Barriers Reported by Nonbinary Adults When Accessing Gender-Affirming Medical Treatments: A Systematic Scoping Literature Review

Like transgender women and men, nonbinary adults (i.e., those who identify outside of the traditional female/male gender binary) may undergo hormone and surgical treatments to physically affirm their gender identities. Yet relatively little is known about whether nonbinary adults report similar or additional barriers to treatment compared to transgender men and women. Thus, the present systematic scoping literature review aimed to examine and synthesise the literature on the barriers nonbinary adults report when accessing gender-affirming medical treatments. Systematic literature searches were conducted on the Google Scholar, Scopus, PubMed, and PsycINFO databases. Additional eligible studies were sourced from Google Scholar search alerts. The latest research we found at the time of writing (October 2023) was published in August 2023. Findings from 45 studies suggest that nonbinary adults report seven major treatment barriers. These include barriers also reported by transgender women and men: the inability to find a qualified health care provider who is accepting of gender diverse identities, long waiting times, expensive costs, a lack of social support from friends, family, or partners, and personal circumstances at the time of accessing treatment. However, nonbinary adults face two additional barriers: pressures to transition to a binary gender identity and a lack of available information on gender-affirming care that specifically caters to nonbinary gender identities. We conclude this review by calling for the need to address these reported treatment barriers so that nonbinary adults can better access gender-affirming health care.