Half of transgender youth avoid disclosing gender identity to healthcare providers

Feb. 20 (UPI) -- Nearly half of transgender youth avoid disclosing their gender identity to healthcare providers for fear of discrimination and stigmatization, a new study shows.

Published Thursday in the Journal of Adolescent Health, the findings by researchers at UPMC Children's Hospital of Pittsburgh and the University of Pittsburgh highlight the challenges faced by younger transgender people, even as social acceptance has increased, at least in some parts of the United States.

"I hope the findings increase awareness about the fear of discrimination that many transgender youth face while accessing healthcare," study co-author Gina Sequeira, an adolescent medicine fellow at UPMC Children's Hospital, told UPI. "This is particularly relevant as an increasing number of states propose legislation to restrict access to gender-affirming care for transgender youth and threaten legal action against providers who offer this care."

Several states -- including Colorado, Florida, Illinois, Kentucky, Missouri, Oklahoma, South Carolina and South Dakota -- are considering or have considered bills that would criminalize or revoke medical licenses for gender-related treatments like surgery and drug therapy.

A separate study published this month in Pediatrics indicated that puberty suppression treatment is safe, and lowers risk for suicide among adolescents questioning their gender identity.

"I'm concerned that the stigma and marginalization that arises from this proposed legislation will instate fear," Sequeira said. "Bills like these impede the trust and rapport-building that is critical to patient-provider relationships by discouraging patients from engaging with their providers openly, and they are counter to what existing scientific evidence shows about how we should approach caring for transgender youth. This legislation could also deter providers from discussing gender in the context of a medical visit, given their inability to offer evidence-based interventions without threat of legal ramifications."

For the study, researchers surveyed 153 transgender youth -- between 12 and 26 years of age -- who were patients at a local clinic providing gender-affirming care during the summer and fall of 2018. Two-thirds of the survey respondents identified as male, while roughly one-fifth identified as female. Another one fifth of the respondents described themselves as non-binary.

While 78 percent of the participants said they have disclosed their gender identity to healthcare providers outside the clinic, 47 percent indicated they intentionally avoid disclosure, even in situations where they think it might be important for their health. When asked why they were hesitant to disclose their gender identity, the most common reasons cited by respondents were "feeling uncomfortable" and "not knowing how to bring it up."

Only 25 percent of the respondents said they prefer to be the ones to broach the topic.

"It is up to us as healthcare providers and health systems -- not transgender patients themselves -- to adapt and ensure healthcare environments are more welcoming for patients of all gender identities," Sequeira said.

"Health systems can invest in care coordination services to support patients as they navigate the health system, and clinics can provide training, preferably led by transgender individuals themselves, to ensure all members of the healthcare team use affirming language throughout a clinical encounter, and adapt their intake forms and electronic medical records so they are more inclusive of transgender patients," she added.

Sequeira said the survey findings underscore the need for a supportive family and home environment for young people struggling with issues related to gender identity, as this support can play a "protective role." Support can also help young people feel more confident in discussing their concerns with healthcare providers.

When providers know that a patient is transgender, they're in a better position to ensure access to services, from medical transition to mental health, Sequeira said. Conversely, she fears young people from backgrounds where support is lacking may be more likely to avoid disclosure of their gender identity, "which has the potential to have significant health implications."

The gender clinic where study participants were recruited requires parent or guardian consent for the treatment of minors -- meaning these youth are "out" at home. For a future study, Sequeira plans to expand the study group to include a larger, more diverse group of transgender youth.

Other experts who have studied the challenges faced by transgender youth, and the barriers that may prevent them from getting appropriate and necessary care, aren't surprised by the UPMC findings.

"Societal hostility to gender diversity is apparent to many trans youth," Dan Karasic, a professor of psychiatry at the University California San Francisco, told UPI. Karasic was not involved in the UPMC study, but has published studies on the societal experience of transgender people.

"Healthcare providers have been learning the importance of signalling the safety of a given setting if they expect youth to feel comfortable to open up about aspects of themselves that they might not share publicly," he added. "Similarly, teachers and parents can signal the safety of discussing gender diversity, to initiate conversations in supportive settings."

"More youth are finding support among peers and online, but the burden should not be only on youth to initiate these conversations or to determine the safety of doing so," Karasic said.