The Real-World Characteristics of Gender-Affirming Hormonal Use Among Transgender People in Thailand

Abstract

Background Most Thai transgender people (TG) do not use gender-affirming hormone therapy (GAHT) under medical supervision. Aim To understand the current real-world characteristics of GAHT among TG. Methods A cross-sectional survey was conducted using an online questionnaire between September and December 2020. TG, who resided in Thailand for more than 1 year, were included. Self-reported demographic data and characteristics of GAHT were obtained. The reported GAHT were compared to the reference regimen recommended by the 2017 Endocrine Society Clinical Practice Guideline. Outcomes The characteristics of GAHT used among TG and factors associated with hormonal use outside the reference regimen were reported. Results A total of 401 TG were included in the analysis. Of these, 249 (62%) were transgender men (TM). Most TM (81%) and transgender women (88%) were using GAHT. Only 297 TG provided a complete hormone regimen. A total of 224 TG (75%) used GAHT outside the reference regimen. The main reasons in TM were using intramuscular testosterone with a higher dose per injection and less frequent intervals. In transgender women, using oral contraceptive pills and cyproterone acetate 12.5 mg/d were the two most common reasons. A univariate analysis revealed factors associated with hormonal use outside the reference regimen, including age at a survey participation (OR 1.04, 95%CI 1.00–1.08, P = .047), age at hormone initiation (OR 1.04, 95%CI 1.01–1.08, P = .015), TM (OR 2.08, 95%CI 1.22–3.56, P = .007) and using GAHT, not under medical supervision (OR 1.78, 95%CI 1.04–3.05, P = .037). The multivariate analysis showed that only living outside the capital city was solely statistically significant (AOR 1.77, 95%CI 1.02–3.05, P = .041). Clinical Implications Enhancing health literacy in GAHT among TG is crucial, especially TG not living in the capital city. Strengths and Limitations This study demonstrates a current real-world practice of GAHT use among TG, both under and not under medical care. However, the causality could not be concluded due to the nature of the cross-sectional observation study, and results come with a recall bias. Conclusion There is a high prevalence of GAHT use outside the reference regimen. The only factor associated with hormonal use outside the reference regimen is living outside the capital city.

Healthcare discrimination and factors associated with gender-affirming healthcare avoidance by transgender women and transgender men in Thailand: findings from a cross-sectional online-survey study

“…Our results show that transgender women were fourfold more likely to buy hormone treatment from non-traditional healthcare services (cOR = 3.89; 95% CI = 1.18–12.83) than transgender men. This is consistent with the outcomes of previous studies in Thailand and other countries inferring that transgender women were less likely to attend a hormone management program and transgender-specific care than transgender men [ 33 , 37 , 38 ]. A previous survey in Australia showed that 31% of transgender individuals thought that accessing hormones was too difficult, 17% thought that the cost of a doctor’s appointment was too expensive and 16% were unable to find a doctor to prescribe hormones [ 31 ].…”

“…Hormone usage and the pathway to access it are also interesting. Previously, researchers in the US and Thailand reported that transgender women were less likely than transgender men to attend a hormone management program and transgender-specific care [ 33 , 37 , 38 ]. In addition, in previous studies in the US and Canada, the authors also found that the avoidance of accessing healthcare services by transgender individuals resulted from the lack of healthcare providers who understand transgender concerns [ 26 , 39 ].…”

Prevalence of and factors associated with the use of gender-affirming hormonal therapy outside the reference regimen among transgender people in a community-led clinic in Metro Manila, Philippines: a retrospective cross-sectional study

“…This practice of overdosing has also been noted in previous studies in Metro Manila 11 and other countries, commonly with the motivation to accelerate bodily changes. 5 33 Among TM in our study, using anabolic steroids was the most common reason for deviating from the reference regimen, unlike in the Thailand study, 9 where it was reported as rare. However, unlike our study, most of TM in the Thailand study already received GAHT prescription.…”

“…8 11 26 33 37 Many TW use OCPs despite being not recommended not only because these are ineffective for achieving recommended serum hormonal concentrations but also because these contain ethinyl oestradiol, putting trans people at heightened risk for cardiovascular issues. 1 39 Unlike the Thailand study, 9 TWTFP have approximately thrice the prevalence of hormone intake outside the reference regimen compared with TM. This finding may be explained by the high diversity of oral feminising hormones, including those not recommended, compared with masculinising hormones which are primarily injectables.…”

“…Otherwise, if both the drug and administration route were consistent with the recommendations, we assigned these patients as reported hormone use in accordance with the reference regimen. 9 Limited drugs among the reference regimen are available in the Philippines, including oestradiol valerate oral, oestradiol hemihydrate oral, oestradiol hemihydrate gel, cyproterone acetate oral, spironolactone oral, testosterone enanthate parenteral and testosterone undecanoate parenteral, 18 and none of these are approved for gender affirmation in the Philippines. The rest are obtained from peers, online or overseas.…”