“I Have Nowhere to Go”: A Multiple-Case Study of Transgender and Gender Diverse Youth, Their Families, and Healthcare Experiences

Abstract

Transgender and gender diverse (TGD) youth experience health disparities due to stigma and victimization. Gender-affirming healthcare mitigates these challenges; yet, we have limited understanding of TGD youth’s healthcare experiences in the U.S. Midwest and South. Using a multiple case study design, we aimed to develop an in-depth and cross-contextual understanding of TGD youth healthcare experiences in one Midwestern state. Families with a TGD child under 18 were recruited with the goal of cross-case diversity by child age, gender, race, and/or region of the state; we obtained diversity in child age and region only. Four white families with TGD boys or non-binary youth (4–16) in rural, suburban, and small towns participated in interviews and observations for one year; public data were collected from each family’s community. Thematic analysis was used within and across cases to develop both family-level understanding and identify themes across families. Findings include a summary of each family as it relates to their child’s TGD healthcare experiences as well as the themes identified across cases: accessibility and affirming care. Although limited by a small sample with lack of gender and race diversity, this study contributes to our understanding of TGD youth healthcare in understudied regions.

Erasure of the young trans person: A critical discursive review of contemporary health care literature

“…Participants often regarded being treated with respect and listened to, as well as evidence the health care provider had undertaken independent learning of what it means to be trans, assisted in fostering therapeutic relationships and positive experiences (Bartholomaeus et al, 2021; Dowshen et al, 2017; Eisenberg et al, 2020; Goldenberg et al, 2021; Guss et al, 2019; Strauss et al, 2017). When asked how health care professionals can improve practices, a strong desire to be “treated like normal” was expressed by many young people (Guss et al, 2019; Paceley et al, 2021). Eisenberg et al (2020) asked young trans people how they would like to be treated by health care workers, where one participant advised, “…get it out of your head that it's what's in your pants [that] determine[s] your gender” (p. 1086).…”

“…Where Minority Stress Theory wasn't employed, “discrimination” and “stigma” were used in the literature to explain the adverse health outcomes of trans young people (Bartholomaeus et al, 2021; Dowshen et al, 2017; Guss et al, 2019; Paceley et al, 2021; Strauss et al, 2017). According to Meyer (1995), discrimination and stigma are considered distal elements of Minority Stress Theory (social stressors).…”

“…Gatekeeping practices were also described in many studies (Carlile et al, 2021;Gridley et al, 2016;Horton, 2021Horton, , 2022Paceley et al, 2021) where participants experienced long waitlists, sometimes having to undergo "painful" (Carlile et al, 2021, p. 6) or pathologizing (Horton, 2021) gender assessments to access medically affirming care, family support, education, or counseling.…”

Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories

“…EDs are often first access points to healthcare beyond a child's pediatrician. However, historically, transgender patients have experienced significant discrimination in healthcare settings and often avoid time-sensitive care due to past negative experiences [11 ▪▪ ,12 ▪ ,13]. Practicing gender affirming care can have a significant positive effect on TGD youth in establishing trust within the medical system.…”

“…It is well documented in the literature that transgender patients report negative experiences in EDs [11 13,24]. Patients cite discrimination from unknown or unfamiliar providers, as well as discomfort in answering repetitive or irrelevant questions about their gender identity [24,25].…”