New Clinic for Transgender Youth
Jun 01, 2021 Cedars-Sinai Staff
For about half of transgender people, their true sense of gender identity doesn't develop until puberty or later—a crucial time for support and possible medical intervention. For kids and teens experiencing gender dysphoria at any age, family support is all-important for their health and development.
"Getting connected with other families going through the same thing can help with decisions and knowing how to support kids. Coming together as a community to address something that at first might seem daunting or scary really makes a difference."
To help kids grow into the adults they're meant to be, no matter what stage they're exploring their gender identity, Cedars-Sinai recently opened the Pediatric and Adolescent Gender Wellness Clinic. Pediatrician Dr. Paria Hassouri not only treats patients, but just as importantly, she provides resources to help families navigate how to best support children.
"This is a place where we can support and provide care for families, kids and teens who are transgender or questioning their gender, or anywhere on the gender-diverse spectrum," she says. "Now, by expanding our transgender healthcare program to youth, transgender and gender diverse individuals can have a continuum in gender-affirming care from childhood through adulthood."
Here, Dr. Hassouri outlines what parents should know if their child is questioning their gender identity, and what happens during clinic visits.
First, Dr. Hassouri says, it's helpful for parents and kids to understand basic terms to help with conversations around gender identity.
Gender identity: A person's sense of self as male, female, both or neither
Biological sex: Physical anatomy used to assign gender at birth
Transgender: A person whose gender identity does not match their gender assigned to them as a baby based on physical anatomy
Gender fluid: A person whose gender identity fluctuates between female and male
Nonbinary: A person who doesn't identify as either male or female
Cisgender: A person whose gender identity matches their anatomical sex
Gender expression: How a person presents gender to other people, which encompasses clothing, hair, mannerisms and social roles
Sexual orientation: Based on the gender of the person someone is attracted to romantically or sexually
In short: "Biological sex is your anatomy, gender identity is in your brain, sexual orientation is about attraction in your heart and gender expression is how you present to the outside," she says.
Treatment by age group
Transgender identity can emerge at any phase in life, and Dr. Hassouri treats kids differently based on three categories: early childhood, puberty or early puberty, and late adolescence.
For children exploring transgender identity in early childhood, she says, social support is the only real prescription.
"In pre-puberty, there's nothing to be done medically, so the family should support their child by allowing them to express themselves in whatever clothing feels more comfortable, with the name or pronouns the child feels are appropriate and right, and by making sure the school is supporting them and making the accommodations they need," she says. "Support them in what feels authentic to them."
Right when puberty starts is the time to really seek advice from a physician, Dr. Hassouri says, for puberty blockers—when appropriate. Puberty blockers are safe and reversible hormonal injections or a small implant in the upper arm that postpone certain physical developments such as breast growth or facial hair growth and voice deepening. Pediatricians have traditionally prescribed them for kids diagnosed with early puberty, also known as precocious puberty.
"We can use puberty blockers for at least two years, and they really help to buy the family and the child time to explore what is going on with their gender," she says.
For older adolescents, Dr. Hassouri will also prescribe puberty blockers, or gender-affirming hormone therapy: shots, pills or creams that help develop physical features consistent with the child's gender identity. For transgender youth who may not need or want medical transition, Dr. Hassouri makes referrals to therapists, community services and support groups.
Support for families
"Transgender teens who are not supported by their families have three times higher risk of suicide and suicidal ideation," says Dr. Hassouri. "We know when transgender teens are supported by their families, their risk of suicide drops to the same as cisgender teens. Family support makes all the difference."
Almost all families can benefit from a support group, Dr. Hassouri says, so parents and kids can be educated by families and kids who have gone through transition.
"Getting connected with other families going through the same thing can help with decisions and knowing how to support kids," she says. "Coming together as a community to address something that at first might seem daunting or scary really makes a difference. A lot of families don't know another family who has gone through the same process—and seeing families whose kids are thriving and doing well gives them a lot of optimism about their child's future."