The Importance of Gender Affirming Care for Transgender and Gender Expansive Youth

Growing up is hard enough. For children and teenagers who are questioning their gender identity, the task of taking on commonly experienced milestones of adolescence like puberty can be even more distressing. 

As healthcare professionals educated in the unique needs of transgender and gender expansive youth advocate for access to gender affirming care, opposing voices question the safety of allowing young people taking social and medical steps toward affirming their gender identity, suggesting that they may come to regret treatments such as puberty-suppressing hormones, or “puberty blockers.” 

But according to Catherine Verriere Sumerwell, ARNP, DNP, of Seattle Children’s Gender Clinic, preventing young people from seeking gender affirming healthcare is more harmful.      

“There have been many studies that have shown a significant improvement in mental health and overall well being [when a child] is supported in their gender identity and has access to gender affirming medical care,” Sumerwell said. 

Additionally, research has shown that quality, evidence-based gender affirmation methods can help transgender and gender expansive youth find their true identity and improve their self-worth.  

Feeling a disconnect between one’s gender identity and the one assigned at birth can result in acute distress, also known as gender dysphoria. 

Children may begin diverging from their gender assigned at birth as young as two or three years old, when they begin to have a concept of gender and are able to use language to explain their feelings, said Caroline Miller in an article for the Child Mind Institute. 

When children and teenagers are not given space to explore their gender identity, there can be negative emotional and mental health outcomes. Research on suicidality disparities has shown that transgender youth are more likely to have suicidal ideation and to make a suicide attempt than their cisgender peers. Additionally, trans and gender expansive youth are also at higher risk for anxiety, depression and other mental health issues, according to a research brief on gender affirming care from the Trevor Project. 

Conversely, the research brief from the Trevor Project has shown that allowing transgender youth to embrace their true gender identity can improve their mental health. Young people who are transgender or gender nonconforming may pursue social transition—in which they begin using a new name, gender pronouns, clothing, hairstyles and other forms of gender expression that match their gender identity—as well as age-appropriate gender affirming medical treatment. 

“As a healthcare provider and LGBTQIA+ advocate, I find that the general public does not truly understand that gender affirmation surgeries, procedures and treatments can be lifesaving for those who suffer from gender dysphoria,” said Vanessa Pomarico, EdD, APRN, FNP-BC, FAANP, lead clinician for diversity and inclusion for Northeast Medical Group.

While not all children who explore their gender identity grow up to identify as transgender, it is important to honor their interests and gender expression, according to The World Professional Association for Transgender Health’s Standards of Care.

“The most important thing you can do is support your child as they are today without any agenda for who they will be or what this journey looks like for them,” Sumerwell said. “Just supporting them and believing in them is the most important thing you can do.”

Researcher Jae M. Sevelius defines gender affirmation as “an interpersonal, interactive process whereby a person receives social recognition and support for their gender identity and expression.” 

Gender affirming healthcare can include therapy to address feelings of gender dysphoria, as well as medical treatments that help individuals achieve physical characteristics that better align with their gender identity.  

There are a variety of paths that an individual can take when seeking gender affirming care. Each person’s needs may vary based on their age, where they are in discovering their gender identity and which aspects of their body cause them gender dysphoria. 

“Not everybody wants hormone [therapy] or surgeries,” Sumerwell said. “Every person’s identity and journey with their identity is different and totally valid.” 

TYPES OF GENDER AFFIRMATION TREATMENT

Social transitioning. Making nonmedical changes that allow an individual to explore their gender identity and begin living as their authentic self. This can include choosing a new name and gender pronouns that align with their gender identity along with wearing clothing and choosing a hairstyle that match their gender expression. 

Puberty-suppressing hormones. Prescribed at the onset of puberty, this medical treatment stops the development of secondary sex characteristics that may cause increased gender dysphoria while giving adolescents more time to explore their gender identity.

