Health considerations for transgender women and remaining unknowns : a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address

Transgender and non-binary persons and sexual risk : a critical review of 10 years of research from a feminist intersectional perspective

Research shows that HIV prevalence in transgender and non-binary persons is extremely high, with prevalence rates ranging up to 52.4% (Edwards et al., 2007). This high risk is associated with a number of (trans-specific) factors, such as stigma, discrimination, normative gender roles, involvement in sex work, a lack of knowledge about safe sex and an inaccurate perception of risk. This article critically reviews the last 10 years of research on transgender and non-binary persons and sexual risk from a feminist intersectional perspective that focuses on gender identity, class, ethnicity and other axes of difference that contribute to the high risk for HIV for (some) transgender and non-binary persons. There appears to be an interweaving of different factors in which the discrimination and stigmatisation of transgender and non-binary persons is central. The limitations and pitfalls of current research are pointed out, and suggestions for policy and further research are made

Parental desire and fertility preservation in assigned female at birth transgender people living in Belgium

Objective: To study the considerations and concerns of transgender people regarding fertility preservation and parental desire in a large, nonclinical sample. Gender-affirming care can reduce fertility. Previous research on fertility in transgender people (mainly focused on people visiting health care professionals) shows low fertility preservation use. Design: A web-based survey on fertility and parenthood. Setting: Not applicable. Patient(s): Transgender people assigned female at birth (AFAB) were selected for this analysis (n = 172 or 40.4% of the total sample) of which 116 (67.4%) self-identified as transgender men (TM) and 56 (32.6%) as gender nonbinary (GNB) people. Intervention(s): Not applicable. Main Outcome Measure(s): Data on parental desire and fertility preservation were assessed in a large, nonclinical sample of AFAB transgender people. Result(s): Sixty-seven (39.0%) respondents had a current/future parental desire. Parental desire rates did not differ between TM and GNB persons. Barriers for fulfilling the parental desire (multiple response) included assumed difficulties in the adoption procedure (41.3%), fear of discrimination against the child (38.0%) or being discriminated against as a transgender parent (32.6%), and the cost for using personal genetic material (32.6%). Nine percent had cryopreserved reproductive cells or tissue. Conclusion(s): Even though parental desire rates in this cohort are in line with earlier research, fertility preservation use was lower in the current study. These numbers reflect the barriers transgender people face when considering fertility options, including cost and the need to postpone hormone therapy. In addition, GNB persons have different needs for gender-affirming treatment and subsequently for fertility preservation. ((C) 2019 by American Society for Reproductive Medicine.

Sexual health, transition-related risk behavior and need for health care among transgender sex workers

Background: Research has shown that sexual risk behavior, as well as transition-related risk behavior, such as uncontrolled hormone use, auto-medication, and silicone injections, may lead to several adverse health outcomes for transgender persons. Transgender sex workers are a vulnerable group within the transgender population, who are at increased risk for these health risk behaviors. However, European research into this topic and risk population remains largely absent. Aim: This study explores the prevalence of uncontrolled gender-affirming hormone use, silicone injections, and inconsistent condom use among transgender sex workers working in Antwerp, Belgium. Methods: A descriptive analysis of a survey sample of 46 transgender sex workers, supplemented with nine in-depth interviews with transgender sex workers. Results: This population of transgender sex workers has specific socio-demographic characteristics: they are all assigned male at birth, 83% identifies as female and 76% is from Latin-American descent, mainly from Ecuador. Transition-related and sexual risk behaviors are prevalent. Current uncontrolled hormone use rate is 32%, which should be seen in light of their work as well as their migration status. Inconsistent condom use with clients is reported by 33% of the sample. Of all participants, 65% has silicone injections in one or more parts of the body, and 43% of them cites health problems due to these injections. Conclusion: The specific characteristics of this largely invisible but highly vulnerable population should be taken in account when addressing this population's health risk behavior. Access to health care and social services should be ensured, and culturally tailored health interventions that take into account their social context as well as their gender identity should be developed

Prevalence and associated risk factors of HIV infections in a representative transgender and non-binary population in Flanders and Brussels (Belgium) : protocol for a community-based, cross-sectional study using time-location sampling

IntroductionHIV prevalence and sexual risk have been estimated very high for transgender people. However, the limited sampling and data collection methods used in current research on transgender people potentially led to overrepresentation and generalisation of people at risk for HIV. Current HIV prevalence estimates in transgender populations are generalised from studies mainly focusing on transgender women engaging in sex work. Moreover, studies focusing on non-binary people, who identify with a broad range of identities beyond the traditional male and female gender identities, are scarce. ObjectivesTo estimate the HIV prevalence rate in the Flemish and Brussels (Belgium) transgender population, including transgender women, transgender men and non-binary people, and to identify the associated risk factors. MethodsIn this community-based cross-sectional study, self-identified transgender and non-binary (TGNB) people will be recruited through a two-stage time-location sampling approach. First, community settings in which TGNB people gather will be mapped to develop an accurate sampling frame. Secondly, a multistage sampling design is applied involving a stratification based on setting type (healthcare facilities vs outreach events), a selection of clusters by systematic sampling and a simple random selection of TGNB people within each cluster. Participants will complete an electronic self-reported survey to measure sociological, sexual and drug-using behaviors (risk factors) and oral fluid aliquots will be collected and tested for HIV antibodies. Logistic regression models will be used to evaluate risk factors independently associated with HIV infection. The presented study is registered at ClinicalTrials.gov (NCT04930614). DiscussionThis study will be the first to investigate the HIV prevalence rates and associated risk behaviors in an accurate representation of the TGNB population in a Western European country. The findings will globally serve as a knowledge base for identifying subgroups at risk for becoming infected with HIV within TGNB people and to set up targeted prevention programs. Discussion This study will be the first to investigate the HIV prevalence rates and associated risk behaviors in an accurate representation of the TGNB population in a Western European country. The findings will globally serve as a knowledge base for identifying subgroups at risk for becoming infected with HIV within TGNB people and to set up targeted prevention programs

The counterinsurgency/conservation nexus: guerrilla livelihoods and the dynamics of conflict and violence in the Virunga National Park, Democratic Republic of the Congo

The growing militarisation of nature conservation has refocused attention on the relations between counterinsurgency and conservation. This contribution analyses how these two phenomena entwine in the Virunga National Park, located in the war-ridden east of the Democratic Republic of the Congo. It examines how this entwinement relates to dynamics of conflict and violence, and how these dynamics shape and are shaped by the livelihood and resistance practices of local inhabitants. As it shows, a particularly important form of resistance is ‘guerrilla livelihood’ activities, or cultivation, (prohibited) fishing and logging within the boundaries of the park, which often take place under the protection of armed groups. By studying the interplay among such unauthorised exploitation of natural resources, different types of conflict, and insurgent mobilisation, it is demonstrated that strict law enforcement and joint operations of the Congolese army and park guards fuel, rather than mitigate, the dynamics feeding into armed mobilisation