Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 2 appraisals
PloS one
Development and validation of search hedges for Transgender and Gender Diverse (TGD) populations in Ovid MEDLINE and Ovid APA PsycInfo
INTRODUCTION: This paper describes the development and validation of highly sensitive search hedges for Ovid MEDLINE and Ovid APA PsycInfo that effectively identify literature on transgender and gender diverse (TGD) populations. METHODS: Two librarians developed the search hedges using relevant keywords and controlled vocabulary terms, building on previous work on identifying transgender populations in evidence synthesis. The hedges were tested and refined to capture diverse and expansive gender identities across cultures and disciplines. The hedges were validated for sensitivity using a gold standard set of 144 articles from the Knowsy portal of evidence syntheses tagged as Two-Spirit, transgender, or gender non-binary. To assess precision an international research team of subject experts independently screened a randomized sample of search results in a two-stage screening process with an additional screener resolving disputes. RESULTS: The final search hedges demonstrated 100% sensitivity in both MEDLINE and APA PsycInfo, identifying all 144 relevant articles from the Knowsy gold standard set. The MEDLINE search hedge achieved a 71% precision, and the APA PsycInfo hedge achieved a 67% precision. These results balance comprehensive retrieval while minimizing non-relevant articles for an efficient screening process. CONCLUSIONS: These search hedges in MEDLINE and APA PsycInfo are valuable tools for researchers and librarians to more effectively identify literature on TGD populations. These tools will be crucial for ongoing work in addressing gaps in research and health disparities faced by TGD populations and will be particularly valuable for researchers conducting evidence synthesis projects related to this population.
14 June 2026
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Cancer risk and screening in transgender and gender-diverse individuals on gender-affirming hormone therapy: a review article for the Australasian context
AIM: We aimed to synthesise current evidence on the association between gender-affirming hormone therapy (GAHT) and cancer risk in transgender and gender-diverse (TGD) individuals and to provide evidence-based cancer screening recommendations for Australasian general practitioners. METHODS: A systematic review of epidemiological studies, case reports and clinical guidelines was conducted in accordance with PRISMA 2020 guidelines. Searches were performed across PubMed/MEDLINE, Embase, Scopus and the Cochrane Library for literature published up to December 2025. Key evidence sources were narratively synthesised to develop practical recommendations tailored to the Australasian context. RESULTS: The available evidence, although limited by short follow-up durations and small cohort sizes, does not demonstrate a consistent, statistically significant increase in common cancers among TGD individuals receiving GAHT. However, emerging case reports highlight novel clinical concerns, including malignancies in surgically constructed tissues (neophallus and neovagina). Breast cancer risk in trans women appears to increase with the duration of oestrogen therapy, though it remains lower than in cisgender women. Prostate cancer may present at a higher grade in trans women receiving oestrogen. Screening participation is consistently lower in TGD populations, often resulting in later-stage diagnoses. CONCLUSION: Cancer screening for TGD individuals should be guided by an organ-inventory approach, based on the organs a person has rather than their gender identity. Clinicians should maintain a low threshold for investigating suspicious lesions, particularly in surgically altered tissues. The development of culturally safe and inclusive primary care environments is paramount to improving screening uptake and ensuring equitable health outcomes for TGD communities in Australia and New Zealand.
31 May 2026
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