Transgender Youth's Disclosure of Gender Identity to Providers Outside of Specialized Gender Centers

Abstract

Purpose: Transgender youth face significant health disparities and multiple barriers to receiving quality health care. Gender identity disclosure to health care providers (HCPs) is an important step in creating affirming relationships for transgender youth. The objectives of this study were to (1) determine the prevalence of voluntary disclosure and intentional avoidance to HCPs outside of gender clinics, (2) identify factors associated with voluntary disclosure and intentional avoidance, and (3) elucidate strategies to increase comfort with disclosure.

Methods: A cross-sectional survey was administered to transgender youth aged 12-26 years. Bivariate analyses were conducted using χ² or Fisher's exact tests. Two logistic regression models for each outcome variable were used to examine factors associated with voluntary disclosure and intentional avoidance.

Results: Two thirds (65%) of youth (N = 153) identified as transmasculine, and 57% were under 18 years. Three-quarters (78%) had voluntarily disclosed their gender identity to an HCP outside of gender clinic, whereas 46% had intentionally avoided disclosure. Odds ratios (ORs) of ever having disclosed were lower for participants ≥18 years (OR = .33; 95% confidence interval [CI]: .11-.98), those out to fewer people (OR = .12; 95% CI: .02-.81) and out for <1 year (OR = .03; 95% CI: .004-.31). Odds of intentional avoidance were lower among youth with higher perceived parental support (OR = .83; 95% CI: .70-.98).

Conclusion: A majority of transgender youth reported having voluntarily disclosed their gender identity to an HCP outside of gender clinic, but almost half reported having intentionally avoided disclosure when they felt it was important. Parental support may play a protective role in mitigating avoidance.

Keywords: Gender identity; Intentional avoidance; Transgender youth; Voluntary disclosure.