Doctor's Rec: 64,000+ pediatricians recommend gender-affirming treatment for children based on best available evidence

A September 2015 presentation from the American Academy of Pediatrics notes that treatment recommendations are based on the best available evidence. Their guidance defined three approaches to gender dysphoria in children: “corrective,” “supporting,” and “affirming,” with the AAP advising the “affirming” approach to gender dysphoria in children.

Goal: Help child and family decipher subjective gender experience and differentiate those with persistent transgender identity from those exploring gender non-conforming expression

Tenets

• Gender variations are not disorders
• Gender may be fluid and not always binary
• Some transgender youth can be distinguished from non-transgender youth prior to puberty

Strategies
• Assist youth and families in learning about and engaging in gender transitioning, such as social and medical interventions

Why do we believe in Affirming approach?

• Affirming does not mean encouraging or pushing gender transition

• Children rejected and not supported are at increased risk of the following during adolescence: – Depressive symptoms, low life satisfaction, self-harm, isolation, posttraumatic stress, incarceration, homelessness, and suicidality

• Family acceptance and support during adolescence is tied to the following in young adults: – Positive self-esteem, high social support, positive mental health, less depressive symptoms, greater self-esteem, greater life satisfaction (compared with youth whose families were non-supportive)

Citations: D’Augelli, Grossman, & Starks, 2006; Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Hill, Menvielle, Sica, & Johnson, 2010; Roberts, Rosario, Corliss, Koenen, & Bryn Austin, 2012; Skidmore, Linsenmeier, & Bailey, 2006; Toomey, Ryan, Díaz, Card, & Russell, 2010; Travers et al., 2012

Why do we believe in Affirming approach?

For those whose gender dysphoria persists, affirming gender non-conformity is affirming the child’s core gender identity…

We think that early treatment will lead to a better physical and psychosocial outcome.

Sources:

1. Kim Lacapria. (2016) American Pediatricians Issue Statement That Transgenderism Is ‘Child Abuse’? It was an official-sounding but fringe group of politically motivated pediatricians who issued a statement on gender, not the respected American Academy of Pediatrics. Snopes (6 May 2016) (pdf).

2. Robert Garofalo. (2015) Understanding Gender Nonconformity in Childhood and Adolescence. American Academy of Pediatrics (September 2015). (pdf).

Doctor's Rec: Statement from American Academy of Pediatrics

The official American Academy of Pediatrics published (link to summary article) 9 clear recommendations for caring for youth and adolescents who identify as transgender or gender-diverse.

I highlight the portions that specify providing health care according to what the youth wants, especially to match the youth’s gender expression. Not parent, guardian, teacher, staff member, administrator, guidance counselor, etc.

[Aside: You may have heard a FoxNews Glenn Beck headline about an anti-gay-marriage hate group calling itself “American Pediatricians” creating a hoax claiming supporting a transgender youth is abuse. Read more about how Snopes debunked this, as well as the American Academy of Pediatrics’ internal presentation recommending affirming a child’s gender expression (pdf). —RXS]

1. that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;

2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;

3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;

4. that insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions;

5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;

6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all children without fear of harassment, exclusion, or bullying because of gender expression;

7. that pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;

8. that the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and

9. that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD.

Citation:

Jason Rafferty (2018) Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics Sep 2018, e20182162; DOI: 10.1542/peds.2018-2162 (direct pdf)