Gender affirming care for youth is supportive social, behavioral, and medical healthcare services for transgender and gender expansive young people aimed to help them align their lives with their gender identity.

Understanding the Importance of Parent/Caregiver Support

• Research has shown that parental support and affirmation of transgender and gender expansive youth is associated with higher life satisfaction and resilience, and lower levels of depression, gender dysphoria, anxiety, and suicidality.
• Having even just one supportive adult in an LGBTQ+ child’s life results in a 40% reduction in likelihood to report attempting suicide.
• Transgender and gender expansive youth who live in households where everyone respects and uses their pronouns report attempting suicide less than those in households where everyone they live with did not respect their pronouns.

So, how can you support your child? 

How to Support Trans and Gender Expansive Youth: The ABCs

Affirm your child  

• Always use your child’s name and pronouns that align with their gender identity
•  Make sure your child feels supported and valued by their family
• Celebrate, love, and support your child’s gender expression

Be an advocate

• Call out transphobia
• Learn what your school can do to support your child
• Ask others to respect and affirm your child’s identity
• Work with your child’s school to create a gender support plan or gender communication plan to help facilitate your child’s transition in school. In Philadelphia, Policy 252 can help with this.

Cultivate your knowledge

• Find resources like books, documentaries, or websites to learn more about what it means to be transgender or gender expansive

Gender and Development

Early childhood (ages 2-5)

• Around this age children begin to develop a stronger sense of self. They begin to understand the concept of gender roles and what behaviors are socially “typical” for a boy or a girl.
• Children in preschool or daycare may participate in gender segregated play. During play, children at this age may make comments on their peer's gender expression saying for example: “Boys don’t do that, only girls play with dolls.”
• Children who are transgender or gender expansive may question or challenge “traditional” gender concepts. They may say things like “You say I am a girl, but I am not” or “When am I going to grow a penis?”
• During this stage, it is important to promote gender expansive play, letting the child explore activities they are interested in without limiting them to traditional gendered play based on their assigned sex.  

Middle childhood (ages 6-10)

• Children will begin to make more friends and form strong bonds with their peers. Their social environment is often dominated by a period of rigid rule enforcement that comes with beginning school. Gender specific activities and groupings in school become more prominent. For example, a teacher may call on the girls in the class to line up first.  
• For a transgender or gender expansive child, this may make them feel pressured to conform to their peer’s ideas of gender expression. Children who feel pressured to limit or hide their gender expression may experience behavioral issues.
• Some children may begin the early stages of puberty, developing some secondary sex characteristics like breasts or pubic hair. This experience can be traumatic for transgender and gender expansive youth.  
• At this stage, it is important to meet the transgender or gender expansive child where they are at, validating their feelings about their gender. It is important to not push the child into “making a choice” about their gender identity.  

Adolescence (ages 10-24)

• Adolescents in this age group are experiencing the continued effects and challenges of puberty. They begin to develop secondary sex characteristics like facial hair, facial shape, body hair, hip shape, voice pitch, breasts, or a period. Youth may also be more explicitly treated as their assigned sex. This experience can be traumatic for transgender and gender expansive youth.
• Mental health of transgender and gender expansive youth is especially important to monitor at this age as they are at an increased risk for depression, anxiety, self-harm, and suicide.
• Not all transgender and gender expansive youth desire legal or medical transition but gender affirming care is available to youth to help them affirm their gender in a way that is best for them. 

LGBTQ+ Identity Development Model

1.  Identity confusion: “Who am I?” This stage is often associated with feeling one is different from their peers. Youth begin to question their assigned sex and may voice this feeling others.
2.  Identity comparison: “Where do I belong?” At this stage, youth will often compare themselves to other transgender or gender expansive people to understand more and come to a conclusion about their own gender identity.  
3.  Identity tolerance: “I probably am transgender.” For some youth this stage may overlap with comparison. They may look for others who validate their identity or are transgender or gender expansive themselves to feel connected to their identity.  
4.  Identity acceptance: “I am transgender.” Youth at this stage have established their identity and may tell others.  
5.  Identity pride: “This is my community.” Youth feel personal pride in their identity and may look to become more engaged in the LGBTQ+ community.

Identity development is not always linear and looks different for everyone.

Gender Affirming Care

Social Transition

• Changes like adopting gender affirming names, hairstyles, and clothing to build confidence and satisfaction with one’s appearance. Does not require any medical intervention. Available at any stage and is fully reversible.

