PURPOSE:This study evaluated reproductive intentions, fertility-related knowledge, prior fertility counseling, and factors associated with reproductive intentions among transgender and nonbinary individuals receiving care at a Brazilian public reference center. METHODS:This cross-sectional study with a qualitative component was conducted between July and November 2025 in a specialized gender-affirming care clinic in Brazil. Quantitative data included sociodemographic characteristics, reproductive history, gender-affirming hormone therapy (GAHT), and fertility-related variables. Logistic regression was used to assess factors associated with desire for future parenthood. Responses to a single open-ended question regarding perceived effects of GAHT on fertility were analyzed using thematic content analysis. RESULTS:Eighty-two participants were included (mean age 27.5 ± 7.4 years). Most identified as transgender men (65.9%), followed by transgender women (26.8%) and nonbinary individuals (7.3%); 79.3% were receiving GAHT. Although 63.4% expressed a desire for future parenthood, only 7.3% had children. Current interest in fertility preservation was reported by 20.8% (15/72). Having children (adjusted odds ratio [aOR] = 0.03; 95% confidence interval [CI]: 0.001-0.62; p = 0.023) and each additional year of GAHT duration (aOR = 0.83; 95% CI: 0.70-0.99; p = 0.038) were associated with lower odds of desiring future parenthood. Sex assigned at birth was not independently associated with reproductive intentions. Qualitative analysis revealed misconceptions, uncertainty, and conditional beliefs regarding fertility. CONCLUSIONS:Desire for future parenthood was common among transgender and nonbinary individuals, whereas engagement with fertility preservation remained limited. These findings highlight the need for longitudinal, patient-centered reproductive counseling integrated into gender-affirming care.
PURPOSE:The objective of this study was to evaluate cross-sectional and longitudinal associations between contact with the criminal legal system (CCLS) and substance use among transgender women of color in New York City. METHODS:Data came from the Trying to Understand Relationships, Networks and Neighborhoods among Transgender Women of Color Study in New York City (2020-2023, analytic baseline n = 311). CCLS included arrest and incarceration and was measured at baseline, 6 months, and 12 months. Substance use included recreational substance use (any), alcohol use (any), and specific substance use (cannabis, cocaine, and methamphetamine). Generalized estimating equations were used to assess longitudinal associations between baseline CCLS and substance use over time. RESULTS:At baseline, 50.5% of participants reported having been arrested, and 28.0% reported experiencing incarceration. In multivariable analyses, CCLS was associated with substance use after controlling for confounders. In particular, at baseline, incarceration was associated with a 1.73 times (95% confidence interval: 1.06-2.81) likelihood of recreational substance use. We found no significant associations between CCLS and alcohol or specific substance use. CONCLUSION:The findings suggest that CCLS was associated with recreational substance use among transgender women of color at baseline. Substance use prevention and treatment programs should consider screening for substance use during reentry after incarceration and providing additional support for individuals with criminal legal system involvement.
Immigration and sexual and gender minority (SGM) policies operate as interlocking systems that shape perceived risk, generate fear, and drive care avoidance among SGM immigrants in the United States. This Perspective argues that immigration policy functions as SGM health policy by structuring eligibility, surveillance, and perceived safety within health care systems. We describe how immigration enforcement, asylum restrictions, and SGM-targeted legislation produce psychological harm and suppress care-seeking, particularly among transgender immigrants and asylum seekers. Persistent data gaps obscure these harms. Recognizing these intersecting legal regimes is essential for advancing equity, clinical safety, and public health.
PURPOSE:We conducted a scoping review to map peer-reviewed literature on HIV research concerning sexual minority women (SMW). METHODS:Following guidance from Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we searched PubMed, Embase, PsycInfo, Sociological Abstracts, and CINAHL from inception through May 2023. Eligible studies were English language, peer-reviewed studies, containing disaggregated HIV-related data on SMW. Studies were systematically screened, and relevant data were extracted and then summarized. RESULTS:Our search identified 7615 studies; 187 met eligibility requirements. Most studies were quantitative (82%), cross-sectional (74%), used survey data (80%) obtained via convenience sampling (61%), and conducted in the United States (65%). Annual publications increased over time. Overwhelmingly, studies did not report engaging the community in the research process (93%). Demographic reporting in studies varied; about half reported age (52%) and race (52%), two-thirds reported sexual orientation (68%), and only 25% focused exclusively on SMW. Diverse HIV-related findings were addressed: sexual risk behaviors (64%), HIV testing, prevalence, and risk perception (47%), substance use (43%), sexually transmitted infections (29%), health care access (21%), intimate partner violence (17%), mental health (15%), stigma (10%), and incarceration (9%). CONCLUSIONS:Our review highlights key methodological and topical gaps. Future SMW HIV research guidance includes focusing on structural-level factors and biomedical interventions; researching understudied regions highly impacted by HIV; including qualitative and quantitative approaches; establishing standardized procedural and reporting guidelines; and increasing research and practice resources to focus on SMW's unique HIV-related health strengths and vulnerabilities.
