{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:52:13Z","timestamp":1793256733300,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T00:00:00Z","timestamp":1601942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T00:00:00Z","timestamp":1601942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01-AG034676"],"award-info":[{"award-number":["R01-AG034676"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Biol Sex Differ"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current understanding about health care in the gender diverse population is limited by the lack of community-based, longitudinal data, especially in the USA. We sought to characterize a community-based cohort of transgender individuals including demographics, gender identities, social characteristics, psychiatric and medical conditions, and medical therapy for gender dysphoria\/incongruence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We performed a retrospective chart review of gender diverse residents of Olmsted County, Minnesota, who sought gender-specific healthcare from January 1, 1974, through December 31, 2015, using an infrastructure that links medical records of Olmsted County residents from multiple institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The number of patients seeking gender-specific healthcare increased from 1 to 2 per 5-year interval during the 1970s\u20131990s to 41 from 2011 to 2015 (\n                      <jats:italic>n<\/jats:italic>\n                      = 82). Forty-nine (59.8%) were assigned male sex at birth (AMAB), 31 (37.8%) were assigned female (AFAB), and 2 (2.4%) were intersex. Gender identities evolved over time in 16.3% and 16.1% of patients AMAB and AFAB, respectively, and at most recent follow-up, 8.2% and 12.9% of patients AMAB and AFAB, respectively, were non-binary. Depression affected 78%, followed by anxiety (62.2%), personality disorder (22%), and post-traumatic stress disorder (14.6%). 58.5% experienced suicidal ideation, 22% attempted suicide, and 36.6% were victims of abuse. The most prevalent medical conditions and cardiovascular (CV) risk factors included obesity (42.7%), tobacco use (40.2%), fracture [34.1% (86.2% traumatic)], hypertension (25.6%), hyperlipidemia (25.6%), and hypertriglyceridemia (15.9%). 67.3% of patients AMAB used feminizing and 48.4% of patients AFAB used masculinizing hormone therapy. When compared to US CDC National Health Statistics, there was a significantly greater prevalence of depression and anxiety but no difference in the prevalence of obesity, hypertension, hypercholesterolemia, type 2 diabetes, or stroke.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Transgender and gender diverse individuals represent a population who express various gender identities and are seeking gender-specific healthcare at increasing rates. Psychiatric illness is highly prevalent compared to the US population but there is no difference in the prevalence of CV risk factors including obesity, type 2 diabetes, hypertension, and dyslipidemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13293-020-00332-5","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T17:03:04Z","timestamp":1602003784000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["A community-based study of demographics, medical and psychiatric conditions, and gender dysphoria\/incongruence treatment in transgender\/gender diverse individuals"],"prefix":"10.1186","volume":"11","author":[{"given":"Haleigh A.","family":"James","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice Y.","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reese L.","family":"Imhof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aradhana","family":"Sahoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique M.","family":"Montenegro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole R.","family":"Imhof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar A.","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida N.","family":"Lteif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd B.","family":"Nippoldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9393-7745","authenticated-orcid":false,"given":"Caroline J.","family":"Davidge-Pitts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,6]]},"reference":[{"issue":"11","key":"332_CR1","doi-asserted-by":"publisher","first-page":"3869","DOI":"10.1210\/jc.2017-01658","volume":"102","author":"WC Hembree","year":"2017","unstructured":"Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric\/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869\u2013903.","journal-title":"J Clin Endocrinol Metab"},{"issue":"10042","key":"332_CR2","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/S0140-6736(16)00683-8","volume":"388","author":"S Winter","year":"2016","unstructured":"Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet (London, England). 