Table 1.
Characteristics of studies included in the systematic review (N=77)
| # | Study | Location | N | Sample Descriptor | [Age range] Mean Age, SD |
% racial or ethnic minorities |
Cross-Sectional v. longitudinal v. RCT |
Approach |
|---|---|---|---|---|---|---|---|---|
| Adult Sample Populations | ||||||||
| ICD Code for Gender Dysphoria | ||||||||
| (1) | Blosnich et al. (2013) | U.S.-wide | 1326 | Veterans with ICD Code for gender identity disorder (FY00-FY11) | n.r.b | n.r. | Cross-Sectional | Chart Review |
| (2) | Blosnich et al. (2014) | U.S.-wide | 5117 | Veterans with ICD Codes for gender identity disorder, transsexualism, or transvestic fetishism (FY98-FY13) | n.r.b | n.r. | Cross-Sectional | Chart Review |
| (3) | Blosnich et al. (2016) | U.S.-wide | 1640 | Veterans with ICD Codes for gender identity disorder, transsexualism, or transvestic fetishism with 1 past-year medical visit (FY13) | [n.r.] 54.8, 13.2 | 18.8 | Cross-Sectional | Chart Review |
| (4) | Brown & Jones (2014)* | U.S.-wide | 5135 | Veterans with ICD Code for gender identity disorder (FY96-FY13) | White TG: [n.r.] 56.7,13.2 Black TG: [n.r.] 51.2,13.9 | 7.5 | Cross-Sectional | Chart Review |
| (5) | Brown & Jones (2015) | U.S.-wide | 4793 | Veterans with ICD Codes for gender identity disorder, transsexualism, or transvestic fetishism (FY00-FY13) | [n.r.] 55.5, 13.5 | 19.4 | Cross-Sectional | Chart Review |
| (6) | Brown & Jones (2016)* | U.S.-wide | 5135 | Veterans with ICD Codes for gender identity disorder, transsexualism, or transvestic fetishism (FY96-FY13) | [n.r.] 55.8, 13.5 | 19.8 | Cross-Sectional | Chart Review |
| (7) | Lindsay et al. (2016) | U.S.-wide | 332 | Veterans who served in Afghanistan with ICD Codes for gender identity disorder, transsexualism, transsexualism with asexual history; transsexual with homosexual history; transsexual with heterosexual history (FY00-FY13) | [n.r.] 33.9, 8 | 27.5 | Cross-Sectional | Chart Review |
| (8) | Reisner et al. (2014) | Boston, MA | 23 | Transmen who tested positive for sexually transmitted infection | [n.r.] 32, 7.3 | 52.2 | Cross-Sectional | Chart Review |
| Presenting for Services | ||||||||
| (9) | Keo-Meier et al. (2015) | Houston, TX | 43 | Transmen presenting for hormone treatment | [n.r.] 26.6, 8.4 | 26 | Prospective | Survey pre-post treatment |
| (10) | Leinung et al. (2013) | Albany, NY | 242(n = 192 TW, 50 TM) | Transgender clients who received hormone treatments | [n.r.] 36.3, 12.3 TW: [n.r.] 38, 12.5 TM: [n.r.] 29.9, 9.9 | n.r. | Cross-Sectional | Chart Review |
| (11) | Nemoto et al. (2005) | San Francisco, CA | 109 | Transwomen who participated in a workshop series (health, mental health, substance use, connection to services) hosted by community organization | n.r.b | n.r. | Prospective | Survey pre-post treatment |
| Presenting for Services; Self-Identified | ||||||||
| (12) | Cole et al. (1997) | n.r. | 435 | Transgender clients who presented for gender-related services | TW: [n.r.] 32, 9TM: [n.r.] 30, 8 | n.r. | Cross-Sectional | Chart review |
| Self-Identified | ||||||||
| (13) | Ainsworth & Spiegel (2010) | U.S.-wide | 247 | Transwomen who received facial feminization or genital surgeries | [n.r.] 49, n.r. | n.r. | Cross-Sectional | Web-Based Survey |
| (14) | Barr et al. (2016) | U.S.-wide | 571 | Transgender or gender non-conforming | [18–86] 31.0, 13 | 20 | Cross-Sectional | Web-Based Survey |
