Experiences and Perspectives of Transgender Youths in Accessing Health Care: A Systematic Review

Lauren S.H. Chong, Jasmijn Kerklaan, Simon Clarke, Michael Kohn, Amanda Baumgart, Chandana Guha, David J. Tunnicliffe, Camilla S. Hanson, Jonathan C. Craig, Allison Tong

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Importance: Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care. Objective: To describe the perspectives and needs of transgender youths in accessing health care. Evidence Review: MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021. Qualitative studies of transgender youths' perspectives on accessing health care were selected. Results from primary studies were extracted. Data were analyzed using thematic synthesis. Findings: Ninety-one studies involving 884 participants aged 9 to 24 years across 17 countries were included. We identified 6 themes: experiencing pervasive stigma and discrimination in health care, feeling vulnerable and uncertain in decision-making, traversing risks to overcome systemic barriers to transitioning, internalizing intense fear of consequences, experiencing prejudice undermining help-seeking efforts, and experiencing strengthened gender identity and finding allies. Each theme encapsulated multiple subthemes. Conclusions and Relevance: This review found that transgender youths contend with feelings of gender incongruence, fear, and vulnerability in accessing health care, which are compounded by legal, economic, and social barriers. This can lead to disengagement from care and resorting to high-risk and unsafe interventions. Improving access to gender-affirming care services with a cultural humility lens and addressing sociolegal stressors may improve outcomes in transgender and nonbinary youths..

Original languageEnglish
Number of pages13
JournalJAMA Pediatrics
Early online date19 Jul 2021
DOIs
Publication statusE-pub ahead of print - 19 Jul 2021

Keywords

  • transgender youth
  • non-binary
  • Health care access
  • Barriers to care
  • gender affirming medical care

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