Evaluation of healthcare for transgender veterans

Abstract

Purpose: To identify the cohort of veterans diagnosed with gender dysphoria obtaining care through VA Northern California Healthcare System (VANCHCS), and evaluate their care. Methods: Using ICD-10 criteria, we identified veterans with a diagnosis of gender dysphoria. We stratified these individuals by self-identified gender, and evaluated their medical records for gender affirming-hormone therapy and access to behavioral health, endocrine, speech pathology, and dermatology resources. Results: Of the 148 Veterans found, 95 identified as transwomen, 43 as transmen, and 10 as non-binary. Non-binary Veterans were excluded from further analysis. Transmen were significantly younger than transwomen (42±13.7 vs 51.5±15.9 yrs., p< 0.001 by t-test). Transwomen were more likely to be Air Force Veterans than transmen (21.1% vs 17.1%), and less likely to be Army Veterans (38.9% vs 43.9%), but were more likely to see a Endocrinologist (83.2% vs 72.1%) and Speech Therapist (44.2% vs. 25.6%). Gender affirming hormone therapy for transwomen included combinations of gonadotropin-releasing hormone analogs, spironolactone, finasteride, estradiol, and progesterone, whereas for transmen, testosterone was the sole therapy. The majority of our Veterans (65 transwomen (68.4%) and 38 transmen (88.4%) had not undergone gender-affirming surgery. Only 59 transwomen (62%) had measurements of prostate-specific antigen (PSA). Both groups were followed comparably in Behavioral Health Clinics (87.4% for transwomen, 90.7% for transmen). Only 35 transwomen (36.8%) were seen in Dermatology clinics for gender specific needs. Conclusion: Our patients and their management were diverse. We conclude that care for transgender Veterans could be enhanced by a more consistent, team-based approach to therapy.

Keywords

• Transgender
• Veteran
• Cross-sex hormone therapy
• Speech Therapy