Transgender And Gender Diverse Individuals Research Articles

Cancer screening attendance rates in transgender and gender-diverse patients: a systematic review and meta-analysis

ObjectivesTo examine disparities in attendance rates at cancer screening services between transgender and gender-diverse (TGD) people in comparison with their cisgender (CG) counterparts, and to determine whether these differences were...

Cancer screening attendance rates in transgender and gender-diverse patients: a systematic review and meta-analysis

ObjectivesTo examine disparities in attendance rates at cancer screening services between transgender and gender-diverse (TGD) people in comparison with their cisgender (CG) counterparts, and to determine whether these differences were...

Sexually transmitted infections and the vaginal microbiome after vaginoplasty.

Transgender and gender-diverse individuals (TGD) are at risk for sexually transmitted infections. Gender affirmation surgery is a cornerstone of care for many TGD individuals. For genital gender affirmation, the surgical creation of a vagina may be performed through a number of techniques. Those who have undergone vaginoplasty have unique anatomical and biopsychosocial considerations, which we discuss. While sexually-transmitted infections including HPV, HSV, HIV, gonorrhea, and chlamydia, have been described in TGD individuals after vaginoplasty, the reports are very rare, and the provider should maintain an index of suspicion and maintain a broad differential for symptoms including neovaginal discharge. We discuss the association of the neovaginal microbiota composition with bacterial vaginosis, and how its modulation could potentially reduce bacterial vaginosis and sexually transmitted infection risk. We examine the literature regarding sexually-transmitted infections following vaginoplasty, and the neovaginal microbiome and its similarities and differences relative to the natal vaginal microbiome.

Effects of Alcohol Use and Minority Stress on Intimate Partner Violence Perpetration among Transgender and Gender Diverse People.

Intimate partner violence (IPV) is highly prevalent among transgender and gender diverse (TGD) adults. Integrated theories of minority stress and alcohol-related IPV suggest minority stress risk and protective factors should interact with alcohol use to predict IPV, although this has never been examined in TGD adults. Thus, we examined the synergistic influence of alcohol use, minority stress, and TGD community connectedness on IPV perpetration among TGD adults. A sample of 137 TGD adults completed a cross-sectional survey assessing minority stressors (i.e., internalized transnegativity, identity outness), TGD community connectedness, alcohol use/problems, and IPV perpetration (i.e., psychological, physical, and gender minority identity-specific abuse). We regressed each form of IPV perpetration on alcohol use/problems and tested the moderating effect of internalized transnegativity, identity outness, and community connectedness on the association between alcohol use/problems and IPV perpetration. The association between alcohol use/problems and all forms of IPV perpetration were moderated by internalized transnegativity and identity outness, but not TGD community connectedness. Alcohol use/problems related to each form of IPV perpetration at low and medium, but not high levels, of identity outness and internalized transnegativity. Alcohol use/problems is an important risk factor for IPV perpetration among TGD adults and this association may be exacerbated by less identity outness. Further, internalized transnegativity might not influence IPV risk at high levels of alcohol use. TGD-affirming IPV prevention programs might focus on reducing alcohol use and related problems while providing a safe and accessible space for TGD individuals at various levels of identity outness.

Transgender Lived Experience in Social Work: A Critical Discourse Analysis

To date, social work literature regarding transgender and gender diverse (TGD) individuals situates TGD individuals as objects of social work knowledge and intervention. While this existent work represents an important foundation, it may foreclose other positionalities for TGD individuals. Therefore, this feminist critical discourse analysis of social work literature utilizes professionalization and transnormativity as conceptual anchors to explore the phenomenon of “transgender lived experience” in social work literature in order to understand both the nature of transgender lived experience and who is permitted to have it. Ultimately, this project found that transgender lived experience within social work is a totalizing discourse centered on a wholly painful experience of othering that can only be ameliorated through medical intervention. While this experience can confer expertise upon some individuals, transnormativity and professionalization operate in concert with this discourse to situate TGD people as transgender in the first place, foreclosing any other subjectivity. Therefore, future inquiry into the experiences of TGD individuals in social work must be willing to embrace epistemic perspectives and methodologies that emphasize the nuance and diversity of individuals’ experiences and resist totalizing grand narratives.

