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MMWR Morb Mortal Wkly Rep ; 69(2): 35-39, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945033


Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments† during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care services, reduce HIV transmission, and contribute to ending the HIV epidemic.

Prestación de Atención de Salud , Infecciones por VIH/terapia , Parejas Sexuales , Personas Transgénero , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estados Unidos/epidemiología , Adulto Joven
Curr Urol Rep ; 21(1): 1, 2020 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-31960192


PURPOSE OF REVIEW: Kidney transplantation and gender affirmation treatments are becoming increasingly more prevalent due to advances in technology. However, there is a paucity of data regarding kidney transplantation in transgender patients. Interesting considerations must be made in this patient population, since there are many hormonal interactions with kidney function and the transplantation process. RECENT FINDINGS: The diagnosis of estimated glomerular filtration rate (eGFR), preoperative assessment/counseling, decreased testosterone levels in a transgender male to female patient, increased estrogen/progesterone in a female to male patient, and drug side effects all have important and unique implications for kidney transplant recipients. Kidney transplantation can be safely and effectively managed in transgender patients with special considerations in eGFR calculations, mental health/lifestyle counseling, and drug interactions.

Fallo Renal Crónico/cirugía , Trasplante de Riñón , Personas Transgénero , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/fisiopatología , Transexualismo/tratamiento farmacológico , Transexualismo/metabolismo , Transexualismo/cirugía
J Homosex ; 67(3): 315-324, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30335590


This think piece provides a critical analysis of the terms lesbian, gay, bisexual, transgender, and queer (LGBTQ) from an international perspective that draws on citizenship studies, providing some indications of the implications for LGBTQ studies. It outlines difficulties with the LGBTQ acronym in the Global North and South. Internationally, scholarship to support the human rights of non-heterosexuals and gender-diverse people is badly needed, but the think piece concludes that it is crucial to consider the social context of different cases, and to address the materialist, cultural, neo-colonial, and other forces that affect the formation of non-heterosexual and gender-diverse identities.

Identidad de Género , Minorías Sexuales y de Género , Variación Biológica Poblacional , Bisexualidad , Diversidad Cultural , Femenino , Homosexualidad , Humanos , Masculino , Personas Transgénero
Trab. educ. saúde ; 18(1): e0023469, 2020. tab
Artículo en Portugués | LILACS | ID: biblio-1043489


Resumo Neste artigo, é realizado um mapeamento da produção científica sobre o acesso à saúde pela população transexual pós-2008, ano importante para a saúde trans no Brasil, no qual foi criado o Processo Transexualizador do Sistema Único de Saúde. O objetivo desse trabalho foi realizar uma revisão integrativa da literatura sobre acesso à saúde da população transexual e travesti brasileira, empregando as bases de dados MEDLINE, LILACS e SciELO, empregando-se os seguintes descritores: 'transexualidade', 'transexualismo', 'travestismo', 'travesti' e 'transgênero', foram selecionados 22 artigos. Considerando a produção científica analisada, constatamos inúmeros desafios ao acesso da população trans no Sistema Único de Saúde, como a discriminação, a patologização da transexualidade, a falta de qualificação dos profissionais, o acolhimento inadequado, a escassez de recursos para o financiamento de políticas e programas voltados ao combate à discriminação de origem homofóbica e trans-travestifóbica, bem como a ausência da garantia de serviços específicos - como o processo transexualizador.

Abstract The article presents a mapping of the scientific production regarding the access to health by the transsexual population after 2008, an important year for trans health in Brazil, in which the Transsexualizing Process of the Brazilian Unified Health System (Processo Transexualizador do Sistema Único de Saúde, in Portuguese) was created. The goal of the present work was to conduct an integrative review of the literature regarding the access to health by the Brazilian transsexual and transvestite population in the MEDLINE, LILACS and SciELO databases, using the following descriptors: 'transsexuality,' 'transsexualism,' 'transvestitism,' 'transvestite' and 'transgendered,' and 22 articles were selected. Considering the scientific production analyzed, we verified countless challenges regarding the access of the trans population to the Brazilian Unified Health System, such as discrimination, pathologization of transsexuality, lack of training on the part of the professionals, improper embracement, lack of resources to fund policies and programs geared towards the fight against discrimination due to homophobia or tans/transvestite-phobia, as well as the lack of guarantee of specific services - such as the transsexualizing process.

