Purpose: Inconsistent
access to healthcare represents a barrier to transgender patients receiving
hormone therapy through a licensed provider. Inability to access care leads
many transgender people to buy hormones from unlicensed sources and transition
without medical supervision. Little is known about the factors predisposing
people to rely on this method of transition. It is critical to understand what
leads to non-prescribed hormone use to better support safe medical transitions
for transgender people.
Methods: We
conducted an analysis of a study with 314 transwomen in San Francisco from
August-December 2010, using Respondent Driven Sampling (RDS). The study
collected information on demographics, hormone use, gender identity milestones,
violence and trauma experienced due to gender identity, substance use, sexually
transmitted infections, law enforcement contact and sexual behaviors. We
evaluated whether these demographic and behavioral characteristics were
correlated in the following outcomes: taking hormones not prescribed by
providers and taking hormones consistently without interruptions.
Results: Data
demonstrate that 68.7% of transwomen were currently on hormone replacement
therapy (HRT) but only 41% reported being on hormones consistently. In
addition, 49.1% reported taking hormones for HRT not prescribed by a clinician.
Consistent hormone use was independently and positively associated with being
born in the United States, having contact with a health care provider, and
currently living full-time as a female. Those who reported ever being forced to
have sex or having been raped had 60% lower odds of being consistently on
hormones. We found greater odds of non-prescribed hormone use among
participants who had gender confirmation surgery and among those who had experienced
verbal abuse due to their gender identity and presentation.
Conclusion: Non-prescribed
HRT in transwomen is a common and poorly characterized phenomenon. Increasing
access to healthcare (with culturally-competent, affordable, and accessible providers)
is crucial to assuring trans people are able to have safe, consistent access to
the hormones they need.
Purchase full article at: http://goo.gl/8F4oT9
By: Gene de Haan, MD,1 Glenn-Milo Santos, PhD,
MPH,2,3 Sean Arayasirikul, MSPH,2 and Henry
F. Raymond,DrPH, MPH2,4
1School of Medicine, University of
California San Francisco, San Francisco, California.
2Center for Public Health Research, Population
Health Division, San Francisco Department of Public Health, San Francisco,
California.
3Community Health Systems, School of Nursing, University
of California San Francisco, San Francisco, California.
4Epidemiology and Biostatistics, University
of California San Francisco, San Francisco, California.
Address correspondence to:
Henry F. Raymond, DrPH, MPH
San Francisco Department of Public Health
25 Van Ness Avenue, Suite 500
San Francisco, CA 94102
E-mail: HFisher.Raymond@sfdph.org
More at: https://twitter.com/hiv_insight
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