Differences Between Transgender and Gender Diverse Adults in Michigan Currently Using Gender-Affirming Hormone Therapy and Nonusers Reporting Interest in Future Use.

Purpose: This study explores the sociodemographic, insurance coverage, and substance use differences among transgender and gender diverse (TGD) individuals currently using hormone therapy (HT) and those who have an interest in future HT use. Methods: We surveyed TGD individuals in Michigan in 2018 to examine sociodemographic, health insurance, and substance use differences between those who had used HT and those who were interested but had never accessed HT using logistic regression models. Results: Respondents (N = 536) were 80.1% White and 18.0% nonbinary. About two-thirds of the participants had ever used HT (65.7%). In multivariate analyses, nonbinary participants were much more likely to be interested in future HT use than transmasculine individuals (odds ratio [OR] = 6.91), yet no significant difference between transmasculine and transfeminine individuals was found. Black participants also had higher odds of interest in future HT use (OR = 8.79). Those who did not know if they had trans-specific insurance coverage (OR = 42.39) and those who had no trans-specific insurance coverage (OR = 4.50) were more likely to be in the future interest group compared with those who reported full trans care coverage. Those with a bachelor's degree were less likely to be in the future interest group than those with some college education or an associate's degree, as were heavy marijuana users. Conclusion: Nonbinary individuals may be interested in HT but lack access, and known health care disparities around race and socioeconomic status may also impact HT access. Standard and transparent insurance coverage for gender-affirming care is sorely needed.

Health Care Utilization During the First 5½ Years of Authorized Service by Transgender U.S. Service Members (2016-2021).

Purpose: This study examined the utilization of gender-affirming health care by active-duty service members during the initial 5½ years that transgender and gender-diverse (TGD) individuals were authorized to serve in the U.S. military. The aim of this study was to inform policy discussions regarding inclusion of TGD individuals in the military. Methods: We conducted a retrospective cohort study using administrative health care data from the Military Data Repository (MDR). We assessed the association of demographic factors with the utilization of gender-affirming medical and surgical care. We calculated the incidence rate of initial TGD-related encounters and new prescriptions for gender-affirming hormones among Defense Department Service members between July 2016 and December 2021. Results: We identified 2481 service members with an initial health care encounter with an associated TGD-related diagnosis. More than half (53%) of these service members started gender-affirming hormones, and 14% underwent gender-affirming surgery. Mastectomies and hysterectomies accounted for more than 70% of surgeries. Service members made 3.22 initial encounters with a TGD-related diagnosis per 10,000 service members per year, with an overrepresentation of service members who were designated female in the MDR (8.62), junior enlisted (4.98), and young (4.64). Individuals designated female in the MRD comprised 17% of all service members but accounted for 46% of initial encounters, 51% of new prescriptions, and 73% of surgeries. Conclusion: The study revealed a higher-than-expected number of service members seeking gender-affirming care, particularly among service members designated female in the MDR. Military Health System clinicians provided most of this care, which may mitigate the cost of delivering this essential medical care.

The time-lagged impact of microaggressions at work on the emotional exhaustion of transgender and gender diverse employees

Background Despite the widespread adoption of workplace protections for transgender and gender diverse (TGD) individuals, past research has suggested that microaggressions still occur. Previous literature indicates that microaggressions have a deleterious and cumulative impact on mental health. However, little is known about how microaggressions affect TGD employees over time. Method Using a longitudinal design with lagged measures over a period of three months, we explored the current forms of workplace microaggressions against TGD individuals, as well as their prospective impact on emotional exhaustion. We also examined perceived social support, identity centrality, and identity pride as moderators of the effects of microaggressions on emotional exhaustion as these may inform us of potential mitigating factors and targets for interventions. Results TGD employees chronically experience various types of microaggressions which, in turn, lead to emotional exhaustion over time. None of the hypothesized factors moderated the time-lagged relationship of microaggressions on emotional exhaustion, but direct effects of perceived social support and identity pride on exhaustion were found. Conclusion The findings highlight the urgency to develop strategies that directly reduce microaggressions in organizational settings. In order to provide a safe space for gender minorities in the workplace, we recommend that organizations address microaggressions directly and explicitly within their human resource management policies in an authentic non-tokenistic way. In doing so, organizations should incorporate the experiences of various gender identities and gender expressions, while also defining clear processes for assessment and monitoring, corrective action, and best practice sharing.

