Primary Care of Transgender Adults

  • Asa RadixEmail author
Part of the Contemporary Endocrinology book series (COE)


Transgender and gender non-binary people have become more visible and accepted in society, however, their medical needs are frequently unmet. Primary care medical providers often lack knowledge about how to provide appropriate and culturally competent health care, both transition-related care as well as preventive care services. This chapter provides guidance to the medical provider on how to apply gender- and anatomy-based primary care recommendations to patients of transgender experience.


Transgender Non-binary Primary care Hormones Gender Preventive care 


  1. 1.
    Institute of Medicine (US) Committee on Lesbian, gay, bisexual, and transgender health issues and research gaps and opportunities. 2011.Google Scholar
  2. 2.
    American Academy of Pediatrics, Committee on Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics. 2013;132(1):198–203.Google Scholar
  3. 3.
    The American College of Obstetricians and Gynecologists. Committee Opinion no. 512: health care for transgender individuals. Obstet. Gynecol. 2011;118(6):1454–8.Google Scholar
  4. 4.
    Daniel H, Butkus R. Lesbian, gay, bisexual, and transgender health disparities: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2015;163(2):135–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Society for Adolescent Health and Medicine. Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health: official publication of the Society for Adolescent Medicine. 2013;52(4):506–10.CrossRefGoogle Scholar
  6. 6.
    Shires DA, Stroumsa D, Jaffee KD, Woodford MR. Primary care providers’ willingness to continue gender-affirming hormone therapy for transgender patients. Fam Pract. 2017.Google Scholar
  7. 7.
    Unger CA. Care of the transgender patient: a survey of gynecologists’ current knowledge and practice. J Womens Health (Larchmt). 2015;24(2):114–8.CrossRefGoogle Scholar
  8. 8.
    Grant JM, Mottet LA, Tanis J. National transgender discrimination survey report on health and health care. Washington, DC: National Center for Transgender Equality and the National Gay and Lesbian Task Force; 2010. Contract No.: Report.Google Scholar
  9. 9.
    Jaffee KD, Shires DA, Stroumsa D. Discrimination and delayed health care among transgender women and men: implications for improving medical education and health care delivery. Medical Care. 2016.Google Scholar
  10. 10.
    Glick JL, Theall KP, Andrinopoulos KM, Kendall C. The role of discrimination in care postponement among trans-feminine individuals in the U.S. National Transgender Discrimination Survey. LGBT Health. 2018;5(3):171–9.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014;47(6):808–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Bazzi AR, Whorms DS, King DS, Potter J. Adherence to mammography screening guidelines among transgender persons and sexual minority women. Am J Public Health. 2015;105(11):2356–8.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.PubMedCrossRefGoogle Scholar
  14. 14.
    Pitasi MA, Oraka E, Clark H, Town M, DiNenno EA. HIV testing among transgender women and men—27 states and Guam, 2014–2015. MMWR Morb Mortal Wkly Rep. 2017;66(33):883–7.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943–51.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Buchting FO, Emory KT, Scout Kim Y, Fagan P, Vera LE, et al. Transgender use of cigarettes, cigars, and e-cigarettes in a national study. Am J Prev Med. 2017;53(1):e1–7.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52(3):243–56.PubMedCrossRefGoogle Scholar
  18. 18.
    Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2012.Google Scholar
  19. 19.
    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgenderism. 2011;13:165.CrossRefGoogle Scholar
  20. 20.
    Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903.PubMedCrossRefGoogle Scholar
  21. 21.
    Deutsch MB. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. San Francisco, CA: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco; 2016. Available from: Accessed 3/1/2018.
  22. 22.
    Wanta JW, Unger CA. Review of the transgender literature: where do we go from here? Transgend Health. 2017;2(1):119–28.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    U.S. Preventive Services Task Force. Rockville, MD: U.S. Dept. of Health & Human Services, Agency for Healthcare Research and Quality. Available from: Accessed 3/1/2018.
  24. 24.
    Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. Available from: Accessed 3/1/2018.
  25. 25.
    Edmiston EK, Donald CA, Sattler AR, Peebles JK, Ehrenfeld JM, Eckstrand KL. Opportunities and gaps in primary care preventative health services for transgender patients: a systemic review. Transgend Health. 2016;1(1):216–30.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Madeline B, Deutsch AR, Sari Reisner. What’s in a guideline? Developing collaborative and sound research designs that substantiate best practice recommendations for transgender health care. AMA J Ethics. 2016;18(11):1098–106.CrossRefGoogle Scholar
  27. 27.
