Pediatricians rarely receive training in gender-affirming health care, and as a result, few transgender youths who are eligible for such health care actually receive it, experts say.
Now the authors of a new report have suggested steps to correct that problem.
Transgender people, whose gender does not align with their sex assigned at birth, experience higher rates of anxiety, depression, substance abuse and suicide than other people, the researchers write in the Journal of Adolescent Health.
Timely access to gender-affirming health care, such as puberty blockers and cross-sex hormones, is tied to improved body image and a lower risk of long term mental health problems, according to Samantha Gridley of the Vanderbilt University School of Medicine in Nashville and colleagues.
For the new study, the researchers surveyed 15 transgender youths and 50 caregivers of transgender youths in 2015. Participants were recruited from Seattle clinics, a blog and a support group.
Barriers to appropriate care, according to the youths and the caregivers, included providers untrained in gender-affirming health care, inconsistently applied protocols, inconsistent use of a youth's chosen name or pronoun, uncoordinated care, limited and delayed access to treatments and insurance issues.
For example, one youth said it was difficult to find doctors who were accepting new patients, worked with adolescents and took their insurance, adding, "Finding someone who was trans-friendly made it all but impossible."
A caregiver reported that a doctor repeatedly called a child by the wrong name and pronoun. "I keep saying 'he,' 'Jack,' and she starts getting angry with me and flipping her head at me, like I was causing her to be annoyed . . . She gave me a look to kill."
To improve health care access for transgender youths, Gridley's team recommends mandatory training for pediatric providers and staff on gender affirming health care and awareness. They recommend developing protocols for the care of transgender youths and a roadmap for their families.
They also recommend that a child's chosen name and pronoun be recorded in medical records, and that clinics designate patient navigators to help transgender patients.
In addition, they call for more gender clinics, and they urge doctors to provide gender-affirming treatments to youths so they develop alongside their peers.
The study's senior author Dr. David Breland, of Seattle Children's Research Institute, was unable respond to a request for comment by press time.
Dr. Aron Janssen, who directs the Gender and Sexuality Service at NYU Langone's Child Study Center in New York City and wasn't involved in the study, told Reuters Health that access to health care for transgender youths is generally moving in the right direction. But still, he said, there are things in medical education that need to change.
He said some organizations are helping to train doctors to care for transgender youths and adults. Doctors who don't feel equipped to provide competent care should take steps to get educated, he said.
"The important piece about the study is that it incorporates the patient's family's voice," said Janssen. "All too often, services are developed without the perspective of patients and their families. I think it's a vital piece and a piece that we haven't heard much of."
He added, "Too often the patient and family voices are absent in the scientific literature and they're the ones who are most affected by treatment and access issues, and they're crucial to the research we do."