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

BackgroundHealth inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals. MethodsWe analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016–December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation. ResultsThe mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00–1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37–2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12–1.59) and mental (PR = 1.49; 95 %CI = 1.33–1.66) health days. ConclusionHCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.

Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses

ObjectivesThis discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. MethodsRelevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. ResultsTGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. ConclusionAPNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. Implications for Nursing PracticeAPNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.

The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Considerations for Medical Affirmation-Part II.

Recently, with discriminatory legislation efforts and changing participation policies in organized sports, media attention surrounding transgender and gender-diverse (TGD) individuals has increased. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in subpar patient care and a misunderstanding of the athletic trainer's (AT's) role within the health care and compliance systems. This literature review is the second part of a 2-paper series, and our objective was to educate ATs on the processes relevant to medical affirmation, including compliance considerations regarding medical eligibility, and to establish the AT's role. The gender affirmation framework includes social and legal components, which are discussed in part 1 of this literature, and the medical component is thoroughly discussed in part 2. All health care providers involved in the care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender-affirmation process, including gender-affirming hormone therapy, surgical options, known risks and complications, and the general health needs of TGD patients. With this knowledge, ATs, as point-of-care providers and members of the interprofessional care team, are uniquely positioned to help reduce health and health care disparities. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility in the evolving policies of sporting organizations.

Food Insecurity and Mental Health Outcomes Among Transgender and Gender-Diverse Communities in the United States Post-COVID-19

A growing body of literature has shown that people in the transgender and gender-diverse (TGD) community have worse health outcomes than cisgender (cis) people, including higher rates of poor mental health. Additionally, during COVID-19, TGD persons experienced higher rates of food insecurity. In this article, we extend the literature by looking at new data in the post-COVID-19 period, a period of greater stability. Using data from the U.S. Census Household Pulse Survey (HPS), we explore the relationship between gender identity and health outcomes. The HPS began collecting data on gender identity of participants from July 2021. We analyze responses from 1.2 million survey participants between July 2021 and May 2023. Using an ordinary least squares regression model with state and week fixed effects, we show that, on average, TGD people are seven percentage points more likely to report experiencing food insecurity compared with cis persons. TGD persons also report more symptoms of depression (six percentage points) and anxiety (four percentage points) than cis persons. These results hold after controlling for the socioeconomic, demographic, and sexual identity characteristics of the individuals, suggesting that this gender identity imposes an additional cost that cannot be explained by social determinants of health. We find that health insurance and the Supplemental Nutrition Assistance Program do not provide very much protection to TGD individuals. In summary, our article suggests the need for safety nets that target specific contextual and institutional challenges faced by TGD communities to reduce health disparities across the country.

Prevalence and Determinants of Cervicovaginal, Oral, and Anal Human Papillomavirus Infection in a Population of Transgender and Gender Diverse People Assigned Female at Birth.

Purpose: The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening. This study estimated the prevalence of HPV in self-collected cervicovaginal, oral, and anal samples from Midwestern TGD individuals AFAB. Methods: We recruited TGD individuals AFAB for an observational study, mailing them materials to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for high-risk (HR; 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and other HPV genotypes (6, 11, 66, 68, 73, 90) using a polymerase chain reaction mass array test. Prevalence ratios for HPV infection at each site as a function of participant characteristics were estimated in log-binomial models. Results: Out of 137 consenting participants, 102 completed sample collection. Among those with valid tests, 8.8% (HR = 6.6%; HPV 16/18 = 3.3%) were positive for oral HPV, 30.5% (HR = 26.8%; HPV 16/18 = 9.7%) for cervicovaginal HPV, and 39.6% (HR = 33.3%; HPV 16/18 = 8.3%) for anal HPV. A larger fraction of oral (71.4%) than anal infections (50.0%) were concordant with a cervicovaginal infection of the same type. Conclusions: We detected HR cervicovaginal, oral, and anal HPV in TGD people AFAB. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.

