• Sari L Reisner, Madeline B Deutsch, Kenneth H Mayer, David R Pletta, Juwan Campbell, Jennifer Potter, Alex S Keuroghlian, Jaclyn M W Hughto, Andrew Asquith, Dana J Pardee, Alexander Harris, Meg Quint, Chris Grasso, Alex Gonzalez, and Asa Radix.
• Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, USA. sreisner@bwh.harvard.edu.
• J Gen Intern Med. 2024 May 1; 39 (7): 116411721164-1172.

BackgroundTransgender and gender diverse (TGD) adults in the U.S. experience health disparities, including in anogenital sexually transmitted infections (STI). Gender-affirming hormone therapy (GAHT) is known to be medically necessary and improve health. Few studies have assessed the effect of GAHT on STI diagnoses.ObjectiveTo evaluate the effect of GAHT delivered in primary care as an intervention to improve STI outcomes for TGD adults.DesignLEGACY is a longitudinal, multisite cohort study of adult TGD primary care patients from two federally qualified community health centers in Boston, MA, and New York, NY.ParticipantsElectronic health record data for eligible adult TGD patients contributed to the LEGACY research data warehouse (RDW). A total of 6330 LEGACY RDW patients were followed from 2016 to 2019, with 2555 patients providing STI testing data.Main MeasuresGAHT exposure was being prescribed hormones, and the clinical outcome was anogenital gonorrhea or chlamydia diagnoses. Log-Poisson generalized estimating equations assessed the effect of prescription GAHT on primary outcomes, adjusting for age, race, ethnicity, gender identity, poverty level, health insurance, clinical site, and cohort years.Key ResultsThe median age was 28 years (IQR = 13); the racial breakdown was 20.4% Black, 8.1% Multiracial, 6.9% Asian/Pacific Islander, 1.8% Other; 62.8% White; 21.3% Hispanic/Latinx; 47.0% were assigned female at birth, and 16.0% identified as nonbinary. 86.3% were prescribed hormones. Among those tested, the percentage of patients with a positive anogenital STI diagnosis ranged annually from 10.0 to 12.5% between 2016 and 2019. GAHT prescription was associated with a significant reduction in the risk of anogenital STI diagnosis (aRR = 0.75; 95% CI = 0.59-0.96) over follow-up.ConclusionsGAHT delivered in primary care was associated with less STI morbidity in this TGD cohort over follow-up. Patients may benefit from individualized and tailored clinical care alongside GAHT to optimize STI outcomes.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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