Hormone Prescription and HIV Screening/Preventive Practices Among Clinicians Providing Care for Transgender Individuals

Mabel Toribio; Madeline Cetlin; Evelynne S Fulda; Sarah M Chu; Jorge Gómez Tejeda Zañudo; Tonia Poteat; Karen Donelan; Markella V Zanni

doi:10.1089/trgh.2021.0118

Hormone Prescription and HIV Screening/Preventive Practices Among Clinicians Providing Care for Transgender Individuals

Transgend Health. 2023 Feb 8;8(1):64-73. doi: 10.1089/trgh.2021.0118. eCollection 2023 Feb.

Authors

Mabel Toribio¹, Madeline Cetlin¹, Evelynne S Fulda¹, Sarah M Chu¹, Jorge Gómez Tejeda Zañudo^{2

3}, Tonia Poteat⁴, Karen Donelan⁵, Markella V Zanni¹

Affiliations

¹ Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
² Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
³ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Purpose: Through a survey-based approach, we sought to investigate regional differences in gender-affirming hormone therapy (GAHT) prescribing practices, as well as HIV screening and prevention practices among clinicians providing care to transgender individuals.

Methods: Our survey was disseminated between December 2019 and January 2021 to clinicians who prescribe GAHT within New England (United States). Between-group differences in GAHT prescribing and HIV screening/prevention practices were evaluated by practice setting and subspecialty.

Results: Of the 20 survey respondents, 55% practiced in health care settings affiliated with an academic institution, 45% practiced in a community-based health care setting, and 30% were Endocrinologists. Clinicians in community-based health care settings reported more frequently prescribing oral 17β-estradiol (p=0.02) and spironolactone (p=0.007) for feminizing GAHT compared with clinicians in health care settings affiliated with an academic institution, who reported more frequently prescribing leuprolide (p=0.03). For masculinizing GAHT, clinicians from health care settings affiliated with an academic institution reported more frequently prescribing topical testosterone (p=0.03). There were no significant between-group differences in reported barriers to initiation or reasons for stopping GAHT. While non-Endocrinologists reported "often" or "always" offering HIV screening, most Endocrinologists reported "rarely" or "never" offering HIV screening and "rarely" or "never" offering pre-exposure or postexposure prophylaxis to their transgender patients.

Conclusions: Regional GAHT prescribing practices varied by setting. Additional research is needed to better understand whether these differences translate to differences in GAHT efficacy and side-effects. Further, HIV screening/prevention practices varied by subspecialty. Integrated GAHT and HIV screening/prevention across subspecialties could help reduce the disproportionate burden of HIV faced by the transgender community.

Keywords: HIV; HIV prevention; HIV screening; gender-affirming hormone therapy; transgender.

Abstract

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