The roles of protective factors in facing gender-related interpersonal stigma among Chinese transgender and gender diverse individuals: A mixed-method study

Background Transgender and gender diverse (TGD) individuals report high rates of mistreatment in the form of interpersonal stigma. These experiences can negatively impact their mental health. However, few studies have explored this relationship within a Chinese context. This study aims to investigate the connection between various forms of interpersonal stigma and mental health among Chinese TGD individuals. It also seeks to understand the role of collective and personal protective factors in mitigating the effects of interpersonal stigma. Methods This study used explanatory sequential mixed methods, combining primary quantitative research with supplementary qualitative research. A total of 398 Chinese TGD individuals participated in an online questionnaire survey, with seven of these participants also taking part in semi-structured interviews. Results Of the Chinese TGD participants, 48.7% reported experiencing mild or more severe depressive symptoms, while 42.2% of them reported a low level of well-being status. The interpersonal stigma was found to be positively associated with depression and negatively associated with well-being status. Among the examined protective factors, the interactions of community consciousness and identity pride with the interpersonal stigma aggravated the relationships between the interpersonal stigma and well-being status. The qualitative interviews confirmed the widespread presence of interpersonal stigma and provided additional insights into the exacerbating effects of community consciousness and identity pride. Conclusions This study highlighted the existence of pervasive interpersonal stigma and its negative impact on the mental health of Chinese TGD individuals. The community consciousness and identity pride should be questioned for the validity of acting as protective factors. Such findings provided evidence for further developing intervention programs and clinical instructions for healthcare providers.

A Gender-Affirming Approach to Contraceptive Care for Transgender and Gender-Diverse Patients

Transgender and gender-diverse (TGD) reproductive health care is a field with an abundance of misinformation and a paucity of quality literature available for both health care professionals and their patients. Clinicians often receive limited education and training in this area, and TGD individuals face many barriers to reproductive health care, including the lack of gender-affirming, inclusive, and knowledgeable clinicians as well as concerns about gender biases. As such, TGD individuals often feel uncomfortable discussing their reproductive health with their health care professionals and are deterred from seeking the appropriate care they need. Contraceptive counseling is a key component of reproductive health care but is often neglected in discussions between TGD patients and their health care professionals. Clinicians must strive to meet the contraceptive health care needs and desires of TGD patients in a gender-affirming manner within a safe and accepting space. Here, we summarize the current reproductive health care landscape and provide contemporary perspectives on how to improve contraceptive care for TGD individuals.

Toward a Better Understanding of Cardiovascular Risk in the Transgender and Gender-Diverse Community: A Global Call to Action.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Requests for vulvoplasty as gender-affirming surgery: a cross-sectional study in Denmark.

Vulvoplasty, described as a promising procedure for transgender and gender diverse (TGD) persons who were assigned male at birth and who, for example, do not need a vagina or who have contraindications to vaginoplasty, is a procedure that in accordance with current guidelines is not offered as genital gender-affirming surgery in Denmark. In this study we sought to quantify the need for offering vulvoplasty in Denmark. An online questionnaire was developed. The target group included TGD persons who were assigned male at birth and a minimum of 18years old. Prior to data collection, the questionnaire was tested with stakeholders from the target group and was subsequently distributed exclusively in closed groups and online fora for TGD persons. Data collection took place from September 1 to October 31, 2022. Primary outcomes were type of bottom surgery respondents preferred, when vulvoplasty was chosen, the reason(s) for choosing it. A total of 152 responses were included for data analysis, and 134 records were complete responses. Out of 134 respondents, 35 (26.1%) preferred vulvoplasty. The reasons for preferring vulvoplasty were the belief that there is less risk with the procedure (71%), followed by not wanting to dilate (54%), no need for a vagina (48%), and no need for vaginal penetration (40%). Health issues or other reasons were infrequent (5%). Out of 122 respondents who had not had prior bottom surgery, 106 (86.9%) wanted it in the future. Some TGD individuals in Denmark could benefit from vulvoplasty and would choose it if offered. Strengths of this study were that the questionnaire was thoroughly tested prior to application and that the survey could only be accessed via closed fora and groups for TDG persons. Limitations were that the sample size was small, and that the response rate could not be estimated. The results of this study imply that there is an unmet need for vulvoplasty, and bottom surgery in general, in Denmark.

