A practice that is trying to welcome these questions will have thought about what is communicated on the website, at the front desk, and on the forms to be filled in, as well as in the exam room. So parents should listen for the ways that questions are asked on intake forms and in initial interviews: “Are they asking questions in ways that allow somebody who is not straight and binary and cisgender to answer?” Dr. Sherer asked. “Do they understand that gay, straight, bisexual are not the only choices?” Look for doctors who ask open-ended questions, and who understand the diversity of child development, she said, and be wary of comments that “gender kids unnecessarily — are they giving a boy a He-Man sticker or letting him choose?”
Dr. Sherer cares for many families with transgender and gender-diverse children, some who have been in her practice since early childhood, and others who find her because she speaks and writes about this population. “I hear being transgender being talked about like it’s a disorder,” she said. “My transgender kids are some of the kindest, bravest kids I have.” She tries to model for parents how to help and support their children, while also handling their own emotions, which can be complex, she said: “There’s obviously a loss to the parent but it’s not a loss of their child — it’s a loss of who they thought the child was.”
For parents whose children are questioning their gender identity, “don’t be afraid to reach out to your pediatrician,” said Dr. Paria Hassouri, a pediatrician in Los Angeles who provides gender-affirming care, and who has written about her own experience as the parent of a transgender child. “Information is going to empower you to support your child and make decisions down the line.”
The proportion of adolescents who report that they identify as other than heterosexual has been going up. Dr. Patterson was the corresponding author of a commentary published in late May in the journal JAMA Pediatrics, which discussed recent data — in one survey, 14.3 percent of adolescents in 2017 claimed an identity that was “lesbian, gay, bisexual, other, or questioning,” up from 7.3 percent in 2009. The article argued that while greater societal openness may have encouraged more honest answers, these adolescents are still vulnerable to stigma, bullying and abuse, and consequent mental health problems. So a strong and supportive relationship with a medical provider can be really important in helping an adolescent navigate these years.
What to Expect From Your Pediatrician
Parents should expect pediatricians to promise adolescents confidentiality. But there are some situations — especially if the child is at risk of self-harm — where a doctor can’t promise confidentiality; we lay those out clearly with kids.
Parents should expect their children’s doctors to be trained in asking and answering questions about sexual behavior and sexual health, but also about issues of identification and identity.
With adolescents, we’re also asking about identity, self-image, body changes, mental health, friendships, academic performance, risky behaviors (smoking, drugs, alcohol) — the whole complex mix of adolescent activity and adjustment. When she’s talking to patients in the general pediatric clinic, Dr. Hassouri said, she starts by asking, “Do you feel comfortable in your body, how do you identify, what are the gender or genders of the people you are attracted to, rather than ‘Are you gay, straight or bisexual?’”