Helping teens navigate gender confirmation options

People often comment on how far our society has come over the past decades in terms of reducing discrimination and raising awareness of marginalized groups. But parents of transgender teens know we still have a very long way to go. And while these parents may worry about how the outside world will treat their children as they grow older, those who have taken the time to understand their children’s plight also worry about how best to support them. themselves.

Especially when it comes to gender confirmation options.

What medical options are available for adolescents?

Dana M. Cea is a licensed clinical mental health counselor and LGBTQ + advocate who uses his pronouns. She explained that the first medical option available to most transgender teens is puberty blockers, drugs designed to stop hormones that usually rise around puberty.

“The next step would be gender-affirming hormones,” she said, referring to hormone replacement therapy.

And the last step? Gender affirming surgeries. But not all teens have access to these last two options.

“The age at which adolescents can receive gender-affirming hormones and surgeries depends on the country and, in the case of the United States of America, also depends on the state,” Cea explained.

The legal arguments pros and cons of hormones and gender-affirming surgeries are long and complicated, with different states drawing different lines as to what they are willing to allow. Different clinics also draw different lines, even within the same state.

Loren Schechter, medical director of The Weiss Memorial Hospital Gender Confirmation Surgery Center, recently said, “It is important to recognize that we do not perform surgery on children. However, there are surgical options for adolescents.

He explained that the most commonly used surgery for transgender teens is thoracic male surgery.

“So mastectomy for transmasculine adolescence,” he explained, adding that at age 17, a vaginoplasty (surgery to build or repair a vagina) can also be done.

“These would be the two most common procedures, but chest surgery is by far the most common,” he said.

Decide what is best for your teenager.

According to Schechter, he could write an entire book based just on the questions families have when considering gender confirming surgery for their teenager.

“It’s a decision that is usually based on a multidisciplinary review, usually with healthcare professionals, pediatricians, parents and surgeons,” he said.

In other words: it’s not a decision parents should make on their own, and there are plenty of opportunities to ask questions along the way.

“It’s hard to pin down specific issues because there are so many at different stages of the process,” he said. “These are usually very thoughtful decisions that come after a lot of discussion and work with the multidisciplinary team.”

For him, he said the most important question really becomes: At what point in this person’s life would surgery be the most appropriate course of action?

“Preserving fertility is also an important aspect of care that must be considered if patients are to do this,” he said.

Cea agreed, explaining that parents really need to remember that the most important thing to keep in mind is their individual teenager and that child’s needs.

“Some transgender teens may not want gender affirming surgery,” she said. “For other transgender adolescents, gender affirmation surgery can save lives.”

She does not speak in hyperbole: research found that transgender people who have access to gender-confirming surgeries are significantly less likely to experience psychological distress and suicidal thoughts compared to their peers who do not have the same access.

The importance of parental support

None of these decisions are allowed to be made by adolescents. In the case of gender-affirming hormones and surgeries, parents need to be on board.

“Because parental or guardian consent is required, ideally we have both parents and the individual as well as the health care team all on the same page,” Schechter said.

Most clinics working with transgender youth aim to keep this in mind and help everyone involved reach that common ground.

“A lot of the job is helping the person, helping the parents make the decision that is most appropriate for the person, and getting everyone on the same page,” he said. “It’s essential that I have a supportive environment, and that means it’s very important that parents support me. “

This supportive environment is not only important for the medical team, but it is also extremely important for the adolescent.

Cea explained, “Adolescents generally need a supportive and assertive space to discuss their gender-affirming care decisions. They are also likely to need help accessing gender-affirming care providers and coverage.

It’s not just about consent: transgender teens also need to know that their parents see and understand them as they navigate these life-changing decisions themselves.

I think it’s about working collaboratively with the healthcare team and making good healthcare decisions, ”Schechter said. “Then if people decide to have surgery, they have support.”

But, he added, this support must go beyond the clinical space. “It’s important that they are supported emotionally, mentally, financially, physically… really in every way. And that is why we have lowered the age at which we perform these surgeries, recognizing how important it is for the person to have the support of their parents.

By involving parents in the decision-making process, they are often able to get the education they need to know how far these surgeries can be confirmed.

There is another way for parents to help their teens through this process, according to Cea. “Teens may want to talk with other transgender folx who have had gender affirmation surgeries. Parents can support them by connecting them with resources while also contributing to adolescents’ sense of acceptance and worth.

Weighing options

Any parent who walks through the clinic doors with their teenager is doing their best to support them. But they can also have fears and worries about the potential drawbacks of the surgery, and that’s okay.

“I think there is a lot at stake right now in the news and in the media and I think it is important to recognize that this is not a decision that is taken overnight,” said Schechter said. “These are very thoughtful decisions; they involve an interdisciplinary and multidisciplinary healthcare team. And not everyone wants all of the surgical options available; everyone is different.

Families and medical teams can work together to find the right path for each person looking for their options.

“It’s an individualized process,” he explained. “We practice in accordance with WPath guidelines and standards of care, and we try to help people make the best informed decision possible.

While navigating this route, the CEA said language and education are still important.

“Use language like ‘gender affirmation surgery’ rather than ‘sex reassignment surgery,’ she encouraged, adding that parents should remember that cisgender children and adolescents have received it safely. puberty blockers, hormonal treatments (eg, birth control), and genital or thoracic surgeries (eg, hypospadias surgery) for decades.

Your child is not the first to experience this. And you are not the first family to face these decisions. By leading with love, you can make the right plan together.

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