McQuillan Mollie T, Kuhns Lisa M, Miller Aaron A, McDade Thomas, Garofalo Robert
Department of Educational Leadership and Policy Analysis, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Transgend Health. 2021 Apr 16;6(2):91-100. doi: 10.1089/trgh.2020.0019. eCollection 2021 Apr.
Transgender and gender-nonconforming (TGNC) youth often report higher rates of chronic social stressors such as victimization, discrimination, and rejection. Some of these gender-based stressors may have long-range physical health consequences through inflammation pathways. This study evaluates the feasibility and acceptability of adding biological measures of inflammation to an ongoing prospective clinical study of TGNC youth (ages 9-20 years), initiating affirming medical therapy at a large, urban children's hospital (=56). We also examine the relationship between gender-based sources of stress and support with inflammation. This is the first study to explore how gender identity, social stressors, and social supports may contribute to poorer health in TGNC youth through inflammation and immune dysregulation pathways. Between October 2016 and August 2018, the study team collected dried blood spot (DBS) samples and health measures during clinical visits. Participants also completed computer-assisted surveys assessing gender minority stress and support during these visits. We used regression analysis to evaluate differences in C-reactive protein (CRP) controlling for demographics, health, gender-based stress, and supports. The results from this study indicate that adding DBS samples to assess inflammation was feasible and acceptable in a clinical sample of TGNC youth seeking affirming-medical interventions. We found an association between greater inflammation and the composite score for greater gender-based stressors and lower gender-based supports using the Gender Minority Stress and Resilience Tool (GMSR); however, we did not find statistically significant differences in CRP associated with any of the individual GMSR subscales assessing various types of gender-based supports or stressors. More research is necessary to evaluate how different sources of gender-based support and stress relate to inflammation with larger sample sizes.
跨性别和性别不一致（TGNC）的青少年经常报告遭受诸如受害、歧视和排斥等慢性社会压力源的比例较高。其中一些基于性别的压力源可能通过炎症途径产生长期的身体健康后果。本研究评估了在一项正在进行的针对TGNC青少年（9至20岁）的前瞻性临床研究中增加炎症生物学指标的可行性和可接受性，该研究在一家大型城市儿童医院开展了肯定性医学治疗（n = 56）。我们还研究了基于性别的压力源和支持与炎症之间的关系。这是第一项探索性别认同、社会压力源和社会支持如何通过炎症和免疫失调途径导致TGNC青少年健康状况较差的研究。在2016年10月至2018年8月期间，研究团队在临床就诊时收集了干血斑（DBS）样本和健康指标。参与者还在这些就诊期间完成了计算机辅助调查，评估性别少数群体的压力和支持情况。我们使用回归分析来评估在控制人口统计学、健康状况、基于性别的压力和支持因素后，C反应蛋白（CRP）的差异。本研究结果表明，在寻求肯定性医学干预的TGNC青少年临床样本中，增加DBS样本以评估炎症是可行且可接受的。我们使用性别少数群体压力与复原力工具（GMSR）发现，炎症加剧与基于性别的更大压力源综合得分以及更低的基于性别的支持得分之间存在关联；然而，我们没有发现与评估各种类型基于性别的支持或压力源的任何单个GMSR子量表相关的CRP有统计学显著差异。需要更多研究来评估不同来源的基于性别的支持和压力如何与更大样本量的炎症相关。
