By Dr. Mandy Coles, Boston University
When Charlie, a 10-year-old boy, came in for his first visit, he didn’t look at me or my colleague. Angry and crying, he insisted that he was cisgender – that he was a boy and was born a man.
Get on the same page
The first thing our team does is make sure our patients and families understand what gender care is. We always start the first visits the same way. “Our goal is to support you and your family on this journey, whatever it looks like to you. My name is Mandy and I am one of the physicians at CATCH – the Child and Adolescent Trans / Gender Center for Health program. I use she / her pronouns. ”Sharing pronouns allows trans people to feel seen and validated.
Then we ask patients and families to share their gender journey so we can better understand where they come from and where they hope to go. Charlie’s story is one we hear often. A child may not think much about gender until puberty, but begin to experience worsening gender dysphoria when their bodies begin to change in what feels like a wrong way.
In addition to being accepted at home, young people often want to live in the world in their identified gender. This may include changing their names and pronouns and coming out to friends and family. It can also include using public spaces such as schools and bathrooms, participating in same-sex sports teams, and getting dressed or doing other things like tying breasts or tucking back male genitalia to present more in line with their gender identity. While more research needs to be done, studies show that young people who transition socially have depressions comparable to cisgender peers.
Many young people believe that making a social transition can be an important step in affirming identity. For those still struggling with depression, anxiety, and managing societal transphobia, it may also be helpful to see a therapist who is knowledgeable and experienced in gender diversity identities and gender dysphoria.
However, most young people also need to make physical changes to their bodies to really feel comfortable.
Gender-affirming medical interventions
When I first met Charlie, he had already passed over socially, but still had dysphoria. Charlie, like many people, wanted his physical body to match his gender identity, and this can only be achieved through medical interventions – namely, puberty blockers, hormonal medications, or surgery.
For patients like Charlie who have experienced early female or male puberty, hormone blockers are usually the first option. These drugs act like a pause button on the physical changes brought on by puberty. They are well studied, safe and completely reversible. If a person stops taking hormone blockers, their body will resume puberty the way it would. Blockers give people time to further explore gender and develop social support. Studies show that hormone blockers reduce depression, anxiety and suicide risk in transgender youth.
Once a person has started or completed puberty, taking prescription hormones can help people tailor their bodies to their gender identity. One of my patients, Zoe, is an 18-year-old transgender woman who has already passed male puberty. She uses estrogen and a drug to block the effects of testosterone. Together, these will help Zoë’s body develop breasts, reduce hair growth and achieve an overall more feminine shape.
Leo, another of my patients, is a 16-year-old transgender using testosterone. Testosterone will deepen Leo’s voice, help him grow facial hair and lead to a more masculine body shape. In addition to testosterone, transgender men can take extra short-term medication to stop menstruation. For nonbinary people like my 15 year old patient Ty, who is not exclusively male or female, my colleagues and I personalize their treatments to meet their specific needs.
The health risks of taking hormones are incredibly small – in fact, not significantly different from the risks that a cisgender faces from the hormones in their body. Some prescribed hormone effects are partially reversible, but others are more permanent, such as deepening of the voice and growth of facial hair or breasts. Hormones can also affect fertility, so I always make sure my patients and their families thoroughly understand the process.
The most permanent medical options available are gender-confirmation surgeries. These surgeries can include changes in genitals, chest or breasts, and facial structure. Surgeries are not easily reversible, so my colleagues and I always make sure that patients fully understand this decision. Some people think that gender-confirmation surgeries are going too far and that minors are too young to make such a big decision. However, based on available research and my own experience, patients undergoing these surgeries experience improvements in their quality of life due to a reduction in dysphoria. Patients have told me sex-confirmation surgery “literally saved my life. I was free [from dysphoria]
Ongoing gender concern
In March 2021, almost five years after our first visit, Charlie walked into my exam room. When we first met, he struggled with his gender, anxiety, and depression. This time, he immediately started talking about playing hockey, hanging out with friends and making the roll of honor. He’s been taking hormone blockers for five years and testosterone for nearly a year. With the help of a supportive family and a gender-skilled therapist, Charlie is now thriving.
Being transgender is not something that disappears. It’s something my patients live with all their lives. Our multidisciplinary healthcare team continues to see patients like Charlie regularly and often follows them into young adulthood.
While more research is always needed, a gender-affirming approach and evidence-based medicine enable young transgender people to live in the world as their authentic selves. This improves quality of life and saves lives, as one of our transgender patients said of his experience receiving gender-affirming care. “I really don’t think I would have been here if I hadn’t been allowed to switch at that time. I’m not always 100%. But I have hope. I’m happy to see tomorrow and I know I will make my dreams come true.”
Mandy Coles, clinical associate professor of pediatrics and co-director of the Child and Adolescent Trans / Gender Center for Health, Boston University
This article has been republished from The Conversation under a Creative Commons license. Read the original article.
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