Men and women who have gone through gender reassignment have all the typical medical needs as well as some that are specific to transgender people. Yet most physicians are uncertain about treatment options for transgender people. In this SC CTSI-supported study, Maddie Deutsch, MD, director of Transgender Health Care at the Los Angeles Gay & Lesbian Center, is collecting cardiovascular and metabolic data following cross-sex hormone therapy, as well as data on attitudes and other issues. Read the full story: http://sc-ctsi.org/index.php/news-dev/researchers-share-how-they-work-with-community-members-to-address-critica Learn more about SC CTSI at USC and CHLA: http://sc-ctsi.org/

1. Slide #1
The Cardiovascular & Metabolic
Health of Transgender Persons:
Implications in Primary Care
PI - Madeline B. Deutsch, MD
Director
Transgender Health Program
LA Gay & Lesbian Center
Assistant Clinical Professor
UCSF Department of Family & Community Medicine

2. Slide #2
Study Team
• Madeline Deutsch, MD – PI
– LA Gay & Lesbian Center
• Vipra Bhakri, MPH - Research Navigator
– Comm. Clinics Assoc of LA County
• Katrina Kubicek, PhD – Collaborator
– USC CTSI
• JoAnna Olson, MD – Co-Investigator
– CHLA
• Special thanks to Marvin Belzer, MD
(CHLA)

3. Slide #3
Funding
• CTSI – In kind funds (lab costs, incentives,
CASI equipment)
• LAGLC – In kind PI time, overall project
support and management
• CCALAC – 50% Research Navigator
• CHLA – In kind co-investigator time

4. Slide #4
Background and Significance
• Body of research on transgender people is
severely limited
• 2011 report from the IOM recommends
funding research in all areas of
transgender health

5. Slide #5
Trans Research –Why
Important?
• 50% of transgender patients report having
to teach their health provider about care
– National Transgender Discrimination Survey 2011
• 11% report being refused care outright
– State of Transgender California 2009
• Only 30% of medical school curriculae
include content on transition-related care
– Obedin-Mailver et al JAMA Sept 7, 2011

6. Slide #6
Transgender Care – Why
Important?
• Hormone therapy reduces anxiety,
depression and improves social
functioning & QOL
• Surgery improves global functioning and
quality of life
Newfield E, Hart S, Dibble S, Kohler L. Quality of Life Research. 2006 Jun 7;15(9):1447–57.
Gómez-Gil E, Zubiaurre-Elorza L, Esteva I, Guillamon A, Godás T, Cruz Almaraz M, et al.
Psychoneuroendocrinology [Internet]. 2011 [cited 2012 Dec 10];
Meier SLC, Fitzgerald KM, Pardo ST, Babcock J. Journal of Gay & Lesbian Mental Health.
2011;15(3):281–99.

7. Slide #7
Primary Aim
1) Collect metabolic and cardiovascular
parameters on transgender patients before
and after 6 months of cross-sex hormones
2) Collect information on transgender patient
attitudes about primary care

8. Slide #8
Secondary Aims
• Develop infrastructure for future
transgender research at the study site
• Test feasibility of conducting community-
based transgender research and
subsequent translation into clinical
practice
• Explore research collaborations between
the multiple involved institutions

9. Slide #9
Study Site (LA Gay & Lesbian
Center)
• Oldest and largest (by budget) LGBT
organization in the world
• Federally Qualified Health Center
(Lookalike) & Ryan White Grantee
• Existing research programs focused
primarily on HIV
• Transgender Health Program census =
approx 500 individuals

10. Slide #10
Methods
• Collect baseline and 6 month metabolic
data
• Baseline and 6 month survey of attitudes
about primary care
• Subjects receive covered lab costs and
$25 gift card incentives at enrollment and
again at completion
• Planned N determined by budget (75)
• Retention efforts include reminder calls &
texts

11. Slide #11
Study Population
• 18 years of age or older
• Patient registered in LAGLC Transgender Health
Program
• No prior cross-sex hormone treatment (csHT)
• Intend to begin csHT
• Transgender identified
• No contraindication to csHT
• Sequential patients enrolled

12. Slide #12
Initial Results
• 57 sequential patients enrolled
– 34 FTM, 23 MTF
• Reasons for under-enrollment
– Front office/scheduling difficulties
– Shifting patient demographics (higher
percentage of new-to-LAGLC patients coming
from another clinic already on hormones)
– Enrollment closed in January 2013 in order to
allow completion of study within projected
time frame of August 2013