| (15) | Bazargan & Galvan (2012) | Los Angeles, CA | 220 | Latina Transwomen | [18+] n.r.a | 100 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (16) | Benotsch et al. (2013) | Mid-Atlantic Richmond, VA & Washington DC areas | 155 | Transgender individuals recruited at transgender health clinics or community venues | [n.r.] 31.9, 11.6 | 62.3 | Cross-Sectional | Survey |
| (17) | Bradford et al. (2013)* | VA, 44% cities and towns represented | 350 | Transgender or gender-non conforming [Virginia Transgender Health Initiative Study] | [n.r.] 37.2, 12.7 | 38 | Cross-Sectional | Web-Based Survey; Mail-In Survey |
| (18) | Budge et al. (2013) | U.S.-wide | 351 | Transwomen or Transmen, excluding non-binary and cross-dressing | [18–78] 40, 13 | 14 | Cross-Sectional | Web-Based Survey |
| (19) | Clements-Nolle et al. (2001)* | San Francisco, CA | 515(n = 392 TW, 123 TM) | Transgender or gender-nonconforming | TW: [18–67], 34, n.r. TM: [19–61], 36, n.r. | TW: 73 TM: 33 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (20) | Clements-Nolle et al. (2006)* | San Francisco, CA | 515(n = 392 TW, 123 TM) | Transgender or gender-nonconforming | TW: [18–67] 34, n.r. TM: [19–61] 37, n.r. | TW: 73 TM: 34 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (21) | Colton-Meier et al. (2011) | U.S.-wide | 369 | Transmen who self-identified as “female-to-male transsexuals” | [18–68] 28, n.r. | 23 | Cross-Sectional | Web-Based Survey |
| (22) | Dowshen et al. (2016) | 15 U.S. cities | 66 | Transgender youth living with HIV | [18–24] 21.1, 2.2 | n.r. | Cross-Sectional | Computer-Based Survey (CASI) |
| (23) | DuBois (2012) | Western MA; Boston, MA; Southern VT | 65 | Transmen using testosterone | [n.r.] 31.8, 9.1 | 26 | Cross-Sectional | Semi-Structured (Clinical) Interview |
| (24) | Flentje et al. (2014) | San Francisco, CA | 199(n = 146 TW, 53 TM) | Transgender clients accessing substance abuse treatment | [n.r.] 38.3, 13.5 | TW: 62.3 TM: 45.3 | Cross-Sectional | Chart Review |
| (25) | Flentje et al. (2016) | San Francisco, CA | 49 | Transgender individuals who were homeless | n.r.b | TW: 76 TM: 44 | Cross-Sectional | Survey |
| (26) | Fredriksen-Goldsen et al. (2013)* | U.S.-wide | 174 | Transgender sub-sample from survey of LGBT older adults (50+) [Aging with Pride Project] | [n.r.] 61, 9 | 21 | Cross-Sectional | Web-Based Survey; Mail-In Survey |
| (27) | Gameral et al. (2014) | San Francisco, CA | 191 | Couples; Transwomen with cisgender male partners | [n.r.] 36, 11 | 79 | Cross-Sectional | Computer-Based Survey (CASI) |
| (28) | Glynn et al. (2016) | San Francisco, CA | 573 | Transwomen with histories of sex work | [n.r.] 35.1, 9.4 | 79 | Cross-Sectional | Survey |
| (29) | Goldblum et al. (2012)* | VA (statewide) | 290 | Transgender or gender-nonconforming [Virginia Transgender Health Initiative Study] | [18–65] 37, 13 | 34 | Cross-Sectional | Web-Based Survey; Mail-In Survey |
| (30) | Horvath et al. (2014) | U.S.-wide, split rural non-rural | 1229 | Transgender people living in rural and non-rural communities | TW: [n.r.] 38, n.r.TM: [n.r.] 26.2, n.r. | 18.5 | Cross-Sectional | Web-Based Survey |
| (31) | Hoy-Ellis et al. (2017)* | U.S.-wide | 183 | Transgender sub-sample from survey of LGBT older adults (50+) [Aging with Pride Project] | [n.r.] 60.1, n.r. | 32 | Cross-Sectional | Web-Based Survey |
