Introduction

Transgender and gender non-conforming (TGNC) individuals face numerous barriers to healthcare, which contribute to many health disparities. TGNC persons must initially receive a diagnosis of gender incongruence, previously known as gender dysphoria [1], in order to begin the management of their incongruence with the help of medical interventions such as surgical procedures, and/or hormone replacement therapy (HRT). Despite the expanding use of hormone replacement therapies, the long-term outcomes of HRT on bone health and metabolism, are still relatively unknown. To explore HRT's effects on bone health via measuring bone mineral density, dual-energy x-ray absorptiometry, or DXA, scan has been labeled the gold standard [2]. By using bone densitometry, health care providers are able monitor bone health over time, as well as provide a diagnosis of osteoporosis by using T- and Z-scores.

1. Moser, C., ICD-11 and Gender Incongruence: Language is Important. Arch Sex Behav, 2017. 46: p. 2515-2516.

2. Punda, M. and S. Grazio, [Bone densitometry–the gold standard for diagnosis of osteoporosis]. Reumatizam, 2014. 61(2): p. 70-4.

Objectives

This study's purpose was to analyze what sex and gender was used to calculate T-score and Z-score for individuals who identify as TGNC in the authors’ hospital system.

Methods

A retrospective chart review was utilized to determine how DXA technicians and physicians are recording, scoring, and reading DXA scans for the TGNC population. The qualitative data was determined as "correct" or "incorrect" based on positions provided from the International Society of Clinical Densitometry (ISCD).

Results

13 DXA scans results were obtained between 11 transgender and gender non-conforming patients. In total, 24 T-scores and Z-scores of the 13 DXA were reviewed and scored. Based off ISCD positions, 58% of the T-score and Z-scores were calculated incorrectly.

Conclusions

Like DXA scans, many current healthcare standards and protocols are based on a patient's sex or gender, which may cause confusion amongst healthcare personnel who have not received proper training regarding the TGNC population. This was seen in our present study evaluating standards for bone densitometry in the TGNC population at TUKHS. Ultimately, access to appropriate training regarding gender identity and future research looking to determine HRT's effects on BMD in the TGNC population in the United States is needed to help correct this healthcare disparity.

中文翻译：

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双 X 射线吸收法扫描跨性别人群中的程序变异

介绍

跨性别和不符合性别规范 (TGNC) 的人在医疗保健方面面临着许多障碍，这导致了许多健康差异。TGNC 患者必须首先接受性别不一致的诊断，以前称为性别焦虑症 [1]，以便在外科手术和/或激素替代疗法 (HRT) 等医疗干预的帮助下开始管理他们的不一致。尽管激素替代疗法的使用不断扩大，但 HRT 对骨骼健康和新陈代谢的长期结果仍然相对未知。为了通过测量骨矿物质密度、双能 X 射线骨密度仪或 DXA 来探索 HRT 对骨骼健康的影响，扫描已被标记为金标准 [2]。通过使用骨密度测定，医疗保健提供者能够随着时间的推移监测骨骼健康，

1. Moser, C.，ICD-11 和性别不一致：语言很重要。Arch Sex Behav，2017。46：p。2515-2516。

2. Punda, M. 和 S. Grazio，[骨密度测定——诊断骨质疏松症的金标准]。Reumatizam, 2014. 61(2): p. 70-4。

目标

本研究的目的是分析在作者所在医院系统中被认定为 TGNC 的个体使用何种性别和性别来计算 T 分数和 Z 分数。

方法

回顾性图表审查用于确定 DXA 技术人员和医生如何记录、评分和阅读 TGNC 人群的 DXA 扫描。根据国际临床密度测量学会 (ISCD) 提供的位置，将定性数据确定为“正确”或“不正确”。

结果

在 11 名跨性别和性别不合格患者之间获得了 13 次 DXA 扫描结果。总共对 13 个 DXA 的 24 个 T 分数和 Z 分数进行了审查和评分。根据 ISCD 位置，58% 的 T 分数和 Z 分数计算不正确。

结论

与 DXA 扫描一样，许多当前的医疗保健标准和协议都是基于患者的性别或性别，这可能会导致未接受过有关 TGNC 人群适当培训的医疗保健人员产生混淆。这在我们目前评估 TUKHS TGNC 人群骨密度测定标准的研究中得到了体现。最终，需要获得有关性别认同和未来研究的适当培训，以确定 HRT 对美国 TGNC 人群 BMD 的影响，以帮助纠正这种医疗保健差异。