Beyond the Binary: Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents

Abstract

Awareness and visibility of transgender individuals have grown exponentially. However, conceptualizing sexual and reproductive health (SRH) as “women's” or “men's” health services further marginalizes transgender and gender-expansive (TGE) youth. Multiple reviews and commentaries have been published on the topic of SRH care for adults under the umbrella term of sexual and gender minorities, all with a call to action for more inclusive care and the need for more clinical research involving TGE individuals, and notably, TGE youth. Results from adult TGE studies are often translated to describe adolescent models. However, models specific to adolescent TGE populations are needed to understand their unique SRH needs. This review will describe the current literature relating to SRH needs of TGE youth and adults, highlighting key areas with significant disparities in need of further research. This comprehensive summary will also provide recommendations for clinicians and researchers with the goal of improving SRH care and obtaining wider representation in both clinical settings and research directed toward TGE youth.

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones

“…Multimedia aids have been found to improve participant knowledge more effectively than informed consent documents alone but are still no substitute for discussions about the risks and benefits of care that occur between pediatric patients, their guardians, and their care team (47). TNB youth need access to SRH that is affirming, inclusive, and accurate (48)(49)(50), and goes beyond the information needed, regardless of mode of presentation, to provide informed consent to PS, MH or FH. Some consent forms sought to include more robust details about SRH topics but the benefit of presenting information in this way is unclear.…”

Looking at Resilience among Transgender and Gender Diverse People in Portugal: Gender Affirmation Paths and Parenting Aspirations

“…Importantly, participants without children but intending to have them also identified as "trans/non-binary". The parenthood aspirations of gender fluid and nonbinary people are still scarcely investigated (e.g., Lunde et al 2021;Rodriguez-Wallberg et al 2022;Tornello and Bos 2017), but could significantly contribute to the understanding of queer intimacies (Hammack et al 2019), and to parenthood beyond maternity and paternity (see McKenzie 2022).…”

“…Indeed, the sexual and reproductive health (SRH) of people or groups who are socially and economically marginalized, because of systemic and interpersonal discrimination, has received little attention and has been understudied (Agénor et al 2021). Importantly, this is the case for TGGD individuals, who face multidimensional barriers to reproductive health and rights (Rodriguez-Wallberg et al 2022), and may have less access to quality SRH care and specialized services (Lunde et al 2021;Pezaro et al 2023). Hormonal treatments and surgical interventions may take place in the medical gender-affirming processes of TGGD adults and impact their ability to have children and be involved in family planning options (Rodriguez-Wallberg et al 2022).…”

A community informed cross-sectional analysis of the sexual and reproductive health barriers and recommendations of MSM and TGW in Rwanda

“…Historically, this set of care services has been conceptualized as being speci c to "women's" and "men's" sexual health needs. This binary understanding marginalizes transgender, non-binary and gender-expansive individuals; often discouraging or impeding care-seeking behaviors (3). SRH care for "sexual and gender minorities" has been highly commented on in recent years, with calls for action on improving inclusivity of care and representation in clinical research (3); two such populations are men who have sex with men (MSM) and transgender women (TGW).…”

“…This binary understanding marginalizes transgender, non-binary and gender-expansive individuals; often discouraging or impeding care-seeking behaviors (3). SRH care for "sexual and gender minorities" has been highly commented on in recent years, with calls for action on improving inclusivity of care and representation in clinical research (3); two such populations are men who have sex with men (MSM) and transgender women (TGW). It is important to note that the term 'MSM' is often used in a more clinical sense; referring to sexual behavior alone as opposed to an orientation or identity.…”