Date of Award

January 2022

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Christy Olezeski


The proportion of children and adolescents identifying as transgender or gender-expansive (TGE) in the United States is increasing. This work describes two studies on healthcare services and priorities of TGE youth in two pertinent healthcare domains. The first study was a national survey of inpatient pediatric behavioral health facilities on training, policies, and staff comfort related to care for transgender and gender-expansive youth. A majority (52.5%) stated that their facility had mandatory training on working with TGE patients, and the vast majority (86.2%) indicated that their facility had a gender non-discrimination policy. A small portion (12.1%) stated that TGE patients were roomed based on sex assigned at birth. Approximately three-quarters of participants stated that staff at their facility were comfortable discussing gender diversity. Staff comfort did not differ by staff training status or facility location, but staff comfort did correlate with presence of a non-discrimination policy. The second study was an extension of a previous survey on reproductive knowledge and attitudes among TGE patients at the Yale Gender Program. The survey also assessed information sources used and preferred by patients. Over a third (39.1%) stated that it was important to have a child one day, but only 23.2% expressed an interest in biological parenthood. Number of reproductive concerns did not differ by age or treatment status. Half of participants reported having unmet information needs. Online research was the most utilized informational source, while discussion with a doctor was preferred. These surveys indicate room for improvement in provision of inclusive care and informational counseling for TGE youth. Further work must be done to elucidate the healthcare needs and experiences of this marginalized and growing patient population.


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