Health Care for Transgender Kids

Jun 26, 2018

Yesterday, we learned about a new adult transgender clinic in the University of Virginia hospital system. With an estimated 700 transgender adults living in and around Charlottesville, they should have plenty of demand. But what about kids struggling with their gender identities? Where do THEY go? Today, WMRA’s  Emily Richardson-Lorente takes us to a clinic designed just for them.

DALLAS DUCAR: It wasn't around until the fourth grade that I began to first really encounter sadness.

That’s Dallas Ducar,

DUCAR: And around that time too, starting to dress up in female clothing and being so utterly ashamed of it.

Ashamed because she was born a boy, but struggled with her identity. It would be another 14 years before Dallas found her way to the transgender clinic at UVA’s Teen & Young Adult Health Center. On most days, the health center is open to any young person with an appointment. But every three months, for two days, it’s reserved for transgender youth. Here, they can get all the medical, psychological and support service referrals they need, in a single day, in one safe and welcoming place.

NANCY MCLAREN: I had a patient the other day who knew even at age two or three was saying to his parent, I'm a boy, I'm a boy, wants to play with boy's toys, tries to pee standing up, really is identifying very much as a boy.

That’s Nancy McLaren, an adolescent medicine physician here at the transgender clinic. She says for families of very young children, the doctors here talk first about social transition, not medical. That means changing hairstyles, clothes, names. Then … 

MCLAREN: If the child gets to be ten, eleven or twelve and then says, “I don't want to transition,” it's all reversible. You can go back and change names again, you can go back and change clothing.

For moms and dads who fear that this is all just indulging a child’s whims and that maybe “tough love” is in order, Dr. McLaren says consider the alternative.

MCLAREN: These kids can get very depressed, very anxious, really struggle then in school, struggle with friends.

Much of that sounds familiar to Dallas, who went through puberty as a boy, and eventually enrolled at UVa as a young man. She even joined a fraternity.

DUCAR: There was a lot of  … a lot of of alcohol dependency before transitioning. There was a lot of depression before transitioning. There was a lot of anxiety, a lot of depersonalization even.

Many transgender teens struggle with mental health problems and substance abuse. And suicide is a huge issue. In fact, in a study from Cincinnati Children’s Hospital, 30 percent of transgender youth reported having made at least one suicide attempt.

CHRISTINE SOLORZANO: They are really at risk, and so our job is really to protect them.

That’s Doctor Christine Solorzano, a pediatric endocrinologist at UVa. She co-founded the transgender clinic with Dr. Mclaren, and says the kids that come here face a lot of mental health challenges. Bullying, rejection, and fear of being outed all contribute. As does “gender dysphoria.”

SOLORZANO: What it describes is the feeling of anxiety or sadness or angst from being in the wrong body when you have a gender identity that doesn't match.

Children under 18 need to receive an official diagnosis of “gender dysphoria” from a mental health professional before they can start medication at the clinic.

MCLAREN: We really don't just jump right in and say, “Oh, you're here today, we're going to start hormones.”

That’s Dr. McLaren again.

MCLAREN: We really are, you know, let's get a therapist involved, we'll get that going for you. And I think families appreciate that because it is a thoughtful process.

Once a child is diagnosed with gender dysphoria, an endocrinologist can prescribe what are called “puberty blockers,” to delay, for instance, breast development in a transgender boy or facial hair growth in a transgender girl.

MCLAREN: With the goal of: how do we help sort of stop puberty and give the child more time to explore what's going on. And it may in the long run then, mean less surgeries further on down the road.

Surgery is not generally an option until age 18, but for kids whose dysphoria continues into their teens, “gender-affirming hormones” are often the next step. That means testosterone for people transitioning to male, and estrogen for people like Dallas, who are transitioning to female.

DUCAR: It wasn't the dysphoria that I found, but it was the euphoria. It was finally being able to be seen for the first time in a coffee shop where someone can say, “Ma'am, here's your coffee.”

Dr. Solorzano says that every patient’s transition is different, but the most frequent response she sees once her patients start gender-affirming hormones?

SOLORZANO: It's just a sense of relief that they're finally on the path that affirms who they are.

Of course, so much of the care that the staff provides here at the youth trans clinic has nothing to do with medicine.

MCLAREN: We also help them as far as what needs do they have in schools. For example, how do they manage P.E. class? Where do they change?

Having treated nearly 200 patients in the years since they first opened the youth trans clinic, Dr. McLaren says many stories end the same way.

MCLAREN: Yeah. A lot of parents will end up saying, well, I had a daughter, but my daughter was really unhappy, and now I have a lovely son and they're happy.

Nearly two years after beginning her own transition, Dallas Ducar says she’s finally herself — and she has the youth trans clinic to thank, in part.

DUCAR: I am alive and I am no longer sad, and I no longer need to drink and I no longer feel like my mind is ripping out of my body but instead I can just -- I can just breathe.

And that, arguably, is what good healthcare should do for all of us.