2016;388(10042):390\u2013400.","journal-title":"Lancet (London, England)"},{"issue":"5","key":"332_CR3","doi-asserted-by":"publisher","first-page":"943","DOI":"10.2105\/AJPH.2013.301241","volume":"103","author":"WO Bockting","year":"2013","unstructured":"Bockting WO, Miner MH, Swinburne Romine RE, et al. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943\u201351.","journal-title":"Am J Public Health"},{"issue":"10","key":"332_CR4","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.2105\/AJPH.2013.301507","volume":"103","author":"JR Blosnich","year":"2013","unstructured":"Blosnich JR, Brown GR, Shipherd Phd JC, et al. Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. Am J Public Health. 2013;103(10):e27\u201332.","journal-title":"Am J Public Health"},{"issue":"1","key":"332_CR5","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1089\/trgh.2016.0036","volume":"2","author":"N Adams","year":"2017","unstructured":"Adams N, Hitomi M, Moody C. Varied reports of adult transgender suicidality: synthesizing and describing the peer-reviewed and gray Literature. Transgender Health. 2017;2(1):60\u201375.","journal-title":"Transgender Health"},{"issue":"3","key":"332_CR6","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/S1473-3099(12)70315-8","volume":"13","author":"SD Baral","year":"2013","unstructured":"Baral SD, Poteat T, Stromdahl S, et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214\u201322.","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"332_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10461-007-9299-3","volume":"12","author":"JH Herbst","year":"2008","unstructured":"Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1\u201317.","journal-title":"AIDS Behav"},{"issue":"7","key":"332_CR8","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1080\/09540121.2013.855701","volume":"26","author":"SL Reisner","year":"2014","unstructured":"Reisner SL, White JM, Mayer KH, et al. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS Care. 2014;26(7):857\u201364.","journal-title":"AIDS Care"},{"issue":"7","key":"332_CR9","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1007\/s10461-013-0657-z","volume":"18","author":"CJ Reback","year":"2014","unstructured":"Reback CJ, Fletcher JB. HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS Behav. 2014;18(7):1359\u201367.","journal-title":"AIDS Behav"},{"issue":"1-2","key":"332_CR10","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.drugalcdep.2013.02.027","volume":"132","author":"EG Benotsch","year":"2013","unstructured":"Benotsch EG, Zimmerman R, Cathers L, et al. Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults. Drug Alcohol Depend. 2013;132(1-2):391\u20134.","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"332_CR11","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1093\/geront\/gnt021","volume":"54","author":"KI Fredriksen-Goldsen","year":"2014","unstructured":"Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, et al. Physical and mental health of transgender older adults: an at-risk and underserved population. The Gerontologist. 2014;54(3):488\u2013500.","journal-title":"The Gerontologist"},{"key":"332_CR12","first-page":"7(12)","volume":"27","author":"VP Quinn","year":"2017","unstructured":"Quinn VP, Nash R, Hunkeler E, et al. Cohort profile: study of transition, outcomes and gender (STRONG) to assess health status of transgender people. BMJ Open. 2017 Dec;27:7(12).","journal-title":"BMJ Open"},{"key":"332_CR13","unstructured":"James SE, Herman JL, Rankin S, et al. Executive summary of the report of the 2015 U.S. transgender survey. 2016."},{"issue":"2","key":"332_CR14","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.mayocp.2011.11.009","volume":"87","author":"JL St Sauver","year":"2012","unstructured":"St Sauver JL, Grossardt BR, Leibson CL, et al. Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project. Mayo Clin Proc. 2012;87(2):151\u201360.","journal-title":"Mayo Clin Proc"},{"issue":"6","key":"332_CR15","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1093\/ije\/dys195","volume":"41","author":"JL St Sauver","year":"2012","unstructured":"St Sauver JL, Grossardt BR, Yawn BP, et al. Data Resource Profile: The Rochester Epidemiology Project (REP) medical records-linkage system. Int J Epidemiol. 2012;41(6):1614\u201324.","journal-title":"Int J Epidemiol"},{"issue":"12","key":"332_CR16","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1016\/j.mayocp.2012.08.012","volume":"87","author":"WA Rocca","year":"2012","unstructured":"Rocca WA, Yawn BP, St. Sauver JL, Grossardt BR, Melton LJ III. History of the Rochester Epidemiology Project: half a century of medical records linkage in a US Population. Mayo Clin Proc. 2012;87(12):1202\u201313.","journal-title":"Mayo Clin Proc"},{"key":"332_CR17","unstructured":"Centers for Disease Control and Prevention. National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017."