PB1495 - Comfort and Experiences Providing Care to Transgender Youth Among Hematologists in the Midwestern United States

Background: Transgender and gender nonconforming (TG) youth who are at increased risk of thrombosis may be evaluated by a hematologist to discuss thromboprophylaxis prior to starting gender-affirming hormone therapy. However, without guidelines to inform management, it is unknown how hematologists are approaching these patients.

Aims: Among hematologists, characterize comfort with caring for TG youth and experiences recommending and prescribing thromboprophylaxis to such youth.

Methods: From 6/2022-1/2023, we recruited hematologists caring for patients 13-22 years-old and practicing in the Midwestern U.S. for individual semi-structured interviews. Interviews assessed demographics, practice characteristics, comfort caring for TG patients, interventions to improve comfort, and experiences caring for TG patients. Transcripts were analyzed using team-based framework analysis. The study was IRB approved; informed consent was obtained.

Results: Ten hematologists from four academic centers participated. Mean age was 50.1 years (SD7.5). Eight participants identified as white; two were Latino/a. Nine participants had provided care to TG adolescents (13-17 years-old); all ten had provided care to TG young adults (18-22 years-old). Participants reported on average 2.7 (SD3.4) TG adolescents and 2.7 (SD3.0) TG young adults in their practices currently. Hematologists reported variable comfort with elements of caring for TG youth (Table 1). Suggested interventions to improve comfort included education, consultation with colleagues, more data about thrombotic risks, in-clinic interventions (i.e., references for gender-affirming terms), and optimization of electronic medical records (EMRs). Four participants had recommended or prescribed thromboprophylaxis to eight TG youth (Table 2); all of these youth were transgender women. Rivaroxaban was prescribed to six youth and aspirin to one.

Conclusion(s): Although comfort caring for TG youth was variable, hematologists are providing counseling about and prescribing thromboprophylaxis to youth who are starting gender-affirming hormone therapy. Providing in-clinic interventions and optimizing EMRs to identify TG youth may improve clinical care of this population.

Funding: NIH R01HL161153; Cincinnati Children's Hospital Medical Center Gap Funding