Family Environment Associated With Age at Which Youth Present to Gender-affirming Medical Care: Study

Youth experiencing gender dysphoria often experience distress associated with the discrepancy between their sex assigned at birth and gender identity. These youth can have high rates of mental health issues, yet many present to gender-affirming medical care later in adolescence and puberty. A Canadian study from The Hospital for Sick Children (SickKids) found that several factors related to family environment were associated with the age at which youth presented to gender-affirming medical care. The study, “Factors Associated with Age of Presentation to Gender-Affirming Medical Care,” published in the April 2021 Pediatrics (published online March 15) found that youth who were older when they presented to care (age 15 or older) recognized gender incongruence at older ages than did adolescents who presented at younger ages (under age 15). In general, youth recognized this incongruence long before it became apparent to their caregivers. Fewer older than younger youth reported having caregivers who helped them access gender-affirming medical care, as well as fewer having LGBTQ+ family members.  Older youth and caregivers of older youth were more likely to report that their family identified with a specific religion and to view family religion as a reason for waiting to come out, compared to younger-presenting youth and their caregivers. The findings suggest that family environment appears to be a key determinant of transgender identity formation and recognition, affecting when youth present to gender-affirming medical care. The timing of receiving gender-affirming medical care is relevant when considering the use of hormone blockers, as they are most effective in preventing unwanted physical changes when initiated before puberty is complete.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.