Hormone therapy. Taking testosterone (masculinizing) or estrogen (feminizing) to develop secondary post-pubescent sex characteristics that better allign with one’s gender identity. Regimens are personalized to the needs of each person. For example, teenagers receive a lower dose to mimic puberty as it would be experienced at their age. 

Gender affirming surgery. Surgical procedures to alter the physical appearance of an individual to match their gender identity. 

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These nonmedical and medical interventions may be considered for individuals who are transgender or are exploring their gender identity. While certain interventions are suggested based on an individual’s age and stage of development, they are not required as part of receiving gender affirming healthcare. 

9 years old and younger:

• Social Transitioning

10–14 years old:

• Social Transitioning
• Puberty-Suppressing Hormones

15–17 years old:

• Social Transitioning
• Hormone Therapy (note: Parental consent is required)

18+:

• Social Transitioning
• Hormone Therapy 
• Gender Affirming Surgeries

Source: World Professional Association for Transgender Health. (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender-Conforming People [7th version].

There are many things that parents, loved ones and other people in a child’s life can do to support their gender exploration journey. While every child is different, these tips can serve as a good starting point. 

Ways to Support Children Who Are Exploring Their Gender Identity  

Honor their gender identity by using their pronouns and chosen name and allowing them to experiment with their gender expression through clothing and hairstyle choices.   

Correct others who do not respect your child’s gender identity.

Set boundaries with family members who may not be accepting of your child’s identity. 

Avoid “outing” your child by communicating about which  parts of their identity they want to share and which aspects they only want select people to know.

Find a support group for trans and gender expansive youth and their families for guidance in navigating your child’s gender exploration. 

In addition to finding providers who offer gender affirming healthcare services to children and teenagers, identifying inclusive healthcare providers for other needs, such as primary care or mental health, can benefit transgender and gender nonconforming individuals. 

Searching online or reaching out to healthcare providers is a helpful first step to find inclusive care. 

“Parents can simply call the pediatrician’s office or internal medicine office and ask if there are any providers who are well-versed in the care of this population,” Pomarico said.

Parents who participate in family support groups for gender diverse youth may also be able to identify potential providers through word-of-mouth, Sumerwell said. 

According to a parenting resource from Gender Spectrum, parents should look for the following qualities in a healthcare provider: 

To help determine if a healthcare provider is a potential good fit, it’s important to have a conversation before your child visits with them. 

The following example questions can serve as guidance when having these conversations: 

Do you have experience working with young gender expansive or transgender patients? 

What role do you think providers should play in a child’s exploration of gender identity?

Do you think children are too young to determine their gender identity?

I am struggling to understand this myself—how do you meet parents where they are to help them support their child?

World Professional Association for Transgender Health | Find a Provider  
WPATH’s online directory allows users to search for healthcare providers by location and specialty. 

Gender Diversity
This organization aims to bring awareness to gender diversity in children and provides resources for families on how to support their transgender and gender nonconforming loved ones. 

Gender Spectrum
Based out of California, Gender Spectrum provides resources for parents, youth, educators, faith leaders and more on understanding gender and how to support transgender and gender expansive individuals. 

Stand with Trans
Focused on advocacy, this group provides the “tools needed by transgender youth so they will be empowered, supported and validated as they transition to their authentic life.”

TransFamilies 
This organization offers resources for transgender youth and their families, including support groups that meet through video chat or phone conference. 

TransYouth Family Allies (TYFA)
Established by allies of transgender and gender nonconforming children and teenagers, TYFA offers resources for parents, educators, healthcare providers and more. 

Trevor Project
The Trevor Project provides crisis intervention for LGBTQ+ youth to help prevent suicide. In addition to their crisis hotline, the organization’s website provides a variety of resources on gender, sexuality, and how to support the LGBTQ+ community. 

Advocates for Youth – LGBTQ+ Health 
In partnership with young people in the U.S. and across the globe, Advocates for Youth advocate for “sexual health, rights, and justice.” LGBTQ+ health is one of the organization’s areas of focus.  

Please note that this article is for informational purposes only. Individuals should consult their healthcare provider before following any of the information provided.

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