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1.
Soc Sci Med ; : 113218, 2020 Jul 17.
Article in English | MEDLINE | ID: mdl-32732096

ABSTRACT

Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.

2.
J Chin Med Assoc ; 2020 Jul 22.
Article in English | MEDLINE | ID: mdl-32732531

ABSTRACT

BACKGROUND: Animal models of trauma have shown that females have better post-traumatic survival; however results of previous studies on the influence of gender on major trauma patients have been controversial. This study aimed to evaluate the association between gender and survival in major trauma patients. METHODS: We retrospectively analyzed patients registered in Taiwan's National Health Insurance Research Database between 2008 and 2012 with the diagnosis codes 800-939 and 950-957 (ICD-9-CM). Data on gender, age, catastrophic illness, and new injury severity score (NISS) ≥ 16 were collected for comparing patients' mortality after trauma. Propensity score matching (PSM) was performed to eliminate dissimilarities in age, comorbidities, NISS, and primary traumatic regions between the genders. RESULTS: Among 10,012 major trauma patients included in the study cohort, 28.8% (n = 2,880) were women. The PSM patient group consisted of 50% (2,876 of 5,752) women. Women had a higher 30-day (15.4% of women vs. 13.8% of men, p < 0.05) and hospital (16.1% of women vs. 14.5% of men, p < 0.05) mortality and lower incidence rates of acute respiratory dysfunction (62.5% of women vs. 65.9% of men, p < 0.005) and acute hepatic dysfunction (0.8% of women vs. 2.1% of men, p < 0.001). However, the analysis of PSM patient groups showed lower mortality rates in women with moderate trauma (NISS 16-24) in the acute phase within three days (1.4% of women vs. 2.7% of men, p = 0.03). Analysis of patients with a NISS of 16-24 who died within three days showed a higher NISS in women than in men (19.7 ± 2.3 vs. 18.0 ± 1.9, respectively, p <0.05). CONCLUSION: There is no gender difference in 30-day or hospital mortality among major trauma patients. However, women admitted for moderate major trauma had higher survival within three days of major trauma.

3.
J Subst Abuse Treat ; : 108078, 2020 Jul 15.
Article in English | MEDLINE | ID: mdl-32736926

ABSTRACT

OBJECTIVE: Brief intervention (BI) for unhealthy alcohol use is a top prevention priority for adults in the U.S, but rates of BI receipt vary across patients. We examine BI receipt across race/ethnicity and gender in a national cohort of patients from the Department of Veterans Affairs (VA)-the largest U.S. integrated healthcare system and a leader in implementing preventive care for unhealthy alcohol use. METHODS: Among 779,041 VA patients with documented race/ethnicity and gender who screened positive for unhealthy alcohol use (AUDIT-C score ≥ 5) between 10/1/09 and 5/30/13, we fit Poisson regression models to estimate the predicted prevalence of BI (EHR-documented advice to reduce or abstain from drinking) across race/ethnicity and gender. RESULTS: Rates of BI were lowest among Black women (67%), Black men (68%), and Asian/Pacific Islander women (68%), and highest among white men (75%), Hispanic men (75%), and Asian/Pacific Islander men (75%). A significant race/ethnicity by gender interaction indicated that the associations between race/ethnicity and gender with BI depended on the other factor. Gender differences were largest among Asian/Pacific Islander patients and were nonsignificant among American Indian/Alaska Native patients. Adjustment for covariates not expected to be on the causal pathway (e.g., age, year of AUDIT-C screen) slightly attenuated but did not change the direction of results. CONCLUSIONS: Receipt of BI for unhealthy alcohol use varied by race/ethnicity and gender, and the impact of one factor depended on the other. Black women, Black men, and Asian/Pacific Islander women had the lowest rates of receiving recommended alcohol-related care. We found these disparities in a healthcare system that has implemented universal alcohol screening and incentivized BI for all patients with unhealthy alcohol use, suggesting that reducing disparities in alcohol-related care may require targeted interventions.

