Study title, author and year | Study design/participant information | Aims | Outcome measures | Main findings | Follow-up |
Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. Gridley et al (2016)37 | Qualitative: interviews, focus groups and online surveys. 15 transgender youth aged between 14 and 22, and 50 parents. Majority of participants were white (67% and 78%, respectively) 80% of trans youth were too old/ineligible for puberty blockers. | To understand barriers for transgender youth and caregivers in accessing healthcare services. | None stated. | Insurance refusals, delays in hormone blockers and cross sex hormone prescription, inconsistent use of pronoun/name, few accessible gender affirming practitioners, lack of consistent protocols, uncoordinated care and gatekeeping were all factors consistent with experiences of barriers in healthcare services. | None stated |
Health Care providers comfort with and barriers to care of transgender youth. Vance et al (2015)38 | Survey. 475 members from the Society for Adolescent Health and Medicine and the Pediatric Endocrine Society were recruited. | To explore provider side barriers to giving care to TGD youth. | 36-item survey comprising questions on demographic information, practice characteristics, clinical exposure to transgender youth aged 8–21 years, familiarity with and adherence to existing clinical practice guidelines, and perceived barriers to and comfort and confidence with providing transgender-related care. | 62% reported feeling comfortable providing care to TGD people. 6.4% of healthcare providers objected to treating TGD people medically based on religious and cultural beliefs. 14.3% reported discouragement from colleagues. 38% have prescribed transgender-related medications (puberty blockers/cross-sex hormones). Physician-related barriers include lack of training, little exposure to TGD patients, insurance reimbursement issues and lack of mental health professionals. Despite high willingness to offer care. | NA |
‘Completely out-at-sea’ with ‘two-gender medicine’: a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. Snelgrove et al (2012)39 | Qualitative: semistructured interviews, grounded theory approach. 13 participants, 9 of which were general practitioners. 11 practised in urban or small cities whereas 2 practised in rural settings. | To explore physician-side barriers to the provision of care for TGD people. | None stated. | Physicians perceive significant barriers in provision of care to TGD youth, uncertainty in multiple areas of healthcare provision. Access barriers seen when searching for reliable information, and during patient referral. Patient expectations also comprised a barrier, with healthcare providers feeling that expectations were unrealistic and were concerned with outcomes of transition for the patient. | None stated |
NA, not available; TGD, transgender and gender diverse.