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

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• 作者：Samantha J. Gridley^a ; ^b ; Julia M. Crouch ; M.P.H.^b ; Yolanda Evans ; M.D. ; M.P.H.^b ; ^c ; Whitney Eng ; M.D.^c ; Emily Antoon ; M.D. ; M.A.^c ; Melissa Lyapustina ; R.N.^d ; Allison Schimmel-Bristow^b ; ^e ; Jake Woodward^b ; ^f ; Kelly Dundon ; M.D.^c ; RaNette Schaff ; R.N. ; C.P.N.^g ; Carolyn McCarty ; Ph.D.^b ; ^c ; Kym Ahrens ; M.D. ; M.P.H.^b ; ^c ; David J. Breland ; M.D. ; M.P.H.^b ; ^{david.breland@seatttlechildrens.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Transgender ; Gender dysphoria ; Gender incongruence ; Adolescents ; Qualitative study ; Puberty suppression ; Cross-sex hormones ; Preferred name ; Barriers ; Multidisciplinary gender clinic
• 刊名：Journal of Adolescent Health
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：59
• 期：3
• 页码：254-261
• 全文大小：531 K

文摘

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.