Perspectives of trans and gender diverse young people accessing primary care and gender-affirming medical services: Findings from Trans Pathways

Abstract

Background: Increasing numbers of trans young people are seeking medical services worldwide, but there have been few qualitative investigations of the experiences of trans young people attempting to engage with these services to explore in-depth experiences of clinical interactions. Aims: We aimed to explore the experiences of trans young people accessing primary care and gender-affirming medical services in Australia for reasons related to their gender. Methods: Using data from a large mixed methods cross-sectional study, we explored the personal experiences of trans young people aged 14-25 (N = 859) receiving care within primary care services and gender-affirming medical services. Qualitative data on these service experiences were thematically analyzed. Results: Trans young people in Australia reported experiencing difficulties when accessing medical services, especially in relation to gender-affirming medical intervention, referrals to specialist services, and obtaining clinical support in an affordable and timely manner. We found that trans young people were frequently confronted with negative experiences due to clinicians lacking expertise in providing gender-affirming care. Trans young people also reported many positive experiences, including feeling their gender identity was valued and respected by certain services. Although many practitioners attempted to assist their trans patients, they often did not provide satisfactory care and young people were often left to navigate the health care system unsupported. These interactions were often constrained by long waiting times and service cost. Discussion: In general, clinicians require further training to be able to respectfully interact with trans patients and to adequately assist trans young people to obtain necessary medical care. The danger of providing such non-affirmative care to a trans young person is not only invalidating the young person's identity, but also an elevated risk of ill-health due to later avoidance of health care.

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“…2018; Strauss et al. 2021), lack of access due to geographic location (Nemoto et al. 2015; White Hughto et al.…”

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“… 148 Trans people have often experienced discrimination, stigma and health care provider ignorance in previous attempts to access medical care, which often results in hesitancy to seek out medical attention, which delays treatment. 114 These barriers have been reported to result in less frequent HIV/STI testing. 115 In an Australian national survey of sexual health clinics, it was found that the incidence of HIV was around 3.5% in trans males and 5.7% in trans females on first visit, which is significantly higher than 1.2% in cis individuals.…”

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