Carl Streed

Boston Medical Center · Department of Medicine

Objective: To adapt and validate an algorithm to ascertain transgender and gender diverse (TGD) patients within electronic health record (EHR) data. Methods: Using a previously unvalidated algorithm of identifying TGD persons within administrative claims data in a multistep, hierarchical process, we validated this algorithm in an EHR data set wi...

Introduction: There is evidence that lesbian, gay, and bisexual (LGB) adults have poorer cardiovascular health than their heterosexual peers, but studies of the association between sexual orientation (SO) and diabetes mellitus (DM) have been few. Prior studies have largely been cross-sectional, rely on self-reported data, and have small sample size...

A higher burden of cardiovascular disease risk factors has been reported in sexual minority populations (SM), such as lesbian, gay, bisexual, and non-heterosexual, compared to heterosexual populations. Therefore, primordial prevention, i.e., preventing risk factor onset in the first place, may be a relevant preventative strategy in this population....

Importance: Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions. Objective: To investigate sexual identity differences in CVH, measured using the American H...

Transgender and gender-diverse (TGD) people are disproportionately impacted by incarceration, interpersonal violence, HIV and other sexually transmitted infections, substance use disorders, and suicidality. Little is known about successful approaches to improve health outcomes for TGD individuals impacted by incarceration. We review the barriers to...

LGBTQ+ adults with disabilities describe their experiences interacting with healthcare providers and how they make decisions about which aspects of their identity to reveal.

Gender diverse adults with disabilities have greater unmet care needs than cisgender adults with disabilities.

Background Over 1.4 million US adults identify as transgender when gender identity differs from the sex assigned at birth [1]. Although transgender patients face adverse health outcomes, they remain an understudied population [2]. A 2017 study surveyed 411 practicing clinicians and found that 80% had been involved in treating a transgender patient,...

This preprint is a response to a recent article in Pediatrics by Turban et al. “Sex Assigned at Birth Ratio Among Transgender and Gender Diverse Adolescents in the United States” and highlights the methodological and theoretical shortcomings of their approach and analysis.

Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distribute...

Importance: Although HIV preexposure prophylaxis (PrEP) implementation among persons who inject drugs has been inadequate, national HIV monitoring programs do not include data on PrEP, and specific trends in PrEP use are not well understood. Objective: To estimate HIV PrEP uptake among commercially insured persons with opioid or stimulant use di...

It has been over 50 years since the Stonewall Inn Riots in June 1969, a seminal event for the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender diverse minorities' (LGBTQI+, or lesbian, gay, bisexual, transgender, queer, intersex, and everyone else) rights movement. However, sexual and gender minority (SGM) individua...

The purpose of this article is to provide guidance on completing a thorough, competent, and culturally appropriate health history with details specific to the care of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons and communities.

Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the od...

Background The coronavirus disease 2019 (COVID-19) pandemic has challenged researchers performing clinical trials to develop innovative approaches to mitigate infectious risk while maintaining rigorous safety monitoring. Methods In this report we describe the implementation of a novel exclusively remote randomized clinical trial (ClinicalTrials.go...

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and p...

Objectives: In the midst of the opioid crisis, increasing attention has been given to assessing and addressing substance use disorders (SUDs) among transgender and gender diverse (TGD) populations. As electronic health records begin to more uniformly collect gender identity data, clinicians and public health professionals are better able to examin...

Background: Because of concerns about sexual minorities' poor cancer survivorship, this study compared cancer survivors' health outcomes in relation to multiple intersecting social positions, namely gender, sexual orientation, and race/ethnicity. Methods: This secondary data analysis used 2014-2019 Behavior Risk Factor Surveillance Survey data....

Purpose: We examined the health of sexual and gender minority (SGM) adults with disabilities compared with their non-SGM peers. Methods: The National Survey on Health and Disability is an internet-based survey fielded October 2019 through January 2020. We performed bivariate analyses to compare sociodemographic factors, disability type, and health...

Introduction Existing data on cardiovascular disease among transgender people are inconsistent and are derived from nonrepresentative samples or population-based data sets that do not include transgender-specific risk factors such as gender-affirming hormone use and gender minority stressors. A nationally representative sample of cisgender and tran...