},{"key":"332_CR18","unstructured":"National Center for Health Statistics. Health, United States, 2017: with special feature on mortality. Hyattsville, Maryland. 2018."},{"key":"332_CR19","unstructured":"Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015\u20132016. NCHS data brief, no 288. Hyattsville, MD: National Center for Health Statistics. 2017."},{"key":"332_CR20","unstructured":"U.S. Census Bureau Population Division. Annual estimates of the resident population: April 1, 2010 to July 1, 2017. https:\/\/factfinder.census.gov\/faces\/tableservices\/jsf\/pages\/productview.xhtml?src=CF (accessed April 13, 2018."},{"key":"332_CR21","unstructured":"Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. 2017. https:\/\/www.cdc.gov\/nchhstp\/atlas\/index.htm (accessed April 21, 2018."},{"issue":"3","key":"332_CR22","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3934\/publichealth.2014.3.137","volume":"1","author":"MVA Vilas","year":"2014","unstructured":"Vilas MVA, Rubalcava G, Becerra A, et al. Nutritional status and obesity prevalence in people with gender dysphoria. AIMS Public Health. 2014;1(3):137\u201346.","journal-title":"AIMS Public Health"},{"issue":"1","key":"332_CR23","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jadohealth.2016.08.027","volume":"60","author":"CE Guss","year":"2017","unstructured":"Guss CE, Williams DN, Reisner SL, et al. Disordered weight management behaviors, nonprescription steroid use, and weight perception in transgender youth. The Journal of Adolescent health : Official Publication of the society for Adolescent Medicine. 2017;60(1):17\u201322.","journal-title":"The Journal of Adolescent health : Official Publication of the society for Adolescent Medicine"},{"issue":"1","key":"332_CR24","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1037\/abn0000399","volume":"128","author":"RM Butler","year":"2019","unstructured":"Butler RM, Horenstein A, Gitlin M. Social anxiety among transgender and gender nonconforming individuals: the role of gender-affirming medical interventions. J Abnorm Psychol. 2019 Jan;128(1):25\u201331.","journal-title":"J Abnorm Psychol"},{"issue":"11","key":"332_CR25","doi-asserted-by":"publisher","first-page":"3914","DOI":"10.1210\/jc.2017-01643","volume":"102","author":"S Maraka","year":"2017","unstructured":"Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, et al. Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2017 Nov;102(11):3914\u201323.","journal-title":"The Journal of Clinical Endocrinology & Metabolism"},{"issue":"4","key":"332_CR26","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1210\/jc.2016-3007","volume":"102","author":"C Davidge-Pitts","year":"2017","unstructured":"Davidge-Pitts C, Nippoldt TB, Danoff A, et al. Transgender health in endocrinology: current status of endocrinology fellowship programs and practicing clinicians. J Clin Endocrinol Metab. 2017;102(4):1286\u201390.","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"332_CR27","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1016\/j.jsxm.2016.03.371","volume":"13","author":"MJ Dekker","year":"2016","unstructured":"Dekker MJ, Wierckx K, Van Caenegem E, et al. A European network for the investigation of gender incongruence: endocrine part. J Sex Med. 2016;13(6):994\u20139.","journal-title":"J Sex Med"},{"issue":"4","key":"332_CR28","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1530\/EJE-10-1038","volume":"164","author":"H Asscheman","year":"2011","unstructured":"Asscheman H, Giltay EJ, Megens JA, et al. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2011 Apr;164(4):635\u201342.","journal-title":"Eur J Endocrinol"}],"container-title":["Biology of Sex Differences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13293-020-00332-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13293-020-00332-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13293-020-00332-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T03:29:09Z","timestamp":1633490949000},"score":1,"resource":{"primary":{"URL":"https:\/\/bsd.biomedcentral.com\/articles\/10.1186\/s13293-020-00332-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,6]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["332"],"URL":"https:\/\/doi.org\/10.1186\/s13293-020-00332-5","relation":{},"ISSN":["2042-6410"],"issn-type":[{"value":"2042-6410","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,6]]},"assertion":[{"value":"13 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Mayo Clinic and Olmsted Medical Center Institutional Review Boards (IRBs) who review all REP research proposals to ensure that the rights and safety of study participants are protected. Additionally, all REP studies must comply with Minnesota Research Authorization (Minnesota State privacy law\u2014statute 144.335, 1997). This state statute requires that individuals provide permission for their medical records to be used for research studies.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"55"}}