Health Service Utilization and Its Associations with Depression and Sexual Risk Behaviors Among Transgender Women in Shanghai, China.

[PURPOSE] Given the limited research on health care utilization among transgender women in China, we described the use of primary health care and gender-affirming health care, and the associations between utilization of gender-affirming health care and depression and sexual risk behaviors.

[METHODS] We conducted a cross-sectional survey in 2017 among a purposive sample of transgender women in Shanghai, China (=199). We examined correlates of health care utilization and its association with depression and sexual risk behaviors with Chi-square (), Fisher's exact tests, and analysis of variance.

[RESULTS] The majority of the sample (78.5%) only had physician appointments when having an illness, while about one-fifth of the sample had physician appointments for yearly checkups. Nineteen out of 199 participants (9.5%) received gender-affirming surgery, among which only five used hormone therapy prescribed by a doctor (26.3%). Receiving some form of gender-affirming surgery was associated with higher depression scores [Welch's =4.16, =0.04], engagement in sex work (=0.001), having 7 or more male sexual partners in the last 30 days (=0.003), lifetime unprotected sex with a man (=0.050), and unprotected sex with a main partner (=0.043). Compared with transgender women who received both breast augmentation and vulvo-vaginoplasty (mean=5.86), those who received breast augmentation only (mean=12.33) scored higher on depression (=0.04).

[CONCLUSIONS] Access to gender-affirming health care is low among transgender women in this study. The utilization of gender-affirming surgery is associated with depression and sexual risk behaviors. Findings suggest China should establish national guidelines on transgender-related health care and set up more clinics to provide consultation and services for the transgender population in China.