Affirming Pediatric Care for Transgender and Gender Expansive Youth

Abstract

Transgender and gender diverse children and youth experience significant health disparities and adverse health outcomes. Pediatricians have an opportunity to improve those outcomes by practicing gender-affirming care. This includes creating a welcoming environment through changes in office settings, intake forms, communication skills, language used, and support for families. Clinicians should be comfortable discussing social transition, puberty blockers, and gender-affirming hormone therapy with patients as needed. For clinicians caring for teenagers, adaptations in sexual health counseling and fertility counseling are necessary. Clinicians should also be aware of the trauma that has been historically inflicted by the medical and mental health system against people who identify as transgender/nonbinary, and that significant disparities exist even within this group along racial and gender lines. These aspects of caring for gender diverse youth are part of primary care pediatrics, and further education in these areas will improve access to care and health outcomes for these youth. [ Pediatr Ann . 2021;50(2):e65–e71.]

Breaking the Binary: How Clinicians Can Ensure Everyone Receives High Quality Reproductive Health Services

“…Limited knowledge of sexual and reproductive health concerns among SGM youth contributes to their relative invisibility in the healthcare system; 7 however, there has been increased research interest and evidence on sexual health and fertility among SGM adolescents in recent years. The American Academy of Pediatrics, the Society of Adolescent Health and Medicine, and the Pediatric Endocrine Society support access to developmentally appropriate gender affirming care.…”

“…The American Academy of Pediatrics, the Society of Adolescent Health and Medicine, and the Pediatric Endocrine Society support access to developmentally appropriate gender affirming care. 10 SGM youth often experience gender identity with the same level of certainty as cisgender peers, 7 and gender affirming care ideally begins before the onset of puberty or Tanner stage 2. 11…”

“…Both gender and sexual minority patients often encounter systemic prejudice when interacting with the healthcare system, and experience increased risk for gender-based violence. 7 Gender identity and sexual histories can interact and affect some of the clinical details of sexual and reproductive healthcare. For instance, transgender men may desire counseling on pregnancy risk or options, depending upon sexual practices.…”

Child Maltreatment and the Child Welfare System as Environmental Factors in the International Classification of Functioning

“…Sex at birth, gender identification, and sexual orientation are currently considered in more expansive categories than were evaluated in the MAP study [e.g., transgender, non-binary, gender queer, etc. ( 77 )]. While sex may be a distal category, gender may be better considered as a proximal variable.…”

Beyond the Binary: Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents

“…Specifically, TGE youth are at high risk for sexual abuse and engaging in commercial or survival sex, ( 67 ) increasing the need for appropriate contraceptive counseling and sexually transmitted infection protection. The interpersonal and structural barriers to high-quality healthcare outlined above have led to contraception access issues, including the inability to afford services, lack of clinicians with expertise in gender-affirming therapy, difficulty in securing health insurance, and misconceptions about unintended pregnancy ( 68 ). Health care professionals, and those who care for adolescents, need to be aware of who may require and should receive advice about pregnancy prevention and contraception.…”