







Tailored healthcare ensures a healthy, holistic transition

by Dr. Peter Bustamante IV, Child and Adolescent Physiatrist; Dr. Jennifer Feldmann, Assistant Medical Director of Pediatrics and Adolescent Medicine; Kristin Dupeire, LCSW, Senior Director of Social Services; Ciandra Jackson, Director of Communications, Legacy Community Health

At birth, our sex is assigned immediately. From that moment on, society sees us as a member of either the blue or pink team. But for some, the body presented at birth does not match the internal, personal sense of feeling like a boy or a girl.

With increased support from society, more transgender people have come forward to share their stories of hope and advocate for equality in areas such as the workplace, marriage, and healthcare. When Laverne Cox from Orange Is the New Black exhibited extraordinary acting abilities, audiences applauded her talent and appreciated storylines focused on the experiences of a transgender woman.

Not only is the world beginning to listen to the voices of transgender adults, but society is hearing an echo from transgender adolescents and their families, expressing their desire for compassionate, excellent healthcare services.

What does it mean to be transgender?

It is difficult to truly define what it means to be transgender. Traditionally, it means a person’s gender identity is not aligned with their birth sex; however, our culture continues to expand the language used to discuss gender, such as gender nonconforming (individuals whose gender expression is different from society’s expectations related to gender), gender fluid (individuals who feel like a mix of the two traditional genders, but may feel more male some days and more female other days), or genderqueer/nonbinary (individuals who identify as neither entirely male nor entirely female). This growing list reflects an understanding that gender is not only male or female, but is expressed and understood in many ways, even at a young age. Whether a person identifies as gender fluid or decides to reassign their gender completely, they should have the basic human right of access to knowledgeable healthcare.

Michael’s story

For as long as Michael (name changed to protect his privacy) can remember, he felt like a boy. “I was forced to wear dresses, and I ripped them off constantly,” Michael says. “At three years old, my family did not think much of my behavior, but I knew, even at that age, something was different. By the time Michael was eight years old, he started to feel angry and confused. “My family did not understand my turmoil and they began to see me as messed up because I wanted to be a boy,” he says. “My family would say, God does not make mistakes, and it was his will for you to be a girl.” This constant message from Michael’s family instilled the idea that he was indeed a mistake and not worthy. As Michael reached puberty, feelings of self-hatred increased.

At age 12, he was sexually abused by a close family member and was admitted to multiple mental institutions. “The abuse was a tactic to ‘straighten me out.’ Also, my family and some doctors truly believed I was sick and needed to be cured,” Michael says. “I feel this caused more self-hatred because I was made to feel abnormal and, personally, I could not explain why I identified as a boy.”

Throughout Michael’s teenage years, he experimented with drugs and suffered from self-harm. He also succumbed to the wishes of society and his family and attempted to dress and act feminine.

Entering adulthood, Michael decided to change his life and seek help and guidance. “In my early 20s, I started to truly understand what it meant to be transgender. Before my transition, I looked like a masculine female, but I still was not my authentic self,” he says. Life changed at 26 years old when Michael met his first transgender person. From that point on, Michael began to better understand his true gender identity. By conducting research, asking questions, and seeking compassionate physical and mental healthcare, Michael not only changed his gender, but changed his entire life for the better. “Before treatment, I actively attempted to end my life. If not for my personal doctors and their acceptance, I would have been gone.”

When asked about younger children identifying with a gender opposite from their birth sex, Michael firmly states that parents must listen to their children and seek help early. “I can confidently say that 99 percent of the trauma I experienced could have been prevented if I had access to compassionate healthcare before puberty.” When asked if he is happy now, Michael says not yet. “I am working toward happiness. I have been through a lot, but now I have self-acceptance, and my existence is justified.”

Transgender youth face challenges

Unfortunately, Michael experienced many traumatic events during his journey to discovering his true self. Still to this day, many young people who are exploring their gender are unable to access information, healthcare, or even a support system.

