From “I am Jazz” and the National Geographic’s “Gender Revolution” cover story to Sesame Street’s recent pride message on Twitter, the issue of transgender and gender non-conformity is undoubtedly in the spotlight. Although it is estimated that only 0.4 percent of the population identifies as transgender, this is an issue that every pediatrician should be prepared to encounter in the office.
In many cases, pediatricians will be the first medical provider to be privy to this information. When a patient discloses they are transgender, it is, first and foremost, a privilege. Pediatricians and pediatric health care providers can offer a wealth of support including positive patient engagement with the medical system and the very real chance of providing a life-saving intervention.
The facts: According to the National Center for Transgender Equality 2015 Report, 33 percent of transgender people who saw a health care provider had at least one negative experience including refusal of treatment, verbal harassment and having to teach the provider about transgender.
A majority of transgender kids have been bullied, harassed and mistreated, both in the school and at home. Twenty-three percent of respondents did not seek medical care when needed for fear of being mistreated. Finally, a statistic that has been broadcast time and time again is the 41 percent suicide attempt rate among transgender people.
How do pediatric health care professionals respond when a patient discloses they are gender expansive, non-conforming or transgender, and what can you do to protect your patient from potential negative experiences?
Assume nothing. If a patient discloses they are uncomfortable in their gender, it is important to understand that this does not equal “transgender.” Ask their preferred pronouns, ask what name they would like you to use, and use it. If you slip up, acknowledge, apologize and move on.
Educate front desk staff. This is important and can often make a huge difference. Make a note or flag the chart to alert the staff that this patient may not use their given name or gender.
Recommend a mental health professional. Comorbidities, such as anxiety and depression, are common and need to be addressed. A referral to a mental health professional who is comfortable with gender issues is preferred, but certainly not required.
Offer resources. There are wonderful organizations for parents and children, both on line and “in real life,” listed below.
Call us (617-355-GeMS). We have programs for children and young adults ages 3-25 and are happy to work with you in triaging patients, particularly those who are in the early to mid-stages of puberty.
Despite the statistics, it seems clear that we can, and are, working hard on improving the overall health of our gender non-conforming youth. The body of literature is not large, but studies show that treatment of gender dysphoria at all stages does improve mental health outcomes — this includes even the initial visit to a gender clinic. Additionally, parental support can provide a talisman against poor outcomes later on, which anecdotally we observe all the time.
Learn more about Boston Children’s Disorders of Sex Development (DSD) and Gender Management Service (GeMS).
About our expert: Jeremi Carswell, MD, is the director of Boston Children’s Gender Management Service (GeMS) Program and instructor in Pediatrics at Harvard Medical School.