Citation

Gridley SJ, Crouch JM, Evans Y, Eng W, Antoon E, Lyapustina M, Schimmel-Bristow A, Woodward J, Dundon K, Schaff R, McCarty C, Ahrens K, Breland DJ. J. Adolesc. Health 2016; 59(3): 254-261.

Affiliation

Seattle Children's Research Institute, Seattle, Washington. Electronic address: david.breland@seatttlechildrens.org.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.jadohealth.2016.03.017

PMID

27235374

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.

Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Language: en