A Modified Delphi Process to Identify Clinical and Research Priorities for Aging Transgender Adults

BACKGROUND: Aging transgender adults experience unique medical and social challenges, but limited data exist regarding healthcare needs and priorities. Identifying these can help guide transgender-informed, patient-centered care and aging research. METHODS: We employed a modified, two-round Delphi method with a consensus committee to identify clinical and research priorities for aging transgender adults. Expert panelists with experience in transgender, geriatric, and/or HIV care and research rated 15 clinical and 7 research topics using a 5-point Likert scale. Consensus was defined as > 80% of expert panelists ranking a topic as "Very important" or "Extremely important." Following Round 1, a consensus committee of older transgender adults reviewed topics and write-in suggestions and could elevate, reinstate, or add priorities by unanimous agreement. Topics selected by the committee advanced to Round 2 for expert panel ranking, followed by consensus committee review. RESULTS: Forty-eight expert panelists completed Round 1, and 31 completed Round 2. After Round 1, 11 clinical and 3 research topics reached consensus. Following consensus committee review, 10 clinical and 6 research priorities advanced to Round 2. After final review, the highest-ranked clinical priorities were "Provider knowledge on the unique needs of older transgender adults," "Evaluation of social isolation, loneliness, and social support networks," and "Provider/clinic knowledge of social, legal, financial, and mental health resources for transgender persons." The highest-ranked research priorities were "Clinical implications of long-term gender-affirming hormone therapy and hormone cessation," "Biologic mechanisms of hormone therapy on aging and aging outcomes," and "Health, social, and structural needs of older transgender persons." CONCLUSIONS: Using a community-engaged modified Delphi approach, this study identified key clinical and research priorities for older transgender adults. Findings highlight the importance of provider knowledge, social support, and addressing knowledge gaps in gender-affirming care and aging. These results provide direction for future research and best practice guidelines for this population.