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Gender Health Program Offers Sensitive, Affirming Care

September 18, 2019

Angela Kade Goepferd, MD, FAAP

While nearly 3 percent of Minnesota high school students identify as gender diverse, many of them do not know where to turn when it comes to finding culturally sensitive, gender-affirming care. And despite recent advances in health care, transgender and gender-diverse youth continue to face significant health disparities, including higher rates of harassment, discrimination, homelessness, and suicidality.

As part of Children’s Minnesota’s commitment to provide equitable and inclusive care to all children, we launched the Gender Health Program in April. This personalized and comprehensive pediatric multispecialty clinic provides transgender and gender-diverse children and their families with medical care and support from pediatric experts they can trust, including experts in pediatric gender health, endocrinology, and gynecology.

About the program

Each family that comes to the Gender Health Program will start with a gender consultation with one of our physicians. During this initial consultation, children and their families meet with a gender health expert to discuss developmental questions or concerns about gender identity and develop a personal care plan. Each family comes to the program at a different place and with a different path, so this consultation helps to answer questions, discuss goals, and think about next steps. Often youth—especially teenagers—and their families come to this initial consultation with different questions and goals. Our team is committed to helping understand what each child, parent, and family needs before moving forward. We can often help youth and families understand each other and learn to speak a common language as they navigate future steps on their journey.

One key component for most families is appropriate mental health assessment and referrals as needed. Our program includes a social worker/care navigator who participates in the initial intake assessment for each family to help determine what resources are needed. We can connect parents with resources and support for their questions, and can connect youth with individualized support systems. Our goal is to optimize care and outcomes for each patient, by supporting the mental and physical well-being of the whole child and the whole family.

The onset of puberty can be difficult for many transgender and gender-diverse adolescents, and Children’s offers both pubertal and menstrual suppression. These reversible interventions pause puberty and/or menstruation for patients as necessary. Patients may also meet with a pediatric gynecologist for a consultation to discuss options to preserve fertility prior to beginning pubertal suppression and/or gender-affirming treatment.

For patients who are in middle-to-late adolescence, gender-affirming hormone treatment may be appropriate. This hormone treatment creates changes in the body to align with the patient’s gender identity. The decision to move forward with such treatment is made with one of our gender health experts, along with a readiness assessment by a mental health professional to optimize outcomes—and to gauge the support and obtain the consent of parents.

Gender-affirming surgeries are most often performed for patients who are over the age of 18 and are not done at Children’s Minnesota. While Children’s Gender Health Program does not perform these surgeries, we can refer patients to plastic surgeons in the community as needed.

Tips for primary care physicians

While transgender and gender-diverse children and adolescents may come to the Children’s Gender Health Program for specialized and expert care related to their gender identities, they will continue to receive their primary care (including well-child exams, immunizations, and ill-child visits) through their primary care offices. Primary care clinicians often have questions about how to best provide supportive and affirming care to transgender patients and their families.

Ask each child the name they would like to be called, and the pronoun they use, and be sure to use this name and pronoun at each visit.                       

Educate staff about how to ask each patient what name they would like to be called and what pronoun they use, so that they can do the same; this is especially important for those answering phones, checking in, and rooming patients. It’s also important to remember that we all make mistakes, even when we are trying to do our best. When mistakes happen, we should acknowledge them, apologize, and commit to continuing to get it right in the future.

Often, mistakes in calling a patient the correct name or using the correct pronoun are made due to limitations and barriers of the electronic medical record (EMR). Primary care providers should find out the best way to optimize their EMR system to visibly display the preferred or declared name of each child, as well as the pronoun they use. Being misgendered when seeking medical care is a common fear of transgender and gender-diverse patients and their parents, and anything we can do to ensure a smooth and affirming patient care experience will allow children and families to relax and focus on the medical reason for their visit.

Parents often struggle to know how to best support their kids on top of dealing with their own feelings of grief, anger, disappointment, or fear. Primary care clinicians can affirm to parents that asking questions is OK, and seeking supportive resources is encouraged. Parents often need just as much, if not more, room to ask questions and seek support as they learn more about their child’s identity. Parental rejection is a significant risk factor for poor physical and mental health outcomes for transgender youth, including a significantly increased risk of suicide, so clinicians should always encourage parents to consistently reassure their children that they love them, even when they are struggling to understand their expressed identities. Unconditional parental love is the single biggest protective factor to keep transgender and gender-diverse kids healthy and safe.

Although positive steps have been taken in recent years, transgender and gender-diverse youth are still a medically underserved population, experiencing a variety of health disparities. The Children’s Gender Health Program offers transgender and gender-diverse children and their families a place to go for exclusively pediatric, comprehensive, compassionate medical care when they have questions about their gender. With this program, Children’s continues to strive to be every family’s essential partner, and to ensure that transgender and gender-diverse children can grow up happy, healthy, safe, and strong.

 

About the Author

Angela Kade Goepferd, MD, FAAP, is the medical director of Children’s Minnesota’s Gender Health Program, the director of Medical Education and vice chief of staff for Children’s Minnesota, and a general pediatrician in the Children’s Minneapolis Primary Care clinic. An advocate for advancing equitable health care for all children, Dr. Goepferd works to ensure a positive human experience for patients, families, and professional staff, and has been an engaged member and leader on several committees, strategic planning teams, and other initiatives across the organization.

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