Moral Distress Among Gender-Affirming Care Providers for Transgender and Gender-Diverse Youth

Current policies and research on gender-affirming care (GAC) for transgender and gender-diverse (TGD) youth often exclude the perspectives of providers who specialize in GAC. This study pays particular attention to moral distress experienced by providers (MD, DO, PA, NP) treating TGD youth in politically and socially challenging environments.

Forty-three semi-constructed interviews with providers of GAC were conducted by the principal investigator with 41 providers answering the question: Do you experience moral distress regarding issues of GAC? The study sample represented states with differing GAC legislation (shield law, legislative ban, and no legislation) to understand how legislative context shapes providers' practices and experiences. The interviews were analyzed thematically using inductive qualitative coding.

Of the 41 participants who responded to the question, 39 answered yes and two answered no. The following key themes emerged: causes of moral distress, emotional responses, ethical dilemmas, and legal and ethical constraints. Subthemes of institutional constraints, frustration, wanting to do more, and legal restrictions highlight primary drivers of provider moral distress.

Providers caring for TGD youth experience high levels of moral distress due to legal and institutional constraints, which may contribute to burnout and workforce instability. The findings highlight the need for institutional protections, legislative advocacy, and mental health resources to support GAC providers. As policies evolve, addressing provider distress is crucial to sustaining the health-care workforce and ensuring equitable health-care access for TGD youth.