Alex S Keuroghlian

• MD MPH
• Professor (Associate) at Massachusetts General Hospital/Harvard Medical School/The Fenway Institute

Gender-affirming care for transgender and gender diverse people should be inclusive, community led and evidence informed to support mental health and wellbeing.

Background In the United States, transgender, nonbinary, and gender diverse (TGD) young adults experience a higher risk of depression compared to their cisgender peers. Understanding factors associated with increased risk of depression within the TGD young adult population is important to guide clinical care as well as inform the development of int...

Importance In the US, transgender, nonbinary, and gender diverse (TGD) adults have high rates of depression. Gender-affirming hormone therapy (GAHT) is associated with improved mental health outcomes, yet existing US studies have short follow ups and lack sample diversity. Objective To evaluate the use of GAHT delivered in primary care as an inter...

This article explores the potential of 3,4-methylenedioxyme-thamphetamine (MDMA)-assisted therapy to enhance exposure and response prevention in obsessive-compulsive disorder treatment. We discuss the mechanisms of MDMA, including fear extinction, psychological flexibility, and empathogenic effects that may improve adherence and efficacy, as well a...

As HIV diagnoses continue to decrease and rates of viral suppression increase in the United States, key populations of underserved individuals represent a disproportionate share of those left undiagnosed, unengaged in care, and not virally suppressed. In 2021, the Health Resources and Services Administration's HIV/AIDS Bureau funded 20 HIV care org...

Interventions that leverage telehealth technologies have the potential to improve health outcomes among people with HIV who experience multiple complex barriers to care. To assess the current state of knowledge on telehealth interventions for people with HIV in the United States, we searched the literature for recent (2019-2023) telehealth interven...

Clinical research should recruit participants from LGBTQIA+ populations, and this requires specific actions and policies to create affirming and welcoming environments. Lesbian, gay, bisexual, transgender, queer, intersex, asexual and all sexually and gender diverse (LGBTQIA+) populations experience well-documented health disparities, and yet are u...

This Viewpoint discusses potential changes to sexual and gender minority health care under the Trump-Vance administration.

Importance In the 2020 Bostock v Clayton County decision, the US Supreme Court extended employment nondiscrimination protection to sexual minority adults. The health impacts of this ruling and similar policies related to sexual orientation–based discrimination are not currently known. Objective To estimate changes in mental health following the Bo...

Background Contraception knowledge and attitudes are largely formed from conversations within one’s social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy. Meth...

Background Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eri...

Objective: This study assesses differences in opioid use disorder (OUD) treatment among sexually and gender diverse (SGD) vs non-SGD people. Methods: Using electronic health record data from a federally qualified health center, this retrospective cohort study explores OUD treatment for adults with an OUD diagnosis, as well as any clinic visit from...

Sexual and gender minority (SGM) people experience worse health outcomes than their non-SGM counterparts. 1, 2 One driver of these inequi-ties is care avoidance due to anticipated and experienced discrimination. 3 Hospitals can foster inclusive and affirming care environments for SGM patients , including through their online presence. We assessed h...

Since 2020, there has been a significant cultural and political backlash in the USA to growing acceptance of gender diversity and gender-affirming care. Legislative attacks, particularly targeting gender-affirming care access for transgender and gender diverse youth, have occurred in a media environment rife with misinformation and disinformation....

Despite advances in HIV care and treatment in the U.S., disparities in outcomes along the HIV care continuum persist. The widespread replication of effective and sustainable interventions that prioritize the engagement of underserved populations has been identified as a promising path to ending the HIV epidemic in the U.S. Intervention disseminatio...

Since starting high school, Gary has been experiencing stress surrounding gender expression. Gary has always been considered "girly" by peers, wearing longer hair and traditionally feminine clothing. Now as a sophomore, Gary has been called names and assaulted by some of the boys at school who criticize Gary's appearance and mannerisms. Having grow...

