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Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):198-207. doi: 10.1097/MED.0000000000000229.

Advancing methods for US transgender health research.

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aThe Fenway Institute, Fenway Health bDepartment of Epidemiology, Harvard T.H. Chan School of Public Health cDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts dDepartment of Family and Community Medicine, University of California, San Francisco, California eResearch Program in Men's Health: Aging and Metabolism Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts fLGBT Health Initiative, New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of Nursing, New York City, New York gQuillen College of Medicine, East Tennessee State University, Johnson City, Tennessee hDepartment of Family Medicine and Community Health, University of Minnesota, School of Medicine, Minneapolis, Minnesota iDepartment of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA jCenter of Expertise on Gender Dysphoria, Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands kCallen-Lorde Community Health Center, New York City, New York lSection of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine, Boston, Massachusetts mDivision of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta nThe Atlanta VA Medical Center, Decatur, Georgia, USA oDepartment of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium pDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.



This article describes methodological challenges, gaps, and opportunities in US transgender health research.


Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of sex affirmation (e.g., hormones and surgical interventions), and inconsistent use of definitions across studies hinder evidence-based care for transgender people. Systematic high-quality observational and intervention-testing studies may be carried out using several approaches, including general population-based, health systems-based, clinic-based, venue-based, and hybrid designs. Each of these approaches has its strength and limitations; however, harmonization of research efforts is needed. Ongoing development of evidence-based clinical recommendations will benefit from a series of observational and intervention studies aimed at identification, recruitment, and follow-up of transgender people of different ages, from different racial, ethnic, and socioeconomic backgrounds and with diverse gender identities.


Transgender health research faces challenges that include standardization of lexicon, agreed upon population definitions, study design, sampling, measurement, outcome ascertainment, and sample size. Application of existing and new methods is needed to fill existing gaps, increase the scientific rigor and reach of transgender health research, and inform evidence-based prevention and care for this underserved population.

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