TY - JOUR
T1 - Pathways to Care for Adolescents Attending a First Hormone Appointment at Canadian Gender Affirming Medical Clinics
T2 - A Cross-Sectional Analysis From the Trans Youth CAN! Study
AU - Lawson, Margaret L.
AU - Gotovac, Sandra
AU - Couch, Bob
AU - Gale, Lorraine
AU - Vandermorris, Ashley
AU - Ghosh, Shuvo
AU - Bauer, Greta R.
N1 - Publisher Copyright:
© 2023 Society for Adolescent Health and Medicine
PY - 2024/1
Y1 - 2024/1
N2 - Purpose: Limited research has examined adolescents’ pathways to gender-affirming medical care. Methods: Enrollment in Trans Youth CAN! was at an initial appointment for hormone suppression or gender-affirming hormones, if pubertal or postpubertal, and < 16 years old. Adolescent/parent surveys and clinical records were obtained for 174 adolescents and 160 matched parents at 10 medical clinics across Canada. Results: Participants’ mean age was 14.3 years, 95% confidence interval (CI) [14.1–14.6]; 126 (75.8%) identified as boys, 32 (15.9%) girls, and 14 (8.3%) nonbinary. Average wait time after referral was 269 days (95% CI [244, 294]). Adolescents reported 13.5 months seeking gender-affirming medical care, longer than reported by their parents (p = .0001). Family physicians or pediatricians provided 68% of referrals. Prior to clinic, adolescents saw an average of 2.7 (maximum eight) different types of providers (95% CI [2.4, 2.9]). Indigenous background and greater number of types of providers seen were associated with longer time seeking care. The majority of adolescents had ever engaged in self-harm (67.6%), with 58.1% ever seriously considering suicide and 36.0% attempting. Previous self-harm and suicidal thoughts were associated with longer wait times and older age. Seventeen point seven percent of parents/caregivers reported their adolescents had participated in conversion therapy or that parents had considered it. Discussion: The majority of participants were referred by family physicians or pediatricians, seeing multiple types of providers regarding their gender prior to referral. Adolescents experienced significant wait times. Indigenous adolescents reported longer times seeking care. Adolescents with longer wait times were more likely to have ever engaged in self-harm or had suicidal ideation.
AB - Purpose: Limited research has examined adolescents’ pathways to gender-affirming medical care. Methods: Enrollment in Trans Youth CAN! was at an initial appointment for hormone suppression or gender-affirming hormones, if pubertal or postpubertal, and < 16 years old. Adolescent/parent surveys and clinical records were obtained for 174 adolescents and 160 matched parents at 10 medical clinics across Canada. Results: Participants’ mean age was 14.3 years, 95% confidence interval (CI) [14.1–14.6]; 126 (75.8%) identified as boys, 32 (15.9%) girls, and 14 (8.3%) nonbinary. Average wait time after referral was 269 days (95% CI [244, 294]). Adolescents reported 13.5 months seeking gender-affirming medical care, longer than reported by their parents (p = .0001). Family physicians or pediatricians provided 68% of referrals. Prior to clinic, adolescents saw an average of 2.7 (maximum eight) different types of providers (95% CI [2.4, 2.9]). Indigenous background and greater number of types of providers seen were associated with longer time seeking care. The majority of adolescents had ever engaged in self-harm (67.6%), with 58.1% ever seriously considering suicide and 36.0% attempting. Previous self-harm and suicidal thoughts were associated with longer wait times and older age. Seventeen point seven percent of parents/caregivers reported their adolescents had participated in conversion therapy or that parents had considered it. Discussion: The majority of participants were referred by family physicians or pediatricians, seeing multiple types of providers regarding their gender prior to referral. Adolescents experienced significant wait times. Indigenous adolescents reported longer times seeking care. Adolescents with longer wait times were more likely to have ever engaged in self-harm or had suicidal ideation.
KW - Access to care
KW - Adolescents
KW - Gender-affirming care
KW - Mental health
KW - Transgender
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U2 - 10.1016/j.jadohealth.2023.07.021
DO - 10.1016/j.jadohealth.2023.07.021
M3 - Article
C2 - 37791927
AN - SCOPUS:85173027427
SN - 1054-139X
VL - 74
SP - 140
EP - 147
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 1
ER -