LAUSR

The past decade has seen a marked increase in the visibility of transgender and gender diverse (TGD) individuals within Western society. From press coverage of celebrities, such as Caitlyn Jenner, Elliot Page, and Chelsea Manning, to broader representation of fictional TGD characters within the mainstream media, public awareness and understanding of gender diversity have grown substantially. Many of these stories have helped to empower TGD people and to depathologize gender diversity. In our clinical experience, TGD individuals often identify media as a helpful source of information that can facilitate exploration of their identity and act as a trigger to seek assistance from health professionals. Consistent with the latter, we previously observed an association between increased TGD-related media coverage and higher numbers of young people presenting to specialist pediatric gender clinics.1 However, recent years have also seen greater public discussion questioning the rights of TGD individuals to access public spaces (eg, toilets and changerooms) and to participate in certain occupations (eg, the military) and sporting activities, all of which has been echoed and amplified in the press. Similarly, there has been an increase in negative media coverage focused on clinics that specialize in the provision of gender-affirming health care to TGD children and adolescents. These reports have helped to stoke various concerns. For example, some have suggested that the growing number of referrals to such clinics is not owing to greater awareness of gender diversity and empowerment of TGD young people but is instead being driven by other factors such as peer influence,2 while others have warned that the use of gender-affirming hormonal interventions in TGD young people represents an undue risk. The study by Indremo and colleagues3 highlights the potentially pernicious influence of such negative media coverage on TGD children and adolescents. In particular, the authors examined whether referral numbers to specialist pediatric gender clinics across Sweden changed after the airing of a controversial 2019 Swedish television documentary series that highlighted the recent increase in pediatric referral numbers, featured stories of young adults who came to regret the gender-affirming treatment they received as adolescents, and raised concerns about the scientific basis for such treatment. The documentary, which was subsequently criticized for its negative bias, led to widespread debate within the Swedish press and, as Indremo and colleagues3 observed, was associated with a decrease in total referral numbers of children and adolescents by 31% over the subsequent 6 months.3 Although the mechanisms underlying this decrease were not formally explored in their study, the authors reasonably speculated that both parents and referring health professionals may have been less likely to support a child or adolescent’s attendance at a specialist pediatric gender clinic following the documentary.3 In this way, one of the critical outcomes associated with negative media coverage on TGD young people is likely to be reduced access to gender-affirming health care. Such care, which is recommended by leading professional organizations, such as the Endocrine Society4 and the American Academy of Pediatrics,5 is associated with improved mental health in a population that is known to be at high risk of developing mental health problems compared with their cisgender peers.4-6 Therefore, by decreasing the number of young people referred for gender-affirming care, negative media coverage may result in worse mental health among a vulnerable group of society who already face numerous barriers and risks in accessing such care.7 + Related article