Low income, lack of family support delay gender-affirming hormone therapies for youths
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Low income, Medicaid insurance and lack of family support were among the factors associated with transgender and nonbinary youths experiencing delays in receiving puberty blockers or gender-affirming hormones, according to study data.
“Although there has been an increasing number of multidisciplinary gender care centers in the United States, prior studies have demonstrated they are not reaching many or even most [transgender and nonbinary] youth, especially those who experience socioeconomic and geographic barriers or lack familial support. It is estimated that only one in five youth who desire puberty blockers or gender-affirming hormones are able to access them,” Diana M. Tordoff, MPH, a PhD candidate in the department of epidemiology at the University of Washington, Seattle, told Healio. “We conducted this study because it is important to understand the structural and clinic-level factors that delay or produce inequitable access to gender-affirming care."
Tordoff and colleagues analyzed longitudinal data from a prospective cohort of transgender and nonbinary youths seeking care at Seattle Children’s Hospital Gender Clinic, a multidisciplinary pediatric gender clinic, from August 2017 to June 2018. Researchers determined the time between initial clinic contact, phone intake, first medical appointment and initiating puberty blockers/gender-affirming hormones.
In all, 104 patients aged 13 and 20 years were included in the study: 63 transgender male or male, 27 transgender female or female, 10 nonbinary or gender fluid, and four unsure or missing data.
“We found that trans youth waited a median of 10 months from their initial contact with the clinic to receive puberty blockers or gender-affirming hormones,” Tordoff said. “The time to accessing these medications varied widely, from just under 2 months to over 2 years. Certain subsets of [transgender and nonbinary] youth disproportionately experience longer times to receiving gender-affirming care: youth with lower incomes, Medicaid insurance, lack of family support, and youth who experience delays in completing mental health assessments.”
Median time from contacting the clinic to initiating puberty blockers/gender-affirming hormones was 307 days, with a range of 54 to 807 days.
Compared with those aged 13 to 14 years, older youths experienced longer times to first medical appointment. Furthermore, researchers observed delays from first medical appointment to initiating puberty blockers/gender-affirming hormones among youths younger than 18 years who did not complete a mental health assessment before their first medical appointment (HR = 0.44; 95% CI, 0.22-0.88).
“Our study findings further highlight the need to investigate ways gender care providers can develop clinical infrastructure and systems that better meet the needs of low-income [transgender and nonbinary] youth and their families,” Tordoff said.
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