Healthcare experiences of LGBTQ+ young people: a qualitative evidence synthesis

Abstract

LGBTQ+ (lesbian, gay, bisexual, trans, queer and other sexual or gender diverse) young people experience marked health disparities, yet structural mechanisms through which healthcare systems produce them have not been systematically examined across LGBTQ+ identities, healthcare contexts, and geographies. This qualitative evidence synthesis (QES) applied three-stage thematic synthesis to 30 qualitative studies (2019–2025) from Australia, the United States, Canada, and Sweden, examining how LGBTQ+ people aged 25 years or younger describe their healthcare experiences. Line-by-line coding by four reviewers was validated through team review and community consultation with LGBTQ+ young people in rural Western Victoria, Australia. Five analytical themes resulted. The ‘precondition tax’ identifies the invisible labour young people perform before care can begin, including assessing provider safety, managing disclosure, and educating clinicians. The ‘lottery of encounter’ shows provider competency is unpredictable in the absence of system-wide LGBTQ+ clinical standards. ‘Compounded erasure’ shows that systems that address only one identity category at a time fail intersectional patients multiplicatively, as each additional marginalised identity narrows the pool of adequate providers. ‘Geography as an amplifier’ reveals that rural location intensifies every preceding mechanism. ‘Communities as counter infrastructure’ documents the parallel system LGBTQ+ young people build for each other through referral, education, accompaniment, crisis support, and identity affirmation, performing functions the formal system has not. Healthcare failure for LGBTQ+ young people is not incidental but structural, patterned, and preventable. The mechanisms are amenable to change through mandatory competency standards, intersectional service design, equitable geographic distribution of specialist services, and institutional accountability. Community infrastructure compensating for these failures should be resourced and protected, not co-opted as a substitute for structural reform. https://doi.org/10.17605/OSF.IO/7S8CZ . CRD420251129560.