A significant proportion of transgender youth may be reluctant to disclose their gender to a healthcare provider outside of a specialized gender clinic, suggests study data published in the Journal of Adolescent Health. Youth with higher perceived parental support were less likely to avoid gender disclosure, whereas those who were older and had been out for a shorter period of time were more likely to endorse intentional avoidance.
This cross-sectional survey was administered via electronic tablet to transgender youths receiving care at a gender clinic in southwestern Pennsylvania. Between July and November 2018, patients were approached for participation in a survey about gender identity. Cisgender patients were excluded. Participants completed a 78-item survey regarding disclosure of gender and sexuality. The language of the survey was assessed and validated by transgender health experts to ensure validity and appropriateness. The primary outcome variables were voluntary disclosure and intentional avoidance of gender disclosure at clinics that did not specialize in gender. Logistic regression was performed to identify predictors of each outcome, expressed as odds ratios (ORs).
Of 204 participants, 75% provided complete survey data. Two-thirds of the sample (65%) identified as transmasculine; 16% as transfeminine; and 19% as nonbinary. The majority (84%) were attending the participating clinic for gender care, and 66% reported traveling for longer than 30 minutes to reach the clinic. More than half (57%) were <18 years of age, and 88% were white. Three-fourths (78%) reported voluntary disclosure of gender identity to a healthcare provider outside of the gender clinic at some point in their lifetime. However, 46% said they had intentionally avoided disclosure. In the initial regression model, transfeminine participants were nominally less likely to endorse voluntary disclosure compared with transmasculine participants (OR, 0.39; 95% CI, 0.13-1.15). This association disappeared in models adjusted for gender-related characteristics, including time since first coming out, gender expression, and self-perceived passing as gender.
In these fully adjusted regression models, odds ratios (ORs) of gender disclosure were lower in patients ≥18 years (OR, 0 .33; 95% confidence interval [CI], 0.11-0.98), patients out to fewer people (OR, 0.12; 95% CI, 0.02-0.81), and patients who had been out for <1 year (OR, 0.03; 95% CI, 0.004-0.31). Intentional avoidance was less likely among youth with higher perceived parental support (OR, 0.83; 95% CI, 0.70-0.98). Overall, one-third of youth said they had both voluntarily disclosed and intentionally avoided, suggesting that comfort in clinical settings occurs on a case-by-case basis. When asked what could be done to improve likelihood of disclosure, the majority endorsed the use of name and pronouns in waiting room (85%) and the use of forms with inclusive gender language and options (81%).
Although three-quarters of surveyed youths reported intentional disclosure of gender identity, half had also avoided disclosure at some point in time. Parental support may be protective against intentional avoidance. Of note, survey data were collected from 1 site that treated primarily white patients. Researchers acknowledge that a broader sample of transgender youth is necessary to expand on their findings.
Overall, these results suggest a “continued need to facilitate change at the…health system [level] to create affirming environments and mitigate health disparities,” authors wrote.
Sequeira GM, Ray KN, Miller E, Coulter RWS. Transgender youth’s disclosure of gender identity to providers outside of specialized gender centers [published online February 1, 2020]. J Adolesc Health. doi: 10.1016/j.jadohealth.2018.10.101