Project Name:
Comparative Risks and Benefits of Gender Reassignment Therapies

Principal Investigator:
Michael Goodman, MD MPH

Principal Investigator Contact Information:
mgoodm2@emory.edu

Principal Investigator institution:
Emory University

Funder
PCORI

Funding Period:
05/2013 – 04/2016

Abstract:
The goal of this study is to understand the short- and long-term health issues among transgender persons who had or are planning to have a sex change treatment. Members of the transgender community and their doctors express concerns about mental and physical health problems in this group of people; however, large studies of transgender persons in the United States have not been conducted. This project is an electronic medical record based study evaluating a group of 6,500 transgender individuals, whose care is covered by the Veterans Administration (nationally) or by Kaiser Permanente (in Georgia and in Northern and Southern California). In this study, we will compare frequencies of various diseases and deaths from various causes in transgender persons and separately in those who request female-to-male and male-to-female sex change to similar measures in a sample of men and women who are not transgender and are of the same age and race. We will also compare health problems by treatment categories (e.g., no medical treatment, versus treatment with hormones only, versus hormones plus surgery). The proposed project will be carried out by a team that includes experts in chronic and infectious diseases, mental disorders, and sexual minority health issues. All of the project activities will be implemented in consultation with the study advisors who will serve as advocates for the transgender community. This will likely be the largest study of transgender persons available to date, and the first study of its kind conducted in the United States.

Grant Number:
N/A

Participating Sites:               
Emory University
Kaiser Permanente Georgia
Kaiser Permanente Northern California
Kaiser Permanente Southern California
The Veterans Health Administration

Investigators:
Michael Goodman
Ashli Owen-Smith
Dennis Tolsma
Enid Hunkeler
Virginia Quinn
Douglas Roblin
Theresa Gillespie

Major Goals:
The goal of this study is to understand the short- and long-term health issues among transgender persons who had or are planning to have a sex change treatment.

Description of study sample:
6,500 transgender individuals, whose care is covered by the Veterans Administration (nationally) or by Kaiser Permanente (in Georgia and in Northern and Southern California).

Current Status:  
Project completed

Study Registration:
HSRP20143115

Publications:
Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of Transgender Depends on the "Case" Definition: A Systematic Review. J Sex Med. 2016 Apr;13(4):613-26. doi: 10.1016/j.jsxm.2016.02.001. Epub 2016 Mar 25.

Holz LE, Goodman M. Epidemiology of advanced prostate cancer: overview of known and less explored disparities in prostate cancer prognosis. Curr Probl Cancer. 2015 Jan-Feb;39(1):11-6. doi: 10.1016/j.currproblcancer.2014.11.003. Epub 2014 Nov 26.

Reisner SL, Deutsch MB, Bhasin S, Bockting W, Brown GR, Feldman J, Garofalo R, Kreukels B, Radix A, Safer JD, Tangpricha V, T?Sjoen G, Goodman M. Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):198-207. doi: 10.1097/MED.0000000000000229.

Roblin D, Barzilay J, Tolsma D, Robinson B, Schild L, Cromwell L, Braun H, Nash R, Gerth J, Hunkeler E, Quinn VP, Tangpricha V, Goodman M.  A novel method for estimating transgender status using electronic medical records. Ann Epidemiol. 2016 Mar;26(3):198-203. doi: 10.1016/j.annepidem.2016.01.004. Epub 2016 Feb 4.

Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E. Size and distribution of transgender and gender non-conforming populations: A narrative review. Endocrinology and Metabolism Clinics of North America 2019 8(2):303-321

Gerth J, Becerra-Culqui T, Bradlyn A, Getahun D, Hunkeler E, Lash T, Millman A, Nash R, Quinn V, Robinson B, Roblin D, Silverberg M, Tangpricha V, Vupputuri S, Goodman M. Agreement between medical records and self-reports: Implications for transgender health research.  Reviews in Endocrine and Metabolic Disorders 2018 19(3):263-269

Getahun D, Nash R, Flanders D, Baird T, Becerra-Culqui T, Cromwell L, Hunkeler E, Lash T, Millman A, Quinn V, Robinson B, Roblin D, Silverberg M, Safer J, Slovis J, Tangpricha V, Goodman M. Cross-sex hormones and acute cardiovascular events in transgender persons:  A cohort study.  Annals of Internal Medicine 2018 169(4):205-213

Nash R, Ward K, Jemal A, Sandberg D, Tangpricha V, Goodman M. Frequency and distribution of cancers among gender minority patients: an analysis of U.S. national surveillance data.  Cancer Epidemiology 2018 54(6):1-6

Becerra-Culqui T, Liu Y, Nash R, Cromwell L, Flanders W, Getahun D, Giammattei S, Hunkeler E, Lash T, Millman A, Quinn V, Robinson B, Roblin D, Sandberg D, Silverberg M, Tangpricha V, Goodman M.  Mental health of transgender and gender non-conforming youth compared with their peers.  Pediatrics 2018 141(5): e20173845

Owen-Smith A, Gerth J, Sineath C, Barzilay J, Becerra-Culqui T, Getahun D, Giammattei S, Hunkeler E, Lash T, Millman A, Nash R, Quinn V, Robinson B, Roblin D, Sanchez T, Silverberg M, Tangpricha V, Valentine C, Winter S, Woodyatt C, Goodman M.  Association between gender confirmation treatments and perceived gender congruence, body satisfaction and mental health in a cohort of transgender individuals.  Journal of Sexual Medicine 2018 15(4):591-600

Quinn V, Nash R, Hunkeler E, Contreras R, Cromwell L, Becerra-Culqui T, Getahun D, Giammattei S, Lash T, Millman A, Robinson B, Roblin D, Silverberg M, Slovis J, Tangpricha V, Tolsma D, Valentine C, Ward K, Winter S, Goodman M.  Cohort profile:  study of transition, outcomes & gender (STRONG) to assess health status of transgender people.  BMJ Open 2017 7(12):e018121

Silverberg M, Nash R, Becerra-Culqui T, Cromwell L, Getahun D, Hunkeler E, Lash T, Millman A, Quinn V, Robinson B, Roblin D, Slovis J, Tangpricha V, Goodman M. Cohort study of cancer risk among insured transgender people. Annals of Epidemiology 2017 27(8):499-501

Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in transgender people: Evidence and methodological considerations. Epidemiologic Reviews 2017 39(1):93-107

Owen-Smith A, Sineath C, Sanchez T, Dea R, Giammattei S, Gillespie T, Helms M, Hunkeler E, Quinn V, Roblin D, Slovis J, Stephenson R, Sullivan P, Tangpricha V, Woodyatt C, Goodman M. Perception of community tolerance and prevalence of depression among transgender persons  Journal of Gay & Lesbian Mental Health 2017 21(1) 64-76

Owen-Smith A, Woodyatt C, Sineath C, Hunkeler E, Barnwell L, Graham A, Goodman M. Perceptions of barriers to and facilitators of participation in health research among transgender people  Transgender Health 2016 1(1): 187-196.

Sineath C, Woodyatt C, Sanchez Y, Giammattei S, Gillespie T, Hunkeler E, Owen-Smith A, Quinn V, Roblin D, Stephenson R, Sullivan P, Tangpricha V, Goodman M.  Determinants of and barriers to hormonal and surgical treatment receipt among transgender people.  Transgender Health 2016 1(1):129-136

Resources:
N/A

Lessons Learned:
To date-the study supported 15 publications.  Many additional analyses are on-going

What’s next?
We seeking additional funding to expand the cohort and extend follow up through 2025.