Table 1.
Studies and study characteristics included in systematic review.
| Study ID | Study sample | Country | Sampling method | Study design | Trans sample size | Chronic condition outcomes |
|---|---|---|---|---|---|---|
| ASIA | ||||||
| (Chen et al., 2019) | Transgender people | China | Convenience | Cross-sectional | 1309 | Mental health and substance use disorders |
| (Kalra and Shah, 2013) | Hijras accessing an STI clinic | India | Clinical | Cross-sectional | 50 | Mental health and substance use disorders |
| (Baba et al., 2011) | Transgender men patients at a GID clinic | Japan | Clinical | Cross-sectional | 178 | Metabolic and endocrine disorders |
| (Hoshiai et al., 2010) | GID clinic patients | Japan | Clinical | Cross-sectional | 579 | Mental health and substance use disorders |
| (Rutledge et al., 2018) | Transgender women | Malaysia | Convenience | Cross-sectional | 199 | Mental health and substance use disorders |
| (Lim et al., 2019) | Transgender OBGYN clinic patients | South Korea | EMR | Cross-sectional | 54 | Mental health and substance use disorders |
| EUROPE | ||||||
| (Cuypere et al., 1995) | Applicants for GAS at a gender identity clinic | Belgium | Clinical | Cross-sectional | 35 | Mental health and substance use disorders |
| (Defreyne et al., 2017) | Transgender endocrine clinic patients starting GAHT | Belgium | Clinical | Cross-sectional | 1081 | Metabolic and endocrine disorders |
| (Weyers et al., 2009) | Transsexual women accessing GAS | Belgium | Clinical | Cross-sectional | 50 | Unspecified and other diseases |
| (Wierckx et al., 2013) | Transgender gender clinic patients accessing GAHT, with cisgender control group | Belgium | Clinical | Cross-sectional | 352 | Cerebro/Cardiovascular diseases |
| (Simonsen et al., 2016) | Transsexual people accessing GAS at a public GID clinic | Denmark | EMR | Retrospective cohort | 104 | Cancer; Cerebro/Cardiovascular diseases; Chronic liver and kidney disease; Other and unspecified diseases; Respiratory disease |
| (Simonsen et al., 2016) | Transsexual people accessing GAS at a public GID clinic | Denmark | EMR | Retrospective cohort | 104 | Mental health and substance use disorders |
| (Holt et al., 2016) | Youth referred to a gender identity clinic | England | Clinical | Cross-sectional | 218 | Mental health and substance use disorders |
| Judge et al. (Judge et al., 2014) | Endocrine clinic patients with suspected or confirmed GD referred for GAHT | Ireland | Clinical | Cross-sectional | 218 | Cerebro/Cardiovascular conditions; Metabolic and endocrine disorders; Mental health and substance use disorders |
| (Colizzi et al., 2014) | Transgender patients at a gender identity clinic | Italy | Clinical | Prospective cohort | 118 | Mental health and substance use disorders |
| (Fisher et al., 2013) | Patients with GID at a GID clinic, without previous GAS | Italy | Clinical | Cross-sectional | 140 | Mental health and substance use disorders |
| (Madeddu et al., 2009) | Transsexual GID psychiatric clinic patients seeking GAS | Italy | Clinical | Cross-sectional | 50 | Mental health and substance use disorders |
| (Heylens et al., 2014) | Adults with GID seeking GAHT/GAS at gender clinics | Multiple (The Netherlands, Belgium, Germany, Norway) | Clinical | Cross-sectional | 305 | Mental health and substance use disorders |
| (Haraldsen and Dahl, 2000) | Transsexual patients with GAS history and cisgender personality disorder patients and cisgender healthy controls | Norway | Clinical | Cross-sectional | 86 | Mental health and substance use disorders |
| (Duišin et al., 2014) | Transgender psychiatric clinic patients and cisgender heterosexual comparison group | Serbia | Clinical | Cross-sectional | 30 | Mental health and substance use disorders |
| (Becerra-Fernandez et al., 2014) | Transgender men patients with GD diagnosis at GID clinic | Spain | Clinical | Cross-sectional | 77 | Metabolic and endocrine disorders |
| (Bergero-Miguel et al., 2016) | Transgender patients with GD at a public gender identity clinic | Spain | Clinical | Cross-sectional | 210 | Mental health and substance use disorders |
| (Gómez-Gil et al., 2009) | Transsexual patients with GD seeking GAS/GAHT | Spain | Clinical | Cross-sectional | 230 | Mental health and substance use disorders |
| (Guzmán-Parra et al., 2016) | Transsexual patients of a gender identity clinic | Spain | Clinical | Cross-sectional | 197 | Mental health and substance use disorders |
