Primary Care Considerations for Transgender and Gender-Diverse Youth.

Abstract

1. Jason R. Rafferty, MD, MPH, EdM*,†,‡ 2. Abigail A. Donaldson, MD†,‡ 3. Michelle Forcier, MD, MPH†,‡ 1. *Thundermist Health Centers, Woonsocket, RI 2. †Rhode Island Hospital/Hasbro Children’s Hospital, Providence, RI 3. ‡Warren Alpert Medical School of Brown University, Providence, RI * Abbreviations: FDA: : Food and Drug Administration GnRH: : gonadotropin-releasing hormone HEEADSSS: : Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Safety, Suicide, Strengths PPCP: : pediatric primary care provider TGD: : transgender and gender diverse Pediatric primary care providers must recognize that developmentally appropriate, gender-affirming approaches to the care of transgender and gender-diverse youth are necessary to reduce comorbidities, including high rates of suicide. After completing this article, readers should be able to: 1. Describe the developmental context for emerging gender identity in children. 2. Identify ways in which clinicians can explore gender development as a part of routine pediatric care. 3. Recognize that early identification and affirmation of gender identity is essential to engaging supports and promoting positive mental health outcomes. 4. Describe approaches and options for care available to transgender and gender-diverse youth and their families. 5. Recognize the potential medical and mental health disparities and risks faced by this historically marginalized population. Pediatric primary care providers (PPCPs) establish care with patients at birth and manage individuals throughout childhood, adolescence, and young adulthood. Thus, pediatricians are uniquely situated to screen, identify, and care for transgender and gender-diverse (TGD) youth. Large, systematic prevalence studies of TGD identity in children have not been conducted. (1) A 2016 national survey estimated that 0.6% of adults in the United States identify as transgender. This is approximately 1.5 million people and is twice the prevalence found a decade earlier. (2) Estimates suggest that today’s adolescents identify as transgender more often than adults. (1) As children and adolescents become increasingly aware of gender diversity, PPCPs should be attentive to physical and emotional cues that point to gender-related distress. Early identification of potential distress, supported exploration of identity, and affirmation foster healthy growth and development in a particularly vulnerable …