Primary care providers are often the first place families turn when a child experiences gender identity concerns. Primary care providers can play an important role in providing a safe nonjudgmental environment for patients and families to discuss their concerns, and connecting patients and families to appropriate resources. Providers should first work to educate themselves and their staff about issues affecting GN youth and learn to provide culturally competent care to these youth. Asking youth their preferred names and preferred pronouns (for example, “he/him/his,” “she/her/hers,” “they/them/their,” or something else), documenting this in the medical record, and training clinic staff to use preferred names and pronouns creates an environment that validates, supports, and respects these youth.
It is important to ask all adolescents if they have questions or concerns about their gender identity, in addition to asking questions about sexual identity. It is important when asking these questions to avoid assumptions about an individual’s gender identity based on his or her gender expression. Providers also should familiarize themselves with local referral resources for these youth. As mentioned earlier, GN youth are at high risk for mental health complications including suicide, self-harm, and mood disorders. When referring patients for mental health services, you should be familiar with providers who have expertise in issues of gender identity. A recent report by the Substance Abuse and Mental Health Services Administration states that variations in gender identity are normal, and conversion therapies or other efforts to change gender identity are not effective, are harmful, and are not appropriate therapeutic practices.4
As increasing numbers of youth are identifying as transgender or gender nonconforming, the number of clinics that can coordinate with local providers to provide multidisciplinary care for GN patients is growing.
Resources for health care professionals
• National LGBT Health Education Center, the Fenway Institute. At its website, learning modules, webinars, and other educational resources are available for health care organizations.
• World Professional Association of Transgender Health. This website provides standards of care for transgender patients and a provider directory.
• The Genderbread Person. This website has a helpful infographic illustrating differences between biologic sex, gender identity, gender expression, and sexual orientation, which can be useful for education with patients, families, and trainees.
• Center of Excellence for Transgender Health. This organization works to increase access to comprehensive, effective, and affirming health care services for trans communities.
Resources for patients and families
• The Trevor Project. This website provides crisis intervention and suicide prevention services.
• National Center for Transgender Equality. This advocacy organization works to promote policy change to advance transgender equality.
• Family Acceptance Project. This research, intervention, education, and policy initiative works to prevent health and mental health risks for lesbian, gay, bisexual, and transgender children and youth, including suicide, homelessness, and HIV – in the context of their families, cultures, and faith communities.
References
1. Pediatrics. 2012 Mar;129(3):418-25.
2. Pediatrics. 2014 Dec;134(6):1184-92.
3. When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV, Lambda Legal, 2010. Available at www.lambdalegal.org/health-care-report.
4. Substance Abuse and Mental Health Services Administration. Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth. HHS Publication No. (SMA) 15-4928. October 2015. Available at http://store.samhsa.gov/shin/content//SMA15-4928/SMA15-4928.pdf.
Dr. Chelvakumar is an attending physician in the division of adolescent medicine at Nationwide Children’s Hospital and an assistant professor of clinical pediatrics at the Ohio State University, both in Columbus.