For many pediatricians, the thought of providing care to children who live outside of gender norms is daunting. But it is time for the pediatric community to awaken to the realities of our world. We need to stand behind our gender-expansive and transgender children, because their well-being depends on it.
Under our current administration, we as the pediatric community have the opportunity to define our goals and our vision as a collective profession. We are being called to write our own values. Rather than perpetuate hate, we have the opportunity to affirm justice.
The American Academy of Pediatrics (AAP) recently released a sweeping, brand-new policy statement on the need for pediatricians to provide gender-affirmative care to transgender and gender-diverse (TGD) children and youth. It is comprehensive in its scope and offers a useful overview of where we are today.
Evidence shows that this population experiences high rates of depression, anxiety, self-harm and suicide. Further research demonstrates that TGD youth face significant stigma, discrimination and bullying. This population experiences high rates of homelessness, physical and sexual violence, and substance use. The reasons for these disparities are nuanced and multifaceted, stemming from the complex social circumstances and inequities.
One of the key implications of this policy statement is that the health care system itself — including health care providers themselves — still serve as structural and interpersonal barriers to care. According to a 2011 survey by the National LGBTQ Taskforce, nearly one in five transgender or gender-nonconforming people had been refused medical care based on their gender status. Twenty-eight of the people had chosen to skip an appointment while sick due to discrimination.
Though its recommendations are broad, the AAP statement could more strongly demand that future efforts be directed towards addressing the multiplicities of oppressions that TGD youth of color face. Families with a gender-expansive child likely face additional challenges if they are people of color, low-income, disabled, suffer from chronic illness, come families who immigrated to the U.S., etc. Working toward equity for the TGD community must align with our greater anti-racism and anti-oppression movements.
Part of moving forward means looking backward. It is well known within the LGBTQ community that medicine has a long history of inflicting harm. Even as visibility increases for queer and transgender individuals in America, people still do not feel safe. Patients still visit the doctor’s office in fear, if at all. As physicians, we enter the profession with the pledge to do no harm. If we, as doctors, are still perpetuating trauma and pain, we are not doing the job we promised to do.
We must understand this lineage of historical — and frankly, ongoing — trauma to enter this space and this work with humility. Trauma exists through personal experience as much as exclusionary policy. It exists through diagnosis. Not long ago, homosexuality was defined as a mental illness.Until only five years ago, “persistent cross-gender identification” was considered a mental illness. Physicians pathologize at every turn.
Including the voice of TGD children and youth themselves is crucial, both in research processes and through our media. As a cisgender woman, I recognize that part of my engagement in this work requires examining my own privilege. We each have our own gender narrative, whether it be related to how we viewed our bodies in adolescence or to the clothes we wanted to wear when we were growing up. Regardless of identity, the constraints of gender affect all of us.
Pediatricians have a unique opportunity to set a standard of justice and affirmation rather than discrimination and shame. We enter children’s lives at a point early enough to open pathways to leading entire lives that feel authentic to them. That kind of care is not only life-changing but life-saving.
Olivia Low is a pediatric resident.
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