PURPOSE:This study reviewed the U.S. insurance landscape for gender-affirming surgery (GAS) and examined how regional, legislative, and health care infrastructure factors influence coverage patterns to inform policy reform and advocacy. METHODS:Policies from the top three insurers in each state, identified via the National Association of Insurance Commissioners, were analyzed in November 2024. Coverage was compared across census regions, and criteria concordance with the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8, was assessed. GAS fellowship availability, policy information accessibility (7-point Likert scale), and legislative favorability (Movement Advancement Project scores) were also evaluated. Coverage rates were compared across procedures using analysis of variance with post hoc Tukey tests. Poisson regression identified predictors of coverage, and ordinal logistic regression assessed predictors of policy information accessibility. All analyses were conducted in R 4.4.1. RESULTS:We included 144 state insurance policies, representing 77% of the U.S. market. Overall GAS coverage was 67.7%, with significantly lower rates for fertility cryopreservation (6.6%), facial feminization (37.3%), and GAS reversal (65.7%). GAS fellowship presence positively predicted coverage (p < 0.001). States with fair (p = 0.041) or medium legislative favorability (p = 0.004) had higher coverage compared with negatively rated states. Only 61.9% of policies were concordant with WPATH guidelines. Coverage information access was uniformly limited and was more limited in Southern states than in other regions (p < 0.001). CONCLUSION:Insurance coverage for GAS was inconsistent and strongly influenced by political and health care infrastructure factors rather than medical necessity. The lack of guideline concordance and systematic information barriers highlights the need for targeted reforms.
PURPOSE:Cardiovascular diseases (CVDs) are a significant cause of death, with health conditions and lifestyle behaviors playing essential roles. We sought to explore CVD risk classes, their associations with self-reported CVD, and differences among classes as a function of intersectional minority stressors (IMS) among sexual and gender minority people of color (SGM POC). METHODS:A sample of 232 SGM POC (mean age = 33.50 ± 9.77) completed an online survey in 2020 assessing CVD risk indicators and specific IMS, measured using the LGBT People of Color Microaggressions Scale subscales. Latent class analyses were conducted to identify CVD risk classes, followed by logistic regressions to examine associations between classes and self-reported CVD, classes and IMS on self-reported CVD, and interactions between the classes and IMS on self-reported CVD. RESULTS:Three classes emerged: a low-risk class with low probabilities for all indicators, a lifestyle-risk class with high probabilities for smoking, alcohol use, and substance use, and a high-risk class with greater probabilities for most CVD indicators. Significant interactions showed that increased LGBT racism was associated with a lower likelihood of self-reported CVD (b = -0.40, standard error [SE] = 0.19, adjusted odds ratio [aOR] = 0.67, p = 0.036) whereas greater heterosexism within communities of color (b = 0.57, SE = 0.22, aOR = 1.77, p = 0.008) was associated with a higher likelihood of self-reported CVD in the high-risk compared with the low-risk class. CONCLUSION:These exploratory findings support the existence of three distinct CVD risk classes among SGM POC and highlight that specific IMS moderate CVD risk for SGM POC.
