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Opinion and Commentary from TMA

Supporting Transgender and Gender-Diverse Teens

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This week is Global Teen Health Week, and today we are focusing on the health of LGBTQ (lesbian, gay, bisexual, transgender, and queer) youth and young adults, specifically the health of transgender and gender non-conforming (TGNC) youth. 

MongeGender is a core principle of self. Most teenagers identify as the gender that they were assigned at birth (known as “cisgender”), but some do not, and these teens identify as transgender or gender non-conforming (TGNC). 

It is difficult to know the exact numbers of teens who identify as TGNC, though current estimates are about 1 in 137 (0.7 percent) teens are transgender. Texas has the second-highest population of transgender teens in the United States. 

There are many unique needs of TGNC teens, and addressing them in a timely and supportive manner is often a life or death situation, because TGNC teens have much higher rates than other teenagers of depression, self-injury, anxiety, suicidal thoughts, and being the victim of bullying. As a matter of fact, 2 in 3 TGNC teens have seriously thought about suicide compared with only 1-2 in 10 of cisgender teens. 

Creating supportive environments in the home, school, and medical office can go a long way to improve the mental and physical health of TGNC teenagers. Transgender children who are allowed to live as their identified gender have rates of depression and anxiety that are almost identical to cisgender children. 

Transgender teenagers who have the support of their families have remarkably better life satisfaction; self-esteem; mental health, including decreased suicide attempts; and adequate housing, than transgender teens who do not have the support of their families.

Although it is difficult to know exactly what an individual TGNC teen may be struggling with, some common issues include:  

  • Fear of family or friend rejection;
  • Fear of bullying or personal safety;
  • Feelings of shame and guilt;
  • Not understanding what they are feeling or why they are feeling it;
  • Not having words to explain what they are feeling; and
  • Fear that the topic of gender is off-limits with their family or friends.  

Families may be struggling with thoughts such as:  

  • Is my teen safe?
  • What does my teen’s gender diversity mean about my parenting?
  • Is my child normal?  

Many aspects of TGNC teen lives are confusing and challenging for both the teens and their families, and physicians should be able to provide a supportive environment to help. 

Here are some examples of ways that doctor’s offices can be safe and supportive, and what families with TGNC teens should look for: 

  • Doctors, nurses, and staff use a teen’s chosen name and pronouns;
  • Willingness to learn and to be open about not having all the answers;
  • Robust family support to help the families support their TGNC teens;
  • Physical exams, often a big source of stress for TGNC teens, should be explained well in advance, including the exact body parts that need to be examined and the reason for doing the exam. The teen should be given a choice as to when the exam occurs during the visit; and
  • Willingness to advocate for TGNC patients and work with schools to help create supportive environments.  

Maria Monge, MD, is a pediatrician in Austin.