Ever since the Cass Review was released in April—an evaluation by the United Kingdom’s National Health Service that has led to a ban on pubertysuppressing medication for transgender and gender diverse (TGD) youth—there has been criticism of the assessment and its recommendations, and concern about how it could be leveraged to more broadly affect pu...

Sexually and gender diverse (SGD) populations experience an increased prevalence and severity of posttraumatic stress disorder (PTSD) compared with the general population. Minority stress theory contextualizes this increased disease burden by outlining how stigma and discrimination (e.g., homophobia and transphobia) contribute to worse mental healt...

Background Contraception knowledge and attitudes are largely formed from conversations within one’s social network. More recently, this network has expanded to include social media. As the most used social media platform, we aimed to assess popular contraception videos on TikTok for content understandability and accuracy. Methods This is a seconda...

Lesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) youth with HIV face multiple barriers to progression along the HIV care continuum. We searched PubMed, PsycInfo, clinicaltrials.gov, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions for interventions focused on improving linkage to care, re...

Sexual and gender minority (SGM) adults experience poor health outcomes, in part due to frequent avoidance of necessary health care. Little is known, however, about factors contributing to patterns of health care utilization in this population. Using national data from the All of Us Research Program, this study evaluated the prevalence of care avoi...

The National Institutes of Health has designated transgender and gender-diverse (TGD) people as a population that experiences health disparities. A 2017 US study documented physical and mental health inequities between TGD and cisgender adults. 1 Since then, a record number of enacted laws has threatened the rights and protections of TGD people, in...

OBJECTIVES To reduce health inequities for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) people, healthcare professionals need increased access to education and training resources on LGBTQIA + health. Web-based, asynchronous, electronic learning (e-learning) resources are critical for...

Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC. MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduc...

This Viewpoint describes strategies for payers to improve health outcomes among sexual and gender minority people.

Fertility preservation is the process of collecting and storing oocytes, sperm, or reproductive tissue so that a person may retain their ability to have biologically related children. In instances of infertility caused by medical intervention or an underlying medical condition, this procedure is often sought by affected patient populations. U.S. Ti...

Since the inclusion of gender identity disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), psychiatry and the broader medical field have made substantial alterations in their recognition of and respect for transgender and gender diverse (TGD) identities. As this recognition continues to expand, psyc...

While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health M...

The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions withou...

The visibility of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) families is growing. Anti-LGBTQIA+ rhetoric and actions continue to shape the public discourse, legislation, and health care. This article highlights unique challenges and strengths of children raised by LGBTQIA+ parents....

Purpose Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults’ odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult’s...

Purpose: The study was designed to evaluate whether an educational intervention to train the health center (HC) staff to optimize care for sexual and gender minority (SGM) patients could improve documentation of sexual orientation and gender identity (SOGI) and increase preventive screenings. Methods: Twelve HCs were matched and randomized to eithe...

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. To evaluate the effect of GAHT delivered i...

The Authors respond: We appreciate Dr. Kalatunga-Moruzi's interest in our recent publication that, in a large sample of transgender and gender diverse (TGD) adults from the 2015 US Transgender Survey (USTS), examined the age at which people first came to understand their TGD identities and the age at which they first shared these with another perso...

Objectives To assess HIV pre-exposure prophylaxis (PrEP) provision in U.S. health centers (HCs). Design The U.S. Ending the HIV Epidemic (EHE) initiative designated HCs as the main health care system through which PrEP scale-up occurs. HCs offer primary care to over 30 million disproportionately uninsured, racially or ethnically minoritized, and l...

Purpose Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults’ odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult’s...

Disclosure: C.C. Pedreira: None. S. Tchir-Bourgeois: None. S. Tuli: None. A. Giancola: None. A.P. Lopez Lopez: None. A.S. Keuroghlian: None. M. Misra: None. J.M. Andreano: None. Background: In the last decade, there has been an increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and health care. Thes...

