Transgender Youth Face Health Disparities, and It's Up to Providers to Address Them

Transgender and gender-nonconforming (TGNC) adolescents have poorer overall health and receive less healthcare than their cisgender peers, according to a new study published in Pediatrics.¹

Drawing on data from the Minnesota Student Survey, a state-wide surveillance system coordinated by the Departments of Education, Health, Human Services, and Public Safety to assess health and well-being of public school students, a research team led by G. Nicole Rider, PhD, evaluated data for 80,929 ninth and eleventh graders. Among the participants, 97.3% (n = 78,761) identified themselves as cisgender and 2.7% (2168) identified themselves as TGNC.

Approximately two-thirds of TGNC youth (62.1%) reported that their health was poor, fair, or good (versus very good or excellent), a rate nearly double that of their cisgender peers (33.1%). Additionally, 59.3% of TGNC youth said that they had a long-term mental health issue (versus 17.4% of cisgender youth), and 51.5% of TGNC youth reported having stayed home from school because of illness on at least 1 occasion during the past month (versus 42.6% of cisgender youth). TGNC respondents reported lower rates of preventative healthcare utilization, and visited the school nurse’s office more often than cisgender respondents.

Perceived gender expression among TGNC youth had a correlation with health status measures; students who were assigned male at birth and who said that they were perceived by others as equally feminine and masculine (49.2%) or somewhat masculine (57.5%) were significantly more likely to report poorer general health than those who said that others perceived them as very masculine (32.1%).

For those students assigned female at birth, those who said that others perceived them as somewhat feminine (69.5%), equally feminine and masculine (70.4%), or somewhat masculine (71.7%) were significantly more likely to report poorer general health than those who said that others perceived them as very feminine (54%) in their gender expression.

According to the study’s authors, these poorer health outcomes may be linked to TGNC adolescents’ barriers to accessing affirming healthcare, which may result in delays in seeking necessary healthcare services. For example, students who are perceived as gender nonconforming may not trust healthcare providers because of the potential for the individual’s gender identity or expression to be misunderstood. Furthermore, perceived gender nonconformity may be a risk factor for stressors—including non-affirmation or discrimination—that elevate adverse health outcomes. The authors call on healthcare providers to develop their competency in working with adolescents from a diverse range of gender identities and expressions.

Writing in an article accompanying the study, Daniel Shumer, MD, MPH, of the division of pediatric endocrinology at the University of Michigan, noted that poor health outcomes for TGNC youth are not inevitable.² Shumer points to long-term outcome data from the Netherlands that demonstrate that gender nonconforming children who received gender-affirming treatment in adolescence and young adulthood had an overall mental health status similar to that of the general Dutch population as adults.

“Given the tremendous disparities that are known to exist for these youth and the knowledge that these disparities are not inevitable, solutions to bridge this gap and eliminate these disparities are desperately needed,” wrote Shumer.

However, before solutions can be implemented, providers must better understand this patient population. Part of developing that understanding is relinquishing current medical guidance’s thinking about gender as masculine or feminine only. Wrote Shumer, “Youth are rejecting this binary thinking and are asking adults to keep up.”

References

1. Rider GN, McMorris BJ, Gower AL, Coleman E, Eisenberg ME. Health and care utilization of transgender and gender nonconforming youth: a population-based study. Pediatrics. 2018;141(2). Published online February 5, 2018. DOI: 10.1542/peds.2017-1683.

2. Shumer D. Health disparities facing transgender and gender nonconforming youth are not inevitable. Pediatrics. 2018;141(2). Published online February 5, 2018. DOI: 10.1542/peds.2017-4079.