Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research

• Published in: PloS one 2024-05, Vol.19 (5), p.e0302895
• Main Authors: Ho, Tiffany F, Zenger, Brian, Mark, Bayarmaa, Hiatt, Laurel, Sullivan, Erika, Steinberg, Benjamin A, Lyons, Ann, Spivak, Adam M, Agarwal, Cori, Adelman, Marisa, Hotaling, James, Kiraly, Bernadette, Talboys, Sharon
• Format: Article
• Language: English
• Subjects: 17β-Estradiol; Adolescent; Adult; Adults; Aged; Biology and Life Sciences; Body mass index; Electronic health records; Electronic Health Records - statistics & numerical data; Electronic medical records; Female; Gender; Gender aspects; Gender Identity; Gender reassignment surgery; Health aspects; Health care; Health disparities; Health Equity; Humans; Male; Medical records; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Patients; People and Places; Retrospective Studies; Rural areas; Rural communities; Sex hormones; Sex Reassignment Surgery; Sexual behavior; Social Sciences; Standardization; Testosterone; Transgender people; Transgender Persons - statistics & numerical data; Utah; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0302895

Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.