Access Barriers Among Transgender and Gender Diverse Youth Seeking Gender-Affirming Care in Canada: A Literature Review
Bibliographic record
Abstract
Introduction: There are increasing numbers of Canadian youth who identify as genders different from their assigned sex at birth. As a result, healthcare providers are encountering more transgender and gender diverse (TGD) youth seeking gender-affirming healthcare. Unfortunately, due to the effects of gender identity-related stigma, as well as distress related to the development of secondary sex characteristics during puberty, TGD youth often have complex medical, psychological, and social needs, and face high levels of social adversity, adverse mental health outcomes, substance use, and suicidal ideation. Research provides increasing evidence that access to gender-affirming care (GAC) is crucial in improving the health and social functioning of TGD youth. Unfortunately, many Canadian TGD youth are unable to access the GAC that they need, due to numerous provider, patient and systemic barriers. Objectives: The purpose of this literature review is to identify the barriers that Canadian TGD youth face when accessing GAC, and to investigate possible solutions that can be implemented within the healthcare system to improve access to GAC for this population. Additionally, this literature review will investigate how Physician Assistants (PAs) may have a role in improving this population’s access to GAC. Methods: A literature search using PubMed and Scopus databases was performed using key terms pertaining to access barriers to gender-affirming care among TGD youth in Canada. Seven articles were found to meet the inclusion criteria and were analyzed in this literature review. Results: Seven studies explored the challenges that TGD youth in Canada experience when accessing gender-affirming care. Six studies investigated potential modifications that may be implemented to improve accessibility of GAC for TGD youth in Canada. No research was found concerning how PAs may assist in the provision of GAC for TGD youth in Canada. Conclusion: The barriers to GAC for TGD youth in Canada identified in this literature review concern delayed access to care, challenges related to systemic health system issues, lack of provider knowledge or sensitivity, and financial constraints. Strategies to improve access to GAC for TGD youth include increasing training and knowledge of all providers in GAC; advocating for policy changes to make GAC more accessible; and requiring staff of medical facilities to undergo gender-sensitivity training.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.025 | 0.037 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".