Affirming Care Research Articles

Abortion is healthcare: In what sense?

In the wake of Dobbs versus Jackson Women's Health Organization, many nursing organizations asserted that “abortion is health care” and access to it must be protected. Such a phrase makes clear claims about the meanings of “health” and “care.” How one defines these terms gives decisive direction to how a nurse must practice regarding not just elective abortion but also myriad interventions that divide bioethicists, including gender affirmative care, cosmetic surgery, and euthanasia. We consider the issue of elective abortion to illustrate the nature of disputes about the scope and limits of professional nursing. We describe two competing intuitions about the nature of health care namely that health care is either for 1) health, objectively defined or 2) well-being, patient defined. We discuss how these intuitions lead to different understandings of the intelligibility of the phrase “abortion is health care” and the implications for ethical discourse within professional nursing.

Clinical Characteristics and Care Trajectories of Transgender and Gender Diverse Patients With Cancer Seen in a Pediatric Gender Clinic.

There is very little information on the experiences of transgender and gender diverse (TGD) youth with cancer. To examine clinical characteristics and care trajectories of TGD youth a history of cancer. This case series reviewed records of 2790 pediatric gender clinic patients seen between 2007 and 2022 to identify 14 with a history of cancer diagnosis. Demographics, clinical characteristics, disclosure of gender identity to oncology teams, oncology teams' use of correct names and pronouns, documented interprofessional communication between gender health and oncology teams, and course of medical gender affirmation were reviewed. Of 14 TGD youth with a history of cancer, 11 (78.6%) were diagnosed prior to presenting to the gender clinic (mean [SD]=8.2 [4.7] years), three following initial gender care (mean [SD]=1.1 [0.2] years). Six (42.9%) patients were engaged in annual survivorship care when presenting, and 8 (57.1%) were seen concurrently by both clinics. Nine (64.3%) patients had documented communication between teams. Three-quarters of patients who were seen concurrently by both clinics had documented interprofessional communication. Eight (57.1%) patients received gender affirming hormones, after cancer treatment concluded. TGD youth with cancer experiences present for gender affirming care and merit clinical attention. There was variability in (1) patients' and families' disclosure of TGD identities to oncology teams, (2) whether oncology documentation consistently used patients' correct name and pronouns, and (3) whether there was documented interprofessional consultation between teams. There is need for ongoing improvement in research and clinical protocols for TGD youth with cancer.

Self-determination and self-affirmative paths of trans* and gender diverse people in Portugal: Diverse identities and healthcare

Abstract Background Trans* and gender diverse (TGD) people are very heterogeneous. While legal contexts and healthcare practices have been growingly endorsing self-determination and consent for gender affirmative care in some countries, gender affirmation trajectories need to be understood as unique and fluid processes, constructed and negotiated by each individual in a given social and cultural context. This study aimed to characterize diverse profiles of TGD people in Portugal, regarding individual choices and trajectories in social, legal, and medical gender affirmative processes. Methods A questionnaire, first developed in France and used in Brazil, Italy, Norway, and Chile, was adapted to the Portuguese context. The conducted survey is comprised of 120 questions, organized into six sections: 1) sociodemographic variables; 2) gender affirmation processes and medical and psychological care; 3) general health and sexual health; 4) mental health; 5) sexuality and sexual concerns; 6) experiences of discrimination and gender identity. Data were collected from a convenience sample of 115 adults who identified as TGD. Content analysis was performed on the written responses, and later categorized. Results Approximately 21% of people identified as men, 17% as trans men, 7% as women, 12% as trans women, 26% as non-binary persons, and 17% as agender or other identifications. Differences were calculated among profiles of TGD participants and their choices for affirmative care, social, and legal transition, revealing an association between the way people self-identify and the request for legal recognition of gender identity, as well as the choices of procedures (or aspirations) for medical affirmation (i.e., hormonal treatments, top surgery, bottom surgery). Conclusions The provision of health care practices consistent with the principles of self-determination requires training of health care professionals and adjustment of public policies, to allow for unique trajectories and profiles.

Living Dead: Trans Cooperations with Mad Necropolitics and the Mad Trans Coalitions that Might Replace Them.

