Frequency and Distribution of Gender-Affirming Interventions in Large Integrated Health Systems Restricted; Files Only

Abstract

Background: Transgender and gender diverse (TGD) individuals often seek gender-affirming procedures (GAP) and surgeries (GAS) to align their physical appearance with their gender identities, and to improve their psychological well-being and quality of life. Although the utilization of these interventions is increasing, limited data are available on the characteristics TGD individuals seeking GAP and GAS.

Methods: Data for the present analysis were obtained from the Study of Transition, Outcomes & Gender (STRONG), a cohort of TGD members identified from electronic health records at three Kaiser Permanente (KP) health plans located in Georgia and in Northern and Southern California. Eligible participants included the STRONG cohort members with confirmed eligibility and established transmasculine (TM) and transfeminine (TF) status. Outcomes included the receipt of GAP and GAS, determined using specific Current Procedure Terminology and International Classification of Diseases codes. Independent variables of interest included age at index (first date of documented TGD status, race/ethnicity, insurance type, TM/TF group, KP site, and area-based measures of socioeconomic status. Sample characteristics were summarized for the overall cohort and by TM/TF group. Multivariable logistic regression models were generated for each outcome of interest with results stratified by TM/TF group.

Results: Among the 15,564 study participants, nearly half (45%) had a history of GAP and about a quarter (27%) had a history of GAS. Among TF individuals, 48% had a history of GAP while the same proportion among TM individuals was 42%. The proportion of participants with history of GAS was higher among TM individuals (33%) than among TF individuals (19%). Older age at index and Medicaid insurance were associated with higher odds of both GAP and GAS, particularly among TF individuals. In almost all analyses, California residents had significantly higher odds of interventions compared to Georgia residents. No significant racial/ethnic or socioeconomic disparities in utilization were observed.

Conclusion: A substantial proportion of TGD individuals within this integrated health system have undergone gender-affirming interventions. These results suggest that providing TGD individuals with equitable insurance coverage and access to healthcare services may help mitigate the inequities that are well documented in other segments of the society.

Table of Contents

Introduction …………………………………………………………………………………….. 1

Methods …………………………………………………………………………………………. 5

           Data Sources …..…………………………………………………………………………. 5

           Outcomes ……………………………………………………………………………….... 6

           Independent Variables …………………………………………………………………… 6

           Statistical Analysis ………………………………………………………………………. 7

Results …………………………………………………………………………………………… 7

           Cohort Characteristics …………………………………………………………………… 7

           Multivariable Analysis …………………………………………………………………... 8

Discussion ……………………………………………………………………………………….. 8

References …………………………………………………………………………………..…. 13

Tables/Figures …………………………………………………………………………………. 16

           Figure 1 …………………………………………………………………………………. 16

           Figure 2a …………………………………………………………………………...…… 17

           Figure 2b …………………………………………………………………………...…… 17

           Figure 2c …………………………………………………………………………...…… 18

           Table 1 ………………………………………………………………………………….. 19

           Table 2 ………………………………………………………………………………….. 20

           Table 3 ………………………………………………………………………………….. 21

Supplemental Materials ……………………………………………………….…………….... 22

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, General Health Sciences, Surgery
Palavra-chave	transgender gender-affirming surgery
Committee Chair / Thesis Advisor	Michael Goodman, Emory University
Committee Members	Amita Manatunga, Emory University Vin Tangpricha, Emory University

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