4.
Anesth Analg ; 2020 Jul 21.
Article in English | MEDLINE | ID: mdl-32739963

ABSTRACT

BACKGROUND: Health care and outcome of critically ill patients are marked by gender-related differences. Several studies have shown that male patients in intensive care units (ICU) more often receive mechanical ventilation, dialysis, pulmonary arterial catheterization (PAC), and central venous catheterization (CVC). We investigated gender-related differences in ICU treatment and mortality. METHODS: This retrospective, single-center study analyzed adult ICU patients admitted to the University Medical Center Regensburg between January 2010 and December 2017. Illness severity was measured with the Simplified Acute Physiology Score II (SAPS II) at ICU admission. We evaluated the intensity of ICU treatment according to the implementation of tracheostomy and extracorporeal membrane oxygenation (ECMO). We then assessed gender-related differences in the duration of mechanical ventilation and other invasive monitoring (PAC) and treatment methods (CVC, endotracheal intubation rate, and dialysis). ICU treatment and mortality data were obtained from an electronic data capture system. After adjusting for age, reason for hospitalization, and SAPS II score, we assessed the influence of gender on the intensity of ICU treatment using multivariable logistic regression. Odds ratios (OR) for the logistic regression models and incidence rate ratios (IRR) for the negative binomial regression models were calculated as effect estimates together with the corresponding 95% confidence intervals (95% CI). A P value of <.05 was considered significant. RESULTS: The study analyzed 26,711 ICU patients (64.8% men). The ICU mortality rate was 8.8%. Illness severity, ICU, and hospital mortality did not differ by gender. Women were older than men (62.6 vs 61.3 years; P < .001) at ICU admission. After multivariable adjustment, men were more likely to undergo tracheostomy (OR = 1.39 [1.26-1.54]), ECMO (OR = 1.37 [1.02-1.83]), dialysis (OR = 1.29 [1.18-1.41]), and PAC insertion (OR = 1.81 [1.40-2.33]) and had a longer duration of mechanical ventilation than women (IRR = 1.07 [1.02-1.12]). The frequency of endotracheal intubation (OR = 1.04 [0.98-1.11]) and placement of CVC (OR = 1.05 [0.98-1.11]) showed no gender-specific differences. Of ICU nonsurvivors, men were more likely to undergo tracheostomy (20.1% vs 15.3%; P = .004) and dialysis (54% vs 46.4%; P < .001) than women and had a longer duration of mechanical ventilation (6.3 vs 5.4 days; P = .015). CONCLUSIONS: After adjustment for severity of disease and outcome, ICU treatment differs between men and women. Men were more likely than women to undergo tracheostomy and ECMO.

5.
J Interpers Violence ; : 886260520944536, 2020 Aug 01.
Article in English | MEDLINE | ID: mdl-32741237

ABSTRACT

Previous research has demonstrated that most veterans who have experienced military sexual trauma (MST) have provider gender preferences. Although provider gender mismatch, defined as not receiving a provider of the gender of one's preference, may deter veterans from disclosing MST or seeking MST-related care, there is little research that has examined this issue. The current study aimed to explore how provider gender mismatch is related to veterans' comfort with providers, perception of their providers' competency, and their endorsement of perceived provider barriers when communicating about MST. The current study was conducted as part of a larger national survey of veterans' barriers to accessing MST-related care. Participants in the study were identified using Veterans Health Administration (VHA) administrative data. Criteria for inclusion in the overall study were being enrolled in VHA health care, having screened positive for MST, and having received at least one VHA outpatient service. A subset of eligible veterans who had endorsed MST, reported a provider gender preference, and endorsed discussing MST with a VHA provider (N = 1,591) were included in the current study. Results demonstrated that provider gender preference mismatch was associated with greater endorsement of perceived provider barriers, less comfort with providers, and lower perceived provider competency in women; and greater perceived provider barriers and less comfort with providers among men. The study demonstrates that provider gender preferences may affect care for veterans who have experienced MST, and that the impact may differ for men and women. These findings may be used to improve patient-centered care and inform future research regarding veterans' provider gender preferences.

