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1.
Transgend Health ; 8(5): 420-428, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37810940

ABSTRACT

Purpose: To describe barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs). Methods: We used longitudinal data from a prospective cohort of TNB youth seeking care at a multidisciplinary pediatric gender clinic between August 2017 and June 2018. We calculated the time between (i) initial clinic contact, (ii) phone intake, (iii) first medical appointment, and (iv) initiating PBs/GAHs. We estimated Kaplan-Meier curves for each time-to-care interval and used Cox regression models to estimate hazard ratios (HRs) for factors hypothesized to be barriers and facilitators of care. Results: Our cohort included 104 youth aged 13-20 years. The median time from contacting the clinic to initiating PBs/GAHs was 307 days (range, 54-807). Lower income level, Medicaid insurance, and lack of family support were associated with longer times from contacting the clinic to completing the first medical appointment. In addition, older youth experienced longer times to first medical appointment relative to youth aged 13-14 years. Youth younger than 18 years of age who did not complete a mental health assessment before their first medical appointment experienced delays from first medical appointment to initiating PBs/GAHs (HR=0.44, 95% confidence interval, 0.22-0.88). Conclusion: Certain subsets of youth disproportionately experienced delays in receiving gender-affirming medications, and these factors varied by stage of care engagement. Given the association between gender-affirming care and improved mental health, identifying sociostructural and clinic-level barriers to care is critically important to facilitating more equitable access.

2.
J Adolesc Health ; 68(6): 1215-1219, 2021 06.
Article in English | MEDLINE | ID: mdl-33707147

ABSTRACT

Transgender youth with autism spectrum disorder (ASD) may experience complex relationships with eating because of cognitive rigidity, including inflexible thoughts and behaviors around food and/or their body. Yet, there is no research that provides guidance to clinicians providing care for youth with the unique triad of gender dysphoria, ASD, and disordered eating. This case series discusses trends in presentation and management of three cases from a multidisciplinary gender care clinic. All three individuals endorsed rigid thoughts around food and/or body appearance, which affected nutritional intake; however, their presenting eating disorder behaviors, described etiology for disordered thoughts, diagnosis, and level of engagement in a multidisciplinary treatment model varied. Based on these cases we hypothesize several strategies including early engagement with ASD specialists, proactive screening and discussions around eating with all transgender youth with suspected/confirmed ASD, continued discussions throughout care, as disordered eating behaviors may change after the initiation of gender-affirming medications, dietician visits early in treatment regardless of endorsed thoughts and behaviors, tailored management to the unique needs of each individual and their eating thoughts/behaviors, and consistent multidisciplinary collaboration.


Subject(s)
Autism Spectrum Disorder , Feeding and Eating Disorders , Gender Dysphoria , Transgender Persons , Adolescent , Autism Spectrum Disorder/therapy , Feeding and Eating Disorders/therapy , Gender Identity , Humans
3.
J Adolesc Young Adult Oncol ; 9(1): 128-131, 2020 02.
Article in English | MEDLINE | ID: mdl-31580768

ABSTRACT

Hypogonadism is a known late effect of cancer treatment. Hypogonadism requires replacement of sex steroids to ensure appropriate development of secondary sex characteristics, growth, and other beneficial health effects. We present a cancer survivor with hypogonadotropic hypogonadism and gender dysphoria. The patient received gender affirming care in our gender clinic with a multidisciplinary team that included an endocrinologist. This is not an isolated case at our institution. Survivorship oncologists must include a discussion about gender concurrently with conversations about survivors' development of puberty. Conversations should start early to ensure appropriate referrals and gender affirming hormone replacement.


Subject(s)
Cancer Survivors/statistics & numerical data , Hormone Replacement Therapy/methods , Hypogonadism/drug therapy , Neoplasms/complications , Adolescent , Humans , Male
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