Does Age Matter? Mental Health Implications and Determinants of When Youth Present to a Gender Clinic

Background: Gender-affirming medical care (GAMC) improves the psychological functioning of transgender adolescents and adults. Purpose: 1) To assess the relationship between age at presentation to GAMC and rates of mental health comorbidities. 2) To identify factors influencing when youth present to GAMC. 3) To determine whether older presenting youth face more barriers to care. Methods: 1) Cross-sectional chart review of new patients to a gender clinic. 2) Sequential exploratory mixed methods study involving semi-structured interviews and subsequent questionnaire design and distribution. Results: Older age at presentation was associated with psychoactive medication use. Late pubertal stage was associated with depressive and anxiety disorders. Younger presenting youth recognized gender incongruence earlier and were more likely to have LGBTQ+ family members. More older presenting youth endorsed familial religious affiliations. Conclusions: Later presentation to GAMC is associated with higher rates of mental health comorbidities and may be driven by later recognition of gender incongruence.M.Sc