Transgender Men and Pregnancy

Transgender people have experienced significant advances in societal acceptance despite experiencing continued stigma and discrimination. While it can still be difficult to access quality health care, and there is a great deal to be done to create affirming health care organizations, there is growing interest around the United States in advancing transgender health. 

The focus of this commentary is to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy. Terms transgender and gender nonconforming specifically refer to those whose gender identity (e.g., being a man) differs from their female sex assigned at birth. Many, if not most transgender men retain their female reproductive organs and retain the capacity to have children. 

Review of their experience demonstrates the need for preconception counseling that includes discussion of stopping testosterone while trying to conceive and during pregnancy, and anticipating increasing experiences of gender dysphoria during and after pregnancy. The clinical aspects of delivery itself fall within the realm of routine obstetrical care, although further research is needed into how mode and environment of delivery may affect gender dysphoria. Postpartum considerations include discussion of options for chest (breast) feeding, and how and when to reinitiate testosterone. 

A positive perinatal experience begins from the moment transgender men first present for care and depends on comprehensive affirmation of gender diversity.

Full article at:   http://goo.gl/Fo1LMb

By:  Juno Obedin-Maliver1,2 and Harvey J Makadon3,4

¹Department of Medicine, University of California San Francisco, San Francisco, CA, USA

²Department of Gynecology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

³National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA

⁴Harvard Medical School, Boston, MA, USA

Harvey J Makadon, National LGBT Health Education Center, The Fenway Institute, 1340 Boylston Street, Boston, MA, USA

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Qualitative Study of Cervical Cancer Screening among Lesbian and Bisexual Women and Transgender Men

BACKGROUND:

Lesbian, bisexual, and queer (LBQ) women, as well as transgender men, are less likely than their heterosexual and female-identifying counterparts to access cervical cancer screening services. Although numerous factors that influence receipt of cervical screening have been identified, several gaps in research and knowledge merit additional research.

OBJECTIVE:

The aims of this study were to examine cervical cancer screening behaviors of LBQ women and transgender men using American Cancer Society guidelines as the standards for comparison and to determine factors that influence participation in cervical cancer screening.

METHODS:

A convenience sample of 21- to 65-year-old LBQ women and transgender men was recruited from the Internet and community events. Qualitative data were collected through in-depth telephone interviews and open-ended questions on an online questionnaire. A deductive-inductive content analysis approach was used.

RESULTS:

The sample was mostly non-Hispanic white women who identified as lesbian. Most were routine cervical cancer screeners. Eighteen factors/themes were identified in the data and were contextualized within a health services theoretical framework.

CONCLUSIONS:

This study showed that although some factors overlap with the general female population, there are other areas that are specific to LBQ women and transgender men. Creating welcoming and inclusive healthcare environments is particularly important to facilitating cervical screening among LBQ women.

IMPLICATIONS FOR PRACTICE:

Nurse leaders can modify clinical environments, and clinical nurses can be educated to provide safe care for LBQ women and transgender men.

Purchase full article at:   http://goo.gl/ZwQayf

By:  Johnson MJ1, Nemeth LS, Mueller M, Eliason MJ, Stuart GW.

• 1Author Affiliations: College of Nursing, University of Wisconsin-Milwaukee (Dr Johnson); College of Nursing, Medical University of South Carolina, Charleston (Drs Nemeth, Mueller, and Stuart); and Department of Health Education, San Francisco State University, California (Dr Eliason).
• Cancer Nurs. 2016 Feb 8.  

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Risk Behavior and Sexually Transmitted Infections among Transgender Women and Men Undergoing Community-Based Screening for Acute and Early HIV Infection in San Diego

The transgender community represents an understudied population in the literature. The objective of this study was to compare risk behavior, and HIV and sexually transmitted infection (STI) rates between transgender women and transgender men undergoing community-based HIV testing.

With this retrospective analysis of a cohort study, we characterize HIV infection rates as well as reported risk behaviors and reported STI in 151 individual transgender women and 30 individual transgender men undergoing community based, voluntary screening for acute and early HIV infection (AEH) in San Diego, California between April 2008 and July 2014.HIV positivity rate was low for both, transgender women and transgender men undergoing AEH screening (2% and 3%, respectively), and the self-reported STI rate for the prior 12 months was 13% for both. Although transgender women appeared to engage in higher rates of risk behavior overall, with 69% engaged in condomless receptive anal intercourse (CRAI) and 11% engaged in sex work, it is important to note that 91% of transgender women reported recent sexual intercourse, 73% had more than 1 sexual partner, 63% reported intercourse with males, 37% intercourse with males and females, and 30% had CRAI.

Our results indicate that in some settings rates of HIV infection, as well as rates of reported STIs and sexual risk behavior in transgender men may resemble those found in transgender women. Our findings support the need for comprehensive HIV prevention in both, transgender women and men.

Full article at: http://goo.gl/fJmKVh

By: Green N1, Hoenigl M, Morris S, Little SJ.

• 1From the Division of Infectious Diseases, Department of Medicine, University of California San Diego (UCSD) (NG, MH, SM, SJL); Division of Family Medicine, University of California San Diego (UCSD), San Diego, CA (SM); Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine (MH); and Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria (MH).  

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