{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:42:29Z","timestamp":1789101749287,"version":"build-2803163510"},"reference-count":45,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T00:00:00Z","timestamp":1693872000000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Australian Federation of AIDS Organisations","award":["QMZ-H-AFAO"],"award-info":[{"award-number":["QMZ-H-AFAO"]}]},{"DOI":"10.13039\/100004417","name":"The Global Fund to Fight AIDS, Tuberculosis, and Malaria","doi-asserted-by":"crossref","award":["QMZ-H-AFAO"],"award-info":[{"award-number":["QMZ-H-AFAO"]}],"id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,8,22]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to describe the gender-affirming hormonal therapy (GAHT) intake behaviour and regimen and the factors associated with the use of hormones inconsistent with reference GAHT regimen among transgender people in the Philippines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Transgender community clinic in Metro Manila, Philippines from March 2017 to December 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Gender-affirming care-seeking individuals of at least 18 years old, who self-identified as transgender or non-binary, and who self-reported current or previous use of GAHT at baseline consult.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Reported drugs and\/or administration routes not congruent with the World Professional Association for Transgender Health Standard of Care eighth edition were classified as hormone use outside the reference regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>253 transgender people reported current or previous intake of GAHT. Many trans women and transfeminine people (TWTFP; 58.9%, 86\/146) reported using oral contraceptive pills (OCPs), whereas most trans men (TM; 73.8%, 79\/107) reported injecting testosterone esters. Furthermore, 59.7% (151\/253) used hormones outside the reference regimen, widely using OCP and anabolic steroids among TWTFP and TM, respectively. TWTFP (crude prevalence ratio, PR, 3.52; 95% CI 2.35 to 5.49) and those who take unprescribed GAHT (crude PR 2.37; 95% CI 1.08 to 6.68) were more likely to use hormones outside the reference regimen than TM and taking healthcare provider-prescribed GAHT, respectively. On adjusting for covariates, the prevalence of using hormones outside the reference regimen was approximately three times higher (adjusted PR 3.22; 95% CI 2.09 to 5.12) among TWTFP than TM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Trans people act on their high unmet gender-affirming care needs by taking unprescribed GAHT, many outside the reference regimen. Structural changes in the health system are warranted, including strengthened community-based self-administration practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072252","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T11:42:34Z","timestamp":1693914154000},"page":"e072252","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Prevalence of and factors associated with the use of gender-affirming hormonal therapy outside the reference regimen among transgender people in a community-led clinic in Metro Manila, Philippines: a retrospective cross-sectional study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8522-1122","authenticated-orcid":false,"given":"Patrick C","family":"Eustaquio","sequence":"first","affiliation":[{"name":"LoveYourself Inc, Mandaluyong City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4030-0548","authenticated-orcid":false,"given":"Jan Dio Miguel","family":"Dela Cruz","sequence":"additional","affiliation":[{"name":"LoveYourself Inc, Mandaluyong City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4289-034X","authenticated-orcid":false,"given":"Yanyan","family":"Ara\u00f1a","sequence":"additional","affiliation":[{"name":"LoveYourself Inc, Mandaluyong City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4762-6249","authenticated-orcid":false,"given":"Bubbles","family":"Rosos","sequence":"additional","affiliation":[{"name":"LoveYourself Inc, Mandaluyong City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9885-5300","authenticated-orcid":false,"given":"John Danvic T","family":"Rosadi\u00f1o","sequence":"additional","affiliation":[{"name":"LoveYourself Inc, Mandaluyong City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronivin G","family":"Pagtakhan","sequence":"additional","affiliation":[{"name":"LoveYourself Inc, Mandaluyong City, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3383-6336","authenticated-orcid":false,"given":"Zypher Jude G","family":"Regencia","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines"},{"name":"Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3888-8880","authenticated-orcid":false,"given":"Emmanuel S","family":"Baja","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines"},{"name":"Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,9,5]]},"reference":[{"key":"2025121222561247000_13.9.e072252.1","doi-asserted-by":"publisher","DOI":"10.1080\/26895269.2022.2100644"},{"key":"2025121222561247000_13.9.e072252.2","unstructured":"Joint United Nations Programme on HIV\/AIDS . IN DANGER: UNAIDS Global AIDS Update 2022. Geneva, Switzerland: UNAIDS, 2022."