Is "Gender-Affirming Medical Care" Any of These?

Background It is frequently reported that access to gender affirming medical care (GAMC) is burdened with many barriers, such as lack of parental support, geographic distance, absence of social support, and medical professionals’ lack of knowledge. While the current knowledge shows that trans and nonbinary youth (TNBY) experience many challenges when accessing GAMC, there is still limited information available regarding how they navigate GAMC decisions as youth approach puberty. Methods To fulfill that gap, a team of researchers conducted semi-structured interviews in six countries (Australia, Canada, India, Switzerland, the UK, and the US) with TNBY ages 8–14 years and their families. Results Thematic analysis was conducted on baseline interview data from an international longitudinal study, yielding three themes, and subthemes, relevant to making GAMC decisions: (1) Participants’ decisions guided by expectations, (2) conditions for reaching an informed decision, and (3) the role of time in GAMC decision-making. Of these themes, several subthemes allowed researchers to understand how families navigate whether to seek GAMC, and if so, deciding on specific care trajectories. Conclusion Results indicated that making decisions regarding GAMC is a process that moves beyond medical impacts and side-effects, as many family dynamics, access to information and time also played into TNBY’s decisions to seek GAMC.

Purpose: Gender affirming medical care (GAMC) aims to alleviate gender dysphoria by helping people align their physical body more closely with their gender identity. Bills seeking to limit or prohibit GAMC for trans children and adolescents have become a controversial topic. This study aimed to examine whether exposures to GAMC during adolescence are associated with adult psychological and general health outcomes, and to demonstrate the mechanism through which state-level legislation may work to moderate the association. Methods: We conducted analyses using data from the 2015 U.S. Transgender Survey, which surveyed 27,715 transgender and gender diverse (TGD) adults between August and September of 2015. The study compared the health outcomes of those who had GAMC exposures during adolescence with those who did not. Moderation analysis with propensity score matching was used to adjust for potential confounding factors. The general and psychological health outcomes measured were past-month severe psychological distress, past-year suicidal ideation, participant's general health, and past-year health care avoidance due to possible mistreatment. Results: GAMC during adolescence was negatively associated with severe psychological distress in adulthood. When examining past-year health care avoidance due to possible mistreatment, the effect sizes differed significantly between those in a trans-supportive state and those in a trans-unsupportive state. Conclusion: Our work highlights the importance of state-level policy stigma in understanding the association between GAMC and health outcomes. Findings point to the importance of enacting long-term legislative safeguards against TGD discrimination and removing barriers to access the full spectrum of care for adolescents who identify as TGD.

BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise.

Various studies show that transgender people may experience diverse challenges to attaining sexual well-being. Receiving gender-affirming medical care (GAMC) may influence one’s sexual experiences, but there is little insight into the way sexuality is addressed in GAMC. We conducted a qualitative focus group study among transgender individuals on their experiences and needs related to the way sexuality is addressed in the GAMC context. We included 28 participants (aged 21-60) who were assigned to six groups based on their GAMC trajectories and treatment goals. Each group convened twice for two hours (12 focus groups in total). We analyzed the data using reflexive thematic analysis and identified three main themes. Regarding sexuality in GAMC, participants articulated the need for 1) personalized and balanced information, 2) insight into the experiences of others, and 3) the opportunity for support and guidance concerning sexuality by a healthcare provider. This study highlights the necessity to improve information provision and guidance to promote sexual well-being of people receiving GAMC. Such information ought to transcend cis- and heteronormative sexual assumptions and needs to be tailored to an individual’s experiences. Finally, GAMC organizations and their healthcare providers should foster an environment where questions and concerns related to sexuality can be discussed.

Research suggests that gender-affirming medical care (GAMC) is associated with improved health outcomes; however, there are increasing efforts to limit access to this care for minors. Little prior research has explored transgender and nonbinary (TNB) adolescents' perspectives regarding the impact of accessing GAMC. The goal of this study was to understand the impact receiving GAMC as minors has had on the lives of TNB adolescents. Adolescents ages 14-17 who reported having received GAMC were recruited in August 2023 via their electronic health record portal account to participate in an anonymous, qualitative study. Participants completed an electronic survey containing two open-ended questions about how accessing GAMC in adolescence had impacted their life. Free-text responses were reviewed to develop a de novo codebook. Each response was coded and themes were generated iteratively using an inductive thematic analysis framework. In total, 60 adolescents (82% White, 55% identified as a boy or man) completed the survey. Three themes and two subthemes were identified from participants (n = 60): (1) Congruence, involving ways accessing GAMC enhanced alignment between their gender identity and physical appearance and their ability to self-love, (2) Mental Health, describing how receiving GAMC impacted adolescents' mental health, and (3) Thriving, focusing on how GAMC impacted adolescents' ability to engage with others and become more future-oriented. Findings from this study highlight the positive impact GAMC has on adolescent mental health and social well-being and thus add to our growing understanding of the impact of GAMC and the possible harms associated with limiting access.