Trans subjectivities continue to be included in major compendia of mental illness, despite recent moves to depathologize "cross-gender identification." Regardless, the inclusion of "gender dysphoria" is often framed as a formal mechanism to support access to gender affirming care as transgender subjectivities are re-conceptualized as part of sex/gender diversity and away from madness. The latter permits trans individuals to evade sanist oppressions. However, moves to disassociate from mad individuals also often serve to condone sanism. For instance, a contemporary policy landscape often sees transgender advocates arguing for the "medical necessity" of gender affirming care for gender dysphoria as a "recognized medical condition," thereby skirting the inclusion of gender dysphoria as a psychiatric condition and implying that gender dysphoria carries a special ontological status that separates it from madness (reified as "mental illness"). More though, this framework endorses material violences toward mad individuals that are often advanced via the workings of the state to consign marginalized constituents to death by withholding the means of life, i.e., necropolitics. In the following, I argue that trans disassociations from madness often endorses or assents to mad necropolitics. Drawing from Mbembe's (Necropolitics. Duke University Press, Durham, 2019) framework, I suggest that medicalizing trans narratives, despite being used to object to anti-trans laws in contemporary context, ideologically support mad "death worlds" organized through the U.S.A. welfare state and prison industrial complex. However, I also suggest alternative strategies, i.e., intersectional collaboration, that may uplift mad and/or trans communities.

7467 Supplement Use Among Transgender Patients: Case Reports and Literature Review

Abstract Disclosure: H. Cunningham: None. Q. Jones: None. C. Kelley: None. The barriers to initiating gender affirming medical treatment are innumerable and increasing in the wake of wide-sweeping anti-trans legislation, leading many transgender individuals to utilize more accessible means of transitioning. We provide examples of patient-initiated supplement use at a gender medicine clinic in the Southeast. We describe a 60-year-old transgender woman who was unable to establish care due to lack of affirming providers in her region and insurance approval delays. She began taking Pueraria mirifica, along with saw palmetto and fenugreek, for feminization. Subsequently, her breast size increased from an A to B cup, and she noticed fat redistribution to her hips. When finally seen one year later, labs demonstrated suppressed luteinizing and follicle stimulating hormones and increased sex hormone binding globulin, with an associated decrease in estradiol and testosterone levels. Cessation of supplements resulted in lab normalization. Our second case describes masculinizing effects, including voice deepening, experienced by a transgender man using a supplement that contained "orchic extract.” Supplements used for gender affirmation can also have more adverse effects, including polycythemia in the setting of trenbolone, an illicit steroidogenic performance enhancing supplement used for masculinization by some patients assigned female at birth. Patients without access to gender affirming hormones through a medical provider, or who do not feel comfortable accessing health care, may be more likely to use supplements purchased online without a prescription. Considering this, we must create more safe spaces for gender affirming care and ask all transgender patients about supplement use. Providers should consider supplement use as a possible explanation for unexpected lab results. The literature on supplement use for gender-affirming effects is sparse; this presentation provides a summary of and contributes to the current literature on this topic. Presentation: 6/2/2024

Contraception Considerations in Transmasculine and Gender Diverse Adolescents and Young Adults.

Contraception care is an important aspect of comprehensive gender affirming care in transmasculine and gender non-binary (TGD) adolescent and young adults (AYA). TGD AYA seek contraception care for a variety of reasons and there are several important considerations that are unique to this population. In addition to pregnancy prevention, transmasculine and gender nonbinary persons may seek contraception to achieve amenorrhea, reduce gender dysphoria, or as part of their gender affirming journey. While patients on testosterone therapy often experience amenorrhea, pregnancy has been reported and testosterone is not a form of contraception. Visits for contraceptive counseling provide an opportunity to discuss fertility goals and preservation planning as well as the possibility that some methods may provide endometrial protection. In this narrative review, we analyze the current literature and discuss specific considerations for contraceptive use in this population. We also propose a contraception overview for shared decision making for patients and their clinicians.

Associations between misgendering, invalidation, pride, community connectedness, and trauma among nonbinary adults.

