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Principal Investigator: Guneet Jasuja
Organization: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: Transgender people experience discord between their gender identity and birth sex, defined as
gender dysphoria. Gender-affirming treatments (GATs) are medically necessary treatments to reduce gender
dysphoria. However, among transgender Veterans (trans Vets) who desire GATs, not much is known about
barriers and facilitators to accessing and receiving GATs in VA and VA Community Care (CC). To ensure
effective and equitable GAT access for trans Vets, it is critical to understand: [1] GATs trans Vets receive and
where they receive them, [2] barriers, including social determinants of health (SDOH) barriers that are highly
prevalent among trans Vets, and facilitators associated with desired GAT receipt in VA and CC, [3] how
barriers and facilitators influence GAT access and desire, and [4] how to improve GAT access in VA and CC.
Significance: This study addresses the 2022 HSR&D priority areas of Access to Care, Health Equity/SDOH,
MISSION Act, and research gap of underserved LGBTQ+ Veterans. It is also a high priority for our operational
partners in VA LGBTQ+ Health Program, Pharmacy Benefits Management, Office of Integrated Veteran Care,
and Office of Mental Health and Suicide Prevention. Knowledge gained from this study will ensure that GAT
delivery in the VA is patient-centered and is responsive to the lived realities and needs of trans Vets.
Innovation and Impact: This study will be the first to characterize the GATs received in VA and/or CC to
understand how VA and CC are balanced in terms of delivering GATs. This study will also provide novel data
on trans Vet experiences related to GAT access in CC, which will be likely relevant to other underserved
Veterans accessing CC. Further, it will be innovative in providing data on services and resources used by trans
Vets to address barriers that influence GAT access. This will be key to developing patient-centered
implementation strategies to improve GAT access in VA and CC.
Specific Aims: We propose a sequential explanatory mixed method study whose aims are to:
Aim 1. Characterize the GATs received by trans Vets in VA and/or CC (VA/CC)
Aim 2. Identify barriers and facilitators associated with desired GAT receipt in VA and CC
Aim 3: Understand trans Vet experiences related to GAT access in VA and CC.
Methodology: Database Aim 1: We will expand our VA cohort of 9,608 trans Vets (IIR 17-238) from 2006-18
to the data available at the time of funding. We will add CC data to determine the types of GATs received by
trans Vets in VA and/or CC. Survey Aim 2: We will survey a national sample of trans Vets identified from Aim
1. Among trans Vets who desire GATs, we will determine SDOH barriers, other barriers, and facilitators
associated with desired GAT receipt. Among trans Vets who did not desire GATs, we will determine reasons
for not wanting GATs. Qualitative Aim 3: From Aim 2 participants, we will recruit a purposive sample of trans
Vets who received all desired GAT(s), who received some desired GAT(s), and who received no desired
GAT(s). We will also recruit a national sample of LGBTQ+ Veteran Care Coordinators. We will seek to
understand experiences and perspectives on GAT access in VA and CC, how SDOH barriers, other barriers,
and facilitators influence GAT access and desire, and how to improve GAT access in VA and CC. Informed by
study findings and in partnership with our Stakeholder Advisory Group, we will develop patient-centered
implementation strategies to mitigate barriers and enhance facilitators to improve GAT access in VA and CC.
Next Steps/Implementation: We will conduct a follow-up hybrid implementation effectiveness study to deploy
these strategies to address barriers that impede GAT access and improve GAT access in VA and CC.
Terms: <Access to Care><Active Follow-up><Address><Area><Behavioral Model><Birth><Caring><Cognitive Discrimination><Collaborations><Communities><Community Health Care><Community Healthcare><Competence><Data><Data Bases><Databases><Depilation><Diagnosis><Discrimination><Distress><Endocrine Gland Secretion><Endocrine Therapy><Ensure><Epilation><Evidence based treatment><Feeling suicidal><Financial Hardship><Follow-Up Studies><Followup Studies><Funding><Gender Identity><Goals><Hair Removal><Health><Health Priorities><Health Services Accessibility><Hormonal Therapy><Hormones><Knowledge><LGBTQ><Lesbian Gay Bi-sexual Transgender Queer><Lesbian Gay Bisexual Transgender Queer><Low income><Mental Health><Mental Hygiene><Methodology><Methods><Operative Procedures><Operative Surgical Procedures><Participant><Parturition><Patients><Persons><Position><Positioning Attribute><Prosthesis><Prosthetic device><Prosthetics><Psychological Health><Psychotherapy><QOL><Quality of life><Reporting><Research><Research Resources><Resources><Sampling><Services><Site><Suggestion><Suicidal thoughts><Suicide precaution><Suicide prevention><Surgical><Surgical Interventions><Surgical Procedure><Survey Instrument><Surveys><Therapeutic Hormone><Time><Travel><Unemployment><Veterans><Violence><Vulnerable Populations><Work><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><active followup><availability of services><care access><cohort><community care><cost><data base><effectiveness/implementation hybrid study><effectiveness/implementation study><experience><financial adversity><financial burden><financial distress><financial insecurity><financial strain><financial stress><follow up><follow-up><followed up><followup><gender affirmation therapy><gender affirmation treatment><gender affirming therapy><gender affirming treatment><gender dysphoria><gender dysphoric><gender equity><hazard><health care access><health care availability><health care service><health care service access><health care service availability><health equity><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service><healthcare service access><healthcare service availability><hormone therapy><housing instability><implementation strategy><improved><innovate><innovation><innovative><instably housed><jobless><joblessness><medically necessary><medically necessary care><nonbinary><novel><out of work><participant interview><patient centered><patient oriented><pharmacy benefit><prevent suicidality><prevent suicide><programs><recruit><reduce suicidality><reduce suicide><reducing suicidality><reducing suicide><service availability><sex><social health determinants><strategies for implementation><suicidal ideation><suicidal mortality><suicidal thinking><suicidality prevention><suicide ideation><suicide intervention><suicide mortality><suicide mortality rate><surgery><thoughts about suicide><trans*><transgender><treatment access><unemployed><unstable housing><unstably housed><violent><violent behavior><vulnerable group><vulnerable individual><vulnerable people>