PURPOSE:This study sought to identify latent classes of psychosocial adversity among men who have sex with men (MSM) who use stimulants, examine sociodemographic correlates of class membership, and assess differences in health service utilization across classes. METHODS:This secondary analysis used baseline data from 205 MSM who use stimulants in Boston, Massachusetts, and Miami, Florida (March 2018-March 2024). Latent class analysis was applied to identify patterns of psychosocial adversity based on childhood sexual abuse (CSA), four forms of interpersonal violence (IPV), and three types of sexual minority stress. Sociodemographic characteristics included age, sexual orientation, race and ethnicity, and socioeconomic status. Outcomes were binary (any/none) indicators of mental health care, substance use care, emergency department (ED) encounters, and inpatient admissions in the past 4 months. RESULTS:A three-class solution was selected: Low Psychosocial Adversity (n = 107; 52.2%), Past-Year IPV-sexual orientation discrimination (SOD; n = 56; 27.3%), and Prior IPV-CSA (n = 42; 20.5%). Lower socioeconomic status was associated with higher odds of membership in the Past-Year IPV-SOD class compared with the Low Psychosocial Adversity class (odds ratio = 2.30; 95% confidence interval = 1.04-5.23, P = 0.046). In exploratory pairwise comparisons, participants in the Prior IPV-CSA class had a higher prevalence of any ED encounters (47.6%) than those in the Low Psychosocial Adversity class (28.1%; χ2[1,204] = 4.44; P = 0.035). CONCLUSION:Among MSM who use stimulants, configurations of psychosocial adversity varied by sociodemographic context, with socioeconomic status distinguishing patterns of adversity, and showed limited differentiation in health service utilization. These findings underscore the role of structural conditions and support syndemic-informed, person-centered approaches to inform more equitable prevention and service strategies.
Purpose: We examined smoking and smoking cessation by sex assigned at birth and sexual orientation and gender identity (SOGI) among Hispanic/Latino adults. Methods: We used data from visit 1 (2008-2011), visit 2 (2014-2017), and visit 3 (2020-2024) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Our analysis focused on participants (N = 8847) who responded to SOGI questions at visit 3 and provided data on smoking measures at visits 1-3. Accounting for survey design and weights, we estimated logistic regression models of associations between SOGI status and current smoking at visit 1. We also estimated discrete time models of associations between SOGI status and smoking cessation by visit 3. Results: In analyses adjusted for sociodemographic covariates, male sexual and gender minority (SGM) participants had 40% reduced odds of smoking compared with male cisgender heterosexual participants (95% confidence interval [CI]: 0.36-1.00). However, female SGM participants had 2.72 (95% CI: 1.92-3.86) times the odds of smoking compared with female cisgender heterosexual participants. In contrast, we found no significant differences in smoking cessation between male SGM and cisgender heterosexual participants or between female SGM and cisgender heterosexual participants. For all HCHS/SOL participants, the likelihood of cessation increased over time and increased the most for those with more than a high school education. Conclusion: SGM females had high rates of current smoking and were as unlikely to quit as other participants. Thus, prevention of smoking initiation is critical. Programs to prevent smoking among Hispanic/Latino individuals should be designed with consideration of differences by sex and SOGI status.
Purpose: This study examined factors associated with Italian healthcare practitioners' clinical skills when working with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients across primary, sexual and reproductive, and mental health domains.Methods: A cross-sectional sample of 165 practitioners completed measures assessing clinical skills, heteronormative beliefs, and prejudice against sexual and gender diversity, along with sociodemographic and professional variables, between May 2024 and June 2025.Results: Participants (44 assigned male at birth, 121 assigned female at birth; mean age = 39.3 ± 11.4 years; 163 cisgender, 2 nonbinary; 49 identifying as LGBTQ) yielded significant differences across healthcare domains: primary care practitioners reported lower overall clinical skills, more negative attitudes and prejudice than mental health practitioners, as well as the lowest attendance at LGBTQ specific training among groups. Across the whole sample, greater clinical skills were associated with lower heteronormative beliefs and prejudice, attendance at LGBTQ training, and having at least one LGBTQ person among friends or relatives.Conclusions: These findings underscore the need for comprehensive educational interventions aimed at enhancing both knowledge and attitudinal components of LGBTQ clinical skills. Policy efforts should prioritize mandatory, experiential, and context-specific training programs and promote inclusive guidelines to reduce heteronormativity in Italian healthcare. Strengthening practitioners' LGBTQ clinical skills can foster more equitable, compassionate, and accessible health services across all domains of care.
Purpose: The goal of the current meta-analytic review was to systematically examine whether sleep outcomes across several dimensions of sleep differ between lesbian, gay, and bisexual (LGB) and heterosexual individuals, as well as to examine potential study-level moderators of these associations. Methods: Systematic searches of PsycInfo, Medline, and PubMed databases were conducted to identify relevant observational studies published in English between January 1, 2000, and January 31, 2026. Studies were eligible if they reported an effect size comparing LGB and heterosexual groups on at least one measure of sleep. Results: This systematic search yielded a total of 44 studies with 69 effect sizes. Effect size data were analyzed using a random effects model. LGB individuals were more likely to report shorter sleep duration, longer sleep onset latency, and poorer sleep quality than heterosexual individuals (all p < 0.001). Effect sizes for associations between sexual orientation and sleep duration were larger in studies with more LGB women/girls, bisexual individuals, and racial/ethnic minority individuals (all p < 0.05). Conclusion: These findings indicate that LGB individuals experience poorer sleep health than heterosexual individuals, and that sleep problems across different dimensions of sleep may be greater for LGB women/girls, bisexual individuals, and racial/ethnic minority individuals. These findings may help to explain mental health disparities among LGB individuals, and future studies should examine the role of minority stress in LGB sleep health.
