Background : National and international care guidelines support the importance of access to gender-affirming healthcare for TNG youth. While negative experiences in healthcare have been well-documented amongst TNG adults, TNG youth’s experiences in and access to healthcare have not been well-described. We conducted a needs assessment to inform strategic planning to improve health for TNG youth in Wisconsin.
Methods : We conducted an online survey of TNG youth (ages 12-22) in Wisconsin. The survey assessed access to care and experiences within healthcare, including assessment of negative experiences, access to gender-affirming care, and competency of medical and mental health providers. Youth who completed >70% of the survey were included in analysis. Descriptive analysis was performed using SPSS.
Results : Of 311 TNG youth included, 50% had not disclosed their gender identity to their PCP. Only 20% had access to TNG-competent healthcare providers and 2.3% reported insurance coverage of the full range of gender-affirming healthcare. More than half (55%) had educated their medical provider about TNG health. A large majority of TNG youth (79%) had experienced harm in healthcare.
Conclusions : TNG youth in WI experience barriers to care including limited provider competence, lack of insurance access and information related to gender-affirming care, difficulty navigating the healthcare system, and limited family support. Policy and practice recommendations include implementing developmentally appropriate informed consent procedures and promoting systems-level change to increase access to and quality of care.