Receipt of Gender-Affirming Surgeries Among Transgender and Gender Diverse Veterans

被引：2

作者：

Littman, Alyson J. ^{[1
,2
,3
]}

Jeon, Amy ^{[1
]}

Fort, Carolyn L. ^{[2
]}

Dashtestani, Krista ^{[2
]}

Korpak, Anna ^{[1
]}

Kauth, Michael R. ^{[4
,5
]}

Shipherd, Jillian C. ^{[4
,6
,7
]}

Jasuja, Guneet K. ^{[8
,9
,10
]}

Wolfe, Hill L. ^{[11
,12
]}

Neira, Paula M. ^{[13
,14
]}

Caballero, Josie ^{[15
,16
]}

Garcia, Sady ^{[16
]}

Williamson, Cassandra

Collongues, Benjamin

Simpson, Tracy L. ^{[17
,18
]}

机构：

[1] Dept Vet Affairs Puget Sound Hlth Care Syst, Seattle Epidemiol Res & Informat Ctr, Seattle, WA 98108 USA

[2] Dept Vet Affairs Puget Sound Hlth Care Syst, Seattle Denver Ctr Innovat Vet Ctr & Value Driven, Seattle, WA 98108 USA

[3] Univ Washington, Sch Publ Hlth, Dept Epidemiol, Seattle, WA 98195 USA

[4] LGBTQ Hlth Program, Dept Vet Affairs, Off Patient Care Serv, Washington, DC USA

[5] UMass Chan, TH Chan Sch Med, Dept Pediat, Med Sch, Worcester, MA USA

[6] VA Boston Healthcare Syst, Natl Ctr PTSD, Boston, MA USA

[7] Boston Univ, Chobanian & Avedisian Sch Med, Boston, MA USA

[8] VA Bedford Healthcare Syst, Ctr Healthcare Org & Implementat Res, Bedford, MA USA

[9] Boston Univ, Chobanian & Avedisian Sch Med, Sect Gen Internal Med, Boston, MA USA

[10] Boston Univ, Sch Publ Hlth, Dept Hlth Law Policy & Management, Boston, MA USA

[11] VA Connecticut Healthcare Syst, VA Pain Res Informat Multimorbid & Educ PRIME Ctr, West Haven, CT USA

[12] Yale Sch Med, Dept Biomed Informat & Data Sci, New Haven, CT USA

[13] Johns Hopkins Med Off Divers Inclus & Hlth Equ, Baltimore, MD USA

[14] Johns Hopkins Univ, Sch Med, Dept Plast & Reconstruct Surg, Baltimore, MD USA

[15] Natl Ctr Transgender Equal, Washington, DC USA

[16] Transgender Amer Vet Assoc, Washington, DC USA

[17] VA Puget Sound Ctr Excellence Subst Addict Treatme, Seattle, WA USA

[18] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA USA

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 2024年 / 39卷 / 15期

关键词：

transgender; veterans; gender-affirming surgery; disparities; HORMONE-THERAPY; HEALTH; CARE; COVERAGE; COSTS;

D O I：

10.1007/s11606-024-08917-1

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Gender-affirming surgery (GAS) can be an important part of comprehensive care for transgender and gender diverse (TGD) individuals, but this care is not provided by the Department of Veterans Affairs (VA) because of an exclusion in the medical benefits package. Objective: To describe the receipt of GAS by veterans and assess the associations between key sociodemographic characteristics and receipt of chest ("top") and genital ("bottom") surgeries. Design: Cross-sectional national survey (the GendeR Affirming Care Evaluation (GRACE)), among TGD Veterans conducted between September 2022 and July 2023. Participants: A total of 6653 Veterans (54% response rate) completed the survey. Main Measures: Self-reported "top" and "bottom" GAS were key outcomes. Covariates included gender identity, sex assigned at birth, age, race, ethnicity, income, employment status, education, relationship status, sexual orientation, and geographic region. Key Result: sAmong all respondents, 39% had >= 1 GAS. Among the 4430 veterans interested in top surgery, 38% received it; 23% of 3911 veterans interested in bottom surgery had received it. In multivariable models, older age (50 + vs. 18-39) was associated with higher receipt of top and bottom surgery while nonbinary gender identity (vs. binary gender identity), lower household income (< $50,000 vs. > $75,000), less education (less than a college graduate vs. Master's degree or more), sexual orientations other than heterosexual, and residing in a region other than the Pacific were associated with lower receipt of top and bottom surgery. Individuals assigned male (vs. assigned female) at birth had lower receipt of top surgery and higher receipt of bottom surgery. Conclusions: GAS receipt was low and there were important disparities by gender, sex, income, education, sexual orientation, and region. By removing the exclusion to providing GAS, VA could reduce barriers to accessing GAS and decrease disparities among TGD veterans.

引用

页码：3042 / 3051

页数：10

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