Single-Center Retrospective Analysis of Safety and Efficacy of Subcutaneous Estradiol Use in Transgender and Nonbinary Adolescents and Young Adults.

Over the past two decades, substantial research efforts have been devoted to examining the influence of military deployments and combat exposure on Veteran health and well-being. This research has highlighted the evolving nature of military service eras, noting that the post-9/11 conflicts were characterized by lengthy deployments, redeployments, and fewer breaks between deployments for service members (; ). Additional work illustrated how advancements in military weaponry, body armor, and medical technologies resulted in fewer casualties for Iraq/Afghanistan-era Veterans compared to prior wars, but an increase in “invisible wounds” such as mental health conditions and cognitive difficulties, as well as physical injuries and other medical comorbidities (; ). Although there is ample evidence in the existing literature showing that the post-9/11 conflicts have taken a toll on Veterans’ health and well-being (; ), there is an ongoing need to better understand how deployment and combat experiences specifically impact service members following their discharge from the military. Doing so is crucial for identifying at-risk individuals and providing top-quality care for Veterans. To date, several studies have sought to characterize associations between combat exposure and a wide range of clinical outcomes. The overwhelming majority of this research has focused on mental health outcomes and has demonstrated strong relationships between combat exposure and posttraumatic stress disorder (; ; ; ), depression (; ; ; ), and alcohol-related problems (; ). Other studies have identified associations between combat exposure and physical health problems (; ) as well as poorer health-related quality of life (). Rates of traumatic brain injury (TBI) are also elevated in combat-exposed post-9/11 Veterans (; ; ). While much has been learned from examining associations between combat exposure and clinical outcomes in post-9/11 Veterans, there are some considerations that must be taken into account when interpreting this literature. Namely, a number of tools have been used to assess combat exposure (; ; ; ; ), and these tools differ in their response scales and associated assessment windows (e.g., entire duration of deployment, deployments in the previous 3 years). Furthermore, the study design varies considerably across studies. While some researchers have compared combat Veterans to non-combat Veterans (; ; ), others have assessed “combat intensity” or “combat exposure severity” (i.e., utilization of a total score from a combat measure) (; ; ). Far fewer studies have focused on the extent to which specific combat experiences relate to clinical outcomes in this Veteran cohort, though this may be a key indicator of well-being in this population (; ).