Even before a child is born, parents learn their baby's sex, sometimes throw a themed party to announce it to friends and family, and then expect this child to conform to social gender norms after birth. But for an estimated 0.7 percent of young people, the gender they identify with is not the one they were born with.
Gender diversity is a controversial topic that can be uncomfortable for parents, so the American Academy of Pediatrics (AAP) is stepping up to better support transgender and gender diverse (TGD) youth and their families.
Why the need for a new policy
In a new policy statement published this month, the AAP gives evidence-based direction to medical professionals who might have barely covered this topic in medical school, if at all. It's happening now because TGD young people and their parents are increasingly coming to their doctors for the care, guidance, and advocacy that can help them grow up mentally, socially, and physically healthy.
"The is the first-ever policy for pediatricians and other healthcare providers on gender-affirming care," says Cora Collette Breuner, M.D., MPH, FAAP, of Seattle Children's Hospital, who is one of the authors of the statement. "It's a guide for pediatricians to help their patients and families."
The AAP is also taking a stance against intolerance, discrimination, and marginalization of TGD youth. Research shows TGD people have an increased risk of anxiety, depression, substance abuse, self-harm, and suicide—and this is not an inherent result of being TGD. They are subject to high rates of bullying, harassment, and even physical violence. The stigma they experience can be so distressing it leads to a psychological condition called gender dysphoria, in which the internal conflict about their gender affects relationships, school performance, and daily functioning.
"These kids and families need support," Dr. Breuner says. Studies show a lack of support doesn't change TGD people's gender identity, but it does negatively affect their well-being. On the other hand, gender-affirming care reduces those risks, Dr. Breuner says.
Pediatricians who follow the AAP's "gender-affirmative care model" (GACM) can help TGD young people and their families work through any issues they're experiencing, and offer a supportive, nonjudgmental environment to address questions and concerns. In addition, TGD youth may eventually need a doctor's guidance for gender-affirming medical interventions. "There are resources in this statement available to help parents and health care practitioners so that ultimately we have happy and healthy children, teens and families," Dr. Breuner says.
What does it mean to be transgender or gender-diverse (TGD)?
Doctors, as well as parents, previously might not have even had the proper language to describe and understand what being TGD means, so the new policy also clarifies that. "Natal gender" or "sex" describes the gender assigned at birth based on anatomy. "Gender identity" is the internal sense of what gender a person is, and can also be a combination of both genders or neither.
Those who are "cisgender" identify with their natal gender; those who are "gender diverse" may not. Gender-diverse is an umbrella term for all the many ways gender can be identified; "transgender" is a subset of those whose gender identity consistently over time doesn't match their birth sex.
Parents should note that this is separate from sexual orientation, which is the gender a person is sexually attracted to. Gender identity develops before puberty and is really about self-perception and self-expression. Even young children can have a gender identity that's different from their natal gender; it simply has to do with how they see themselves.
Accepting children for who they are
If you think your child may be TGD, Dr. Breuner advises talking to them about it. "Ask the child—they know," Dr. Breuner says. "And if they aren't sure, they will tell their parent that, too." You can also have a frank conversation with your pediatrician to make sure they'll be supportive and are aware of the AAP's new policy—and if not, find a new doctor who is. "Ask the clinics if they provide gender-affirming care," Dr. Breuner advises.
Being the parent of a TGD child is understandably scary and can be hard to wrap your head around. It challenges long-held notions and possibly even religious beliefs. But from a medical standpoint, which has been well-researched and scientifically examined, the AAP asserts that it's in a child's best interests to receive gender-affirming and supportive care from their family and doctors. In addition, the AAP is striving to work with schools, policymakers, insurance companies, and communities to recognize the unique needs of TGD youth.