},{"key":"2025121222561247000_13.9.e072252.3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)00684-x"},{"key":"2025121222561247000_13.9.e072252.4","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-018-9459-y"},{"key":"2025121222561247000_13.9.e072252.5","doi-asserted-by":"crossref","DOI":"10.1057\/s41599-022-01291-5","article-title":"Gender affirming hormone therapy dosing behaviors among Transgender and Nonbinary adults","volume":"9","author":"Restar","year":"2022","journal-title":"Humanit Soc Sci Commun"},{"key":"2025121222561247000_13.9.e072252.6","unstructured":"Department of Health Epidemiology Bureau . 2018 integrated HIV behavioral and serologic surveillance (IHBSS). 2018."},{"key":"2025121222561247000_13.9.e072252.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.esxm.2022.100497","article-title":"Prevalence and factors associated with gender-affirming surgery among Transgender women & Transgender men in a community-based clinic in","volume":"10","author":"Eustaquio","year":"2022","journal-title":"Sex Med"},{"key":"2025121222561247000_13.9.e072252.8","unstructured":"Asia Pacific Transgender Network . Regional Mapping Report on Trans Health, Rights and Development in Asia. Bangkok, Thailand: APTN, 2017."},{"key":"2025121222561247000_13.9.e072252.9","article-title":"The real-world characteristics of gender-affirming hormonal use among Transgender people in Thailand","volume":"10","author":"Ittiphisit","year":"2022","journal-title":"Sex Med"},{"key":"2025121222561247000_13.9.e072252.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0224133","article-title":"Gender affirmative HIV care framework: decisions on Feminizing hormone therapy (FHT) and antiretroviral therapy (ART) among Transgender women","volume":"14","author":"Restar","year":"2019","journal-title":"PLoS One"},{"key":"2025121222561247000_13.9.e072252.11","unstructured":"World Health Organization - Regional Office for the Western Pacific . Regional assessment of HIV, STI and other health needs of transgender people in Asia and the Pacific. Manila: WHO Regional Office for the Western Pacific, 2013."},{"key":"2025121222561247000_13.9.e072252.12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-01658"},{"key":"2025121222561247000_13.9.e072252.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2020.01.012"},{"key":"2025121222561247000_13.9.e072252.14","unstructured":"Asia Pacific Transgender Network . Towards transformative healthcare: Asia Pacific trans health and rights module. Asia-Pacific Transgender Network. Bangkok, Thailand, 2022."},{"key":"2025121222561247000_13.9.e072252.15","unstructured":"Center of Excellence in Transgender Health Chulalongkorn University, Institute of HIV and Research Innovation . The Thai Handbook of Transgender Healthcare Services. Bangkok, Thailand: Chulalongkorn University, 2021."},{"key":"2025121222561247000_13.9.e072252.16","doi-asserted-by":"crossref","first-page":"151","DOI":"10.15605\/jafes.028.02.09","article-title":"The transformation of Transsexual individuals","volume":"28","author":"Ngalob","year":"2013","journal-title":"JAFES"},{"key":"2025121222561247000_13.9.e072252.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2025121222561247000_13.9.e072252.18","unstructured":"ISEAN-Hivos . ISEAN-Hivos Program\u2019s Trans Health Training Module for Health Service Providers (Version 4). Metro Manila, Philippines, 2017."},{"key":"2025121222561247000_13.9.e072252.19","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/00224490902898728","article-title":"The gender identity\/gender Dysphoria questionnaire for adolescents and adults: further validity evidence","volume":"47","author":"Singh","year":"2010","journal-title":"J Sex Res"},{"key":"2025121222561247000_13.9.e072252.20","unstructured":"Guha M . Diagnostic and statistical Manual of mental disorders: DSM-5. Reference Reviews 2014."},{"key":"2025121222561247000_13.9.e072252.21","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-3-21","article-title":"Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio","volume":"3","author":"Barros","year":"2003","journal-title":"BMC Med Res Methodol"},{"key":"2025121222561247000_13.9.e072252.22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7059"},{"key":"2025121222561247000_13.9.e072252.23","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi188"},{"key":"2025121222561247000_13.9.e072252.24","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"2025121222561247000_13.9.e072252.25","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000864"},{"key":"2025121222561247000_13.9.e072252.26","doi-asserted-by":"crossref","DOI":"10.1590\/1980-549720190004.supl.1","article-title":"Characteristics of hormone use by Travestis and Transgender women of the Brazilian Federal District","volume":"22","author":"Kr\u00fcger","year":"2019","journal-title":"Rev Bras Epidemiol"},{"key":"2025121222561247000_13.9.e072252.27","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.1016\/j.jsxm.2020.07.081","article-title":"The desire and status of gender-affirming hormone therapy and surgery in Transgender men and women in China: A national population study","volume":"17","author":"Liu","year":"2020","journal-title":"J Sex Med"},{"key":"2025121222561247000_13.9.e072252.