This study aimed to explore potential factors impacting parental consent for gender-affirming medical care (GAMC) among transgender and nonbinary (TNB) young adults who desired GAMC as minors but were unable to receive it due to the lack of parental consent. Participants were recruited in 2023 from patients age 18-20 years old receiving care through Plume, a virtual GAMC provider, and completed a single online survey about their experiences. Post hoc pairwise comparisons were used to test for differences in potential facilitators of parental consent and the characteristics of doctors, other parents, and support groups by demographic characteristics. Respondents (N = 224) indicated that parental interaction with supportive medical providers, other parents, and support groups may have aided in parental consent; meeting with a doctor supportive of GAMC was rated as most helpful. Desired characteristics of doctors, parents, and support groups varied by race, ethnicity, and rurality. Critical in addressing barriers to GAMC, these data aid in our understanding of the support needs of parents of TNB adolescents and how these needs vary by race, ethnicity, and rurality. These data support a need for GAMC education and support for a diverse workforce in subspecialist and primary care settings.

Although prior studies have explored the barriers that transgender and nonbinary (TNB) adolescents experience in receiving gender-affirming medical care (GAMC), few have sought to understand how these barriers may differ among racial and ethnic minority groups. Accordingly, this study used data from a survey of TNB young adults (ages 18–20 years) to explore how barriers to GAMC during adolescence varied by race and ethnicity. Differences in the impact of 11 potential barriers when comparing the members of each racial and ethnic group with those who did not identify with that racial or ethnic group were evaluated usingttests. The results showed that Indigenous respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit and not being able to find a clinic contributed significantly more compared with those who did not identify as Indigenous. Black respondents indicated that not knowing it was possible to receive GAMC during adolescence and previous negative experiences in healthcare related to race or ethnicity contributed significantly more to their inability to receive GAMC during adolescence compared with those who did not identify as Black. Latine respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit, worries about cost, and previous negative experiences in healthcare due to race or ethnicity contributed significantly more compared with those who did not identify as Latine. Overall, the results suggest disproportionate barriers in access to GAMC during adolescence among Indigenous, Black, and Latine TNB individuals and illustrate a need for additional resources and interventions to promote more equitable access.

Though prior studies have explored barriers that transgender and nonbinary (TNB) adolescents experience in receiving gender-affirming medical care (GAMC), few have sought to understand how these barriers may differ among racial and ethnic minority groups. Accordingly, this study used data from a survey of TNB young adults (ages 18-20) to explore how barriers to GAMC during adolescence varied by race and ethnicity. T-tests evaluated differences in the impact of 11 potential barriers when comparing members of each racial and ethnic group to those who did not identify with that racial or ethnic group. Results showed that Indigenous respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit and not being able to find a clinic contributed significantly more compared to those who did not identify as Indigenous. Black respondents indicated that not knowing it was possible to receive GAMC during adolescence and previous negative experiences in healthcare related to race or ethnicity contributed significantly more to their inability to receive GAMC during adolescence compared to those who did not identify as Black. Latine respondents indicated that parental unwillingness to consent for GAMC and attend a clinic visit, worries about cost, and previous negative experiences in healthcare due to race or ethnicity contributed significantly more compared to those who did not identify as Latine. Overall, results suggest disproportionate barriers in access to GAMC during adolescence among Indigenous, Black, and Latine TNB individuals and illustrate a need for additional resources and interventions to promote more equitable access.

Gender-affirming medical care is the provision of transition-related medical services that support a transgender person’s own gender identity. Gender transitioning is a process that requires not only social support but also psychological and medical support, This paper attempts to document the challenges faced by transgender individuals (TG) especially in the context of gender affirming medical care in the Kerala context. The transition process is extremely complex as the preference for such process is varied. Some transgender individuals preferred social transition and/or medical transition to align their gender expression with their gender identity, while others chose to have a gender expression or identity outside the traditional gender binary. In Kerala, despite proactive policy and positive legal support, transgender individuals face many challenges in gender-affirming medical care which include lack of family support and equity-related issues with respect to a number of social support institutions including health services. A few possible interventions are suggested such as changes in medical curriculum, more active State support and sensitization of the society including health workers.

Gender affirming medical care access: The role of healthcare stereotype threat and social support in a national probability sample of transgender adults.

