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AAP National Conference: Expert shares how pediatricians can support transgender youths :

October 25, 2016

Pediatricians often are the “first responders” when issues arise regarding a child’s psychosexual development, said Johanna Olson-Kennedy, M.D., medical director of the Center for Transyouth Health and Development at Children's Hospital Los Angeles.

“Pediatricians are so well-situated to be that first person that maybe opens up this discussion with people, and that’s exciting,” she said.

The age at which children start talking about gender incongruence or gender dysphoria and seeking related care is going down, she said. Therefore, pediatricians need to know what gender development looks like for these youths and have an understanding of what medical interventions are available so they can help families make good decisions.

Dr. Olson-Kennedy shared the latest information about gender dysphoria and challenges children face during a session titled “Gender Nonconforming Children and Adolescents.”

The Division of Adolescent Medicine at Children’s Hospital Los Angeles has been providing services for transgender youths for about 20 years. When Dr. Olson-Kennedy started as an attending in 2006, a Dutch team had just put out a protocol for using puberty blockers to temporarily suspend the process of endogenous puberty.

“I was very taken with this idea that as a physician, as a pediatrician, as an adolescent medicine specialist that I can play this very, very important role not just in medical intervention but really in a human rights movement,” she said. “I had done a lot of work in politics and social justice in addition to science and medicine. So this was a place that these two worlds came together.”

While it is difficult to know how many people identify as a gender other than the one assigned at birth, studies show the number is rising. The latest study put the prevalence at 0.6% of the population, said Dr. Olson-Kennedy, adding that the number varies greatly by geography.

Pediatricians, therefore, are increasingly likely to have patients who disclose that they are transgender.

While more youths are opening up about their gender dysphoria, the road is not easy.

“There are certainly a lot of young people that land in my clinic who have gotten really harmful messages from professionals, including medical professionals, educators, mental health providers, pediatricians, psychiatrists, and they bring that trauma into the visit with them,” Dr. Olson-Kennedy said.

During the session, she discussed the use of puberty blockers, gender-affirming hormones and making referrals for appropriate surgeries.

“Pediatricians have an opportunity to be talking to all children about gender, to be making sure that kids’ gender identities feel right for them and they’re not struggling with gender dysphoria and if they are, they have access to earlier care.”

She also talked about how pediatricians can support children and families.

“It’s about helping families build tools to manage things that are inevitably going to happen when there’s a trans kid in the picture,” she said. “There’s no right way to raise your trans kid. At the end of the day, it’s about being loving and supportive and helping that kid, creating an environment for that kid that is as safe and as healthy as it possibly can be.”

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