“What if That’s the Deciding Factor and You Don’t Even Know It?”

Abstract Eligibility criteria for accessing gender care have played an important role in the patient experience. Instances of clinical gatekeeping and patient performativity are well-documented in the literature. In a paediatric setting, young people often feel that they have to prove they are “trans enough” in order to access care. However, it is unclear what exactly young people understand to be required of them in order to access paediatric gender care and the extent to which this understanding impacts how they interact with their clinicians and access care. This paper reports on findings from qualitative semi-structured interviews with fourteen young adults (aged 18–22) who tried to access gender care as minors (under the age of eighteen) in Australia. Interviews explored participants’ paediatric experiences, focusing specifically on how participants understood, and subsequently navigated, the requirements for accessing care. Using reflexive thematic analysis, four overarching themes were identified: 1) requirements are unpredictable, 2) requirements are vague, 3) pressure impacts requirements, and 4) requirements must be navigated. Participants experienced significant uncertainty around what was required of them and how clinical decisions about their care were made, which increased their fears of jeopardizing their care and undermined open communication during the clinical encounter. This research suggests that greater transparency from clinical services and clinicians around eligibility criteria and clinical processes, as well as clinical strategies to foster trust, are needed to improve the process of informed consent and to encourage young people to engage more fully in the therapeutic opportunities available to them when accessing paediatric gender care.