(P442) Unique challenges in recruiting transgender men in the Southeastern United States for genital microbiome research

Background: Transgender men (TGM) are underrepresented in vaginitis and genital microbiome research. We are conducting a prospective study investigating changes in the genital microbiota over time in TGM initiating testosterone (T) therapy. Here, we examine study recruitment data of TGM in Birmingham, Alabama in the context of this longitudinal study.



Methods: Inclusion criteria are assigned female sex at birth, TGM or non-binary identity, age ≥18 years, interested in injectable T but willing to wait 7 days after enrollment before starting, and engaged with a T-prescribing provider. Exclusion criteria are recent antibiotic use, HIV/STI infection, current vaginal infection, pregnancy, or past 6 months T use. Recruitment initiatives include community advertisements via flyers and social media posts and referral from local gender health clinics, including two academic (caring for ~80 TGM) and one community clinic (caring for ~180 TGM). Interested individuals are referred to the University of Alabama at Birmingham (UAB) Sexual Health Research Clinic for potential inclusion.



Results: Between February 2022-January 2023, 41 individuals contacted our clinic. Of these, 19/41 (46%) responded to community flyers and 2/41 (5%) word-of-mouth while 13/41 (32%), 3/41 (7%), and 2/41 (5%) were referred from the UAB Gender Health Clinic, UAB Student Health Clinic, and Magic City Wellness Center, respectively; 15/41 (36.6%) qualified for in-person screening, 7/15 (46.7%) were enrolled. Common reasons for study inquiry but failure to complete a screening visit included difficulty coordinating care with a T-prescribing provider (8/26; 31%), already on T (7/26; 27%), and not willing to wait to initiate T (2/26; 8%). The most common reason for in-person screening exclusion was abnormal genital microbiota (7/8; 88%). Additional enrollment challenges were engagement of TGM of color (all enrollees were white) and limited local trans-care resources for uninsured/underinsured.



Conclusion: Despite fairly robust study inquiry by TGM, screening and enrollment were limited by specific eligibility criteria. Excitement among TGM for research representation should be leveraged in future work by engaging transgender community stakeholders at the inception of study development, particularly regarding recruitment of TGM of color. These results also highlight the need for more clinical resources for transgender care, especially in the Southeastern U.S..