Transgender youth face multiple barriers to healthcare, findings

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

She lives just outside Atlanta and has a supportive family and two rescued leopard geckos, Saturn and Junho. Queer Med, a private gender clinic, is just a short drive away. Two years ago, after a five-month question, she started a hormonal regimen to confirm her gender there — a relatively short wait. The treatment has brought about a major change in Piper’s own perception. “I’m more confident in my body,” she said. (Piper’s family asked her to be identified by her name alone to protect her privacy.)

Things aren’t perfect. Piper still sees a regular pediatrician for her other health needs, but the staff there still sometimes still sometimes use the wrong pronoun or her previous name. Her family’s new insurance plan is unacceptable at QueerMed and will have to be paid at your own expense each time you visit. It’s about $ 150, excluding lab fees.

Georgia is one of the 20 states that introduced legislation banning or limiting gender-verifying treatments for minors this year, so there is always a threat that her care will be unavailable. Piper will leave the South after graduating from high school, concerned about her health and safety. But she knows it can all be much worse. “I’m very lucky,” Piper said. “Many people don’t get the chance.”

According to a recent study in the journal, many disabilities prevent young transgender people from receiving the medical care they need. JAMA PediatricsThese include prejudice and discrimination from the health care system and legal, economic and social obstacles to receiving gender-affirming care. NS 2019 study According to the US Centers for Disease Control and Prevention, about 1.8% of high school students in the United States are identified as transgender.

JAMA’s treatise is the first review of a qualitative study of the experience of transgender youth accessing healthcare. This included 91 studies from 17 countries over decades, including transgender and non-binary adolescents between the ages of 9 and 24.

“Currently, there is a huge gap between healthcare providers and transgender youth,” said Dr. Lauren Chung, a pediatric trainee and review author at the Sydney Children’s Hospital Network in Australia. ..

“The findings weren’t surprising at all,” said Taren Wright, a graduate student studying the mental health of transgender people at University College London’s psychiatry, who wasn’t involved in the study. .. “It’s a strong proof that things need to change.”

Major medical associations, including the American Medical Association and the American Academy of Pediatrics, approve adolescent gender-verifying treatments. (However, mMedical guidelines Not recommended for children under the age of 18 undergoing sex reassignment surgery. )

However, treatment remains controversial for some healthcare providers, lawmakers, and parents simply because it involves adolescents. Puberty suppressant Hormone therapy, two gender-confirming treatments given to minors, is most effective when taken at the onset of puberty around the age of 8-14 years, before the age of independent medical consent in most states.

There is no set of rules that govern when and how transgender adolescents can receive gender-affirming care. However, clinicians generally perform a series of mental health assessments according to care practices. Global specialized organization for transgender health care or Endocrine Society.. These assessments are intended to assess adolescents’ own understanding and to ensure that medical intervention makes sense.

“It’s about ensuring that patients make informed decisions that protect their future well-being,” said Dr. Chung.

Dr. Michel Hutchison, a pediatric endocrinologist at Arkansas Children’s Hospital who was not involved in the study, added:

In most cases, she said her young patients were convinced of their decision. “By the time these kids came to me, they knew for a long time,” she said.

However, some young patients in the JAMA review, in these assessments, “gatekeeping” to limit timely access to adolescent inhibitors and hormone therapy at the moment of development when these treatments are most effective. I criticized what I saw as a countermeasure. Some adolescents felt they needed to prove to be “sufficiently transgender” to get approval, while others were frustrated when their parents blocked access to care because they did not give approval for hormone therapy. Some young people expressed that.

Dr. Gina Sequeira, co-director of the Seattle Children’s Gender Clinic, who was not involved in the study, said: “The majority of the children I see have already overcome many, many barriers.”

Transgender patients also face broader barriers to health care, a JAMA review found. Insurance has proven to be a common and annoying problem. Some families struggled to cover puberty suppressants, while others struggled to find a trans-friendly provider on the network. And uninsured people faced high costs.

There is also a waiting list for making reservations, which is often months long. Dr. Kathy Brady, a pediatric endocrinologist at Vanderbilt University in Tennessee who was not involved in the study, said her clinic often has a waiting list of about 50 people. “We are doing everything we can to accept these children,” she said.

For young transgender people, the prospect of entering the clinic can simply be disastrous. A 14-year-old reviewer said, “MineralizationEnters the place for fear that gender identity will be ridiculed or rejected. Another adolescent, a clinician understands his identity and “Just a phase.. “

Hayden Wolff, who graduated from Tufts University in Massachusetts in 2021, began the medical transition at the age of 18. He remembered visiting a school clinic where electronic medical records were out of date.

“Here I have a high fever, I’m trying to take care of it, and I’m misunderstood in front of everyone else in the room,” Wolff said.

The authors of the review also noted that more research is needed on the long-term effects of gender-identifying treatments. When Mr Wolf met a doctor in Boston, he was urged to refrain from hormones if he was worried about giving birth. A California doctor told him not to worry if he didn’t know the long-term consequences.

“We have to make decisions without a lot of information or data,” Wolff said.

He decided to freeze the eggs. The doctor who saw him in Boston had never treated a transgender patient and made Wolff feel like a “trans specimen,” he said. Clinic nurses asked Wolff an invasive question that had nothing to do with the egg freezing procedure.

“Lab nurses will ask me if I’m going to get my penis after this, it’s not their job in the end,” he said. “If you’re a kid, I don’t feel that someone has the power to say,’You’re offending me.’ “

Clinicians said it would not take long to begin improving the medical experience of young transgender patients. For example, patients should be allowed to list their name and gender before seeing a doctor. Dr. Bear Carrington, a Seattle Children’s pediatrician, said:

Dr. Chung said doctors and attendants should use gender-neutral terms and avoid terms such as “ovary” and “uterus” in the office. “You can just say the reproductive organs,” she said.

Dr. Sequeira said young transgender people of color, and rural youth, are disproportionately undervalued in pediatric gender clinics. “The future of this work is to make it available to young people we are not currently serving,” she added.

Telemedicine could help fill that gap, and doctors in all disciplines could be better educated on how to care for transgender patients, she said. Dr. Karrington said during pediatric training that he learned about transgender health care only in adolescent rotation. This did not accommodate young transgender children being treated elsewhere in the hospital.

Both transgender adolescents and clinicians have expressed their desire to meet more transgender donors who may share their life experiences with younger patients. Dr. Carrington, the first transgender trainee in their program, said they could count the number of transgender pediatricians they knew with both hands. In Atlanta, Queer Med’s Piper doctor was transgender and she felt comforting it. “They know what I’m experiencing and can prove the fact that it’s getting better,” Piper said.

Piper wants more transgender people to be doctors, but he wants to be a gecko-inspired zoologist. “That’s my call,” she said. “I knew it for a long time.”