Transgender and nonbinary (TNB) people experience elevated rates of posttraumatic stress (PTS) due to transphobic violence, discrimination, microaggressions, and minority stress. Nonbinary people in particular experience unique chronic minority stressors (e.g., misgendering, interpersonal invalidation) because of the assumption that gender is inherently binary. Such examples of oppression against TNB people could contribute to complex PTS (c-PTS) symptoms, which arise due to exposure to chronic, cumulative, and interpersonal trauma. This study aimed to examine how misgendering and invalidation may be associated with PTS and c-PTS symptoms among nonbinary people and whether this association is moderated by pride and community connectedness. Cross-sectional data from 610 nonbinary people living in the United States and Canada were analyzed using hierarchical linear regressions. Misgendering and invalidation had significant positive associations with PTS and c-PTS symptoms. However, pride and community connectedness were not significant moderators of these associations. Findings from this study contribute to the conceptualizations of traumatic stress among nonbinary people and provide considerations for more affirming trauma-informed care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth

Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth

A National Survey to Assess Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Curricular Needs in Pediatrics Residency Programs

ObjectiveDespite incremental increases in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) health education, there are no uniform training requirements in graduate medical education and the extent to which pediatrics residency programs incorporate LGBTQ+ curricula remains unknown. We aimed to assess the current state of LGBTQ+ health education in pediatrics residency programs. MethodsWe surveyed all 202 Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical pediatrics program directors (PDs) in the United States. PDs were contacted via the Association for Pediatrics Program Directors (APPD) listserv with a link to an anonymous electronic survey. ResultsWe had a 53.4% response rate (107/202) with representation from all regions, sizes, and settings. Only 7.5% of programs have robust LGBTQ+ curricula, but many (71%) offer some sessions. About half (54.2%) believe their residents are not at all or somewhat prepared to care for LGBTQ+ patients after training. Many PDs are not at all or somewhat confident their residents learn about gender affirming care (49.5%) or are aware of community resources for LGBTQ+ youth (54.2%). In 91% of programs, 0–25% of faculty educate trainees about LGBTQ+ health. The majority (74.8%) of PDs are very or moderately likely to implement a standardized LGBTQ+ health curriculum. The most prominent barriers were inadequate time (55.1%) and lack of faculty training (51.4%). ConclusionMany pediatrics programs have implemented some LGBTQ+ health education; however, PDs lack confidence in residents’ abilities to independently care for LGBTQ+ youth after training. An accessible and standardized curriculum is not only needed but desired by programs.

Receipt of Gender-Affirming Surgeries Among Transgender and Gender Diverse Veterans.

Gender-affirming surgery (GAS) can be an important part of comprehensive care for transgender and gender diverse (TGD) individuals, but this care is not provided by the Department of Veterans Affairs (VA) because of an exclusion in the medical benefits package. To describe the receipt of GAS by veterans and assess the associations between key sociodemographic characteristics and receipt of chest ("top") and genital ("bottom") surgeries. Cross-sectional national survey (the GendeR Affirming Care Evaluation (GRACE)), among TGD Veterans conducted between September 2022 and July 2023. A total of 6653 Veterans (54% response rate) completed the survey. Self-reported "top" and "bottom" GAS were key outcomes. Covariates included gender identity, sex assigned at birth, age, race, ethnicity, income, employment status, education, relationship status, sexual orientation, and geographic region. Among all respondents, 39% had ≥ 1 GAS. Among the 4430 veterans interested in top surgery, 38% received it; 23% of 3911 veterans interested in bottom surgery had received it. In multivariable models, older age (50 + vs. 18-39) was associated with higher receipt of top and bottom surgery while nonbinary gender identity (vs. binary gender identity), lower household income (< $50,000 vs. > $75,000), less education (less than a college graduate vs. Master's degree or more), sexual orientations other than heterosexual, and residing in a region other than the Pacific were associated with lower receipt of top and bottom surgery. Individuals assigned male (vs. assigned female) at birth had lower receipt of top surgery and higher receipt of bottom surgery. GAS receipt was low and there were important disparities by gender, sex, income, education, sexual orientation, and region. By removing the exclusion to providing GAS, VA could reduce barriers to accessing GAS and decrease disparities among TGD veterans.

Gender Harmony: A Case for Nursing Informatics.

The design of digital health information systems around a conflated gender/sex binary contributes to health inequities. Lack of specific information that supports affirming communication lead to inappropriate care, disrespectful encounters with healthcare staff, and avoidance of health services by clients who have been harmed by misgendering, deadnaming and being outed. The HL7 International Gender Harmony Model (HL7 GHM) supports the design, implementation and use of DHIS that enable affirming clinical interactions and care. This case study will demonstrate how applying the HL7 GHM can address the harms reported in a recently published account of one patient in Canada.

