Cohen Mara, Karrington Baer, Trachtman Howard, Salas-Humara Caroline
Department of Pediatrics, New York University Langone, New York, NY, United States.
JMIR Res Protoc. 2021 May 19;10(5):e24100. doi: 10.2196/24100.
A growing number of adolescents are coming out as transgender and gender expansive (TGE). These teenagers have been shown to have significantly worse health outcomes than their cisgender peers. Hypotheses to explain this discrepancy are based on increased stress levels surrounding the societal acceptance of gender identity. In this context, elevated allostatic load (AL), which describes the wear and tear sustained by the body in response to repeated exposure to stress, has been associated with adverse long-term health outcomes.
This protocol aims to measure AL among TGE adolescents compared with their cisgender peers and assess how AL varies depending on psychological stress and perceived societal acceptance.
This is an observational proof-of-concept pilot study in which AL will be measured by assaying an array of inflammatory cytokines and cortisol in urine, saliva, and hair samples of TGE youth, and these parameters will be compared with those of age-matched control participants. A questionnaire will assess 4 aspects of psychosocial well-being: presence and management of depression and anxiety, gender identity support by family members, gender minority stress, and degree of perceived safety in the surrounding community. Samples and surveys will be collected at 3 visits (baseline, 6 months, and 12 months). This study will incorporate TGE coinvestigators to inform all aspects of design, data collection, and analysis and ensure that practices are carried out in a respectful and sensitive manner.
As of May 2021, the start of data collection for this project has continued to be postponed as a result of the COVID-19 pandemic, which has both impacted the functioning of the clinic and funding requests. We hope to begin participant recruitment and interviews with coinvestigators soon.
We hypothesize that AL will be primarily influenced by psychological well-being and perceived support and that it will be similar in TGE adolescents and in age-matched cisgender control participants when acceptance and perceived support are high. The results of this study have the potential to increase our understanding of the health challenges faced by TGE individuals during adolescence as well as to show that low levels of acceptance may have detrimental health outcomes secondary to elevated ALs; this may lead to the development of a biomarker profile to assess allostatic stress in TGE patients that can be used to guide management.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/24100.
越来越多的青少年公开自己的跨性别和性别扩展（TGE）身份。这些青少年的健康状况明显比他们的顺性别同龄人差。解释这种差异的假设基于围绕性别认同社会接受度的压力水平增加。在这种情况下，累积生理负荷（AL），即身体因反复暴露于压力而承受的损耗，已与不良的长期健康结果相关联。
本方案旨在测量TGE青少年与他们的顺性别同龄人相比的AL，并评估AL如何根据心理压力和感知到的社会接受度而变化。
这是一项观察性概念验证试点研究，其中将通过检测TGE青少年尿液、唾液和头发样本中的一系列炎性细胞因子和皮质醇来测量AL，并将这些参数与年龄匹配的对照参与者的参数进行比较。一份问卷将评估心理社会福祉的四个方面：抑郁和焦虑的存在及管理、家庭成员对性别认同的支持、性别少数群体压力以及在周围社区中感知到的安全程度。样本和调查将在三次访视时收集（基线、6个月和12个月）。本研究将纳入TGE联合研究者，以指导设计、数据收集和分析的各个方面，并确保以尊重和敏感的方式开展各项工作。
截至2021年5月，由于COVID-19大流行，该项目的数据收集工作继续推迟，这既影响了诊所的运作，也影响了资金申请。我们希望很快开始招募参与者并与联合研究者进行访谈。
我们假设AL将主要受心理健康和感知到的支持影响，并且当接受度和感知到的支持较高时，TGE青少年和年龄匹配的顺性别对照参与者中的AL将相似。本研究的结果有可能增进我们对TGE个体在青春期所面临的健康挑战的理解，并表明低水平的接受度可能会因AL升高而产生有害的健康结果；这可能会导致开发一种生物标志物谱来评估TGE患者的累积应激，可用于指导管理。
国际注册报告识别码（IRRID）：PRR1-10.2196/24100。
