Behavior & Development • May 01, 2015

What does it mean to be a transgender child?

tiaraI work in adolescent medicine. I’ve seen teens who struggle with secrets and fears, and how keeping those secrets can transform emotional issues into physical maladies, even major diseases.

Months ago, one patient came to me, tortured. She was so miserable and unable to share what was going on. She had lost a significant amount of weight and was extremely depressed; suicidal most of the time. Over the next several months, though, I had the opportunity to walk alongside this individual, link the patient to therapy and support services and help facilitate conversations and validate concerns that allowed this patient to finally identify the core issue: she did not identify herself as a she.  She identified as he.

This issue is nothing new, but the open dialogue is.

Earlier this week, Channel 2 aired a story about a support group for children who are non-gender conforming here in St. Louis. I had my reservations when I first learned the station would attend the group and even interview children, but then the mother who started TransParent years ago helped me realize something important: it’s not only about transgender kids. It’s about all of us changing how we accept gender and gender expression, and how we accept and support one another. So much of that begins with the medical community.

At St. Louis Children’s Hospital, we recently added a question to our standard patient intake form:

“Do you feel your gender identity matches your assigned sex at birth?”

Statistics indicate the suicide rate in the transgender community is roughly 40 percent. Can you imagine looking at your child and thinking, based solely on how that child was born, he or she has hardly better than a 50-50 shot? I don’t like those odds as a parent. As a physician, it’s my responsibility to change them.

Your pediatrician is the first place you’re going to go as a parent if a child is expressing non-gender conforming behaviors. That’s your first resource.  So the onus is on us as healthcare providers to lift the stigma, start a conversation and facilitate medical intervention where appropriate.

If a pubertal  child is truly transgender, it makes a huge difference to receive hormone blockade and cross-hormone treatment in a timely fashion. At St. Louis Children’s Hospital, we offer two methods of intervention:

  1. Hormone blockade is a medication that blocks pubertal development. It stalls the development of the secondary sexual characteristics of biologic gender. For girls, it blocks breast development, blocks female weight distribution, etc. For males, it interrupts androgen, or male hormone, to prevent  facial hair growth, deepening of the voice, development of the Adam’s Apple and face shape change.
  2. Cross-hormone treatment can give biologically male children female hormone, or estrogen, to promote the  development of female characteristics. Biologically female transgender adolescents can be treated with testosterone to develop a more masculine body.

Pubertal blockade is reversible, while cross-hormone treatment may cause irreversible physical changes; neither treatment  is undertaken lightly. Mental health professionals are involved in helping families determine the course of action most appropriate to their situation. Our endocrinologists follow evidence-based, published guidelines on when to treat, what to do and how to go about it. National and international professional organizations have vetted these protocols.

While we follow these studies for how to treat non-gender conforming patients, we are just now beginning to see the results of studies that follow patients we’ve ushered through the process. Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.

None of these children has the advantage of an easy path. But that patient I met several months ago, he’s doing well today. He still has a road ahead of him, but with professionals to walk alongside him and support him as he discovers how he can live a healthy life, his odds are better than 50-50. And I feel privileged to work in a profession and in an institution that has the capacity to meet the needs of all patients – regardless of their race, ethnicity, gender or any other characteristic.