The sculpture “Together,” by Dennis Smith, stands outside the AAP headquarters in Elk Grove Village, IL.We all have secrets. I ate the cookie. I broke the lamp and blamed it on my sister. The car battery wasn’t dead the night I stayed out past curfew. These little secrets are part of growing up.As pediatricians, we often get wrapped up in secrets that affect the health of our patients. When a mother brings her teenage daughter with abdominal pain and she turns out to be pregnant. When a teenage son blacks out and has to admit to using drugs. In cases like these, we are trained to listen without judgment and help facilitate communication so the children can get the medical intervention they need.
But I have to admit, I never considered gender dysphoria to be a medical problem, much less a pediatric problem. I just assumed most gender nonconforming people would hide their secret identity until they found a safe environment in which to express themselves.
After reading “Approach to Children and Adolescents with Gender Dysphoria,” I realize how wrong I have been. Authors Lopez, Stewart, and Jacobson-Dickman describe the case of Racquel whose battle with gender dysphoria ended in suicide. This moving narrative illustrates the shocking statistic that 41% of transgender adults have attempted suicide, according to a survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. The same study also reports that transgender adults have staggeringly high rates of HIV and of using drugs and alcohol to cope with discrimination.
We have an obligation to recognize the signs of gender dysphoria and to help the family provide an encouraging and supportive environment for the child before it is too late. If, as pediatricians, we fail to understand the complex medical and emotional needs of transgender youth, they will suffer the irreversible changes of puberty making suicide, HIV, and drug abuse much more likely.
To demonstrate the benefits of a supportive family, we invited a commentary by Jazz and Jeanette Jennings. Jazz is a remarkable young woman whose parents have supported her transition since she was 5 years old. Her mother, Jeanette, admits she was heart-broken when Jazz was diagnosed with what is now known as gender dysphoria. Thanks to her supportive family, Jazz does not have to cope with the consequences of hiding her gender identity. She has found a voice sharing her story in the media and uses her platform to be an inspiration to other young people struggling with their own gender expression.
Sources:
Grant JM, Mottet LA, Tanis J, Herman JL, Harrison J, Keisling M. National Gay and Lesbian Task Force: National Transgender Discrimination Survey Report on Health and Health Care. Washington, DC: National Center for Transgender Equality, National Gay and Lesbian Task Force; 2010. http://www.thetaskforce.org/static_html/downloads/resources_and_tools/ntds_report_on_health.pdf. Accessed February 29, 2016.
