Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth

Tordoff, Diana M.; Sequeira, Gina M.; Shook, Alic; Williams, Florence; Hayden, Lara; Kasenic, Ash; Inwards-Breland, David J.; Ahrens, Kym R.

doi:10.1089/trgh.2021.0116

Cited by 8 publications

(6 citation statements)

References 41 publications

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“…The present findings are consistent with literature that indicates transgender and gender-diverse people who are socioeconomically marginalized and lack agency, such as junior enlisted transgender Service members, can experience delays in receipt of gender-affirming care 31–33 . Such findings are consistent with one study of transgender and non-binary youth showing that time from clinic presentation to gender-affirming hormones was slower in families with low-income levels or Medicaid insurance compared with reference groups in a single multidisciplinary center 34 . In the present study, rank can serve as a proxy for positionality and income.…”

Section: Discussionsupporting

confidence: 92%

“…[31][32][33] Such findings are consistent with one study of transgender and non-binary youth showing that time from clinic presentation to genderaffirming hormones was slower in families with low-income levels or Medicaid insurance compared with reference groups in a single multidisciplinary center. 34 In the present study, rank can serve as a proxy for positionality and income. While the small number of senior officers identified had similar time-to-initiation as junior enlisted members, this may reflect additional personal concern in starting treatment while serving in senior leadership positions or be an effect of the sample size.…”

Section: Discussionmentioning

confidence: 85%

“…From an institutional policy and care model perspective, the present findings indicated faster time-to-gender-affirming hormone therapy in Air Force Service members; the Air Force had the most centralized model of care per Service-level policy, compared with other Services. Centralized models of care have demonstrated benefit in delivering timely, comprehensive care 34 while potentially mitigating the risk of having healthcare visits with nonaffirming clinicians, a major barrier to care 35 . In the Air Force model, transgender Service members, upon formal evaluation by a mental health clinician, receive consultation, clearance, and some care coordination from a centralized gender-affirming healthcare center 36 .…”

Section: Discussionmentioning

confidence: 99%

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Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Klein,

Gonzalez,

Highland

et al. 2024

Medical Care

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Background: Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired. Objective: This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System. Research Design: This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository. Participants: A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code. Measures: Time-to-gender-affirming hormone initiation after diagnosis receipt. Results: A total of 2439 Service members were included (Mage 24 y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female (P<0.001), and Asian and Pacific Islander (P=0.02) and Black (P=0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis. Conclusion: The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Klein,

Gonzalez,

Highland

et al. 2024

Medical Care

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“…Reliance on gender norms and stereotypes in pediatric practice is particularly concerning since it risks inculcating and reinforcing these norms and stereotypes among children, restricting their freedom and perpetuating inequalities (see e.g., Eliot, 2010; Weisgram & Dinella, 2018; Yu et al, 2017). Authors have reported that gender assessments create unnecessary delays in accessing gender-affirming care and aggravate inequities in access to such care for marginalized trans people (MacKinnon et al, 2020; Stroumsa, Minadeo, et al, 2022; Tordoff et al, 2022). For those reasons, many practitioners are opposed to gender assessments (Stroumsa, Minadeo, et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Do gender assessments prevent regret in transgender healthcare? A narrative review.

Ashley,

Parsa,

kus

et al. 2023

Psychology of Sexual Orientation and Gender Diversity

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Gender assessments are traditionally required before accessing gender-affirming interventions such as hormone therapy and transition-related surgeries. Gender assessments are presented as a way of preventing regret experienced by some people who reidentify with the gender they were assigned at birth after medically transitioning. This article reviews the theoretical and empirical foundations of commonly used methods and predictors for assessing trans patients’ gender identity and/or dysphoria as a condition of eligibility for gender-affirming interventions. We find that the DSM-5 diagnosis, taking gender history, standardized questionnaires, and regret correlates rely on stereotyping, arbitrary, and unproven considerations and, as a result, do not offer reliable ways of predicting future regret over-and-above self-reported gender identity and embodiment goals. This finding is corroborated by empirical data suggesting that individuals who circumvent gender assessments or pursue care under an informed consent model do not present heightened rates of regret. The article concludes that there is no evidence that gender assessments can reliably predict or prevent regret better than self-reported gender identity and embodiment goals. This conclusion provides additional support for informed consent models of care, which deemphasize gender assessments in favor of supporting patient decision making.

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“…Considering the apparent pervasive lack of access to comprehensive puberty health needs, coupled with transgender information and options are not widely made available to youth. Moreover, many of the GIaNT individuals come to an understanding of their gender identities in a variety of timelines [10,18,22]. To this end, it is necessary to broaden our age range to include seemingly older individuals as youth.…”

Section: Plos Onementioning

confidence: 99%

The development and the use of gender-affirming online resources and games for gender-independent, intersex, non-binary, and transgender (GIaNT) children and youth: A scoping review protocol

Haghiri-Vijeh,

Newman-Seymour,

Huizenga

et al. 2023

PLoS ONE

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Objective The objective of this scoping review protocol is to review what has been reported on the development and the use of gender-affirming online resources and games for gender-independent, intersex, non-binary, and transgender (GIaNT) youth (aged 9–26). Introduction GIaNT youth and their specialized health care needs are mostly exempt from curriculums. There is limited information on the specific online sources available for GIaNT children and youth. Inclusion criteria The inclusion criteria are sources that include GIaNT children and youth and focus on online spaces and games for the identified population. Methods The Joanna Briggs Institute (JBI) method for scoping reviews has guided the development of this protocol. Databases to be searched include CINAHL, Cochrane, Epistemonikos, ERIC, Gender Studies Database, GenderWatch, LGBTQ+ Source, ProQuest, PyscInfo, and Scopus. Unpublished studies and gray literature searches will be undertaken in ProQuest thesis and dissertation and a limited number of relevant websites. No limit on date or region will be applied. Records will be screened and extracted by two independent reviewers. Results will be presented as tables with accompanying narrative summary. Conclusion This scoping review protocol will guide the review and mapping of literature on available sources for online spaces and games for GIaNT children and youth.

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Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth

Cited by 8 publications

References 41 publications

Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Do gender assessments prevent regret in transgender healthcare? A narrative review.

The development and the use of gender-affirming online resources and games for gender-independent, intersex, non-binary, and transgender (GIaNT) children and youth: A scoping review protocol

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