What to Know About Gender-Affirming Care for Children and Adolescents

New policies regarding LGBTQIA+ rights have been in the news recently, and the potential impact could be far-reaching — much of it directly affecting transgender and nonbinary youth.

According to a report from the Centers for Disease Control and Prevention (CDC), almost 2% of high school students identify as transgender, and of those 27% felt unsafe at school, 35% had been bullied at school, and 35% had attempted suicide in the past year.

One way to support transgender youth and improve outcomes for their mental health and overall well-being is by providing gender-affirming care, says Dr. Jane Chang, an associate attending pediatrician at NewYork-Presbyterian Komansky Children’s Hospital and associate professor of clinical pediatrics at Weill Cornell Medicine.

“Gender-affirming care, at its most basic level, is about validating and supporting children and loving them for who they are as they explore their gender identity,” says Dr. Chang, who specializes in adolescent medicine.

Dr. Chang, who is also medical director of NewYork-Presbyterian’s Compass Program, a comprehensive program for transgender and nonbinary children and adolescents enrolled in Medicaid, shared with Health Matters what people should know about gender-affirming care for youth.

Gender-affirming care for transgender youth is supported by the American Academy of Pediatrics, the Pediatric Endocrine Society, the American Psychological Association, and the American Medical Association.

The World Professional Association for Transgender Health (WPATH) provides detailed guidelines for gender-affirming care through their Standards of Care. “Patients under the age of 18 who are seeking medical intervention will need parental consent,” says Dr. Chang. “If they do start medical interventions, such as hormones, they are followed carefully by a pediatric endocrinologist. A comprehensive gender-affirming program, such as Compass, provides families with access to a team that includes a pediatrician, endocrinologist, mental health professional, and social worker.

“Gender-affirming care is evidence-based and done in a developmentally appropriate manner as we give patients and families the space to express the youth’s individual gender experience and journey,” says Dr. Chang.

Adolescents who identify as transgender or gender-diverse have higher rates of depression, anxiety, eating disorders, self-harm, and suicide. A 2021 National Survey on LGBTQ Youth Mental Health conducted by The Trevor Project reported that 52% of transgender and nonbinary youth seriously considered suicide in the past year, and 20% attempted suicide in the past year. For cisgender youth (whose personal and gender identity correspond with their sex assigned at birth) among this group, those numbers were 32% and 10%, respectively.

“Data also supports that transgender and gender-diverse youth have better mental health outcomes when they have the support of their family, including the use of their chosen name and pronouns at home,” says Dr. Chang. “We always tell families we cannot predict the future, but we know that data and research show that children who are supported by their families and affirmed in their gender identity have better outcomes in terms of depression, anxiety, suicide.”

Dr. Chang stresses the importance of providing support and guidance during social transitions.

That support can come in many areas and can greatly impact mental health. Her team will reach out to schools on behalf of their patients if there are issues regarding access to gender-neutral bathrooms or locker rooms, or help families understand pronoun use and expand their vocabulary. “For social transition, sometimes it will be about cutting their hair or dressing a certain way,” she says. “Other patients may have questions about chest binding or puberty suppression, which is not the same as hormones. These are all reversible things that can really support the adolescent and make them feel a lot better.”

Providers of gender-affirming care don’t just work with the patient, but with the entire family. “It’s really a triad of decision-making when we work with children and adolescents,” says Dr. Chang. “Our team of providers works with patients and their families as we present options and help facilitate conversations.”

Dr. Chang is mindful about hearing all the concerns and questions family members have, which aren’t always the same as patients’ concerns. For example, “The young patients are less worried about fertility, but the parents are often wondering about fertility. And when the patients want hormones, the families understandably have many questions,” she says.

As patients get older and may become interested in learning about further transition options, it becomes an ongoing group conversation between the parents, the adolescent, and the entire care team. “A lot of their questions are around fear of the unknown, questions around what’s reversible and what’s not, and fear of how their children will be perceived,” she says. “We always say it’s a journey for the patient, but it’s also a journey for the parent. We’re here to answer those questions, and to work with children and their families so that we can help support and improve outcomes for their health and well-being.”

For young patients, Dr. Chang stresses that gender-affirming care is about following the child’s lead and evolution in their gender identity. That includes ongoing conversations and constant learning.

“People may assume that gender care means that you’re going to do surgery, or you’re going to put them on hormones. While that might be part of it, that’s really not the focus,” says Dr. Chang. “It’s a lot of continual checking in and seeing where the child is on their journey. It’s about love and support and affirmation.”

Jane Chang, M.D., is an adolescent medicine specialist at NewYork-Presbyterian Komansky Children’s Hospital and in the Department of Pediatrics at Weill Cornell Medicine. She has been working with adolescents for 20 years and established the Compass Program for transgender and gender-diverse youth at NewYork-Presbyterian in 2018.