Lauren Abern’s research while affiliated with Brown University and other places

INTRODUCTION Little is known about transmasculine and nonbinary individuals assigned female at birth and their experiences with emergency contraception (EC). Our goal is to determine use and reasons for EC choice in this population. METHODS Transmasculine and nonbinary individuals assigned female at birth aged 18 and older participated in an online anonymous survey about their experiences with reproductive health care. The study was IRB approved by Emory University. RESULTS Four hundred thirteen responded. The mean age was 34 (SD 8), and the majority identified as White (89%) and non-Hispanic (94%). Most were college educated (71%), and insured (91%). One hundred thirty-five (36%) needed EC, and 106 (79%) of those have used it: 62 (46%) before, 26 (19%) after, and 17 (13%) both before and after transitioning. Twenty-nine (67%) have taken EC while on testosterone. Five (17%) used ulipristal acetate (UA). Most (40%) chose UA because it was recommended by a clinician. No pregnancies (100%) occurred after UA. Twenty-three (79%) individuals used the levonorgestrel pill. The main reason was it did not require a prescription (41%). Eighty-two percent obtained levonorgestrel over the counter. Two (9%) became pregnant after taking it. Two (7%) opted for the copper IUD because it did not have hormones. Two (7%) chose the levonorgestrel IUD because it was long acting (50%) and recommended by a clinician (50%). Neither (100%) reported a pregnancy after either IUD. CONCLUSIONS/IMPLICATIONS Transmasculine and nonbinary individuals assigned female at birth do use EC both before and after transitioning, and while on testosterone. More research is needed to better determine side effects and acceptance for those on testosterone in this population.

INTRODUCTION Transgender and gender nonbinary individuals assigned female at birth (TGNB-AFAB) use contraceptives for a variety of reasons including menstrual suppression or pregnancy prevention. However, the use of contraceptives could trigger gender dysphoria and deter use. Our goal is to determine the effect of gendered advertisement on the use of contraceptives in this population. METHODS TGNB-AFAB individuals, ages 18 and older, participated in an online anonymous survey about their experiences with sexual and reproductive health care. The study was IRB approved by Emory University. RESULTS Ninety-two TGNB-AFAB individuals responded. The mean age was 34 (SD 7.8). The majority of respondents identified as White (89.3%) and non-Hispanic (94.0%). 66 (78.6%) were college educated. 33 (38.4%) respondents currently use contraception. Primary forms of contraception include oral contraceptives (15.6%), condoms (21.9%), intrauterine devices, and implants (21.9%). 38 (45.2%) reported gendered advertisement or packaging makes them less likely to use contraceptives and 62 (73.8%) believed gendered advertisement makes other TGNB-AFAB individuals less likely to use contraceptives. 36 (42.9%) respondents said they would be more likely to use contraceptives if the packaging were gender neutral or gender inclusive and 33 (39.3%) if it was marketed specifically for trangender and gender-diverse individuals. The data from this study are preliminary. CONCLUSION Contraceptive use is common in TGNB-AFAB; however, gendered advertising and packaging can be a deterrent for these individuals. Gender-neutral and/or gender-inclusive advertisement could potentially increase the use of contraceptives in this population.

Synopsis Providers should not overlook counseling LGBQPA cisgender women about the benefits of an IUD given their risk of unplanned pregnancy and desire for menstrual suppression.

Objective: To describe choices of transgender and gender diverse (TGD) late adolescents assigned female at birth regarding gender affirming surgery (GAS). Methods: Participants aged 18-21 completed an online survey which included demographics, surgical history, desire for GAS, and barriers to care. Results: Two hundred sixty surveys were completed. Forty-three (16.7%) underwent GAS. Of those who had not, 178 (83%) plan to do so in the future, and 15 (7%) reported no desire to undergo GAS. One hundred sixteen (54%) have not due to financial reasons, 54 (25%) due to insurance difficulties, and 28 (13%) were unable to find a surgeon. Discussion: TGD late adolescents assigned female at birth have varying desires for future GAS that align with their gender expression. They also face many barriers to care. It is important for healthcare providers to be aware of the unique desires of TGD adolescents, not assume any particular surgical path for gender affirmation, and acknowledge barriers experienced.