Purpose: Gender-diverse youth (GDY) face significant health disparities, which can be mitigated by gender-affirming medical care. Understanding parents' experiences seeking care for their GDY can identify barriers to care and improve access. This study sought to understand parents' experiences accessing gender-affirming medical care with their GDY. Methods: We asked parents of GDY in the United States to describe their experiences with gender-affirming medical care through a single open-ended item on an online survey disseminated through social media in February of 2020. Open-ended survey responses were analyzed through inductive thematic analysis by two authors using an iteratively developed codebook adjudicated by consensus. This codebook was used to identify key themes. Results: We analyzed 277 responses from majority White (93.9%) parents from 41 U.S. states. Themes included (1) Experiences accessing care: finding a provider, financial and insurance-related considerations, the impact of geography on care access; (2) Experiences receiving care: factors in successful or unsuccessful patient-provider interactions, differing approaches to initiating care, sense of community with other families; and (3) Outcomes related to receiving care: how care for their child was perceived to be lifesaving or helped their child thrive. Conclusions: Parents highlighted how access to gender-affirming medical care improved their GDY's health and wellbeing, and described numerous barriers they experienced with finding and receiving this care. Given the evidence that gender-affirming medical care mitigates health disparities, providers, policymakers, insurance companies, and health systems leaders should urgently address these challenges to ensure equitable receipt of care for all GDY.

There is a need to improve the evidence base for gender-affirming medical care provided to adolescents, including the experiences of those who have received this care. To examine rates of satisfaction, regret, and continuity of care in adolescents who received puberty blockers and/or gender-affirming hormones as part of gender-affirming medical care. This survey study used the 2023 online survey wave of an ongoing longitudinal study, the Trans Youth Project, among a community-based sample of transgender youth and their parents initially recruited throughout the US and Canada between 2013 and 2017. The satisfaction and regret data include responses from a youth or their parent representing 87% of the youth aged 12 years or older in the cohort who have received gender-affirming medical care (235 of 269 youths). Of these, 220 completed the 2023 survey (main sample); information about continuity of care was available for all youth. Data analysis was performed from April to August 2024. Satisfaction, regret, and continuity of care following puberty blockers or suppression and/or gender-affirming hormones. Self- or parent-reported satisfaction or regret with gender-affirming care and continuation of care. Among the 220 youths in the main sample (mean [SD] age, 16.07 [2.40] years; 30 [14%] multiracial, non-Hispanic; 18 [8%] White, Hispanic; 155 [70%] White, non-Hispanic; 17 [8%] other race and ethnicity, including Asian, Black [Hispanic and non-Hispanic], Hispanic with unknown race, multiracial Hispanic, or Native American; gender at last interaction: 68 [31%] boys, 132 [60%] girls, 20 [9%] gender diverse, eg, nonbinary) and their parents, very high levels of satisfaction and low levels of regret with puberty blockers and gender-affirming hormones as well as high levels of continuation of care were reported. Of these 220 respondents in the main sample, 9 were regretful of having received blockers (n = 8) and/or hormones (n = 3; 2 of these individuals reported regret with both), of whom 4 have stopped all gender-affirming medical care and 1 has continued to receive blockers but plans to stop. The 4 others have continued care, suggesting that regret is not synonymous with stopping care. The findings suggest that youth accessing puberty blockers and hormones as part of gender-affirming care tend to be satisfied with and not regretful of that care several years later. While regret was rare, these experiences need to be better understood.

Transgender and gender diverse (TGD) people with severe mental illness (SMI) face significant barriers to health care access, leading to unmet needs and inequitable health outcomes. Reverse integration models embed primary care services within mental health centers (MHCs) that serve as primary contact points to broader health care systems for people with SMI. Such models have been shown to improve health outcomes in this population by promoting access to screening, preventative care, and chronic metabolic condition management. This article highlights the benefits of gender-affirming medical care (GAMC)-including reductions in depression, at-risk substance use, and suicidality-and explores reverse integration models for promoting equitable access to GAMC for TGD people with SMI. We propose two strategies: (1) colocation of GAMC services within MHCs and (2) coordinated referrals to external GAMC practices. Additionally, we address clinical considerations for supporting GAMC access for people with SMI, emphasizing the importance of individualized, person-centered care, clinician education, care coordination, and ongoing collaboration between MHCs and gender-affirming medical practitioners to equitably serve this population. Recognizing the ethical principles of justice and autonomy, we advocate for integrating supportive GAMC pathways within MHCs to ensure access to comprehensive, affirming care in settings that foster trust and continuity.

BACKGROUND Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14–26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22–14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05–1.63]). CONCLUSIONS Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.

"From Having Regular Care With a Team of Doctors to Fleeing the State": Parent Experiences Supporting Gender Diverse Youth in States With Care Bans.