| (32) | Jefferson et al. (2013) | San Francisco, CA | 98 | Transwomen of color | [n.r.] 45, 9.8 | 100 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (33) | Kattari et al. (2016) | CO (statewide) | 417 | Transgender or gender-nonconforming[Colorado Transgender Health Survey-2014] | [n.r.] 38, n.r. | 16 | Cross-Sectional | Web-Based Survey; Mail-In Survey |
| (34) | Katz-Wise et al. (2017)* | MA | 452 | Transgender or gender-nonconforming [Project VOICE] | [n.r.] 33, 13 | 21 | Cross-Sectional | Web-Based Survey; Mail-In Survey |
| (35) | Keuroughlian et al. (2015)* | MA | 452 | Transgender or gender-nonconforming [Project VOICE] | [n.r.] 33.6, 12.8 | 20.6 | Cross-Sectional | Web-Based Survey |
| (36) | Lehavot et al. (2016) | U.S.-wide | 212(n = 186 TW, 26 TM) | Veterans who self-identified as transgender | [n.r.] 49.9, 14.9 | 10.4 | Cross-Sectional | Web-Based Survey |
| (37) | Maguen et al. (2010) | Boston, MA | 153(n = 125 TW, 28 TM) | Transgender or gender non-conforming conference attendees [2004] | [18–75] 47, 11 | 3(4 TW, 0 TM) | Cross-Sectional | Self-Report Survey |
| (38) | Mathy (2003) | U.S.-wide | 73 | Transgender sub-sample from online survey | [19–58] 37, 10 | n.r. | Cross-Sectional | Web-Based Survey |
| (39) | McDuffie & Brown(2010) | Clinic in TN | 70 | Veterans seeking treatment for gender-related concerns (FY87-FY07) | [20–70] n.r.a | 14 | Cross-Sectional | Chart Review |
| (40) | Meyer et al.(2017) | 19 U.S. states; Guam | 691 | Transgender sub-sample from a population based surveillance survey | n.r.b | n.r. | Cross-Sectional | Semi-Structured Phone Interview |
| (41) | Nemoto et al. (2015) | San Francisco & Oakland, CA | 235 | African-American Transwomen with history of sex work | [n.r.] 35.1, n.r. | 100 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (42) | Newfield et al. (2006) | San Francisco Bay area, CA | 376 | Transmen living in the U.S. | [n.r.] 32.6, 10.8 | 11 | Cross-Sectional | Web-Based Survey |
| (43) | Nuttbrock et al. (2010) | New York, NY | 571 | Transwomen (baseline) | [19–59] 37, n.r. | 73 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (44) | Nuttbrock et al. (2014) | New York, NY | 230 | Transwomen (baseline & follow-up) | [19–59] 34, n.r. | 65 | Prospective | Semi-Structured Face-to-Face Interview |
| (45) | Operario et al. (2011) | San Francisco Bay area, CA | 174 | Transwomen with cisgender male sexual partners | [18+] 37.8, 10.7 | 88 | Cross-Sectional | Computer-Based Survey (CASI) |
| (46) | Pflum et al. (2015) | U.S.; Canada | 865(n = 145 M, 106 W, 259 TM, 163 TW, 34 GQ-MaB, 158 GQ-FaB) | Transgender or gender-nonconforming | M: [n.r.] 31.9,11 W: [n.r.] 39.2, 16.2 TM: [n.r.] 30.9, 11.3 TW: [n.r.] 37.2, 14.9 GQ-MaB: [n.r.] 34.6, 13.9 GQ-FaB: [n.r.] 24.5, 7.1 | M: 13.8 W: 11.3 TM: 11.6 TW: 9.2 GQ-MaB: 5.9 GQ-FaB: 13.9 | Cross-Sectional | Web-Based Survey |
| (47) | Reisner et al. (2016a) | Boston, MA | Two Samples: 12, 17 | Transmen with cisgender male sexual partners | [18–29] 24.3, 2.8 | 3.5 | Prospective | Semi-Structured Face-to-Face Interview (pre-post) |
| (48) | Reisner et al. (2016b)* | MA | 452(n = 285 FTM, 167 MTF) | Transgender or gender-nonconforming [Project VOICE] | [n.r.] 33, 13 | 21 | Cross-Sectional | Web-Based Survey |
| (49) | Salzar et al. (2017) | Atlanta, GA | 92 | Transwomen with cisgender male sexual partners | [n.r.] 34, n.r. | 89 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (50) | Sanchez & Vilain(2009) | AZ, CA | 53 | Transwomen who attended a transgender conference | [21–77] 51, 11.6 | 14 | Cross-Sectional | Survey |
