Characteristics of Transgender Patient Cases Managed by a Toxicologist: an Analysis of the Toxicology Investigator’s Consortium (ToxIC) Registry: January 2017–June 2019

Abstract

Introduction The Toxicology Investigators Consortium (ToxIC) database, created in 2010 by the American College of Medical Toxicology (ACMT), compiles data recorded by medical toxicologists. In January 2017, the data field for transgender (and if transgender, male-to-female or female-to-male) was added to the ToxIC form. Little is known regarding trends in poisonings among transgender patients. We sought to review consultations managed by a bedside toxicologist and provide descriptive data in trends among types of exposures within the transgender demographic. Methods A retrospective ToxIC database evaluation of cases in which the patient identified as transgender were reviewed from January 2017-June 2019 and descriptive demographics reported. ResultsThe registry contained 113 cases that involved transgender patients. Of those with complete data, 41 (36.6%) were maleto-female, 68 (60.7%) were female-to-male, and 3 (2.7%) identified as gender non-conforming. Of those with complete data, the most common reason for encounter was intentional use of a pharmaceutical drug (N = 97, 85.8%), of which 85 (87.6%) were classified as intentional pharmaceutical use intended for self-harm. Analgesics were the most common class of drugs used out of those reported (N = 24, 22%). Forty-six (90.2%) patients aged 13-18 with complete data were identified as encounters due to selfharm. Attempt at self-harm was the most common reason for intentional pharmaceutical encounter among the sample of transgender patients with complete data (N = 85, 87.6%); with female-to-male patients having an N = 53 (77.9%). Conclusion Among transgender patients in the ToxIC registry,themost commonprimaryreasonfortheencounter was intentionaluse of a pharmaceutical drug intended for self-harm. In this small cohort, there were some age and transition differences in prevalence. These findingsmayinformpoisoningpreventionpracticesaswellassex-andgender-basedmanagementofpatientsinthisvulnerablepopulation.

Experiences of transgender and gender diverse patients in emergency psychiatric settings: A scoping review

“…One such example of this is the ToxIC database, which did not add the term transgender until 2017. 23 Furthermore, we are limited by the lack of standardization in data collection when it comes to TGD individuals.…”

“…One such example of this is the study by Surmaitis et al 23 that looked at toxicology consults in transgender patients. They found that the most common reason for the encounter was intentional self-harm.…”

“…These consults were sometimes performed during their ED stay; however, our search terms did not pick up on this. Thus, although the article fits our topic, it was not included in our review 23 . Also, until recently, some databases did not look at gender identity, and only used dichotomous sex definitions, and thus would have been missed by our search.…”

“…Also, until recently, some databases did not look at gender identity, and only used dichotomous sex definitions, and thus would have been missed by our search. One such example of this is the ToxIC database, which did not add the term transgender until 2017 23 . Furthermore, we are limited by the lack of standardization in data collection when it comes to TGD individuals.…”

Transgender and Nonbinary Deaths Investigated by the State Medical Examiner in the Portland, Oregon, Metro Area and Their Concordance With Vital Records, 2011-2021

“…Transgender persons also have an increased use of illicit substances and nonmedical prescription drug use compared with the US population,3 with potential reasons including coping mechanisms for minority stress 1. One recent analysis of transgender cases managed by a toxicologist showed that the most common primary encounter reason (for either an inpatient or an outpatient toxicology consult) was for intentional use for self-harm 15…”