Experienced barriers of care within European treatment seeking transgender individuals: A multicenter ENIGI follow-up study

Figures & data

Table 1. Sample characteristics.

	All	The Netherlands	Belgium	Germany
	(n = 307)	(n = 172)	(n = 84)	(n = 51)	Test statistics
Age, M (SD)	36.7 (13.1)	37.5 (13.5)	34.8 (12.3)	37.1 (12.9)	F(2,293) = 1.2, P = .29
Gender identity, n (%)					χ^2(2) = 3.5, P = .18
Trans feminine	166 (54.1)	94 (54.7)	50 (59.5)	22 (43.1)
Trans masculine	141 (45.9)	78 (45.3)	34 (40.5)	29 (56.9)
Marital status, n (%)					χ^2(8) = 6.4, P = .59
Single	169 (55.8)	99 (58.2)	45 (54.2)	25 (50.0)
In a relationship	54 (17.8)	29 (17.1)	13 (15.7)	12 (24.0)
Married	45 (14.9)	23 (13.5)	13 (15.7)	9 (18.0)
Divorced	14 (4.6)	6 (3.5)	7 (8.4)	1 (2.0)
Other	21 (6.9)	13 (7.6)	5 (6.0)	3 (6.)
Education level, n (%)					χ^2(4) = 7.5, P = .11
Basic	22 (7.3)	12 (7.1)	7 (8.4)	3 (6.0)
Secondary	160 (52.8)	85 (50.0)	40 (48.2)	35 (70.0)
Tertiary	121 (39.9)	73 (42.9)	36 (43.4)	12 (24.0)
Income level, n (%)					χ^2(4) = 9.3, P = .06
Below poverty line	60 (19.8)	40 (23.5)	11 (13.3)	9 (18.0)
Around poverty line	72 (23.8)	45 (26.5)	14 (16.9)	13 (26.0)
Above poverty line	171 (56.4)	85 (50.0)	58 (69.9)	28 (56.0)
Employment status, n (%)					χ^2(4) = 21.0, P < .001
Employed	216 (71.8)	104 (61.5)	68 (82.9)	44 (88.0)
Unemployed	82 (27.2)	62 (36.7)	14 (17.1)	6 (12.0)
Other	3 (1.0)	3 (1.8)	–	–
Treatments received trans masculine participants, n (%)					χ^2(8) = 33.3, P < .001
None	–	–	–	–
Hormones only	5 (3.6)	2 (2.6)	1 (2.9)	2 (6.9)
Mastectomy only	2 (1.4)	1 (1.3)	–	1 (3.4)
Hormones and mastectomy	97 (69.3)	62 (80.5)	12 (35.3)	23 (79.3)
Hormones, mastectomy and metoidioplasty	8 (5.7)	3 (3.9)	5 (14.7)	–
Hormones, mastectomy and phalloplasty	28 (20.0)	9 (11.7)	16 (47.1)	3 (10.3)
Treatments received trans feminine participants, n (%)					χ^2(6) = 9.7, P = .14
None	2 (1.2)	1 (1.0)	–	1 (4.5)
Hormones only	35 (21.1)	17 (18.0)	10 (20.0)	8 (36.4)
Hormones and breast augmentation	9 (5.4)	3 (3.2)	5 (10.0)	1 (4.5)
Hormones and vaginoplasty	120 (72.3)	73 (76.8)	35 (70.0)	12 (54.5)
Missing		1 (1.0)
Further treatment wish, n (%)					χ^2(4) = 2.2, P = .70
No	106 (34.5)	61 (35.5)	29 (34.5)	16 (31.4)
Unsure	70 (22.8)	37 (21.5)	23 (27.4)	10 (19.6)
Yes	131 (42.7)	74 (43.0)	32 (38.1)	25 (49.0)
SCL-90R, GSI (follow-up), M (SD)	1.63 (.65)	1.63 (.68)	1.72 (.69)	1.50 (.44)	F(2,285) = 1.99, P = .14

SCL-90R, Symptom Checklist 90-Revised; GSI, Global Scale Index.

Table 2. Experienced barriers to care.

