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Black transgender and gender diverse youth (TGDY) often face barriers and inequities in accessing gender affirming medical care, even before factoring in intersectionality and community stigma. Pediatric gender care is often provided in large multi-disciplinary gender clinics, which can present barriers for Black TGDY as they often include long wait times, prioritization of patients seeking gender affirming medications (as opposed to social transition only), and a lack of diversity among gender clinic providers and staff. It is known that having a primary care physician (PCP) is associated with greater trust, better patient-provider communication, and an increased likelihood that patients will receive appropriate care (1). Little is known about the gender affirmation goals among Black TGDY compared to those of other races and ethnicities, and how PCPs can be utilized to improve access to care. The purpose of this study was to understand provider's perspectives of their Black TGDY’s gender affirmation goals and barriers to care.
This study was conducted at the Odessa Brown Children’s Clinic (OBCC) which is the only pediatric primary care clinic affiliated with Seattle Children’s Hospital in Seattle, Washington. An 18-item open-ended investigator derived survey asking providers to recall their interactions with TGDY at OBCC from January 2019 - January 2021 was created using catalyst software and distributed to all OBCC providers via an anonymous email link.
A total of 20 participants completed the survey including 11 medical providers, 4 dental providers, 4 mental health providers, and 1 clinic staff. Participants reported approximately 90 TGDY of all races and ethnicities were seen at OBCC in the last two years. To avoid redundancy, only responses of medical providers were included in the results. Black patients made up only 25% of all TGDY seen at OBCC, despite making up 40% of the 9,000 total patients seen at the clinic yearly. Respondents reported Black TGDY were “out” to their caregivers at a rate of 65%, compared to 90% among non-Black TGDY. Among patients seen, providers estimated 8% of Black TGDY and 27% of non-Black TGDY were receiving gender affirming hormones (defined as estrogen, testosterone, or puberty blockers). Additionally, providers reported 57% of Black TGDY had a desire to only socially transition compared to 39% of non-Black TGDY. Reported barriers to accessing care at large pediatric gender centers included a lack of caregiver support, dysfunctional referral processes, concerns of racism and bias, and a desire to obtain gender affirming care solely with patient’s PCP.
Our data suggest goals related to social transition, gender affirming medication utilization, and barriers to accessing care may differ between Black and non-Black TGDY. Our findings also indicate the provision of gender affirming care in the primary care setting may help TGDY overcome existing barriers to care and improve access. To ensure providers are meeting the needs of Black TGDY, further research must be conducted to better understand their gender affirming care goals and barriers to accessing care.
Sources of Support
1. Office of Disease Prevention and Health Promotion. Access to Health Services. Accessed at https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services. Accessed Sept 1, 2021.