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. 2023 Oct 4;8(5):420-428.
doi: 10.1089/trgh.2021.0116. eCollection 2023 Oct.

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

Diana M Tordoff  1 , Gina M Sequeira  2   3 , Alic G Shook  4   5 , Florence Williams  2 , Lara Hayden  6 , Ash Kasenic  6 , David Inwards-Breland  7   8 , Kym Ahrens  2   3
Affiliations

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

Diana M Tordoff et al. Transgend Health. .

Abstract

Purpose: To describe barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs).

Methods: We used longitudinal data from a prospective cohort of TNB youth seeking care at a multidisciplinary pediatric gender clinic between August 2017 and June 2018. We calculated the time between (i) initial clinic contact, (ii) phone intake, (iii) first medical appointment, and (iv) initiating PBs/GAHs. We estimated Kaplan-Meier curves for each time-to-care interval and used Cox regression models to estimate hazard ratios (HRs) for factors hypothesized to be barriers and facilitators of care.

Results: Our cohort included 104 youth aged 13-20 years. The median time from contacting the clinic to initiating PBs/GAHs was 307 days (range, 54-807). Lower income level, Medicaid insurance, and lack of family support were associated with longer times from contacting the clinic to completing the first medical appointment. In addition, older youth experienced longer times to first medical appointment relative to youth aged 13-14 years. Youth younger than 18 years of age who did not complete a mental health assessment before their first medical appointment experienced delays from first medical appointment to initiating PBs/GAHs (HR=0.44, 95% confidence interval, 0.22-0.88).

Conclusion: Certain subsets of youth disproportionately experienced delays in receiving gender-affirming medications, and these factors varied by stage of care engagement. Given the association between gender-affirming care and improved mental health, identifying sociostructural and clinic-level barriers to care is critically important to facilitating more equitable access.

Keywords: gender-affirming hormones; health care barriers; mental health assessment; puberty blockers; survival analysis; transgender youth.

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Conflict of interest statement

D.M.T. receives support unrelated to this work from National Institutes of Health National Institute of Allergy and Infectious Diseases (Grant No. F31AI152542). The authors have no conflicts of interest to report.

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References

    1. Gridley SJ, Crouch JM, Evans Y, et al. . Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. J Adolesc Health. 2016;59:254–261. - PubMed
    1. Safer JD, Coleman E, Feldman J, et al. . Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016;23:168–171. - PMC - PubMed
    1. Vance SR, Halpern-Felsher BL, Rosenthal SM. Health care providers' comfort with and barriers to care of transgender youth. J Adolesc Health. 2015;56:251–253. - PubMed
    1. Padula WV, Baker K. Coverage for gender-affirming care: making health insurance work for transgender Americans. LGBT Health. 2017;4:244–247. - PubMed
    1. Chen M, Fuqua J, Eugster EA. Characteristics of referrals for gender dysphoria over a 13-year period. J Adolesc Health. 2016;58:369–371. - PMC - PubMed