Healthcare experiences of gender diverse youth: a scoping review of youth and caregiver perspectives

Transgender and gender diverse (TGD) youth experience significant inequities in healthcare access, safety, and quality. Caregivers play a critical role in facilitating access to care; however, they also experience emotional burden and cumulative stress when navigating complex healthcare systems for their children. A comprehensive understanding of both youth and caregiver perspectives is needed to inform more equitable healthcare. To synthesise qualitative evidence on the healthcare experiences of TGD youth from the perspectives of both youth and their caregivers, and provide recommendations for more equitable care based on this evidence. A scoping review was conducted in accordance with PRISMA-ScR guidelines. PsycINFO, CINAHL, PubMed, Scopus, and Google Scholar were searched for primary, peer-reviewed studies including qualitative data published in the past 10 years. Data were analysed using thematic synthesis. Forty-six studies representing 664 youth and 932 caregivers were included. Five themes were generated: (1) limited access to timely, affordable and competent care; (2) fragmented systems and unclear care pathways; (3) balancing in-person and telehealth care; (4) the importance of affirming and patient-centred care; and (5) negotiating care in the context of unequal power and control. Healthcare experiences for TGD youth, as reported by young people and their caregivers, are often complex and challenging. Access to appropriate and safe care depends on supportive caregivers who advocate for their children’s needs, and providers who are accepting and knowledgeable. To improve health equity for TGD youth, four recommendations are offered: enhancing provider education, implementing inclusive clinical practices, adopting a relational model of care, and advancing practitioner-led structural advocacy.