Cardiopulmonary Exercise Testing in Transgender and Gender-Diverse Patients: The Influence of Sex and Gender on Predicted Aerobic Capacity

BackgroundSex assigned at birth (SAB) is currently used to calculate predicted normative values for oxygen consumption (VO2) during cardiopulmonary exercise testing (CPET) in transgender and gender diverse (TGD) patients. It is unclear if this is physiologically valid once gender-affirming hormonal therapy (GAHT) has been instituted. Research QuestionWhat are the changes in functional aerobic capacity (FAC) and in percentage of predicted (%pred) peak VO2 when gender is used, instead of SAB, to estimated normative predicted values among TGD patients >14 years of age who are receiving GAHT? Study Design and MethodsWe retrospectively analyzed 16 referred TGD patients (8 transgender men, 8 transgender women) receiving GAHT therapy at the time of the test. Data collected and analyzed included: clinical indication for CPET, biometrics (age, height, and weight), CPET parameters (treadmill, Mayo Clinic protocol, without chest binder), chest imaging, echocardiographic results, and hemoglobin levels. ResultsIn transgender women, the use of gender congruent normative predictive values, instead of SAB, significantly increased FAC (69.70 ± 4.35 vs. 87.82 ± 5.15 [%]; mean ± SE; for SAB and gender, respectively; p= <0.0001) and %pred peak VO2 (66.53 ± 4.17 vs. 89.69 ± 5.60 [%]; mean ± SE; for SAB and gender, respectively; p= <0.0001). In transgender men, the use of gender congruent normative predictive values showed that both FAC and %pred peak VO2 significantly decreased (approximately 20% and 25%, respectively). Deconditioning was the most frequent CPET finding among transgender men. InterpretationAmong TGD individuals receiving GAHT, the use of gender to calculate normative values affects %pred peak exercise VO2 and FAC significantly. Body composition changes after GAHT require regular monitoring of muscle strength, lean body mass, and aerobic capacity. Cardiopulmonary symptoms among TGD patients should be assessed with these variables in mind –especially in the presence of chronic cardiac and pulmonary diseases.

A patient-centered model of mental health care for trauma and minority stress in transgender and gender diverse people: A bottom-up network analysis.

Transgender and gender diverse (TGD) individuals are disproportionately exposed to traumatic and high-impact minority stressors which can produce an array of transdiagnostic symptoms. Some clinical presentations align well with established evidence-based treatments, but others may require patient-centered modifications or combined approaches to address treatment needs. In this study, we employed a novel, bottom-up approach to derive insights into preferred intervention strategies for a broad range of trauma- and TGD-minority stress-related expressions of clinical distress. Participants (18 TGD individuals, 16 providers) completed a q-sort task by first sorting cards featuring traumatic experiences and/or minority stressors and transdiagnostic psychiatric symptoms into groups based on perceived similarity. Next, participants sorted interventions they believed to be most relevant for addressing these concerns/symptoms. We overlayed networks of stressors and symptoms with intervention networks to evaluate preferred intervention strategies. TGD networks revealed transdiagnostic clustering of intervention strategies and uniquely positioned the expectancy of future harm as a traumatic stressor. Provider networks were more granular in structure; both groups surprisingly emphasized the role of self-defense as intervention. While both networks had high overlap, their discrepancies highlight patient perspectives that practical, material, and structural changes should occur alongside traditional clinical interventions.

Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review.

Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.