Background : Health Outreach to Teens (HOTT) is the adolescent medicine program of Callen-Lorde Community Health Center, which has been at the forefront of providing comprehensive primary care services for transgender and non-binary (TGNB) individuals practicing an informed consent model (ICM) of gender-affirming hormone therapy (HT) for adults. HOTT serves over 800 TGNB patients annually. In 2015 HOTT extended HT to patients aged 13-17 using a modified ICM with legal guardian consent. We performed a program evaluation to determine the demographics of the population, route and speed of access to HT, and retention in care.
Methods : We retrospectively analyzed patient visits from 2/2015-2/2019, and included all who initiated HT prior to their 18th birthday. We excluded those who had transferred HT care from an external clinic and patients who initiated HT less than six months before the final review. We analyzed demographic information, medication, and appointment history directly from the health record. We utilized chart review to determine the patient’s relationship with BH providers prior to HT initiation and retention in HT care.
Patients were defined as retained in HT care if there was medical visit within six months were HT was continued, or if there were HT prescriptions at time of review indicating continued adherence. Patients were defined as not retained in HT care in three categories; documented transfers of care, discontinued HT while in care, and lost to care (LTC), which was defined as no clinical visit within six months and no ongoing HT prescription.
Results : We identified 108 patients who initiated HT as adolescent minors using the modified ICM. Of these, two discontinued hormones in care and seven were lost to follow up.
Conclusions : This is the first description of an adolescent minor cohort initiating HT utilizing an ICM. No adverse events were identified. Both patients discontinuing HT denied regret and retained TGNB identity. Both had BH prior to HT. There is not evidence that lack of BH care before HT correlated to HT discontinuation or loss to care. We have found that the modified ICM for adolescent minors aligns with our goal of positive youth development, has increased access to clinical care, and has not led to adverse events.