Advancing methods for US transgender health research

Abstract

Purpose of Review To describe methodological challenges, gaps, and opportunities in U.S. transgender health research. Recent Findings Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of gender affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and intervention-testing studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidence-based clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities. Summary Transgender health research faces challenges that include standardization of lexicon, agreed-upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population.

Cancer in Transgender People: Evidence and Methodological Considerations

“…Consequently, the data collection methods applicable at 1 site can be disseminated to health systems across the United States as evidenced in the creation of various research consortia, such as the Health Care Systems Research Network (134), the Mental Health Research Network (135), and the Cancer Research Network (136). The existing research networks are already supporting transgender health research at selected sites (137). The ongoing studies can be scaled to include up to 18 integrated health systems serving as many as 20 million US residents.…”

What's in a Guideline? Developing Collaborative and Sound Research Designs that Substantiate Best Practice Recommendations for Transgender Health Care

“…There are several key areas where data needed to inform high-quality guidelines are lacking. Unanswered questions remain regarding the long-term outcomes of hormonal and surgical interventions as well as the comparative safety and efficacy of different approaches to hormone therapy [9]. Most research on the long-term effects of hormones has been conducted in Europe, where hormonal regimens differ from those in the US and other regions [22,25].…”

“…Transgender medicine presents a particular challenge for the development of evidence-based guidelines. First and foremost, data on health outcomes in transgender medicine are currently limited to retrospective studies, case series, and individual case reports due to the lack of funding opportunities for research in this field as well as institutional stigmatization of the transgender community [8,9]. In addition, the lack of uniform data collection by gender identity renders much of the population effectively invisible in health outcome surveillance efforts [10,11].…”

Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers

“…Moreover, a reliance on specialized clinics to identify study participants may yield relatively small sample sizes, making it difficult to select comparable reference groups from the same underlying population. 27 …”