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Shared decision making is key when assessing alcohol use with transgender and gender diverse patients

BOSTON, December 2, 2020—An article published in LGBT Health outlines the limitations of current alcohol use screening tools and guidelines for use with transgender and gender diverse patients and counsels shared decision making between clinicians and patients when assessing alcohol use. The paper is the latest in a series of articles and commentaries by researchers and scientists affiliated with The Fenway Institute offering clinical guidance for the care of transgender and gender diverse patients.

“Current guidance around the use of alcohol is based on assumptions of cisgender and binary gender identities, and screening guidelines of what constitutes heavy drinking do not take transgender and gender-diverse people into account,” said senior author Alex Keuroghlian, MD, MPH, Director of Education and Training Programs at The Fenway Institute. “Gendered social drinking patterns are poorly understood in transgender and gender diverse communities and we also lack information on the ways in which gender affirming medical care such as hormone therapy may influence the metabolism of alcohol.”

The current definition of moderate drinking is one alcoholic beverage per day for women and up to two per day for men. The paper notes that it’s not clear if these recommendations are based on natal sex-based physiology or current sex-based physiology, which may vary for transgender and gender diverse people who’ve accessed gender-affirming medical or surgical care.

The paper also notes that the limited research done to date on alcohol use among transgender and gender diverse people shows that they have different alcohol-related risks than their cisgender counterparts. But many questions remain.

A 2015 study found that transgender people had more frequent heavy drinking episodes compared with cisgender men and women. But a 2020 study found that nonbinary/genderqueer adolescents assigned male sex at birth had lower odds of recent alcohol use then their cisgender peers.

There are also insufficient data to inform alcohol-related clinical counseling for transgender and gender diverse patients. Although there is evidence suggesting that transgender and gender diverse people are more likely to want assistance and support in reducing substance use than their cisgender counterparts, very little is known about inequities they may face in accessing such care.

“One approach for clinicians is to simply discuss what the current guidelines are, acknowledge their limitations, and to collaboratively decide on personal parameters for the patient to follow,” Keuroghlian said. “Clinicians have an obligation to combine a critical appraisal of existing literature and their own knowledge and understanding of gender diversity with a patient’s self-reporting of their behavior to offer care that promotes healthy alcohol-related behaviors.”

The paper, titled, “Screening, Counseling, and Shared Decision Making for Alcohol Use with Transgender and Gender-Diverse Populations,” was published online by LGBT Health and is available here.


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