Grant: Op. Gr. Adv. 2S_LGBTQI+ Heal. Thr. Res. - Advancing 2S/LGBTQI+ Health

Transgender and gender diverse (TGD) youth experience high levels of stigma and discrimination, contributing to significantly poorer health outcomes and an increased risk of suicide compared to the general population. TGD youth also face substantial barriers to healthcare, including limited provider knowledge, discrimination, and a lack of gender-affirming services. Despite these challenges, minimal population-level research exists on the health of TGD youth in Ontario. Most health system data record only sex designation, not self-identified gender identity, making TGD youth largely invisible in research and planning. This study aims to improve understanding of healthcare use and mental health and substance use (MHSU) outcomes among TGD youth (ages 12-24) in Ontario and to identify ways to improve access to affirming care. First, we will develop and validate a new method to identify TGD individuals in Ontario's health administrative data. This will allow us to examine MHSU outcomes and patterns of healthcare use at a population level, including emergency department visits, hospitalizations, and outpatient care, and assess how access to gender-affirming care relates to MHSU outcomes over time. Second, we will conduct interviews with 30 TGD youth, including those in northern and rural communities, to explore experiences accessing gender-affirming care, including perceived barriers, supports, and unmet needs, and how access (or lack of access) has impacted their MHSU outcomes. Youths' lived experiences will help explain and contextualize patterns observed in the health administrative data. By combining population-level health data with the lived experiences of TGD youth, this study will generate evidence to inform health policy and clinical practice. Findings will support the development of more equitable, affirming, and accessible MHSU services for TGD youth in Ontario and beyond.