Resumen En este artículo, se realiza un mapeo de la producción científica sobre el acceso a la salud por la población transexual después de 2008, un año importante para la salud trans en Brasil, en el cual se creó el Proceso Transexualizante del Sistema Único de Salud (Processo Transexualizador do Sistema Único de Saúde, en portugués). El objetivo de este trabajo fue realizar una revisión integrante de la literatura sobre el acceso a la salud de la población transexual y travesti brasileña, en las bases de datos MEDLINE, LILACS y SciELO, utilizando los siguientes descriptores: "transexualidad", "transexualismo", "travestismo", "travesti" y "transgénero", y se seleccionaron 22 artículos. Considerando la producción científica analizada, constatamos inúmeros desafíos al acceso de la población trans en el Sistema Único de Salud, como la discriminación, la patologización de la transexualidad, la falta de calificación de los profesionales, la acogida inadecuada, la escasez de recursos para el financiamiento de políticas y programas direccionados a la lucha en contra de la discriminación de origen homofóbica y trans-travestifóbica, así como la ausencia da garantía de servicios específicos - como el proceso transexualizante.

Humanos , Personas Transgénero , Accesibilidad a los Servicios de Salud
Klin Padiatr ; 232(1): 5-12, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31847010


INTRODUCTION: Gender dysphoria (GD) in childhood and adolescence is characterized by an incongruence between sex at birth and gender identity, which usually increases during puberty. Gender dysphoric children and adolescents often suffer from psychological comorbidities such as depression. The purpose of our study is to give an overview of the patients treated in our clinic. METHODS: We analyzed data of 66 patients who presented with GD at our outpatient clinic between 2005 and 2018. RESULTS: We noted a rise of presentations with one or no patient with GD per year between 2005 and 2008 up to 18 patients in 2018, although the percentage of all 14.339 endocrinological outpatients (2005-2018) is low. 54 patients were assigned as female and 12 as male at birth resulting in a ratio of 4.5:1. The mean age at their first appointment was 13.6 years. 49 patients (74%) had reached tanner stadium P3/B3 or P3/G3. 30 (45%) showed symptoms of a comorbidity related to GD. 48 (73%) showed symptoms of GD before puberty. 15 patients (23%) experienced a negative response regarding their outing and 17 (26%) were victims of mobbing in school. CONCLUSION: The number of patients increased in the last years. About half of the patients suffered from a psychological comorbidity. They often experienced negative response regarding their GD in the family. The variability of appearance and the comorbidities pose the challenge in the treatment of gender dysphoric children and adolescents.

Disforia de Género/psicología , Disforia de Género/cirugía , Cirugía de Reasignación de Sexo , Personas Transgénero/psicología , Adolescente , Niño , Comorbilidad , Femenino , Disforia de Género/diagnóstico , Identidad de Género , Humanos , Masculino , Maduración Sexual
Actas dermo-sifiliogr. (Ed. impr.) ; 110(10): 841-849, dic. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-185606


Introducción: Desde el año 2000 se ha descrito un aumento progresivo de los casos de sífilis en diferentes ciudades europeas, sobre todo en hombres que tienen sexo con hombres (HSH). Las manifestaciones clínicas de la sífilis pueden estar influidas por la coinfección del VIH o por el antecedente de sífilis. El objetivo del presente estudio es describir las características epidemiológicas y clínicas de los casos de sífilis precoz diagnosticados en Barcelona. Métodos: Estudio retrospectivo de casos de sífilis precoz diagnosticados en Barcelona (2003-2013). Se revisaron las historias clínicas y los datos epidemiológicos y clínicos fueron recogidos de forma estructurada. Las variables se compararon según el estatus serológico del VIH y el antecedente de sífilis. Resultados: Se diagnosticaron 1.702 casos de sífilis precoz (37% primaria, 48% secundaria y 14% latente precoz), 93% de ellos en HSH. Entre ellos, el 40% presentaba una coinfección por VIH. Los casos de sífilis en pacientes VIH positivos estaban asociados con un episodio previo de sífilis (aOR, 5,2 [IC del 95%, 3,32-8,24]) y con haber tenido sexo anal desprotegido (aOR, 1,75 [IC del 95%, 1,17-2,63]). Los casos con antecedentes de sífilis se presentaron con menor frecuencia como sífilis primaria (27,5% vs. 40%) (aOR, 0,58 [IC del 95%, 0,44-0,77]). Un año después del tratamiento, la evolución clínica y serológica fue similar en los pacientes VIH positivo y negativo. Conclusiones: La epidemia de sífilis en Barcelona afecta desproporcionalmente a HSH y está estrechamente relacionada con el VIH. La forma de presentación de la sífilis está influida por el antecedente de sífilis y por el VIH, sin diferencias significativas en cuanto a la evolución un año después del tratamiento

