Advertisement

Retrospective Review of Sexual and Reproductive Health Conversations During Initial Visits of Adolescents Seeking Gender-Affirming Testosterone

  • Garrett Garborcauskas
    Correspondence
    Address correspondence to: Garrett Garborcauskas, 300 Longwood Avenue Boston, MA 02115
    Affiliations
    Frank H Netter School of Medicine at Quinnipiac University, North Haven, Connecticut
    Search for articles by this author
  • Elizabeth R. Boskey
    Affiliations
    Center for Gender Surgery, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Surgery, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Carly E. Guss
    Affiliations
    Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts

    Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Frances W. Grimstad
    Affiliations
    Center for Gender Surgery, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts

    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
Published:September 23, 2022DOI:https://doi.org/10.1016/j.jpag.2022.09.004

      Abstract

      Study Objective

      To use a retrospective review of sexual and reproductive health (SRH) counseling that occurred during initial visits of adolescents seeking testosterone gender-affirming hormone therapy to determine the feasibility of using such visits to manage SRH

      Design

      Retrospective chart review

      Setting

      Children's hospital, multidisciplinary gender clinic

      Participants

      Transgender male and nonbinary patients assigned female at birth (TGD-M) aged 15-17 seen for initiation of testosterone between January 1, 2010, and December 31, 2019

      Interventions

      Not applicable

      Main outcome measure(s)

      Counseling on (1) testosterone impact on fertility and (2) fertility preservation; assessment of (3) desire for gender-affirming surgery, (4) sexual activity, (5) sexual orientation, and (6) human papilloma virus vaccination as documented during the initial visit.

      Results

      Of 195 patients who met the inclusion criteria, only 3 (1.5%) had all 6 measures addressed. The median number addressed was 4 out of 6 (IQR = 2-5/6), with fertility counseling (95.9%, n = 187) being most common, followed by assessment of surgery desire (74.4%, n = 145), sexual orientation (69.2%, n = 135), and sexual activity (69.2%, n = 135). The odds of being asked about sexual orientation were 5.3 times higher in patients who endorsed sexual activity than in those who did not (P < .001; 95% CI, 9.8-10.3).

      Conclusion

      Providers of adolescent gender-affirming hormone therapy regularly assess and counsel on certain aspects of SRH as part of their initial visits for those seeking testosterone. Our data suggest that these initial visits for patients seeking testosterone represent an opportunity to expand SRH assessment and counseling among TGD-M adolescents.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Sexual and reproductive health care: a position paper of the Society for Adolescent Health and Medicine.
        J Adolesc Health. 2014; 54: 491-496https://doi.org/10.1016/j.jadohealth.2014.01.010
      2. Committee on Gynecologic Practice, Committee on Health Care for Underserved Women.
        Committee Opinion Number 823: Health care for transgender and gender diverse individuals. 2021; 137: 14
        • Puckett JA
        • Tornello S
        • Mustanski B
        • Newcomb ME
        Gender variations, generational effects, and mental health of transgender people in relation to timing and status of gender identity milestones.
        Psychol Sex Orientat Gender Divers. 2021; 9: 165-178https://doi.org/10.1037/sgd0000391
        • Feldman JL
        • Luhur WE
        • Herman JL
        • et al.
        Health and health care access in the US transgender population health (TransPop) survey.
        Andrology. 2021; 9: 1707-1718https://doi.org/10.1111/andr.13052
        • Denno DM
        • Hoopes AJ
        • Chandra-Mouli V
        Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.
        J Adolesc Health. 2015; 56: S22-S41https://doi.org/10.1016/j.jadohealth.2014.09.012
        • Grant JM
        • Mottet LA
        • Tanis J
        • et al.
        Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.
        National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, DC2011
        • Hoxmeier JC
        Sexual assault and relationship abuse victimization of transgender undergraduate students in a national sample.
        Violence Gend. 2016; 3: 202-207https://doi.org/10.1089/vio.2016.0008
        • Nahata L
        • Chen D
        • Moravek MB
        • et al.
        Understudied and under-reported: fertility issues in transgender youth-a narrative review.
        J Pediatr. 2019; 205: 265-271https://doi.org/10.1016/j.jpeds.2018.09.009
        • Krempasky C
        • Harris M
        • Abern L
        • Grimstad F
        Contraception across the transmasculine spectrum.
        Am J Obstet Gynecol. 2020; 222: 134-143https://doi.org/10.1016/j.ajog.2019.07.043
        • Klein DA
        • Paradise SL
        • Goodwin ET
        Caring for transgender and gender-diverse persons: what clinicians should know.
        Early Puberty. 2018; 98: 14
        • Rafferty JR
        • Donaldson AA
        • Forcier M
        Primary care considerations for transgender and gender-diverse youth.
        Pediatr Rev. 2020; 41: 437-454https://doi.org/10.1542/pir.2018-0194
        • Hembree WC
        • Cohen-Kettenis PT
        • Gooren L
        • et al.
        Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline.
        J Clin Endocrinol Metabol. 2017; 102: 3869-3903https://doi.org/10.1210/jc.2017-01658
        • World Professional Association for Transgender Health
        Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People.
        WPATH. 2012; (Available:) (Accessed October 26, 2021)
        • Ham P
        • Allen C
        Adolescent health screening and counseling.
        Am Fam Physician. 2012; 86: 8
      3. Hagan JF Shaw JS Duncan PM Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. American Academy of Pediatrics, Elk Grove Village, IL2017
        • Leichliter JS
        • Copen C
        • Dittus PJ
        Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15–25 years — United States, 2013–2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 237-241https://doi.org/10.15585/mmwr.mm6609a1
        • Marcell AV
        • Burstein GR
        Committee on Adolescence: Sexual and reproductive health care services in the pediatric setting.
        Pediatrics. 2017; 140e20172858https://doi.org/10.1542/peds.2017-2858
        • Meites E
        • Szilagyi PG
        • Chesson HW
        • et al.
        Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices.
        Morb Mortal Wkly Rep. 2019; 68: 5
      4. Committee on Adolescent Health Care: Committee Opinion: The initial reproductive health visit, Obstet Gynecol, 136 (4) 2020, 11

