Ethics and youth gender health care : hormone therapy initiation decision-making of transgender youth, parents, and health care providers
Bibliographic record
Abstract
Many transgender (trans) youth require hormone therapy to bring their bodies into alignment with their gender; however, these youth frequently experience barriers to needed health care. Health care providers supporting trans youth encounter challenges of their own, including unresolved ethical dilemmas, a lack of consensus surrounding clinical practices, and a limited body of empirical research. Increased understanding of youth and parent experiences with decision-making around hormone therapy initiation could serve to inform clinical practices, but this topic remains unexamined in the literature. Existing research on trans youth experiences with hormone therapy generally includes youth who are enrolled in gender clinics, without attention to those actively experiencing barriers to care. Therefore, the aim of this study was to explore how trans youth with a broad range of health care experiences, parents of trans youth, and health care providers made decisions around hormone therapy initiation. This constructivist grounded theory study was conducted in British Columbia, Canada. Trans youth (aged 14-18), parents of trans youth, and health care providers offering hormone therapy readiness assessment/care planning services participated in semi-structured interviews. Youth and parents responded to questions and created lifeline drawings detailing their experiences both making and enacting decisions related to hormone therapy initiation. Health care provider interviews focused on ethical dilemmas and decision-making. Three-phase temporal models of decision-making processes were generated based on youth and parent interviews, highlighting common experiences before, during, and after engagement with health care providers. Decision-making processes varied; some decisions were made independently and some were shared. Five conditions necessary for engagement in shared decision-making within youth gender health care emerged, focused on strong relationships, strong communication, role agreement, decision agreement, and time. The Belief-Dilemma-Action Model was developed to illustrate three key constructs relevant to health care provider ethical decision-making processes. Beliefs, dilemmas, and actions were found to interact with one another, influencing the construction and resolution of ethical dilemmas in practice. Key dilemmas identified centered around family conflict, potential harm (e.g., regret), youth capacity to consent to care, and resource scarcity. Recommendations are given for clinical practice, ethical decision-making approaches, health care provider education, and future research.
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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 | 0.014 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.013 | 0.015 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 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".