Background: Since 2000, substantial increases in syphilis have been reported in metropolitan areas of Western countries, with increases noted among men who have sex with men (MSM). Clinical manifestations of syphilis might be influenced by concomitant VIH infection and previous episodes of syphilis. The objectives of this study were to describe the epidemiological and clinical characteristics of the cases of syphilis diagnosed in Barcelona. Methods: Retrospective study of cases with early syphilis diagnosed in the referral STI Unit of Barcelona from January 2003 to December 2013. Revision of medical records with structured collection of epidemiological and clinical data. Univariate and multivariate statistical analyses comparing the characteristics of MSM cases with and without VIH infection and with and without previous syphilis. Results: A total of 1702 cases of syphilis (37% primary, 48% secondary and 14% early latent) were diagnosed, 93% of them in MSM. Among MSM 40% were coinfected with VIH, VIH-positive cases were associated with a previous syphilis (aOR, 5.2 [95% CI, 3.32-8.24]) and with unprotected anal intercourse (aOR, 1.75 [95%CI, 1.17-2.63]). Cases with a history of syphilis presented less often with primary syphilis compared to those without it (27.5% vs. 40%) (aOR, 0.58 [95% CI, 0.44-0.77]). One year after treatment, the clinical and serological evolution were similar between VIH-positive and VIH-negative cases. Conclusion: The epidemic of syphilis in Barcelona disproportionately affects MSM and is closelly linked to VIH infection. The presentation of syphilis is influenced by VIH infection and by previous history of syphilis, without significant differences in their evolution after one year of treatment

Humanos , Sífilis/epidemiología , Epidemias , Diagnóstico Precoz , Síndromes de Inmunodeficiencia/epidemiología , España/epidemiología , Estudios Retrospectivos , Infecciones por VIH/complicaciones , Microscopía , Análisis Estadístico , Personas Transgénero , Minorías Sexuales y de Género
Movimento (Porto Alegre) ; 25(1): e25032, jan.- dez. 2019.
Artículo en Portugués | LILACS | ID: biblio-1048143


O objetivo deste trabalho é compreender a trajetória pessoal de Tifanny Abreu em seu processo de inserção e permanência no voleibol de alto rendimento. Desenvolvemos um estudo de caso descritivo e qualitativo. Para coletar nossos dados, realizamos uma entrevista semiestruturada, posteriormente transcrita e analisada através da técnica de análise de conteúdo. Como resultados, encontramos resistências ao longo da trajetória pessoal de Tifanny envolvendo sua transição de gênero e manutenção no Esporte, o tratamento por parte da mídia e das torcidas e o usufruto do vestiário

This study looks into the personal history of Tifanny Abreu in her process to enter and remain in high performance volleyball. We conducted a descriptive and qualitative case study. To collect our data, we used a semi-structured interview, later transcribed and submitted to content analysis. As results, we found resistance throughout Tifanny's personal history involving her gender transition and permanence in volleyball, her treatment by the media and fans, and her use of the changing room

El objetivo de este trabajo es entender la trayectoria personal de Tifanny Abreu en su proceso de inserción y permanencia en el voleibol de alto rendimiento. Desarrollamos un estudio de caso descriptivo y cualitativo. Para recopilar nuestros datos, realizamos una entrevista semiestructurada, posteriormente transcrita y analizada a través de la técnica de análisis de contenido. Como resultados, encontramos resistencias a lo largo de la trayectoria personal de Tifanny involucrando su transición de género y su permanencia en el deporte, el trato por parte de los medios y de las hinchadas y la utilización de los vestuarios

