Availability of Protocols Supporting Transgender and Gender-Expansive Patients: Results From a National Survey of...

Publicly supported clinics providing contraceptive care serve millions of people each year, and their patient populations include large proportions of uninsured, low-income, and young people. They are uniquely situated to incorporate transgender-inclusive services, although data are lacking on the availability of this care.

This study aimed to describe the extent to which publicly supported clinics offering contraceptive care follow protocols supportive of transgender patients overall, by clinic type, and by state policy regarding youth gender-affirming care.

Using a national sample of publicly supported contraceptive-providing clinics in the United States, we conducted a cross-sectional survey from November 2022 through December 2023 that included measures of service provision for transgender patients. We used descriptive statistics to summarize sample characteristics, provision of gender-affirming hormone therapy, and use of transgender-inclusive protocols. We used χ² tests and logistic regression to assess how these protocols differ by clinic type and state policy.

Among our analytic sample of 446 clinics, a quarter reported offering gender-affirming hormone therapy. A high proportion of Planned Parenthood clinics reported adhering to transgender-inclusive protocols compared with other clinic types, and higher proportions of clinics in states where youth gender-affirming care is allowed reported following such protocols than in clinics located in states with bans.

Many publicly supported clinics providing contraceptive services have adopted protocols supportive of transgender patients, although this masks significant variation by clinic type. Planned Parenthood clinics report widespread availability of transgender-inclusive services, whereas health department clinics report low availability. Furthermore, our findings suggest that bans on youth access to gender-affirming care may limit the availability of transgender-inclusive care for patients of all ages.