Gender-affirming Treatment Patterns among Transfeminine People in Mumbai, India 公开
Khong, Tu (Spring 2024)
Published
Abstract
While transgender health research in low- and middle-income countries may face numerous logistical and methodological difficulties, one notable exception is India, where transfeminine (TF) persons, sometimes referred to as “hijra,” are officially recognized as the ‘third gender’. Although the HIV epidemic in the TF community in India is relatively well described, other aspects of health in this population including the frequency and types of gender-affirming hormonal treatment (GAHT) are largely unknown.
This cross-sectional study was based on a survey of 201 TF individuals identified among members of hijra communes, as well as other transgender and gender-diverse persons receiving support and counseling at a research and advocacy organization in Mumbai, India. The main outcome variables were past and current GAHT use including feminizing hormone therapy (fHT) and various gender-affirming surgical procedures. Data analyses evaluated the frequency and distribution of GAHT with the study group. Determinants of fHT were examined using multivariable Poisson models.
Among all study participants, 39% (n=79) denied receiving any GAHT, 35% (n=70) reported using ‘improper fHT’ (defined as non-prescribed and/or nonstandard hormone use), 11% (n=22) had castration alone, 8% had improper fHT in combination with castration (n=17), and only 7% (n=13) of individuals received appropriate fHT, as recommended by the current guidelines. Among 100 persons who reported using fHT, only 33 indicated that they obtained prescriptions for hormone medications. Factors associated with fHT receipt included at least some high school education and self-identification as transgender women as opposed to hijra or other non-binary categories. In the analyses evaluating factors associated with prescribed (as opposed to informally obtained) fHT, only education was related to the endpoint of interest. However, most results were accompanied by wide confidence intervals that usually included 1.0.
Based on these data, most TF people who use fHT receive their medications through informal means rather than by prescription. More importantly, only a small proportion of fHT users undergo treatment in accordance with current recommendations. These findings highlight the problem of inadequate access to guideline-concordant gender-affirming care among TF people in India.
Table of Contents
Background: 1
Methods: 2
Results: 5
Discussion: 6
Limitations: 8
Conclusions: 8
References: 9
Table 1 - Descriptive characteristics of survey participants by fHT receipt: 13
Table 2 - Descriptive characteristics of participants receiving fHT by source of medication: 14
Figure 1A/1B - Gender-affirming Care Patterns Among All Participants vs Self-Identified Transgender Women: 15
Table 3 - Association of participant characteristics with fHT use and fHT prescription receipt: 16
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