Hormone Prescription and HIV Screening/Preventive Practices Among Clinicians Providing Care for Transgender Individuals

Purpose: Through a survey-based approach, we sought to investigate regional differences in gender-affirming hormone therapy (GAHT) prescribing practices, as well as HIV screening and prevention practices among clinicians providing care to transgender individuals.Methods: Our survey was disseminated between December 2019 and January 2021 to clinicians who prescribe GAHT within New England (United States). Between-group differences in GAHT prescribing and HIV screening/prevention practices were evaluated by practice setting and subspecialty.Results: Of the 20 survey respondents, 55% practiced in health care settings affiliated with an academic institution, 45% practiced in a community-based health care setting, and 30% were Endocrinologists. Clinicians in community-based health care settings reported more frequently prescribing oral 17 beta-estradiol (p=0.02) and spironolactone (p=0.007) for feminizing GAHT compared with clinicians in health care settings affiliated with an academic institution, who reported more frequently prescribing leuprolide (p=0.03). For masculinizing GAHT, clinicians from health care settings affiliated with an academic institution reported more frequently prescribing topical testosterone (p=0.03). There were no significant between-group differences in reported barriers to initiation or reasons for stopping GAHT. While non-Endocrinologists reported "often" or "always" offering HIV screening, most Endocrinologists reported "rarely" or "never" offering HIV screening and "rarely" or "never" offering pre-exposure or postexposure prophylaxis to their transgender patients.Conclusions: Regional GAHT prescribing practices varied by setting. Additional research is needed to better understand whether these differences translate to differences in GAHT efficacy and side-effects. Further, HIV screening/prevention practices varied by subspecialty. Integrated GAHT and HIV screening/prevention across subspecialties could help reduce the disproportionate burden of HIV faced by the transgender community.