“The worst thing I’ve ever experienced” – comparing experiences of affirmative and non-affirmative healthcare provision for trans adolescents in the UK

Background Within trans youth healthcare two fundamentally different models of care persist, with a significant difference between affirmative and non-affirmative healthcare services. To date there has been limited lived-experience-centred research contrasting child and family perspectives on affirmative and non-affirmative services from those with experience in both approaches.Aims This article examines trans adolescent and family experiences in affirmative and non-affirmative healthcare services in the UK.Methods 20 semi-structured interviews were conducted with parents/carers (14) and adolescents (6) on their experiences in non-affirmative NHS gender clinics and in affirmative NHS primary healthcare and private sector provision in the UK. All interviewees had experienced at least one affirmative provider; 10 parent/carer interviewees and four adolescent interviewees had experienced at least one non-affirmative provider. Data were analyzed through reflexive thematic analysis.Results The research highlighted three significant differences between affirmative and non-affirmative care, related to identity probing, uncomfortable questioning, and asserting power.Discussion This article provides lived experience perspectives on the harms and failings in non-affirmative healthcare provision in NHS children’s gender clinics in the UK. It also provides lived experience insight on the benefits and strengths of affirmative healthcare provision, that were unanimously desired and found beneficial by those interviewed.Implications This article provides insights that should be of interest to those designing and delivering healthcare services. It also provides insights to help potential service users, especially trans children and young people, better understand the challenges, harms, and risks inherent in non-affirmative healthcare.