M.S. THESIS: Binary/Non-binary Trans-Men, Testosterone H.R.T. and Vaginal Atrophy: Changes in Pathogenic Susceptibility
Tiondrae Pier, Lianne Kurina, Andrew Hoffman, Michael Baiocchi
Stanford University School of Medicine, Stanford, CA, USA
This work is an unstructured, narrative literature review and meta-synthesis concerning transgender medical care and core concepts to express the importance of advancement in transgender healthcare and potential interventions.
The scope of this piece targets biological aspects particular to trans-MSM (men who have sex with men) communities as evident and available points for health disparity mitigation, and notes of social and behavioral impacts in health disparity. Transgender populations are growing in population size and visibility while experiencing deficits in scientific research and clinical practice as a function of historical erasure, stigmatization, standing as a population minority, and resulting complication to binary representation in clinical practice and research. Healthcare providers mention feelings of incompetence treating transgender populations.
Trans-MSM in particular may operate inside behavioral and sexual health risk categories like cisgender MSM, but experience biological cascades not well understood by the clinical knowledge available. Testosterone HRT (hormone replacement therapy) enables potential reductions in gender dysphoria and access to different sexual networks.
Behavioral aspects merit exploration as an under-developed evidence base. Testosterone HRT can precipitate vaginal atrophy from treatment initiation, as far as two years into use of testosterone HRT. Vaginal atrophy may be related to histologic and physiologic changes in “female” genital tract linings that could heighten pathogenic susceptibility.
Local administration of estrogen to the vaginal lumen is known as a gold standard in cisgender women to remedy vaginal atrophy, and use of fractional CO2 laser stands as an innovation requiring fewer treatments and conferring beneficial effects with little known risks. (Finalized 21 August 2018)