Risultati per: Transgender – Competenze e ruoli del medico di medicina generale

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In Reply We appreciate the constructive feedback regarding our study on prostate cancer (PC) among transgender women published in JAMA Oncology.

To the Editor The recent study by Manfredi et al found a lower prevalence of prostate cancer (PC) in transgender women undergoing gender-affirming hormone therapy (GAHT), but a correlation between GAHT and more aggressive PC. We have concerns regarding the analyses and conclusions.

To the Editor Following the article by Manfredi et al regarding prostate cancer (PC) among transgender women, we are encouraged that the oncology community is taking an interest in this underserved group. However, we are concerned that the use of claims data for such studies, without sufficient methodological rigor, resulted in potentially inaccurate results. Our concern is that this may jeopardize access to gender-affirming hormone therapy (GAHT) for transgender people. This issue has been noted by other authors in response to similar methodologies.

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Progetto internisti-Caffè onlus per l’umanizzazione delle cure

Objectives
For transgender and gender-diverse (TGD) people, it is known that there is a lack of healthcare professionals with experience in trans healthcare. This may result in either inadequate provision of healthcare or in an increased seeking of adequate trans healthcare. Little is known about healthcare services utilisation and resulting costs in treatment-seeking TGD people with gender incongruence or gender dysphoria (GIC/GD). Therefore, the aim of this study was to determine the excess costs associated with GIC/GD in Germany.

Design
In a secondary analysis, baseline data of a randomised controlled trial with a sample of TGD people with GIC/GD were combined with data of a telephone survey conducted in a representative sample of the general German population. The data sets were matched using entropy balancing. Self-reported healthcare services utilisation was valued by standardised unit costs for the German healthcare system, and absenteeism from work and unemployment were valued with the gross hourly wage of persons in manufacturing and services sectors.

Settings
TGD people with GIC/GD living at least 50 km outside Hamburg in the federal state Bremen, Mecklenburg-Western Pomerania, Lower Saxony or Schleswig Holstein and the German general adult population.

Participants
Treatment-seeking TGD people with GIC/GD (n=167) and people of the general German population (n=2811).

Primary and secondary outcome measures
6-month excess healthcare costs and indirect costs from a societal perspective were calculated for the year 2020 using two-part models with logit specification for the first part and a generalised linear model with gamma family and log link function for the second part.

Results
The total 6-month excess costs associated with GIC/GD from a societal perspective were estimated to be 672 (95% CI: –3315 to 4657; p=0.741) per person. The direct excess healthcare costs were estimated to be 2 (–1115 to 1119; p=0.977) and the indirect excess costs due to absenteeism from work and unemployment were 669 (–3031 to 4370; p=0.723) per person. The total excess costs associated with GIC/GD in trans men, trans women and non-binary people were estimated to be –5572 (–12 232 to 1088), 4238 (–1694 to 10 170) and 3041 (–4268 to 10 351) per person (all with p >0.05), respectively.

Conclusions
The total 6-month costs in TGD people with GIC/GD did not differ statistically significantly from the costs in the general German population. Indirect excess costs due to absenteeism from work accounted for the largest part of the excess costs associated with GIC/GD, yet with wide 95% CIs. Potential causes of absenteeism from work, such as experienced or expected discrimination, need to be identified and addressed so that TGD people can experience a healthy work environment.

Trial registration number
NCT04290286.

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