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McNamara M, Gentry KR, Sequeira GM, Kidd KM. State-Level Bans on the Care of Transgender and Gender Diverse Youth in the United States: Implications for Ethics and Advocacy. J Pediatr 2024:114182. [PMID: 38964438 DOI: 10.1016/j.jpeds.2024.114182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/26/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Affiliation(s)
| | - Katherine R Gentry
- University of Washington School of Medicine, Department of Anesthesiology & Pain Medicine; Seattle Children's Hospital, Treuman Katz Center for Pediatric Bioethics and Palliative Care
| | - Gina M Sequeira
- Seattle Children's Hospital, Department of Pediatrics; University of Washington School of Medicine, Department of Pediatrics
| | - Kacie M Kidd
- West Virginia University School of Medicine, Department of Pediatrics
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Downing J, Cunetta M, Sequeira GM, Kirkley J, Kyweluk M. Family Support in Transgender and Gender-Diverse Young Adults Seeking Telehealth for Hormone Therapy. Telemed J E Health 2024. [PMID: 38916878 DOI: 10.1089/tmj.2023.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: Family support (FS) is a key social determinant of health for transgender and gender-diverse (TGD) young adults. We examined the association between FS and health outcomes in young adults seeking gender-affirming hormone therapy (GAHT) from a US telehealth service. Methods: Cross-sectional data from TGD young adults ages 18-24 (n = 7,740) who provided demographic information and information on FS at intake were analyzed. Relationships between FS, geography, insurance status, rates of depression, and smoking status were examined. Results: Less than half of respondents reported having FS. Patients with FS reported lower rates of depression and higher incidence of previous gender-affirming medical care (e.g., hormone therapy, surgeries), had lower rates of being uninsured, and were more likely to reside in the Northeast or Western United States. Young adults assigned female at birth had higher rates of FS. Conclusion: FS may mitigate mental health disparities in TGD young adults including rates of depression. FS and insurance status are closely related in a geographically diverse population seeking telehealth services. The finding underscores the importance of FS as a social determinant of health and the unique characteristics of patients seeking telehealth services.
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Affiliation(s)
- Jae Downing
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael Cunetta
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Gina M Sequeira
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Moira Kyweluk
- Plume Health, Denver, Colorado, USA
- Third Space, LLC, Philadelphia, Pennsylvania, USA
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Sequeira GM, Kahn NF, Kyweluk MA, Kidd KM, Asante PG, Karrington B, Bocek K, Lucas R, Christakis D, Pratt W, Richardson LP. Desire for Gender-Affirming Medical Care Before Age 18 in Transgender and Nonbinary Young Adults. LGBT Health 2024. [PMID: 38800949 DOI: 10.1089/lgbt.2023.0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Purpose: We aimed to understand transgender and nonbinary (TNB) young adults' desire to receive gender-affirming medical care (GAMC) before age 18 and identify barriers and facilitators to receiving this care in adolescence. Methods: A cross-sectional survey was administered to TNB young adults presenting for care between ages 18 and 20 in 2023. Descriptive statistics characterized the sample, χ2 tests with post hoc pairwise comparisons identified differences in desire for gender-affirming medications, outness, and parental consent by gender identity and sex assigned at birth, and t-tests evaluated differences in barriers and facilitators to receiving care by outness to parents. Results: A total of 230 TNB respondents had complete data. Nearly all (94.3%) indicated they desired GAMC before age 18. Half (55.7%) of the respondents reported being out about their gender identity to a parent before age 18. Outness, discussing desire for GAMC, and asking for consent to receive GAMC from a parent were significantly more common among participants who identified as men compared to those who identified as women and among those assigned female at birth compared to those assigned male at birth. No such differences emerged when comparing nonbinary individuals to those who identified as men or women. Lack of parental willingness to consent for GAMC was cited as the primary contributor of not having received care in adolescence. Conclusions: Many TNB young adults desire GAMC in adolescence; however, lack of parental support is a key barrier to receiving this care, suggesting a need for more readily available resources for parents to support TNB adolescents.
