Providing necessary care to transgender teenagers

For many of the patients seen in pediatric care, the gender assigned at birth matches, but for some children the gender at birth is incongruent with their identity. Gender development in children who are gender diverse can be fraught and a number of children will have gender dysphoria. Presenting “Caring for transgender youth” at the virtual 2020 American Academy of Pediatrics National Conference & Exhibition, Johanna Olson-Kennedy, MD, medical director at the Center for Transyouth Health and Development at the Children’s Hospital Los Angeles in California, and Aydin Olson-Kennedy, LCSW, executive director of the Los Angeles Gender Center in California, discussed the onset of puberty in transgender adolescents, using gender affirming hormones in transgender adolescents, and gender dysphoria.

For the transgender adolescent about to start puberty, it can be a period of social isolation, depression, anxiety, self-harm, suicidality, and maladaptive coping, said Johanna Olson-Kennedy, MD. Among these patients who are preparing to enter puberty, puberty blocking through gonadotropin-releasing hormone analog treatment can help prevent transgender adolescent from going through the “wrong” puberty. Utilizing the treatment can prevent the development of unwanted secondary sex characteristics and possibly prevent future surgeries. The patient’s distress can be eased, which can help aid any psychotherapy the patient is undergoing. Additionally, the treatment is completely reversible.

When a patient wants to start gender affirming hormones, there are some concerns including what happens if the patient changes his or her mind and whether a teenager can make a decision that big. Johanna Olson-Kennedy ended the section by pointing out that hormones save lives by mitigating the impact of gender dysphoria in these patients. During her discussion on both the feminizing and masculinizing process, she implored clinicians to manage the expectations of the patient, saying that 25 mg of Estradiol will not turn a transfeminine person into Beyonce, nor will 50 mg of testosterone turn a transmasculine person into Channing Tatum.

Aydin Olson-Kennedy then turned the presentation over to the subject of gender dysphoria. He discussed how for the transgender individual, there is both a coming in and coming out process. Coming in covers when the individual comes to understand that the gender identity at birth does not match who he or she is. This process can involve turning to search engines and social media platforms such as YouTube to find out more information. This quest for information may actually cause a peak in gender dysphoria, not because of access to the information, but because the person becomes more cognizant of the incongruent nature of the assigned gender. For many transgender individuals, there is a significant gap between coming in and then coming out. When a patient undergoes hormone therapy, gender dysphoria can ebb and flow, particularly for transmasculine individual. He also said that gender dysphoria will often remain high for transfeminine individuals who had late interventions. For both transmasculine and transfeminine individuals, bouts of gender dysphoria may occur after intervention. He concluded his presentation by saying that transgender individuals often feel out of step with their cisgender peers because of delays in puberty and focusing on achieving some level of gender confirmation.