Helping Pediatricians Care for Transgender Children

From The New York Times:

A new statement from the American Academy of Pediatrics tries to guide doctors and dispel myths about growing up with gender identity questions.

By Perri Klass, M.D.
Oct. 15, 2018

We’ve all seen news stories about schools attempting to grapple with gender identity issues in children and adolescents, from name changes to restroom policies. In many cases, educators have found themselves making it up as they go along in trying to serve these children — and so has the medical system.

This month, the American Academy of Pediatrics put out its first policy statement to guide people providing medical care for children and adolescents who are transgender or questioning their gender identity. It arose in part as a direct response to queries from pediatricians, parents and patients, said Dr. Cora Breuner, a professor of pediatrics and adolescent medicine at Seattle Children’s Hospital and the University of Washington, who was one of the authors.

The goal of treatment is “understanding who each individual child is, and supporting them on that journey,” said Dr. Jason Rafferty, a pediatrician and psychiatrist at Thundermist Health Center and Hasbro Children’s Hospital in Rhode Island, who was the lead author on the statement; he spoke of “creating a system where all children feel they have access to supportive and nonjudgmental care.”

Dr. Breuner said that “many times, when there are gender issues, we don’t have a road map.” The statement puts forward a model of “gender-affirmative care,” based in the idea that “variations in gender identity and expression are normal aspects of human diversity,” and that mental health problems in these children arise from stigma and negative experiences, and can be prevented by a supportive family and environment — including health care.

The term “gender diverse” describes those whose gender identity does not match the sex they have been assigned, or the norms that are expected to go with that assignment.

“Gender identity is a brain thing, it’s your sense of whether you’re male or female in your head; it is independent of your body parts, it is independent of who are you attracted to,” said Dr. John Steever, an adolescent medicine specialist and assistant professor of pediatrics at the Icahn School of Medicine at Mount Sinai.

“People can have a sense of being male, female, both, somewhere in between, all of these are normal variations,” he said. “Just because they’re not very common doesn’t mean they’re abnormal, and my job is to help patients and parents understand all this.”

The new A.A.P. statement tries to dispel a variety of myths about growing up with gender identity questions, Dr. Breuner said, such as the idea that parents should assume this is only a passing phase. “And still, colleagues look at me askance, say, ‘Isn’t this something they grow out of, I was taught that in medical school,’” Dr. Breuner said. “So was I. It’s incorrect.”

And these issues sometimes emerge in relatively young children. Children may say that they don’t feel right in their bodies as young as 4 or 5, Dr. Breuner said, or may say more specifically something like, “even though I look like a boy, I feel like I’m a girl.”

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