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Review
July 19, 2021

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

Author Affiliations
  • 1Faculty of Medicine, University of New South Wales, Sydney, Australia
  • 2Sydney School of Public Health, University of Sydney, Sydney, Australia
  • 3Kids Research, The Children’s Hospital at Westmead, Westmead, Australia
  • 4Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, the Netherlands
  • 5Centre for Research into Adolescent’s Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, Australia
  • 6Faculty of Medicine, University of Sydney, Sydney, Australia
  • 7College of Medicine and Public Health, Flinders University, Adelaide, Australia
JAMA Pediatr. Published online July 19, 2021. doi:10.1001/jamapediatrics.2021.2061
Key Points

Question  What are the experiences, challenges, and needs of transgender youths in accessing health care?

Findings  In this systematic review, we identified 6 themes regarding the experiences and needs of transgender youths: 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.

Meaning  This review suggests that improving access to gender-affirming services with a cultural humility lens and addressing sociolegal stressors may promote engagement in care, minimize the use of unsafe interventions, and improve health outcomes in this population.

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.

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