Background Transgender and gender-diverse individuals use gender-affirming hormone therapy (GAHT) to induce affirming physical changes and improve psychosocial functioning. Limited longitudinal data exists describing GAHT formulations, doses, and individual-level use patterns.Aims To examine longitudinal utilization and treatment patterns in people initiating subsidized GAHT in Australia during 2013-2023.Methods We conducted a retrospective cohort study using a 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing claims. Individuals aged 12-99 years were identified if initiating PBS-subsidized testosterone or estradiol with an incongruent gender marker or congruent gender marker, if updated. Outcomes included GAHT utilization, defined daily doses (DDD) over first treatment year, and longitudinal treatment regimens, stratified by sex recorded at birth (assigned male at birth [AMAB]; assigned female at birth [AFAB]).Results Among 2519 GAHT initiators (1487 AMAB; 1032 AFAB), median initiation age was 24 years (interquartile range [IQR]: 20-32). 30% (n = 763) updated their gender marker. Most AMAB individuals used estradiol tablets (n = 1197; 72.2%) and antiandrogens (n = 1197; 80.5%), while most AFAB individuals used testosterone undecanoate injections (n = 851; 82.5%). First-year mean estradiol DDDs increased from 1.43 to 1.60 DDDs; mean testosterone DDDs declined from 1.11 to 0.63 DDDs. AMAB individuals used more regimens (n = 6475; median 3) than AFAB individuals (n = 1845; median 1) over a median of 4.2 years (IQR: 2.4-6.8). Estradiol tablets were the most common AMAB starting regimen (n = 506; 34%), and estradiol tablets with an antiandrogen were most common overall (n = 1426; 22%). Testosterone undecanoate injections were the most common AFAB starting regimen (n = 594; 57.6%) and regimen overall (n = 964; 52.3%).Discussion The most common regimens were estradiol tablets with an antiandrogen in AMAB individuals and testosterone undecanoate injections in AFAB individuals. Over time, testosterone DDDs decreased, likely reflecting testosterone undecanoate dosing. Estradiol DDDs increased, though they were lower than expected. These findings offer insights into real-world GAHT utilization and treatment patterns, though further research is needed to optimize personalized care.
Background Gender identity conversion practices (GICPs), interventions intended to suppress or change an individual's gender identity or expression, persist globally despite professional consensus that they are harmful. Evidence from non-Western, collectivistic contexts remains limited, particularly regarding the socioecological mechanisms sustaining GICPs and their harms to transgender and nonbinary (TGNB) individuals. This study examined how GICPs are enacted and maintained within China's family-centered socioecology, to inform cultural-responsive gender-affirming care and public health policy.Methods Between June 2023 and March 2024, we conducted in-depth, semi-structured interviews with nine TGNB young adults who had experienced GICPs in China. Participants were purposively sampled to capture variation in age at exposure and conversion contexts. Data was analyzed using reflexive thematic analysis.Results Five forms of GICPs emerged: psychiatric, psychological, religious, military-style correctional school-based, and family-driven practices. Across contexts, participants described severe biopsychosocial harms, including suicidal ideation, family estrangement, and mistrust of mental-health services. Furthermore, we developed a conceptual framework identifying socioecological mechanisms sustaining GICPs across micro-, meso-, and macro-level systems. Families initiated GICPs and collaborated with professionals to enforce them, while sociocultural norms and the absence of legal and professional protections reinforced these harmful practices.Interpretation GICPs targeting TGNB young adults in China constitute a preventable public health harm that contributes to health inequities. Findings underscore the need for explicit policy prohibitions, strengthened regulatory oversight, mandatory gender-affirming training for health professionals, and expanded access to culturally responsive clinical care and support services.
