Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Biol Sex Differ. 2020 Oct 6;11(1):55. doi: 10.1186/s13293-020-00332-5.
Current understanding about health care in the gender diverse population is limited by the lack of community-based, longitudinal data, especially in the USA. We sought to characterize a community-based cohort of transgender individuals including demographics, gender identities, social characteristics, psychiatric and medical conditions, and medical therapy for gender dysphoria/incongruence.
We performed a retrospective chart review of gender diverse residents of Olmsted County, Minnesota, who sought gender-specific healthcare from January 1, 1974, through December 31, 2015, using an infrastructure that links medical records of Olmsted County residents from multiple institutions.
The number of patients seeking gender-specific healthcare increased from 1 to 2 per 5-year interval during the 1970s-1990s to 41 from 2011 to 2015 (n = 82). Forty-nine (59.8%) were assigned male sex at birth (AMAB), 31 (37.8%) were assigned female (AFAB), and 2 (2.4%) were intersex. Gender identities evolved over time in 16.3% and 16.1% of patients AMAB and AFAB, respectively, and at most recent follow-up, 8.2% and 12.9% of patients AMAB and AFAB, respectively, were non-binary. Depression affected 78%, followed by anxiety (62.2%), personality disorder (22%), and post-traumatic stress disorder (14.6%). 58.5% experienced suicidal ideation, 22% attempted suicide, and 36.6% were victims of abuse. The most prevalent medical conditions and cardiovascular (CV) risk factors included obesity (42.7%), tobacco use (40.2%), fracture [34.1% (86.2% traumatic)], hypertension (25.6%), hyperlipidemia (25.6%), and hypertriglyceridemia (15.9%). 67.3% of patients AMAB used feminizing and 48.4% of patients AFAB used masculinizing hormone therapy. When compared to US CDC National Health Statistics, there was a significantly greater prevalence of depression and anxiety but no difference in the prevalence of obesity, hypertension, hypercholesterolemia, type 2 diabetes, or stroke.
Transgender and gender diverse individuals represent a population who express various gender identities and are seeking gender-specific healthcare at increasing rates. Psychiatric illness is highly prevalent compared to the US population but there is no difference in the prevalence of CV risk factors including obesity, type 2 diabetes, hypertension, and dyslipidemia.
目前对性别多样化人群的医疗保健的了解受到社区为基础的纵向数据的缺乏的限制，尤其是在美国。我们试图描述一个基于社区的跨性别个体队列，包括人口统计学、性别认同、社会特征、精神和医疗状况，以及治疗性别焦虑/不和谐的医疗方法。
我们对明尼苏达州奥姆斯特德县的寻求特定性别的医疗保健的跨性别居民进行了回顾性图表审查，这些居民从 1974 年 1 月 1 日至 2015 年 12 月 31 日，通过链接奥姆斯特德县居民来自多个机构的医疗记录的基础设施来寻求特定性别的医疗保健。
在 1970 年代至 1990 年代，寻求特定性别的医疗保健的患者人数从每 5 年间隔的 1 到 2 人增加到 2011 年至 2015 年的 41 人（n = 82）。49 人（59.8%）出生时被分配为男性（AMAB），31 人（37.8%）被分配为女性（AFAB），2 人（2.4%）为间性。16.3%和 16.1%的 AMAB 和 AFAB 患者的性别认同随时间演变，在最近的随访中，分别有 8.2%和 12.9%的 AMAB 和 AFAB 患者是非二元性别。78%的患者患有抑郁症，其次是焦虑症（62.2%）、人格障碍（22%）和创伤后应激障碍（14.6%）。58.5%的患者有自杀意念，22%的患者试图自杀，36.6%的患者是虐待的受害者。最常见的医疗状况和心血管（CV）危险因素包括肥胖症（42.7%）、吸烟（40.2%）、骨折[34.1%（86.2%为创伤性）]、高血压（25.6%）、高血脂（25.6%）和高甘油三酯血症（15.9%）。67.3%的 AMAB 患者使用女性化激素治疗，48.4%的 AFAB 患者使用男性化激素治疗。与美国疾病控制与预防中心（CDC）国家健康统计数据相比，抑郁症和焦虑症的患病率明显更高，但肥胖症、高血压、高胆固醇血症、2 型糖尿病或中风的患病率没有差异。
跨性别和性别多样化的个体代表了一个表达各种性别认同并以不断增加的速度寻求特定性别的医疗保健的人群。与美国人口相比，精神疾病的患病率很高，但肥胖症、2 型糖尿病、高血压和血脂异常等心血管风险因素的患病率没有差异。