9.
Glob Health Action ; 13(sup2): 1777713, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32741343

ABSTRACT

BACKGROUND: The use of contraception in Lao PDR remains inadequate. In 2017, unmet contraception needs among married women aged 15-49 were 14.3% in Lao PDR overall and 18.6% in the province of Savannakhet. Although the government has a goal to reduce gender inequalities, they still persist in many areas. OBJECTIVE: The aim of this research was to understand the extent to which couples' dynamics and gender attitudes affect contraception use in Savannakhet, Lao PDR. METHODS: To conduct this research, mixed methods were used. Quantitative methods took the form of a survey filled out by 200 married couples in the province of Savannakhet. Afterwards, focus group discussions were carried out to give meaning to the quantitative data and to obtain a deeper understanding of gender roles and contraceptive use. RESULTS: Findings showed that most couples rely on female-dependent contraceptives and that while women hold most of the family planning responsibility, men's opinions have more weight on the final decision. Additionally, women's financial autonomy and spousal communication regarding birth control were associated with contraceptive use within the couple. However, this communication usually began after the birth of the third child. Lastly, the hypothesis that egalitarian gender attitudes were associated with contraceptive use could not be confirmed. CONCLUSION: This study clearly demonstrates that contraception use is influenced by couples' dynamics, more specifically spousal communication, in Lao PDR. The findings have highlighted the need to involve men in all stages of family planning, and to foster both spousal communication and financial autonomy for women. If the findings are implemented, this may foster shared decision making within couples.

10.
Article in English | MEDLINE | ID: mdl-32743778

ABSTRACT

PURPOSE: Previous research on associations between screen media use and mental health produced mixed findings, possibly because studies have not examined screen activities separately or accounted for gender differences. We sought to examine associations between different types of screen activities (social media, internet, gaming, and TV) and mental health indicators separately for boys and girls. METHODS: We drew from a nationally representative sample of 13-15-year-old adolescents in the UK (n = 11,427) asking about hours per day spent on specific screen media activities and four mental health indicators: self-harm behavior, depressive symptoms, life satisfaction, and self-esteem. RESULTS: Hours spent on social media and Internet use were more strongly associated with self-harm behaviors, depressive symptoms, low life satisfaction, and low self-esteem than hours spent on electronic gaming and TV watching. Girls generally demonstrated stronger associations between screen media time and mental health indicators than boys (e.g., heavy Internet users were 166% more likely to have clinically relevant levels of depressive symptoms than low users among girls, compared to 75% more likely among boys). CONCLUSION: Thus, not all screen time is created equal; social media and Internet use among adolescent girls are the most strongly associated with compromised mental health. Future research should examine different screen media activities and boys and girls separately where possible. Practitioners should be aware that some types of screen time are more likely to be linked to mental health issues than others.

11.
J Cardiovasc Nurs ; 2020 Jul 27.
Article in English | MEDLINE | ID: mdl-32732778

ABSTRACT

BACKGROUND: Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel. OBJECTIVE: The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups. METHODS: A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, χ test, and linear-by-linear χ test. Statistical significance was defined as P < .05. RESULTS: The MetS prevalence was 14.0% (15.1% in men and 5.3% in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%). CONCLUSIONS: Our findings suggest that military nurses and other health providers should consider the gender- and age-based MetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks.

12.
J Psychiatr Res ; 129: 168-175, 2020 Jul 24.
Article in English | MEDLINE | ID: mdl-32739617

ABSTRACT

Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.

