The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

Abstract

Background : Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate. Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions. Methods : The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery. Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions. Discussion : The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.

Expanding and improving trans affirming care in Australia: experiences with healthcare professionals among transgender young people and their parents

“…Overall, and as expected, transgender young people and their parents received more informed and affirming care from dedicated gender clinics than from broader healthcare services. Largely positive experiences of care in gender clinics reflects the existing limited number of studies with young people and their families in Australia (Tollit et al, 2019), Canada (Pullen Sansfaçon et al, 2019), and the US (Inwards-Breland et al, 2019). Receiving such care is particularly important for those accessing medical treatment (puberty blockers and hormones).…”

“…In terms of strengths, professionals who are supportive, knowledgeable, and, respectfulincluding by using correct names and pronounsare experienced as affirming (Corliss, Belzer, Forbes, & Wilson, 2007;Guss et al, 2019;Riggs, Bartholomaeus, & Pullen Sansfaçon, 2020;Strauss et al, 2017). Experiences of such affirming responses have been related to high levels of satisfaction among young people and their families attending paediatric gender clinics (Inwards-Breland et al, 2019;Pullen Sansfaçon et al, 2019;Tollit, Feldman, McKie, & Telfer, 2019). In terms of limitations, research has identified a lack of understanding by healthcare professionals of transgender young people's needs, discrimination, misgendering, and a lack of training about gender diversity (Carlile, 2020;Corliss et al, 2007;Eisenberg, McMorris, Rider, Gower, & Coleman, 2020;Goldenberg et al, 2019;Gridley et al, 2016;Guss et al, 2019;Heard et al, 2018;Strauss et al, 2017;Temple Newhook, Benson, Bridger, Crowther, & Sinnott, 2018).…”

Pathways to gender affirmation in trans youth: A qualitative and participative study with youth and their parents

“…Based on the research protocol of a pan-Canadian qualitative research project, “Stories of gender affirming care: learning from children, youth and their families,” we adapted the data collection tools to the Swiss context to provide baseline data for future comparison (Pullen Sansfaçon et al funded by CIHR 2016–2019). The Canadian project examines the experiences of gender diverse and transgender children and youth and their parents/caregivers who have been referred to gender affirmative clinics.…”

“…Literature on coming out and gender identity shows that the development of a transgender or gender diverse identity appears on average between the ages of five and eight (Olson and al., 2011). But disclosure to the family and social circle generally occurs years later (Olson and et al, 2015; Riggs, 2019; Pullen Sansfaçon et al, 2019). This huge gap produces a long period of secrecy and sometimes isolation where communication in the family is not optimal.…”

Factors Associated With Age of Presentation to Gender-Affirming Medical Care

“…12 In addition, although a cause-effect relationship has not been established, an association between later presentation to GAMC and worse mental health among genderincongruent youth has been identified. 2 Barriers to GAMC 13,14 as well as the care-seeking experiences [15][16][17] and decision-making processes 18,19 of gender-incongruent youth have been described. However, the important questions of whether genderincongruent youth who present for GAMC at older ages have different care-seeking experiences or face different barriers than youth who present younger have not been addressed.…”