Gender-Affirming Care: A 21st Century Bibliometric Perspective

Introduction: Health of transgender people is a globally relevant issue, and research on the topic has expanded rapidly in the 21st century, warranting a bibliometric approach. We aim to characterize the transgender health-related publication landscape and describe the current state of research. Methods: A bibliometric analysis was conducted in Medline, restricted to publications indexed after December 31, 1999. The search string contained keywords including possible identity labels, diagnostic terminology, and gender-affirming interventions. Metadata were extracted using custom code on September 22, 2025. Thematic clusters, or super-nodes, were identified from reference lists and further characterized through text-mining analyses. Results: A total of 20,506 articles were identified. Transgender-related research grew at a rate four times higher than the overall Medline publication growth. The h-index of the body of evidence was 129. The publications originated from 132 unique countries, with most papers coming from the United States of America (46.6%). Other leading countries included the United Kingdom (8.5%) and Canada (7.6%). Cluster analysis revealed that the largest super-node focused on "Human Immunodeficiency Virus" (HIV, 19.5% of articles), followed by "Discrimination" (15.3%) and "Youth and Adolescents" (12.7%). A recurring recommendation across studies was the routine inclusion of Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (SOGIESC) data in research initiatives. Conclusion: Transgender health-related research has grown exponentially, outpacing background Medline growth. This reflects a field in motion, addressing the needs of a formerly underserved group. Topics such as "Discrimination" and "HIV" are closely linked to gender-affirming care. Standardizing methods for assessing gender-identity status appears crucial for future research.