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By Jill Drachenberg, Editor, Relias Media
Transgender adolescents and young adults often feel scared, anxious, and unsupported as they begin their transitions. They also face barriers to high-quality healthcare, including transphobia and dismissal of their medical needs. Improving access to gender-affirming healthcare services with a “cultural humility lens and addressing sociolegal stressors may improve outcomes in transgender and nonbinary youths,” according to the authors of a recent systematic review.
The authors reviewed 91 studies across 17 countries (64% in the United States) that reported the experiences of 884 participants who identified as transgender or nonbinary. They identified six key themes: being hurt by pervasive stigma and discrimination in the health system, 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.
Participants reported feeling “petrified” to attend medical appointments due to potential transphobia from medical staff. Others noted they felt stripped of their dignity. Participants also noted being misgendered by medical staff, leaving them feeling invalidated or unseen. Other youths reported receiving inadequate or no information on sexual health or reproductive issues. They also faced legal and insurance policy barriers to gender-affirming care. Many faced marginalization from family and society and were stigmatized due to their identity.
“Transgender and nonbinary youths contend with limited availability of gender-affirming services, strict gatekeeping measures to accessing therapy, and restricted insurance coverage and thus feel fearful, vulnerable, and uncertain when accessing healthcare,” the authors concluded. “Specific strategies to improve access to gender-affirming care services with a cultural humility lens, provide support during the transition process, and manage comorbidities and sociolegal stressors may contribute toward improved therapeutic outcomes and quality of life among transgender and nonbinary youths.”
Healthcare providers should do what they can to learn about LGBT patients and make them feel comfortable, seen, and heard, including using a patient’s preferred name and pronouns. Many transgender youths seeking reproductive care or sexually transmitted infection screenings might leave a clinic if staff make them feel uncomfortable.
“Helping [LGBTQ] individuals in the area of contraception, future fertility, and stated desire to become pregnant is confusing for reproductive health providers,” says Robert A. Hatcher, MD, MPH, chairman of the Contraceptive Technology Update editorial board. “Listening carefully to patients is always important and cannot be stressed too much when providing services to LGBTQ clients.”
Providers should take the time to know their patients and understand their lives. “As far as transgender and different sexual orientations, there are many different perspectives. If you don’t ask you’ll never know,” Brett Worly, MD, MBA, FACOG, associate professor and Learning Communities program director at The Ohio State University told Contraceptive Technology Update. “If you’re respectful and take time to listen to patients, they’ll tell you about their lives so you can have more background knowledge.”
The cultural stigma around transgender patients has been changing in recent years, with high-profile transgender athletes, performers, politicians, and others serving as role models and turning the tide toward acceptance.
“Now, we’re in a society that I think really believes people deserve our respect, attention, and care, and they don’t deserve to be treated improperly or insulted,” Worly said. “Transgender people have a much higher rate of depression, suicide, and interpartner violence.”