Gender affirming care
Gender affirming care has been in the news a lot lately. So what does the American Academy of Pediatrics (AAP) have to say about it?
In the October 2018 issue of Pediatrics, the AAP issued its first-ever policy statement on the care and support for transgender and gender-diverse youth. In that statement, the AAP took an official stand against some of the legacy practices such as “watchful waiting” — hoping the child grows out of so-called gender confusion — and conversion therapy — the process of trying to push a child toward a more socially acceptable identity. Instead, the AAP issued its support for a gender-affirming approach that focuses on “promoting the health and positive development of youth that identify as transgender or gender diverse while eliminating discrimination and stigma (AAP, 2018)." In an interview with NBC news, Dr. Jason Rafferty, MD, MPH, Ed, FAAP, lead author of the statement, stressed that this did not mark a major policy change for the AAP but instead brought the AAP's policies more in line with current best practices.
The 2018 policy statement further defined the gender affirmative model of care (GACM) as an integrated approach combining medical, mental health and social services as well as resources and supports for parents and families. "Providers work together to destigmatize gender variance, promote the child's self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender" (AAP, 2018).
The AAP crafted its statement after a thorough analysis of data indicating that an affirmative model of care, coupled with family acceptance, contributes to increased mental and physical wellness among transgender and gender-diverse young people, helping to reduce the significant risk factors and health disparities that otherwise occur and allowing children and adolescents to flourish and thrive.
Since that time, care for transgender and gender diverse youth has become highly politicized, with more than two dozen state legislatures proposing legislation to prohibit gender-affirming care for minors. The AAP's dedication to the health of all children, including transgender and gender-diverse youth, has led the organization to come out strongly against legislation aiming to ban gender-affirming care for young people. "Politics has no place here," declares AAP CEO Mark Del Monte, JD. "These are individual conversations between clinicians, patients and families about what's best (Korioth, 2021, para. 4)."
In 2023, the AAP affirmed the 2018 policy statement and authorized development of an expanded set of guidance for pediatricians based on a systematic review of the evidence, while reiterating that the AAP--like other major medical organizations — including the American Medical Association, the American College of Obstetricians and Gynecologists and the World Health Organization — continues to support providing transgender adolescents access to the health care they need (Wyckoff, 2023).
Featured Content
Read the AAP’s policy statement as presented in the AAP journal Pediatrics, along with its list of recommendations for parents and practitioners.
Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents
Take a look at pediatricians' response to proposed and enacted legislation relating to gender-affirming care in this issue of AAP News.
Pediatricians say state bills would harm transgender youths
Doctors treating transgender and gender diverse youth are in agreement on the importance of an affirmative model of care, but there are debates within the medical community over when to provide hormones or surgeries. You can read about the perspectives on both sides of these debates in this article published by the New York Times.
Doctors debate whether trans teens need therapy before hormones
References:
Fitzsimons, T. (2018, September 17). Pediatric group recommends 'affirmative care' for transgender youth. NBC News. https://www.nbcnews.com/feature/nbc-out/pediatricians-group-recommends-affirmative-care-transgender-youth-n910451
Ghorayshi, Azeen. (2022, January 13). Doctors Debate Whether Trans Teens Need Therapy Before Hormones. New York Times. https://www.nytimes.com/2022/01/13/health/transgender-teens-hormones.html
Green, Amy E., et al. (2021, December 14). Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. Journal of Adolescent Health. https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext
Johns, MM, Lowry, R, Andrzejewski, J, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students. MMWR Morb Mortal Wkly 2019; 68: 67-71. https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a3.htm
Korioth, Trisha. (2021, March 9). Pediatricians say state bills would harm transgender youths. AAP News. https://publications.aap.org/aapnews/news/12780
Rafferty, J., AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. (2018, October). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4). https://pediatrics.aappublications.org/content/142/4/e20182162
Wyckoff, Alyson Sulaski. (2023, August 4). AAP reaffirms gender-affirming care policy, authorizes systematic review of evidence to guide update. AAP News. https://publications.aap.org/aapnews/news/25340/AAP-reaffirms-gender-affirming-care-policy
Dee
Who is Dee?
Gender Identity
Our core sense of who we are as a man, a woman, a mixture of both, or neither.
Gender Expression
How we show up in the world through choices like clothing, hair style, mannerisms or tone of voice.
Attraction
How we feel toward others sexually, romantically and/or emotionally.
Biological Sex
Physical attributes such as reproductive organs and genitalia, chromosomes, genes and hormone levels.
Explore More
Explore groundbreaking research that examines the impact of gender-affirming hormone therapy on the mental health of transgender and nonbinary young people.
Read this report from the CDC about the experience of violence and other risks faced by high school students who are transgender.