# Understanding Hormone Therapy Care Received by Transgender Veterans in VHA

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2020 · —

## Abstract

Background: The prevalence of transgender Veterans (“trans vets”) is on the rise. Transgender individuals
experience discord between their self-identified gender and biological sex, defined as gender dysphoria (GD).
Untreated and/or undertreated GD is associated with increased mortality and morbidity including depression,
anxiety, and suicidality. Hormone therapy is generally the first, and often the only, medical intervention
accessed by trans persons with GD who seek to masculinize or feminize their body to be consistent with their
gender identity. In 2012, Pharmacy Benefits Management (PBM) issued Criteria for Use (CFU) for trans vet
hormone therapy care. In our pilot work, we identified that out of 7,944 trans vets with GD from FY 2005-17,
4,977 were on hormone therapy, with 7-fold variation on one quality of measure recommended by CFU across
sites. In order to identify more such gaps in delivery of this care, we need to understand the current patterns of
care, determine the degree of concordance with recommendations, and factors driving trans vet hormone care.
Objectives: We propose a quantitative study with the following 3 specific aims:
1: Refine methods for identifying trans vets on hormone therapy using VHA data and validate by chart reviews.
2: Examine the hormone therapy care provided to trans vets in VHA.
 2a: Describe the current state of hormone care for trans vets in VHA.
 2b: Determine the degree that hormone care is concordant with PBM CFU and non-VHA guidelines.
3: Identify patient-, clinician-, and site-level predictors of trans vet guideline-concordant hormone care.
Methods: Aim 1: After having identified a population of GD documented trans vets on hormone therapy using
national VHA data, we will also consider alternative approaches of identification, including receipt of hormones
by opposite sex, and change in coded gender over time, which will be further validated by chart reviews.
Aim 2: We will then describe the study cohort in terms of demographics, proportion of those receiving each
type of hormone therapy (estrogen vs. testosterone vs. none), route of administration (oral, transdermal,
injectable), dosage and titration schedule, and duration of therapy. We will also proceed with the work of
identifying key aspects of care recommended by PBM CFU and non-VHA guidelines (e.g. adequacy of
laboratory monitoring) against which the current care can be measured. Aim 3: We will apply Generalized
Linear Mixed Models to examine factors associated with guideline-concordant hormone therapy care at the
patient- (e.g. housing instability), provider- (e.g. availability of trans electronic consultations) and site-level (e.g.
trans specialty training offered at site).
Anticipated Impacts on Veterans’ Healthcare: VHA has an imperative to provide high-quality care to trans
vets, which is also a primary goal of our operational partners in the Lesbian, Gay, Bisexual, and Transgender
(LGBT) Health Program in the Office of Patient Care Service...

## Key facts

- **NIH application ID:** 9935910
- **Project number:** 5I01HX002556-02
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Guneet Jasuja
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-04-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9935910

## Citation

> US National Institutes of Health, RePORTER application 9935910, Understanding Hormone Therapy Care Received by Transgender Veterans in VHA (5I01HX002556-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9935910. Licensed CC0.

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