Affirmative Care for Transgender and Gender Diverse Youth

Current Psychiatry Reports | 2023, Vol. 23, article number 33, p. 1-10

Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes

David C. Call; Department of Psychiatry and Behavioral Sciences, Children’s National Hospital, Washington, DC, USA

Mamatha Challa; Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA

Cynthia J. Telingator; Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA

Purpose of Review: This paper reviews the evolving body of research on the mental health of transgender and gender diverse (TGD) youth. Minority stress experiences in families, schools, and the community impact the health and well-being of this population due to experiences of stigma, discrimination, and rejection. Poor healthcare access and outcomes may be compounded in youth with intersectional identities. 

Recent Findings: There is increasing evidence that gender-affirming interventions improve mental health outcomes for TGD youth. TGD youth report worse mental health outcomes in invalidating school and family environments and improved outcomes in affirming climates. TGD youth experience significant healthcare disparities, and intersectional clinical approaches are needed to increase access to affirmative care.

Summary: Providers can best support TGD youth by considering ways they can affirm these youth in their healthcare settings, and helping them access support in schools, family systems, and communities. Understanding the intersection of multiple minority identities can help providers address potential barriers to care to mitigate the health disparities seen in this population.

 Transgender; gender diverse; intersectionality; disparities; youth;  gender-affirmative care

The article addresses the critical need for healthcare providers to deliver supportive and informed care to transgender and gender-diverse (TGD) youth. This population faces significant health disparities and mental health challenges due to minority stress, stigmatization, and systemic barriers. The article aims to examine the disparities in healthcare, the effectiveness of gender-affirming interventions, and the outcomes for TGD youth, emphasizing the importance of affirmative care in mitigating negative mental health outcomes.

TGD youth encounter numerous healthcare disparities, including limited access to gender-affirming care and a lack of knowledgeable providers. Previous findings indicate that these disparities stem from systemic issues such as discrimination, lack of insurance coverage for gender-affirming treatments, and a general lack of understanding among healthcare providers. These barriers contribute to poorer mental health outcomes, including higher rates of depression, anxiety, and suicidal ideation among TGD youth. 

The article highlights the effectiveness of gender-affirming interventions, such as puberty blockers and hormone therapy, in improving the mental health and well-being of TGD youth. Research shows that these interventions can significantly reduce symptoms of gender dysphoria, depression, and anxiety and improve overall quality of life. The importance of providing timely and appropriate gender-affirming care cannot be overstated, as delays or denial of such care can exacerbate mental health issues and contribute to a higher risk of self-harm and suicidal behavior.

The outcomes for TGD youth who receive affirmative care are markedly better than for those who do not. The article discusses how supportive family, school, and peer environments can further enhance the positive effects of gender-affirming interventions. Previous findings underscore the role of social support in reducing experiences of violence, discrimination, and mental health challenges. The article emphasizes that fostering supportive environments and educating families and communities about the needs of TGD youth are integral to promoting their mental health and overall well-being.

In conclusion, the article underscores the necessity of affirmative care for TGD youth, highlighting the significant disparities they face and the positive impact of gender-affirming interventions. By addressing systemic barriers, providing appropriate medical care, and fostering supportive environments, healthcare providers can help improve the mental health outcomes and quality of life for TGD youth.

Training and Education: Clinicians need consistent training to work effectively with transgender and gender-diverse (TGD) youth. This includes understanding current language and terminology to address and validate TGD identities appropriately.

Affirmative Care: Clinicians should provide gender-affirming care, being familiar with common interventions and outcomes. This includes understanding the use of puberty blockers, hormone therapy, and other gender-affirming treatments.

Understanding Disparities: Awareness of healthcare disparities faced by TGD youth is crucial. Clinicians must recognize the significant impact of minority stress and intersectional stigmatized identities on TGD youth’s access to affirmative care.

Creating Safe Spaces: Clinical spaces should be safe, respectful, and affirming for TGD youth. Clinicians need to understand and mitigate the obstacles to care that TGD youth face both within clinical settings and in broader societal contexts.

Family and Social Support: Emphasize the role of family, school, and peer support in reducing violence victimization and self-harm among TGD youth. Clinicians should work with families and communities to foster supportive environments.

Addressing Structural Issues: Recognize and address systemic issues such as structural racism and barriers to medical care. This includes advocating for policies and practices that improve healthcare access and outcomes for TGD youth.

Resilience and Coping: Promote resilience and coping strategies among TGD youth by leveraging their unique strengths and cultural backgrounds. Clinicians should explore protective factors that can help mitigate the effects of minority stress.

“TGD youth experience significant healthcare disparities. In order to create safe, respectful, and affirming clinical spaces, providers must understand the obstacles to care that TGD youth face both inside and outside of the office. TGD youth’s access to affirmative care is significantly impacted by minority stress and intersectional stigmatized identities. Intersectional approaches to research, healthcare, and education are all shedding light on ways to mitigate mental health disparities for TGD youth. These approaches highlight the importance of understanding each individual through an intersectional lens to assess how multiple identities influence areas of vulnerability and strength. Recognizing diversity among experiences, backgrounds, and identities can help providers understand the complex factors and struggles that impact TGD children and their families, and ultimately improve healthcare outcomes for this vulnerable group” (p. 6).

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