Many gender-nonconforming youth face the challenge of creating a healthy sense of self because of limited exposure to positive role models across the gender spectrum. Fortunately, society is becoming more open-minded. When President Obama addressed the nation during his most recent State of the Union, he declared that America shall not condemn women, religious minorities, or people who identify as lesbian, gay, bisexual, or transgender. His statement marked the first time a president used the word “transgender,” which publicly affirmed the trans movement.

Although society is more accepting of transgender people, we still have a long way to go, especially when a young child asserts a gender identity different than their birth sex. Just like Michael, these children are oftentimes pushed to accept their birth sex as their gender, which can lead to confusion and feelings of rejection. Chronic stress and persistent messages of rejection can provoke shame, anxiety, depression, and thoughts of suicide.

According to studies from the American Foundation for Suicide Prevention and the Williams Institute at UCLA School of Law, trans people are at an extremely high risk of attempting suicide, especially if they are victims of rejection, discrimination, and physical assault. Also, as it relates to drug addiction, the Center for American Progress reports that an estimated 20 to 30 percent of gay and trans people abuse illicit substances, compared to about 9 percent of the general population.

Although the statistics are upsetting, the reality of the situation presents an

opportunity to learn more and better understand gender health, while instilling a sense of hope and optimism among transgender youth.

Specific healthcare needs for transgender youth

In addition to general pediatric and adolescent healthcare, these youth have needs specific to their gender health. Healthcare providers approach care based on age and physical development stages. Providers typically see children up to 12 years old as being more curious about their bodies and gender identity. This can be a passing period, but it is helpful to avoid the message that nontraditional gender expressions are undesirable.

Family support is extremely important for those children who consistently identify with a gender different from their birth sex. Education and strengthening the family bond is the main focus. Providers usually recommend that families participate in counseling in order to better interpret a changed family dynamic. Overall, during this period, children need to feel loved and accepted.

The puberty years, ranging from eight to 14 years old, are often very distressing for adolescents, especially if they are exploring their gender identity. At this point, healthcare providers will intervene to halt the progression of puberty. Medical intervention is done by administering puberty-blocking medication that delays unwanted physical changes such as breast development and menstruation for girls and voice changes and facial hair for boys. The medication is not harmful, and puberty will commence as normal if the intervention is stopped.

Puberty-blocking intervention can be a relief for a young person, because they are able to explore their gender identity and develop the understanding needed to consider permanent gender reassignment.

As an adolescent grows into adulthood, their sense of self is more stable and clear. From 13 to 18 years old and beyond, those who continue to identify in a gender different from their birth sex will probably maintain this identity throughout life. From then on, healthcare providers help trans youth begin hormone therapy to transition the body to match their internal gender identity. Hormone therapy can be administered as early as 14 years old. With younger adolescents, hormone therapy is delivered slowly over a three-year period to match the outward changes of their peers. In order to maintain the physical changes, these youth must maintain hormone therapy for life.

Regardless of whether gender reassignment takes place at 15 years old or 18 years old, it is imperative for trans youth and their families to seek medical care in a safe, nonjudgmental environment.

A place of their own

Once children assert themselves to be gender nonconforming, where do parents go for support and resources? Access to transgender healthcare is not mainstream. Furthermore, when a young person transitions to another gender, whom do they turn to for mental-health needs or social services?

Legacy Community Health has a rich a history of providing progressive, culturally competent care to all individuals. To address the emerging needs of transgender youth, Legacy recently launched a practice especially for them. The providers consist of an adolescent medicine specialist, an internal medicine specialist, an OB/GYN, and pediatric and adult psychiatrists who are all specifically trained to treat transgender/gender-nonconforming youth. Through this broad array of invested team members, Legacy is able to provide holistic care that addresses medical care, home needs, and school challenges. These providers are committed to helping youth and families through the process of self-discovery, acceptance, and excellent health and well-being.

Exploring gender identity is very complex. Legacy is proud to have a collection of providers and staff dedicated to promoting healthy gender development and expression. Legacy’s providers want these youth to see the agency as a home where they feel empowered, safe, and valued.