MetroDoctors Guest Post: Angela Kade Goepferd, MD
Angela Kade Goepferd (they/them), MD, is the Chief Education Officer and Medical Director of the Gender Health program at Children’s Minnesota.
Angela Kade Goepferd, MD | LinkedIn
Access to Gender Affirming Care Saves Young Lives
As our society gains more understanding and language around gender identity, gender expression and sexual identities, the number of Minnesota youth who identify as transgender, gender diverse or a member of the LGBTQ+ community has grown. According to the 2022 Minnesota Student Survey, approximately 11% of students in 8th grade or higher identified themselves as transgender, genderfluid, nonbinary, two spirit, unsure or didn’t answer the question. The majority of the responding students, 63%, reported long-term mental health, behavioral or emotional problems due to societal stigma. What these data tells us is that in order to optimize outcomes for transgender and gender-diverse youth, and help them thrive, trans youth and their families need a safe and accepting place to have their questions answered by an expert in gender affirming care, e.g., a provider who has, at a minimum, a good baseline understanding of how gender identity develops in children or youth and can advise them on issues from social transition, school advocacy, medical help with puberty suppression and medical help with transition-related care. Indeed, transgender and gender-diverse youth deserve specialized health care tailored to their needs, just as any other child with a specialized healthcare need such as asthma, diabetes or otherwise, would seek expert care to optimize their health outcomes.
What we do in the gender health clinic
A glossary of commonly referenced terms can be found at: Language of Gender - Gender Spectrum).
Guided by our commitment to equity and inclusion and advancing health care for all kids, Children’s Minnesota launched its Gender Health program in the spring of 2019. Our clinic provides a supportive environment for children and families to ask questions to healthcare professionals who specialize in the care of transgender and gender-diverse youth. Questions can range from how to address bullying in school, to how parents or caregivers can support their child who may be exploring their gender expression and/or gender identity. Like other specialized medical care, gender-affirming care is supported by evidence-based research and the expert opinion of every major medical society in the United States, including: the American Academy of Pediatrics, American Psychological Association, CDC and Society for Adolescent Health and Medicine.
Our approach to transgender and gender-diverse kids includes understanding and supporting the whole child within the context of their family and community, which includes understanding both their medical as well as their mental health needs. Our Gender Health program is an integrated care model, mirroring best practice as defined by the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) version 8, where each new intake into our program includes both mental health and medical assessments. Our multidisciplinary care team works together with patients and their families to make care decisions that are tailored and unique for each individual. We offer patients gender consultation and developmentally-appropriate treatment, which can include puberty suppression, menstrual suppression, voice therapy, gender affirming hormones, and fertility preservation.
The case for gender-affirming care
No two children are alike. Each has their own unique needs, especially when it comes to the health care they receive. This is particularly true for transgender and gender-diverse youth, who have healthcare challenges that are distinct from their cis-gender peers.
Even before the COVID-19 pandemic, research reveals that transgender and gender-diverse youth are at a higher risk for depression, anxiety and suicide compared to their cis-gender peers. They often face significant discrimination in their daily lives in the form of bullying, harassment and sometimes violence. The discrimination is worse for transgender youth of color. Furthermore, several states in recent years have passed anti-LGBTQ policies that go as far as restricting or criminalizing gender-affirming care. The harms caused by these policies go beyond the legislation. Research has shown that transgender youth living in states where legislation is introduced that seeks to ban transgender youth from competing in sports or accessing health care or public or school-based bathrooms, makes them feel stigmatized and contributes to an increased rates of depression, anxiety and suicidality.
Transgender and gender-diverse youth also face challenges when seeking health care. They may be misgendered, lack insurance coverage or even refused treatment. They may see a provider who asks invasive questions about their personal lives or has limited knowledge about transgender health.
Furthermore, health care that is not gender affirming, such as reparative or conversion therapy, is harmful to transgender and gender-diverse youth, and for this reason has been outlawed in many states and cities. The practice has also been denounced by every major medical and scientific association.
A research brief from The Trevor Project found that access to gender-affirming medical care can decrease behavioral and emotional problems, and has positive effects on body image and overall well-being while reducing thoughts of suicide.
The evidence is clear: gender-affirming care can be life saving for transgender and gender-diverse kids. These patients and their families do better when they receive access to healthcare professionals who see them, hear them, and believe them.
How to support transgender and gender-diverse patients
Talking Pediatrics is a clinical pediatric podcast by Children’s Minnesota.
As health care strives to become more equitable, inclusive, and accessible, we need to remember that transgender and gender-diverse kids and families need advocates and allies. These efforts need to extend beyond gender health clinics to all points in their healthcare journey, from primary care to community health.
There are several steps healthcare professionals and healthcare systems can take to provide more equitable and inclusive care to our transgender and gender-diverse patients.
Practice gender-inclusive pronouns. In 2021, the American Academy of Pediatrics (AAP) released guidance called Words Matter to address the use of anti-biased and inclusive language to help promote diversity, inclusion and equity. In addition to gender and gender identity, the guidance includes tips for when talking about disability, race and ethnicity.
Review your patient intake forms, policies and procedures to make sure they are trans inclusive. Create space for patients to give their pronouns and gender identity. Ask inclusive questions about dating and sexual health practices. And most importantly, first impressions matter. Ensure that your scheduling, front desk and patient rooming teams know how to inclusively welcome and refer to transgender and gender-diverse patients to avoid using the wrong name and misgendering them.
Develop your understanding of the unique healthcare needs and challenges faced by transgender kids. Seek out Grand Rounds or medical journals about care for transgender patients. Check out Children’s Minnesota Education and Training resources as well as the Talking Pediatrics podcast, a clinical pediatric podcast by Children’s Minnesota.
Follow the local issues in your community’s schools and at the state legislature and advocate for the rights and protections of transgender and gender-diverse youth and adults.
Health care has made significant progress when it comes to the health and wellness of LGBTQ youth. However, the work is not done. Listen to patients and their families so that you can respond to and provide the care they deserve. Seek out the advice from the experts on your staff and in your community about what inclusive and equitable care looks like. All kids deserve access to inclusive and affirming health care, including and especially transgender and gender-diverse youth and their families.