Barriers and facilitators in gender-affirming hormone therapy: Scoping review of healthcare providers’ and transgender patients’ perspectives

Introduction: Gender-affirming hormone therapy is a critical component of healthcare for transgender individuals. However, barriers in access and provision persist, impacting both patients and healthcare providers. This study aimed to explore the literature on gender-affirming hormone therapy provision from the perspectives of transgender adult patients and healthcare practitioners to identify facilitators and barriers to care. Methods: A scoping review was conducted using the JBI methodology and guided by the PRISMA extension for scoping reviews. A systematic search was performed in PubMed, CINAHL, and Scopus databases. Inclusion criteria focused both healthcare providers’ and transgender adults’ experiences with gender-affirming hormone therapy. The search, conducted on July 23, 2022, and updated on March 1, 2023, identified 12 studies meeting the inclusion criteria for the final analysis. Results: Facilitators for gender-affirming hormone therapy included regular access to primary care providers, multidisciplinary care approaches, and strong patient-provider relationships. Barriers identified were the lack of knowledgeable providers, denial or refusal of care, and inappropriate treatment. Both patients and providers emphasized the need for improved training and competence in transgender healthcare. Conclusion: Significant gaps in provider competence and systemic issues in accessing gender-affirming hormone therapy was identified. Addressing these barriers through targeted education and improved care systems is essential for ensuring affirming, patient-centered care and better health outcomes for transgender adults.