Equality Texas, through the Equality Texas Foundation, is critical in developing evidence-based medical and healthcare outcomes through leadership in TransFORWARD: Texas Transgender Health, a unique collaboration with Texas Health Institute.

No other Equality organization is in a position to directly improve a LGBTQ+ person’s life through patient-centered outcomes research by engaging the community at the grassroots level and including these voices at the leadership table. Research collaborations formed through TransFORWARD’s multi-sectoral collaboration ensures transgender and gender diverse voices directly, and LGBQ+ voices in general, are at the leadership and decision-making table. The Equality Texas Foundation, together with Transgender Education Network of Texas, ensure “Nothing About Us Without Us” is not just a phrase but essential in providing key stakeholders in our work.

TransFORWARD’s 10-year goal is to reduce suicides, suicide attempts, and suicide ideation by improving transgender and gender diverse lives through evidence-based patient outcomes research. Three research capacity and foundation building accomplishments took place in 2020.

Three Accomplishments in 2020

1) Creating Safe Spaces — Addressing mental health, housing, and employment issues during the COVID-19 pandemic was launched on August 31. TransFORWARD used THI’s Project ECHO hub to create 22 individual one-hour sessions to explore the pandemic’s impact on transgender and gender diverse people. The first seven sessions focusing on mental health enabled a large number of grassroots leaders from BIPOC communities to take an active part in shaping the project’s outcomes.

This novel approach included innovative online brainstorming to capture and synthesize six session discussions into a summary containing integrated services, leadership, training, and policy recommendations. The Patient-Centered Outcomes Research Institute (PCORI) awarded a One-Year COVID-19 Enhancement of $132,342 to the 2-year project TransFORWARD: Creating a Statewide Transgender-Powered Research Network in Texas, increasing the total funding over 3 years to $382,342. 

2) Research — Simply put, there is relatively little transgender and gender diverse research included in clinical decision-making. Most of the current research is based on East and West Coast studies which involve small sample sizes and primarily focus on HIV. Clinicians need evidence-based data informed by patients to make clinical decisions.

TransFORWARD’s Capstone Collaborative Summit brought together 40 project leaders to review the key themes that emerged from over two hundred participants in eight regional summits during 2019. Evidence-based patient outcome studies on gender affirming hormone replacement therapy is the number one medical research issue by far. Clinical guidelines and WPATH (World Professional Association for Transgender Health) Standards of Care leave clinicians choosing treatment options without the benefit of patient outcomes research — an important gap in scientific knowledge.

Mental health or substance abuse, including tobacco, is the second most requested area of study. The Capstone Summit identified the priorities and need to further develop research capacity and create transgender-focused research proposals.

3) Reducing risk of a disease to improve and extend a person’s life is an important medical, healthcare, and public health focus. In November, the American Heart Association published a “Scientific Statement Assessing and Addressing Cardiovascular Health in LGBTQ Adults”. The AHA conceptual model of cardiovascular health in LGBTQ adults is a cornerstone in TransFORWARD’s emerging medical research capacity building program. Research team members and several of the AHA Statement authors are submitting two ancillary studies to The PRIDE Study to review existing data from 21,000 participants to begin understanding the role tobacco and hormones play in cardiovascular health.

The PRIDE Study, the only national attempt to enroll 100,000 LGBTQ+ people in research studies, is crucial in understanding LGBTQ+ health issues. TransFORWARD, a PRIDE Study/net community engagement partner, will complete one of its remaining PCORI deliverables with these submissions. Importantly, members of TransFORWARD’s research team have also submitted additional research proposals. A Merck Long Acting PrEP proposal is in final review with the expectation it will be awarded shortly.

TransFORWARD is the community engagement lead and key partner in a full application PCORI asked UT Southwestern Medical Center and UT Dell Medical Center to submit. The four+ year project “Preventing Suicide and Gender Diverse Young Adults in Primary Care”, will compare the effectiveness of two culturally adapted suicide intervention approaches among 18 to 24 year old adults in the Dallas/Fort Worth and Central Texas metropolitan areas.

Finally, TransFORWARD‘s research team is developing data to submit a Letter of Intent to develop evidence-based research through a statewide gender affirming hormone replacement therapy clinical study. The LOI is due in February 2021 and if funded could enable TransFORWARD to develop some of the first evidence-based data in prescribing hormones.

These three accomplishments position the Equality Texas Foundation, Texas Health Institute, and TransFORWARD to scale up funded research projects in 2021 to improve the lives of LGBTQ+ people in Texas.