By Linda Carroll

(Reuters Health) – Nearly half of transgender teens and young adults say they sometimes hide their gender identity from healthcare providers, a U.S. study finds.

The survey of more than 200 transgender youth revealed that most shared their gender identity with some doctors, but 46% said they had sometimes avoided disclosure, even when they thought it might be important for their health.

“This was surprising and worrisome,” said study leader Dr. Gina Sequeira of the Children’s Hospital of Pittsburgh at UPMC.

There are times when knowing a person’s gender identity can make a big difference, Sequeira said. “For example, let’s say someone comes into the ER with abdominal pain and they identify and present as male,” she said. “If I assume that person is male and don’t create a space for them to disclose that they have ovaries I may not be able to provide the best medical care.”

In that example, Sequeira explained, the patient’s pain could be coming from a problem with an ovary – and there can be significant health effects if the doctor doesn’t recognize it.

Why wouldn’t a transgender teen or young adult disclose their gender identity? The researchers didn’t ask that question, but they did leave room for survey participants to add comments.

“Young people said they didn’t know how to bring it up,” Sequeira said. “So, it can be a combination of both not having the language to start the conversation and not having a provider open the door for them.” Some worry there could be fallout with disclosure. “Young people I take care of have talked about negative experiences after disclosing their gender identity to a pediatrician or primary care physician, so they were fearful about doing it again,” Sequeira said.

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Sequeira suggests physicians introduce themselves with both their names and also the pronoun they use as a way of opening the door. “I often also ask them to tell me if their gender is something they would like to talk about or have questions about,” she said.

Two survey questions the researchers were particularly interested in were: “Have you ever chosen to tell a health care provider outside of the gender clinic about your gender identity?” and “Have there been times you felt it could be important for your health care provider to know your gender identity but you avoided telling them?”

They found that 78% of the young transgender people had told someone outside the gender clinic about their gender identity, but also that 46% had avoided disclosing their gender identity at some point.

Nearly half, 47%, said they would prefer that the healthcare provider initiate the discussion about gender, while 25% said they would prefer to bring it up themselves.

The findings echo what is found in other areas of healthcare, said Dr. Joshua Safer, executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York City.

“People don’t always volunteer all the information one needs as a medical provider and it’s important to ask,” Safer said. “And if you start going to topics that are more uncomfortable to ask about, such as sexuality and gender identity, it’s only going to be worse.”

One way for physicians to initiate conversation is to include questions, such as preferred pronoun, on the registration sheet, Safer said. “Here, just in December, we finally got pronouns put into the computer system so we could collect that information at registration,” he added.

SOURCE: Journal of Adolescent Health, online February 20, 2020.