Disclosure: C.C. Pedreira: None. S. Tchir-Bourgeois: None. S. Tuli: None. A. Giancola: None. C. Loxton: None. A.S. Keuroghlian: None. M. Misra: None. J.M. Andreano: None. Background: Previous research has indicated that both acute gonadal hormone treatments and fluctuations in ovarian hormone levels over the course of the menstrual cycle can signif...

Objective: While sexually and gender diverse (SGD) people have higher odds of alcohol use disorder (AUD) compared to heterosexual and cisgender people, AUD treatment access and use disparities are not well characterized. The purpose of this study is to assess differences in AUD treatment among SGD versus non-SGD populations. Methods: A retrospectiv...

Objective: Increasing workforce capacity to provide knowledgeable, skilled, and affirming care for transgender and gender diverse people is critical to reduce health inequities; however, few clinicians receive sufficient training on this topic. This article describes Advancing Excellence in Transgender Health (AETH), an annual international confer...

Objective: We sought to describe the current Medicaid coverage landscape for gender-affirming surgery across the U.S. at the procedure level and identify factors associated with coverage. Summary background data: Medicaid coverage for gender-affirming surgery differs by state, despite a federal ban on gender identity-based discrimination in heal...

HIV pre-exposure prophylaxis (PrEP) is highly effective, but PrEP use has been suboptimal. We describe a telementoring program for clinics in high-HIV burden areas, focusing on systems-level practice transformation and care for populations disproportionately affected by HIV. We developed and delivered a telementoring program for U.S. health centers...

The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also i...

Objectives. To assess the performance of US federally qualified health centers (FQHCs) after 6 years of required sexual orientation and gender identity (SOGI) data reporting and update estimated proportions of sexual and gender minorities cared for at FQHCs. Methods. We conducted secondary analyses of data reported to the 2020 and 2021 Uniform Data...

Objectives. To assess the performance of US federally qualified health centers (FQHCs) after 6 years of required sexual orientation and gender identity (SOGI) data reporting and update estimated proportions of sexual and gender minorities cared for at FQHCs. Methods. We conducted secondary analyses of data reported to the 2020 and 2021 Uniform Data...

Congenital adrenal hyperplasia (CAH) is most often caused by adrenal deficiency of 21-hydroxylase (21-OH). The resulting increase in androgens can cause clitoromegaly in fetuses with XX chromosomes. 21-OH CAH is the most common reason for cosmetic clitoroplasty in childhood. "Nerve-sparing" (NS) clitoral reduction surgeries are described as offerin...

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Despite societal, legal, and cultural improvements in their well-being, sexual and gender minority (SGM) people in the United States still face substantial physical and mental health disparities that are exacerbated by physician stigma and lack of training. Although there have been efforts at medical schools nationwide to address these disparities...

The prevalence of alcohol misuse is high among people with HIV (PWH); however, access to and utilization of evidence-based alcohol misuse interventions remain limited. Telehealth is one treatment approach with the potential for enhancing substance use disorder treatment utilization for PWH served by Federally Qualified Health Centers (FQHCs). Howev...

With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, front-line, primary medic...

Purpose: The "rapid-onset gender dysphoria" (ROGD) hypothesis theorized, based on a parent-report survey, a distinct and more transient form of gender dysphoria in which individuals purportedly come to understand themselves as transgender and/or gender diverse (TGD) suddenly during adolescence. This study evaluated components of ROGD by (1) estima...

Purpose: Few clinicians have received training to provide comprehensive primary care for transgender and gender diverse (TGD) people. This article describes the program design and evaluation outcomes of TransECHO, a national professional development program for training primary care teams on the provision of affirming integrated medical and behavio...

Purpose: This study identified barriers and facilitators associated with providing culturally responsive care for sexual and gender minority (SGM) patients at federally qualified health centers (FQHCs) in the United States, from the perspective of clinical leadership. Methods: Between July and December 2018, 23 semistructured, in-depth qualitative...

Since then, there have been substantial policy, legislative (eg, Obergefell vs Hodges), and sociocultural shifts that may have differentially affected sexual minority subgroups by recognizing the constitutional right to marriage equality, expanding state-level pro-tections for LGB populations, and increasing public support for LGB-related issues. U...

