Transgender Youth Face Multiple Barriers to Health Care, Study Findings

Piper, a 17-year-old transgender girl, says she knows she’s lucky.

He lives just outside of Atlanta with a supportive family and two rescued leopard geckos, Saturn and Juno. Queer Med, a private gender clinic, is a short drive away; Two years ago, after five months, after a relatively short waiting period, she started on a sex-affirming hormone regimen. The treatments accelerated a monumental change in Piper’s self-perception. “I trust my body more,” she said. (Piper’s family members asked to be identified only by her first name to protect their privacy.)

Things are not perfect. Piper still goes to a regular pediatrician for other health needs, but the staff there still occasionally uses the wrong pronoun or old name. His family’s new insurance plan isn’t accepted at Queer Med, so they have to pay out of pocket for each visit—about $150 excluding lab fees.

The threat of unavailability of her care is constant, as Georgia is one of 20 states this year that has introduced bills to ban or restrict gender-affirming treatments for minors. Piper plans to leave the South for her health and safety after high school. But things could have been much worse, he knows. “I’m so lucky,” Piper said. “A lot of people don’t have a chance.”

Many barriers prevent young transgender people from getting the health care they need, according to a recent study in the journal. JAMA Pediatrics; these include stigma and discrimination from the health system, as well as legal, economic and social barriers to receiving gender-affirming care. A 2019 study The Centers for Disease Control and Prevention estimates that about 1.8 percent of high school students in the United States identify as transgender.

The JAMA article is the first review of qualitative studies on young transgender people’s experience of accessing healthcare. It covered 91 studies from 17 countries over several decades and included transgender and non-binary youth 9 to 24 years old – a wide range required by extremely limited data on the subject.

Pediatric intern at the Sydney Children’s Hospitals Network in Australia and author of the review, Dr. “There is a huge disconnect between healthcare providers and transgender youth right now,” Lauren Chong said.

“The findings were not surprising at all,” said Talen Wright, a graduate student in psychiatry at University College London who studies transgender mental health and was not involved in the research. “It’s strong evidence that something has to change.”

Major medical societies, including the American Medical Association and the American Academy of Pediatrics, have approved gender-affirming treatment for adolescents. (However, mmedical guidelines (I would recommend against children under 18 years of age undergoing gender-confirming genital surgery.)

But treatment remains controversial for some healthcare providers, lawmakers, and parents, precisely because adolescents are involved. puberty blockers and hormone therapy, bisexual confirmatory treatment given to minors, is most effective if taken when puberty begins between the ages of 8 and 14, before the age of independent medical consent in most states.

No single set of rules determines when and how transgender adolescents can receive gender-affirming care. However, clinicians generally conduct a range of mental health assessments in accordance with care practices such as those determined by clinicians. World Transgender Health Professional Organization or Endocrine Society. These assessments are to assess an adolescent’s understanding of themselves and to confirm that medical intervention is reasonable.

Dr. “This is to enable patients to make a fully informed decision that protects their future health,” Chong said.

D., a pediatric endocrinologist at Arkansas Children’s Hospital who was not involved in the research. Michele Hutchison added: “To the extent you can do that in medicine, we want to make sure it’s 100 percent justified and safe.”

For the most part, she said, her young patients were confident in their decisions. “When these kids came to me, they already knew,” he said.

However, some young patients in the JAMA review criticized what they saw in these assessments as “gate-guarding” measures that limit timely access to puberty blockers and hormone therapy at the time of development when these treatments will be most effective. Some adolescents said they felt the need to prove they were “trans enough” to gain approval, and others expressed disappointment when a parent denied their consent for hormone therapy, hindering their access to care.

Co-director of the Seattle Children’s Gender Clinic, who was not involved in the study, Dr. “As providers, we have to be really thoughtful about the structural barriers we create for ourselves,” said Gina Sequeira. “Most of the children I have seen have already overcome many obstacles.”

Transgender patients also face wider barriers to healthcare, according to the JAMA review. Insurance was a common and thorny issue; some families struggled to cover puberty blockers, and others struggled to find a trans-friendly provider on the network. And those without insurance faced high costs.

There are also waiting lists that usually take several months to get an appointment. D., a pediatric endocrinologist at Vanderbilt University in Tennessee who was not involved in the research. Cassie Brady said her clinic usually has a waiting list of around 50 people. “We’re doing everything we can to get these kids in.”

For a young trans person, the mere prospect of entering a clinic can be distressing. In the review, a 14-year-old said he felt “petrified“entering venues for fear of being mocked or rejected for their gender identity. Another adolescent reported that clinicians concealed their identities and “just one step

Hayden Wolff, who graduated from Tufts University in Massachusetts in 2021, began his medical transition at age 18. He remembered a visit to his school’s clinic, where his electronic health records were obsolete.

“Here I have a high fever, I try to be interested and I get the wrong sex in front of everyone in the room,” said Mr. Wolff.

The authors of the review also noted that more research is needed on the long-term effects of gender-affirming treatments. When Mr. Wolff met with doctors in Boston, he was asked to wean off the hormones if he was worried about fertility. Doctors in California told him not to worry, although they were unsure of the long-term results.

“You have to make decisions without a lot of information and data,” said Mr. Wolff.

She decided to freeze her eggs. The doctor who saw him in Boston had never treated a trans patient before and said it made Mr. Wolff feel like a “trans specimen”. Nurses at the clinic asked Mr. Wolff invasive questions unrelated to the egg freezing procedure.

“The lab nurses used to ask if I could have my penis after that, it’s not their business after all,” she said. “If you’re a kid, you don’t feel like you have the strength to say ‘You’re bothering me’ to someone.”

Clinicians said it won’t take long to start improving the healthcare experience for young transgender patients. For example, patients should be allowed to state their own name and gender before seeing a doctor. A pediatric assistant at Seattle Children’s, Dr. “This struck me the most as a transgender person who had received medical care, waiting for them to say the wrong name or call me ‘mr.’,” Baer Karrington said.

Dr. Chong said doctors and staff in the exam room should use gender-neutral terminology and avoid terms like “ovaries” and “womb.” “You could just call it genitals,” he said.

Dr. Sequeira noted that rural youth, as well as young transgender people of color, are disproportionately underrepresented in pediatric gender clinics. “The future of this work is to make it accessible to young people we currently do not serve,” he added.

Telemedicine can help bridge this gap and doctors in all fields can be better trained on how to care for transgender patients, he said. Dr. Karrington said that during pediatric training, they learned about transgender health care only in adolescent rotation, which did not address younger transgender children who were treated elsewhere in the hospital.

Transgender adolescents and clinicians expressed a desire to see more transgender providers who could share their life experiences with their younger patients. The first transgender assistant in their program, Dr. Karrington said they can count the number of transgender pediatricians they know from both hands. In Atlanta, Piper’s doctor at Queer Med is transgender and puts her at ease. “They know what I’m going through and can confirm that everything is getting better,” Piper said.

While Piper hopes for more trans people to become doctors, she wants to become a zoologist inspired by her lizards. “My call,” he said. “I’ve known that for a long time.”

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