Most Young Transgender, Nonbinary People Uncomfortable Telling a Healthcare Provider Their Gender Identity, Survey Reveals

A survey of young transgender and nonbinary people revealed most have at some point avoided disclosing their gender identity with healthcare workers outside of gender clinics. Experts fear this could stop them from accessing vital care, and could damage their physical and mental health.

The study published in the Journal of Adolescent Health involved a total of 153 patients at a multidisciplinary gender clinic in Southwestern Pennsylvania, aged between 12- to 26-years-old. Of the total, 65 percent identified as transmasculine, or assigned female at birth but who later came out as men; one were fifth transfeminie; and 19 percent nonbinary, where a person's gender identity sits outside of the categories of man and woman. The participants, 57 percent of whom were under the age of 18, completed the survey between July and November 2018.

When asked whether they had ever voluntarily disclosed their gender identity to a healthcare provide outside a gender clinic, 78 percent said they had at some point, and 46 percent said they hadn't on purpose.The team found that both respondents over the age of 18 as well as those of all ages who were less open about their gender identity were less likely to share the information. Young people who felt they were supported by their parents, meanwhile, were more likely to disclose.

Of the 70 participants who chose no to state their gender identity, even though they felt it was important, the most common explanations were not feeling comfortable talking about it and not knowing how to discuss it with their provider.

The healthcare provider's environment made a difference to the young person's decision, the survey revealed. Respondents said they felt more comfortable revealing their gender if their chosen names and pronouns were used in the waiting room; they were given the opportunity to list them on forms; and front desk staff were were aware of their importance. These factors rated higher than fears their parents would find out, or that their gender identity would be documented on health records.

"Transgender youth often face significant societal stigma and discrimination in addition to multiple barriers to receiving quality health care. It is like that a combination of these factors contributes to the development of the significant health disparities and lower rates of healthcare utilization seen in this population," the authors wrote in their paper.

Dr. Gina Sequeira, an adolescent medicine fellow at UPMC Children's Hospital of Pittsburgh and co-author of the paper, told Newsweek she was inspired to conduct the study after hearing a patient's "horrifying" experience with a pediatrician who stopped treating him after years, upon learning he was trangender.

"When we, as providers, do not give patients the opportunity to feel affirmed and respected during a clinical encounter, we risk making them feel like they can't be present and respected as their true selves in the healthcare setting," said Sequeira. "This additional stigma compounds the physical and mental health disparities many transgender individuals already experience."

The study was limited, Sequeira acknowledged, because the participants included young people recruited from a multidisciplinary gender clinic and so the findings might not relate to those outside of this group.

The paper comes against a backdrop of a number of states, including Idaho and Florida, trying to block transgender youths from accessing medical care, which have been condemned by the American Academy of Child and Adolescent Psychiatry as having the potential to indirectly harm children.

"Our findings, particularly the high rates of intentional avoidance, suggest that many transgender youth continue to fear discrimination while accessing healthcare," said Sequeira. "This is particularly worrisome given the increasing number of state legislators proposing restrictions to gender affirming care provision and threatening legal ramifications for the physicians providing this care."

Dr. Alex Keuroghlian, director of the National LGBT Health Education Center at The Fenway Institute who did not work on the paper, told Newsweek, "Disclosing gender identity to health care providers is necessary for receiving high-quality, culturally responsive, primary and preventative health care in all settings, yet unfortunately 46 percent of participants in this cross-sectional study reported avoiding this disclosure outside of gender clinics."

Keuroghlian, who is also director of the Massachusetts General Hospital Psychiatry Gender Identity Program, said the study highlights the importance of training healthcare provides to communicate sensitively and effectively when discussing gender identity with their patients.

"The findings are consistent with what we hear from many members of transgender and gender-diverse communities, who report experiencing extensive mistreatment in health care settings and by health care providers attributed to their gender identity. Many people would rather avoid being stigmatized while seeking needed primary, preventative or urgent care," Keuroghlian said.

Keuroghlian said such barriers could stop healthcare providers from caring for their patients, as they need to understand an individual's identity and sex assigned to do so.

"In addition, transgender and gender-diverse people who do not feel comfortable and safe disclosing their gender identity to health care providers will likely experience increased gender minority stress in these settings and may avoid seeking needed care altogether, in order to avoid experiencing further stigmatization," she said. "This can lead to adverse mental and physical health outcomes."

Keuroghlian added future studies can build on this work by assessing whether patients who share their identity might change over time, and in what context.

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A stock image shows a young person speaking with a doctor. Getty