Purpose

To explore differences in healthcare experiences, healthcare avoidance, and well visit attendance between binary and nonbinary transgender adolescents; also, to explore the association between distinct healthcare experiences and healthcare avoidance and well visits.

Methods

We surveyed transgender adolescents ages 12–26 (n = 156) recruited from a multidisciplinary gender clinic from July through November 2018. Differences in distinct healthcare experiences by demographics were assessed using multivariable linear regression. Multivariable logistic regression was used to examine independent associations between demographics and lifetime healthcare avoidance and past-year well visit and also, associations between distinct healthcare experiences and lifetime healthcare avoidance and past-year well visit.

Results

Compared to transfeminine adolescents, more non-affirming healthcare experiences were reported by nonbinary (β = 1.41, 95% confidence interval [CI]: 0.49, 2.33) and transmasculine adolescents (β = 0.78, 95% CI: 0.02, 1.53). Gender-affirming healthcare experiences did not differ by demographics. Transmasculine adolescents had over three times the odds of lifetime healthcare avoidance (adjusted odds ratio [aOR] = 3.58, 95% CI: 1.41, 9.08) than transfeminine peers. Only younger age was associated with past-year well visit (aOR = 3.83, 95% CI: 1.44, 10.17). Non-affirming healthcare experiences were positively associated with healthcare avoidance (aOR = 1.85, 95% CI: 1.47, 2.34). Gender-affirming healthcare experiences were not associated with healthcare avoidance or past-year well visit.

Discussion

Nonbinary and transmasculine adolescents experienced more non-affirming healthcare experiences than transfeminine adolescents. Non-affirming healthcare experiences were associated with healthcare avoidance, which was disproportionately more prevalent among transmasculine adolescents. Providers must be better equipped to provide inclusive, gender-affirming care to increase receipt of care for transgender adolescents beyond specialized gender clinics.

中文翻译：

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二元和非二元跨性别青少年的医疗经历、回避和就诊

目的

探讨二元和非二元跨性别青少年在医疗保健体验、医疗保健回避和健康就诊率方面的差异；此外，还探讨了不同的医疗保健体验与医疗保健回避和健康就诊之间的关联。

方法

 我们对 2018 年 7 月至 11 月从多学科性别诊所招募的12-26 岁跨性别青少年 ( n = 156) 进行了调查。使用多元线性回归评估了不同人口统计特征的不同医疗保健体验的差异。使用多变量逻辑回归来检查人口统计数据与终身医疗保健避免和过去一年的健康访问之间的独立关联，以及不同的医疗保健经历与终身医疗保健避免和过去一年的健康访问之间的关联。

结果

与跨女性青少年相比，非二元青少年（β = 1.41，95% 置信区间 [CI]：0.49，2.33）和跨男性青少年（β = 0.78，95% CI：0.02，1.53）报告了更多的非肯定性医疗体验。性别肯定的医疗保健体验并没有因人口统计数据的不同而存在差异。跨男性青少年终身回避医疗保健的几率（调整后优势比 [aOR] = 3.58，95% CI：1.41，9.08）是跨女性同龄人的三倍以上。只有较年轻的年龄与去年的探井次数相关（aOR = 3.83，95% CI：1.44，10.17）。不确定的医疗体验与医疗保健回避呈正相关（aOR = 1.85，95% CI：1.47，2.34）。性别肯定的医疗保健经历与回避医疗保健或过去一年的健康访问无关。

讨论

非二元性别和跨男性青少年比跨女性青少年经历更多非肯定性医疗保健经历。不确定的医疗体验与医疗保健回避相关，这在跨男性青少年中更为普遍。提供者必须具备更好的能力，提供包容性、性别肯定的护理，以增加跨性别青少年在专门的性别诊所之外获得的护理。