Gender-affirming care has been in the news a lot lately. But what does that mean, exactly?
In the October 2018 issue of Pediatrics, the American Academy of Pediatrics 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 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 (Raferty, 2018, para. 1)." In an interview with NBC news, Dr. Jason Rafferty, MD, MPH, Ed, FAAP, lead author of the statement, stressed that this does not mark a major policy change for the AAP but instead brings the AAP's policies more in line with current best practices.
According to a summary of the statement, “The AAP recommends taking a ‘gender-affirming,’ nonjudgmental approach that helps children feel safe in a society that too often marginalizes or stigmatizes those seen as different." “The gender-affirming model strengthens family resiliency and takes the emphasis off heightened concerns over gender while allowing children the freedom to focus on academics, relationship-building and other typical developmental tasks (Rafferty, 2018, para. 8)."
The AAP crafted its statement after a thorough analysis of the most recent data, which indicates that transgender and gender diverse young people suffer higher rates of depression, anxiety, eating disorders, self-harm, and suicide than their cisgender peers. One study in particular found that 56% of youth who identify as transgender have contemplated suicide and 31% have attempted suicide (Rafferty, 2018, para. 10).
These disparities stem from multiple factors, particularly bias and discrimination. Young people experiencing rejection and isolation due to bias and discrimination are also at increased risk of experiencing homelessness, physical violence and substance abuse.
That's why the AAP recommends developmentally appropriate care that is oriented toward understanding and appreciating a young person's gender experience. There is growing evidence 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 disparities that otherwise occur and allowing children and adolescents to flourish and thrive.
Kathryn Lowe, M.D., FAAP, a member of the AAP Section on Lesbian, Gay, Bisexual, Transgender Health and Wellness Executive Committee, became an advocate for transgender children based on her own experience witnessing the change that came over a young person when they were able to affirm their identity.
“It was an incredible experience to watch her truly blossom and come to life once her parents understood that she was transgender and allowed her to transition and live as her authentic self,” she said. “Seeing this (individual) go from struggling with depression and anxiety to being a happy thriving child is what inspired me to do all I can to support gender diverse kids as well as work to help build a society that also supports and affirms gender-diverse kids (Korioth, 2021, para. 17).”
The AAP's dedication to the health of all children, including transgender and gender-diverse youth, has led pediatricians 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)."
Read the AAP’s policy statement as presented in the AAP journal Pediatrics, along with its list of recommendations for parents and practitioners.
Take a look at pediatricians' response to recently proposed and enacted legislation in this recent issue of AAP News.
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 recent article published by the New York Times.
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
DeeWho 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 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.