. 2025 Mar 17;78(Suppl 2):e20240266. doi: 10.1590/0034-7167-2024-0266

Chart 1. Characterization of included studies (N=08), São Paulo, São Paulo, Brazil. 2023.

Author, year and country	Objective	Design and level of evidence	Results/conclusion
American Academy of Pediatrics, 2013, United States⁽²⁰⁾	Discuss strategies for welcoming transgender children and adolescents in medical offices.	Expert report; Level VII	Experts point to sexual presumption, lack of gender identification, and an unwelcoming environment with structural homophobia as barriers. The manuscript discusses mainly two strategies: approaching transsexuality in a welcoming manner and continuing education for healthcare professionals.
Vance SRJ et al.; 2015; United States⁽²¹⁾	Explore clinical experiences, comfort, professional confidence, and barriers to providing care to transgender youth.	Qualitative study; Level VI	Professionals reported as barriers low knowledge on the subject, interactions marked by judgments and prejudices linked mainly to the low frequency of care for transgender youth, and lack of interconnection in the RAS. The strategies were training, since graduation, which continues in professionals’ work.
Gridley SJ et al.; 2016; United States⁽²²⁾	Understand the barriers that transgender youth and their caregivers face in accessing transgender healthcare.	Qualitative study; Level VI	Young people and their caregivers reported barriers such as the use of registered names, outdated and offensive language used by professionals, hostile interactions, reduced clinical complaints and overvaluation of gender, low professional knowledge, lack of protocols, interconnection between the RAS and low health insurance coverage. The strategies used were questioning gender and pronouns, continuing education, formulation of clinical protocols and respectful and inclusive environments.
Clark BA et al.; 2017; Canada⁽²³⁾	Analyze the issues of access to primary care among transgender adolescents and youth.	Qualitative study; Level VI	Young people indicated that the lack of a welcoming space was a barrier to accessing healthcare services, mainly associated with previous negative experiences, limited healthcare service coverage and the fear that communications would not be confidential. The strategies indicate the future possibility of teleconsultations.
Rider GN et al.; 2019; United States⁽²⁴⁾	Analyze the experiences and attitudes of healthcare professionals about working with transgender youth.	Qualitative study; Level VI	Professionals indicated as barriers fear, mainly, in questioning the social name and pronouns, their low knowledge, hostile interactions, which visualize the performance by colleagues, and lack of interconnection between the RAS. The strategies refer to the desire for professional training, with continuing education offered by healthcare services.
Eisenberg ME et al.; 2019; United States⁽⁸⁾	Describe transgender adolescents’ experiences, concerns, and needs in healthcare settings.	Qualitative study; Level VI	Low professional knowledge was identified as a barrier. As strategies, two main topics were identified in the reports, such as questioning about gender and pronouns, and healthcare professionals’ continuing education. Furthermore, the manuscript indicates the need to focus on health complaints and promote a respectful and inclusive environment.
Acosta W et al.; 2019; United States⁽²⁵⁾	Understand transgender adolescents’ experience in healthcare services.	Qualitative study; Level VI	Adolescents identified as barriers presumption of sexuality, lack of gender identification, repeated use of registered name, low professional knowledge that leads to hostile interactions. Strategies included questioning gender and pronouns in case of unconscious use, apologizing, making an effort to respect, offering space to speak, in a respectful and inclusive environment, and continuing education.
Pontes JC et al.; 2020; Brazil⁽²⁶⁾	Describe and discuss the meanings and concepts attributed by a group of healthcare professionals to the categories of trans “children” and “adolescents” and their relationship with the care practices carried out.	Qualitative study; Level VI	A reduction in transsexuality to transitory stages was observed, with hostile interactions. There is a reduced number of professionals in the multidisciplinary team, and those present tend to downplay complaints and overvalue gender, indicating an unwelcoming environment, with structural homophobia. Strategies were questioning gender identity and the use of pronouns, promoting a space for speech, with a focus on complaints.