FROM GENDER-AFFIRMING CARE TO TRANS-AFFIRMING CARE: Trans Youth Discourses of Healthcare Access

Abstract

Transgender youth in the United States face intersecting forms of societal marginalization and discrimination that places them at higher risk for disparate health outcomes compared to their cisgender peers. Access to care is known to improve long-term health outcomes among transgender adolescents, yet existing studies demonstrate that few youth receive transgender-affirming services. The overarching goal of this study was to better understand the healthcare-seeking experiences of transgender youth under 18 (both with and without parental support), highlighting how youths’ perspectives might challenge existing ideas in health research and practice about what constitutes equitable access to care in this population. The present study was comprised of three interrelated analyses. The first analyzes the discursive framing of contemporary transgender youth in the existing healthcare literature by applying discursive analytic methods to a small, purposely assembled sample of 10 articles in which ideas about the diagnosis and treatment of transgender youth are presented, discussed, and evaluated. The second utilizes discursive analytic methods and principles of community-based participatory research to analyze data from interviews with self-identified transgender youth between the ages of 13 to 17 (n=11) and parents of transgender youth (n=6) to better understand how youths’ transgender identity and legal status as minors impacted their ability to access health care or influenced the quality of care they received. Youth participants were invited to participate as members of the data analysis team. Two of the 11 youth participants served as data analysts. The third and final analysis integrates the perspectives of 8 additional trans youth who participated in a focus group regarding access to care for transgender minors and utilizes discursive analytic methods to evaluate how notions of age, consent, and autonomy influenced youth’s ability to access care and their inclusion in informed consent processes. Findings from this study suggest that a shift in research paradigms is needed for sufficiently addressing the health disparities facing trans youth, especially those most likely to experience inequitable access to care, particularly poor transgender youth, transgender youth who lack parental support, and transgender youth of color.