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003023"},{"key":"2025121222561247000_13.9.e072252.29","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12691"},{"key":"2025121222561247000_13.9.e072252.30","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1089\/lgbt.2014.0128","article-title":"Non-prescribed hormone use and barriers to care for Transgender women in San Francisco","volume":"2","author":"de Haan","year":"2015","journal-title":"LGBT Health"},{"key":"2025121222561247000_13.9.e072252.31","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301348"},{"key":"2025121222561247000_13.9.e072252.32","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1089\/trgh.2021.0049","article-title":"Estradiol and testosterone concentrations among Thai Transgender women in a Transgender-led, integrated gender-affirming care and sexual health clinic: A real-world analysis","volume":"7","author":"Hiransuthikul","year":"2022","journal-title":"Transgend Health"},{"key":"2025121222561247000_13.9.e072252.33","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1080\/13691058.2018.1533144","article-title":"From silicone and hormone injecting to sex Reassignment surgery: the precarious road to becoming female of Transgender funeral performers in Ho Chi Minh city","volume":"21","author":"Nguyen","year":"2019","journal-title":"Culture, Health & Sexuality"},{"key":"2025121222561247000_13.9.e072252.34","doi-asserted-by":"crossref","DOI":"10.1016\/j.esxm.2020.100306","article-title":"Physical and psychological effects of gender-affirming hormonal treatment using Intramuscular testosterone enanthate in Japanese Transgender men","volume":"9","author":"Kirisawa","year":"2021","journal-title":"Sex Med"},{"key":"2025121222561247000_13.9.e072252.35","unstructured":"Health Policy Project, Asia Pacific Transgender Network, United Nations Development Programme . Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities. Washington, DC: Futures Group, Health Policy Project, 2015."},{"key":"2025121222561247000_13.9.e072252.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-14158-w","article-title":"Non-uptake of HIV testing among Trans men and Trans women: cross-sectional study of client records from 2017 to 2019 in a community-based Transgender health center in Metro Manila, Philippines","volume":"22","author":"Regencia","year":"2022","journal-title":"BMC Public Health"},{"key":"2025121222561247000_13.9.e072252.37","doi-asserted-by":"crossref","unstructured":"S D , S M , A F , et al . Hormone consumption among mak Nyahs in Kuantan town: a preliminary survey. Imjm 2018;17. doi:10.31436\/imjm.v17i1.301 Available: https:\/\/journals.iium.edu.my\/kom\/index.php\/imjm\/issue\/view\/6","DOI":"10.31436\/imjm.v17i1.301"},{"key":"2025121222561247000_13.9.e072252.38","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1089\/trgh.2020.0119","article-title":"Use of hormones among Trans women in the West coast of Peninsular Malaysia: A mixed methods study","volume":"7","author":"Rashid","year":"2022","journal-title":"Transgend Health"},{"key":"2025121222561247000_13.9.e072252.39","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.jsxm.2022.02.023","article-title":"Hormone concentrations in Transgender women who self-prescribe gender affirming hormone therapy: A retrospective study","volume":"19","author":"Salakphet","year":"2022","journal-title":"J Sex Med"},{"key":"2025121222561247000_13.9.e072252.40","unstructured":"Tan ML , Tan MT . Revisiting usog, pasma, kulam. UP Press, 2008."},{"key":"2025121222561247000_13.9.e072252.41","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3390\/ijerph192416532","article-title":"Discrimination against and associated stigma experienced by Transgender women with Intersectional identities in Thailand","volume":"19","author":"Srikummoon","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025121222561247000_13.9.e072252.42","doi-asserted-by":"crossref","DOI":"10.1177\/20503121211051546","article-title":"Effects of testosterone treatment on Transgender males: A single-institution study","volume":"9","author":"Korpaisarn","year":"2021","journal-title":"SAGE Open Med"},{"key":"2025121222561247000_13.9.e072252.43","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1507\/endocrj.EJ12-0319","article-title":"Dose-response analysis of testosterone replacement therapy in patients with female to male gender identity disorder","volume":"60","author":"Nakamura","year":"2013","journal-title":"Endocr J"},{"key":"2025121222561247000_13.9.e072252.44","doi-asserted-by":"crossref","DOI":"10.1080\/26410397.2022.2045066","article-title":"Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers","volume":"29","author":"Kennedy","year":"2021","journal-title":"Sex Reprod Health Matters"},{"key":"2025121222561247000_13.9.e072252.45","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1089\/trgh.2017.0025","article-title":"Advocacy for gender affirming care: learning from the Injectable estrogen shortage","volume":"3","author":"Geffen","year":"2018","journal-title":"Transgend Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-072252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:56:22Z","timestamp":1765608982000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-072252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,5]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/bmjopen-2023-072252"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-072252","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}