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THENPROLEANDTHETRANSGENDERADOLESCENT

KATHRYN REVELES PHD, DNP, APRN, CPNP-PC

DISCLOSURES

• Ihavenothing todisclose

• Iwillnot discuss offlabeluseof medications

DEFINITIONS(OBJECTIVE1)

• Biologicalor anatomical sex– phys icalanatomy

• Gender identity – internalized, deeplyfelt senseofbeing male,female, or neither

• Gender express ion– how weexternalize our gender

• Gender variance/gender nonconformity – behaviors/ interests that fallouts ide what is cons iderednormal for aperson’s ass ignedbiologicalsex.

• Transgender/Cross -gender – anindividual whosegender identity does not matchtheir ass ignedbirthgender

( Br ill & Pepper , 2008)

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HOWCOMMONISTRANSGENDER

• Some specialis ts estimateas manyas 1in500 children is s ignificantlygender-variant or transgender

• Maybe alowestimate

HOWDOYOUKNOWIFAYOUNGCHILDISTRANSGENDER?

• Most arevery clear

• Goes thru aphaseof ins is tingthey arethe oppos ite gender and thephase does not end

• Watchbathroom behavior

• Swimsuit avers ion

• Whattype of underpants do they select

• Strong des ire toplaywith toys typicallyass ignedto the oppos ite sex

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HOWTOSCREEN?

AskParents?• Child play,hair,&dress preferences/parent

concerns withthese

• Concerns with behavior, friends , bullying,anger,isolation

• Hear anys tatements like:

• “shetoldme in1st grade shewas aboy!”

• “sherefuses to wearadress to church”

• “hewanted to playthefemale role intheschoolplay”

AskPatient:• Do youfeel likeagirl?Boy?Both?

• Whatname or pronoun fits you?

• How would youliketodress or wear your hair?

• Do youfeel uneasyinyour body?

HEALTHCARENEEDS(OBJECTIVE2)

• Itis important to understand that expertise about transgender children is notbasedon academicdegrees , but onthe experiences and understanding ofindividual clinicians .

• Needto understand that sexualorientation andgender identity are separate parts ofcore identity.

PROVIDER’SROLE

• Examine yourown feelings ,attitudes , andbeliefs about gender

• Determine where the transgender patient is intheir trans ition

• Screen thepatient for anyphys icalormental health problems

• Assess theirsupport system

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PROVIDERREDFLAGS

• Discipline thegender variance out ofchild

• Do not permit or support their variance

• Child is tooyoung toknow their gender identity

• Youare wrong insupporting their natural gender express ion

WHATTODO

• UseChosenName

• Refer to as chosenidentity

• Usepronouns cons is tent withappearance

• Appropriate Documentation

HEALTHSCREENING

• Sexuallytransmitted infections

• Mental

• Sexualbehaviors

• Medication andsubstanceabuse

• Social,environmental, and culture

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PHYSICAL&MENTALRISKS

• Substance abuse

• Riskysexualbehavior

• Suicide

• Anxiety anddepress ion

• Disturbed body image

• Aggress iveness andviolence

• Anorexia/bulimia

• Phys icalandmental abuse

• Homelessness

• Conduct disorders

• Purchas ing hormones illegally

GUIDANCE:FAMILY&PEERSUPPORT(OBJECTIVE2)

• Essential

• Bullying

OPTIONS

• Psychologicalevaluation with anexperienced gender-affirming therapis t

• Medical treatment is basedon TannerStage andage

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DELAYINGPUBERTY

• GnRH inhibitors or analogues

• Shut down puberty

• Begin atTanner Stage2– do not makethem wait until16-17 years of age

• Maybe shorter than peers andappear younger

• Cognitive development delayed

• 1or 3month injections or yearlyimplant

• $500-$600/month andup to$15,000/year

CROSS-SEXHORMONES

• Stop the child’s puberty inthe wrong gender andallow them togo forward inpuberty inthe rightgender

• Typicallyat16years of age,but individualized

• Estrogen is giventofemale-identified teens tofeminize their bodies

• Testosterone is givento male-identified teens to virilizetheir bodies

• Injections weeklySQ,gels ,patches ,nasalsprays ,testosterone pellets

• Fertility

OTHERFACTORSTOCONSIDER

• Availability ofspecializedGDclinic

• Cost

• School

• Familydynamics/support

• Religion and/or culture

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LEGALISSUES

• Ifyou tellateen no…..

• Emancipated minors

• SylviaRiveraLawProject

RESOURCES

• http:/ /www.wpath.org

• http:/ / transgenderlawcenter.org

• http:/ /srlp.org

• https :/ /www.genderspectrum.org

• http:/ /safeschoolscoalition.org

• Brill, S.,&Pepper, R.(2008). The Transgender Child: AHandbook forFamilies andProfess ionals . SanFrancisco:Cleis Press ,Inc.