PURPOSE:Given limited measurement of intersectional microaggressions among those who identify as lesbian, gay, bisexual, transgender, queer, or additional sexual or gender minority (LGBTQ+) identities and as people of color (POC), this study tested whether differences exist in the factor structure of the LGBT People of Color Microaggression Scale (LGBT-PCMS) between Latina/o/x and non-Latina/o/x POC groups. METHODS:Using Amazon's Mechanical Turk, a sample of 491 LGBTQ+ Latina/o/x people and non-Latina/o/x POC (mean age = 29.66 ± 7.60) completed an online survey in December 2018, assessing psychosocial variables, intersectional minority stress measured via the LGBT-PCMS, and perceived stress. Hierarchical confirmatory factor analyses (CFA) assessed the fit of the LGBT-PCMS, with its three subscales specified as first-order latent factors and intersectional minority stress as a second-order latent factor. Invariance testing compared a second-order factor structure of the LGBT-PCMS between LGBTQ+ Latina/o/x people (n = 244) and LGBTQ+ non-Latina/o/x POC (n = 247) groups. Structural equation modeling was used to examine convergent validity with the perceived stress subscales. RESULTS:Findings from the second-order CFA showed that the LGBT-PCMS demonstrated acceptable fit across the full sample, LGBTQ+ Latina/o/x people, and LGBTQ+ non-Latina/o/x POC. Full invariance was demonstrated between LGBTQ+ Latina/o/x people and LGBTQ+ non-Latina/o/x POC groups. No link between the LGBT-PCMS and perceived stress subscales emerged. CONCLUSION:The LGBT-PCMS was indistinguishable between LGBTQ+ Latina/o/x people and LGBTQ+ non-Latina/o/x POC, supporting that the LGBT-PCMS can be used as a single measure of intersectional minority stress or separate subscales.
The current U.S. sociopolitical climate-marked by recent targeted anti-lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) legislation and executive orders (i.e., sociopolitical stressors)-including those focused on antidiversity, equity, and inclusion-leads to heightened minority stress among current LGBTQ+ public health trainees, threatening their well-being and career trajectories. Macro-level (distal) stressors, such as discriminatory funding cuts, institutional censorship, and sociopolitical hostility interact with proximal stressors (i.e., expectations of rejection, concealment, internalized stigma, and moral injury) to undermine trainee retention. Without mitigation strategies-such as enhanced structural support-these compounded stressors could cause a significant loss to the public health infrastructure and workforce.
Purpose: This study examined differences in rates of gynecological health care utilization among lesbian, gay, and bisexual (LGB) women veterans relative to heterosexual women veterans. Methods: Women veterans (N = 1729) recruited via the Veterans Affairs/Department of Defense Identity Repository (14.3% LGB, n = 248) answered questionnaires related to gynecological health care utilization between September 2018 and June 2019. Binary logistic regression was used to examine differences in Pap smear receipt and gynecological care visits, controlling for age, race/ethnicity, posttraumatic stress disorder symptoms, and sexual trauma exposure. Results: LGB women veterans were equally likely to receive Pap smears compared to heterosexual veterans (ps > 0.05). Gay or lesbian, but not bisexual, veterans were less likely to undergo routine gynecology visits relative to heterosexual women veterans (71% vs. 81%, p = 0.004). Conclusion: Given that annual gynecology visits are recommended for reproductive-aged women for preventive and interventional care, it is important to address factors that may contribute to underutilization among gay or lesbian women veterans.
