Alcohol Use Disorder Treatment in Sexually and Gender Diverse Patients: A Retrospective Cohort Study.

Objective: While sexually and gender diverse (SGD) people have higher odds of alcohol use disorder (AUD) compared to heterosexual and cisgender people, AUD treatment access and use disparities are not well characterized. The purpose of this study is to assess differences in AUD treatment among SGD versus non-SGD populations.Methods: A retrospective cohort study was performed using data from a federally qualified health center electronic health record system in Boston, Massachusetts. Patients were 18 years or older with an International Classification of Diseases (ICD)-9 or ICD-10 AUD diagnosis and any clinic visit from January 2013 until June 2021 (N = 3,607). Treatment for AUD was identified using binary variables for medication prescription orders and visits for AUD.Results: Among patients identifying as lesbian/gay, 6.9% had an AUD diagnosis, as compared to 2.6% of patients identifying as straight/heterosexual (P < .001). The prevalence of AUD was higher in the gender diverse group as compared to the cisgender group (5.5% vs 4.4%, P < .001). There were no significant differences in receipt of a prescription for injectable naltrexone, acamprosate, or disulfiram between SGD and non-SGD patients. For oral naltrexone, 16.1% of sexually diverse patients received a prescription, as compared to 9.8% of straight/heterosexual patients (P < .001). For visits, both the straight/heterosexual cohort and the cisgender cohorts had the lowest proportion of AUD-related pharmacotherapy and individual psychotherapy visits, as compared to SGD cohorts.Conclusions: SGD patients had higher proportions of AUD diagnosis and AUD care utilization through behavioral health as compared to non-SGD patients.

Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study.

BACKGROUND: Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE: We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS: Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS: TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS: Inability to determine causation and limited generalizability. CONCLUSION: TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.

Incidence and Factors Associated With Acne Among Transgender Patients Receiving Masculinizing Hormone Therapy.

Importance: Acne is a common condition among transgender patients receiving masculinizing hormone therapy (MHT), but the incident risk and predictors of developing acne in this population have not yet been studied on a large scale. Objective: To assess risk of acne among a large population of transgender patients receiving MHT and clinical risk factors for acne diagnosis. Design, Setting, and Participants: A retrospective cohort study that included 988 patients who started MHT between January 1, 2014, and December 31, 2017, with at least 1 year of follow-up was performed. Data analysis was conducted from September 1 to 15, 2019. Data were obtained using electronic health records from a community health center serving the sexual and gender minority community. The population included every patient who began receiving MHT during the study period who was aged 18 years or older at the time of MHT initiation and whose assigned sex at birth was female. Main Outcomes and Measures: The main outcome was acne defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for acne. Overall prevalence and incidence proportions over 2 years after initiation of MHT were calculated. Baseline demographic and clinical characteristics were collected at the time of MHT initiation. A series of univariate analyses for all factors was calculated to test for an association with acne diagnosis, followed by multivariate analyses to test for independent predictors. Results: For 988 patients (median age, 25.8 years; interquartile range, 20.8-28.2 years), there was an overall acne prevalence of 31.1% (n = 307). The 1-year post-MHT acne incidence proportion was 19.0% and the 2-year incidence proportion was 25.1%. A younger age at MHT initiation was associated with a higher likelihood of developing acne, with a median of 22.4 years (interquartile range, 19.7-25.6 years) among patients who developed acne vs 24.7 years (interquartile range, 21.3-29.4 years) among patients who did not (P = .002). Conclusions and Relevance: Acne is a common condition among transgender patients on MHT, with a prevalence increasing from 6.3% to 31.1% following MHT initiation. Patients aged 18 to 21 years appear to be the most likely to develop acne after MHT initiation.

Health Insurance Coverage of Permanent Hair Removal in Transgender and Gender-Minority Patients.

Importance: Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective: To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting: Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy's medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures: Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results: A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance: Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.

Trends in smoking documentation rates in safety net clinics.

