Samantha J Gridley1, Julia M Crouch2, Yolanda Evans3, Whitney Eng4, Emily Antoon4, Melissa Lyapustina5, Allison Schimmel-Bristow6, Jake Woodward7, Kelly Dundon4, RaNette Schaff8, Carolyn McCarty3, Kym Ahrens3, David J Breland9. 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.
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.
Authors: Yolanda N Evans; Samantha J Gridley; Julia Crouch; Alicia Wang; Megan A Moreno; Kym Ahrens; David J Breland Journal: Transgend Health Date: 2017-08-01
Authors: Tamar Goldenberg; Laura Jadwin-Cakmak; Elliot Popoff; Sari L Reisner; Bré A Campbell; Gary W Harper Journal: J Adolesc Health Date: 2019-07-11 Impact factor: 5.012
Authors: John F Strang; Meredith D Powers; Megan Knauss; Ely Sibarium; Scott F Leibowitz; Lauren Kenworthy; Eleonora Sadikova; Shannon Wyss; Laura Willing; Reid Caplan; Noor Pervez; Joel Nowak; Dena Gohari; Veronica Gomez-Lobo; David Call; Laura G Anthony Journal: J Autism Dev Disord Date: 2018-12
Authors: Laura Jadwin-Cakmak; José A Bauermeister; Jacob M Cutler; Jimena Loveluck; Triana Kazaleh Sirdenis; Kathryn B Fessler; Elliot E Popoff; Akilah Benton; Naomi F Pomerantz; Stevi L Gotts Atkins; Teresa Springer; Gary W Harper Journal: J Adolesc Health Date: 2020-04-05 Impact factor: 5.012