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  • Thursday, February 2, 2017

    February 04, 2017 8:52 AM - February 04, 2017 9:05 AM


    • Melinda Pierce, MD MCR ;
    • Amy Penkin, MSW LCSW ;
    • Craigan Usher, MD ;
    • Naomi Fishman, MD ;
    • Kara Connelly, MD

    Society is increasingly recognizing the importance of multidisciplinary care to serve the needs of transgender and gender-nonconforming (TGNC) youth. The number of TGNC seeking gender-affirming medical care has risen dramatically over the past several years. There are estimated to be between 34-65 organized gender clinics in North America. National and international guidelines stress the importance of mental health providers (MHP) in the initial evaluation and follow-up. However, these guidelines do not offer guidance on the best methods for incorporating MHPs into the clinic. We sought to learn: 1) whether and how clinics are providing multidisciplinary, gender affirming care to children, adolescents, and families and; 2) if and how clinics are providing mental health support.

    Materials and Methods:

    A secure, structured survey was distributed via email to providers on the Pediatric and Adolescent Transgender Heath list-serve and those participating in the Pediatric Endocrine Society Transgender Special Interest Group. Programs serving TGNC youth (<18 years old) were eligible to participate. Questions focused on the composition, organization, and funding of the clinic, clinical practices regarding formal mental health evaluation, and interdisciplinary services provided.


    Thirty-four eligible providers participated in the survey, and 29 completed the survey. Responses from the 5 who did not complete the survey were included where available. Eighty percent of respondents were physicians who coordinate their program, though most had less than 20% of their time assigned to the program. Forty-six percent of programs receive no formal funding to support clinical efforts; the remainder receive funding from national and local grants, or their associated hospitals or universities. More than 75% of programs require that all patients access mental health services with an assessment to determine readiness for medical interventions, yet only about half of programs have a MHP embedded in their clinic. Programs with MHPs rely most heavily on social workers or masters level MHPs (16/17 clinics), though 12/16 had either a psychologist or psychiatrist also in the clinic. Amongst those that do not require the readiness assessment, in over half of the cases this was directly related to a lack of mental health resources in the community. Of those who did not have a MHP in clinic, 90% required an evaluation by an MHP in the community.


    We estimate a near 50% response rate to our survey of organized clinics providing gender-affirming care to youth in North America. We found that access to adequate, trained mental health professionals remains a significant barrier in the provision of patient-centered multidisciplinary care for transgender/gender-nonconforming youth. Many clinics also struggle with adequate funding and time allotment for providers.

    Category: Standards of Care