    MacCarthy S, Reisner SL, Nunn A, Perez-Brumer A, Operario D. The time is now: attention increases to transgender health in the United States but scientific knowledge gaps remain. LGBT Health. 2015;2(4):287–91.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Croghan CF, Moone RP, Olson AM. Working with LGBT Baby boomers and older adults: factors that signal a welcoming service environment. J Gerontol Soc Work. 2015;58(6):637–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W 3rd, et al. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):188–97.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Reisner SL, Bradford J, Hopwood R, Gonzalez A, Makadon H, Todisco D, et al. Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health. J Urban Health Bull NY Acad Med. 2015;92(3):584–92.CrossRefGoogle Scholar
  31. 31.
    Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S235–42.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Potter J, Peitzmeier SM, Bernstein I, Reisner SL, Alizaga NM, Agénor M, et al. Cervical cancer screening for patients on the female-to-male spectrum: a narrative review and guide for clinicians. J Gen Intern Med. 2015;30(12):1857–64.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Cahill S, Singal R, Grasso C, King D, Mayer K, Baker K, et al. Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American Community Health Centers. PLoS ONE. 2014;9(9):e107104.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Deutsch MB, Green J, Keatley J, Mayer G, Hastings J, Hall AM. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J Am Med Inf Assoc JAMIA. 2013;20(4):700–3.CrossRefGoogle Scholar
  35. 35.
    Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.Google Scholar
  36. 36.
    Institute of Medicine Committee on Lesbian GB, Transgender Health I, Research G, Opportunities. The National Academies Collection: Reports funded by National Institutes of Health. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC; 2011.Google Scholar
  37. 37.
    Asscheman H, Giltay EJ, Megens JA, de Ronde WP, van Trotsenburg MA, Gooren LJ. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol/Eur Fed Endocr Soc. 2011;164(4):635–42.CrossRefGoogle Scholar
  38. 38.
    Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, et al. Sex Steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2017;102(11):3914–23.PubMedCrossRefGoogle Scholar
  39. 39.
    Elbers JMH, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol. 2003;58:562.CrossRefGoogle Scholar
  40. 40.
    Polderman KH, Gooren LJ, Asscheman H, Bakker A, Heine RJ. Induction of insulin resistance by androgens and estrogens. J Clin Endocrinol Metab. 1994;79(1):265–71.PubMedGoogle Scholar
  41. 41.
    Gooren LJ, Wierckx K, Giltay EJ. Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern. Eur J Endocrinol/Eur Fed Endocr Soc. 2014;170(6):809–19.CrossRefGoogle Scholar
  42. 42.
    Defreyne J, De Bacquer D, Shadid S, Lapauw B, T’Sjoen G. Is type 1 diabetes mellitus more prevalent than expected in transgender persons? A local observation. Sex Med. 2017;5(3):e215–8.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Streed CG Jr, Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: a narrative review. Ann Intern Med. 2017;167(4):256–67.PubMedCrossRefGoogle Scholar
  44. 44.
    Committee on Health Care for Underserved W. Committee Opinion no. 512: health care for transgender individuals. Obstet Gynecol. 2011;118(6):1454–8.Google Scholar
  45. 45.
    Moyer VA. on behalf of the USPSTF. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156(12):880–91.PubMedCrossRefGoogle Scholar
  46. 46.
    Reisner SL, Gamarel KE, Dunham E, Hopwood R, Hwahng S. Female-to-male transmasculine adult health: a mixed-methods community-based needs assessment. J Am Psychiatr Nurses Assoc. 2013;19(5):293–303.PubMedCrossRefGoogle Scholar
  47. 47.
    Reisner SL, Deutsch MB, Peitzmeier SM, White Hughto JM, Cavanaugh TP, Pardee DJ, et al. Test performance and acceptability of self- versus provider-collected swabs for high-risk HPV DNA testing in female-to-male trans masculine patients. PLoS ONE. 2018;13(3):e0190172.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening. J Gen Intern Med. 2014;29(5):778–84.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Baker KE. The future of transgender coverage. N Engl J Med. 2017;376(19):1801–4.PubMedCrossRefGoogle Scholar
  50. 50.
