Walch Abby, Lee Janet Y, Wong Jenise C, Deutsch Madeline, Ehrensaft Diane, Okumura Megumi, Rosenthal Stephen M
Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Transgend Health. 2025 Apr 11;10(2):150-159. doi: 10.1089/trgh.2023.0029. eCollection 2025 Apr.
The purpose of this study was to determine whether clinician comfort differs in the provision of gender-affirming medical care to transgender and gender diverse (TGD) youth with binary versus nonbinary gender identities.
A cross-sectional survey was distributed to three international health professional electronic mailing lists. Comfort providing gonadotropin-releasing hormone agonist (GnRHa) and gender-affirming hormone therapy (GAHT) to nonbinary and binary TGD youth was assessed using 5-point Likert scales and analyzed with Wilcoxon signed-rank tests. Logistic regression modeling comfort providing GnRHa and GAHT to nonbinary compared to binary TGD youth was performed to identify relevant predictors.
Fifty-five respondents completed the survey. Respondents reported more comfort providing both GnRHa therapy and GAHT to binary compared to nonbinary TGD youth. In univariate analyses, being in a pediatric endocrinology specialty and work within a multidisciplinary clinic setting were associated with less comfort providing GAHT to nonbinary compared to binary TGD youth. Non-straight/non-heterosexual sexual orientation, being in a general pediatrics specialty, and higher estimated percentage of nonbinary TGD youth cared for in clinical practice were associated with more comfort. Only nonstraight/nonheterosexual sexual orientation maintained significance after adjusting for potential confounders in multivariate analyses.
Clinicians are less comfortable providing gender-affirming medical care to nonbinary versus binary TGD youth. Efforts to decrease barriers and to inform development of clinical practice guidelines inclusive of nonbinary TGD youth are needed.
本研究旨在确定临床医生在为具有二元性别身份与非二元性别身份的跨性别和性别多样化（TGD）青少年提供性别肯定性医疗服务时，其舒适度是否存在差异。
向三个国际卫生专业人员电子邮件列表分发了一项横断面调查。使用5点李克特量表评估为非二元和二元TGD青少年提供促性腺激素释放激素激动剂（GnRHa）和性别肯定性激素疗法（GAHT）时的舒适度，并采用Wilcoxon符号秩检验进行分析。进行逻辑回归建模，以确定与为非二元TGD青少年相比为二元TGD青少年提供GnRHa和GAHT时舒适度相关的预测因素。
55名受访者完成了调查。与非二元TGD青少年相比，受访者报告为二元TGD青少年提供GnRHa疗法和GAHT时更舒适。在单因素分析中，与为二元TGD青少年相比，从事儿科内分泌专科工作以及在多学科诊所环境中工作与为非二元TGD青少年提供GAHT时舒适度较低相关。非异性恋性取向、从事普通儿科专科工作以及临床实践中照顾的非二元TGD青少年估计比例较高与舒适度较高相关。在多因素分析中调整潜在混杂因素后，只有非异性恋性取向仍具有统计学意义。
与为二元TGD青少年相比，临床医生在为非二元TGD青少年提供性别肯定性医疗服务时舒适度较低。需要努力减少障碍，并为制定包括非二元TGD青少年在内的临床实践指南提供信息。
