Gender-Affirming Care for Adolescents

Adolescents may seek gender-affirming care for many reasons – to align their gender identity with their physical traits, to support their mental health, or for other personal reasons. Gender-affirming care plays an important role in holistically supporting transgender and nonbinary youth.

Key takeaways:
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    Gender-affirming medical care for adolescents involves a team of providers who support the physical, mental, and social aspects of transgender and nonbinary youth’s gender identity.
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    There are several kinds of gender-affirming medical care, such as puberty blockers, hormone therapy, and surgical interventions.
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    Children know their gender identity in early childhood. Gender-affirming care reduces depression and suicidality in transgender and non-binary youth.

What is gender-affirming medical care?

Gender-affirming medical care is safe and holistic care by a team of providers who support an adolescent’s gender identity through integrating physical, mental, and social services into their medical care.

Who makes up a gender care team?

Primary care provider

As providers who have more frequent contact with patients, they can refer adolescents seeking gender care to a gender clinic. They can also play an important role in providing mental health resources to adolescents.

Medical gender care provider

Sometimes called an Adolescent Medicine doctors, these providers facilitate the medical aspects of gender care such as puberty blockers, gender-affirming hormones, and gender-affirming surgery.

Mental health therapist

Transgender and non-binary youth face discrimination that can be isolating. A gender-affirming therapist can help adolescents, and their families, address anxiety or depression, support an adolescent’s resiliency, and develop skills to deal with gender-based stigma.

Nurses

They can help coordinate care by teaching families how to give hormone injections at home and assist with navigating insurance barriers for prescription coverage and other treatments.

Social workers

Advocates for safe and affirming care, social workers can guide families through processes such as legal name changes on birth certificates, driver’s licenses, and other documents.

What are the medical aspects of gender-based care?

Puberty blockers

Physical changes during puberty can cause significant stress to gender non-conforming adolescents. The medicine that blocks puberty is called a gonadotropin-releasing hormone agonist. Taking this medication stops the body from making hormones that lead to puberty changes. Adolescent Medicine doctors can talk with families about the best time to start a puberty blocker, but it does require an adolescent to be in the early stages of puberty or later. The medicine is given via a monthly or every three-month injection or via an implant that is replaced yearly.

Gender-affirming hormones

Gender-affirming hormones allow an adolescent’s physical body to match their gender identity by changing the level of sex hormones in the body. There is feminizing hormone therapy, such as estrogen and spironolactone, and masculinizing hormone therapy, such as testosterone. These hormones can be taken via a patch, a pill, an injection, or a topical gel. It’s important to have regular blood draws while taking hormones to measure hormone levels in the body.

Gender-affirming surgery

There are different kinds of surgery that can affirm transgender or non-binary adolescents’ gender identity such as top surgery to alter the chest or breast area, bottom surgery to alter the genitals, facial-affirming surgery, or thyroid cartilage surgery to alter Adam’s apple. Some surgeries can be done before 18 years of age while bottom surgery requires an adolescent to be 18 years or older. Adolescent Medicine doctors can refer youth to plastic surgeons to discuss surgical options.

Fertilization preservation

Some gender-affirming care can alter future fertility. Adolescent Medicine providers can counsel adolescents on options for preserving their ability to reproduce before undergoing some gender-affirming care. This includes storing sperm or eggs or freezing testicular or ovarian tissue.

Obstacles to receiving gender-affirming care

Unfortunately, there are barriers for some youth to receive gender-affirming care. Transgender and non-binary youth cite family acceptance as an obstacle to receiving gender-affirming care because parental consent and insurance are required for some care. There is also a safety concern when deciding whether or not to share their identity due to stigma and discrimination within their communities as well as in medical settings.

In the U.S., many states have introduced harmful bills that attempt to restrict healthcare for transgender and non-binary youth. Inadequate access to gender-affirming care has a significant impact on mental health, and it can be difficult for gender-diverse youth to find a therapist. Gender-affirming care is becoming more available, but there are still many obstacles for transgender and nonbinary adolescents to receive care.

When should adolescents seek gender care?

Children have a sense of their gender identity in early childhood. Children who identify as transgender or non-binary before puberty know their gender just as well as cis-gender children of the same developmental age, so they should be taken seriously. Studies show that transgender and non-binary youth who receive gender-affirming care are 60% less likely to experience depression and 73% less likely to be suicidal. Parents can encourage adolescents to talk to their primary care provider about their gender identity when they feel safe and ready to share so that their primary care doctor can refer them to a gender clinic.

Gender-affirming medical care is safe and supportive care from a medical team that involves many different roles, including medical providers, mental health therapists, nurses, and social workers. There are different kinds of gender-affirming care such as puberty blockers, hormone therapy, and surgery. Unfortunately, there are still some barriers for transgender and non-binary youth to receive gender-affirming care. Adolescents seeking gender-affirming care can start by talking with their primary care provider who can refer them to a gender clinic.