	All	The Netherlands	Belgium	Germany
	(n = 307)	(n = 172)	(n = 84)	(n = 51)	Test statistics
Have you experienced the following barriers during your treatment at our center? (n, %)
My family or friends	88 (28.7)	44 (25.6)	31 (36.9)	13 (25.5)	χ^2(2) = 3.8, P =.15, Cramer’s V = .11
Travel time and costs	85 (27.7)	50 (29.1)	29 (24.5)	6 (11.8)	χ^2(2) = 8.6, P =.01, Cramer’s V = .17
Treatment protocol in general	66 (21.5)	53 (30.8)	6 (7.1)	7 (13.7)	χ^2(2) = 20.9, P < .001, Cramer’s V = .26
Fear of treatment consequences	46 (15.0)	20 (11.6)	21 (25.0)	5 (9.8)	χ^2(2) = 9.2, P = .01, Cramer’s V = .17
My psychiatric or medical condition	44 (14.3)	33 (19.2)	6 (7.1)	5 (9.3)	χ^2(2) = 7.7, P = .02, Cramer’s V = .16
Match gender and/or treatment and protocol	37 (12.1)	27 (15.7)	6 (7.1)	4 (7.8)	χ^2(2) = 4.9, P = .09, Cramer’s V = .13
Referral to care	13 (4.2)	6 (3.5)	3 (3.6)	4 (7.8)	χ^2(2) = 2.0, P = .37, Cramer’s V = .08
Which of the following statements applies to you? (n, %)
I feel like I had to convince my healthcare provider I needed care	107 (34.9)	71 (41.3)	14 (16.7)	22 (43.1)	χ^2(2) = 17.0, P < .001, Cramer’s V = .24
I investigated how to increase my chance of receiving care	71 (23.1)	37 (21.5)	14 (16.7)	20 (39.2)	χ^2(2) = 9.7, P = .01, Cramer’s V = .18
If I would register myself today, I would express my treatment wishes differently	64 (20.8)	37 (21.5)	16 (19.0)	11 (21.6)	χ^2(2) = .23, P = .89, Cramer’s V = .03
If I would sign myself up today, I would express my gender differently	27 (8.8)	16 (9.3)	3 (3.6)	8 (15.7)	χ^2(2) = 5.9, P = .05, Cramer’s V = .14

Table 3. Factors associated with experienced barriers to care, odds ratio (95% CI).

	1	2	3	4	5	6	7	Total no.^a
Constant B (SE)	–2.67	–2.16	–2.54	–.45	–.44	.04	–5.67	1.74
	(.96)	(.69)	(.57)	(1.09)	(1.16)	(1.23)	(1.35)	(.59)
Age	1.03
	(1.01–1.05)*
Gender identity	.47			.47	.44	.37		–.19
	(.25–.89)*			(.22–1.02)	(.19–1.01)	(.15–.91)*		(–3.15)**
Income		.72						–.11
		(.51–1.02)						(–2.00)*
Bottom surgery^b				.33	.33	.38	3.88	–.16
				(.15–.71)**	(.15–.76)**	(.16–.89)*	(.96–14.4)	(–2.58)*
Further treatment wish^c	1.34	1.76	1.36					.15
	(.97–1.86)	(1.26–2.45)**	(.95–1.99)					(2.68)**
SCL-90, FU	1.75	1.71	1.87	1.83	2.56	1.73		.29
	(1.18–2.61)**	(1.14–2.55)**	(1.21–2.91)**	(1.15–2.91)*	(1.61–4.07)***	(1.05–2.84)*		(5.15)***
Country^d
Netherlands vs. Belgium	1.80 (.99–3.29)		.14 (.05–.38)***	3.04 (1.48–6.25)**	.31 (.16–.86)*	.38 (.13–1.08)		–.10 (–1.87)
Netherlands vs. Germany		.31 (.12–.78)**	.42 (.17–.1.01)				3.85 (1.03–14.4)*

1 – Family or friends: χ²(5) = 35.8, R² =.17, P < .001.

2 – Travel time and costs: χ²(4) = 32.6, R² = .16, P < .001.

3 – Treatment protocol (general): χ²(4) = 33.6, R² = .17, P < .001.

4 – Fear of consequences: χ²(4) = 27.2, R² = .16, P < .001.

5 – Psychiatric/medical conditions: χ²(4) = 30.5, R² = .18, P < .001.

6 – Treatment protocol (match gender/requests): χ²(4) = 16.0, R² = .11, P = .003.

7 – Referrals: χ²(2) = 6.2, R² = .07, P = .05.

Total no. – Total number of barriers experienced: F(6,277) = 11.9, R² = .21, P < .001.

^a Linear regression, beta coefficients displayed (t-value).

^b None = 1, Any = 2.

^c No = 1, Unsure = 2, Yes = 3.

^d Netherlands = 0, Belgium/Germany = 1.

CI, Confidence Interval; FU, Follow-up; SCL-90 R, Symptom Checklist- 90 Revised; SE, Standard Error.

* P < .05, **P < .01, ***P < .001.