Cyclical uncertainty: Healthcare providers and gender affirming care in Central Appalachia

An estimated 1.4-2.3 million transgender and gender nonbinary (TGNB) adults live in the United States. Very few studies have explored TGNB healthcare delivery from the perspectives of primary care providers in the Southeast region broadly, and even fewer have focused on the Central Appalachian region in particular. This project explores the perspectives of providers in the area to better understand the needs of this population.

Healthcare providers in community health organizations within Central Appalachia participated in sixteen in-depth interviews. Researchers performed a qualitative thematic analysis to identify major themes in experiences of providing gender affirming care (GAC) for TGNB in the region.

Data analysis revealed four major themes: 1) practitioners' baseline knowledge of GAC influences their perception of providing care for TGNB patients, 2) practitioners report a lack of certainty in providing care to TGNB patients, 3) practitioners show interest in and recognize the need for educational resources and support in providing GAC, and 4) colleagues and patients are a useful source of knowledge for providing GAC.

Participants held inconsistent definitions for what Gender Affirming Care means, but did not express confusion or uncertainty about the importance of providing GAC as part of primary care. Hesitation to treat was most often associated with a lack of self-confidence in a provider's ability to provide appropriate care to patients. This suggests a misunderstanding or lack of education related to the health needs of this population, and specifically a lack of awareness that providing GAC goes beyond the provision of transition related medicine.