Barriers to Gender‐Affirming Care for Nonbinary People: A Systematic‐Narrative Hybrid Literature Review

Background Nonbinary people can experience more barriers to accessing gender‐affirming care than binary transgender people, with impacts on health equity outcomes for this population. This systematic‐narrative hybrid review identifies and synthesises the barriers experienced by nonbinary people when accessing gender‐affirming care to inform future health promotion with this population. Methods A systematic‐narrative hybrid literature review was conducted in accordance with PRISMA guidelines, adapted for narrative reviews. Searches were performed on APA Psycinfo, EBSCOHost, PubMed, Scopus, Proquest and CINAHL Ultimate databases. The search used keywords related to nonbinary identity, gender‐affirming care, hormone therapy, surgery and experiences of care. Qualitative, quantitative and mixed‐methods studies were included, as well as systematic and scoping reviews. A quality appraisal of the studies was conducted using both MMAT and ROBIS checklist tools. Results Twenty‐seven studies were included. A total of four themes were identified: (1) A foot in the door: Access, (2) Medical gatekeeping, (3) Nowhere, invisible, and (4) The inconvenience of the complexity of gender. Each theme discusses the various barriers to gender‐affirming care that nonbinary people experience. Discussion This review expands understandings of the barriers faced by nonbinary people while accessing gender‐affirming care. The analysis highlights the determinants of health that lead to the unique barriers that nonbinary people experience when accessing gender‐affirming care. Most importantly, this paper provides insights for how to advance health equity outcomes for this population. So What? Identifying the barriers to gender‐affirming care for nonbinary people can inform health promotion strategies that address the health inequities experienced by this population and improve access to care.