Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth

Abstract

This is the first study aimed at understanding perceived barriers to care among transgender youth and their caregivers. Themed barriers to care led to the following recommendations: (1) mandatory training on gender-affirming health care and cultural humility for providers/staff; (2) development of protocols for the care of young transgender patients, as well as roadmaps for families; (3) asking and recording of chosen name/pronoun; (4) increased number of multidisciplinary gender clinics; (5) providing cross-sex hormones at an age that permits peer-congruent development; and (6) designating a navigator for transgender patients in clinics.

Transactional pathways of transgender identity development in transgender and gender-nonconforming youth and caregiver perspectives from the Trans Youth Family Study

“…A supportive environment is a necessary pre-requisite to adjustment and acceptance of a transgender family member (Dierckx et al, 2016). Although many caregivers need support in coping with stigma and in advocating for their gender nonconforming child (Riley et al, 2011), there continues to be a lack of policy protection, trans-positive services, and overall access to affirmative healthcare (Gridley et al, 2016; Minter & Kriesling, 2010), particularly for transgender individuals who also have low income or are people of color.…”

ESPE and PES International Survey of Centers and Clinicians Delivering Specialist Care for Children and Adolescents with Gender Dysphoria

“…Treatment is initially aimed at suppression of endogenous puberty and subsequently, in case of persisting GD, at the induction of sex characteristics that are in line with the affirmed gender. However, several reports from the USA state that treatment as recommended by the guidelines is not available or cannot be afforded by many individuals because of lack of specialist services and lack of insurance coverage [5-7]. Little information is available on the situation in Europe.…”

Dermatologic care of sexual and gender minority/LGBTQIA youth, Part I: An update for the dermatologist on providing inclusive care

“…Furthermore, as more children identify and are accepted as transgender, the need for dermatologists as a component of multidisciplinary care teams may increase, particularly in the context of transitioning (the process by which individuals change their physical presentation and/or sexual characteristics to align with their internal gender identity). Anecdotally, it is often difficult for SGM patients to identify dermatologists in their communities who are able to provide comprehensive and empathic care, whether because of availability, accessibility, limits based on insurance coverage, or provider discomfort . Implicit and unconscious bias against sexual minorities among health care providers has also been recognized and may hinder dermatologic care access .…”

“…Studies examining SGM adolescents' preferences when receiving medical care demonstrate that this population's needs and expectations for quality care do not differ considerably from their cisgender/heterosexual counterparts . Namely, SGM youth desire health care that is accessible, that respects patient confidentiality and autonomy, and that delivers counseling in a private, nonjudgmental manner .…”

“…One way that providers and staff can exhibit openness is by evaluating their own implicit bias and not assuming heterosexuality or a cisgender “norm” with their patients . Directly asking a patient with which gender they identify and what pronoun they prefer (eg, “he,” “she,” “they,” or other) and inquiring about their sexuality in a direct, nonjudgmental manner (“Are you attracted to or do you have sex with women, men, or both?” “Do you have oral, vaginal, or anal sex?” “When was the last time you had sexual intercourse?”) are simple but effective ways of demonstrating inclusiveness . For providers and staff concerned about offending cisgender/heterosexual (non‐SGM) patients who may regard such questions negatively, it may be helpful to preface such questions by stating, “To make sure that our clinic is a safe space for all of our patients, we like to ask everyone…,” thereby normalizing the process by which gender and sexual identity/activity is obtained during the clinical encounter.…”