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J Adolesc Health. 2016 Sep;59(3):254-261. doi: 10.1016/j.jadohealth.2016.03.017. Epub 2016 May 24.

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

Author information

1
Vanderbilt University School of Medicine, Nashville, Tennessee; Seattle Children's Research Institute, Seattle, Washington.
2
Seattle Children's Research Institute, Seattle, Washington.
3
Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
4
Department of Pediatrics, University of Washington, Seattle, Washington.
5
Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington.
6
Seattle Children's Research Institute, Seattle, Washington; Loyola University Maryland, Baltimore, Maryland.
7
Seattle Children's Research Institute, Seattle, Washington; Carleton College, Northfield, Minnesota.
8
Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
9
Seattle Children's Research Institute, Seattle, Washington. Electronic address: david.breland@seatttlechildrens.org.

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

[Indexed for MEDLINE]

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