A new study published to the JAMA* — Pediatrics reveals some very disturbing information.

Eleven investigators were involved in this review. Most are in Australia. Subjects, however, were around the globe.

The most important take-away (which is a matter of opinion on my part) is that trans youth who are comfortable (confident) in their gender identity are more likely to have positive relationships with clinicians. This is likely to improve their overall health.

Another way to look at it is this: Prejudice and discrimination deteriorate the health of transgender kids.

You can read more here:

Being Targeted for Transphobia:
Participants felt “petrified” to enter health care spaces because of having their gender identity mocked and dismissed by staff or other patients. Their fear of discrimination was exacerbated by having to repeatedly out themselves to staff without knowing how they would react to their identity.

Feeling Invalidated by Misgendering:
Improper pronoun use was common, distressing, and annoying for participants, who felt that it reflected a disrespect and doubt about their gender identity.

Feeling Stripped of Personal Dignity:
Some participants were angered by clinicians who they thought made prejudiced assumptions about their sexuality, HIV status, and recreational activities. Others reported clinicians “preaching” to them to revert their gender status.

Feeling Burdened by Needing to Educate Clinicians:
Participants were frustrated by clinicians they felt had “poor and inadequate” knowledge of transgender anatomy and health preferences.

Feeling Dehumanized by Strict Gatekeeping:
Participants underwent strict medical and psychological evaluations to be deemed eligible to have hormonal and surgical therapy. They felt pressured to fit a stereotype and were angered by the need to take arbitrary measures such as “getting a haircut” to prove to clinicians they were “trans enough.”

Note: These psychological evaluations are WPATH standards of care.

"They could not access services through their parents’ insurance, were physically and mentally abused …"

Struggling and Taking Risks to Afford Treatment:
Participants in lower socioeconomic strata struggled to afford the high cost of treatment, including hormones, surgery, fertility preservation, and HIV care, as well as associated travel. Some female trans youths turned to prostitution or survival sex as “the only way to get enough money.”

Experiencing Societal Marginalization:
Participants felt “kicked out of the loop" by society, experiencing rejection from peers, employers, teachers, and landlords. Some trans youths struggled to overcome stigma and were reluctant to attend treatment clinics in case of breach of confidentiality.

Hiding Their Sexuality to Avoid Family Rejection:
Some were traumatized by familial disapproval. They could not access services through their parents’ insurance, were physically and mentally abused, and were disowned without financial support.

Experiencing Disapproval Because of Gender Dysphoria:
Some younger participants struggled with gender incongruence, identifying themselves as “freaks” or separate from “real girls” or boys. They felt ashamed.
vs.
Feeling Confidence of Identity to Pursue Treatment:
Some participants who embraced their identity and had a positive relationship with their body were better able to “express [themselves] in health care centers."
Conclusions

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 health care. They experience barriers to accessing health care that are largely attributable to legal, economic, and social deprivations, discrimination, violence, and homelessness. 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.

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* Journal of the American Medical Association

By David Cary Hart

Retired CEO. Formerly a W.E. Deming-trained quality-management consultant. Now just a cranky Jewish queer. Gay cis. He/Him/His.