I’m a pediatrician who cares for transgender kids – here’s what you need to know about social support, puberty blockers and other medical options that improve lives of transgender youth
Transgender medicine takes a multidisciplinary approach to helping trans teenagers live happier lives. Sudowoodo / iStock via Getty Images Plus
When Charlie, a 10-year-old boy, came for his first visit, he wasn't looking at me or my colleague. Angry and crying, he insisted that he was cisgender - that he was a boy and had been born male.
A few months before Charlie came into our office, he gave his mother a note with four simple words: "I'm a boy." Up until this point, Charlie had been a woman - the sex assigned to him at birth - although he didn't feel that way inside. Charlie suffered from severe gender dysphoria - a feeling of distress someone feels when their gender identity does not match their assigned gender.
I am a pediatrician and adolescent medicine specialist who has cared for transgender youth for over a decade, using what is known as a gender affirmative approach. In this type of care, medical and mental health providers work side by side to educate patients and families, guide people to social support, address mental health issues, and discuss medical interventions.
Come to the same page
The first thing our team does is make sure our patients and families understand what gender care is. We always start the first visits the same way. “Our goal is to support you and your family on this journey, however that may be for you. My name is Mandy and I am one of the doctors at CATCH - the program for child and youth trans / gender centers for health. I use them / their pronouns. "Sharing pronouns helps transgender people feel seen and validated.
We then ask patients and families to share their gender journey so we can better understand where they are from and where they want to go. Charlie's story is one we hear a lot. A child may not think much about gender until puberty, but they begin to deteriorate when their body changes in ways that feel wrong.
A young transgender woman hugging her mother.
Social transitions with family help
Transgender and gender-sensitive adolescents (those whose gender identity does not match the norms expected of their assigned gender) may face transphobia and discrimination, and have alarmingly higher rates of depression, anxiety, self-harm, and suicide than their cisgender counterparts. One possibility can be the social transition to their identified gender, both at home and in the outside world.
An important first step is to help parents become allies and advocates. Linking parents with individual and group support can help foster education and acceptance, and help families process their own experiences. Charlie's parents had attended a local parenting group to help them better understand gender dysphoria.
Young people are not only accepted at home, but often want to live in the world in their identified gender. This could include changing their name and pronouns, and reaching out to friends and family. It can also include using public spaces like schools and bathrooms, participating in same-sex sports teams and getting dressed or doing other things like tying breasts or hiding male genitals to showcase more in line with their gender identity. While more research needs to be done, studies show that adolescents who are socially changing have a rate of depression similar to that of their peers.
Many young people find that social transition can be an important step in establishing identity. For those still struggling with depression, anxiety, and dealing with social transphobia, it can also be helpful to seek out a therapist who has knowledge and experience with gender identities and gender dysphoria.
However, most young people also need to make physical changes to their bodies to be truly comfortable.
A teenage transgender boy with his mother talking to a doctor.
Gender-affirming medical interventions
When I first met Charlie, he was already socially defunct but still had dysphoria. Charlie, like many people, wanted his physical body to match his gender identity and this can only be achieved through medical intervention - namely puberty blockers, hormonal drugs, or surgery.
For patients like Charlie, who started on women or men in early puberty, hormone blockers are usually the first option. These drugs act like a pause button in physical changes caused by puberty. They are well studied, safe and completely reversible. When a person stops taking hormone blockers, their body goes back to puberty as it did during puberty. Blockers give people time to further research gender and develop social support. Studies show that hormone blockers reduce depression, anxiety, and the risk of suicide in transgender adolescents.
Once a person has started or finished puberty, taking prescribed hormones can help people align their bodies with their gender identity. One of my patients, Zoe, is an 18 year old transgender woman who has already completed male puberty. She takes estrogen and a drug to block the effects of testosterone. Together, these Zoe's bodies help develop breasts, reduce hair growth, and look more feminine in shape overall.
Another patient of mine, Leo, is a 16 year old transgender man who uses testosterone. Testosterone will deepen Leo's voice, help him grow facial hair, and lead to a more masculine body shape. In addition to testosterone, transgender men can use additional short-term medication to stop menstruation. For non-binary people like my 15 year old patient Ty, who is not exclusively male or female, my colleagues and I tailor their treatments to their specific needs.
The health risks from taking hormones are incredibly small - they are not much different from the risks a cisgender person is exposed to from the hormones in their body. Some prescribed hormone effects are partially reversible, others are more permanent, such as: B. the deepening of the voice and the growth of facial hair or breasts. Hormones can also affect fertility. That's why I always make sure that my patients and their families understand the process thoroughly.
The most permanent medical options available are gender-affirming surgery. These surgeries can include changes to the genitals, breast or breasts, and the structure of the face. Surgery is not easily reversible, so my colleagues and I always make sure that patients fully understand this decision. Some people think that gender-affirming surgery goes too far and that minors are too young to make such a big decision. Based on the research available and my own experience, patients who receive these surgeries experience an improvement in their quality of life through a reduction in dysphoria. Patients have told me that gender-affirming surgery “literally saved my life. I was free [from dysphoria]. "
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Ongoing gender care
In March 2021, almost five years after our first visit, Charlie walked into my exam room. When we first met, he was struggling with his gender, anxiety, and depression. This time, he immediately started talking about playing hockey, hanging out with friends, and doing the roll of honor. He's been on hormone blockers for five years and on testosterone for almost a year. With the help of a supportive family and a gender-literate therapist, Charlie is fine now.
Being transgender isn't something that goes away. My patients live with it all their lives. Our multidisciplinary care team continues to see patients like Charlie on a regular basis and often accompanies them into young adulthood.
While more research is needed, a gender-affirming approach and evidence-based medicine enables young transgender people to live in the world as their authentic selves. This improves the quality of life and saves lives, as one of our transgender patients said of his experience with gender-affirming care. "I honestly don't think I would be here if I hadn't been allowed to switch at this point. I'm not always 100%. But I have hope. I'm looking forward to seeing tomorrow and I know that I can meet my dreams will realize. "
This article was republished by The Conversation, a non-profit news site dedicated to sharing ideas from academic experts. It was written by: Mandy Coles, Boston University.
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Mandy Coles does not work for any company or organization that would benefit from this article, does not consult any stocks or companies that would benefit from this article, and has not disclosed any relevant affiliations beyond her academic appointment.
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