Clinicians Report Less Comfort in Provision of Medical Care to Nonbinary Transgender Youth

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.