Transgender and gender diverse youth often avoid medical care after negative experience with health care providers

BCHS graduate Taylor Boyer's recent study focuses on transgender and gender diverse youth. 

Transmasculine and nonbinary or gender diverse adolescents are more likely to have had a non-affirming health care experience than their transfeminine peers, according to a new Journal of Adolescent Health study that found negative experiences with health care providers were linked with avoiding medical care.

Because forgoing medical care could exacerbate health disparities that already exist in these populations, the researchers emphasize the need to support gender-affirming care through better education and training programs for health care providers.

“We know that transgender adolescents experience significant challenges in accessing and receiving health care,” said Taylor Boyer, who conducted this research as a master’s student at the University of Pittsburgh School of Public Health and is now a health science specialist at the VA Pittsburgh Healthcare System. “What’s unique about this study is that we also looked at nonbinary and gender diverse adolescents because not as much is known about their experiences with health care.”  

Through surveying 34 transfeminine, 91 transmasculine and 31 nonbinary patients aged 12 through 26, Boyer and their team found that negative experiences with health care providers were linked with avoiding medical care because of worry about how a provider may react to their gender identity.

“Non-affirming experiences could include providers using incorrect names or pronouns, having to teach a provider about transgender health and, in some cases, judgmental or hostile interactions,” explained Boyer.

On the other hand, gender-affirming care acknowledges patients’ affirmed name and pronouns, uses an organ-based approach to define anatomy and asks questions relevant to the provision of care only. In some cases, gender-affirming care may include medical interventions such as hormone therapy.

Nonbinary and gender diverse adolescents — who do not exclusively identify as feminine or masculine — reported more negative experiences with health care providers than their transfeminine peers.

“We know from recent literature that nonbinary individuals often feel like providers approach them from a binary perspective — transfeminine or transmasculine — which is problematic for those who identify as another gender that may not be recognized by their provider,” said Boyer.

A surprising finding was that transmasculine youth reported more negative health care experiences than their transfeminine peers. Notably, 50% of transmasculine youth reported avoiding health care even when they felt it was important for their health, which was double the prevalence of avoidance in transfeminine youth.

The researchers say that experiencing stigma in the form of non-affirming care likely prompts individuals to anticipate future stigma and consequently delay or avoid medical care as a coping mechanism. Putting off needed medical care or skipping preventive appointments, such as immunizations and annual check-ups, could worsen health disparities that already exist between transgender and cisgender people.

In the U.S., transgender youth have worse physical and mental health than their cisgender counterparts, according to recent research. Transgender youth also do not receive preventive care as often as their cisgender peers.  

In the December issue – online now – the Journal of Adolescent Health included a complimentary letter to the editor advocating for health professionals to receive specific education in providing gender-affirming care to sexual and minority youth in light of the study findings. The study authors agreed and offered a confirmatory reply highlighting the importance of transgender health training for all health professionals – medical trainees and practicing providers.

“Many health care providers have never been educated about transgender health or trained to provide care to transgender and gender diverse patients,” said Boyer. “To avoid adverse interactions in the provision of care to transgender and gender diverse youth, we need to increase providers’ capacity to deliver evidence-based, gender-affirming care.”

They suggest integrating transgender health content in medical school curricula and increasing the availability of real-time consultation services, which offer providers access to experts to talk about transgender health including clinical support for specific patient cases.

“Ultimately, if health care for transgender and gender diverse youth is not improved and gender-affirming care is not more widely available, these negative experiences with providers will persist and individuals may continue to avoid seeking the medical care they need,” said Boyer. “These negative interactions are harmful.”