title: Mental Health Concerns and Insurance Denials Among Transgender Adolescents.
abstract: Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy.
  
  
  
  An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization.
  
  
  
  Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage.
  
  
  
  Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.
authors.affiliation: 1 Division of Endocrinology, The Research Institute , Nationwide Children's Hospital, Columbus, Ohio.|2 Center for Biobehavioral Health, The Research Institute , Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Leena
authors.initials: L
authors.lastname: Nahata
authors.affiliation: 3 Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa, Florida.|4 Morsani College of Medicine, University of South Florida , Tampa, Florida.
authors.forename: Gwendolyn P
authors.initials: GP
authors.lastname: Quinn
authors.affiliation: 2 Center for Biobehavioral Health, The Research Institute , Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Caltabellotta
authors.affiliation: 5 Harvard Medical School , Boston, Massachusetts.|6 Departments of Endocrinology, Urology and Psychiatry, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Tishelman
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health; D002648:Child; D019548:Crime Victims; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000628:therapy; D008603:Mental Health; D012189:Retrospective Studies; D063106:Transgender Persons / Q000523:psychology
chemical_list: D006728:Hormones
keywords: adolescents; disparities; insurance coverage; mental health; transgender