Many transgender youths avoid disclosing gender to health providers
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Almost half of transgender youths reported that they had intentionally avoided divulging their gender identity at one point to a health care provider, even in situations where it would have been important for health reasons.
Gina M. Sequeira, MD, MS, an adolescent medicine fellow at UPMC Children’s Hospital of Pittsburgh, and colleagues surveyed 204 youths aged 12 to 26 years who identified as transgender. Three-quarters (78%) said they had voluntarily disclosed their gender identity to a health care provider outside of a gender clinic at some point in their lives, whereas 46% (n = 70) reported ever intentionally avoiding disclosure to a provider.
“As providers and health systems, we need to do a better job making health care spaces more welcoming to transgender youth to talk about their identity when they are ready to do so,” Sequeira told Healio.
According to the study, the most common reasons that respondents avoided disclosure were that they did not feel comfortable talking about their sexual identity (66%) or did not know how to bring it up (65%).
The odds that a respondent would intentionally avoid disclosing their gender identity were lower among youths with a higher perception of parental support (OR = 0.83; 95% CI, 0.70-0.98).
Also, 85% of youths reported that using their name and correct pronoun in the waiting room would make them feel more comfortable and more likely to voluntarily disclose gender identity to a health care provider.
Other preferred strategies were the use of forms that allow youths to list their correct name and pronoun (81%); forms that allow them to list their gender identity (76%); and having front desk employees educated on the use of correct names and pronouns (79%).
“I think there are really two primary messages for clinicians here,” Sequeira said. “One, our data suggest there is much-needed change at the level of providers and health systems to create affirming spaces for patients of all gender identities. And two, that youths want their clinicians to provide them with opportunities for them to talk about their gender identity instead of having to initiate this conversation themselves.”
Sequeira said the findings were similar to data from larger studies focusing on transgender adults. In the current study, respondents over the age of 18 and those who were “less out” about their identities were less likely to have ever voluntarily disclosed information on their sexual identity.
Another study conducted by Sequeira and colleagues assessed the same 204 transgendered youths’ preferences regarding electronic medical records focusing on name and pronoun documentation.
They found that 69% (n = 138) used a different name than their legal one when filling out medical records and 79% (n = 156) preferred to have both their name and pronoun documented on all EMRs. Only 9% (n = 17) indicated that they were always or often asked if they wanted their name and pronoun documented.
“It is important that health systems and electronic medical records provide opportunities for young people to document their name and pronouns regardless of whether they have undergone legal name change,” Sequeira said.
Sequeira said they are currently planning a subsequent study with a nonclinical sample of transgender youths to better understand their experiences. – by Ken Downey Jr.
References:
Sequeira GM, et al. J Adolesc Health. 2020; doi:10.1016/j.jadohealth.2019.12.010
Sequeria GM, et al. JAMA Pediatr. 2020; doi:10.1001/jamapediatrics.2019.6071
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Cora Collette Breuner, MD, MPH, FAAP
PERSPECTIVE
Transgender youths face considerable stigma and discrimination in the health care system, which can lead to lower rates of health care use and disparate provision of care. Access to gender-affirming environments and gender-affirming medical care can reduce poor health outcomes. In this landmark study, the prevalence of voluntary disclosure or intentional avoidance was evaluated in transgender youths. Studies in transgender adults have revealed that disclosure is important.
Disclosure in adults may differ based on gender identity: binary transgender adults are more likely to discuss than those who identify as nonbinary. Sequeira and colleagues found that a majority of transgender youths discussed their gender identity to a heath care provider, but 25% did not.
One hypothesis is that without gender-affirming care and a supportive health care system and compassionate parents, youths may be less likely to discuss their gender identity. Youths over 18 and who were not "out" were less likely to disclose their gender identity.
Of note, in this study, transgender youths chose a number of health system strategies to increase comfort with disclosure, reflecting that youths themselves are key drivers in making sure that the health care they are provided is appropriate, equitable, welcoming and affirming.
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