| (Vilas et al., 2014) | Transgender gender disorder clinic patients accessing GAHT | Spain | Clinical | Prospective cohort | 157 | Metabolic and endocrine disorders |
| (Bodlund and Kullgren, 1996) | Transsexual patients accessing GAS | Sweden | Clinical | Prospective cohort | 19 | Mental health and substance use disorders |
| (Hepp et al., 2005) | Psychiatric clinic patients with GID | Switzerland | Clinical | Cross-sectional | 31 | Mental health and substance use disorders |
| (de Vries et al., 2011) | Adolescent gender identity clinic patients with GID | The Netherlands | Clinical | Cross-sectional | 105 | Mental health and substance use disorders |
| (Gooren et al., 2013) | Transsexual patients accessing GAHT | The Netherlands | EMR | Retrospective cohort | 3102 | Cancer |
| (Gooren and Morgentaler, 2014) | Transsexual women gender clinic patients with history of GAHT and orchiectomy | The Netherlands | EMR | Retrospective cohort | 2306 | Cancer |
| (Van Kesteren et al., 1997) | Transsexuals receiving GAHT | The Netherlands | EMR | Retrospective cohort | 1109 | Cerebro/Cardiovascular diseases |
| (Wallien et al., 2007) | Dutch children referred to a GID clinic, and a comparison group of children referred to an ADHD clinic | The Netherlands | Clinical | Cross-sectional | 120 | Mental health and substance use disorders |
| LATIN AMERICA | ||||||
| (Fontanari et al., 2018) | Transgender women patients at a GD clinic | Brazil | Clinical | Cross-sectional | 289 | Mental health and substance use disorders |
| (Lobato et al., 2007) | Transsexual patients in a GID program | Brazil | Clinical | Cross-sectional | 138 | Mental health and substance use disorders |
| MIDDLE EAST AND NORTHERN AFRICA REGION | ||||||
| (Aghabikloo et al., 2012) | Patients with GID seeking GAS | Iran | Clinical | Cross-sectional | 69 | Mental health and substance use disorders |
| (Havar et al., 2015) | Patients with GID accessing GAS | Iran | Clinical | Cross-sectional | 108 | Mental health and substance use disorders |
| (Mazaheri Meybodi et al., 2014) | Transsexual psychiatric clinic patients with GID | Iran | Clinical | Cross-sectional | 83 | Mental health and substance use disorders |
| (Ibrahim et al., 2016) | Transgender and cisgender adult controls | Lebanon | RDS/Snowball | Cross-sectional | 20 | Mental health and substance use disorders |
| (Basar and Oz, 2016) | GD diagnosed psychiatric clinic patients | Turkey | Clinical | Cross-sectional | 116 | Mental health and substance use disorders |
| (Yildirim et al., 2017) | Children and adolescent psychiatric clinic patients with GID and a matched control group with non-GID diagnoses | Turkey | Clinical | Matched cross-sectional | 20 | Mental health and substance use disorders |
| NORTH AMERICA | ||||||
| (Chiniara et al., 2018) | Adolescents presenting to a transgender youth clinic | Canada | Clinical | Cross-sectional | 203 | Mental health and substance use disorders |
| (Drummond et al., 2018) | Assigned female sex at birth patients referred to a gender identity clinic as youth | Canada | Clinical | Prospective cohort | 25 | Mental health and substance use disorders |
| (Heard et al., 2018) | Transgender youth patients of a GD program | Canada | Clinical | Cross-sectional | 174 | Mental health and substance use disorders |
| (Rotondi et al., 2011) | Transfeminine adults | Canada | RDS/Snowball | Cross-sectional | 186 | Mental health and substance use disorders |
| (Rotondi et al., 2011) | Transmasculine adults | Canada | RDS/Snowball | Cross-sectional | 205 | Mental health and substance use disorders |
| (Williams et al., 2017) | Women and transgender/gender liminal people | Canada | Convenience | Cross-sectional | 193 | Mental health and substance use disorders |
| (Becerra-Culqui et al., 2018) | Transgender youth patients | United States | EMR | Matched cross-sectional | 1333 | Mental health and substance use disorders |
| (Beckwith et al., 2017) | HIV-positive adults with criminal justice system involvement history | United States | Convenience | Randomized controlled trial | 20 | Mental health and substance use disorders |
| (Beckwith et al., 2017) | Transgender patients at an LGBT community clinic | United States | EMR | Cross-sectional | 145 | Mental health and substance use disorders |
| (Brocksmith et al., 2018) | Pediatric endocrine clinic patients with GD diagnosis | United States | Clinical | Cross-sectional | 78 | Metabolic and endocrine disorders |