    The American College of Obstetricians and Gynecologists. Practice Bulletin Number 179: Breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017;130(1):e1–16.CrossRefGoogle Scholar
  51. 51.
    US Preventive Services Task Force GD, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, Doubeni CA, Ebell M, Epling JW Jr, Kemper AR, Krist AH, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Siu AL, Tseng CW. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716–26, w-236.Google Scholar
  52. 52.
    Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat. 2015;149(1):191–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Deutsch MB, Radix A, Wesp L. Breast cancer screening, management, and a review of case study literature in transgender populations. Semin Reprod Med. 2017;35(5):434–41.PubMedCrossRefGoogle Scholar
  54. 54.
    Wilson E, Rapues J, Jin H, Raymond HF. The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013. J Sex Med. 2014;11(7):1717–24.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Scaranelo AM, de Fatima Ribeiro Maia M. Sonographic and mammographic findings of breast liquid silicone injection. J. Clin. Ultrasound JCU. 2006;34(6):273–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Gooren LJ, van Trotsenburg MAA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10(12):3129–34.PubMedCrossRefGoogle Scholar
  57. 57.
    US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(23):2564–75.CrossRefGoogle Scholar
  58. 58.
    Tabaac AR, Sutter ME, Wall CSJ, Baker KE. Gender identity disparities in cancer screening behaviors. Am J Prev Med. 2018;54(3):385–93.PubMedCrossRefGoogle Scholar
  59. 59.
    Gooren L, Morgentaler A. Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens. Andrologia. 2013.Google Scholar
  60. 60.
    Matzkin H, Barak M, Braf Z. Effect of finasteride on free and total serum prostate-specific antigen in men with benign prostatic hyperplasia. Br J Urol. 1996;78(3):405–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Etzioni RD, Howlader N, Shaw PA, Ankerst DP, Penson DF, Goodman PJ, et al. Long-term effects of finasteride on prostate specific antigen levels: results from the prostate cancer prevention trial. J Urol. 2005;174(3):877–81.PubMedCrossRefGoogle Scholar
  62. 62.
    Sundar S, Dickinson PD. Spironolactone, a possible selective androgen receptor modulator, should be used with caution in patients with metastatic carcinoma of the prostate. BMJ Case Reports. 2012;2012.Google Scholar
  63. 63.
    Andriole GL, Bostwick D, Brawley OW, Gomella L, Marberger M, Montorsi F, et al. The effect of dutasteride on the usefulness of prostate specific antigen for the diagnosis of high grade and clinically relevant prostate cancer in men with a previous negative biopsy: results from the REDUCE study. J Urol. 2011;185(1):126–31.PubMedCrossRefGoogle Scholar
  64. 64.
    Andriole GL, Guess HA, Epstein JI, Wise H, Kadmon D, Crawford ED, et al. Treatment with finasteride preserves usefulness of prostate-specific antigen in the detection of prostate cancer: results of a randomized, double-blind, placebo-controlled clinical trial. PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology. 1998;52(2):195–201; discussion-2.PubMedCrossRefGoogle Scholar
  65. 65.
    Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2016. Endocr Pract: Official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2016;22(Suppl 4):1–42.CrossRefGoogle Scholar
  66. 66.
    Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(6):1802–22.PubMedCrossRefGoogle Scholar
  67. 67.
    The American College of Obstetricians and Gynecologists. ACOG Practice Bulletin N. 129. Osteoporosis. Obstetrics and Gynecology. 2012;120(3):718–34.Google Scholar
  68. 68.
    U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2011;154(5):356–64.CrossRefGoogle Scholar
  69. 69.
    Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(1):1–10.PubMedCrossRefGoogle Scholar
  70. 70.
    Wierckx K, Mueller S, Weyers S, Van Caenegem E, Roef G, Heylens G, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641–51.PubMedCrossRefGoogle Scholar
  71. 71.
    Lapauw B, Taes Y, Simoens S, Van Caenegem E, Weyers S, Goemaere S, et al. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone. 2008;43(6):1016–21.PubMedCrossRefGoogle Scholar
  72. 72.
    van Kesteren PJ, Asscheman H, Megens JA, Gooren LJ. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol. 1997;47(3):337–42.CrossRefGoogle Scholar
  73. 73.
