and trans men face multiple service-access barriers, many related to stigma and discrimination, as well as concerns around provider attitudes and knowledge. Violations of human rights and privacy are a concern for queer womxn and trans men patients. There are insufficient numbers of facilities, programmes, and information to meet the needs of queer womxn and trans men, which leads to a lack of holistic care or patients delaying care and preventative interventions. ConclusionMental health and trans health are areas that are particularly poorly equipped to serve the informants’ needs, highlighting the need to address the exclusion of sexual and gender minorities in the vulnerable groups of the National Mental Health Policy. Resources regarding the use of services need to be made available, and service providers need to be educated to provide non-judgmental, inclusive care for queer womxn and trans men in Kenya.

Gender dysphoria and sexual euphoria - A Bayesian perspective on the influence of gender-affirming hormone therapy on sexual arousal

While the concept of sexual orientation is more clearly defined in cisgender, this is less so in transgender individuals. Both experienced gender and sex hormones have a relation to sexual preferences, arousal in response to erotic stimuli, and thus sexual orientation. In transgender individuals sexual orientation occasionally changes before or during transition, which may involve gender-affirming hormone therapy. Using functional magnetic resonance imaging, we investigated whether the neuronal and behavioral patterns of sexual arousal in transgender individuals moved from the given (before) to their chosen gender after 4.5 months of hormone therapy. To this aim, trans women and men as well as age-matched cisgender controls rated visual stimuli showing heterosexual, lesbian or gay intercourse for subjective sexual arousal. Utilizing a Bayesian framework allowed us to incorporate behavioral findings in cisgender individuals of different sexual orientations. The hypothesized changes in response patterns could indeed be observed in the behavioral responses to the single but not the differentiation between stimulus categories with the strongest results for trans men and lesbian scenes. Activation of the ventral striatum supported our hypothesis only for lesbian scenes in trans women. This prominent role of lesbian stimuli might be explained by their differential responses in cis women and men. We show that correlates of sexual arousal in transgender individuals might change in direction of the chosen gender. Future investigations longer into transition might resolve the discrepancy on behavioral and neuronal levels.

Race Without Gender? Trends and Limitations in the Higher Education Scholarship Regarding Men of Color

The underrepresentation and underperformance of men of color relative to women of color within institutions of higher education have been extensively studied the past 20 years. The purpose of this study is to understand trends in how this research has been conducted rather than understand “best practices” to support this student population. To achieve this, we reviewed 153 pieces of scholarship from 1999 to 2019 using an intersectional and critical content analysis approach. Findings revealed that the bulk of scholarship involved onetime interviews for its empirical foundations, and the overwhelming majority centered the racial experiences of Black and Latinx men. In contrast, few analyses critically explored gender, sexual orientation, or social class. Additionally, scholarship that centered Asian American, Indigenous, multiracial, and trans* men of color was scant or nonexistent. Given these large gaps in the knowledge base, we offer guidance for the next generation of men of color in higher education scholarship in terms of analytical foci, theoretical frameworks, and methodologies.

Self-testing for HIV could increase diagnoses in the trans community

The study Witzel TC, Wright T, McCabe L, et al. Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales. EClinicalMedicine 2021;32:100700. To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/hiv-self-testing-increases-diagnoses-trans-people/

HIV Testing Preferences Among Trans Men and Trans Women: A Retrospective Study of Client Records from 2017 to 2019 in a Community-Based Transgender Health Center in Metro Manila, Philippines

Background: Transgender individuals are considered as high-risk for contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their HIV testing preferences. Methods: We conducted a retrospective study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and HIV testing preferences. The effect of gender identity on HIV testing preferences was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. Results: Five hundred twenty-five clients were included in the study, of which about four out of five clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HTC services was 48% higher [adjusted Prevalence Ratio (aPR): 1.48; 95% Confidence Interval (CI): 1.31–1.67] among TM compared to TW. Clients who initially consulted in 2017 had a 25% higher prevalence of refusal for HTC services (aPR: 1.25; 95% CI: 1.08–1.43) than clients who initially consulted in 2019. Approximately 4% and 11% of the TM and TW, respectively, who accessed the HTC services were reactive and linked to antiretroviral therapy treatment. Conclusion: HTC service uptake of TM and TW is low. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.