13.
Nutr J ; 19(1): 78, 2020 Jul 30.
Article in English | MEDLINE | ID: mdl-32731865

ABSTRACT

BACKGROUND: Young adulthood has become synonymous with the development of poor lifestyle behaviours associated with an increased risk of preventable chronic disease in later years. Interventions aiming to improve health behaviours may be more engaging and effective if they are targeted to males or females than interventions with a gender-neutral approach. This review will examine the outcome effectiveness of gender-targeted and gender-neutral interventions targeting nutrition, physical activity or overweight/obesity in young adults (17-35 years). METHODS: Six electronic databases were searched for randomised controlled trials (RCTs) published up to December 2019 that evaluated nutrition, physical activity and/or overweight/obesity interventions in young adults (17-35 years). An effective intervention was one where the change in one or more primary outcome was positive and statistically significantly different from baseline, compared with control, or if no control comparator, compared with another active intervention. Effectiveness of outcomes was compared between gender-targeted and gender-neutral studies. RESULTS: In total 21,582 manuscripts were identified and 107 RCTs were included; 30 gender-targeted studies (28%) and 77 gender-neutral (72%). Most gender-targeted studies were female targeted (n = 22, 73%). Primary outcome/s were adiposity (n = 36, 34%), nutrition (n = 29, 27%), physical activity (n = 28, 26%), or a combination of (n = 14, 14%). A greater proportion of gender-targeted than gender-neutral studies were effective in improving nutrition (n = 6, 100% and n = 17, 74% of studies respectively) and physical activity outcomes (n = 6, 86% and n = 14, 67% respectively), where as a greater proportion of gender-neutral studies were effective in improving adiposity outcomes (n = 13, 59% and n = 5, 36% respectively). None of these differences were statistically significant. Meta-analyses for weight found no significant differences between gender-targeted and gender-neutral studies for weight loss or weight gain prevention studies. Meta-analysis for fruit and vegetable intake demonstrated a significantly greater increase in intervention participants in gender-targeted studies of +158 g/day for > 3 months. CONCLUSIONS: Although differences in outcome effectiveness were identified between gender-targeted and gender-neutral studies, these were not significantly different. This is likely due to an insufficient number of studies to detect a difference. The meta-analysis for fruit and vegetable intake findings should be interpreted with caution due to including only two gender-targeted studies. The findings collectively are suggestive of a potential difference requiring further investigation. To truly determine the effectiveness of gender-targeted interventions, well-designed RCTs comparing gender-targeted interventions with gender-neutral and control are needed. REGISTRATION: This systematic review is a secondary analysis of studies included in a systematic review examining the effectiveness of interventions targeting nutrition, physical activity, or overweight/obesity in young adults, for which a predefined protocol was registered with PROSPERO (CRD42017075795).

14.
BMC Public Health ; 20(1): 1052, 2020 Jul 16.
Article in English | MEDLINE | ID: mdl-32669103

ABSTRACT

BACKGROUND: The pressing demands of work over the years have had a significant constraint on the family and social life of working adults. Moreover, failure to achieve a 'balance' between these domains of life may have an adverse effect on their health. This study investigated the relationship between work-life conflict and self-reported health among working adults in contemporary welfare countries in Europe. METHODS: Data from the 6th European Working Conditions Survey 2015 on 32,275 working adults from 30 countries in Europe were analysed. Multivariate logistic regression models were used to examine the associations between work-life balance and self-reported health among men and women. We further used a 2 stage multi-level logistic regression to assess variations in self-reported health among welfare state regimes by gender. RESULTS: The results showed a strong association between work-life conflict and poor self-reported health among working adults in Europe (aOR = 2.07; 95% CI: 1.93-2.23). However, the magnitude of the effect differed slightly by gender (men: aOR = 1.97; 95% CI: 1.78-2.18 vs women: aOR = 2.23; 95% CI: 2.01-2.47). Furthermore, we found variations in the relationship between work-life conflict and poor self-reported health between welfare states regimes. The association was found to be weaker in the Nordic and Southern welfare states than the Liberal, Conservative, and Central Eastern European welfare states. Although the associations were more consistent among men than women in the Conservative welfare states regime, we found higher associations for women than men in the Southern, Nordic, Liberal, and Central Eastern European welfare states. CONCLUSIONS: This study provides evidence of some variations in the association between work-life conflict and poor self-reported health among men and women across welfare states regimes in Europe. The results demonstrate the need for governments, organizations and policymakers to provide conducive working conditions and social policies for working adults to deal with competing demands from work and family activities.

