Abstract
Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths' experiences accessing gender-affirming healthcare. A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled "The Rainbow Brick Road". This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker's behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors' conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.
Highlights
For the purpose of this paper, the terms transgender, trans and non-binary will be used to encompass the spectrum of gender identities that represent participants across the studies
The authors will be exploring the experiences of transgender and non-binary young people accessing gender-affirming care as a gender non-conforming young person experiencing gender dysphoria
Reasons for exclusion are detailed on the PRISMA (Preferred Reporting Items of Systematic reviews and MetaAnalyses) flow diagram (Fig 1)
Summary
For the purpose of this paper, the terms transgender, trans and non-binary will be used to encompass the spectrum of gender identities that represent participants across the studies. The authors acknowledge the ever-changing nature of language and gender identity, and recognize that one definition cannot fit all adequately. The authors will be exploring the experiences of transgender and non-binary young people accessing gender-affirming care as a gender non-conforming young person experiencing gender dysphoria. Researchers have struggled to produce accurate statistics on the prevalence of transgender people [12, 13]. In 2015, a systematic review of 12 studies reported a prevalence of 4.6 per 100,000 or 1 in every 21,739 individuals [14]
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