Sociodemographics, psychiatric comorbidities, service utilisation, barriers to interventions, regret after interventions, and suicidality among transgender adults: a 6-year review of a gender identity clinic in Hong Kong.

OBJECTIVES: To compare individuals assigned male at birth (AMAB) and assigned female at birth (AFAB) in terms of sociodemographics, psychiatric comorbidities, requests for gender-affirming interventions, service utilisation (waiting times and private versus public care), barriers to gender-affirming interventions, regret after gender-affirming interventions, and death by suicide. METHODS: Medical records of consecutive patients referred to the Gender Identity Clinic for gender-affirming interventions between 1 November 2016 and 31 December 2022 were retrospectively reviewed. RESULTS: In total, 349 AMAB and 260 AFAB were included in the analysis. Although 51.6% of service users had tertiary education or above, the unemployment rate was disproportionately high at 16.4%. Compared with AFAB, AMAB were older at referral and were more likely to be unemployed and have divorced or married. AMAB had higher rates of psychiatric comorbidities than AFAB (31.5% vs 24.2%), particularly autism spectrum disorder and previous suicide attempts. AFAB had a higher rate of requesting gender-affirming surgeries than AMAB (73.4% vs 56.2%). The waiting times for endocrine assessment substantially increased from approximately 105 days in 2017 and earlier to >400 days in 2022, reflecting unmet service demand. Barriers to gender-affirming surgery were primarily related to pending appointments for surgeries. Four AMAB reported regret after feminising genital reconstructive surgery. Two AMAB and one AFAB died by suicide while awaiting service. CONCLUSION: AMAB and AFAB service users differ in sociodemographic characteristics, mental health profiles, and treatment requests. The unmet demand for gender-affirming interventions and prolonged waiting times underscore the need to improve equitable access to medically necessary healthcare, particularly for AMAB.