Puberty Pausing Medications

• Puberty pausing medications temporarily stops unwanted physical and developmental changes of puberty. They pause things like a period, breast development, voice changes, or facial hair. Available to youth in consultation with a medical provider and parental consent during puberty and is fully reversible.
•  Allows youth to have more time to explore their gender identity and expression by pausing puberty that is not aligned with their gender identity.
•  Can make other transition opens available later in life easier by preventing the physical and developmental changes of puberty that do not align with their gender identity.  

Hormones

• Hormones, like testosterone and estrogen, cause the body to physically develop secondary sex characteristics. This can include development of facial hair, facial shape, body hair, hip shape, voice pitch, and breasts. Typically, available to people over 18 with provider supervision and management. Hormones can be prescribed to youth under 18 with parental consent.

Surgery

• Gender affirming surgeries, like “top” surgeries to make changes to the chest or “bottom” surgeries to make changes to the genitals, are typically not available to transgender and gender expansive youth under the age of 18.

PACTS at Mazzoni Center

Mazzoni Center’s Pediatric and Adolescent Comprehensive Transgender Services, PACTS, provides gender affirming medical care to transgender and gender expansive youth. Patients under 18 must have parental consent from parents or guardians with medical decision-making rights to begin and continue receiving gender affirming care.

What to Expect

A PACTS team member will reach out for a phone screen to discuss your child’s goals for care at Mazzoni Center and to schedule an intake appointment.

At the intake:  

Before meeting with a medical provider, your child will meet with a licensed social worker for a thorough evaluation and intake. They will talk with you about your child’s gender identity, social support, mental health, and readiness for receiving gender affirming medical intervention.

During the first medical visit:  

At this visit, you and your child will meet with the medical provider to discuss the process for possible medical intervention. Depending on your child’s age and goals for gender affirming care, this discussion could include laying out a plan to start puberty pausing medications and/or hormone therapy.

Insurance:

We accept a variety of insurance types and can offer a sliding scale for uninsured families.  

Follow up:  

After the first medical visit, your child will follow up with their medical provider every 3 months. Your provider will ensure safety, monitor physical changes and mental health, review medication effectiveness, look for potential side effects, and order labs: adjusting treatment plans as needed.

Helpful Resources

TransYouth Family Allies: FAQ http://www.imatyfa.org/assets/tyfa-faq-06-08.pdf  

Affirming vs. Non-Affirming Parenting: https://www.dropbox.com/s/rzjkrmsw7iklvh1/Affirming%20vs%20Non-affirming...  

Fenway Health Tips for Parents: https://www.lgbtmap.org/file/English%20National%20Resource%20Sheet%20for...

HRC Trans Children and Youth Basics: https://www.hrc.org/resources/transgender-children-and-youth-understandi...  

Gender Spectrum Tool Kit: https://www.genderspectrum.org/new-page  

PFLAG: https://pflag.org/chapter/philadelphia/

The Attic Youth Center: https://atticyouthcenter.org/

Seattle Children’s Patient and Family Resources: https://www.seattlechildrens.org/clinics/gender-clinic/patient-family-re...

References

1. Matouk, K. M., & Wald, M. (2022, December 8). Gender-affirming care saves lives. Columbia University Department of Psychiatry. https://www.columbiapsychiatry.org/news/gender-affirming-care-saves-lives

2. Boerner, H. (2022, May 12). What the science on gender-affirming care for transgender kids really shows. Scientific American. https://www.scientificamerican.com/article/what-the-science-on-gender-af...

3. Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2). https://doi.org/10.1001/jamanetworkopen.2022.0978’

4. Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-3223

5. 2023 U.S. National Survey on the Mental Health of LGBTQ Young People. The Trevor Project. (2023). https://www.thetrevorproject.org/survey-2023/

6. Transgender Children & Youth: Understanding the basics. Human Rights Campaign. (n.d.). https://www.hrc.org/resources/transgender-children-and-youth-understandi...

7. Perry, J.R. & Green, E.R. (2017). Safe & Respected: Policy, Best Practices & Guidance for Serving Transgender, Gender Expansive, and Non-Binary Children and Youth Involved in the Child Welfare, Detention, and Juvenile Justice Systems. New York City, NY: New York City’s Administration for Children’s Services. https://www.nyc.gov/assets/acs/pdf/lgbtq/SAFEAndRespectedUpdate061417.pdf