Health Care for Transgender Youth Is Taking Root in the US

A growing number of clinics are providing specialty care to transgender kids, who are at a higher risk of suicide and substance abuse than their cisgender peers.

In 2012, when he was a medical resident at Washington University Medical School in St. Louis, Missouri, Chris Lewis attended a meeting for parents of transgender children. He was surprised to hear them discuss the harassment, discrimination, and incompetency that their children faced within the medical system.

But that’s likely old news to many members of the transgender community. Almost 30 percent of transgender patients have been harassed in a medical setting, according to a report by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. Half of the patients polled said they had to educate their doctors about transgender health care.

“When you’re going through medical school,” said Lewis, “you get taught about all sorts of rare and very not-common diseases.” But, he added, “Very rarely are people given more than an hour lecture, if an hour, on transgender health.”

Lewis continued his outreach to transgender patients during the remainder of his medical fellowship. Now, five years later and with Lewis’s help, Washington University and St. Louis Children’s Hospital opened the Transgender Center of Excellence, the first health clinic for transgender youth in St. Louis.

The clinic is part of a growing network of roughly 40 clinics nationwide serving transgender youth and their families. Most of the other healthcare clinics for transgender youth are on the coasts, said Lewis, who serves as the center’s co-director. The next closest clinic that caters to transgender youth is over 250 miles away in Kansas City.

“There’s not as much for the central portion of the country,” Lewis said.

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Diane Ehrensaft, clinical psychologist and mental health director of the Child and Adolescent Gender Center Clinic at the University of California, San Francisco, said that when they first opened their facility five years ago, she could count on one hand the number of clinics providing services to the transgender community.

Ehrensaft said she is “astounded” at the high demand for services at UCSF’s Gender Center Clinic, which has 500 clients in its patient database. “There’s been such a desperate need for this,” she said.

“What we know really clearly now is that gender-expansive kids do a lot better when they have a wrap-around system of support,” she said.

At both the San Francisco and St. Louis clinics, adolescents have access to physicians, as well as psychologists, dermatologists, voice therapists, and plastic surgeons. Housing all of these services under one roof makes the provision of care easier and more comprehensive

As much as transgender youth face many of the same health issues as any adolescent, they are are at much higher risk of depression, suicidal thoughts, substance use, and homelessness compared to their non-transgender peers. Almost half of transgender or gender non-conforming youth aged 18-24 attempted suicide, according to the 2014 National Transgender Discrimination Survey, which is why doctors emphasize access to mental health services.

From January to May of 2017, Lewis and his colleagues have seen over 70 patients through their individual practices. They estimate that by the end of the year, they will see hundreds more through the newly opened clinic. Despite opening only one week ago, the facility is booked up until September.

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Treating transgender children and adolescents remains a controversial topic despite evidence that children are happiest and healthiest when allowed to express their true gender identity — well, as happy as any pubescent teenager might be.

The menu of medical services at the St. Louis clinic highlights some of the unique needs of transgender youth. The clinic provides puberty-blocking and gender-affirming hormones, including testosterone and estrogen, to qualified youth. The clinic will not, however, begin hormone therapy on anyone in prepubescence, instead recommending that they seek supportive counseling aimed at preventing depression and anxiety.

Lewis hopes that the clinic can not only be a medical resource for transgender youth and their families, but also a tool to foster awareness and dialogue about transgender issues in the medical community. He and his colleagues are planning to give lectures to medical students about transgender health and are developing an LGBT-education curriculum for doctors and medical students.

Though there’s still a great distance to go in providing adequate care to all transgender youth across the country, the medical community, Lewis said, is finally stepping up to meet the needs that exist in the transgender community.

With the opening of the clinic, transgender youth in St. Louis no longer need to drive hours for basic medical care provided by doctors attentive to their specific needs. And that quite possibly is improving — and saving — lives.

“More people are living their affirmed lives as they want to be and who they are,” said Lewis.

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