Great article, very positive, well worth reading.

A new statement from the American Academy of Pediatrics tries to guide doctors and dispel myths about growing up with gender identity questions.

Helping Pediatricians Care for Transgender Children

Article text follows:

We’ve all seen news stories about schools attempting to grapple with gender identity issues in children and adolescents, from name changes to restroom policies. In many cases, educators have found themselves making it up as they go along in trying to serve these children — and so has the medical system.

This month, the American Academy of Pediatrics put out its first policy statement to guide people providing medical care for children and adolescents who are transgender or questioning their gender identity. It arose in part as a direct response to queries from pediatricians, parents and patients, said Dr. Cora Breuner, a professor of pediatrics and adolescent medicine at Seattle Children’s Hospital and the University of Washington, who was one of the authors.

The goal of treatment is "understanding who each individual child is, and supporting them on that journey,” said Dr. Jason Rafferty, a pediatrician and psychiatrist at Thundermist Health Center and Hasbro Children’s Hospital in Rhode Island, who was the lead author on the statement; he spoke of “creating a system where all children feel they have access to supportive and nonjudgmental care.”

Dr. Breuner said that “many times, when there are gender issues, we don’t have a road map.” The statement puts forward a model of “gender-affirmative care,” based in the idea that “variations in gender identity and expression are normal aspects of human diversity,” and that mental health problems in these children arise from stigma and negative experiences, and can be prevented by a supportive family and environment — including health care.

The term “gender diverse” describes those whose gender identity does not match the sex they have been assigned, or the norms that are expected to go with that assignment.

“Gender identity is a brain thing, it’s your sense of whether you’re male or female in your head; it is independent of your body parts, it is independent of who are you attracted to,” said Dr. John Steever, an adolescent medicine specialist and assistant professor of pediatrics at the Icahn School of Medicine at Mount Sinai.

“People can have a sense of being male, female, both, somewhere in between, all of these are normal variations,” he said. “Just because they’re not very common doesn’t mean they’re abnormal, and my job is to help patients and parents understand all this.”

The new A.A.P. statement tries to dispel a variety of myths about growing up with gender identity questions, Dr. Breuner said, such as the idea that parents should assume this is only a passing phase. “And still, colleagues look at me askance, say, ‘Isn’t this something they grow out of, I was taught that in medical school,’” Dr. Breuner said. “So was I. It’s incorrect.”

And these issues sometimes emerge in relatively young children. Children may say that they don’t feel right in their bodies as young as 4 or 5, Dr. Breuner said, or may say more specifically something like, “even though I look like a boy, I feel like I’m a girl.”

Growing up gender-diverse means children and adolescents are much more likely to be bullied and excluded, and they are at high risk for depression, suicidal thoughts and suicide. “The statistics are pretty stark,” Dr. Breuner said, “triple the rate of suicide, five times the risk of suicidal ideation, bullying, teasing, abuse. It’s just horrific.”

“The biggest reason for doing a lot of this work is to try and prevent some of the traditional horrible outcomes that transgender or gender-nonconforming youth have ended up with,” Dr. Steever said. “We know that many of these people, if unsupported, have grown up and dealt with depression, suicidal ideation and attempts, substance use and abuse, S.T.D.s, including high rates of H.I.V. in transgender women, domestic violence, physical abuse and discrimination — the work we’re trying to do here is to prevent some of those outcomes.”

But the research shows, he said, that if the children are accepted, they do much better. Dr. Breuner agreed: It’s the environment that endangers the child, she said, not the gender issues; if the child’s family and school and health care system are supportive, she said, the child should not be at higher risk than the general population.

Some worry that “gender-affirming care” may push children toward thinking they have gender issues, Dr. Breuner said, but in a much broader sense, “we just have to be as parents really open to whatever conversation our kids want to have with us.”

Dr. Rafferty noted: “Part of the affirmation process is parents understanding their kids, and kids understanding the perspective of parents.”

If parents are looking for health care for a child who is gender-diverse, Dr. Breuner said, look for a clinic that pays attention to the details of affirming the child’s identity: The providers ask what pronouns the child uses, the bathrooms are all-gender, and when you check in, they ask what the child wants to be called. “The clinic should have the capacity for a child to be able to change the name in the system,” she said.

Some families will decide to use drugs that block puberty, preventing the body from developing the secondary sexual characteristics of the gender that the child wants to abandon, Such drugs block characteristics like breast development in biological females, and voice deepening and facial hair in biological males. Dr. Steever called it a “pause button,” which gives families time for counseling and a chance to be sure of the child’s wishes. Some adolescents will decide to pursue further interventions, medical or surgical, sometimes called transitioning.

“I always tell parents I’m in no rush, I don’t have an agenda here,” he said. Many kids, he said, feel much better after they start transitioning. On the other hand, “just because you start transition doesn’t mean it’s going to be always sunshine and rainbows — kids are going to need support.”

This is a medically underserved population, in adolescence as in adulthood, with medical needs to be met, and which may be complex during puberty. If a biological female is transitioning to male, the doctor still needs to talk about menstrual periods. And those statistics about the risks of suicide and self-harm mean that screening for depression is crucial at health care visits.

Growing up with these issues can be hard on children, and it also asks a lot of parents. “Parents have brought their kid to my clinic even though they may be fairly uncomfortable,” Dr. Steever said. “I know they’re doing it from a position of, ‘I want to support my child.’”