| (Brown and Jones, 2016) | Veterans | United States | EMR | Matched case-control | 5135 | Cancer; Cerebro/Cardiovascular diseases; Chronic liver and kidney disease; Mental health and substance use disorders; Metabolic and endocrine disorders; Other and unspecified diseases; Respiratory disease |
| (Chen et al., 2016) | Pediatric endocrinology clinic patients referred for GD | United States | Clinical | Retrospective cohort | 38 | Mental health and substance use disorders |
| (Cole et al., 1997) | Individuals presenting to a gender clinic with GD or transsexualism | United States | Clinical | Cross-sectional | 435 | Mental health and substance use disorders |
| (Dai and Hao, 2019) | Adults | United States | Probability-based | Cross-sectional | 669 | Cancer; Cerebro/Cardiovascular diseases; Chronic liver and kidney disease; Mental health and substance use disorders; Metabolic and endocrine disorders; Other and unspecified chronic diseases; Respiratory conditions |
| (Dawson et al., 2017) | Amazon Mechanical Turk workers | United States | Convenience | Cross-sectional | 54 | Mental health and substance use disorders |
| (Dragon et al., 2017) | Medicare beneficiaries | United States | EMR | Cross-sectional | 7454 | Cancer; Cerebro/Cardiovascular conditions; Chronic liver and kidney disease; Mental health and substance use disorders; Metabolic and endocrine disorders; Other and unspecified diseases; Respiratory disease |
| (Flentje et al., 2014) | People entering publicly funded substance abuse treatment | United States | EMR | Cross-sectional | 199 | Mental health and substance use disorders |
| (Flentje et al., 2016) | Urban homeless sexual and gender minorities | United States | Convenience | Cross-sectional | 49 | Mental health and substance use disorders; Unspecified and other diseases |
| (Gaither et al., 2017) | Transgender women patients seeking GAS from a high-volume surgeon | United States | Clinical | Cross-sectional | 330 | Cerebro/Cardiovascular diseases; Mental health and substance use disorders; Metabolic and endocrine disorders; Respiratory disease; Unspecified and other diseases |
| (Hill et al., 2016) | Transgender veterans and active duty service members | United States | Convenience | Cross-sectional | 106 | Cancer; Cerebro/Cardiovascular diseases; Mental health and substance use disorders; Metabolic and endocrine disorders; Other and unspecified diseases; Respiratory disease |
| (Hutchison et al., 2018) | Transgender patients in a state cancer registry | United States | EMR | Retrospective cohort | 230 | Cancer |
| (Jarin et al., 2017) | Adolescent patients with GD on GAHT | United States | EMR | Retrospective cohort | 116 | Mental health and substance use disorders |
| (Katz-Wise et al., 2017) | Transgender and gender non-conforming adults | United States | Convenience | Cross-sectional | 452 | Mental health and substance use disorders |
| (Katz-Wise et al., 2018) | Transgender and gender non-conforming youth and their families | United States | Convenience | Cross-sectional | 33 | Mental health and substance use disorders |
| (Keuroghlian et al., 2015) | Transgender and gender non-conforming adults | United States | Convenience | Cross-sectional | 452 | Mental health and substance use disorders |
| (Klemmer et al., 2018) | Transgender women | United States | RDS/Snowball | Cross-sectional | 233 | Mental health and substance use disorders |
| (Lindsay et al., 2016) | Transgender veterans of Iraq or Afghanistan accessing the VHA | United States | EMR | Cross-sectional | 332 | Mental health and substance use disorders |
| (Liu et al., 2019) | College students | United States | Probability-based | Cross-sectional | 301 | Mental health and substance use disorders |
| (Lothstein, 1980) | Adolescent gender identity clinic patients seeking GAS | United States | Clinical | Prospective cohort | 27 | Mental health and substance use disorders |
| (Lytle et al., 2016) | College students | United States | Probability-based | Cross-sectional | 123 | Mental health and substance use disorders |
| (Mustanski et al., 2010) | LGBT youth | United States | Convenience | Cross-sectional | 20 | Mental health and substance use disorders |
| (Nahata et al., 2017) | Transgender adolescents at an urban clinical gender program, referred for GAHT | United States | EMR | Cross-sectional | 79 | Mental health and substance use disorders |
