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Studies: Transgender Hormone Therapy Less Risky Than Birth Control Pills

New research published in Men’s Health Issue of AACC’s Clinical Chemistry journal find transgender hormone therapy Is less risky than birth control pills

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Novel studies published in the Men’s Health Issue of American Association for Clinical Chemistry‘s journal Clinical Chemistry suggest that hormone therapy for transgender people increases the risk of blood clots less than birth control pills and does not increase the risk of cardiovascular disease at all. These preliminary results could help more transgender individuals to access essential hormone therapy by increasing physician comfort with prescribing it.

Obstacles to Therapy

All major medical associations agree that transgender individuals need to be able to express their gender in ways with which they feel comfortable and that this is the most effective treatment for psychological distress caused by incongruence between sex assigned at birth and gender. For many transgender individuals, expressing their gender involves physically changing their body through medical steps such as taking hormone therapy. However, transgender patients often experience difficulty getting hormone therapy prescriptions, to the point that 1 in 4 transgender women have to resort to illegally obtaining cross-sex hormones. Part of this is because existing research on transgender hormone therapy is limited and conflicting, which has led to some physicians denying patients this treatment out of concern that it could significantly increase the risk of health problems such as blood clots and cardiovascular disease.

First Study

A team of researchers led by Dina N. Greene, PhD, of the University of Washington in Seattle has now estimated that in transgender women prescribed estrogen, blood clots only occur at a rate of 2.3 per 1,000 person-years. While this is higher than the estimated incidence rate of blood clots in the general population (1.0-1.8 per 1,000 person-years), it is less than the estimated rate in premenopausal women taking oral contraceptives (3.5 per 1,000 person-years), which means that it is an acceptable level of risk. In order to determine this, Greene’s team performed a systematic review of all studies that have included the incidence rate of blood clots in transgender women receiving estrogen therapy, identifying 12 that were most relevant. The researchers then used meta-analysis to combine the results of these 12 studies and calculate a risk estimate that is based on all available evidence to date.  

“Documenting the risks associated with hormone treatment may allow for prescribers to feel more comfortable with prescribing practices, allowing for better overall management of transgender people,” said Greene. “Our data support the risk of thrombotic events in transgender women taking estrogen therapy being roughly comparable to the risk of thrombotic risks associated with oral contraceptives in premenopausal women. Given the widespread use of oral contraception, this level of risk appears to be broadly accepted.”

Second Study

In a second study, a team of researchers led by Guy G.R. T’Sjoen, MD, PhD, also conducted a systematic review of all studies that have measured risk factors for cardiovascular disease in transgender people taking hormone therapy. The researchers identified 77 relevant studies in this area and found that the majority of them report no increase in cardiovascular disease in either transgender men or women after 10 years of hormone therapy. The studies that did indicate a higher cardiovascular disease risk for transgender women in particular mainly involved patients using ethinyl estradiol, a now obsolete estrogen agent, and are therefore no longer valid.

T’Sjoen’s team does state that their results are not conclusive due to the small sample sizes and relatively short duration of the studies in this area (and Greene’s team included a similar caveat for their work). However, it is important to look at Greene and T’Sjoen’s studies in the context of transgender research as a whole. The field only began to receive National Institutes of Health funding in 2017 and is also lagging due to the fact that transgender patients often aren’t identified in medical databases that provide data for research. In light of this, these studies are significant not only because they suggest that transgender hormone therapy is safe, but also because they underscore the need for longer-term, large scale studies involving this underserved population.

Source: Press release

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Austin

Kind Clinic Launches Telehealth Service

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The Kind Clinic

Patients at Texas Health Action‘s Kind Clinic won’t have to worry about taking time off from work or figuring out how to get to the clinic. The Kind Clinic, which provides sexual health services including PrEP and PEP access, STI testing and treatment, HIV testing, and gender affirming care to Central Texans in need, regardless of race, creed, gender expression, or sexual orientation, has launched TeleKind, Austin’s first telehealth service offering quality sexual healthcare to patients through convenient and confidential video chat on a mobile device or computer.

Existing Kind Clinic patients will be able use TeleKind for follow-up appointments, prescription refills, and health care questions. TeleKind is available to all Kind Clinic patients, insured and uninsured

“Our mission through TeleKind is to ensure that sexual health is attainable for Central Texans, regardless of clinic proximity,” said Texas Health Action CEO Christopher Hamilton. “TeleKind will allow our expert providers to support our patients’ sexual wellness goals through a convenient, user-friendly platform they can access from anywhere.”

