Clinician Perspectives on Gender-Affirming Medical Care of Nonbinary Youth

Purpose: The purpose of this study was to investigate the perceptions, challenges, and opportunities in providing care to nonbinary youth from the clinician perspective. Methods: This was a qualitative study investigating views of pediatric and adult primary care and subspecialty clinicians who provide gender-affirming medical care to nonbinary adolescents. Purposeful sampling was used to select and interview clinicians from across the United States from July to November 2022. Data were analyzed using a grounded theoretical approach. Major categories were chosen by consensus from the research team, and a conceptual model regarding the provision of gender-affirming medical care to nonbinary youth was developed. Results: Sixteen clinicians were interviewed to reach saturation. Five main categories were developed: clinical approach, clinician resources, clinician characteristics, nonbinary youth supported in their decision-making and treatment, and society-level factors. An overarching category was acknowledgment and acceptance of gender as nonbinary. The conceptual model incorporates these categories and demonstrates the importance of an embodiment-goal approach in the care of nonbinary adolescent patients. Conclusion: Recognition and acceptance of nonbinary genders are critical in the provision of gender-affirming medical care to nonbinary youth from the clinician perspective. Use of an embodiment-goal approach—goals that focus on how an individual wishes to embody their gender—may facilitate gender-affirming care of nonbinary adolescents delivered by clinicians. Future prospective research studies acknowledging and testing treatment approaches and best practices for nonbinary persons should be incorporated into future standards of care and clinical practice guidelines.