The Effects of Gender-Affirming Hormone Therapy on Quality of Life: The Importance of Research on Youth.

Gender-affirming hormone therapy (GAHT) plays a significant role in the medical care of transgender individuals, helping to align their physical characteristics with their gender identity. While numerous studies have investigated the impact of GAHT on adults, research focusing on its effects on the quality of life (QoL) of transgender youth is limited. In this opinion paper, we aim to address selected challenges associated with gender-affirming medical care, such as (1) the necessity for evidence-based youth gender-affirming medical care, (2) the urge to explore different approaches to gender-affirming medical care diversely in transgender youth research, and (3) understanding the challenges of the detransition process (which refers to stopping or reversing gender-affirming medical or surgical treatments), as well as suggest possible solutions for meaningful progress. Notably, the available evidence underlines a positive impact of GAHT on various aspects of QoL of transgender youth, such as mental health and social functioning, by alleviating gender dysphoria, improving body satisfaction, and facilitating appearance congruence (the degree to which an individual's physical appearance represents their gender identity). However, challenges related to methodological limitations, as well as ethical considerations, and several sociocultural factors highlight the need for further research to better understand the long-term effects of GAHT on the QoL of transgender youth. Ethical considerations, such as ensuring informed consent and weighing potential benefits against risks, are pivotal in guiding healthcare decisions. Additionally, navigating these ethical responsibilities amid sociocultural contexts is crucial for providing inclusive and respectful care to transgender youth. Addressing these research gaps is, therefore, crucial to developing successful healthcare programmes, raising awareness, and promoting the holistic well-being of transgender youth through comprehensive and affirming care.

Needs of transgender children and adolescents presenting to an urban gender health program

Youth who identify as transgender and gender diverse (TGD) are increasingly presenting to pediatric providers. Gender-affirming surgery is often delayed until after a patient reaches the age of majority; however, patients may desire surgery at a younger age. We explore the specific clinical needs of this vulnerable population, including surgical requests. We present a cross-sectional study of patient intake interviews at time of presentation to our gender health program from 2017 to 2020. We summarize patient demographics, medical histories, and gender-affirming care needs by gender identity and age of presentation. Of 92 patients analyzed, those included were 19 trans girls, 55 trans boys, and 18 non-binary individuals. The median age of our sample was 15 (range 5-17). The median age (IQR) while first questioning gender was 10 (7-12). Sexual orientation was variable with 28 (43%) not sure/unknown. The majority of patients present for primary care services (grade schoolers 75%, early teens 78%, and late teens 77%, p=0.97) and hormone management (grade schoolers 42%, early teens 62%, and late teens 77%, p=0.06). Late teens were more likely to present for surgical services (49%) compared to grade schoolers (25%) and early teens (11%), p=0.001. Prior psychiatric diagnoses were common in all age groups. Trans girls were interested in a variety of affirming procedures whereas trans boys and non-binary individuals primarily sought chest surgery (see summary figure). Pediatric gender affirming care needs are varied and multidisciplinary within our center. By age 16, about half of TGD individuals are seeking surgical services. On average, there was a 4-5 year delay from age at first questioning one's gender and presenting to our gender health program. Primary care physicians in particular may prepare to serve this complex population by familiarizing themselves with treatment needs, including developing a network of competent surgical referrals.

