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Decreased Anogenital Gonorrhea and Chlamydia in Transgender and Gender Diverse Primary Care Patients Receiving Gender-Affirming Hormone Therapy

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Abstract

Background

Transgender and gender diverse (TGD) adults in the U.S. experience health disparities, including in anogenital sexually transmitted infections (STI). Gender-affirming hormone therapy (GAHT) is known to be medically necessary and improve health. Few studies have assessed the effect of GAHT on STI diagnoses.

Objective

To evaluate the effect of GAHT delivered in primary care as an intervention to improve STI outcomes for TGD adults.

Design

LEGACY is a longitudinal, multisite cohort study of adult TGD primary care patients from two federally qualified community health centers in Boston, MA, and New York, NY.

Participants

Electronic health record data for eligible adult TGD patients contributed to the LEGACY research data warehouse (RDW). A total of 6330 LEGACY RDW patients were followed from 2016 to 2019, with 2555 patients providing STI testing data.

Main Measures

GAHT exposure was being prescribed hormones, and the clinical outcome was anogenital gonorrhea or chlamydia diagnoses. Log-Poisson generalized estimating equations assessed the effect of prescription GAHT on primary outcomes, adjusting for age, race, ethnicity, gender identity, poverty level, health insurance, clinical site, and cohort years.

Key Results

The median age was 28 years (IQR = 13); the racial breakdown was 20.4% Black, 8.1% Multiracial, 6.9% Asian/Pacific Islander, 1.8% Other; 62.8% White; 21.3% Hispanic/Latinx; 47.0% were assigned female at birth, and 16.0% identified as nonbinary. 86.3% were prescribed hormones. Among those tested, the percentage of patients with a positive anogenital STI diagnosis ranged annually from 10.0 to 12.5% between 2016 and 2019. GAHT prescription was associated with a significant reduction in the risk of anogenital STI diagnosis (aRR = 0.75; 95% CI = 0.59–0.96) over follow-up.

Conclusions

GAHT delivered in primary care was associated with less STI morbidity in this TGD cohort over follow-up. Patients may benefit from individualized and tailored clinical care alongside GAHT to optimize STI outcomes.

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Acknowledgements:

We would like to thank our Community Advisory Board, Scientific Advisory Board, and Research Support Coalition for their invaluable contributions to this project. Additionally, we would like to thank the participants of this study for lending their voices and experiences. Without them, this work would not be possible.

Funding

The research reported in this publication was supported by the Patient-Centered Research Outcomes Institute (PCORI) under Award Number AD-2017C1-6569 (PI: Dr. Sari L. Reisner). The content is solely the responsibility of the authors and does not necessarily represent the official views of PCORI. PCORI was not involved in the collection, analysis, or interpretation of study data. 

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Authors and Affiliations

  1. Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA, USA

    Sari L. Reisner ScD & Meg Quint BS

  2. Harvard Medical School, Boston, MA, USA

    Sari L. Reisner ScD, Kenneth H. Mayer MD, Jennifer Potter MD, Alex S. Keuroghlian MD, MPH & Alex Gonzalez MD, MPH

  3. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Sari L. Reisner ScD, Kenneth H. Mayer MD & David R. Pletta PhD, MPH

  4. The Fenway Institute, Fenway Health, Boston, MA, USA

    Sari L. Reisner ScD, Kenneth H. Mayer MD, David R. Pletta PhD, MPH, Juwan Campbell MA, Jennifer Potter MD, Alex S. Keuroghlian MD, MPH, Jaclyn M. W. Hughto PhD, MPH, Andrew Asquith BA, Dana J. Pardee MBA, Chris Grasso MPH & Alex Gonzalez MD, MPH

  5. University of California San Francisco, San Francisco, CA, USA

    Madeline B. Deutsch MD, MPH

  6. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth H. Mayer MD, Jennifer Potter MD & Alex Gonzalez MD, MPH

  7. Massachusetts General Hospital, Boston, MA, USA

    Alex S. Keuroghlian MD, MPH

  8. Brown University School of Public Health, Providence, RI, USA

    Jaclyn M. W. Hughto PhD, MPH

  9. Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA

    Jaclyn M. W. Hughto PhD, MPH

  10. Callen-Lorde Community Health Center, New York, NY, USA

    Alexander Harris MPH & Asa Radix MD, PhD

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Corresponding author

Correspondence to Sari L. Reisner ScD.

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Conflict of Interest:

Authors SLR, JP, and ASK receive royalties from McGraw Hill for editing the textbook, “Transgender and Gender Diverse Health Care: The Fenway Guide.”

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Prior Presentations:

A preliminary analysis of study findings was presented at the World Professional Association for Transgender Health (WPATH) 27th Scientific Symposium in Montreal, Canada, on Sept 18, 2022. Presentation title: “Improved clinical outcomes in transgender and gender diverse primary care patients receiving gender-affirming care: Findings from the LEGACY project” (presenter: Dr. Sari L. Reisner).

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Reisner, S.L., Deutsch, M.B., Mayer, K.H. et al. Decreased Anogenital Gonorrhea and Chlamydia in Transgender and Gender Diverse Primary Care Patients Receiving Gender-Affirming Hormone Therapy. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08531-7

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