This month’s Pediatrics has a research brief (10.1542/peds.2020-049823) and accompanying commentary (10.1542/peds.2021-050278) on gender-diverse youth in a school survey. There are three findings that the articles discuss which are important to both pediatricians and gender researchers.
Kidd et al surveyed 3,100 adolescents in an urban school district and found that almost 10% of respondents identified as gender-diverse. This is in stark contrast to prior studies in which less that two percent of respondents identified as gender-diverse.1 This 5-fold difference in prevalence highlights the importance of gender-diverse systems and the need for appropriate gender-affirming medical care, which is even more concerning given the recent push in some states to prohibit gender-affirming care.2
The second message was the survey process that Kidd et al used to assess gender diversity. Prior researchers asked if adolescents identified as transgender. Kidd et al instead asked two questions: 1. “What is your sex (the sex you were assigned at birth, on your certificate)?” and 2. “Which of the following best describes you (select all that apply)?” with seven possible answers including “another identity”. This appears to be a better process to evaluating gender identity than a single transgender question. Giving youth the range of responses including a nonbinary option can be used by pediatricians and pediatric offices to start the conversation about gender diversity and open the door for more children to receive appropriate care.
Finally, the most disturbing finding in this study was that far more racially diverse adolescents identify as gender diverse than would be expected based on the number of adolescents receiving gender-confirming care. Currently, gender clinics care for mostly white adolescents who identify as male or masculine.3 This racial disparity in children who have access to gender-affirming care can compound the long-term emotional and psychological trauma for those who are already at significant risk.
So what can be done? Here are some takeaways:
- Be aware of the racial disparities highlighted in the above articles
- Thoughtfully and respectfully ask patients about gender identity and sexual orientation
- Assist with discussions with families and be ready to support and refer our patients as needed
References:
- Johns MM, Lowry R, Andrzejewski J, Barrios LC et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report. 2017; 68: 67.
- https://www.nbcnews.com/feature/nbc-out/texas-bill-could-send-parents-prison-providing-gender-affirming-care-n1264060
- Sequeira GM, Ray KN, Mill E, Couter RW. Transgender youth’s disclosure of gender identity providers outside of specialized gender centers. Journal of Adolescent Health. 2020; 66:691-698.