Purpose: The purpose of this study was to examine the experiences and prevalence of conversion practices and their association with mental health among sexually and gender diverse (SGD) people in Portugal. Methods: Four hundred and twenty-four SGD individuals (mean age = 26.6) completed an online survey regarding their experiences of therapy and conversion practices. Data were collected between March 2021 and December 2022. Through analysis of variance, participants who reported experiencing a conversion practice were compared with those who did not on their levels of psychological distress (Clinical Outcome Routine Evaluation – Outcome Measure). Results: Almost 22% of participants reported being subjected to conversion practices, with 22% of such practices performed by a mental health professional. The mean age at the start of the practice was 16.5 years. More than half of the sample who were subjected to a conversion practice reported feeling coerced into doing so, and over a third felt forced to stay in the process. After controlling for participants’ previous experience of therapy and being in therapy at the time of the study, participants reporting a conversion experience showed significantly lower subjective well-being and life functioning and significantly higher problems/symptoms and risk than those who did not. Conclusion: A high prevalence of conversion practices and their pervasive effects on SGD individuals’ mental health were found in this study. It further highlighted how SGD youth are at greater risk of being subjected to such practices. We argue that legislation to criminalize such practices and protect SGD individuals is urgent.
PURPOSE:This systematic review aimed to summarize evidence on continuous testosterone therapy during ovarian stimulation in trans masculine individuals. METHODS:A search of Medline, EMBASE, Cochrane, PubMed, CINAHL, Web of Science, and ClinicalTrials.gov was conducted through October 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting ovarian stimulation on continuous testosterone therapy were included. The Joanna Briggs Institute Checklist for Case Reports was used to assess risk of bias, and descriptive statistics and qualitative synthesis were conducted. RESULTS:The review included six articles involving eight patients. Median age at oocyte cryopreservation was 27 years (range 20-34), and median age at initiation of testosterone was 24 (range 18-27). An antagonist protocol was used for seven patients. Letrozole was given to three patients during their cycle. Oocytes were cryopreserved for four patients, embryos were cryopreserved at the time of stimulation for two patients, and two patients created embryos from cryopreserved oocytes. The median number of oocytes retrieved from seven patients was 20 (range 13-56), and the median number of oocytes cryopreserved from six patients was 22.5 (range 9-30). To date, three embryo transfers (two frozen and one fresh) have been reported, all resulting in live births. CONCLUSION:Live births, oocyte and embryo cryopreservation, are possible across a range of stimulation protocols under testosterone exposure. As trans masculine patients report gender dysphoria with the fertility preservation process, these case reports present an opportunity for reconsideration of current practices and propose a paradigm shift in fertility care for transgender individuals.
PURPOSE:This study aimed to examine associations between romantic involvement and depression symptoms, anxiety symptoms, substance use problems, and recent substance use, as well as assess the moderating roles of internalized stigma, parental acceptance, and demographic characteristics. METHODS:Participants were drawn from the 2022 LGBTQ+ National Teen Survey, an online cross-sectional study of sexual and gender minority (SGM) adolescents; a total of 6248 participants were included in the present study. Multivariable linear and logistic regression models were performed to assess associations between romantic involvement and depression symptoms, anxiety symptoms, substance use problems, and recent alcohol, heavy alcohol, marijuana, and nicotine use, with additional models for each stigma-based or demographic moderator. RESULTS:Romantic involvement was significantly associated with increased depression symptoms, anxiety symptoms, recent substance use, and substance use problems. Both lower internalized stigma and higher parental acceptance diminished the associations between romantic involvement and substance use problems, but not other outcomes. Age also moderated the effect of romantic involvement across recent substance use measures. CONCLUSION:Given consistent associations between romantic involvement and adverse mental and behavioral health observed in this study, clinicians and researchers should further explore protective influences for SGM adolescents in romantic relationships and promote individual and relationship interventions for romantically involved SGM adolescents.
PURPOSE:The purpose of this study was to describe disparities in the severity of substance use disorders (SUDs) between sexual minority (SM) and heterosexual youth. METHODS:The current study analyzed data from the 2023 National Survey on Drug Use and Health to examine differences in SUDs between SM and heterosexual youth. Analyses were limited to participants aged 12-25 years (n = 23,333). Participants reported on their sexual identity and completed items on past-year substance use. SUDs were classified using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. A separate multinomial regression model was conducted for each outcome (alcohol use disorder [AUD] severity, cannabis use disorder [CUD] severity, and drug use disorder severity), stratified by age and sex. Each model included sexual identity as the primary predictor. RESULTS:Odds for meeting criteria for an SUD at any severity level were generally highest for bisexual youth compared with all other youth, with few exceptions. AUD severity varied slightly among adolescents, and CUD varied slightly among males. CONCLUSION:This study is the first to identify differences in DSM-5 SUD severity between SM and heterosexual youth. The findings underscore the importance of developing clinical interventions tailored to the distinct challenges faced by SM youth, especially bisexual youth, to help reduce disparities in substance use outcomes.
