Experiences of Transgender and Non-binary Youth Accessing Gender-affirming Care: A Systematic Review and Meta-ethnography

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Sep 10

PMID 34506559

Citations 20

Authors

Sean Kearns

Thilo Kroll

Donal OShea

Karl Neff

Affiliations

Soon will be listed here.

Abstract

Objective: Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths' experiences accessing gender-affirming healthcare.

Method: A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908).

Results: Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled "The Rainbow Brick Road".

Conclusion: This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker's behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors' conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.

Citing Articles

Shifting Paradigms: A Deep Dive Into Public Perceptions of Gender-affirming Surgery.

Camacho J, Alfertshofer M, Patel H, Najafali D, Thompson N, Stoffel V Plast Reconstr Surg Glob Open. 2025; 13(1):e6472.

PMID: 39839450 PMC: 11749661. DOI: 10.1097/GOX.0000000000006472.

Navigating payment and policy barriers to gender-affirming care for transmasculine individuals: A qualitative study and policy assessment.

DAngelo A, Dearolf M, Restar A, Tsui E, Zewde N, Grov C Soc Sci Med. 2025; 366:117666.

PMID: 39837078 PMC: 11821434. DOI: 10.1016/j.socscimed.2024.117666.

Intentions to Use PrEP Among a National Sample of Transgender and Gender-Expansive Youth and Emerging Adults: Examining Gender Minority Stress, Substance Use, and Gender Affirmation.

Cluesman S, Gwadz M, Cleland C AIDS Behav. 2025; .

PMID: 39821058 DOI: 10.1007/s10461-025-04613-1.

Access to transition-related health care among transmasculine people in India: A mixed-methods investigation.

Chakrapani V, Santos H, Battala M, Gupta S, Sharma S, Batavia A PLOS Glob Public Health. 2024; 4(10):e0003506.

PMID: 39471207 PMC: 11521280. DOI: 10.1371/journal.pgph.0003506.

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review.

Clark K, Jewell J, Sherman A, Balthazar M, Murray S, Bosse J Int J Ment Health Nurs. 2024; 34(1):e13455.

PMID: 39435958 PMC: 11771681. DOI: 10.1111/inm.13455.

References

Goldman R, Kaser D, Missmer S, Farland L, Scout , Ashby R . Fertility treatment for the transgender community: a public opinion study. J Assist Reprod Genet. 2017; 34(11):1457-1467. PMC: 5699998. DOI: 10.1007/s10815-017-1035-y. View

Pullen Sansfacon A, Temple-Newhook J, Suerich-Gulick F, Feder S, Lawson M, Ducharme J . The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics. Int J Transgend. 2020; 20(4):371-387. PMC: 6913674. DOI: 10.1080/15532739.2019.1652129. View

Lindroth M . 'Competent persons who can treat you with competence, as simple as that' - an interview study with transgender people on their experiences of meeting health care professionals. J Clin Nurs. 2016; 25(23-24):3511-3521. DOI: 10.1111/jocn.13384. View

Roller C, Sedlak C, Draucker C . Navigating the System: How Transgender Individuals Engage in Health Care Services. J Nurs Scholarsh. 2015; 47(5):417-24. DOI: 10.1111/jnu.12160. View

Bazargan M, Galvan F . Perceived discrimination and depression among low-income Latina male-to-female transgender women. BMC Public Health. 2012; 12:663. PMC: 3497862. DOI: 10.1186/1471-2458-12-663. View

Judge C, ODonovan C, Callaghan G, Gaoatswe G, OShea D . Gender dysphoria - prevalence and co-morbidities in an irish adult population. Front Endocrinol (Lausanne). 2014; 5:87. PMC: 4056308. DOI: 10.3389/fendo.2014.00087. View

Puckett J, Cleary P, Rossman K, Newcomb M, Mustanski B . Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals. Sex Res Social Policy. 2018; 15(1):48-59. PMC: 5842950. DOI: 10.1007/s13178-017-0295-8. View

Ritterbusch A, Correa Salazar C, Correa A . Stigma-related access barriers and violence against trans women in the Colombian healthcare system. Glob Public Health. 2018; 13(12):1831-1845. DOI: 10.1080/17441692.2018.1455887. View

Nemoto T, Bodeker B, Iwamoto M . Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. Am J Public Health. 2011; 101(10):1980-8. PMC: 3222349. DOI: 10.2105/AJPH.2010.197285. View

10.

Connolly M, Zervos M, Barone 2nd C, Johnson C, Joseph C . The Mental Health of Transgender Youth: Advances in Understanding. J Adolesc Health. 2016; 59(5):489-495. DOI: 10.1016/j.jadohealth.2016.06.012. View

11.

Gridley S, Crouch J, Evans Y, Eng W, Antoon E, Lyapustina M . Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth. J Adolesc Health. 2016; 59(3):254-261. DOI: 10.1016/j.jadohealth.2016.03.017. View

12.

Roberts T, Fantz C . Barriers to quality health care for the transgender population. Clin Biochem. 2014; 47(10-11):983-7. DOI: 10.1016/j.clinbiochem.2014.02.009. View

13.

Bauer G, Redman N, Bradley K, Scheim A . Sexual Health of Trans Men Who Are Gay, Bisexual, or Who Have Sex with Men: Results from Ontario, Canada. Int J Transgend. 2014; 14(2):66-74. PMC: 4059421. DOI: 10.1080/15532739.2013.791650. View

14.

Snelgrove J, Jasudavisius A, Rowe B, Head E, Bauer G . "Completely out-at-sea" with "two-gender medicine": a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Serv Res. 2012; 12:110. PMC: 3464167. DOI: 10.1186/1472-6963-12-110. View

15.

Jones B, Arcelus J, Bouman W, Haycraft E . Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies. Sports Med. 2016; 47(4):701-716. PMC: 5357259. DOI: 10.1007/s40279-016-0621-y. View

16.

Carlile A . The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England, UK: Interviews with members of a family support group. Int J Transgend Health. 2020; 21(1):16-32. PMC: 7430470. DOI: 10.1080/15532739.2019.1693472. View

17.

Gonzales G, Henning-Smith C . Barriers to Care Among Transgender and Gender Nonconforming Adults. Milbank Q. 2017; 95(4):726-748. PMC: 5723709. DOI: 10.1111/1468-0009.12297. View

18.

Arcelus J, Bouman W, Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F . Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry. 2015; 30(6):807-15. DOI: 10.1016/j.eurpsy.2015.04.005. View

19.

Tong A, Flemming K, Mcinnes E, Oliver S, Craig J . Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012; 12:181. PMC: 3552766. DOI: 10.1186/1471-2288-12-181. View

20.

Samuels E, Tape C, Garber N, Bowman S, Choo E . "Sometimes You Feel Like the Freak Show": A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Ann Emerg Med. 2017; 71(2):170-182.e1. DOI: 10.1016/j.annemergmed.2017.05.002. View