SUN-129 Mental Health Complexities and Care Access for Transgender and Gender Diverse Youth: A Retrospective Cohort Study

Abstract Disclosure: F. Mbaye: None. D. Shill: None. R. Kasdin: None. M. Neha: None. C.J. Romero: None. R. Fader: None. M. Yau: None. Background: Transgender and gender diverse (TGD) youth seek care to affirm their gender identities and improve their quality of life and mental health. There are high rates of depression, anxiety and suicidal attempts in TGD youth. Simultaneously, there are often delays between the age of onset of gender dysphoria and the age of presentation to pediatric endocrinologists for initiation of gender affirming hormone therapy (GAHT). Prior to the initiation of GAHT, any coexisting psychological or social problems that could interfere with treatment must be addressed. Identifying barriers to gender affirming care for TGD youth is important to the child’s long-term outcome. Objective: We aim to qualitatively analyze the mental health evaluations of transgender and gender diverse youth for trends in psychiatric comorbidities, psychiatric care, and barriers to gender affirming care to inform interventions to address these complexities in gender affirming care. Design/Methods: We conducted a retrospective cohort study of 89 pediatric TGD patients < 22 years of age who initiated gender affirming care at an outpatient urban multidisciplinary clinic between 2020-2023. Eligible patients were identified from the clinic population. Their psychiatric comorbidities were gathered and recorded from the electronic medical record. Mental health intake evaluations were collected and analyzed for themes related to mental wellbeing, psychiatric diagnoses, and barriers to gender affirming care according to a descriptive study methodology. Results: The majority of our patients had at least one mental health concern and 66.7% (42) of the gender diverse patients seeking GAHT at our clinic continue to engage in therapy after their initial mental health evaluation. Moreover, a lack of parental or social support for GAHT was the most common reason given for a delay between gender dysphoria, age of coming out, and presentation to endocrinology for gender affirming hormone therapy. Difficulty navigating the healthcare system and finding supportive providers, especially during the height of the COVID-19 pandemic, also contributed to the delay in presentation for GAHT. Conclusions: Psychiatric comorbidities are common among TGD youth. While GAHT can improve mental health, patients should be encouraged to continue mental health therapy after the initiation of GAHT. Poor parental and social support, along with lack of access to gender affirming care were cited as the most common causes for delay between dysphoria, coming out, and presentation for GAHT. Additional surveys and interviews would allow for more targeted interventions against barriers to care for TGD youth. Presentation: Sunday, July 13, 2025