16.
Chest ; 2020 Jul 17.
Article in English | MEDLINE | ID: mdl-32687910

ABSTRACT

BACKGROUND: Continuous positive airway pressure (CPAP) effectiveness is limited by suboptimal adherence. Prior studies of adherence have focused on middle-aged men. RESEARCH QUESTION: Does CPAP adherence vary by age and gender? STUDY DESIGN AND METHODS: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in patients initiating CPAP therapy between November 2015 and October 2018. Analyses were restricted to patients in the United States aged 18-90 years. RESULTS: Across 789,260 patients initiated on CPAP (mean age 55 ± 14 years, 58.2% male), overall adherence by US Centers of Medicare & Medicaid Services criteria was 72.6% but varied dramatically by age and gender ranging from 51.3% in 18-30 year old women to 80.6% in 71-80 year old men. Patterns of use over the first 90-days demonstrated younger age groups had peak CPAP use by the 2nd night with a subsequent decay in use including abandonment of CPAP that was greatest among 18-30 year old women. In contrast, older patients steadily increase use taking more than a week to maximize usage and then have much slower decays in use over time. Younger, but not older, patients have lower use of CPAP on weekend compared to weekday nights. INTERPRETATION: CPAP adherence rates vary substantially by demographics, with 18-30 year old women having the lowest adherence. The pattern of use over the first 90 days also varies substantially by age and gender. Further research to understand and address the etiology of disparities will be crucial to maximizing the benefits of CPAP therapy.

17.
JDR Clin Trans Res ; : 2380084420942163, 2020 Jul 20.
Article in English | MEDLINE | ID: mdl-32689857

ABSTRACT

OBJECTIVE: While there is an increasing number of women entering the dental profession, they are still underrepresented in leadership roles in major dental organizations, academia, and journal boards. Keynote and invited speaking roles in professional and scientific conferences recognize expertise and leadership and are key factors in career advancement and academic promotions. The aim of this study was to investigate gender differences in representation at dental continuing professional development (CPD) events and conferences in Australia. METHODS: An analysis of the gender of speakers was conducted with CPD and conference programs that are publicly available online from the federal and Victorian branches of the Australian Dental Association, the peak national body for dentists. RESULTS: The planned 2020 Victorian Branch CPD program featured 30 events, with a mean 2.5 speakers per event. There were 58 scientific presentations in the schedule, 22 (38%) of which were allocated to female speakers. Seven CPD events in 2020 included only female speakers, and 13 included only male speakers.The 37th and 38th Australian Dental Congresses featured 25% and 36% of female speakers, respectively. All keynote speakers were male for both events, and men accounted for 86% and 93% of international speakers. CONCLUSIONS: While women are approaching parity in local and state-level CPD events, there is a large discrepancy in the male-to-female speaker ratio for major national conferences. Suggestions to improve gender imbalance include having women on the convening committee and developing and implementing policies to address the imbalance. There has been significant progress in addressing gender inequity in dentistry, but gender-balanced leadership in major conferences still needs to be addressed. KNOWLEDGE TRANSFER STATEMENT: The findings of this study show that while women may be approaching parity with small continuing professional development events, they are still underrepresented as speakers in major conferences. It is recommended that active policies be implemented to reduce the imbalance to ensure gender-balanced leadership in one aspect of the dental profession in Australia.

