February 5, 2018 / 6:26 PM / 6 months ago

Trans teens may not get care they need

(Reuters Health) - Transgender teens may be more likely to miss preventive health checkups and have untreated medical problems than their non-transgender peers, a U.S. study suggests.

Researchers examined survey data from 80,929 high school students in Minnesota, including 2,168 youth who identified themselves as transgender or gender non-conforming. Participants reported their gender identity and their assigned gender at birth, any chronic physical or mental health problems, any days they stayed home sick or saw the school nurse, and the timing of their last routine medical and dental checkups.

Overall, transgender adolescents were almost twice as likely as other teens to report their health as “poor, fair or good” as opposed to “very good or excellent,” the study found.

“When youth present differently than what society would expect for their birth-assigned sex, they often receive messages in society that they are behaving in a way that is ‘wrong’ or that they are ‘wrong’ in some way,” said lead study author Nic Rider, a human sexuality researcher at the University of Minnesota Medical School in Minneapolis.

“The stress and invalidation from this really impacts the health of these youth,” Rider said by email.

Just 38 percent of the transgender teens said their general health was “very good or excellent,” compared with 67 percent of the adolescents who identified as cisgender, meaning their gender identity matches the sex they were assigned at birth, the study found.

At the same time, about 25 percent of transgender youth had chronic medical issues or disabilities, and 60 percent had mental health problems. By comparison, only about 15 percent of cisgender teens had chronic physical health issues about 17 percent had psychological issues.

While more than half of the transgender teens said they had stayed home sick at least once in the previous month, only 43 percent of the cisgender participants had sick days.

About 41 percent of the transgender youth visited the school nurse at least once during the past month, compared with 26 percent of other students.

More than half of the youth got preventive health and dental checkups in the past year, but this was less likely to happen for transgender teens, researchers report in Pediatrics.

Among transgender youth, the teens whose gender expression most closely matched their assigned sex at birth had better overall health and fewer mental health issues.

One limitation of the study is that the survey questioned teens about their “biological sex” rather than their “sex assigned at birth,” which may have confused some students, the authors note. The survey also didn’t assess several factors that can influence health of non-cisgender youth, like whether they had received any medical interventions to support their gender identity such as puberty blockers or hormones, or whether they had socially transitioned to match their gender identity.

Still, there are many reasons transgender teens might wait longer than their cisgender peers to seek medical care, said Dr. Daniel Shumer, author of an accompanying editorial and a pediatric endocrinologist at the University of Michigan in Ann Arbor.

These teens may fear that they’ll be mistreated, or refused treatment, or they might experience more subtle discrimination like a clinician not using their preferred pronouns that match their gender identity, Shumer said by email. They might also be anxious about having a physical exam.

“Parents can advocate for their child by choosing primary care providers who are supportive of children with diverse gender identities and who are knowledgeable about local resources, including referral options for hormones,” Shumer added. “Remember that many physicians did not receive education about gender identity in medical school, however, all physicians have access to resources outlining how to support transgender youth.”

SOURCES: bit.ly/2nEAKCd and bit.ly/2E2sO7L Pediatrics, online February 5, 2018.

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