Transgender and gender diverse (TGD) populations are often excluded from research or inappropriately grouped with other gender modalities despite significant disparities in health and health care. According to models of community-engaged research, involving TGD community members in establishing research priorities can improve the relevance and impact of research for this population. The purpose of this study was to clarify community priorities for research relevant to TGD populations. Forty-five individuals participated across five asynchronous online focus groups. Participants discussed topics chosen in collaboration with a community research advisory board, including gender-affirming hormone therapy. Rapid qualitative analysis was used to identify salient themes. Research priorities voiced across all represented gender identities were: (1) Longitudinal, prospective research on long-term effects of gender-affirming hormone therapy, (2) Standardized training for providers and researchers, (3) Implementation research on methods to educate the public and reduce discrimination, and (4) Basic research on the biological, historical, and social underpinnings of gender identity. This study provides insight into clinical priorities for TGD populations. Findings highlight a need for basic science research to better understand the underpinnings of gender identity, longitudinal studies to investigate long-term effects of hormone therapy, and education for the public on gender diversity to combat discrimination.

Sexual and gender minority (SGM) communities at increased risk of human immunodeficiency virus (HIV) may be underprescribed preexposure prophylaxis (PrEP), but PrEP research on SGM communities other than transgender women and cisgender men who have sex with men is limited. We sought to better understand SGM individuals' vulnerability to HIV acquisition and awareness and perceptions of PrEP in North Carolina, with a focus on SGM groups less often included in research. We administered a 37-item online survey to adult SGM participants, examining differences in perceived and behavioral HIV risk based on self-reported behaviors. We also compared PrEP awareness, prescriptions, and stigma between SGM identities and used logistic regression to examine associations between HIV risk and PrEP use. In total, 372 participants completed the survey. Although 30.9% reported behaviors that increase the likelihood of HIV acquisition, only 9.5% perceived their risk as elevated. Most (78.5%) were aware of PrEP, but only 15.1% had been prescribed PrEP. PrEP stigma was most pervasive among cisgender women. Nonbinary and queer participants were more likely to have experienced mistreatment by a provider (20.3%, P < 0.0001; 19.2%, P < 0.01) and avoid care fearing mistreatment (31.9%, P < 0.001; 27.7%; P < 0.001) compared with the entire sample. PrEP is prescribed at low rates across many SGM communities, with misperception of HIV risk, PrEP stigma, and mistreatment in health care identified as important barriers. Healthcare providers should take steps to create a safe environment for SGM patients and ask all patients about HIV risk factors and provide information about PrEP regardless of sexual orientation or gender identity.

Background: Transgender women with HIV face higher rates of atherosclerotic cardiovascular disease (ASCVD) than the general population. However, ASCVD risk estimators use binary sex variables that may misclassify their risk. We examined the effects of sex variable inputs in the Predicting Risk of Cardiovascular Disease Events (PREVENT) and Pooled Cohort Equation (PCE) risk calculations and tested for associations of ASCVD risk scores with HIV and hormone use. Setting: Participants were recruited from health centers in Boston, New York, and Washington, DC. Methods: We performed a cross-sectional comparison of PCE and PREVENT scores by sex variable inputs using data from 108 Black and Latina transgender women with HIV. Logistic regression models tested whether hormone duration and time since HIV diagnosis were associated with hyperlipidemia, diabetes, hypertension, or cardiac events. Results: Using an illustrative ≥ 5% risk score as the threshold for statin initiation, 40.6% with PCE versus 9.5% with PREVENT met or exceeded 5% risk when male was entered for all, compared with 17.7% with PCE versus 9.5% with PREVENT when female was entered for all, and 24.0% with PCE versus 8.4% with PREVENT when female was entered for participants taking hormones. Neither years since HIV diagnosis nor hormone duration were associated with ASCVD risk factors or events Conclusion: Use of the PREVENT calculator generates lower ASCVD risk estimates than PCE in transgender women with HIV. Research is needed to determine how best to incorporate gender diversity and intersecting factors into ASCVD risk calculations.

Background: The use of estrogen-based gender-affirming hormone therapy (E-GAHT) has been associated with an increased risk of venous thromboembolism (VTE), but much of the evidence originates from data on cisgender women and from cohorts of transgender and gender diverse (TGD) individuals treated with older estrogen or estrogen/progesterone preparations, often at higher doses. Data on VTE risks associated with more modern E-GAHT regimens in TGD populations are scarce. Methods: A retrospective cohort study of adult TGD individuals who received E-GAHT within the Duke University Health System between January 1996 and June 2025 was conducted. The Duke Enterprise Data Unified Content Explorer (DEDUCE), a Duke electronic medical record search tool, was utilized to identify a cohort of TGD individuals who were prescribed E-GAHT. From this cohort, individuals who experienced a VTE during E-GAHT exposure were identified. Demographic characteristics and comorbidities were compared between the overall study cohort and those who experienced VTE using the SlicerDicer tool within Epic, supplemented by manual chart review. Results: Among 1173 adult TGD individuals prescribed E-GAHT, 16 (1.4%) experienced a VTE. Of these, 11 (68.8%) experienced a pulmonary embolism (PE with/without deep vein thrombosis [DVT]) and five (31.3%) experienced a DVT alone. Among the 16 patients with VTE, six (37.5%) had a transient surgical risk factor prior to VTE, three (18%) had significant non-surgical risk factors, and one (6%) had cancer. The remaining six (37.5%) patients experienced an unprovoked VTE. Patients with VTE were significantly older than the general population of TGD adults and were significantly more likely to experience hypertension, hyperlipidemia, and type 2 diabetes mellitus, compared to TGD patients without VTE. Conclusions: In this retrospective cohort, the proportion of TGD individuals on E-GAHT with VTE was lower than previously reported in the literature. Most events occurred in the presence of other established risk factors, suggesting that E-GAHT itself may confer a lower VTE risk than previously assumed. Larger prospective studies that evaluate both estrogen-specific and patient-specific risk factors are needed to clarify VTE risk in this population.