| (51) | Shipherd et al. (2010) | Boston, MA | 130 | Transgender or gender non-conforming conference attendees [2008] | [22–79] 49.2, 11 | 8 | Cross-Sectional | Survey |
| (52) | Shipherd et al. (2011) | Boston, MA | 97 (n=43 MTD, 54 LTD) | Transwomen conference attendees [2005] | [20–72] 47.5, 10.8 | 6–3.1 | Cross-Sectional | Survey |
| (53) | Shipherd et al. (2012) | Boston, MA | 141(n=43 veterans) | Transwomen conference attendees [2008] | [26–79] 51.6, 10.9 | 3.6 | Cross-Sectional | Survey |
| (54) | Stanton et al. (2017) | U.S.-wide | 376(n = 105 TW, 78 TM, 131 TO) | Transgender sub-sample from online survey [U.S. Social Justice Sexuality Survey] | [18–50+] n.r.a | 77 | Cross-Sectional | Web-Based Survey |
| (55) | Warren et al. (2016) | U.S.-wide | 208(n = 82 TW, 126 TM) | Transgender sub-sample from online survey of LGBT adults | TW: [18–65] 35, n.r.TM: [18–65] 27, n.r. | TW: 24 TM: 22 | Cross-Sectional | Web-Based Survey |
| (56) | White Hughto et al. (2017)* | MA | 412 | Transgender or gender-nonconforming [Project VOICE] | [18–75] 33, 13 | 21 | Cross-Sectional | Web-Based Survey |
| (57) | Wilson et al. (2014) | San Francisco, CA | 314 | Transwomen | n.r.b | n.r. | Cross-Sectional | Web-Based Survey |
| (58) | Bockting et al. (2013) | U.S.-wide, 57% rural | 1093 | Transgender and gender-nonconforming, including cross-dressing | [n.r.] 33, 12 | 21 | Cross-Sectional | Web-Based Survey |
| (59) | Yang et al. (2015) | San Francisco Bay area, CA | 191 | Transwomen with cisgender male sexual partners | [18 −50+] 38, 12 | 84 | Cross-Sectional | Computer-Based Survey (CASI) |
| Child/Adolescent/Young Adult Sample Populations | ||||||||
| ICD Code for Gender Dysphoria | ||||||||
| (60) | Peterson et al. (2016) | Cincinnati, OH | 96(n = 54 TM, 31 TW, 15 TO) | Transgender adolescents with gender dysphoria who presented to a transgender health clinic | [12–22] 17.1, 2.3 | n.r. | Cross-Sectional | Computer-Based Survey (CASI); Chart Review |
| (61) | Spack et al. (2012) | Boston, MA area | 97 | Youth with diagnosis of gender identity disorder (1998–2010) referred to a pediatric clinic, with parental support and letter from mental health provider | [4–20] 12.8, 3.4 | n.r. | Cross-Sectional | Semi-Structured (Clinical) Interview |
| (62) | Reisner et al. (2015a)* | Boston, MA area | 180(n = 105 FTM, 72 MTF) | Transgender youth receiving services at community health center | [12–29] 19.6, 3 | 53 | Cross-Sectional | Chart Review |
| (63) | Reisner et al. (2015b)* | Boston, MA area | 180(n = 105 FTM, 72 MTF) | Transgender youth receiving services at community health center | [12–29] 19.6, 3 | 53 | Cross-Sectional | Chart Review |
| Presenting for Services | ||||||||
| (64) | Chen et al. (2016) | Indianapolis, IN | 38 | Pediatric patients that received referral related to gender dysphoria | [n.r.] 14.4, 3.2 | 21.1 | Cross-Sectional | Chart Review |
| (65) | Simons et al. (2013) | Los Angeles, CA | 66 | Transgender youth presenting for care at a gender clinic | [12–24] 19, 3 | 48 | Cross-Sectional | Survey; Computer-Based Survey (CASI) |
| Self-Identified | ||||||||
