Barriers and Facilitators to Accessing and Providing Gender Affirming Hormone Therapy: A Scoping Review

Abstract

Purpose:

Access to gender affirming hormone therapy (GAHT) is associated with improved health outcomes in transgender and gender-expansive (TGE) youth and adults. We conducted a scoping review to examine the present state of knowledge about barriers and facilitators to accessing GAHT among TGE youth and adults, barriers and facilitators to providing GAHT among health care providers, and identify potential directions for future research.

Methods:

Following the Joanna Briggs Institute guidelines for scoping reviews, we searched the PubMed, Embase, CINAHL, and PsycINFO databases and found a total of 1,492 articles published between January 2000 and March 10, 2023. After screening these articles for relevance, we identified 61 articles for inclusion in the final review. We included English language articles that reported data on barriers and facilitators to accessing GAHT among TGE youth or adults, or barriers and facilitators to providing GAHT among clinicians.

Results:

Our findings indicate that TGE people face pervasive barriers to accessing GAHT, including cost and insurance barriers, a lack of GAHT providers, and lengthy assessment processes required to begin hormones. Health care professionals also face barriers to providing care, including insurance impediments, few training opportunities, and a lack of trans-competent providers for patient referrals. “Self-prescribing” of hormones was prevalent among TGE people who had experienced difficulty accessing care. Telemedicine emerged as a facilitator to both accessing and providing care.

Conclusion:

Future research should explore the GAHT experiences of subgroups among the TGE population, including TGE people of color and nonbinary people, as well as investigate potential facilitators to care beyond telemedicine.