05 The experience of youth on the waitlist for gender-affirming care in Manitoba
Authors: Bhatla Jennifer , James Kristin , Lamb Kaylen (Kay) A E , Neault-Lount Chrystal , Protudjer Jennifer L P , Reitmeier Shayne , Cooney Megan , Wicklow Brandy 
Published: October 2024

Abstract

Background
Waitlist times are often two years for youth to be seen for initial assessment for gender-affirming hormone therapy in Manitoba, Canada. It is well known that transgender youth awaiting hormone therapy have high rates of mental health challenges, including depression, anxiety, and suicidal ideation. Accessing care that is affirming and supportive, including primary care and counselling, can also be a challenge.

Objectives
The purpose of this study was to understand the experiences of youth and their caregivers on the waitlist for the Winnipeg, Manitoba-based Gender Diversity Affirmation and Action for Youth (GDAAY) clinic, the provincial transgender health clinic. Specifically, we were interested in what community based resources youth were accessing, mental health impacts, and suggestions for improvements.

Design/Methods
Qualitative, semi-structured interviews were conducted. Youth aged 14-17 years on the waitlist for 12-24 months for gender-affirming hormone therapy assessment and their caregivers were recruited. Separate interviews were conducted for youth and their caregivers. All interviews were virtual, recorded, and transcribed prior to thematic analysis.

Results
Youth (n=8) and caregivers (n=9) described barriers to supported transition. The first theme, “In a Black Hole” describes frustration and disappointment with the lack of regular ongoing communications from GDAAY. It also extends to the mental health challenges faced by youth and caregivers alike. Anxiety and self-harm were consistently described, with caregivers volunteering more information on self-harm and suicidality than youth. Youth described dysphoria and two youth found alternative providers for hormone therapy while on the waitlist. Our second theme, “Structural Transphobia”, describes the attitudinal, technological, physical, and architectural barriers faced by the participants. For example, one caregiver described a hospital admission for suicide attempt during which the hospital bracelet displayed the wrong gender, the wrong name, contributing to frequent mis-gendering. Frustration with the inability to change the name and gender marker in provincial charting systems was similarly of concern. Our final theme, “Manitoba: An Information Desert” describes the systemic barriers faced including lack of knowledgeable providers and reliable information within the province. Youth and caregivers described concerns with identifying primary care and councilors that understood challenges specific to transgender youth.

Conclusion
Although delays in gender-affirming therapy were noted, youth socially transitioned and accessed existing resources. However, mental health concerns persisted and participants felt frustrated and unsupported during their extensive wait times. Improved experiences may be achieved by additional communication from the clinic, hands-on assistance with accessing relevant resources, and an improved online presence.

Potential competing interests
Funding was obtained by a resident research small grant from the University of Manitoba. A similar abstract was submitted to CPEG but it focuses on a new intervention of a phone call from social work when a youth is added to the waitlist.