      5. Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: a position paper of the Society for Adolescent Health and Medicine.
        J Adolesc Health. 2013; 52: 506-510https://doi.org/10.1016/j.jadohealth.2013.01.015
        • Wingo E
        • Ingraham N
        • Roberts SCM
        Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: a qualitative study.
        Womens Health Issues. 2018; 28: 350-357https://doi.org/10.1016/j.whi.2018.03.002
        • Guss CE
        • Woolverton GA
        • Borus J
        • et al.
        Transgender adolescents’ experiences in primary care: a qualitative study.
        J Adolesc Health. 2019; 65: 344-349https://doi.org/10.1016/j.jadohealth.2019.03.009
        • Nahata L
        • Chen D
        • Quinn GP
        • et al.
        Reproductive attitudes and behaviors among transgender/nonbinary adolescents.
        J Adolesc Health. 2020; 66: 372-374https://doi.org/10.1016/j.jadohealth.2019.09.008
        • Haseen B
        • Kahn A
        • Belton A
        • Roth Bayer C
        Health care for transgender men: what is missing in OB/GYN care?.
        J Low Genit Tract Dis. 2020; 24: 232-233https://doi.org/10.1097/LGT.0000000000000507
        • Stewart T
        • Lee YA
        • Damiano EA
        Do transgender and gender diverse individuals receive adequate gynecologic care? An analysis of a rural academic center.
        Transgend Health. 2020; 5: 50-58https://doi.org/10.1089/trgh.2019.0037
      6. Census - Table Results. Available: https://data.census.gov/cedsci/table?text=s1903&tid=ACSST5Y2018.S1903&hidePreview=false. Accessed October 26, 2021

        • Light AD
        • Obedin-Maliver J
        • Sevelius JM
        • Kerns JL
        Transgender men who experienced pregnancy after female-to-male gender transitioning.
        Obstet Gynecol. 2014; 124: 1120-1127https://doi.org/10.1097/AOG.0000000000000540
        • Riggs DW
        • Bartholomaeus C
        Toward trans reproductive justice: a qualitative analysis of views on fertility preservation for Australian transgender and non-binary people.
        J Soc Issues. 2020; 76: 314-337https://doi.org/10.1111/josi.12364
        • van Trotsenburg MAA
        Gynecological aspects of transgender healthcare.
        Int J Transgend. 2009; 11: 238-246https://doi.org/10.1080/15532730903439484
        • Grimstad F
        • Boskey ER
        • Taghinia A
        • et al.
        The role of androgens in clitorophallus development and possible applications to transgender patients.
        Andrology. 2021; 9: 1719-1728https://doi.org/10.1111/andr.13016
        • Maheux AJ
        • Zhou Y
        • Thoma BC
        • et al.
        Examining sexual behavior among U.S. transgender adolescents.
        J Sex Res. 2021; 58: 1050-1060https://doi.org/10.1080/00224499.2020.1855408
        • Whitlock BL
        • Duda ES
        • Elson MJ
        • et al.
        Primary care in transgender persons.
        Endocrinol Metab Clin North Am. 2019; 48: 377-390https://doi.org/10.1016/j.ecl.2019.02.004
      7. Boskey ER, Ganor R: Sexual orientation and attraction in a cohort of transmasculine adolescents and young adults. Transgend Health. Published online 2021.

        • Charlton BM
        • Nava-Coulter B
        • Coles MS
        • Katz-Wise SL
        Teen pregnancy experiences of sexual minority women.
        J Pediatr Adolesc Gynecol. 2019; 32: 499-505https://doi.org/10.1016/j.jpag.2019.05.009
        • Curry SJ
        • Krist AH
        • et al.
        • US Preventive Services Task Force
        Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2018; 320: 674https://doi.org/10.1001/jama.2018.10897