Innovative NIH-funded project promises to expand care for gender-diverse youth

a map of the united states with the southeast covered in a pink, white, and blue transgender flag
(Image: AdobeStock/Illustration: Fawn Gracey, Boston Children's)

Transgender and gender-diverse young people have historically high rates of suicidal ideation: According to some estimates, more than half of gender-diverse youth will contemplate suicide in their lifetime. This risk is even higher in Black and Latinx trans youth, who experience both gender- and race-based discrimination, stigma, and stress.

Research has shown that trans youth who feel supported in their gender identities have mental health similar to that of their cisgender peers. Likewise, gender-affirming health care has been found to improve mental health in trans young people.

Yet many gender-diverse children, teens, and young adults lack access to this life-changing care. While some states have enacted anti-trans legislation aimed at banning trans-affirming care outright or otherwise curbing trans rights, others are care deserts — areas with limited access to gender-affirming care.

The desire to improve that access inspired Rena Xu, MD, a pediatric urology fellow in the Department of Urology at Boston Children’s Hospital, and her colleagues to pursue a grant from the National Institutes of Health (NIH). The organization’s Transformative Research to Address Health Disparities and Advance Health Equity Initiative helps fund innovative translational research projects meant to improve health equity.   

“The NIH’s motivation to reduce health disparities really resonated with me, both personally as a racial minority and professionally as someone who provides health care to gender-diverse patients,” says Xu. “The topic has never been timelier.”

Spreading expertise to providers

Boston Children’s urologist-in-chief, Carlos Estrada Jr., MD, and Xu worked with colleagues from across Harvard Medical School — namely, epidemiologist Sari Reisner, ScD, from Brigham and Women’s Hospital, social worker Elizabeth Boskey and plastic surgeon Oren Ganor, MD, of Boston Children’s Center for Gender Surgery, and endocrinologist Jessica Kremen, MD, of Boston Children’s Gender Multispecialty Service — to create an application for the innovative project.

In mid-October, they learned that they had received the five-year grant.

The team’s funded project takes a two-pronged approach to addressing disparities in five Southeastern U.S. states with large populations of Black gender-diverse youth: Alabama, Florida, Georgia, Louisiana, and Mississippi. “We want to both increase the number of trained providers in these areas and provide trans youth and their caregivers with support,” explains Boskey.

To that end, the team plans to develop in-depth programming — to be offered as CME credits — aimed at deepening primary care providers’ understanding of gender-diverse care. “We will be providing a platform for training clinicians, as well as a repository of information related to care of transgender youth that will be continually updated with clinical practice changes,” says Kremen. Participating providers will also have access to a peer consultation pathway, connecting them with world-class colleagues at Boston Children’s for insight on challenging cases. “The goal is to keep clinicians up to date, engaged, and aware of existing resources,” she says. “We want to foster a sense of community in areas that might be lacking that.”

An innovative approach

Education and community also play important roles in the second aspect of the project. “When kids come out to their family, they can face a lot of questioning, even from supportive parents,” says Boskey. “We hope to create a digital platform that will allow gender-diverse youth and their caregivers a feeling of community and support.”

Both aspects of the project will rely heavily on educational simulations, to be created in collaboration with Boston Children’s Simulator Program. These include culturally sensitive simulation-based immersive videos — featuring gender-diverse Black and Latinx actors — that are tailored to patients’ unique needs. Educational simulations geared toward youth and caregivers will help to strengthen their communication and mutual insight, while simulations for providers will equip them with the language, knowledge, and skills to provide gender-affirming care. The team plans to assess the effectiveness of the platform in a randomized controlled trial.

“We are so thankful for this opportunity,” says Estrada, who will serve as the study’s corresponding principal investigator. “We have assembled a team of passionate and committed experts and we expect our projects to make a very significant impact.”

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