Transgender and nonbinary young people in Oregon still face significant obstacles to accessing proper medical care, according to a new report from Oregon Health and Science University (OHSU).
The report, which is based on a survey of 194 trans and nonbinary people from across the state ranging in age from 13 to 21, found that the majority of respondents had not received any kind of trans-specific medical care. It also found that about a quarter of them have families that are “rarely” or “never” supportive or understanding of their gender identities.
“The trends we saw were as expected, but they were much more significant than we were anticipating,” said Dr. Kara Connelly, the medical director of OHSU’s Doernbecher Children’s Hospital Gender Clinic. “One of the things that was really surprising is that three-quarters of respondents had not accessed any medical care for their transition, and only a quarter of them had.”
Connelly said the report, which was funded by a grant from the Oregon Health Authority (OHA), is likely the first survey of its kind in Oregon—and that the insights gleaned from it will help inform both medical and advocacy work in the state.
“I don’t know that there’s been a survey that’s been as focused on the experiences of trans youth, and focusing on health care priorities, as this one was,” Connelly said. “We were really pleased with how many respondents we were able to get.”
Connelly said there were likely multiple reasons behind only a quarter of respondents accessing transition-related medical care. One of the most common medical options for trans patients under 18 are hormone blockers, or medication trans kids can start taking as adolescents to delay the onset of puberty. Blockers ease the discomfort and stress that can come with developing secondary sex characteristics that don’t align with their gender identity, and make a full medical transition easier when patients get older.
But blockers aren’t consistently covered by health insurance plans—and when they aren’t, they often can be cost-prohibitive for the average Oregon family, Connelly said. And for trans kids living outside of the Portland metro area, finding doctors who are experienced and comfortable providing trans-related health care can be a challenge—even if they have a comprehensive insurance plan. That’s also true for patients looking for mental health professionals outside of Portland.
OHSU’s Transgender Health Program provides many training programs for Oregon doctors, and the Doernbecher Gender Clinic hostst outreach clinics at seven different locations around the state.
“One of the things that we’re trying to explore more is how we can reach those youth who are not in the Portland metro area,” Connelly said, “so youth can access transition-related medical care in their hometowns, without having to travel to Portland to see a specialist for that.”
The top two reasons respondents gave for not accessing medical care were “my parents don’t support it” and “insurance doesn’t cover treatment.” But Connelly added that there’s another reason trans and nonbinary kids in Oregon might not be using transition-related medical services: Some of them might not need or want to medically transition.
“We know that we are seeing more and more youth identifying as nonbinary, who may not be wanting to pursue medical transition,” Connelly said. “So there are a lot of different ways to interpret that statistic.”
The report also offers insight into young trans Oregonians’ everyday lives. The survey included open-ended questions about respondents’ experiences, including one about what they fear the most.
“The overwhelming majority of them responded that what they fear most is physical abuse, murder, and bullying,” Connelly said. “That was really alarming to us, the high number of youth who have to experience those fears in their everyday life.”
Forty-two percent of respondents reported experience abuse, and 40 percent said they had been hit before.
“My life would be much easier if I didn’t have to fear coming out to people,” one anonymous respondent is quoted as saying in the report. “I don’t feel safe swimming shirtless or showing pride.”
Another challenge for trans youth is getting enough physical exercise: 44 percent of respondents said they rarely or never play sports or work out, and more than half of respondents said their physical activities were very or somewhat limited by their physical condition. Trans people who haven’t undergone a medical transition often wear chest binders or bras with inserts to help their appearance align with their gender identity, and those garments can make physical activity uncomfortable or stressful, especially in a group setting.
“When I had to wear a binder constantly, I just couldn’t exercise,” on respondent said.
“I just wear a bra with inserts because I can’t afford the actual surgery,” another respondent said. “They have a problem staying in front so I don’t get enough fitness.”
Exacerbating this problem is the fact that the issue of trans students using school restrooms and locker rooms has become a linchpin in the national culture wars—making something as simple as changing for gym class a traumatic experience for some trans kids.
“If it’s school-based, there may be some discomfort with having to change clothes, and not having adequate facilities where they can change,” Connelly said.
“This is one of the reasons why we are in big support of teenagers being able to access top surgery, or chest masculinization surgery, so they no longer have to bind,” she continued. “We find really significant, positive outcomes in our youth who are able to access top surgery in adolescent years, and then are able to participate in cross-country and track and all the other sports they like to do without having to bind anymore.”
While Oregon legally mandates insurance providers to cover procedures like top surgery, some policies have strict age limits that require a patient to be 18 or older. Connelly called those restrictions “impossible to appeal.”
Connelly said that she and her colleagues will use the survey results to advocate for stronger insurance provisions for trans Oregonians, and will partner with organizations like OHA and Basic Rights Oregon to continue learning more about trans and nonbinary kids’ experiences.
The survey was conducted online, and respondents were found at local Pride events throughout the state and through the Doernbecher Gender Clinic. That means that respondents are part of a self-selecting group, and the survey may have missed teens who aren’t comfortable going to Pride events or talking to their doctors—or anyone—about their gender identities. But Connelly hopes to work with public school districts for another survey in the future, so they can reach even more people.
Eighty-four percent of survey respondents said they imagined a positive future for themselves.
“We’ve seen with this survey and with other studies looking at trans youth that gender diverse youth have the same hopes and dreams as their cisgender peers, but our systems are failing them,” Connelly said. “We’re really passionate about working with state organizations to be able to try to reduce the stressors they’re experiencing in their daily lives.”