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Affiliation(s)
- Gina M Sequeira
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Nicole F Kahn
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | - Kacie M Kidd
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Baer Karrington
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Dimitri Christakis
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Laura P Richardson
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Kahn NF, Asante PG, Guler J, Reyes V, Anan Y, Bocek K, Kidd KM, Richardson LP, Christakis DA, Pratt W, Sequeira GM. Caregiver perspectives on receiving gender-affirming care with their transgender and gender diverse adolescents via telemedicine. LGBTQ+ FAMILY : AN INTERDISCIPLINARY JOURNAL 2024; 20:190-200. [PMID: 38721330 PMCID: PMC11075659 DOI: 10.1080/27703371.2024.2317139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Telemedicine may help improve access to gender-affirming care for transgender and gender diverse (TGD) adolescents. Parents or guardians (i.e., caregivers) of TGD adolescents play a critical role in supporting TGD adolescents in accessing this care. The purpose of this study was to explore caregivers' perspectives regarding their adolescent receiving pediatric gender-affirming care via telemedicine to help providers and health systems optimize this modality for future care delivery. Caregivers (n=18) of TGD adolescents ages 14-17 participated in semi-structured, individual interviews that were transcribed and analyzed qualitatively. Caregivers cited participating in visits from their home environment, decreased anxiety, COVID safety, ability to have more family members attend, no transportation demands, and effective delivery of care as advantages of telemedicine. Disadvantages included dysphoria or discomfort with self-image, impersonal provider-patient interactions, video teleconferencing fatigue, difficulty with portal navigation, connectivity issues, and lack of privacy. Caregivers largely deferred to their child's preference regarding the choice of visit modality, but many reported a preference for the first to be conducted in-person, and follow-up and less complex visits via telemedicine. Health systems should consider these perspectives as they adapt telemedicine infrastructure to better meet the needs of patients and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Peter G Asante
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jessy Guler
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Valentino Reyes
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Yomna Anan
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Laura P Richardson
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dimitri A Christakis
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, Washington, USA
| | - Gina M Sequeira
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Sequeira GM, Asante PG, Bocek K, Kahn NF, Sethness JL, Hodax JK, Kidd KM, Pratt W, Christakis DA, Richardson LP. Evaluating an Electronic Consultation Platform to Support Pediatric Primary Care Providers in Caring for Transgender and Nonbinary Adolescents. Telemed J E Health 2024; 30:595-600. [PMID: 37624647 PMCID: PMC10877380 DOI: 10.1089/tmj.2023.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/27/2023] Open
Abstract
Background: An electronic consultation (e-consult) platform was implemented to support pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. Following implementation, a study was conducted to (1) explore how access to this e-consult platform impacts PCP confidence and referral patterns, (2) describe the content of questions, and (3) evaluate PCP's perspectives regarding platform usability. Methods: Following each submission, providers completed a 17-item survey. A total of 20 providers submitted 38 e-consults and 26 follow-up surveys between October 2021 and December 2022. Results: All PCPs reported a high overall value and increased confidence caring for TNB adolescents. Nearly one in five (19%) felt it allowed them to avoid submitting a specialty referral. Mean System Usability Scale score was 78.2 indicating good usability. Conclusion: This e-consult platform shows great promise in increasing PCP confidence providing gender-affirming care adolescents. More widespread utilization could help improve access to care and decrease specialty care referrals.
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Affiliation(s)
- Gina M. Sequeira
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter G. Asante
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Janis L. Sethness
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juanita K. Hodax
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M. Kidd
- West Virginia University, Morgantown, West Virginia, USA
| | - Wanda Pratt
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dimitri A. Christakis
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Laura P. Richardson
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Goulding R, Goodwin J, O'Donovan A, Saab MM. Transgender and gender diverse youths' experiences of healthcare: A systematic review of qualitative studies. J Child Health Care 2023:13674935231222054. [PMID: 38131632 DOI: 10.1177/13674935231222054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Transgender and gender-diverse (TGD) populations are identified as high-risk for negative healthcare outcomes. Limited data exists on experiences of TGD youths in healthcare. The review aim is to systematically review literature on healthcare experiences of TGD youths. Seven electronic databases were systematically searched for relevant studies. Pre-determined eligibility criteria were used for inclusion with a double-screening approach. Sixteen studies were included. Studies included were quality appraised, data were extracted, and findings were synthesized narratively. Four narratives were identified including experiences of: accessing care, healthcare settings and services, healthcare providers, and healthcare interventions. Long waiting times, lack of competent providers, and fear were reported as challenges to accessing gender-affirming care. Negative experiences occurred in mental health services and primary care, while school counseling and gender clinics were affirming. Puberty blockers and hormone-replacement therapy were identified as protective factors. TGD youths are at risk of negative health outcomes due to an under resourced healthcare system. Further research is needed to assess interventions implemented to improve TGD youth's experiences.
