New Guidelines Call For Pediatricians To Support Transgender & Non-Binary Kids
Kelly Gonsalves is a sex educator, relationship coach, and journalist. She received her journalism degree from Northwestern University, and her writings on sex, relationships, identity, and wellness have appeared at The Cut, Vice, Teen Vogue, Cosmopolitan, and elsewhere.
Growing up with a gender identity that doesn't fit neatly into the two binary categories that our society organizes around—that is, man or woman—can be a confusing, alienating, and even distressing experience. Many transgender and non-binary children don't have similar peers they can relate to or even similar adults they can learn from and go to for guidance in understanding and exploring their gender identity. The lack of open dialogue and accessible information about gender diversity can not only make these kids feel incredibly alone—it can also leave them vulnerable to mental and physical health challenges.
A new set of pediatric guidelines aims to tackle this dearth of adequate social support. The American Academy of Pediatrics this month released a policy statement urging health professionals to offer trans and non-binary children the resources they need to maintain their well-being. The policy calls on pediatricians to provide nonjudgmental, gender-affirmative care oriented around understanding and supporting children as they explore and actualize their gender identity, whatever it might be. Specifically, the policy sets guidelines for health care providers to treat trans and non-binary youth with sensitivity and respect, offers a glossary of terms related to gender inclusivity, and recommends medical treatment options for affirming one's gender, all backed with scientific facts and research.
"The biggest reason for doing a lot of this work is to try to prevent some of the traditional horrible outcomes that transgender or gender-nonconforming youth have ended up with," said Dr. John Steever, an Icahn School of Medicine at Mount Sinai pediatrics professor who specializes in adolescent medicine, to the New York Times. "We know that many of these people, if unsupported, have grown up and dealt with depression, suicidal ideation and attempts, substance use and abuse, STDs, including high rates of HIV in transgender women, domestic violence, physical abuse, and discrimination—the work we're trying to do here is to prevent some of those outcomes."
The AAP cites research that suggests about 0.6 percent of American adults identify as transgender or non-binary. That doesn't sound like a lot, but it actually represents about 1.4 million people. The data around trans and non-binary youth in particular is extremely lacking, the AAP notes, but some estimates say there are likely about 150,000 trans kids between 13 to 17 years old. And those are just the teenagers and just the ones who are transgender, specifically. Meanwhile, children who later identify as transgender or non-binary say they knew their gender was different from as young as 8 years old.
Gender-affirmative care, which is the model the AAP recommends for treating these kids, treats even a very young child's gender-diverse assertions as valid rather than waiting for some arbitrary age when they're deemed "old enough to know."
"Research substantiates that children who are prepubertal and assert an identity of [being transgender or gender-diverse] know their gender as clearly and as consistently as their developmentally equivalent peers who identify as cisgender and benefit from the same level of social acceptance," the statement reads. "Rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family."
One in four trans adults avoided a needed doctor's visit because they were worried about being mistreated, the statement notes, and so the goal is to avoid the same patterns from repeating among the next generation.
The guidelines also discuss the possibility of using hormones to block puberty for children under 16 years of age if they wish to explore their gender identity before they develop any secondary sex characteristics, such as breasts or facial hair. It also outlines steps for gender affirmation that a family and their doctors can help their child navigate if they desire, including means for social, legal, medical, and surgical affirmation.
In many ways, this new policy statement is pretty bold. It encourages pediatricians to take up an active role in destigmatizing gender variance, urges medical schools to integrate gender-inclusive teachings into its programs, calls on insurance plans to cover gender-affirming treatment, and asks the federal government to devote more resources to researching this population's needs. It's an important step forward for America's transgender and non-binary youth, finally legitimizing their unique health concerns and institutionalizing a protocol of support, care, and advocacy from the health professionals who serve them.
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