13. Slide #13
27
3
0
3
1
0
0
5
10
15
20
25
30
Race Breakdown for FTM
(N=34)
18
1 1 2 0 1
0
5
10
15
20
25
30
Race breakdown for MTF (N=23)

14. Slide #14
Hispanic
32%
Non-
Hispanic
68%
Ethnicity breakdown for FTM
(N=34)
Hispanic
45%
Non-
Hispanic
55%
Ethnicity Breakdown for MTF
(N=23)

15. Slide #15
18
11
5
0
0
12
6
1
3
1
0
2
4
6
8
10
12
14
16
18
20
18-25 26-35 36-45 46-55 >55
#ofPatients Age Distribution for FTM and MTF
FTM
MTF

16. Slide #16
FTM MTF
BP Systolic
Mean ±SD 119.8±13.3 130.8±15.3
Median 120.0 130.0
BP Diastolic
Mean ±SD 74.1±10.9 77.6±12.1
Median 73.0 77.0
Height
Mean ±SD 65.2±3.3 68.3±4
Median 65.0 68.0
Weight
Mean ±SD 183.1±56.1 174.8±55
Median 173.0 153.0
Waist Circumference
Mean ±SD 98.9±19.9 92.5±17.8
Median 96.0 86.0
BMI
Mean ±SD 30±8.4 25.9±5.8
Median 69.6 5.8

17. Slide #17
FTM MTF
Cholesterol Total
Mean ±SD 175.8±31.6 177.9±29.5
Median 172.5 186.5
HDL
Mean ±SD 60±16.9 53.2±17.6
Median 57.0 53.0
LDL (Calc)
Mean ±SD 95.5±26.7 100.7±26.8
Median 92.0 109.5
Triglycerides
Mean ±SD 102±94.3 130.5±120.4
Median 79.0 88.0
Estradiol
Mean ±SD 109.4±65.8 32.4±22.4
Median 141.9 28.9
Testosterone , Total
Mean ±SD 38.8±17.8 410.7±192.9
Median 35.5 399.0
Testosterone , Free
Mean ±SD 0.8±0.5 11.6±5.5
Median 0.7 11.4

18. Slide #18
< 3 mths
21%
3-6 mths
23%
6-12 mths
14%
12-18 mths
16%
18-24 mths
7%
2-3 yrs
3%
> 3 yrs
16%
Time since last routine primary care visit

19. Slide #19
25%
18%
23%
28%
7%
0%
5%
10%
15%
20%
25%
30%
Very Likely Likely Somewhat Likely Unlikely Very Unlikely
How likely are you to see a primary care provider
for routine care?

20. Slide #20
24%
12%
50%
21%
12%
15%
6%
18%
9%
27%
0%
10%
20%
30%
40%
50%
60%
Barriers that may exist to accessing Care

21. Slide #21
Very Important
75%
Somewhat
Important
23%
Neither important
nor unimportant
2%
How important is it for you to recieve
medical care of any kind at an LGBT-
oriented clinic?

22. Slide #22
Very Important
16%
Somewhat
Important
26%
Neither important
nor unimportant
47%
Somewhat
unimportant
2%
Very Unimportant
9%
How important is it for you to have a
primary care provider who is transgender
themself?

23. Slide #23
Much more
comfortable
44%
Somewhat more
comfortable
26%
Does not make a
difference
30%
Somewhat less
comfortable
0%
Much less
comfortable
0%
Does having a transgender medical provider make
you feel more or less comfortable in the healthcare
setting?

24. Slide #24
77%
18%
4% 2% 0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Very Likely Likely Somewhat Likely Unlikely Very Unlikely
How likely is it that you would make future
changes to your lifestyle, diet or exercise routine
if recommended to do so by your provider?

25. Slide #25
Study - Next Steps
• Complete 6 month exit visits
• Conduct rigorous data analysis in
collaboration with CTSI
• Prepare and submit manuscripts for
publication

26. Slide #26
Lessons Learned
• More resources needed to support
scheduling of study patients (front office)
• Areas for improvement in EMR data
abstraction at study site
• Collaborative, community based research
appears to feasible in the study of
transgender patients