Transgender teens and young adults face many barriers to receiving quality health care, including little access to supportive healthcare settings. Voluntary disclosure of gender identity to healthcare providers outside of a specialized, gender-affirming clinic can help transgender youth develop positive relationships with providers. Voluntary disclosure may also be necessary to optimize care.

Researchers from the University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh did what they claim is the first study looking at the voluntary disclosure of gender identity, or its exact opposite, intentionally avoiding disclosure, among transgender youth. They also examined factors that affect young people’s comfort with disclosing their gender identity in a healthcare setting.

Only 25 percent of the teens responding wanted to be the ones to bring up their gender identity; most preferred to wait for their providers to do so.

The researchers surveyed transgender teens and young adults who were between 12 and 26 years old. All were patients at a clinic providing gender-affirming care. The researchers analyzed data from 153 participants. Among these respondents, 65 percent identified as male, 16 percent identified as female and 19 percent identified as non-binary.

The majority of respondents (78 percent) said they reported their gender identity at least once to a healthcare provider other than those at the clinic. However, 46 percent said they purposely avoided disclosing it, even in situations where they thought it could be important for their health.

Teens were less likely to avoid disclosing their gender identity to a healthcare provider if they had more parental support. Gina Sequeira, lead author of the study, told TheDoctor she was surprised so many respondents said they avoided disclosing their gender identity because the clinic where they were treated requires parental consent for the treatment of minors.

So these teens and young adults were out at home, and had at least one supportive caregiver in their lives. The most common reasons cited by respondents for not disclosing their gender identity to a provider were feeling uncomfortable broaching the subject and not knowing how to bring it up.

Only 25 percent of the teens indicated that they wanted to be the ones to bring up their gender identity; most preferred to wait for their providers to do so. The small number of teens wanting to initiate a discussion of their gender identity may have to do with the dynamic between providers and their patients, said Sequeira, a fellow in adolescent medicine at the Children’s Hospital of Pittsburgh. “That’s a really personal decision for every young person, and has to do with being comfortable with that part of their identity in the context of the health care visit.”

Sequeira was taken aback by the experiences young transgender people reported having had in their providers' waiting rooms, when calling to schedule an appointment or while talking with clinic staff. As more providers are educated about how to support trans youth, they can put out signals during a visit to make trans people feel more accepted. For example, providers can introduce themselves with their names and preferred pronouns, or have the forms that patients fill out include places to list their preferred pronouns and gender identity.

“Those experiences really mattered to a lot of the young people we surveyed; they were really important to making trans teens and young adults feel comfortable talking to the clinician about their identity,” said Sequeira.

“I hope that if we do those things, young people will come to understand over time that healthcare systems can be a safe place where they can be their true selves,” she added, saying that she wants transgender teens and young adults to know many healthcare providers are working hard to create healthcare settings that are safer and more affirming for them.

More studies are planned with different patient populations, such as a population that is not recruited through the gender clinic but through social media. Sequeira added, “This will help us understand the experiences of young trans people who do not have access to care or have not accessed care at a gender-affirming clinic…”

The study is published in the Journal of Adolescent Health.