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Health-related quality of life among transgender and gender expansive youth at a rural gender wellness clinic



To address a critical gap in the existing Health-Related Quality of Life (HRQOL) literature by quantifying and describing HRQOL among transgender and gender expansive (TG/GE) youth at a rural gender clinic and comparing the HRQOL of these youth to age-stratified United States (U.S.) population standards.


This cross-sectional study includes results of the baseline HRQOL assessment of 141 TG/GE patients enrolled in the Gender Wellness Center (GWC) Pediatric Patient Registry. HRQOL was assessed using the Child Health Questionnaire-Child Form 87 (CHQ-CF87; ages < 18) and the Short Form-36 (SF-36v2; ages 18–21). Mean subscale scores were compared to the most current U.S. population standards available.


On all but one of the CHQ-CF87 subscales, TG/GE youth scored significantly lower than 2015–2016 U.S. general population youth and youth with two chronic conditions. On the SF-36v2, TG/GE youth scored significantly higher than 2009 U.S. standards on all physical health domains but lower on all but one of the mental health domains.


Cross-sectional HRQOL data from a registry of TG/GE youth indicate significantly poorer mental health measures as compared with the U.S. general population. Longitudinal assessments are needed to evaluate whether HRQOL improves with gender-affirming care. Future studies should aim to identify sociocultural factors at the intersection of rurality and health that contribute to diminished HRQOL among rural TG/GE youth.

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The authors wish to thank Renate Reeves-Ellington for her generous support of research at the GWC. The authors wish to acknowledge the contributions of the following individuals in the establishment of the GWC Pediatric Patient Registry: Diane Georgeson, MD, Justine Woolner Wise, LMSW, Patti Noon, LMSW, Sierra Meads, RN, and Susan Turell, PhD. The GWC Pediatric Patient Registry database was built in REDCap (Research Electronic Data Capture). The use of REDCap in this publication is supported by the National Institutes of Health/National Center for Research Resources (NIH/NCRR) Colorado CTSI Grant Number UL1RR025780 [42]. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.


This research was supported by a grant from the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program.

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Correspondence to Jane O’Bryan.

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Study procedures were approved by the Mary Imogene Bassett Hospital Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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O’Bryan, J., Scribani, M., Leon, K. et al. Health-related quality of life among transgender and gender expansive youth at a rural gender wellness clinic. Qual Life Res 29, 1597–1607 (2020).

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