Purpose: This study aimed to evaluate access to fertility preservation appointments for egg-producing transgender and gender-diverse patients. Methods: Fertility clinics nationwide were identified through the 2018 National Assisted Reproductive Technology Surveillance System dataset of the Centers for Disease Control and Prevention. Using a mystery caller approach with a standardized, community-developed script, three researchers called 456 clinics between July and December 2020 identifying themselves as a transgender man seeking oocyte cryopreservation. Information was collected regarding access to fertility preservation for the caller. Univariate and multivariable logistic regression analysis were used to compare call outcomes by geographic region and clinic demographics. Results: Of 369 clinics included in the final analysis, 90.2% of clinics offered an initial appointment. A clinic that offered an appointment was four times more likely to be located on the West Coast (95% confidence interval [CI] 1.33-12.7; p = 0.014). Notably, endorsement of prior experience caring for transgender patients was most strongly associated with an appointment being offered (odds ratio = 7.31; 95% CI: 3.44-15.5; p < 0.001). Themes across some calls included a lack of knowledge about transgender identities and care models (e.g., requiring a letter of support) leading to additional steps (e.g., having to explain anatomy or being transferred to another staff member) before accessing an appointment. Conclusion: The majority of clinics offered an initial appointment to a caller identifying as a transgender man seeking oocyte cryopreservation, suggesting access to an initial appointment is not a major barrier.

This comprehensive and authoritative book is written by over seventy of the foremost experts working with the care of transgender and gender expansive patients for gynecologists and those working in neighboring disciplines. Among medical specialists, understanding of the complex reality and medical needs of transgender and gender diverse individuals is still limited. This book offers the opportunity to understand transgynecology in a way that is inclusive and up-to-date, with insights into liaison with specialties such as urology, dermatology, sexuology, physiotherapy amongst others. By contextualising transgender/gender diverse medicine before covering specific issues such as imaging, benign disorders, fertility maintenance, medico-legal concerns and uterine transplantation, this book is truly unique. Aimed at gynecologists, obstetricians, general practitioners, counsellors and all those who work with transgender, non-binary, or gender diverse patients, this book prepares the reader for the prerequisites and subtleties of transgynecology.

Transgender individuals are more than four times more likely than cisgender people to experience traumatic events such as rape and sexual assault. The purpose of this study is to determine the percentage of transgender individuals in our cohort that experienced sexual assault and homelessness. Transgender individuals aged 18-64 participated in an online survey that included demographics as well as social and reproductive history. 996 surveys were collected. The mean age was 28 (SD 10, range 18-64). The majority of participants were White (810; 85%), non-Hispanic (859; 89%), and had insurance (893; 90%). 787 (79%) individuals identified as transmasculine or assigned female at birth, and 209 (21%) identified as transfeminine or assigned male at birth. Of all transgender people, 47% have ever been sexually assaulted: 362 (50%) of transmasculine individuals, and 72 (37%) of transfeminine individuals. Although 19% had been homeless, 88% of all transgender people currently feel safe where they live. Even in our predominately White, well-insured population, many survey respondents relayed a history of sexual assault, and one in five had been homeless. As obstetrics and gynecology providers, we should be aware of these numbers and consider universal screening for trauma. We should focus on providing trauma-informed care to help establish a safe physical and emotional environment for patients.

Purpose: The prevalence of vulvar pain and dyspareunia has not been studied in trans masculine individuals. The aim of this study was to determine the prevalence of self-reported vulvar pain symptoms and dyspareunia in this population and investigate its relationship to gender-affirming hormone therapy with testosterone. Methods: Trans masculine individuals of ages 18-64 years participated in a voluntary online survey including questions about demographics, hormone therapy, and whether they experienced vulvar pain symptoms. The study was conducted between May 2017 and October 2018. Descriptive statistics were used to analyze the data. Results: A total of 782 trans masculine individuals completed the survey. The mean age was 27 years (standard deviation 8.6). The majority was White (661/778, 85.0%) and had private health insurance (517/781, 66.2%). Testosterone use was reported by 468 of 782 (59.8%) individuals, and 566 of 672 (84.2%) individuals had been sexually active in their lifetime. Unintentional pain with sexual intercourse was experienced by 372 of 605 (61.5%) participants. A total of 236 of 399 (59.1%) individuals utilized testosterone compared with 136 of 206 (66.0%) individuals who did not (p = 0.11). Of survey respondents, 68 of 710 (9.6%) individuals reported vulvar pain symptoms, and 42 of 452 (9.3%) individuals were on testosterone compared with 26 of 258 (10.1%) individuals not on testosterone (p = 0.79). Of all participants experiencing vulvar pain symptoms, 42 of 68 (61.8%) individuals were on testosterone. Conclusion: In this study, trans masculine individuals had a higher prevalence of dyspareunia than the general population, whereas the prevalence of vulvar pain was similar to that reported in cisgender women. The use of testosterone did not appear to increase the risk of developing unintentional pain with intercourse or vulvar pain symptoms.