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January 4, 2024

Gender Affirming Care is Compassionate Healthcare: “How to be an Effective Ally to Gender-Expansive Children and Youth”

by Stephanie Jones LSCSW, LCSW, MSW

As of June 2023, the state of North Carolina has chosen to ban gender affirming healthcare practices for trans and nonbinary identifying children and youth (HB 808). This means there are limited options to support children and youth in medically transitioning to more affirming gender identities through procedures such as top/bottom surgery, puberty blockers, and gender affirming hormone therapy, to name a few. The impact of limiting these individual’s access to medical care can have some detrimental repercussions for transgender, nonbinary, and gender-expansive children and youth in North Carolina, especially for their mental health. This population faces a set of unique challenges that significantly depends on the support, advocacy, and understanding of adults to provide access and resources to meet their needs.

Advocate for Better Health Outcomes for Youth

Perhaps the most compelling argument in support of promoting gender affirming practices in healthcare settings is because these practices are directly correlated with better health and mental health outcomes for transgender and gender diverse youth. In Heather Boerner’s article What the Science on Gender-Affirming Care for Transgender Kids Really Shows, she references how there have been several studies with gender-expansive youth who have thrived when they were presented with more healthcare choices (puberty blockers, counseling, etc.).

“According to the William’s Institute at the University of California, Los Angeles, a decade of research shows how [providing gender affirming care] reduces depression, suicidality, and self-harming behavior” in this unique population (Boerner, 2023). Additionally, there are ethical guidelines and protocols associated with the practice of demonstrating gender affirming care in healthcare settings through several reputable organizations such as the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, the Endocrine Society, the American Medical Association (AMA), the American Psychological Association (APA), and the American Psychiatric Association (Boerner, 2023).

There is Power in Language

I think one thing that has opened my eyes when working with youth in all stages of gender affirming care is recognizing my own privileges as a cisgender and responding to the nuances to providing whole-person care to this population. Cisgender privilege is endemic in our culture. I have cisgender privilege because I don’t have to worry about what bathroom I can go in or be excluded from sports and clubs based on my gender identity. I’m more aware that there are many misconceptions and confusions about this community that require constant clarification. The first place I usually start on the road to adult allyship is through education, awareness-building, and advocacy. Allies, advocates, and caregivers must develop a shared language around culturally sensitive key terms to consider if a child or youth comes to you and has questions or requests resources. (FYI, terms are not limited to this list only).

Part I: Definitions

Sex: The biological attributes with physiological and physical characteristics such as hormones, reproductive organs, gene expression, and chromosomes. It is usually categorized as male or female but can also include other categories such as intersexed.

Gender: Socially constructed roles, behaviors, and expressions that validate how someone presents to the world. This is usually as man or woman but can also include other categories like non-binary or gender queer.

Cisgender: When a person’s gender identity matches with the sex given to them at birth.

Non-binary: This is a term meant to describe individuals who do not fall into the categories of man or woman. In this culture the gender binary is compulsory, however, individuals often prefer to express identities in many ways.

Gender Dysphoria: When a person experiences psychological distress and an overall disconnect from the gender and/or sex they were assigned to at birth.

Gender Identity: Examples include identifying with the genders of man, woman, or nonbinary.

Gender Expression: The socially constructed way individuals express gender in their societies.

Other terms like gender fluid, gender non-conforming, gender queer, and gender expansive are some other terms used to describe the vast diversity of gender-related identities. (PFLAG Glossary of Terms:

Part II: Transitions

Social Transitions

When someone transitions there are adjustments, they have in relation to their social environment where family members, friends, and employers are encouraged to meet individuals where they are at.  Some examples include when individuals change their appearance to their hair or dress to changing their preferred pronouns or name they prefer to be called.

Legal Transitions

Changes to their legal name from the one given at birth such as on DMV licenses, certifications, school forms, or birth certificates.

Medical Transitions

Procedures such as puberty blockers, medical surgery (top or bottom surgery, etc), and gender-affirming hormone therapy are just a few medical options that have been taken off the table in North Carolina specifically. Just to be clear, individuals may opt in or out of having surgeries but may still identify as trans or non-binary.

Part III: What Can We Do to Support Better Outcomes?

Meet children and youth where they are at

When developing a common and more inclusive shared language, it’s also important to consider cisgender bias and challenge gender normative assumptions about what’s considered “normal” adolescent development. I usually ask parents to reserve judgments because as humans we are quick to label things we cannot understand. I usually validate parents with a lot of questions and encourage them to sit with the emotions of both confusion and love. Usually if we are coming from a place of love and compassion, we can then more readily access the validation, acceptance and reassurance every child and teen needs to feel whole.

Practice radical acceptance

Dr. Caitlin Ryan cites in her research in the development of the Family Acceptance Project that there is a direct correlation between family acceptance of Lesbian, Gay, Bisexual, and Transgender (LGBT+) youth and youth having better healthcare outcomes longitudinally. Ryan states “Research findings that show the critical role of family acceptance and rejection – and earlier ages of coming out – call for a paradigm shift to serve LGBT children and adolescents in the context of their families.” Ryan’s research indicates that family acceptance is a protective factor against depression, suicidal behavior, and substance abuse and it can promote healthy self-esteem development, social support, and overall health (Ryan, 2011).

In conclusion, whether you are a caregiver, healthcare worker, or in the LGBT community and need support education and awareness is the paramount.   Transgender, nonbinary, and gender-expansive youth need support around acquiring better access to healthcare and a robust service array of adequate resources to improve their health outcomes. Hopefully around the clock advocacy and allyship can lead to better healthcare and outcomes for this population in the state of North Carolina. Please refer to the resource guide below.

Resource Guide

  • Boerner, Heather. What the Science on Gender-Affirming Care for Transgender Kids Really Shows, Laws that ban gender-affirming treatment ignore the wealth of research demonstrating its benefits for trans people’s health. May 2nd, 2023.
  • LGBT National Help Center offers confidential peer support connections for LGBT youth, adults and seniors including hotlines, text and online peer chat.
  • PFLAG Glossary of Terms:
  • Ryan, C., & Diaz, R. (2011). Family Acceptance Project: Intervention guidelines and strategies. San Francisco: Family Acceptance Project. Ryan, C., & Monasterio, E. (2011).
  • Substance Abuse and Mental Health Services Administration. (SAMHSA). (2012). Top health issues for LGBT populations information & resource kit. HHS Publication No. (SMA) 12-4684. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  • Trans Lifeline is a 24/7 grassroots hotline and microgrants 501(c)(3) non-profit organization offering direct emotional and financial support to trans people in crisis. It is the first transgender suicide hotline to exist in the USA/Canada and is also the only suicide hotline whose operators are all transgender or non-binary.
  • The Trevor Project is a support network for LGBTQ youth providing crisis intervention and suicide prevention, including a 24-hour text line (Text “START” to 678678).
  • Wilber, S. (2013). Guidelines for managing information related to the sexual orientation and gender identity and expression of children in child welfare systems. Oakland, CA: Putting Pride into Practice Project, Family Builders by Adoption.

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