Purpose: As feminizing gender-affirming surgery becomes increasingly accessible, functional outcomes are increasingly relevant. We aim to develop and validate the first patient-reported outcome questionnaire focusing on postoperative symptomatology and quality of life. Material and methods: Questions were developed from interviews with postopera...

There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behavio...

For years, physicians have debated how best to care for children with differences in sex development (DSD, also termed intersex). Stories of suffering of adults who underwent early surgical intervention for DSD have led many health organizations to call for deferral of unnecessary procedures. While some have instituted full deferral of cosmetic pro...

Historically, the majority of differences in sex development or intersex trait (dsd/I)-specific medical care has been provided by pediatric clinicians, leading to a dearth of adult clinicians qualified to care for this vulnerable population, and pediatricians reticent to transition patients to adult care. Recent changes in routine care of children...

Problem: Medical education aspires to mitigate bias in future professionals by providing robust curricula that include perspectives of and practices for caring for sexual and gender minority (SGM) populations; however, implementation of these ideals remains challenging. Medical school leaders motivated to improve curricula on caring for SGM popula...

Purpose: We examined the association of sexual orientation change efforts (SOCE) with past-week depressive symptoms and past 12-month suicidal ideation and suicide attempts among Korean lesbian, gay, and bisexual adults. Methods: A cross-sectional study of 2168 participants was used. Lifetime SOCE was classified as "never experienced," "been advis...

The annual examination is a comprehensive evaluation of patients in which all aspects of health and well-being are considered, including proper screening, appropriate preventive care, and recommendations and resources for healthy living. Clinicians commonly avoid certain topics with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients be...

For every gap in health and well-being whose contours we have mapped, the widespread lack of comprehensive data collection means that many more disparities — and the policy and programmatic interventions that might address them — remain unknown.

Growing evidence indicates that sexual and gender minority populations might be at greater risk of cardiovascular disease than the general population. Additional population and clinical health research is needed to inform the development of tailored, evidence-based interventions to promote the cardiovascular health of sexual and gender minority pop...

Background: Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category. Objective: The objective of this study was to quantify differences in health care satisfaction among transgender men, trans...

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Prior research has revealed sexual minority youth are more likely to carry weapons both outside of and within school. However, to date, no study has examined the degree to which bullying and harassment is associated with weapon carrying among sexual minority youth. We utilized the Youth Risk Behavior Survey to examine the prevalence and likelihood...

UNSTRUCTURED The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider au...

Background: The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider aud...

There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This America...

Importance Coming out as lesbian, gay, bisexual, or other identities besides heterosexual (LGB+) may represent a susceptible period for cigarette smoking initiation in youth and young adults. Objective To assess whether young people who change their sexual identity have higher risk of cigarette smoking initiation and current smoking compared with...

BACKGROUND The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider audi...

Background: Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. Objective: The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. Resear...

While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and g...

An increasing number of young adolescents who identify as transgender or nonbinary are presenting to the health care system for gender affirmation therapy before the full progression of puberty. Gender-affirming therapy may impair future fertility, but options exist for fertility preservation. This perspective reviews these options for transmasculi...

We explored the health and health care experiences of people with autism spectrum disorder (ASD) who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) using data from a national, internet-based survey of adults with disabilities supplemented by focused interviews. LGBTQ+ respondents had significantly higher rates of mental illness,...

Over the last 70 years, the emergency department (ED) has developed into one of the key access points for medical care. The ED has three primary care functions (1) stabilization of critically ill patients, (2) acute diagnostic care, and (3) health care access and treatment linkage. It is often the main entry point of the hospital and provides a med...

There is a tendency to reduce all LGBTQ health to issues of sexual health, but the well-being of LGBTQ people goes far beyond sexual health. Conversely, sexual health is not an issue specific to LGBTQ populations; it is equally important to LGBTQ individuals as others. Although certain sexual experiences, behaviors, and risks are more commonly asso...