| (66) | Brennan et al. (2012) | Chicago, IL; Los Angeles, CA | 151 | Transwomen living with HIV | [15–24] 21, 2.5 | 95 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (67) | Durwood et al. (2017) | 23 U.S. states; 1 Canadian province | Two samples: 63, 116 | Children who identified as a gender differing from their natal sex in everyday life by using pronouns associated with their asserted gender | [9–14] 10.8, 1.3 | 41 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (68) | Garofalo et al. (2006) | Chicago,` IL | 51 | Racial and ethnic minority transwomen | [16–25] 22, n.r. | 100 | Cross-Sectional | Survey |
| (69) | Le et al. (2016) | San Francisco, CA | 301 | Transwomen | [16–24] n.r.a | 63 | Cross-Sectional | Survey |
| (70) | Olson et al. (2015) | Los Angeles, CA | 96 | Transgender or gender-nonconforming, gender dysphoria, desire to receive cross-sex hormones, and naivety to hormone treatment | [12–24] 19.2, 2.9 | 48 | Cross-Sectional | Survey; Chart Review; Computer-Based Survey (CASI) |
| (71) | Olson et al. (2015) | 23 U.S. states; 1 Canadian province | 73 | Matched Controls; Children who identified as a gender differing from their natal sex in everyday life by using pronouns associated with their asserted gender | [3–12] 7.7, 2.2 | 30 | Cross-Sectional | Survey; Semi-Structured Face-to-Face Interview |
| (72) | Reisner, Biello et al. (2016) | Chicago, IL; Boston, MA | 298 | Sexually active transwomen with cisgender male sexual partners [Project LifeSkills] | [16–29] 23, 3.5 | 74 | Cross-Sectional | Semi-Structured Face-to-Face Interview |
| (73) | Reisner, Katz-Wise et al. (2016) | US-wide | 26 | Transgender sub-sample from online survey [Growing up Today Study 1] | [23–28] 25, n.r. | 25 | Cross-Sectional | Survey |
| (74) | Rowe et al. (2015)* | San Francisco, CA area | 292 | Transwomen, HIV-negative [The SHINE Study] | [16–24] 21, 2 | 63 | Cross-Sectional | Web-Based Survey |
| (75) | Russell et al. (2011) | San Francisco, CA area | 21 | Transgender sub-sample of LGBT youth survey [The Family Acceptance Project] | [21–25] 22.8, 1.4 | 53 | Cross-Sectional | Survey; Computer-Based Survey (CASI) |
| (76) | Sterzing et al. (2017) | US-wide | 310 | Transgender and genderqueer sub-sample of online survey for LGBT youth | [14–19] 16.4, 0.03 | 38 | Cross-Sectional | Survey; Web-Based Survey |
| (77) | Wilson et al. (2016)* | San Francisco, CA area | 216 | Transwomen, HIV-negative [The SHINE Study] | [16–24] n.r.a | 66 | Cross-Sectional | Survey |
a
= both mean age and SD not reported
b
= age range, mean age, and SD not reported
*
Studies 4 and 6 were from the same sample; Studies 17 and 29 were from same sample, the Virginia Transgender Health Initiative Study; Studies 19 and 20 were from same sample; Studies 26 and 31 were from same sample, the Aging with Pride Project; Studies 74 and 77 were from the same sample, The SHINE Study; Studies 34, 35, 56, and 48 were from the same sample, Project VOICE; Studies 62 and 63 were from the same sample.
NOTE: Italicized heading indicate how the TGNC sample was defined.
PTSD = post-traumatic stress disorder; TG = transgender; TW = transwomen; TM = transmen; TO = other transgender (non-binary/gender-fluid); FTM = female to male; MTF = male to female; GQ = genderqueer; W = women; M = men; MaB = male at birth; FaB = female at birth; MTD = more time dressed as women; LTD = less time dressed as women; AZ = Arizona; CA = California; CO = Colorado; GA = Georgia; IL = Illinois; IN = Indianapolis; MA = Massachusetts; NY = New York; OH = Ohio; TN = Tennessee; TX = Texas; VA = Virginia; VT = Vermont