— The doctors and providers who are part of the Child and Adolescent Gender Care program at Duke University have seen a growing need for their services since they opened back in 2015.

The clinic is the first like it in North Carolina and serves both transgender children and teens, along with those with congenital medical conditions related to their reproductive system. Today, the clinic's patient population totals 300 between the ages of 5 and 21 - and there's a waiting list. It's booked until March 2019.

Considering the latest numbers on total transgender youth, the growth is no surprise. A 2018 study in Minnesota found that 2.7 percent of ninth and 11th graders surveyed identified themselves as transgender.

And, for many of them, it's not easy. The same survey found that

two-third of students who identified as transgender reported thoughts of suicide - three times more than their peers whose gender identity matches their biological sex.

one-third reported a suicide attempt - five times more than their peers.

More than one-third reported prejudice-based bullying about their gender - seven times more than their peers.

Studies also show these kids are at higher risk for anxiety and depression, said Kristen Russell, the clinic's clinical licensed social worker.

By the time they reach the clinic, along with their parents, they can be struggling. In one media interview, Russell said, a parent related that she'd "rather have a son than a dead daughter."

"In a lot of cases, that's what these parents are up against," Russell said. "They see their child suffering and what they've tried hasn't worked and they come to us seeking some support and help."

The clinic will offer a free screening Thursday of "Becoming Johanna," which tells the story of a teen's gender transition. The public screening starts at 6 p.m., Thursday, at the Duke University School of Medicine. It's intended for medical students and providers, but it also is open to parents, teachers and others who work with kids who may be LGBTQIA+ or gender nonconforming. The film's subject and its filmmaker will be at the event to take questions.

Ahead of the screening, I checked in with Russell to find out the common questions that she hears from parents when they first come to the clinic with their kids.

Just like their kids, many parents are going through their own journey as they come to terms with who their child may be.

"Their journey just looks very different," Russell said. "A lot of time, there's a disconnect between them. ... It's difficult for them to understand each other."

Here's what parents often ask when they visit the clinic.

What's next? What do we do?

In many cases, older kids and teens have been thinking about who they are for a year or more, but they've only come out to their parents three or six months before, Russell said.

"The child has had a long time to think and process and figure it out and come to the conclusion that this is who they are and now they are ready to come out and take the next step," she said. "But for parents, this is very jarring. They feel rushed. The patient has been thinking about this for two years. Asking them to wait for their parents to catch up is pretty difficult."

At the clinic, which provides a holistic approach to care that includes both physical and mental health services for kids and support for families, Russell hands out thick packets of information to answer parents' most basic questions. They include PFLAG's book "Our Trans Loved Ones," which you can find online.

Is this a phase?

Parents often ask Russell if this is something their child will just snap out of next year. Or, they'll tell her that "their friends are doing it" and it's just popular to be transgender right now. "I get that a lot," she said.

Teens do go through phases, she'll tell them. But they usually last a week or a few months - not two years.

"That's the difference," she said. "If it was a phase, it would be over by now."

"A lot of parents don't understand how difficult it is," she added - especially if the child is experiencing bullying or feels uncomfortable using the bathroom at school.

"This isn't something one chooses," she said. "Being transgender isn't a choice. What to do about it, those are choices. And those are very personal choices that vary from person to person."

What does this mean for my child in the future?

Parents often worry that their child won't be able to get a job in the future or that they won't be safe. They wonder how to tell friends and family or if they'll get used to using their child's preferred name and pronouns. They worry about things like where their child should go to school, what they should do about sleepovers and what sports team they'll join.

"They have a lot that they've taken on," she said. "They feel like it's thrust upon them. Some parents easily adjust because they have a mindset that is a little more flexible. And some parents have a really tough time wrapping their minds around it."

Information and education can help, Russell said, along with an acknowledgement that this can be a tricky path for both parent and child.

But, Russell said, it's important to note that once a child feels accepted for who they are, "that's when we see some changes and their mental health begins to improve."

What if they change their mind?

Parents of minor children must consent to any medications or procedures. Surgery typically happens after a teen turns 18, but gender-affirming hormones can help kids and teens who are ready to make a transition. Some of those changes, however, can be permanent. Once a transgender boy takes testosterone and his voice drop, it will remain lower even if he stops taking the hormones, for instance.

Parents ask, said Russell, "what if they regret their decision later and they blame me for it?"

Russell said few decisions are made quickly and none are made without regular visits with a mental health provider to determine a child's readiness.

"We don't have an agenda in our clinic," Russell said. "It really is up to the patient and their family in concert with their mental health provider to come to the conclusion, 'is this the right thing for me, the right time for me and the right method for me.' Not every patient wants hormones. We just want to remain flexible to each patient experience."