Few studies have considered the diverse mental and physical health impacts of scarring among transgender and gender diverse (TGD) patients after medically necessary gender-affirming surgery (GAS). For some TGD patients, post-GAS scarring may exacerbate gender dysphoria. For others, it is a physical representation of authenticity. The dearth of rese...

Transgender and gender diverse (TGD) populations experience health disparities due to societal stigma that increases TGD individuals' sources of stress and decreases access to health protective resources. Research has linked experiences of stigma to risky alcohol use, yet there remains a dearth of culturally sensitive alcohol use interventions that...

This Viewpoint describes gatekeeping in gender-affirming care and provides recommendations to improve access to gender-affirming surgery for transgender people.

Purpose: Inadequate medical training in lesbian, gay, bisexual, transgender, queer, intersex, asexual, and sexually and gender diverse (LGBTQIA+) health care contributes to health disparities. This article reports on a novel 4-week elective course at Harvard Medical School that prepares students to become physician-leaders in LGBTQIA+ health care....

Background Multiple national organizations recommend that cancer care providers and oncology practices be responsive to the needs of sexual and gender minority (SGM) patients. Oncology practices have attempted to incorporate this recommendation through SGM-focused cultural humility training interventions. It is unclear how best to adapt and impleme...

The World Professional Association for Transgender Health (WPATH) is an international organization that aims to advocate for transgender and gender-diverse (TGD) people by promoting safe and effective ways to access and deliver healthcare to maximize psychological health and well-being. One way this is achieved is through the WPATH’s published Stan...

Purpose: Little is known about the prevalence and predictors of gender-affirming primary care (GAPC) access among rural transgender and gender diverse (TGD) adults. This study therefore sought to characterize the prevalence and predictors of GAPC within a sample of rural TGD adults. Methods: A nonprobability convenience sample (n = 244) of rural TG...

Problem: Sexual and gender minority (SGM) populations face numerous health disparities. Medical school curricula lack adequate educational content preparing students for serving SGM patients, and medical students typically do not experience welcoming, inclusive educational environments conducive to learning about SGM health care. Approach: In 20...

This Viewpoint discusses the potential effects of state-level legislation blocking access to gender-affirming care for US adolescents who identify as transgender.

OBJECTIVE Representatives of some pediatric gender clinics have reported an increase in transgender and gender diverse (TGD) adolescents presenting for care who were assigned female sex at birth (AFAB) relative to those assigned male sex at birth (AMAB). These data have been used to suggest that youth come to identify as TGD because of “social cont...

The integration of behavioral health services within HIV care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behav...

Purpose: This study was conducted to characterize documentation of sexual orientation and gender identity (SOGI) and provision of screening and preventive services in a diverse sample of community health centers (CHCs). Methods: Twelve CHCs provided data submitted to the Health Resources and Services Administration (HRSA) in 2018 from their Uniform...

ProblemLGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) people have unique health care needs related to their sexual orientation, gender identity and expression, and sex development. However, medical education has historically excluded LGBTQIA + health-related content in formal curricula...

The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients,...

Purpose: Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual and other sexual and gender diverse persons (LGBTQIA+ or SGD persons) experience barriers to equitable health care. The purpose of this article is to describe a collaborative process that resulted in core cultural competency recommendations addressing training for those w...

Problem: Sexual and gender minority (SGM) people face multiple health disparities. Clinicians often lack adequate training to address the health needs of SGM people. In this setting, some health care organizations have sought to develop system-wide curricula to build clinician knowledge and capacity around SGM health. Approach: NYC Health + Hosp...

Discrimination based on sexual orientation and gender identity (SOGI) negatively affects the health of sexual and gender minority (SGM) people (people who identify as LGBTQIA+) and functions as a barrier to care. 1 The Obama administration put in place federal regulations prohibiting SOGI discrimination in health care, based on an evolving understa...