The best action primary care clinicians can take to provide gender-affirming care to adolescents is to ask them directly about gender, authors of a review published online have advised in a Canadian Medical Association Journal special issue focusing on transgender health.
These doctors will see an increasing number of adolescents who identify as transgender and should familiarize themselves with the unique medical and psychological needs of this population, the authors explain.
More adolescents with gender dysphoria are coming forward, emboldened by the growing visibility of transgender identities in popular culture, expansion of gay/straight alliances to include transgender individuals, support groups on social media, and greater tolerance among parents or caregivers, lead review author Herbert “Joey” Bonifacio, MD, MPH, told Medscape Medical News. In studies conducted during the past decade, the rates of adolescents reporting a gender identity different from the one assigned at birth have ranged from 1.2% to 4.1%.
Finding appropriate medical care can be hard for these individuals, Bonifacio, assistant professor of pediatrics, University of Toronto, and general pediatrician and adolescent medicine specialist, Inner City Health Program, St. Michael’s Hospital, Toronto, Ontario, Canada, and colleagues write. Many tertiary paediatric centers across Canada and the United States have opened specialized gender clinics, but demand for services often exceeds capacity. Geographical distance or lack of support from parents or clinicians may present other obstacles.
“For such reasons, improving the quality of care for this population will be dependent on the number of primary care providers and the expertise they bring to help these adolescents and their families,” Bonifacio said.
“Adolescents with gender dysphoria present in different ways. Some may overtly state they are transgender. Others,” he added, “may present to their primary care provider with a mental health issue, such as anxiety or depression, while others may have difficulty in school, et cetera. So the only real way we can understand what the youth is going through is to make sure that we ask these questions and connect them with providers that can give appropriate care.”
Clinicians can support transgender youths and their families by providing guidance on the timing of social transitioning, including changing names and pronouns, clothing, and mannerisms; overseeing medical management, such as hormone administration; and facilitating connections between the patients and their families and local resources, the authors write. Even if patients are waiting for gender assessment, clinicians should manage co-occurring conditions, such as depression or anxiety.
Parents in important decisions whenever possible, Bonifacio said: “Changes in name, pronouns, and dress are often major decisions that parents want to be part of, let alone medications. Balancing the needs of the adolescent and their autonomy in making these decisions and the expectations of parents is often challenging but also very much needed for some families.”
REFERENCE: Bonifacio et al: Management of gender dysphoria in adolescents in primary care; http://www.cmaj.ca/content/191/3/E69