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Affiliation(s)
- Ryan Goulding
- Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M Saab
- Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Sequeria GM, Guler J, Reyes V, Asante PG, Kahn N, Anan Y, Bocek K, Kidd K, Christakis D, Pratt W, Richardson LP. Adolescent and Caregiver Perspectives on Receiving Gender-Affirming Care in Primary Care. Pediatrics 2023; 152:e2023062210. [PMID: 37697934 PMCID: PMC10698727 DOI: 10.1542/peds.2023-062210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Transgender and gender-diverse (TGD) adolescents experience barriers to receiving gender-affirming care. Delivering services in the pediatric primary care setting may help facilitate improved access. With this study, we aimed to explore TGD adolescents' and caregivers' experiences receiving primary care services and their perspectives regarding gender-affirming care delivery in pediatric primary care. METHODS TGD adolescents aged 14 to 17 and caregivers of TGD adolescents currently receiving gender-affirming medical care participated in 1-hour-long, semi-structured, individual, virtual interviews. Each interview was recorded and transcribed. Transcripts were then individually coded, and themes were generated iteratively by using a reflexive thematic analysis framework. Recruitment of each group continued until thematic saturation was reached. RESULTS A total of 33 participants (15 adolescents and 18 caregivers) completed interviews. Adolescent participants (mean age of 15.7 years) predominantly identified as transmasculine or trans male (73%), and caregiver participants were predominantly mothers (83.3%). Four themes were identified, which included (1) barriers, such as microaggressions and poor psychosocial support, (2) benefits, such as existing trusted relationships with primary care providers (PCPs) and convenience, (3) improvement strategies, such as training and interdisciplinary collaboration, and (4) opportunities for integrating primary care and specialty gender-affirming care. CONCLUSIONS TGD adolescents and their caregivers reported previous negative interactions with PCPs; however, some desired to receive gender-affirming care in this setting, citing increased convenience, efficiency, and availability. Participants highlighted an ongoing need for further work to provide resources, education, and training to PCPs and their staff and improve PCP-to-specialist communication and collaboration.
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Affiliation(s)
- Gina M Sequeria
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Jessy Guler
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | | | - Peter G Asante
- University of Washington School of Medicine, Seattle, Washington
| | - Nicole Kahn
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Yomna Anan
- Seattle Children's Hospital, Seattle, Washington
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington
| | - Kacie Kidd
- West Virginia University, Morgantown, West Virginia
| | - Dimitri Christakis
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Wanda Pratt
- University of Washington School of Medicine, Seattle, Washington
| | - Laura P Richardson
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Hassan B, Zeitouni F, Ascha M, Sanders R, Liang F. Temporal Trends in Gender Affirmation Surgery Among Transgender and Non-Binary Minors. Cureus 2023; 15:e45948. [PMID: 37885491 PMCID: PMC10599689 DOI: 10.7759/cureus.45948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Over the last decade, a greater number of transgender or non-binary (TGNB) minors have been seeking gender affirmation surgery (GAS). Given the recent concerns about the potential harm of GAS in TGNB minors, we sought to determine the incidence and postoperative outcomes of GAS among TGNB minors. METHODS We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database, 2018-2021, for minors aged 17 years or younger. The primary outcome was the frequency and type of GAS plotted over time. The secondary outcome was the incidence of postoperative complications within 30 days following GAS. Descriptive statistics were calculated. Linear regression was performed to assess the association between the incidence of GAS and time in years. RESULTS A total of 108 TGNB minors were identified. The mean (SD) age was 16.9 (0.8) years without significant variation over time. There was a significant increase in the number of GAS per year over four years (P<.001). Nevertheless, only two (1.9%) patients underwent GAS below the age of 15 (13.9 and 14.5 years). Chest masculinization surgery (CMS) was the predominant procedure type among TGNB minors (n=102, 94.4%). There was no incidence of major complications (mortality, bleeding, sepsis, unplanned intubation) except for unplanned reoperation for hematoma evacuation (n=3, 2.8%). The incidence of minor complications (surgical site infection, wound dehiscence) was low (n=1, 0.9%), each). CONCLUSIONS AND RELEVANCE GAS in minors, primarily in the form of CMS, has been increasing over time. CMS in minors is a safe procedure with rare complications.
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Affiliation(s)
- Bashar Hassan
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Ferris Zeitouni
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Mona Ascha
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Renata Sanders
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
| | - Fan Liang
- Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, USA
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