Gender dysphoria assessment and action for youth: Review of health care services and experiences of trans youth in Manitoba

Heard, Jack; Morris, Amanda Sheffield; Kirouac, Nicole; Ducharme, Jennifer; Trepel, Simon; Wicklow, Brandy

doi:10.1093/pch/pxx156

Cited by 32 publications

(33 citation statements)

References 18 publications

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“…AFAB youth predominated in our population, but this is consistent with what has been described in other recent clinic-based samples. 2,31,32 Although lower than in some populations, 2,7,14 our reported rate of autism spectrum disorders (6%) is similar to that described by other Canadian 3,31 and Dutch gender clinics. 33 Of youth with reported ethnicities, most (147 of 203; 72%) were white, which is in keeping with the predominantly white participants in Canadian studies of GI youth and adults.…”

Section: Figuresupporting

confidence: 85%

Mental Health and Timing of Gender-Affirming Care

Sorbara

Chiniara²,

Thompson

et al. 2020

Pediatrics

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BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (,15 years of age at presentation) or older presenting youth (OPY) ($15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P , .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.

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Section: Figuresupporting

confidence: 85%

Mental Health and Timing of Gender-Affirming Care

Sorbara

Chiniara²,

Thompson

et al. 2020

Pediatrics

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“…All of the participants reported that specialty clinic staff used correct pronouns and names, a finding that contrasts with those of Heard et al. ( 2018 ), who found in a 2015 study of one of the same clinics that a small percentage of participants had reported issues with staff respecting their name and pronouns. This suggests that practices may have improved.…”

Section: Discussioncontrasting

confidence: 71%

The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

Sansfaçon

Temple-Newhook

Suerich-Gulick

et al. 2019

International Journal of Transgenderism

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Background : Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate. Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions. Methods : The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery. Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions. Discussion : The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.

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“…Many research studies have shown that youth and adults experiencing gender diversity can face discrimination from professionals and have difficulties accessing healthcare (Dowshen et al, 2018;Gridley et al, 2016;Heard et al, 2018;Hyde et al, 2014;Snelgrove, 2012). Furthermore, caregivers and gender diverse individuals may feel healthcare professionals lack sufficient knowledge to provide well-informed care and are often left feeling maltreated and stigmatised as a result (Gregor et al, 2015;Gridley et al, 2016;McBride, 2018;Riggs, Coleman, & Due, 2014;Riggs & Due, 2015;Riley, Clemson, Sitharthan, & Diamond, 2013;Sharon, 2016).…”

Section: Access To Care For Gender Diverse Youthmentioning

confidence: 99%

A Survey of Specialist Youth Gender Diversity Services in Australia: A Whole‐of‐Family Approach

Westwater

Riley

Peterson

2019

ANZ J of Family Therapy

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The number of referrals for children and young people seeking to affirm their gender has risen exponentially in Australia and elsewhere. Whilst the individual mental health needs and treatment outcomes for this group have been the subject of recent research, considerably less emphasis has been placed on exploring and amalgamating individual family member experiences, particularly siblings, using circular questioning. Yet, gender diversity is known to affect everyone in the family, and research clearly demonstrates that youth who feel validated and supported by individual family members in their gender identities benefit from improved mental health and global outcomes. This study aims to explore current clinical practices, professional viewpoints, use of circular questioning, and whole‐of‐family involvement in specialist youth gender diversity services in Australia. Clinical leads and coordinators of publicly funded youth gender diversity services and individual specialists across Australia were invited to complete an online survey, exploring individual protocols and practices in relation to involving the family, and the rationale underpinning this. All six respondents agreed that adopting a systemic understanding, considering general family functioning, and seeking individual family member opinions, was critical. Nevertheless, all family members were infrequently seen, with resourcing issues and time constraints being cited as the main reasons. The value of adopting a systemic and whole‐of‐family line of enquiry was supported by all respondents. Whilst sibling viewpoints were considered valuable by most professionals, siblings were infrequently seen for a variety of reasons. Further attention could therefore be given to involving siblings during specialist assessments. The findings consistently highlighted the value of a systemic line of enquiry and whole‐of‐family approach for gender diversity services and specialists. However, no current assessment guidelines incorporate this as a recommendation. Therefore, future Australian guidelines could formalise a systemic approach.

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Gender dysphoria assessment and action for youth: Review of health care services and experiences of trans youth in Manitoba

Cited by 32 publications

References 18 publications

Mental Health and Timing of Gender-Affirming Care

Mental Health and Timing of Gender-Affirming Care

The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

A Survey of Specialist Youth Gender Diversity Services in Australia: A Whole‐of‐Family Approach

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