The goal of this application is to develop a longitudinal cohort study of the short- and long-term health outcomes among individuals who underwent hormonal and/or surgical gender reassignment interventions. Members of the transgender community and health care providers caring for transgender individuals express concerns about mental and physical health problems in this population;however longitudinal studies of transgender populations in the US have not been conducted. This project includes two distinct phases. The first phase is an electronic medical record (EMR) based study evaluating a cohort of 5462 transgender individuals, whose care is covered by the Veterans Administration (nationally) or by Kaiser Permanente (in Georgia and in Northern California). We will compare incidence, prevalence and mortality estimates in the full cohort and in the female-to-male (FTM) and male-to-female (MTF) sub-cohorts to the corresponding measures in the age- and health plan-matched samples of male and female enrollees. We will also perform within-cohort analyses to compare health outcomes across categories of transgender participants (e.g., MTF versus FTM or treatment with hormones versus hormones + surgery). The second phase (Aim 3) of the proposed project will describe facilitators of and barriers to research enrollment, and identify points of influence that would aid recruitment of transgender individuals into future observational studies and intervention trials.
This aim will be achieved through Focus Group Discussions (FGDs), and the resulting information will be analyzed using qualitative methods. FGDs will aim to evaluate three central issues: 1) barriers to enrollment in research, 2) facilitators of research participation, and 3) recommendations for recruitment into future studies. The proposed project will be carried out by a multidisciplinary team that includes experts in epidemiology of chronic and sexually transmitted diseases, mental disorders, and sexual minority health issues. All of the project activities will be implemented in consultation wih the study liaisons who will serve as advocates for the transgender community. The proposed study will likely be the largest cohort of transgender individuals available to date, and the first study of its kind conducted in the United States. Another distinguishing feature of this project is that it will lay foundation for future full-scale studies that will use nationwide data sources.

Public Health Relevance

The purpose of this study is to determine whether transgender persons defined as those who medically change the gender assigned to them at birth (male to female or female to male) have higher or lower risk of death and certain diseases than men and women that do not consider themselves transgender. Participants will be selected from medical records of two large health care systems - the Veterans Affairs Administration and the Kaiser Permanente. Transgender persons will also be asked to join focus group discussions and share their views about factors that may motivate or preclude their participation in research.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (SSPB)
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Newcomer, Susan
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Emory University
Public Health & Prev Medicine
Schools of Public Health
United States
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Nash, Rebecca; Ward, Kevin C; Jemal, Ahmedin et al. (2018) Frequency and distribution of primary site among gender minority cancer patients: An analysis of U.S. national surveillance data. Cancer Epidemiol 54:1-6
Owen-Smith, Ashli A; Gerth, Joseph; Sineath, R Craig et al. (2018) Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals. J Sex Med 15:591-600
Becerra-Culqui, Tracy A; Liu, Yuan; Nash, Rebecca et al. (2018) Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics 141:
Quinn, Virginia P; Nash, Rebecca; Hunkeler, Enid et al. (2017) Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people. BMJ Open 7:e018121
Braun, Hayley; Nash, Rebecca; Tangpricha, Vin et al. (2017) Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev 39:93-107
Owen-Smith, Ashli A; Sineath, Craig; Sanchez, Travis et al. (2017) Perception of Community Tolerance and Prevalence of Depression among Transgender Persons. J Gay Lesbian Ment Health 21:64-76
Collin, Lindsay; Reisner, Sari L; Tangpricha, Vin et al. (2016) Prevalence of Transgender Depends on the ""Case"" Definition: A Systematic Review. J Sex Med 13:613-26
Reisner, Sari L; Deutsch, Madeline B; Bhasin, Shalender et al. (2016) Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes 23:198-207
Roblin, Douglas; Barzilay, Joshua; Tolsma, Dennis et al. (2016) A novel method for estimating transgender status using electronic medical records. Ann Epidemiol 26:198-203