Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis

A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CI

Validation of a Methodology to Investigate Care Inequities for Transgender Patients

Introduction: Pain is a common chief complaint in the emergency department (ED), and there are known disparities in the management of pain among racial/ethnic minorities, women, and older adults. Transgender and gender diverse (TGD) individuals comprise another under-represented patient population in emergency medicine and are also at risk of disparities in care. To measure and evaluate the magnitude of care inequities among TGD individuals, first we need to be able to accurately identify the right cohort and comparison groups. The primary objective of this study was to establish an accurate and generalizable process for identifying TGD patients through the electronic health record (EHR). Secondary objectives included creating and validating a method for matching and comparing of TGD patients to cisgender patients.  Methods: This was a retrospective, observational cohort study that included patients presenting to Mayo Clinic EDs with a chief complaint of abdominal pain across four states (MN, WI, AZ, FL) between July 1, 2018–November 15, 2022. Patients ≥12 years of age were included. Patients’ sex assigned at birth and gender identity was extracted from the EHR via patient-provided registration fields. Two independent investigators independently reviewed each medical record of the identified TGD patient to validate the accuracy of pulled gender identity. Discrepancies were resolved by a third reviewer. Each transgender patient was matched to cisgender GBQ males (gay, bisexual, queer), cisgender LBQ (lesbian, bisexual, queer) females, cisgender heterosexual males, and cisgender heterosexual females using propensity score (PS) matching. We calculated the PS values using a multivariable logistic regression model where being transgender was the outcome, and covariates in the model included age, site, mental health history, and gastrointestinal history. Results: We initially identified 300 patients as TGD based on electronic data pull. An additional 1,000 patients were also included in the cohort for matching purposes. The agreement between electronic and manual review was 99.9%, and the kappa was 0.998 (95% confidence interval 0.994-1.000). We were able to match patients except for GBQ males due to low numbers. There is a significant difference in age between groups (P <0.001) with GBQ males being older than other groups. Conclusion: The methodology for identifying transgender and gender diverse patients in the EHR was accurate compared to manual review of gender identity. The TGD patients were able to be well matched, except to GBQ males. This provides a validated method to identify TGD patients in the EHR and further study disparities they may receive in care

Preferential expression of PAPPA in human preadipocytes from omental fat

Fat distribution differs between individuals, and those with visceral fat predominance develop metabolic profiles that increase the risk of adverse cardiovascular events. This is due, in part, to the proinflammatory state associated with visceral obesity as well as depot-specific adipogenesis. The IGF system is important in adipose tissue development and metabolic function. Pregnancy-associated plasma protein A (PAPPA) is a novel zinc metalloproteinase that regulates local IGF availability. The first aim of this study was to characterize PAPPA mRNA and protein expression in primary cultures of human preadipocytes isolated from omental, mesenteric, and subcutaneous depots. PAPPA expression was significantly increased in omental preadipocytes compared with mesenteric and subcutaneous preadipocytes. The second aim of this study was to investigate the factors regulating PAPPA expression, focusing on proinflammatory cytokines and resveratrol that have been shown to have negative and positive effects, respectively, on metabolism and diet-induced obesity. Treatment of cultured primary human preadipocytes with tumor necrosis factor α and interleukin 1β led to significant increases in PAPPA expression. Activated pathways mediating cytokine-induced PAPPA expression include the nuclear factor κB pathway and the MAPK family, particularly c-Jun NH2-terminal kinase and p38 MAPK. Resveratrol, a polyphenolic compound with beneficial cardiometabolic effects, significantly downregulated PAPPA expression under basal and stimulated conditions. Effects of resveratrol on PAPPA appeared to be mediated through pathways independent of silent mating type information regulation 2 homolog 1 (SIRT1) and AMP kinase activation. Depot-specific PAPPA expression in human preadipocytes may contribute to a depot-specific function.</jats:p

Proper Care of Transgender and Gender Diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective*

Abstract Transgender and gender diverse (TGD) individuals face significant barriers to accessing health care. Recent introductions of regulatory policies at state and federal levels raise concerns over the politicization of gender-affirming health care, the risks of further restricting access to quality care, and the potential criminalization of healthcare professionals who care for TGD patients. The Endocrine Society and the Pediatric Endocrine Society have published several news articles and comments in the last couple of years supporting safe and effective gender-affirming interventions as outlined in the 2017 Endocrine Society’s Clinical Practice Guidelines. The Endocrine Society Position Statement on Transgender Health also acknowledges the rapid expansion in understanding the biological underpinning of gender identity and the need for increased funding to help close gaps in knowledge about the optimal care of TGD individuals. This Policy Perspective affirms these principles in the context of pending and future legislation attempting to discriminate against TGD patients while also stressing the need for science and health care experts to inform health policies.</jats:p