Daniel Summers is a pediatrician in New England. He writes about medicine and LGBTQ issues.
No medical provider likes to confront the thought of having failed a patient.None of us are perfect, and any honest one of us can think of situations where we missed a diagnosis, should have communicated better, or simply didn’t deliver care as best we could have. It’s not a comfortable place to dwell, but acknowledging where things went wrong is a necessary part of learning how to do better.
When it comes to trans kids, I worry there may be patients I am failing. I worry that I don’t even know when I am failing them.
In August, the St. Louis Children’s Hospital opened a clinic dedicated solely to the comprehensive medical needs of trans children and adolescents. St. Louis is the closest major city to the small town in Missouri where I grew up, and when I read the news I was happy to think about trans kids in my own hometown having a place to access expert specialty care. But before they arrive at a specialty clinic, the care of most trans kids will begin with a pediatric generalist like me, and many may not have feasible access to specialty care at all.
Are general pediatricians doing enough to recognize and treat their trans patients?
All too often, the answer is an easy and obvious “no.”
“We switched pediatricians because our previous pediatrician told us it was not a good idea to ‘let her think she could be a girl,’ ” Ari Moffic told me. Moffic is a Chicago-area rabbi and mother of two children, one of whom is an 8-year-old trans girl.
“This pediatrician,” Moffic said, “had never heard of the term ‘social transition’ ”—a process during which trans people adopt the name and pronouns of their gender identity, often with changes in outward presentation like hairstyle and clothing. “She had no resources to offer us,” Moffic continued. “We saw a psychologist who told us to let her wear pink under her ‘boy clothes’ and to remind her that we all have to wear uniforms of sort. She said we could buy a Barbie, but not the Dream House so as not to encourage her gender nonconformity.”
Every trans and gender-nonconforming child deserves better care than this. The American Academy of Pediatrics has issued strong statements in support of transgender children and youth and contributed to “Supporting and Caring for Transgender Children,” a set of guidelines published last year.
“Reparative therapy attempts to ‘correct’ gender-expansive behaviors, while delayed transition prohibits gender transition until a child reaches adolescence or even older, regardless of their gender dysphoria symptoms,” the 2016 document reads. “While researchers have much to learn about gender-expansive and transgender children, there is evidence that both reparative therapy and delayed transition can have serious negative consequences for children.”
It may be true that not all gender-nonconforming children are trans, and medical interventions for one may not be appropriate for all. But it is also true that not all trans kids are gender-nonconforming, and by failing to recognize that we are likely failing to help some kids who need it, with both short- and long-term consequences. Our obligation is to meet all our patients’ needs as best we can, not just those needs that are unambiguous, or comfortably within accepted social norms. If we do not make an effort to investigate the needs of trans kids who present as gender conforming, we are never going to be able to help them.
Living as a trans person in a transphobic society requires a great deal of courage. Surely trans and gender-nonconforming patients are entitled a measure of courage from their medical providers, which we can demonstrate by striving to destigmatize questions about gender development. If pediatricians won’t work to change transphobic norms on behalf of our patients, who within the medical community will?