Hormone overdose and misuse in Chinese transgender and gender non-conforming population: A mixed-methods study protocol

Background There is no existing research on hormone overdose and misuse (HODM) in Chinese transgender and gender non-conforming (TGNC) population, and little is known in this field. Objectives We aim to determine the definition and criteria of HODM in Chinese TGNCs, address the rate of HODM in Chinese TGNC population, explore related factors and behavioral risks, identify the probable causes, and explore long-term effects. Methods We propose: (1) a mixed-method study comprising expert panel meetings and stakeholder engagement to identify HODM criteria, types and grades; (2) a cross-sectional study to quantify HODM prevalence, related factors and behavioral risks; (3) semi-structured interviews and focus groups to explore HODM motivations and reasons; and (4) a prospective cohort study to evaluate HODM long-term effects. Ethics The study protocol was approved by the Medical Ethics Committee of Xiamen University (XDYX202210K27). Dissemination Results: will be published in international peer-reviewed journals, and a public-oriented version of the main findings will be prepared and disseminated through social media and online communities. The study will be completed before September 2023 except for the cohort study. Preliminary findings of the cohort study will be reported by March 2026.