18.
BJPsych Bull ; : 1-9, 2020 Jul 21.
Article in English | MEDLINE | ID: mdl-32690121

ABSTRACT

SUMMARY: In the past decade there has been a rapid increase in gender diversity, particularly in children and young people, with referrals to specialist gender clinics rising. In this article, the evolving terminology around transgender health is considered and the role of psychiatry is explored now that this condition is no longer classified as a mental illness. The concept of conversion therapy with reference to alternative gender identities is examined critically and with reference to psychiatry's historical relationship with conversion therapy for homosexuality. The authors consider the uncertainties that clinicians face when dealing with something that is no longer a disorder nor a mental condition and yet for which medical interventions are frequently sought and in which mental health comorbidities are common.

19.
Soc Sci Med ; : 113169, 2020 Jul 07.
Article in English | MEDLINE | ID: mdl-32690336

ABSTRACT

BACKGROUND: The weathering hypothesis views the elevated rates of illness, disability, and mortality seen among Black Americans as a physiological response to the structural barriers, material hardships, and identity threats that comprise the Black experience. While granting that lifestyle may have some significance, the fundamental explanation for heath inequalities is seen as race-related stressors that accelerate biological aging. OBJECTIVE: The present study tests the weathering hypothesis by examining the impact on accelerated aging of four types of adversity frequently experienced by Black Americans. Further, we investigate whether health risk behaviors mediate the effect of these conditions. METHOD: Our analyses utilize data from 494 middle-age, African American men and women participating in the Family and Community Healthy Study. The newly developed GrimAge index of accelerated aging is used as an indicator of weathering. Education, income, neighborhood disadvantage, and discrimination serve as the independent variables. Three health risk behaviors - diet, exercise, and alcohol consumption - are included as potential mediators of the four types of adversity. Marital status and gender are entered as controls. RESULTS: Multivariate analyses indicated that the four types of adversity predicted acceleration whereas marriage predicted deceleration in speed of aging. Males showed greater accelerated aging than females, but there was no evidence that gender conditioned the effect of adversity. The health risk behaviors were unrelated to accelerated aging and did not mediate the effect of the stressors. CONCLUSION: Modern medicine's emphasis on life style as the primary explanation for race-based health disparities ignores the way race-related adversity rooted in structural and cultural conditions serves to accelerate biological decline, thereby increasing risk of early onset of illness and death. Importantly, these social conditions can only be addressed through social policies and programs that target institutional racism and promote economic equity.

20.
J Bone Miner Metab ; 2020 Jul 20.
Article in English | MEDLINE | ID: mdl-32691168

ABSTRACT

INTRODUCTION: Bone health is a critical issue in transgender women (TW) health care. Conflicting results have been reported on bone status after gender-confirming surgery (GCS). No recent data in Italian TW are available. MATERIALS AND METHODS: The aim of this cross-sectional study was to evaluate fracture risk, lumbar spine BMD and 25OH vitamin D (25OHD) levels in a population of TW on estrogen replacement therapy (ERT) after GCS. We retrospectively analyzed a group of 57 TW, aged 45.3 ± 11.3 years, referred to our Gender Dysphoria Clinic, at least 2 years after GCS. Anthropometric parameters, patient compliance to ERT, biochemical and hormonal assessment, lumbar spine BMD and fracture risk were evaluated. RESULTS: Prevalence of low bone mass (Z-score ≤ -2) was 40% according to the natal gender. In this group, 17ß-estradiol levels were significantly lower (median 21 pg/ml [25th-75th percentile 10.6-48.5] vs 63 pg/ml [38.5-99.5]; p < 0.001) and a higher prevalence of low compliance to ERT was recorded (83% vs 29%; p < 0.0001) compared to those with higher bone mass. An intermediate-high fracture risk was found in 14% of the sample. A high percentage (93%) of hypovitaminosis D was present. CONCLUSIONS: TW on ERT have a high prevalence of low bone mass, significantly associated with low estradiol levels and low compliance to ERT. A high prevalence of hypovitaminosis D was highlighted. Considering that one out of seven TW showed an intermediate-high 10-year fracture risk, such risk assessment may be considered to prevent and manage osteoporosis in this clinical setting.

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