ImportanceUse of exogenous sex steroid hormones, when indicated, may improve outcomes in adolescents and young adults with gender incongruence. Little is known about factors associated with the time from diagnosis of gender dysphoria to initiation of gender-affirming hormone therapy. Identification of inequities in time to treatment may have clinical, policy, and research implications.ObjectiveTo evaluate factors associated with time to initiation of gender-affirming hormone therapy after a diagnosis of gender dysphoria in adolescents and young adults receiving care within the US Military Health System.Design, Setting, and ParticipantsThis retrospective cohort study used TRICARE Prime billing and pharmacy data contained in the Military Health System Data Repository. Patients aged 14 to 22 years, excluding service members and their spouses, who received a diagnosis of gender dysphoria between September 1, 2016, and December 31, 2021, were included. The data were analyzed between August 30 and October 12, 2023.ExposuresIncluded patient characteristics were race and ethnicity, age group, first sex assigned in the medical record, and TRICARE Prime sponsor military rank and service at the time of diagnosis. Health care and contextual characteristics included the year of diagnosis and the primary system in which the patient received health care.Main Outcomes and MeasuresThe primary outcome was the time between initial diagnosis of gender dysphoria to the first prescription for gender-affirming hormone medication within a 2-year period. A Poisson generalized additive model was used to evaluate this primary outcome. Adjusted probability estimates were calculated per specified reference categories.ResultsOf the 3066 patients included (median [IQR] age, 17 [15-19] years; 2259 with first assigned gender marker of female [74%]), an unadjusted survival model accounting for censoring indicated that 37% (95% CI, 35%-39%) initiated therapy by 2 years. Age-adjusted curves indicated that the proportion initiating therapy by 2 years increased by age category (aged 14-16 years, 25%; aged 17-18 years, 39%; aged 19-22 years, 55%). Incidence rate ratios (IRRs) and 2-year adjusted probabilities indicated that longer times to hormone initiation were experienced by adolescents aged 14 to 16 years (IRR, 0.36; 95% CI, 0.30-0.44) and 17 to 18 years (IRR, 0.66; 95% CI, 0.54-0.79) compared with young adults aged 19 to 22 years and Black compared with White adolescents (IRR, 0.73; 95% CI, 0.54-0.99). Senior officer compared with junior enlisted insurance sponsor rank (IRR, 1.93; 95% CI, 1.04-3.55) and civilian compared with military health care setting (IRR, 1.21; 95% CI, 1.02-1.43) was associated with shorter time to hormone initiation.Conclusions and RelevanceIn this cohort study, most adolescents and young adults with a diagnosis of gender dysphoria receiving health care through the US military did not initiate exogenous sex steroid hormone therapy within 2 years of diagnosis. Inequities in time to treatment indicate the need to identify and reduce barriers to care.

中文翻译：

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美国军方青少年和年轻人接受性别肯定激素治疗的时机到了


重要性如果有需要，使用外源性类固醇激素可能会改善性别不一致的青少年和年轻人的预后。对于从诊断出性别不安到开始性别肯定激素治疗的时间相关的因素知之甚少。识别治疗时间的不平等可能具有临床、政策和研究意义。目的评估在美国军事卫生系统内接受护理的青少年和年轻人在诊断出性别不安后与开始性别肯定激素治疗的时间相关的因素设计、设置和参与者这项回顾性队列研究使用了军事卫生系统数据存储库中包含的 TRICARE Prime 计费和药房数据。纳入范围为2016年9月1日至2021年12月31日期间被诊断为性别焦虑症的14至22岁患者（不包括军人及其配偶）。数据分析时间为 2023 年 8 月 30 日至 10 月 12 日。暴露的患者特征包括种族和民族、年龄组、病历中分配的第一性别以及诊断时 TRICARE Prime 赞助商的军衔和服役。医疗保健和背景特征包括诊断年份和患者接受医疗保健的主要系统。主要结果和措施主要结果是从最初诊断出性别不安到在 2 年内第一次开出性别确认激素药物处方之间的时间。年期间。使用泊松广义加性模型来评估这一主要结果。调整后的概率估计值是根据指定的参考类别计算的。结果在纳入的 3066 名患者中（中位 [IQR] 年龄为 17 [15-19] 岁；2259 名患者的第一个指定性别标记为女性 [74%]），未调整的生存模型说明审查表明 37%（95% CI， 35%-39%）在 2 岁时开始治疗。年龄调整曲线表明，按年龄类别，2岁开始治疗的比例有所增加（14-16岁，25%；17-18岁，39%；19-22岁，55%）。发病率比 (IRR) 和 2 年调整概率表明，14 至 16 岁的青少年（IRR，0.36；95% CI，0.30-0.44）和 17 至 18 岁（IRR，0.66）经历了较长的激素起始时间。 ；95% CI，0.54-0.79）与 19 至 22 岁的年轻人相比，黑人与白人青少年相比（IRR，0.73；95% CI，0.54-0.99）。高级军官与初级入伍保险赞助者级别相比（IRR，1.93；95% CI，1.04-3.55）以及文职人员与军事医疗机构相比（IRR，1.21；95% CI，1.02-1.43）与较短的激素治疗时间相关结论和相关性在这项队列研究中，大多数被诊断为性别不安的青少年和年轻人通过美国军方接受医疗保健，在诊断后 2 年内没有开始外源性类固醇激素治疗。治疗时间的不平等表明需要确定并减少护理障碍。