Abstract
Little is known about youth accessing gender-affirming care in Canada. Trans Youth CAN! is a prospective 24-month cohort study of youth referred for puberty suppression/gender affirming hormones, examining pathways to care, medical, social, and family outcomes. Eligible participants were pubertal, aged <16, naïve to puberty blockers/cross-sex hormones, and recruited at their first endocrine appointment, along with their parent/caregiver (P/C), from clinics in 10 Canadian cities. Baseline sociodemographic, health, and family data were collected from interviewer-assisted youth surveys, self-completed (P/C) surveys, and clinic medical records. Youth data included day-to-day discrimination (InDI-D), depression, (MDS), psychological distress (Kessler-6), gender distress (TYC-GDS), gender positivity (TYC-GPS), and P/C support (self-report by youth and P/C). Pathways to accessing gender-affirming medical care included wait times, prior providers seen, length of time seeking care, and age accessing care. P/C data included parental conflict and consideration/involvement in conversion therapy. Baseline data were collected from 09/2017 to 06/2019 on 174 youth and 160 P/Cs. 78.7% of youth were assigned female at birth. 8.1% of those assigned female at birth, and 8.3% of those assigned male at birth, reported a primarily non-binary identity. 25.7% of youth had one or more immigrant P/Cs; 20.5% were Indigenous; and 15.5% were from rural areas. In the past year, 52.9% of youth reported engaging in self-harm, 32.6% had suicidal ideation, and 13.8% had attempted suicide. Bivariate correlations showed that longer wait times were associated with being older when youth first spoke to someone about their gender, seeing more provider types before first endocrine appointment, P/C report of time spent seeking hormone treatment, and lifetime discrimination. Youth with higher current P/C support were younger at their first appointment. Older youth at first appointment had also been older when they first met with someone outside the family about their gender, and had spent a longer time seeking hormone treatment. These youth also had higher gender distress, lower gender positivity, higher psychological distress, higher depression, experienced higher lifetime and past-year discrimination, and had lower average P/C support. P/Cs reported 8.8% of youth had participated in conversion therapy, while an additional 9.7% had considered having their youth participate. Current or past parental conflict about youths’ gender identity was reported by 40.1%, but was not associated with age of accessing care, types of providers seen, length of time accessing care, or age at first appointment. This research will help fill gaps in knowledge for health care providers about youth accessing gender affirming medical care, enhancing gender-affirming care and support for these youth and their parents/families.
Psychological Distress Persists Among COVID-19 Health Care Providers, Suggesting New Challenges and Missed Opportunities for Support