This chapter discusses basic principles for an ongoing care relationship with adult LGBTQ patients. Adult primary care encompasses a vast array of topics. In this chapter, the following areas will be discussed: the role of the primary care provider with an emphasis on advocacy; provision of counseling and patient education for common health concern...

This first-of-its-kind textbook marks a revolutionary effort to reform medical education nationally by providing a comprehensive, high-quality resource to serve as a foundation for lesbian, gay, bisexual, transgender, and queer (LGBTQ) health education across multiple disciplines. Addressing the decades-long unequal weight of medical education gene...

Despite long-standing opposition among professional medical organizations and documented harms, most states have not banned conversion therapy — efforts to change people’s sexual orientation — for minors.

Purpose: The study purpose was to describe trends in the size and demographics of the population of transgender Medicare beneficiaries identified using International Classification of Diseases (ICD) Clinical Modification codes over time. We also assessed how the change from ICD, Ninth Revision (ICD-9) diagnosis codes to ICD, 10th Revision (ICD-10)...

Background Pre-exposure prophylaxis (PrEP) for HIV is effective, yet many providers continue to lack knowledge and comfort in providing this intervention. It remains unclear whether internal medicine (IM) residents receive appropriate training in PrEP care and if this affects their future practices. Objective We sought to evaluate the relationship...

Background Recognizing the unique health needs of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer/questioning individuals) is critical to providing competent and comprehensive healthcare. Objective To assess resident knowledge of healthcare issues uniquely affecting sexual and gender minorities as well as the role of...

Purpose of Review Sexual and gender minority (SGM) populations, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, continue to experience significant health and healthcare disparities. One mechanism proposed to address these disparities is improving the education of healthcare professionals. This narrative review summariz...

Purpose: This study compares the health status of gender nonconforming transgender adults with gender-binary transgender peers (i.e., transgender men and transgender women). Methods: We performed a retrospective analysis of the 2014-2016 Behavioral Risk Factor Surveillance System. Results: After adjustment for sociodemographic characteristics,...

Background A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to ca...

Currently, there are limited resources and training available for otolaryngologists and otolaryngology practice personnel to provide gender-affirming care for transgender or gender nonconforming patients. This unique patient population may present to our offices for gender-specific care or with complaints of the ear, nose, and throat unrelated to g...

Introduction This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health car...

Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The...

To the Editor In “What Surgeons Need to Know About Gender Confirmation Surgery When Providing Care for Transgender Individuals: A Review,” Berli et al¹ highlight the field of gender confirmation surgery in the United States. While this article offers important information all surgeons providing care to transgender patients should know, it also cont...

Healthcare practitioners (e.g., nurses, physicians, physician associates/assistants) face a variety of rewards and challenges both during training and later in clinical practice and other professional workplace settings. A growing body of research on the challenges faced by healthcare practitioners identifies key factors associated with “burn-out,”...

Purpose: Researchers struggle to find effective ways to measure sexual and gender identities to determine whether there are health differences among subsets of the LGBTQ+ population. Method: This study examines responses on the National Health Interview Survey (NHIS) sexual identity questions among 277 LGBTQ+ healthcare providers. Results: Eig...

Lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) healthcare providers face both general work-related stresses and working in heteronormative settings with ill-informed or hostile coworkers and patients, yet there has been little study of whether the coping strategies are specific to LGBTQ+ stress. We analyzed qu...

To the Editor In a Viewpoint, Drs Clayton and Tannebaum¹ highlighted the importance of appropriately reporting sex and gender in clinical research. However, their recommendations to report sex (male, female) and gender (man, woman) fall short of the realities of patients’ genetic, biological, and lived experiences and the effects on their health an...

To provide complete and appropriate care for patients requires an open dialogue built on trust. However, health care providers have an uphill climb to creating such a trusting relationship with their Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI) patients. As with any clinical encounter for the seasoned health care provider, determining...

The World Health Organization's (WHO) new recommendation to encourage pre-exposure prophylaxis in men who have sex with men (MSM) is an important step towards eradicating the HIV epidemic. However, the ethical issues of stigma, privacy and confidentiality, and access must be addressed in order to ensure the optimal implementation of this important...