Care pathways at an Australian public pediatric gender clinic

Background: Families seeking gender-affirming treatment have described the importance of information regarding service procedure and expectations of treatment timelines. Currently, accurate and transparent information regarding pediatric gender service processes is limited.Aims The aim of this study is to explore the care pathways of youth seeking gender-affirming medical care in Western Australia. We sought to understand how families “move through” the service from referral to service exit. We map each patient’s path between these two points including any assessment for or commencement of gender-affirming medical treatment. Additionally, we explored the timeline of each care pathway.Methods This study reports the secondary examination of retrospective administrative data (referrals and treatment records 2015–2020) to determine patient care pathways of patients at the Child and Adolescent Health Service Perth Children’s Hospital Gender Diversity Service (GDS).Results 228 patients comprise the final subset of referrals aged >18 years at audit date, whose pathway through the pediatric service could be definitively determined. The findings illustrate individualized care pathways and timing. Most referrals were from general practitioners and the majority of service exits involved referral on to adult services or discharge back to referring doctor. Approximately one-third of patients commenced any medical gender-affirming treatment while attending the service.Discussion Despite referral increases, even the highest annual referral rate constitutes a tiny proportion of Western Australian youth (0.049%). The findings regarding service access also point to a profound need for dedicated services to provide care for trans young people aged 16–18 and their families in Western Australia. This information may inform service provision and assist with family understanding of gender-affirming medical care pathways.