Gender Diversity in Pediatric Chronic Orthostatic Intolerance: Mental Health and Quality-of-Life Outcomes

This retrospective medical record review examined the proportion of transgender and gender-diverse (TGD) youth within a multidisciplinary pediatric autonomic dysfunction clinic specializing in chronic orthostatic intolerance, compared quality-of-life (QoL) scores between TGD and cisgender youth, and identified opportunities to improve health equity in nonpharmacological recommendations. Data on gender identity, mental health conditions, and QoL scores, were collected over 2 years. Among 145 youth, 6.9% identified as TGD, a proportion higher than population estimates. Transgender and gender-diverse youth had a significantly lower total QoL, with lower scores in social and emotional domains, and demonstrated higher rates of depression and attention-deficit/hyperactivity disorder; all TGD youth had an anxiety diagnosis. Overall, TGD youth demonstrated more frequent mental health concerns and greater QoL impairments than cisgender peers. Future studies are needed to determine specific mental health needs and if individualized treatment plans or adaptations to standard nonpharmacological recommendations improve outcomes in TGD youth.