Humanos , Masculino , Femenino , Voleibol , Atletas , Personas Transgénero , Deportes , Transexualismo , Identidad de Género
Movimento (Porto Alegre) ; 25(1): e25007, jan.- dez. 2019. quadro, ilus
Artículo en Portugués | LILACS | ID: biblio-1047608


Considerando a possibilidade da participação das atividades físicas na construção de características físicas como força e rigidez muscular por homens trans, este estudo buscou analisar a relação dos homens trans com as atividades físicas no processo de "masculinização". Participaram do estudo oito homens trans que fazem uso dos serviços oferecidos pelo Ambulatório de Saúde integral para Travestis e Transexuais na cidade de João Pessoa/PB, que foram submetidos a uma entrevista semiestruturada e um questionário socioeconômico, analisados com base na proposta de Bicudo para a análise fenomenológica. Este estudo concluiu que os entrevistados fazem uso das atividades físicas em busca do ganho de massa corporal e definição muscular, aspectos que na visão deles remetem a um corpo masculino, reforçando não apenas a sua masculinidade, mas ajudando na construção da sua identidade sexual

Considering the possibility of participating in physical activities to build physical characteristics such as strength and muscular rigidity by transsexual men, this study analyzed the latter's relationship with physical activities in the process of "masculinization". Subjects were eight transsexual male users of the services provided by the Total Health Care Ambulatory for Transvestites and Transsexuals in the city of João Pessoa, Paraíba. They answered socioeconomic questionnaires and semi-structured interviews, later submitted to Bicudo's Phenomenological analysis proposal. This study concluded that respondents used physical activities to increase body mass and muscle definition ­ aspects that, in their views, refer to a masculine body, not only reinforcing their masculinity but also helping them to build their sexual identity

Considerando la posibilidad de la participación de las actividades físicas en la construcción de características físicas como fuerza y rigidez muscular por hombres trans, este estudio analizó la relación de los hombres trans con actividades físicas en el proceso de "masculinización". Participaron ocho hombres que hacen uso de los servicios ofrecidos por el Ambulatorio de Salud Integral para Travestis y Transexuales en João Pessoa, Paraíba, que fueron sometidos a una entrevista semiestructurada y a un cuestionario socioeconómico, analizados con base en la propuesta de Bicudo para el análisis fenomenológico. Este estudio concluyó que los entrevistados hacen uso de las actividades físicas buscando ganar masa corporal y definición muscular, aspectos que en su visión remiten a un cuerpo masculino, reforzando no solo su masculinidad, sino ayudando en la construcción de su identidad sexual

Humanos , Masculino , Femenino , Transexualismo , Ejercicio , Personas Transgénero , Cuerpo Humano
Medicine (Baltimore) ; 98(50): e18232, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852085


Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.

Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Homosexualidad Masculina/psicología , Prevención Primaria/métodos , Conducta Sexual , Parejas Sexuales , Personas Transgénero , Adulto , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , Cumplimiento de la Medicación , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología
Nurs Clin North Am ; 54(4): 551-559, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31703780


Transgender individuals are at an increased risk of experiencing health inequalities, such as anxiety, depression, and HIV. It is important that providers and staff in the health care setting are prepared to care for this population to ensure best patient outcomes. An understanding of transgender terminology and the experience of gender dysphoria is key. In addition, a transinclusive environment should be created to reduce the likelihood of transgender-related discrimination. Developing an understanding of potential gender-affirming treatments and surgeries also optimizes patient care. Improving the quality care will reduce health disparities commonly faced by the transgender population.

Prestación de Atención de Salud , Disparidades en Atención de Salud , Personas Transgénero/psicología , Disforia de Género , Humanos
BMC Public Health ; 19(1): 1531, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31730450


