Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a survey study, transgender and gender-diverse adolescents reported barriers, inadequate psychosocial support, and discrimination when receiving gender-affirming care through primary care.

2. They also highlighted benefits, such as convenience, and called for greater care coordination between primary care providers and gender care specialists to improve their experiences.

Evidence Rating Level: 4 (Below average)

Study Rundown:

While gender-affirming care is recommended as the standard of care by the American Academy of Pediatrics, transgender and gender diverse (TGD) adolescents still face many barriers to accessing it. Specialty centers offering gender-affirming care are often limited to large urban areas and have long waitlists. Gender-affirming care provided by primary care providers (PCPs) may be more accessible, but previous studies have found that TGD adolescents have mixed opinions about receiving gender-affirming care in primary care settings. The current study sought to further explore TGD adolescents and their caregivers’ experiences with receiving gender-affirming care in pediatric primary care and their perspectives on how care delivery may be improved. 15 adolescents who were patients at a specialty gender clinic and 18 caregivers each participated in a semi-structured interview. Using qualitative analysis software, the study team identified themes from the interview responses. As in prior relevant studies, the participants expressed mixed feelings about their experiences with receiving gender-affirming care from their PCP, with some sharing un-affirming encounters and others citing positive, trusting relationships with their PCPs. Many participants highlighted the importance of both primary care for an accessible way to receive routine gender-affirming care and specialty gender clinics to cover more complex aspects of their care. Moreover, they called for greater communication between the providers in the two settings to better coordinate their care. Although limited by a very small sample size and its survey design, this study suggests that better integration of primary care with specialty gender clinics may be helpful for gender-affirming care in adolescents. Moving forward, the health outcomes of TGD adolescents receiving gender-affirming care in different settings should be compared to determine the optimal model of care delivery and more clearly identify recommendations for clinical practice.

In-Depth [cross-sectional study]:

The study recruited 15 adolescents between the ages of 14 and 17 years (mean 15.7 years) who were receiving care at an academic medical center-based gender clinic and 18 caregivers. Most of the adolescent participants identified as trans male or male, trans female or female, nonbinary, genderqueer, or gender nonconforming. On a scale of 1 to 10, 1 being not supportive at all and 10 being extremely supportive, the adolescents reported a mean caregiver support for their transition of 8.5. Each participant completed a semi-structured interview, the guides for which were developed in collaboration with a team of TGD adolescents and their caregivers. The interview transcripts were coded in a qualitative analysis software and themes were generated using reflexive thematic analysis. TGD adolescents and caregivers expressed difficulty with finding gender-affirming PCPs and detailed experiences with their PCP being unsupportive or not knowledgeable of gender diversity and gender-affirming care. They also shared several benefits to receiving care in the pediatric primary care office, namely having a trusting relationship with their PCP, feeling like their PCP had a more holistic view of their health than gender care specialists, and greater accessibility. Participants preferred receiving routine care, such as medication refills, from their PCP, but favored their gender care specialist for more complex care, including gender-affirming surgery. In addition to emphasizing the importance of both primary and specialty care and advocating for more training and reducing barriers for PCPs to provide gender-affirming care, they called for greater collaboration between the two systems for optimal care delivery.

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