(036) BASELINE CHARACTERISTICS OF PATIENTS UNDERGOING GENDER AFFIRMING HYSTERECTOMIES

Abstract Introduction Gender affirming hysterectomies (GAH) are one of the many interventions offered to people with uteruses who are seeking gender affirming care. Gender affirming care, especially hormones, has been shown to improve sexual satisfaction outcomes, but no research currently exists on sexual function or orgasm experience after gender affirming hysterectomy in particular. Post-hysterectomy sexual function has only been examined in cisgender populations, and has found mixed results on sexual health, wellness, and function. Research on sexual function and orgasm experience after GAH is needed to inform evidence-based recommendations and advance our understanding of sexual pleasure in a population that has historically been under-researched. Objective To achieve a better understanding of how gender affirming hysterectomies impact the experience of sex through a standardized analysis of orgasms and sexual function. Methods This project is a prospective study of patients receiving gender affirming hysterectomies at a single tertiary care center (November 2023-ongoing). Baseline characteristics (pre-hysterectomy) have been collected and analyzed via surveys asking about demographics, sexual practices, medical history, orgasm satisfaction (Orgasm Rating Scale) and sexual function (Transmasculine Sexual Functioning Index). Results We currently have 5 patients enrolled and anticipate a sample size of 30 participants by mid-February 2024. We plan to present pre-hysterectomy data describing participants’ overall sexual function and satisfaction. We anticipate a diversity of sexual practices and wellbeing. Conclusions There is a dearth in the current literature describing sexual function of individuals pursuing GAH. Further characterizing this population's pre-operative sexual practices and satisfaction will improve our ability to counsel patients considering GAH. Comparing this baseline data to sexual function post-GAH will provide insight into how GAH impacts ability to perform sexually and its influence on overall sexual satisfaction. This data will allow us to provide evidence-based recommendations regarding the impact of hysterectomy on orgasm and sexual function in patients seeking GAH. Disclosure No.

Functional Changes to Achilles Tendon and Enthesis in a Mouse Model of an Adolescent Masculine Gender-Affirming Hormone Treatment.

Many transgender youth seek gender affirming care, such as puberty suppression, to prolong decision-making and to align their physical sex characteristics with their gender identity. During peripubertal growth, connective tissues such as tendon rapidly adapt to applied mechanical loads (e.g., exercise) yet if and how tendon adaptation is influenced by sex and gender affirming hormone therapy during growth remains unknown. The goal of this study was to understand the how pubertal suppression influences the structural and functional properties of the Achilles tendon using an established mouse model of transmasculine gender affirming hormone therapy. C57BL/6N female-born mice were assigned to experimental groups to mimic gender-affirming hormone therapy in human adolescents, and treatment was initiated prior to the onset of puberty (at postnatal day 26, P26). Experimental groups included controls and mice serially treated with gonadotropin release hormone analogue (GnRHa), delayed Testosterone (T), or GnRHa followed by T. We found that puberty suppression using GnRHa, with and without T, improved the overall tendon load capacity in female-born mice. Treatment with T resulted in an increase in the maximum load that tendon can withstand before failure. Additionally, we found that GnRHa, but not T, treatment resulted in a significant increase in cell density at the Achilles enthesis.

Understanding sex and gender: concepts and terminology for gender affirming care.

Lesbian, gay, bisexual, trans, queer, intersex, asexual, and other diverse individuals (LGBTQIA+) people face lower healthcare utilization rates due to discrimination, poor experiences in healthcare, and barriers to accessing care. There is an increasing need to improve care and reduce health care disparities for the LGBTQIA+ population. The medical community can begin by educating themselves on LGBTQIA+ terminology, using inclusive language and developing cultural competence in clinical settings. In order to achieve this, it is first important to understand that sex and gender are distinct and that both sex and gender exist on continuums. This article will build on this understanding by introducing basic and widely accepted terminology that will provide a foundation for providing care to LGBTQIA+ populations. By thoughtfully incorporating this knowledge into our research and clinical practice, the radiology community will enhance the healthcare experiences of all patients.

UK Cancer and Transition Service (UCATS): Providing tailored cancer care to the gender-diverse community.

