Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand

• Published in: Journal of public health (Oxford, England) Vol. 45; no. 2; pp. e225 - e233
• Main Authors: Tan, Kyle K H, Byrne, Jack L, Treharne, Gareth J, Veale, Jaimie F
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 14.06.2023
• Subjects: Adolescent; Humans; Male; Mental Health; New Zealand - epidemiology; Original; Social Determinants of Health; Surveys and Questionnaires; Transgender Persons - psychology; New Zealand; gender-affirming hormones; gender-affirming care; mental health; transgender; youth; suicide
• ISSN: 1741-3842; 1741-3850; 1741-3850
• DOI: 10.1093/pubmed/fdac131

Abstract Background Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities. Methods Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14–26 years; n = 608; Mage = 20.5). Results Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02–3.98) of having attempted suicide in the last 12 months. Conclusions Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth.