Web-based gender affirming treatment decision aid for youth and caregivers: A pilot study

Transgender and gender diverse (TGD) youth and their caregivers, seeking gender affirming treatment (GAT) such as puberty blockers or hormone therapy, must understand complex medical information to participate in shared decision making. Decision aids are one method to provide treatment-based information and enhance shared decision making. This pilot study aimed to develop and evaluate the effect of a web-based decision aid on GAT in a pediatric gender care clinic. This cross-sectional, pre-, and postintervention design study included treatment-naive TGD youth aged 13-25 years or caregivers ( N = 10). Participants were evaluated for their knowledge, fertility attitudes, decisional conflict, and acceptability of the intervention. All participants had high mean GAT knowledge (7.8 [SD = 1.3] vs. 7.4 [SD = 1.8], p = .509) and low mean decisional conflict (18.1 [SD = 19.9] vs. 10.9 [SD = 12.9], p = .187) scores pre- and postintervention. The decision aid reduced decisional conflict in both youth and caregivers but had no change in knowledge scores. Many youth did not want children (66.7%) but felt it was important to learn about the effects of GAT on future fertility (100%). Most participants (80%) found that the decision aid was helpful for their decision-making process. Future testing is needed to evaluate its usefulness in a larger, more diverse sample.