107. Resources Pediatric Primary Care Providers Need to Provide Gender-Affirming Care to Transgender and Gender Diverse Youth

The provision of gender-affirming care to transgender and gender diverse (TGD) youth primarily occurs in multidisciplinary gender clinics located within large pediatric health systems. Pediatric primary care providers (PCPs) have the opportunity to expand access to this care by expanding its provision into the primary care setting; however, many experience barriers that have inhibited them from providing gender-affirming care. The purpose of this study was to identify specific resources pediatric PCPs view as necessary to support them in providing gender-affirming care to TGD youth in the primary care setting. Pediatric PCPs were recruited via email to participate in hour-long, semi-structured, individual interviews over Zoom. Interviews were conducted until thematic saturation was reached. Interviews were transcribed and analyzed using an inductive thematic analysis framework in Dedoose qualitative analysis software. A total of 15 interviews were conducted with PCPs, all of whom were actively providing pediatric primary care services. A majority of PCPs (80%) indicated they had seen more than five TGD patients, however many (60%) indicated referring five or fewer patients to a gender clinic for care. Seven themes were identified as ways to facilitate the provision of gender-affirming care to TGD youth in the primary care setting, including: (1) consultative support from gender specialists, (2) additional training and education in gender-affirming medications, (3) up-to-date clinical guidelines and protocols, (4) resources to provide to families, (5) assistance navigating the health system with affirming behavioral health providers and insurance challenges, (6) data and support in advocating to health system leadership to initiate gender-affirming care in their institutions, and (7) support in creating affirming environments in their own healthcare setting. In addition, pediatric PCPs elaborated on specific topics they would like to see included in a comprehensive resource guide outlining gender-affirming care provision for youth: sample language to discuss gender identity in well-child checks, resources to provide staff education, ways to create welcoming clinical environments, referral resources for all specialists involved in affirming care provision, algorithms and protocols outlining when and how to initiate or continue prescribing gender-affirming medications, how to determine who should provide consent for gender-affirming medications, and resources to help parents support their child’s gender identity. Our results identify a collection of resources pediatric PCPs seek to provide gender-affirming care to TGD youth in the primary care setting. Development of these resources has the potential to empower pediatric PCPs to have more nuanced conversations with TGD youth and their families about their gender affirmation goals, help them develop more welcoming and supportive environments for TGD youth, and enhance the quality of care provided to TGD youth in the primary care setting. Our study indicates that these resources, guidelines, and protocols may provide pediatric PCPs the necessary tools to overcome the barriers they currently experience in providing gender-affirming care and in turn may increase access to gender-affirming care for TGD youth and their families.