Background Transgender and other gender diverse (TGD) youth of color experience stigma within healthcare. Gender affirmation can be a resilience resource; however, little is known about gender affirmation within healthcare. Purpose This study explores TGD youth of color’s experiences of stigma and gender affirmation across the entire healthcare experience and their role on motivation to seek care. Methods In 2015, cross-sectional surveys and individual in-depth interviews were conducted among 187 TGD youth ages 16–24 living in 14 U.S. cities. Analyses followed a mixed-methods design whereby 33 participants were purposively selected for a qualitative phenomenological analysis based on quantitatively reported gender affirmation needs. Subsequent quantitative analyses examined how healthcare use differed by access to gender affirmation. Results Participants qualitatively described experiencing stigma across multiple healthcare settings (e.g., primary care, emergency care, medical gender affirmation), including before (finding providers, scheduling), during (waiting rooms, provider interactions), and after (pharmacy) healthcare visits. Participants who quantitatively reported access to gender-affirming healthcare still described negative healthcare experiences, either because they accessed multiple healthcare services or because of prior negative experiences. Stigma and gender affirmation (both inside and outside of healthcare) influenced motivation to seek care, with variation depending on the type of care. Quantitative analyses confirmed these findings; access to gender affirmation differed for participants who delayed primary care vs. those who did not, but did not vary based on participants’ use of medical gender affirmation. Conclusions Findings highlight the importance of promoting gender-affirming healthcare environments to increase access to care for TGD youth of color.

中文翻译：

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性别肯定是解决跨性别有色人种青年的污名化医疗体验的弹性来源

背景 跨性别者和其他性别多样化 (TGD) 有色人种青年在医疗保健领域遭受耻辱。性别肯定可以成为一种复原力资源；然而，人们对医疗保健领域的性别肯定知之甚少。目的 本研究探讨了 TGD 有色人种青少年在整个医疗保健经历中所经历的耻辱和性别肯定及其在寻求护理动机中的作用。方法 2015年，对居住在美国14个城市的187名16-24岁的TGD青少年进行横断面调查和个人深度访谈。分析采用混合方法设计，根据定量报告的性别肯定需求，有目的地选择 33 名参与者进行定性现象学分析。随后的定量分析研究了医疗保健的使用因获得性别肯定而有何不同。结果 参与者定性描述了在多种医疗保健环境（例如初级保健、紧急护理、医学性别肯定）中经历的耻辱感，包括医疗保健就诊之前（寻找提供者、安排时间）、期间（候诊室、提供者互动）和之后（药房）。定量报告获得性别肯定医疗保健的参与者仍然描述了负面的医疗保健经历，要么是因为他们获得了多种医疗保健服务，要么是因为之前的负面经历。耻辱和性别肯定（医疗保健内部和外部）影响寻求护理的动机，其变化取决于护理类型。定量分析证实了这些发现；延迟初级保健的参与者与未延迟初级保健的参与者获得性别肯定的机会有所不同，但并不因参与者对医疗性别肯定的使用而有所不同。结论 研究结果强调了促进性别肯定的医疗环境对于增加 TGD 有色人种青少年获得护理的机会的重要性。