OBJECTIVE: To assess the impact of provider incentive policy on smoking status documentation. DATA SOURCES: Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). STUDY DESIGN: This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. DATA EXTRACTION METHODS: We extracted structured EMR data for patients age 18 and older with at least one primary care visit. PRINCIPAL FINDINGS: Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. CONCLUSIONS: Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.

Disparities in Exposure to Intimate Partner Violence Among Transgender/Gender Nonconforming and Sexual Minority Primary Care Patients.

PURPOSE: We investigated the odds of intimate partner violence (IPV) among primary care patients across subgroups of transgender and gender nonconforming (TGNC) individuals relative to cisgender women, and cisgender sexual minority men and women relative to cisgender heterosexual men and women. METHODS: Participants completed an IPV screener as part of routine primary care visits at an urban community health center (N = 7572). Electronic medical record data were pooled for all patients who received the IPV screener January 1 to December 31, 2014. RESULTS: Overall, 3.6% of the sample reported experiencing physical or sexual IPV in the past year. Compared to cisgender women (past-year prevalence 2.7%), all TGNC subgroups reported elevated odds of physical or sexual IPV, including transgender women (past-year prevalence 12.1%; adjusted odds ratio [AOR] = 5.0, 95% confidence interval [CI] = 2.9-8.6), transgender men (6.6%; AOR = 2.4, 95% CI: 1.2-4.6), gender non-binary individuals (8.2%, AOR = 3.1, 95% CI = 1.7-5.4), and TGNC individuals who did not report their gender identity (9.1%; AOR = 3.7, 95% CI = 2.2-6.3). The prevalence of isolation-related IPV and controlling behaviors was also high in some TGNC groups. CONCLUSION: Our findings support that IPV is prevalent across genders and sexual orientations. Clinical guidelines for IPV screening should be expanded to include TGNC individuals and not just cisgender women. Future research could explore the complex patterns by which individuals of different genders are at increased risk for different types of IPV, and investigate the best ways to screen TGNC patients and support TGNC survivors.

Adherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women.

We used retrospective (2012-2013) chart review to examine breast cancer screening among transgender persons and sexual minority women (n = 1263) attending an urban community health center in Massachusetts. Transgender were less likely than cisgender patients and bisexuals were less likely than heterosexuals and lesbians to adhere to mammography screening guidelines (respectively, adjusted odds ratios = 0.53 and 0.56; 95% confidence intervals = 0.31, 0.91 and 0.34, 0.92) after adjustment for sociodemographics. Enhanced cancer prevention outreach is needed among gender and sexual minorities.

Comparison of surgical techniques for synovectomy in New Zealand White rabbits with induced inflammatory arthritis.

OBJECTIVE: To compare effects of synovectomy performed by use of monopolar radiofrequency energy (MRFE) versus mechanical debridement in rabbits with induced inflammatory arthritis. ANIMALS: 25 mature female New Zealand White rabbits. PROCEDURE: Inflammatory arthritis was induced in both femoropatellar joints of each rabbit. Joints then were treated by mechanical debridement or MRFE treatment or served as sham-operated controls. Rabbits were euthanatized 2 weeks or 3 months after surgery. Biopsy specimens of synovium were analyzed by use of light microscopy. RESULTS: At 2 weeks after surgery, samples from MRFE-treated joints had fewer plasma cells and more heterophils than the other 2 groups and more lymphocytes than sham-operated controls, whereas samples from mechanically debrided joints had greater numbers of lymphocytes and heterophils than sham-operated controls. At 3 months after surgery, samples from MRFE-treated joints had fewer plasma cells than sham-operated controls, more heterophils than mechanically debrided and sham-operated controls, and more macrophages than mechanically debrided joints. There was no difference in synovial ablation, synovial proliferation, or fibrosis among the 3 groups at 2 weeks or 3 months after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of this study documented a similar degree of synovial ablation when comparing use of MRFE to mechanical debridement. In rabbits with this method of induced inflammatory arthritis, there were no detectable benefits of MRFE or mechanical debridement on the synovium, compared with results for sham-operated control joints, at 2 weeks and 3 months after surgery for most of the synovial variables evaluated.