BACKGROUND: In the U.S., transgender and gender diverse (TGD) populations face structural, interpersonal, and individual barriers to healthcare. Less is known, however, about the HIV prevention and treatment experiences of TGD youth in the U.S. The current study was developed to fill this research gap. METHODS: This article describes the research protocol for a multi-site, U.S.-based mixed-methods study that sought to identify the multi-level facilitators and barriers that influence participation of TGD youth in various stages of the HIV prevention (e.g., pre-exposure prophylaxis uptake) and care continua. A sample of diverse TGD youth ages 16-24 was recruited from 14 U.S. sites. TGD youth participants completed a one-time, in-person visit that included an informed consent process, computer-based quantitative survey, and in-depth qualitative interview assessing experiences accessing HIV prevention and/or care services. Providers serving TGD youth were recruited from the same 14 sites and completed a one-time visit via phone that included informed consent, demographic questionnaire, and in-depth qualitative interview assessing their experiences providing HIV prevention or treatment services to TGD youth. RESULTS: Overall, 186 TGD youth ages 16-24 and 59 providers serving TGD youth were recruited and enrolled from across the 14 U.S. sites. TGD youth participants had a mean age of 20.69; 77.3% youth of color; 59.7% trans-feminine; 15.5% trans-masculine; 24.9% non-binary; 53.6% family income under poverty level. Providers included medical and mental health providers as well as case manager/care coordinators, HIV test counselors, and health educators/outreach workers. Providers were 81.3% cisgender and 30.5% people of color. Successes with community-engagement strategies and gender-affirming research methods are reported. CONCLUSIONS: This study addresses critical gaps in current knowledge about the HIV prevention and care experiences of TGD youth. Findings have implications for the development of HIV interventions across levels to support the health and well-being of TGD youth. Future research is warranted to replicate and expand on lessons learned regarding recruitment and engagement of communities of TGD youth, including longitudinal designs to assess engagement across their developmental stages. Lessons learned working with TGD youth through developing and implementing the study protocol are shared. TRIAL REGISTRATION: Registered on on 05/20/2015 (NCT02449629).

Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Aceptación de la Atención de Salud/psicología , Minorías Sexuales y de Género/psicología , Personas Transgénero/psicología , Adolescente , Femenino , Infecciones por VIH/prevención & control , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Investigación Cualitativa , Proyectos de Investigación , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
Lakartidningen ; 1162019 Oct 11.
Artículo en Sueco | MEDLINE | ID: mdl-31613373


The incidence of gender identity diagnoses in persons younger than 20 years old has increased more than 20 times in Sweden during a 10-year period. The reason for this is unknown, but new categories of patients seeking care or lower diagnostic thresholds are conceivable explanations. Even though gender-confirming health care is believed to ease gender dysphoria and improve quality of life in carefully selected cases, the long-term outcomes of this wider group of patients are unknown. In order to not harm patients, irreversible medical procedures should be used with caution and in the context of clinical trials given the limited evidence base for medical interventions in this group.

Disforia de Género/epidemiología , Adolescente , Disforia de Género/psicología , Disforia de Género/terapia , Humanos , Suecia/epidemiología , Personas Transgénero/psicología , Transexualismo/epidemiología , Transexualismo/terapia , Adulto Joven
Urology ; 132: 121, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31581988
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190004, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576980


INTRODUCTION: Travestis and transgender women resort to the use of hormones for body modification. Due to restrictions in the access to health services, self-medication is frequent. The aim of this study was to describe the self-reported prevalence of hormones used by travestis and transgender women in the Federal District. Method: This is a cross-sectional study with Respondent Driven Sampling (RDS) and Knowledge, Attitudes and Practices questionnaire (KAP) along with travestis and transgender women over 18 years in the FD. Prevalence was calculated using the RDS-II estimator. Logistic models were used to investigate the associated factors. A total of 201 volunteers participated. RESULTS: There was a young sample (median age of 24 years). The overall prevalence of continuous use of hormones was 64.5%. The most used formulation was the combination of estrogen and progesterone (86.2%) by injectable (75.1%) and oral (66%) administration. Most participants (84%) got the hormones without a prescription. Guidance on the use of these hormones came from their peers in 41% of the cases. We observed that the continuous use of hormones is associated with race, income and age, as well as the search for guidance of healthcare professionals, which is also associated with schooling. DISCUSSION: The reality of the process of hormone use by these people in the quest for femininity is reflected in high rates of self-medication. CONCLUSION: This study contributes to the visibility of the need to improve the access conditions of these people to health services.

Hormonas/administración & dosificación , Personas Transgénero/estadística & datos numéricos , Travestismo , Adolescente , Adulto , Factores de Edad , Brasil , Estudios Transversales , Femenino , Identidad de Género , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Automedicación/estadística & datos numéricos , Autoinforme , Factores Socioeconómicos , Travestismo/etnología , Adulto Joven