| (Nokoff et al., 2018) | Adults | United States | Probability-based | Cross-sectional | 764 | Cerebro/Cardiovascular diseases; Metabolic and endocrine disorders |
| (Nuttbrock et al., 2015) | Transgender women | United States | Convenience | Prospective cohort | 230 | Mental health and substance use disorders |
| (Odo and Hawelu, 2001) | Native Hawaiian transgender women HIV prevention program clients and general population comparison group | United States | Clinical | Cross-sectional | 100 | Metabolic and endocrine disorders |
| (Quinn et al., 2017) | Transgender health system patients, and cisgender matched comparison group | United States | EMR | Matched cross-sectional | 6456 | Cancer; Cerebro/Cardiovascular diseases; Mental health and substance use disorders; Metabolic and endocrine disorders |
| (Qureshi et al., 2018) | LGBT adults | United States | Convenience | Cross-sectional | 27 | Cerebro/Cardiovascular diseases |
| (Reisner et al., 2013) | Transmasculine adult attendees of a transgender health conference | United States | Convenience | Cross-sectional | 73 | Mental health and substance use disorders; Metabolic and endocrine disorders; Respiratory disease |
| (Reisner et al., 2014) | Transgender men accessing STI testing at an LGBT community clinic | United States | EMR | Cross-sectional | 23 | Mental health and substance use disorders |
| (Reisner et al., 2015) | Transgender youth/young adult patients of an adolescent urban community health center, and matched cisgender controls | United States | EMR | Matched cross-sectional | 180 | Mental health and substance use disorders |
| (Reisner et al., 2016) | Young transgender women | United States | Convenience | Cross-sectional | 298 | Mental health and substance use disorders |
| (Reisner et al., 2016) | Transmasculine adults who have sex with cisgender men | United States | Convenience | Cross-sectional | 173 | Mental health and substance use disorders |
| (Seelman et al., 2017) | Transgender and gender non-conforming adults | United States | Convenience | Cross-sectional | 417 | Cerebro/Cardiovascular diseases; Mental health and substance use disorders; Metabolic and endocrine disorders; Respiratory disease |
| (Silverberg et al., 2017) | Transgender health system patients, and cisgender matched comparison group | United States | EMR | Matched retrospective cohort | 4889 | Cancer |
| (Spack et al., 2012) | Children and adolescents with GID referred for care to a multidisciplinary gender clinic | United States | Clinical | Cross-sectional | 97 | Mental health and substance use disorders |
| (Vankim et al., 2014) | College students | United States | Probability-based | Cross-sectional | 53 | Metabolic and endocrine disorders |
| (Warren et al., 2016) | LGBT adults | United States | Convenience | Cross-sectional | 208 | Metabolic and endocrine disorders |
| (White Hughto and Reisner, 2018) | Transgender and gender non-conforming older adults | United States | Convenience | Cross-sectional | 452 | Unspecified and other diseases |
| (Wilson et al., 2015) | Transgender women | United States | RDS/Snowball | Cross-sectional | 314 | Mental health and substance use disorders |
| OCEANIA | ||||||
| (Bolger et al., 2014) | Transgender men | Australia | Convenience | Cross-sectional | 279 | Mental health and substance use disorders |
| (Cheung et al., 2018) | New patients with GD at an endocrine and a primary care clinic | Australia | EMR | Cross-sectional | 540 | Cancer; Cerebro/Cardiovascular diseases; Chronic liver and kidney disease; Mental health and substance use disorders; Respiratory disease |
| (Pitts et al., 2009) | Transgender people | Multiple: Australia, New Zealand | Convenience | Cross-sectional | 253 | Mental health and substance use disorders |
| MULTIPLE/GLOBAL | ||||||
| (Witten, 2014) | Transgender adults | Multiple (24 countries including primarily United States, Canada, Australia, Sweden, United Kingdom) | RDS/Snowball | Cross-sectional | 1963 | Unspecified and other disease |
Abbreviations: STI = sexually transmitted infections; GID = Gender Identity Disorder; OBGYN = obstetrician/ gynecologist; EMR = electronic medical record; GAS = gender affirming surgery; GAHT = gender affirming hormone treatment; GD = gender dysphoria; ADHD = Attention-Deficit/ Hyperactivity Disorder; HIV = human immunodeficiency virus; LGBT = lesbian, gay, bisexual, trans; VHA = Veterans Health Administration