Social factors in the design of epidemiological studies of effectiveness of medical procedures of gender transition (analytical review)

Significance. Medical procedures of gender transition are aimed at modifying primary and secondary sex characteristics. Effectiveness of medical procedures of gender transition in reduction of gender dysphoria, improvement of health-related quality of life and psycho-social outcomes attracts attention of a growing number of researchers. However, many authors emphasize poor quality of data explained by the complex nature of gender transition that involves medical, social and legal dimensions. Taking account of non-medical (social) factors when conducting epidemiological studies is necessary to obtain more reliable data on effectiveness of medical procedures of gender transition, which is important, among other reasons, for the development of clinical practice guidelines on gender dysphoria rooted in evidence-based medicine. Purpose. Identify social factors affecting the quality of studies on effectiveness of medical procedures of gender transition and give recommendations for the design of future epidemiological studies. Material and methods. A systematic search of systematic reviews on effectiveness of medical procedures of gender transition was conducted in PubMed, Web of Science and Scopus. The discovered reviews and underlying studies were analyzed in order to identify limitations in their design, especially related to the influence of social factors. In addition, an analysis of publications in journals Transgender Studies Quarterly, International Journal of Transgender Health and Transgender Health was conducted to identify social factors that affect the effectiveness of medical procedures of gender transition. Results. Among the main limitations affecting the quality of epidemiological studies on effectiveness of medical procedures of gender transition are: (a) difficulties of establishing the number of trans people; (b) no consensus on drawing a sample; (c) individual medical needs of trans people; (d) non-linearity and non-chrononormativity of gender transition; (e) poor understanding of social pathways affecting psycho-social outcomes for trans people.