With almost 2,000 Kind Clinic patients making a significant commute to the clinic annually, video chat with the clinic’s sexual health experts ensures timely and consistent care for patients across Central Texas. “We take pride in providing our patients with a safe, supportive and empowering environment to address their sexual health concerns,” said Dr. Cynthia Brinson, Chief Medical Officer for Texas Health Action and the Kind Clinic. “TeleKind will allow us to provide that same personalized care for our patients without the commute.”

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Austin

AIDS Services of Austin Opens Moody Medical Clinic

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Ribbon Cutting for AIDS Service of Austin's Moody Medical Clinic
Ana Herrera, Joah Spearman, Kathie Tovo, Ora Huston, Paul E. Scott, Greg Casar, Jimmy Flannigan, Lloyd Doggett, and Ross Moody at Ribbon Cutting. Photo courtesy: AIDS Services of Austin

AIDS Services of Austin (ASA) celebrated the opening of the ASA Moody Medical Clinic with a ribbon cutting and tours of the new facilities for press and community supporters. In addition to ASA staff and board members, dignitaries attending included Representative Lloyd Doggett, Austin Mayor Pro Tem Kathie Tovo, City Council Members Greg Casar (District 4), Jimmy Flannigan (District 6), and Ora Houston (District 1).

ASA Moody Medical Clinic Ribbon Cutting
Paul E. Scott, Jimmy Flannigan, Kathie Tovo, and Ora Huston watch at Greg Casar reads city proclaimation at ribbon cutting. Photo courtesy AIDS Services of Austin.

Located at ASA’s main campus location at 7215 Cameron Road in North East Austin, the Moody Medical Clinic will provide primary care and HIV specialty care for those living with HIV as well as PrEP services and HIV/STI testing for those at high-risk of transmission. Clinical services will be integrated into ASA’s existing social and direct assistance programs in order to reduce barriers to care.

The ASA Moody Medical Clinic is now open! A special thank you to those that made this clinic a reality: Ross Moody, the…

Posted by AIDS Services of Austin on Thursday, September 13, 2018

“Our new ASA Moody Medical Clinic, working alongside the city and our community partners, will support Austin’s Fast-Track City initiative goals by increasing access to life-affirming care and help Austin get to zero new HIV transmissions,” says ASA Chief Executive Officer Paul Scott.

The clinic was made possible with a million dollar investment by Ross Moody and the Moody Foundation and $600,000 in community donations to support the construction, staffing, and first 6 months of clinical operations. The foundation also supported ASA’s Jack Sansing Dental Clinic.

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Study: Only 4% Gay & Bi Men Use PrEP

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Only 4 percent of gay and bisexual men in the United States reported using pre-exposure prophylaxis, or PrEP; this according to a new study recently published in PLOS ONE. The study also revealed that bisexual and non-urban men were less likely than gay men to use PrEP; while visiting an LGBT clinic and searching for information online on LGBT sources were associated with PrEP use.

PrEP is a pill taken daily that reduces the likelihood of being infected with HIV by over 99 percent and is recommended by the Centers for Disease Control and Prevention (CDC) for those at high risk of HIV/AIDS. Currently, Truvada, manufactured by Gilead, is the only form of PrEP approved by the Food & Drug Administration.

The study used data from the Generations Study using a national probability sample of 470 male participants from three age cohorts: 18-25, 34-41, and 52-59. Researchers examined HIV testing and use, familiarity, and attitudes toward PrEP among HIV-negative gay and bisexual men in the U.S. Participants completed the survey between March, 2016 and March, 2017.

ACCESS, FAMILIARITY & ATTITUDES

“The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing,” said Professor Phillip Hammack of the University of California Santa Cruz’s Department of Psychology. Since it was approved for PrEP six years ago, the wholesale price for Truvada in the U.S. has risen 45 percent, with the list price for a 30-day supply close to $2,000.

Despite low usage, a majority of particpants — 60 percent — reported that they were familiar with PrEP, with the middle cohort, ages 34-41, reporting the highest familiarity at 79 percent. Attitudes toward PrEP were also positive among most men — 68 percent of all participants, with the younger cohort, ages 18-25, at 76 percent.

HIV TESTING

The study also showed that most men did not meet the CDC recommndations for annual HIV testing with more than 25 percent of men in the younger cohort, ages 18-25, and 8 percent of men over 25 never having been tested for HIV.

“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

“Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection,” says principal investigator Ilan H. Meyer of the Williams Institute at the UCLA School of Law. “It is alarming that high-risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.”

The study suggests that “efforts to educate gay and bisexual men about HIV risk and prevention need to be reinvigorated and expanded to include non-gay-identified and non-urban men”.

The study was supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.

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