"I have been thinking about this for a long time": Navigating gender affirming medical care decisions for trans and nonbinary youth and their families in six countries.

Background: It is frequently reported that access to gender affirming medical care (GAMC) is burdened with many barriers, such as lack of parental support, geographic distance, absence of social support, and medical professionals' lack of knowledge. While the current knowledge shows that trans and nonbinary youth (TNBY) experience many challenges when accessing GAMC, there is still limited information available regarding how they navigate GAMC decisions as youth approach puberty. Methods: To fulfill that gap, a team of researchers conducted semi-structured interviews in six countries (Australia, Canada, India, Switzerland, the UK, and the US) with TNBY ages 8-14 years and their families. Results: Thematic analysis was conducted on baseline interview data from an international longitudinal study, yielding three themes, and subthemes, relevant to making GAMC decisions: (1) Participants' decisions guided by expectations, (2) conditions for reaching an informed decision, and (3) the role of time in GAMC decision-making. Of these themes, several subthemes allowed researchers to understand how families navigate whether to seek GAMC, and if so, deciding on specific care trajectories. Conclusion: Results indicated that making decisions regarding GAMC is a process that moves beyond medical impacts and side-effects, as many family dynamics, access to information and time also played into TNBY's decisions to seek GAMC.