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Making a statement on transgender youth

Making a statement on transgender youth

Overshadowed by the cloud of lousy news is a ray of hope for transgender kids and the people who love them in the United States.

The American Academy of Pediatrics (AAP) announced its first-ever policy statement for parents and clinicians caring for transgender and gender-diverse children and adolescents.

The statement, available online, is published in the journal Pediatrics.

“In its dedication to the health of all children, the American Academy of Pediatrics strives to improve healthcare access and eliminate disparities for children and teenagers who identify as lesbian, gay, bisexual, transgender or questioning (LGBTQ) of their sexual or gender identity,” the statement reads.

“Despite some advances in public awareness and legal protections, youth who identify as LGBTQ continue to face disparities that stem from multiple sources, including inequitable laws and policies, societal discrimination, and a lack of access to quality healthcare, including mental health care.

“Such challenges are often more intense for youth who do not conform to social expectations and norms regarding gender.”

The AAP recommends a “gender-affirming” approach that calls for the following:

• Access to family-based therapy and support for parents, caregivers and siblings of youth who identify as transgender.

• Electronic health records, billing systems and other notifications that respect the asserted gender identity of each patient.

• Insurance plans that offer coverage specific to the needs of youth who identify as transgender, including coverage for medical, psychological, and when appropriate, surgical interventions.

• Advocacy by paediatricians for policies and laws that promote acceptance of all children without fear of harassment, exclusion or bullying because of gender expression.

“As a parent, even when you struggle to understand and may not see eye-to-eye, your most important role is to offer understanding, respect and unconditional love for your child,” said Dr Jason Rafferty, lead author of the policy statement.

“This builds trust and puts you in a better position to help them through difficult times.

“Research has shown that if a transgender teen has even just one supportive person in their life they can go to, it greatly reduces their risk of suicide.”

Population-based surveys estimate that 0.7% of teens ages 13 to 17 in the US identify as transgender, according to the AAP.

Studies indicate roughly 50% of teens who identify as transgender have attempted suicide.

Dr Rafferty, a Rhode Island-based paediatrician and child psychologist, added: “There is increasing recognition that gender and sexual development is a normal process for all children starting at an early age, and that some children will exhibit variations, similar to all areas of human health and behaviour.

“Having a vocabulary around gender and sexual diversity facilitates conversations with parents, families and providers, allowing children to label some of their complicated feelings that otherwise may have been suppressed or hidden.”

When asked if he expects pushback from paediatricians about the policy statement, he replied, “No.

“The messages of this policy statement are very much in line with the core principles of paediatrics, including the importance of using a non-judgmental, family-based, developmentally appropriate approach.

“It emphasises that transgender and gender-diverse children – like all children – need support, love and care from family, school and society. When supported and loved as they grow and develop, kids mature into happy and healthy adults.”

Some parents will have an easier time accepting gender differences than others, of course.

“Some transgender youth expect immediate acceptance, but often, family members proceed through a process of becoming more comfortable and understanding of the youth’s gender,” Dr Rafferty said.

“The process often resembles the stages of grieving as it may require letting go of strongly-held expectations for their child.”

Paediatricians can help, he said, by promoting open dialogue and perspective-taking between young people and their parents.

“Gender affirmative care,” he said, “is based on the belief that all children benefit from love and support – a principle that is almost always a place where providers can meet parents to start a discussion.” – Chicago Tribune/Tribune News Service

Should doctors ask patients about their sexual orientation?

Should doctors ask patients about their sexual orientation?

Asking about patients’ sexual orientation is not routine, even among medical professionals who specialise in sexual health.

About half of the medical professionals surveyed by John Hopkins Medicine researchers in the United States said they asked patients directly about sexual orientation, according to a study published in The Journal of Sexual Medicine, while about 40% said sexual orientation is irrelevant to patients’ care.

The survey’s co-author, Dr Amin Herati, urology professor at the Johns Hopkins School of Medicine, said that men who mostly have sex with men are at higher risk of some sexually-transmitted infections, so if doctors don’t know men are gay, for example, their care might not include that consideration.

The researchers suggested that the 84 medical professionals surveyed were more likely to ask about sexual orientation because all are members of the Sexual Medicine Society of North America.

Asking about a patient’s sexual orientation has risks and benefits, said Naomi Goldberg, policy and research director at the Movement Advancement Project, a think tank that works toward equality for LGBT (lesbian, gay, bisexual, transgender) people.

Overall, she said, the benefits of tailoring care toward patients outweighs risks, but the way that someone’s orientation is sought is important.

“Any time you ask about sexual orientation or gender identity, that’s sensitive information that needs to be treated carefully,” she said. And that information should be safeguarded, she added.

As far as how to ask, questions regarding sexual orientation could be included on intake forms, she suggested, along with other questions ascertaining age and ethnicity.

Boxes could include whether patients think of themselves as lesbian, gay or trans, for example. They could also ask what gender they were assigned at birth and how they identify now.

“If someone currently identifies as a woman and checks ‘woman’, and may not check ‘trans’, and if you ask what sex were they assigned at birth and she checks ‘male’, then a physician might be able to have a discussion” more specifically tailored to her health, for example.

Goldberg pointed out that with more information, for example, a doctor might bring up the possibility of using PrEP, the pill that can reduce the risk of HIV infection.

Also, knowing that LGBT people might be more at risk for depression could help doctors better monitor mental health.

“Those are the kinds of things that might get left out because doctors may make assumptions about their patients,” Goldberg said.

She noted that for many people, clinics and community centres that are LGBT-focused are a way to seek care in a safe space, but not everyone has that option.

A report released recently by the US Movement Advancement Project shows that these centres are often understaffed and underfunded, but serve more than 40,000 people each week across the 40 states surveyed.

“Going to an LGBTQ (Q for queer) community centre or somewhere like Howard Brown (in Chicago) that’s focused on LGBTQ people, that is a really nice option for some people,” Goldberg said, adding that those who live elsewhere in the state have fewer options.

“We need to also make sure that the primary care physicians at your local community health clinic or at the local hospital are also aware of the issues.” – Chicago Tribune/Tribune News Service

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