Trans teens may not share gender identity to providers

February 26, 2020

Children who are trans face many hurdles. One of those hurdles can be health care access and gender-affirming care. A recent study indicates that many trans teenagers and young adults don't disclose their gender identity, even when this information could be important.

Children who are trans face a number of hurdles such as the ability to use the restroom of their gender identity, a potential lack of acceptance from parents and peers illustrated by intentional misgendering or using the child’s birth name after it’s been changed, a practice called deadnaming by many. Being trans can even increase the risk of suicide, as shown by a 2018 study in Pediatrics that found that roughly 14% of all adolescent reported a previous suicide attempt, but 50.8% of female to male adolescents; 41.8% of adolescents who did not identify exclusively with either gender; and 29.9% of male to female adolescents reported an attempt.

Previous research has found that trans adults do not utilize the health care system as frequently as cis adults. A

from The National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 28% of trans people had reported verbal harassment at their medical provider’s office and 19% had been refused care because of their gender identity. Due to this stigma, the report found that 28% reported medical care altogether. This makes a recent study published in the Journal of Adolescent Health troublesome.

Trans teens don’t disclose, even when it could be important

The researchers administered a cross-sectional survey to transgender adolescents and young adults aged 12 to 16 years. In the sample, 57% were aged younger than 18 years and 65% identified as transmasculine, meaning that they were born female but identify more with masculinity. The investigators found around 78% had disclosed their identity to a provider in a care setting that specialized in gender, but that 46% of the respondents intentionally avoid disclosing their gender identity, even when the lack of disclosure impacted care.

The odds ratios (OR) of ever disclosing gender identify were lower for participants who were out to fewer people (OR, 0.12; 95% confidence interval [CI], 0.02–0.81); out for <1 year (OR, 0.03; 95% CI, 0.004–0.31); aged ≥18 years (OR, 0.33; 95% CI, 0.11–0.98). Teenagers and young adults with higher perceived parental support had lower odds of intentionally avoiding disclosure (OR, 0.83; 95% CI, 0.70–0.98).

Lifelong care begins in the pediatric office

Providing gender-affirming care is necessary in pediatrics because the pediatrician is often the first medical professional in a child’s journey to affirming gender identity and can set the tone for a lifetime of care.

A few ways to set the tone include:

  • Discussing gender during well visits

  • Provide support if conflict regarding gender identity occurs

  • Including preferred pronouns when introducing oneself to patients, ie, “Hello, I’m Dr. Smith and my pronouns are she/her.”

  • Treating gender concerns with the same care and respect as other concerns.

  • Don’t jump to conclusions.

  • Use tools like the Genderbread Person to increase understanding of gender identity and expression as well as attraction and sex. The tool could also be used when discussing the topics with patients.

References:

1. Sequeira GM, Ray K, Miller E, Coulter, R. Transgender youth’s disclosure of gender identity to providers outside of specialized gender centers. J Adolesc Health. February 20, 2020. Epub ahead of print.