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Study examines health disparities between transgender youths, peers :

February 5, 2018

Transgender teens are more likely to skip doctor checkups and experience more health issues than their peers, according to a new study.

“With our results, we suggest that health care providers should screen for health risks and identify barriers to care for youth who are TGNC (transgender/gender nonconforming) while promoting and bolstering wellness within this community,” authors wrote.

Transgender youths identify as a different gender than their birth-assigned sex, while those who are cisgender have the same gender identity and birth-assigned-sex. Previous research has found TGNC youths may be at heightened risk for depressive symptoms, self-harm and other mental health issues.

Researchers set out to look at whether there are disparities in their physical health as well, documenting their findings in the study “Health and Care Utilization of Transgender/Gender Nonconforming Youth: A Population-Based Study” (Rider GN, et al. Pediatrics. Feb. 5, 2018, https://doi.org/10.1542/peds.2017-1683).

The team analyzed data on more than 80,000 high school students from the 2016 Minnesota Student Survey, of which about 3% consider themselves TGNC. Students were asked about their biological sex, gender identity, the way they are perceived, their health status and health utilization.

About 38% of TGNC teens reported their health as very good/excellent compared to 67% of cisgender teens. In addition, about 59% of TGNC teens said they have a long-term mental health problem compared to 17% of cisgender teens.

TGNC teens reported a lower rate of preventive checkups in the last year (60%) compared to cisgender peers (65%) but had higher rates of nurse office visits in the past month (41% and 26%, respectively). Teens who avoid checkups may fear being misunderstood, according to the study.

“These barriers contribute to delays in seeking services, which may result in poorer health outcomes,” authors wrote.

While previous studies have considered gender as simply male or female, researchers said adolescents don’t necessarily identify as strictly one or the other. Given a range of five options as to how masculine or feminine they are perceived, the highest percentages — 29% of those assigned male at birth and 41% of those assigned female at birth — considered themselves equally feminine and masculine.

The study found the teens experienced lower rates of physical and long-term mental health issues when their perceived gender expression more closely matched the sex they were assigned at birth, authors said.

“Although youth who are TGNC generally appear healthy and many are using health care services, continued research and advocacy are needed to decrease barriers to care and improve health outcomes for these young people, particularly those whose perceived gender expressions transgress societal expectations,” they wrote.

In a related commentary,Daniel Shumer, M.D., M.P.H., noted the high rates of students identifying as TGNC and those who consider themselves equally masculine and feminine. He stressed the importance of understanding the way gender identity is changing.

“Rider et al were able to do what reasonable adults should do when confronted with something new and difficult to understand: they asked the children themselves,” Dr. Shumer wrote. “Continued work to build understanding of how youth understand and express gender is a critical step toward reducing health disparities in this important and valued population.”

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