Introduction to Access to Gender-affirming Care
Access to care refers to how well a healthcare system meets the needs of the community it serves.1 To be accessible, healthcare services should be available, geographically accessible, affordable, acceptable, and accommodating of individuals.1 Having access to healthcare that is supportive and affirming of gender is important for TTNB youth wellbeing.2,3 Gender-affirming care is the process through which a healthcare system cares for and supports an individual while recognizing and acknowledging their gender identity and expression.4 Gender-affirming care can include primary care, mental healthcare, and gender-affirming medical interventions, such as puberty blockers and hormone therapy.
Research about Access to Gender-affirming Care
The following sections summarize research findings showing that access to healthcare is important for TTNB youths’ well-being and documenting barriers youth experience in accessing that care. Following this summary, ideas to support TTNB in accessing gender-affirming healthcare are presented.
Access to healthcare is important for TTNB youth wellbeing
Access to primary care that is gender-affirming is linked to better health outcomes. TTNB youth who feel comfortable with their primary care providers, and whose providers are aware of their genders, tend to report better general and mental health, compared with TTNB youth who are not comfortable with or out to their providers.2 Non-binary youth are less likely to report feeling comfortable talking with primary care providers about their gender and gender health needs, compared to binary trans youth.3
Gender-affirming mental health care is also important for supporting TTNB youth wellbeing. Approaches to mental healthcare that are affirming of youth living in the gender that feels most real or comfortable to them are important for youth well-being, while approaches that are not affirming or seek to change a person’s gender can be harmful.5,6 Recent research confirms the importance that TTNB youth and their parents place on affirming mental healthcare for youth wellbeing.7
Access to gender-affirming medical interventions significantly improves TTNB youth health. TTNB youth who have required and accessed puberty blockers, hormone therapy, and gender-affirming surgery have better mental health outcomes, such as lower rates of depression and anxiety.8–10 Access to puberty blockers and hormone therapy can also reduce suicidality.8,10,11 TTNB youth with access to gender-affirming medical interventions report life satisfaction and happiness similar to cisgender youth.9 Older TTNB youth who have required and accessed gender-affirming surgeries report better mental health than those who are not able to access this care.12
TTNB youth face barriers to accessing healthcare
It can be hard to find a healthcare provider who provides gender-affirming care. TTNB youth may not be able to access needed care because it is not available in their area.2,7,13,14 It may be particularly difficult to find a healthcare provider who will assess for and prescribe gender-affirming hormone therapy.3 Parents have also identified lack of providers as a barrier to accessing care for their children.13 Healthcare providers’ lack of understanding about gender-affirming care can be a barrier for TTNB youth.15 Overall, healthcare provider education on youth gender-affirming care is lacking.13,16,17
Some youth are denied gender-affirming care or referrals to specialists. Whether due to discrimination or lack of knowledge, many TTNB youths are denied care by healthcare providers they try to go to.18–20 For example, youth may be denied hormone therapy, including prescription refills when seeking care.2,20 Primary care providers may also be uncomfortable making referrals for gender-affirming care.7
Some youth do not seek care because they are afraid of discrimination. Some TTNB youth may not access healthcare when they need it because they fear discrimination.3,19 For example, youth may worry about how both staff and healthcare providers will treat them.19 Those who anticipate facing stigma in healthcare are more likely to delay accessing care.21
Youth who have negative healthcare experiences may not go back. Feeling uncomfortable with a primary care provider is connected to TTNB youth not seeking out needed mental health care.2 Negative experiences include being treated disrespectfully by staff and other patients and confidentiality not being maintained.22,23 Lack of knowledge about and comfort with gender-affirming care contributes to negative healthcare experiences for TTNB youth.2,22
Other barriers include lack of transportation, costs, and long wait times. TTNB youth may not have transportation to get to appointments due to travel distance or lack of family support.2,7,19,22 In addition, the cost of gender-affirming care, particularly medications, can be a barrier to care.2,3,7,22,23 Lastly, wait times to see doctors, including any specialist care that is needed, are long and can be frustrating.3,14,22
Helping TTNB youth access healthcare
Ask youth what kind of help they need. You can offer to help by:
- Finding a gender-affirming healthcare provider
- Calling to make appointments
- Preparing questions for appointments
- Going with youth to appointments
- Advocating at appointments for people to use correct names, pronouns, and gender(s)