    Van Caenegem E, Taes Y, Wierckx K, Vandewalle S, Toye K, Kaufman JM, et al. Low bone mass is prevalent in male-to-female transsexual persons before the start of cross-sex hormonal therapy and gonadectomy. Bone. 54(1):92–7.Google Scholar
  74. 74.
    Radix A, Deutsch MB. Bone health and osteoporosis. In: Deutsch MB, editor. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. San Francisco: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California; 2016.Google Scholar
  75. 75.
    Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations and reports: morbidity and mortality weekly report. Recommendations and Reports/Centers for Disease Control. 2006;55(RR-14):1–17; quiz CE1-4.Google Scholar
  76. 76.
    Habarta N, Wang G, Mulatu MS, Larish N. HIV testing by Transgender Status at Centers for disease control and prevention-funded sites in the United States, Puerto Rico, and US Virgin Islands, 2009–2011. Am J Public Health. 2015;105(9):1917–25.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Mizuno Y, Frazier EL, Huang P, Skarbinski J. Characteristics of transgender women living with HIV receiving medical care in the United States. LGBT Health. 2015;2(3):228–34.PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Braun HM, Candelario J, Hanlon CL, Segura ER, Clark JL, Currier JS, et al. Transgender women living with HIV frequently take antiretroviral therapy and/or feminizing hormone therapy differently than prescribed due to drug-drug interaction concerns. LGBT Health. 2017;4(5):371–5.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Centers for Disease Control and Prevention: US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline.Google Scholar
  80. 80.
    Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR recommendations and reports: morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control. 2015;64(RR-03):1–137.Google Scholar
  81. 81.
    Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, et al. Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Am J Public Health. 2013;103(2):300–7.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Gupte S, Daly C, Agarwal V, Gaikwad SB, George B. Introduction of rapid tests for large-scale syphilis screening among female, male, and transgender sex workers in Mumbai. India. Sex Transm Dis. 2011;38(6):499–502.PubMedGoogle Scholar
  83. 83.
    Shrivastava SR, Bobhate PS. Prevalence of HIV and syphilis in patients attending sexually transmitted infections (STI) clinic in an urban slum. J Res Health Sci. 2012;12(1):7–14.PubMedGoogle Scholar
  84. 84.
    Brown B, Monsour E, Klausner JD, Galea JT. Sociodemographic and behavioral correlates of anogenital warts and human papillomavirus-related knowledge among men who have sex with men and transwomen in Lima, Peru. Sex Transm Dis. 2015;42(4):198–201.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Bastos FI, Bastos LS, Coutinho C, Toledo L, Mota JC, Velasco-de-Castro CA, et al. HIV, HCV, HBV, and syphilis among transgender women from Brazil: assessing different methods to adjust infection rates of a hard-to-reach, sparse population. Medicine. 2018;97(1S Suppl 1):S16–s24.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Reisner SL, White JM, Mayer KH, Mimiaga MJ. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS Care. 2014;26(7):857–64.PubMedCrossRefGoogle Scholar
  87. 87.
    Stephens SC, Bernstein KT, Philip SS. Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS Behav. 2011;15(3):683–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Bodsworth NJ, Price R, Davies SC. Gonococcal infection of the neovagina in a male-to-female transsexual. Sex Transm Dis. 1994;21(4):211–2.PubMedCrossRefGoogle Scholar
  89. 89.
    van der Sluis WB, Bouman MB, Gijs L, van Bodegraven AA. Gonorrhoea of the sigmoid neovagina in a male-to-female transgender. Int J STD AIDS. 2015;26(8):595–8.PubMedCrossRefGoogle Scholar
  90. 90.
    Matsuki S, Kusatake K, Hein KZ, Anraku K, Morita E. Condylomata acuminata in the neovagina after male-to-female reassignment treated with CO2 laser and imiquimod. Int J STD AIDS. 2015;26(7):509–11.PubMedCrossRefGoogle Scholar
  91. 91.
    Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014;124(6):1120–7.PubMedCrossRefGoogle Scholar
  92. 92.
    Kim DK, Riley LE, Hunter P, on behalf of the Advisory Committee on Immunization. Recommended immunization schedule for adults aged 19 years or older, United States, 2018*. Ann Intern Med. 2018;168(3):210–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of MedicineCallen-Lorde Community Health CenterNew YorkUSA

Personalised recommendations