Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth
- PMID: 27235374
- DOI: 10.1016/j.jadohealth.2016.03.017
Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth
Abstract
Purpose: Few transgender youth eligible for gender-affirming treatments actually receive them. Multidisciplinary gender clinics improve access and care coordination but are rare. Although experts support use of pubertal blockers and cross-sex hormones for youth who meet criteria, these are uncommonly offered. This study's aim was to understand barriers that transgender youth and their caregivers face in accessing gender-affirming health care.
Methods: Transgender youth (age 14-22 years) and caregivers of transgender youth were recruited from Seattle-based clinics, and readerships from a blog and support group listserv. Through individual interviews, focus groups, or an online survey, participants described their experiences accessing gender-affirming health care. We then used theoretical thematic analysis to analyze data.
Results: Sixty-five participants (15 youth, 50 caregivers) described barriers spanning six themes: (1) few accessible pediatric providers are trained in gender-affirming health care; (2) lack of consistently applied protocols; (3) inconsistent use of chosen name/pronoun; (4) uncoordinated care and gatekeeping; (5) limited/delayed access to pubertal blockers and cross-sex hormones; and (6) insurance exclusions.
Conclusions: 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.
Keywords: Adolescents; Barriers; Cross-sex hormones; Gender dysphoria; Gender incongruence; Multidisciplinary gender clinic; Preferred name; Puberty suppression; Qualitative study; Transgender.
Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Comment in
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Centering Transgender Voices in Research as a Fundamental Strategy Toward Expansion of Access to Care and Social Support.J Adolesc Health. 2016 Sep;59(3):241-242. doi: 10.1016/j.jadohealth.2016.06.019. J Adolesc Health. 2016. PMID: 27562363 No abstract available.
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