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Binary and Nonbinary Transgender Adolescents' Healthcare Experiences, Avoidance, and Well Visits

  • Taylor L. Boyer
    Correspondence
    Address correspondence to: Taylor L. Boyer, M.P.H., Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 151 University Drive C, Pittsburgh, PA 15240.
    Affiliations
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

    Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Gina M. Sequeira
    Affiliations
    Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington

    Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
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  • James E. Egan
    Affiliations
    Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Kristin N. Ray
    Affiliations
    Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Elizabeth Miller
    Affiliations
    Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

    Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

    Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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  • Robert W.S. Coulter
    Affiliations
    Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

    Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

    Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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      Abstract

      Purpose

      To explore differences in healthcare experiences, healthcare avoidance, and well visit attendance between binary and nonbinary transgender adolescents; also, to explore the association between distinct healthcare experiences and healthcare avoidance and well visits.

      Methods

      We surveyed transgender adolescents ages 12–26 (n = 156) recruited from a multidisciplinary gender clinic from July through November 2018. Differences in distinct healthcare experiences by demographics were assessed using multivariable linear regression. Multivariable logistic regression was used to examine independent associations between demographics and lifetime healthcare avoidance and past-year well visit and also, associations between distinct healthcare experiences and lifetime healthcare avoidance and past-year well visit.

      Results

      Compared to transfeminine adolescents, more non-affirming healthcare experiences were reported by nonbinary (β = 1.41, 95% confidence interval [CI]: 0.49, 2.33) and transmasculine adolescents (β = 0.78, 95% CI: 0.02, 1.53). Gender-affirming healthcare experiences did not differ by demographics. Transmasculine adolescents had over three times the odds of lifetime healthcare avoidance (adjusted odds ratio [aOR] = 3.58, 95% CI: 1.41, 9.08) than transfeminine peers. Only younger age was associated with past-year well visit (aOR = 3.83, 95% CI: 1.44, 10.17). Non-affirming healthcare experiences were positively associated with healthcare avoidance (aOR = 1.85, 95% CI: 1.47, 2.34). Gender-affirming healthcare experiences were not associated with healthcare avoidance or past-year well visit.

      Discussion

      Nonbinary and transmasculine adolescents experienced more non-affirming healthcare experiences than transfeminine adolescents. Non-affirming healthcare experiences were associated with healthcare avoidance, which was disproportionately more prevalent among transmasculine adolescents. Providers must be better equipped to provide inclusive, gender-affirming care to increase receipt of care for transgender adolescents beyond specialized gender clinics.

      Keywords

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