Structural Inequities and Social Networks Impact Hormone Use and Misuse Among Transgender Women in Los Angeles County

Abstract

In order to reduce gender dysphoria and combat stigma, transgender women often affirm their gender through social and medical transition, which may include cross-sex hormone therapy. This study examined associations between medically monitored hormone use and hormone misuse (non-prescribed hormone use including “fillers”), structural inequities (access to housing, health insurance, and income) and social network dynamics among 271 transgender women in Los Angeles. Hormone use status was coded trichotomously (hormone use, hormone misuse, no hormone use), and robust multinomial logistic regression as well as novel social network analysis were conducted to examine associations. Results demonstrated that younger, African American/Black transgender women were most likely to engage in hormone misuse compared to transgender women who were older or non-African American/Black. One-third of the sample reported sex work as a main source of income, and this group was more likely to misuse hormones than those with another primary source of income. Transgender women with access to stable housing and health insurance were most likely to engage in medically monitored hormone use. Social network analysis revealed that transgender women with a greater number of hormone-using network alters were most likely to misuse hormones, but that using the Internet to find transgender friends mitigated this association. Results demonstrate the multi-faceted risk profile of transgender women who use and misuse hormones, including that social networks play an important role in hormone usage among transgender women.

Hormone use among Nepali transgender women: a qualitative study

“…Moreover, users require a good level of health literacy in English to comprehend most of the online health information. Clark and colleagues found that for trans women in the USA, having a greater number of hormone-using networks and using the internet to find transgender friends affected the likelihood of misusing hormones in different ways 58. Social science research has suggested that network dynamics can affect the behaviour of trans women regarding hormone use 58 59…”

Dermatologic Conditions in Transgender Populations

“…Transgender individuals often face barriers to care and are affected by the high-cost of these procedures, and are at risk to engage in unsafe practices such as receiving fillers from unlicensed personnel. 47,48 Injections of illicit "filler" material by non-licensed persons are often toxic with complications including foreign-body granulomas; bacterial, fungal or mycobacterial infections; bleeding; pain; scarring and keloid formation; ulceration and necrosis; gross disfiguration; silicone embolism; and death (Figure 4). 47,48 Prevalence estimates of unlicensed silicone injections in the transfeminine population have ranged from 25-32%, this is of particular concern given the high complication rate of silicone injections.…”

“…47,48 Injections of illicit "filler" material by non-licensed persons are often toxic with complications including foreign-body granulomas; bacterial, fungal or mycobacterial infections; bleeding; pain; scarring and keloid formation; ulceration and necrosis; gross disfiguration; silicone embolism; and death (Figure 4). 47,48 Prevalence estimates of unlicensed silicone injections in the transfeminine population have ranged from 25-32%, this is of particular concern given the high complication rate of silicone injections. 49,50 Commonly used FDA-approved materials include collagen, hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate.…”

The Social and Sexual Networks of Black Transgender Women and Black Men Who Have Sex with Men: Results from a Representative Sample

“…In contrast to white TGW and TGW with higher income and levels of education, essential transition resources, such as puberty and hormone treatments and psychosocial support, may be substantially more difficult to access, financially and geographically, for black TGW. Moreover, recent research conducted among black TGW in Los Angeles 22 has shown that this population is more likely to engage in hormone misuse as compared with nonblack TGW, with network analysis demonstrating that this risk may be more elevated among TGW with a greater number of hormone-using network alters.…”

“…Little research has assessed intra-racial group differences, particularly among black persons assigned male at birth with variable gender identities and expressions. 21,22 More recently, in a cross-sectional analysis conducted in Atlanta, researchers determined that, in comparison with black men who have sex with men (MSM), black TGW had lower HIV testing knowledge and a higher likelihood of having engaged in transactional sex. 23 Similar patterns in sexual health disparities between black MSM and black TGW have also been observed elsewhere.…”