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Transgender and gender nonconforming (TGNC) youth reported poorer overall health than their "cisgender" peers, a new study found.
In the study, appearing in Pediatrics and led by G. Nicole Rider, PhD, of the University of Minnesota in Minneapolis, TGNC youth more often reported their own health as poor, fair, or good, rather than very good or excellent compared with cisgender young people (62.1% versus 33.1%, P<0.001).
"Although research on youth who are transgender and gender nonconforming is in its nascence, studies indicate that adolescents who identify as TGNC versus cisgender experience significant mental health disparities," the researchers wrote. "Vulnerability for poorer health outcomes reveals the importance of access to affordable, competent healthcare services for youth who are TGNC."
Drawing upon data from the Minnesota Study Survey, the researchers included a total of 80,929 students between ninth and 11th grade in the analysis; 2,168 students self-identified as being TGNC. Other self-reported variables measured included health status, which included general and long-term physical and mental health, as well as care utilization, which measures nurse office visits and preventive care visits.
Between the gender identity groups of students, those who identified as being TGNC were more likely to be assigned the female sex at birth and receive a free or reduced-price lunch, and were less likely to be white compared with cisgender peers.
Overall, the health status and care utilization of TGNC youth was significantly worse for all measures assessed compared with cisgender youth.
In addition to more TGNC students reporting having poorer health, a greater percentage also reported a presence of long-term physical disabilities or health problems (25.2% versus 15.2%, P<0.001) and long-term mental health problems (59.3% versus 17.4%, P<0.001). They were also more likely to have stayed home from school due to illness at least once within the prior month (51.5% versus 42.6%, P<0.001).
While at school, a much higher percentage of TGNC youth had visited the nurse's office at least once within the past 30 days (41.2% versus 25.9%, P<0.001).
Regarding preventive health check-ups, cisgender youth were significantly more likely to have medical and dental check-ups within the past year (64.7% versus 60% and 82.0% versus 71.1%, respectively).
In an accompanying commentary, Daniel Shumer, MD, MPH, of the University of Michigan in Ann Arbor, praised the study, writing that the researchers "were able to do what reasonable adults should do when confronted with something new and difficult to understand: they asked the children themselves."
Shumer also pointed out that it was interesting to see how among the TGNC group, the majority of those assigned male at birth and those assigned female at birth perceived their own gender expression as equally feminine and masculine: "This is in stark contrast to the way that current medical guidance has focused almost exclusively on the treatment of transgender people with binary views of gender. Youth are rejecting this binary thinking and are asking adults to keep up."
In the post-hoc analysis broken down by perceived gender expressions -- which included "very feminine," "somewhat feminine," "equally feminine and masculine," "somewhat masculine," and "very masculine" -- the only significant differences seen were in regards to long-term mental health problems.
TGNC youth assigned male at birth who perceived themselves as very masculine reported a significantly lower amount of long-term mental health problems compared with all other perceived gender expressions, the study found. Similarly, those assigned female at birth and perceived themselves as very feminine also reported a lower amount of mental health problems compared with other gender expressions.
"With our results, we suggest that healthcare providers should screen for health risks and identify barriers to care for youth who are TGNC while promoting and bolstering wellness within this community," Rider et al concluded. "Although youth who are TGNC generally appear healthy and many are using healthcare 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."
Click here for the American Association of Clinical Endocrinologists' position statement on healthcare disparities.
The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The authors reported having no conflicts of interest.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
PediatricsSource Reference: Rider GN, et al "Health and care utilization of transgender and gender nonconforming youth: A Population-Based Study" Pediatrics 2018; DOI: 10.1542/peds.2017-1683.
PediatricsSource Reference: Shumer D "Health disparities facing transgender and gender nonconforming youth are not inevitable" Pediatrics 2018; DOI: 10.1542/peds.2017-4079.