Experiences and Perspectives of Transgender Youths in Accessing Health Care

Abstract

ransgender and nonbinary people make up around 0.5% of the world's population (25 million people), and most are children, adolescents, and young adults. 1,2 A detailed list of transgender-associated terms and definitions is presented in eTable 1 in the Supplement. Transgender and nonbinary youths face considerable disparities in access to health care and outcomes. 1,[3][4][5][6] They are exposed to stigma and violence, 1 have an increased risk of anxiety and depression, and are more than 20 times more likely to die by suicide than the general population. 1,3 Transgender and nonbinary people have a high prevalence of substance abuse and are more likely to smoke compared with their peers. 1 Transfeminine individuals have a disproportionate burden of HIV infection, with a global prevalence of 20%. 6 In addition to general health care needs, transgender and nonbinary people often require specific medical interventions, namely hormone therapy, gender-affirming surgery, and reproductive care. However, transgender and nonbinary people have reported difficulties in accessing safe treatment and quality care. 5 In many countries, health care for transgender and nonbinary youths are not explicitly addressed in legislation and policy, and patients encounter legal and insurance-associated barriers in accessing care. 3,6 This can lead to disengagement from health services and resorting to nonprescription hormone use or self-performed surgeries, which can lead to life-threatening complications. 7,8 There is very limited understanding of the experiences, challenges, and needs of transgender and nonbinary youths. A systematic review of qualitative studies on the perspectives of transgender and nonbinary youths can generate more comprehensive evidence that spans different populations and health care contexts. We aimed to describe the attitudes and experiences of this population in accessing health care to inform strategies to improve the quality of care and health outcomes. MethodsWe conducted a systematic review and thematic synthesis of primary qualitative studies in which the data were reanalyzed across IMPORTANCE Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care. OBJECTIVE To describe the perspectives and needs of transgender youths in accessing health care.EVIDENCE REVIEW MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021. Qualitative studies of transgender youths' perspectives on accessing health care were selected. Results from primary studies were extracted. Data were analyzed using thematic synthesis.FINDINGS Ninety-one studies involving 884 participants aged 9 to 24 years across 17 countries were included. We identified 6 themes: experiencing pervasive stigma and discrimination in health care, feeling vulnerable and uncertain in decision-making, traversing risks to overcome systemic barriers to transitioning, internalizing intense fear of con...

Poor mental health in the transgender and non-binary youths and its influence on healthcare practices and outcomes

“…The systematic review employed to explore the lived experiences of transgender and non-binary youths discovered six themes: internalising intense fear of consequences, experiencing prejudice undermining help-seeking efforts, experiencing pervasive stigma and discrimination in healthcare, traversing risks to overcome systemic barriers to transitioning, feeling vulnerable and uncertain in decision-making, and experiencing strengthened gender identity and finding allies 1. The review revealed that the youths reluctantly engaged in harmful practices to avoid seeking help from healthcare providers and agencies whom they perceived to have prejudicial beliefs against the health needs of the transgender community.…”

“…The researchers conducted a systemic review which analysed high-risk practices in the transgender youth community due to fear of discrimination from healthcare professionals when seeking care. Selection criteria, data sources and searches, appraisal of transparency of reporting and data analysis were used to conduct the research study 1…”

“…Ninety-one studies, involving 884 participants aged 9–24 years across 17 countries, were used for this systematic review 1. Discrimination and major barriers to healthcare were assessed during the study.…”

“…Transgender and non-binary youths face remarkable challenges in accessing insurance coverage. Furthermore, some older youths resorted to illegal and life-threatening options, including prostitution, needle sharing, street hormones, feminising silicone and self-administering large doses of medication through unregulated private clinics for immediate overnight results, with some even attempting to castrate themselves 1–4…”

Prevalence and Factors Associated With Gender-Affirming Surgery Among Transgender Women & Transgender Men in a Community-Based Clinic in Metro Manila, Philippines: A Retrospective Study

“…Despite its known benefits, access to these services in the Philippines 10 and elsewhere 11 , 12 has been limited and hindered by barriers. In the Philippines, barriers include the previous direct and vicarious experiences of stigma and discrimination, services remaining within spaces intended for HIV and cisgender men who have sex with men, and the absence of local guidelines or programs.…”