Practical Tips for Clinicians to Support Transgender and Gender-Diverse YouthPractical Tips for Clinicians to Support Transgender and Gender-Diverse Youth https://pediatricsnationwide.org/wp-content/uploads/2021/03/062719ds7057-1024x683.jpg 1024 683 Katie Brind'Amour, PhD, MS, CHES Katie Brind'Amour, PhD, MS, CHES https://pediatricsnationwide.org/wp-content/uploads/2021/03/Katie-B-portrait.gif
- September 28, 2021
- Katie Brind'Amour, PhD, MS, CHES
Experts share advice for family medicine and other practitioners hoping to learn more about supporting transgender and gender-diverse patients.
Although gender identity-related health topics have made it into mainstream media in recent months, their lack of discussion in many clinician education programs has left some medical and mental health professionals unsure how to identify, interact with and properly manage or refer pediatric patients with gender identity-related medical and behavioral health needs. To help address this issue, Michael Patrick, Jr., MD, emergency medical physician at Nationwide Children’s Hospital and host of the PediaCast and PediaCast CME series of podcasts, recently hosted a continuing medical education (CME) podcast on the subject.
“Gender identity is one’s personal sense of self as a particular gender, whether that be male, female, or elements of both, and it is distinct from assigned sex at birth,” says Scott Leibowitz, MD, medical director of behavioral health for the THRIVE gender development program at Nationwide Children’s and co-chairperson of the Sexual Orientation Gender Identity Issues Committee for the American Academy of Child and Adolescent Psychiatry. Dr. Leibowitz served as Dr. Patrick’s expert guest during the recent podcast. “We need to practice providing good care to all youngsters and appreciate the fact that gender identity is something we all experience.”
The podcast covers everything from basic definitions of gender-related terms to how physicians can support students through complex, emotionally fraught concerns both at home and at school.
Key takeaways include the following:
- Gender dysphoria, the clinical classification for discomfort that may arise when one’s experienced gender identity and assigned sex at birth differ, appears to have both biological and environmental causes, but the contributing factors differ for everyone.
- TIP: Finding a concrete cause for this is not possible and is often counterproductive. Clinicians should instead focus on trying to address the child’s concerns and support their needs during gender exploration.
- Anxiety, depression and suicidal ideation are more common among gender dysphoric youth.
- TIP: All children should be screened for mental health concerns at appropriate intervals throughout development. Young people with gender identity concerns should be considered for additional attention both related to and independent from their gender-related needs.
- The level of parent and family support can significantly impact the mental and behavioral health of the child.
- TIP: Encouraging open communication between parents and children, as well as a family culture of acceptance and unconditional love, can improve child health. Both parents and children can be referred for counseling (individual and/or joint).
- Puberty-related changes or other gender-related division issues — such as assignment to sports teams or bathrooms based on gender — can cause significant distress for young people exploring their gender identity.
- TIP: Awareness of these emotional triggers among patients can help clinicians identify young people who may be struggling with gender identity matters. Clinicians can work with schools, sports teams and others as appropriate to advance the wellbeing of their patients.
- Multiple treatment options exist on a spectrum of reversibility, from supportive gender gender-affirming therapy to puberty suppression and/or hormones to surgery for some older adolescents. Treatment decisions are based on a patient’s emotional maturity, age, developmental status and numerous other factors.
- TIP: Family practitioners and pediatricians can aid with initial treatment to delay puberty or begin what is called “gender affirmation therapy” in consultation with patients and their families.
“We have to meet parents and families where they are and understand what resources they’ll listen to,” says Dr. Leibowitz. “In addition to major medical groups specialized in these areas, there are appropriate books, faith-based resources, advocacy groups, etc. to help them make sense of these issues. We have also found that hearing from other parents further along the journey is proving to be very helpful for parents and families.”
For clinician support in the management of transgender and gender-diverse young people and their families, clinics such as THRIVE accept referrals and offer a broad spectrum of multidisciplinary services. In addition, medical professional and advocacy organizations (such as the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry) offer further guidance for professional practice.
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