Few topics in pediatrics stir the pots of privacy, personhood, possibility, and politics as does the topic of gender affirming care for minors—though immunizations and various other topics run a close second at times. Today’s newsletter provides some preliminary background on this very complex topic as a prelude to the upcoming AAP-CA3 CME program “Gender Journeys: A Primer for Primary Care” the registration form for which is accessible below.
DEFINITION: Gender-affirming care refers to medical, psychological, and social support provided to individuals who are transgender, non-binary, or gender-diverse.
FAMILY, SOCIAL & SOCIETAL CONCERNS: The multiplicity of societal, cultural, religious, family, peer group, historical and other perspectives that impact dialogues and approaches to the topic can become lightning rods for dissension and conflict. It is hoped that this article and the upcoming virtual CME event will shed more light, than heat on the challenges, potential benefits, and risks of gender affirming care interventions (medical and psychosocial) for all who may be called to address the clinical concern(s).
SOME CLINICAL DATA POINTS:
1) The majority of youth are cisgender in their gender identification and most of these youth and adolescents have stable gender identity throughout their lives
2) Transgender and gender non-conforming youth have variable long-term courses—many maintaining their presenting gender identities, while a substantial number of individuals may have transient periods of gender dysphoria and uncertainty, with later self-identification as cis-gender as adults
3) Transgender, non-binary and gender-diverse individuals face significant social and emotional pressures and are at risk for trauma exposure and the development or the exacerbation of pre-existing behavioral health issues that may need professional attention and supportive care.
LEGAL & PRAGMATIC CONCERNS: Issues of consent (typically from parents/guardians), assent (from affected youth seeking care) are complex. Conflicting views and attitudes can become minefields for all involved—youth, parents, relatives and providers of care. A sensitive, respectful and understanding approach to these factors needs to be at the heart of all gender related medical and psychosocial services. Consensus and a commitment to ongoing dialogue and support are essential considerations for all involved.
References:
1) Olson, Durwood, DeMeules & McLaughlin (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, 137(3)
2) McGuire, Anderson, Toomey, Russell (2010). School Climate for Transgender Youth: A Mixed Method Investigation of Student Experiences and School Responses. Journal of Youth & Adolescence, 39(10), 1175-1188.
3) Perez-Bruner, Day, Russell, Hatzenbuehler (2017). Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings from a Representation, Population-Based Sample of High School Students. Journal of American Academy of Child & Adolescent Psychiatry, 56(9), 739-746.