Exploring the Relationship Between Gender-Affirming Care Delivery and Health Outcomes in Transgender and Gender-Diverse Adults: An Integrative Review.

Transgender and gender-diverse (TGD) adults experience significant health disparities compared with their cisgender peers. Stigma functions as a fundamental cause of health disparity in TGD communities. Stigma can be tempered by gender-affirming care (GAC), in which TGD adults receive care that validates their gender identity. There is little evidence focusing on outcomes associated with integrated GAC as an approach to care delivery. This integrative review explores the extant evidence on the relationship between integrated GAC and health outcomes in TGD adults in the United States. A comprehensive search of 4 electronic databases was conducted in May 2022. Included studies were peer reviewed, conducted in the United States from 2013 to the present, and described integrated GAC delivery for TGD adults aged 18 and older. After screening 3361 records and reviewing 135 full-text articles, 15 articles were included in this review. Articles were critically appraised, and data extraction and analysis using constant comparison were used to identify themes and relationships across studies. Synthesis suggested that GAC relates to three distinct areas of TGD adult health: physical health, mental health, and health services outcomes. GAC was associated with better overall health and improvements in HIV-related outcomes; significant decreases in mental health symptoms and suicidality; and increases in utilization, engagement, and care retention. There is moderate evidence that GAC delivery is associated with positive health outcomes for TGD adults. This integrative review provides empirical and theoretical support for integrated GAC delivery as an approach to improve health and address stigma-related barriers to care.