Study: Adolescents capable of asserting gender-specific care goals
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Key takeaways:
- Most transgender and nonbinary patients desire hormone therapy, a study found.
- Most also desire surgery, although a desire for genital surgery was not common.
A chart review of transgender and nonbinary adolescent patients demonstrated that they are capable of asserting gender-specific care goals in discussions with physicians, a study published in Pediatrics found.
One of the study’s authors told Healio that she is interested in chart review research because of how much safer it is for patients.
“One of my primary areas of clinical practice is in gender-affirming care for children and adolescents, because I'm an adolescent medicine physician,” R. Claire Roden, MD, FAAP, director of adolescent gender and sexual health services for Hershey Medical Center at Penn State Health Children’s Hospital, told Healio.
“We developed a very templatized, interview-based medical assessment form for intakes for resident teaching purposes — for uniformity of patient experience, and also for research purposes,” Roden said. “We have these very templatized intakes, which are just a wealth of data, knowledge and information and are essentially semistructured interviews. Just looking at what we asked people seems like a fairly obvious direction to take some research.”
Roden’s clinic serves patients aged 10 to 24 years, who make appointments through phone intakes — separate from medical intakes — by the patient if they are 18 or older, or through a parent if they are a minor, to the clinic’s referral and intake coordinator.
“Are they asking for therapy services, medical services, psychiatric services?” Roden said. “If they are seeking medical services, they might see a medical provider, depending on what services they want. For the duration of the study period, that was mostly me and the residents.”
Physicians interview patients with an open-ended narrative assessment approach, beginning with asking their preferred name and pronouns, and then working together to outline treatment goals.
For the study, the researchers reviewed a total of 176 patient encounters. Of these, 71% were assigned female at birth, 46.6% of participants experienced a masculine gender and 73.3% had private health insurance. Most patients (97.4%) had a goal of initiating hormone therapy, and 87.1% included eventual surgery in their goals. Of those who had a surgical goal, 87.5% reported interest in surgery of the chest or breast, but just 29.3% reported interest in eventual genital surgery.
The second-largest gender group was patients who either declined to state an asserted gender or reported feeling unable to describe their gender experience, with 23.3% of the patients classed as “eclectic,” the only finding that Roden said she would describe as “surprising.”
“None of the other results were surprising to the study team, because this is part of our day-to-day life and clinical practice. For example, if you’re seeing the medical doctor, you probably want some medicine,” Roden said. “I imagine that the results may be surprising to individuals who are not living in this world.”
Roden hopes that other physicians and providers take the narrative approach with patients.
“A narrative assessment is less pathologizing and allows your patient to tell you what they need and what they want,” Roden said. “If you listen closely, and are open-minded, people will tell you what they want.”
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