O’Bryan et al.: Quality of Life of Transgender and Gender Expansive Youth

In Health-Related Quality of Life Among Transgender and Gender Expansive Youth at a Rural Gender Wellness Clinic, Jane O’Bryan (Department of OBGYN, Yale Medicine); Melissa Scribani, Nancy Tallman, Anne Gadomski (all three of Bassett Research Institute); Kimberly Leon (Columbia-Bassett Program, Columbia University); and Christopher Wolf-Gould and Carolyn Wolf-Gould (both of The Gender Wellness Center, Oneonta, New York) address the critical gap in the existing literature on health related quality of life (“HRQOL”) among transgender and gender expansive (“TG/GE”) youth. The authors claim this is the first study to evaluate HRQOL among TG/GE youth in a rural clinic setting.

The World Health Organization defines HRQOL as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, values, and concerns.”

The authors employ this definition—broken into 14 different quality-of-life domains—in a study of 141 participants from The Gender Wellness Center in Oneonta, New York. The authors used a questionnaire to quantify and describe HRQOL of rural TG/GE youth and compare the HRQOL of these youth to age-stratified United States population standards. (Rural here is defined as a zip code with a population less than 10,000.)

Of the 14 HRQOL domains, a change in 13 of them was statistically significant. The three that had the highest disparity were emotional functioning, self-esteem, and mental health. The one domain that was not statistically significant was physical functioning. These rural TG/GE youth not only scored significantly lower than the US population standards, but also scored significantly lower when compared to youth with two chronic health conditions.

Although the authors were unable to comment on confounding variables that may be affecting TG/GE youth in the study population (such as barriers to care or conditions of rural life), they argue the results cannot be ignored and that this study highlights the necessity for greater services and research related to mental health treatment in rural communities. The literature on TG/GE youth treatment in rural communities is virtually nonexistent. The authors in particular stress the importance of future logitudinal research (over a prolonged period), whereas this study was only cross-sectional (meaning a sample on a specific day and time).