e13676 Background: Gender-diverse individuals identify their gender as different to the sex they were assigned at birth. This population experiences health inequity throughout the cancer care pathway partly stemming from limited access to specialist knowledge of gender-affirming care and its intersections with cancer. Notable issues include safety of gender affirming hormones, mutual implications of gender affirming surgeries with cancer surgeries and radiotherapy, and psychological support when dysphoria is exacerbated by a cancer diagnosis. Methods: In response, we established the UK Cancer and Transition Service (UCATS), a national virtual monthly multidisciplinary meeting (MDM) and clinic. Patients are eligible for referral if they identify as gender-diverse and have active or historical malignancy. The service was coproduced with patient and public involvement, including input from a specialist cancer charity for gender and sexual minority people. The service launched in June 2022 and began advertising and requesting patient feedback from January 2023. Results: Between June 2023 and January 2024 UCATS received 20 referrals (10 from gender services, 5 from oncology, and 5 self-referrals). Patients were aged 18 - 68 years. The most common tumour types were breast (n = 6), prostate (n = 5), and gastrointestinal (n = 3). Others were haematological, testicular, gynaecological, and central nervous system. One patient had a familial cancer syndrome, not active cancer. Patients were offered a virtual clinic appointment and MDM discussion. Reasons for referral included safety of gender affirming hormones and surgeries, and expedited gender consultations in view of prognosis, or need for cancer treatments that may affect gender-affirming care. Two patients did not attend, with one sending a nominated family member. Six patients had at least one external clinician dial in for the appointment. Seven patients received follow-up appointments. There were nine completed feedback forms, 4 after first appointment and 5 after follow-up. All patients rated both the communication at the appointment and the information given as 5/5. All patients rated their likelihood to recommend the service as 4 or 5/5. Other points of positive feedback were the detailed outcome letter, speed of appointment, and a sense of advocacy. Next steps include routine follow-up appointments (in response to feedback), wider advertising, increased frequency, and recruitment of nursing support. Conclusions: UCATS successfully caters to an unmet need, coordinating cancer and gender affirming care for gender diverse patients, and providing specialist knowledge and support for patients and care teams.

Evaluation and medical care of intersex and gender diverse youth.

While there is considerable overlap in the treatment of patients with intersex traits and differences in sex development (I/DSD) with transgender and gender diverse (TGD) youth, the initial medical evaluation varies significantly. I/DSD youth often present due to differences in genitalia development in infancy or pubertal development in adolescence, and this leads to comprehensive biochemical, radiologic, and genetic evaluation. TGD youth, however, tend to have typical development noted at birth and during puberty, but present with a gender identity that does not align with their sex assigned at birth and do not require evaluation for underlying pathology. For both I/DSD and TGD youth, the mainstays of treatment are to better align one's physical appearance to their gender identity. This review discusses the non-medical and medical interventions utilized in gender affirming care. A multidisciplinary team of mental health providers, pediatric medical providers, and surgeons is recommended for providing gender affirming care to both I/DSD youth and TGD youth and their families. Radiologists have an important role in initial evaluation of I/DSD youth and in ongoing monitoring of growth and bone mineral density during puberty induction in I/DSD and TGD youth.

Microaggression Detection in Psychotherapy: Expanding Affirming Care for Transgender and Nonbinary Clients

Transgender and nonbinary (TGNB) people report experiencing discrimination from therapists. A step to reducing these microaggressions is for therapists to be able to identify them. Psychological trainees and psychologists ( n = 105) were randomly assigned to watch a video vignette therapy session: a session with (a) blatant therapist microaggressions (nonaffirming), (b) therapist-led transition focus (transition affirming), and (c) gender exploration focus (nonbinary affirming). There was no difference in microaggression detection between the two affirming conditions. The microaggression condition of participants had a negative effect on ratings of therapist multicultural orientation (MCO). Additionally, attitudes towards transgender people moderated the relationship between microaggression conditions and ratings of therapist’s cultural humility for the affirming conditions; participants in the nonbinary affirming condition rated the therapist more culturally humble as their positive attitudes towards TGNB people increased, and participants rated the therapist as less culturally humble as TGNB attitudes increased in the transition affirming condition.

Making a Statement: Positions of Professional Medical Organizations Towards Gender-Affirming Care.

Despite politically charged media coverage and legislation surrounding gender affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC. A list of U.S. medical professional organizations with likely involvement in GAC based on medical or surgical specialties was compiled. For included organizations, we evaluated the availability, content, and publication year of positions on GAC through October 2023. When available, formal positions were categorized as supportive or unsupportive. A total of 314 professional medical organizations were screened for our study based on specialty, relevance to GAC, and issuance of patient guidelines or position statements. Inclusion criteria were met by 55 organizations. Most organizations (35, 63.6%) had formal position statements on GAC. Support for GAC was described in 97.1% (n=34). Further, 94.2% (n=33) of available statements explicitly addressed GAC in individuals less than 18 years old and were largely supportive (96.9%, n=32). This cross-sectional analysis demonstrates that a majority of multidisciplinary professional medical organizations with relevance to GAC have issued formal position statements on the topic. Available positions were overwhelmingly supportive of individualized access to gender-affirming therapies in adult and adolescent populations. However, silence from some organizations continues to represent a modifiable disparity in the provision of GAC.