Awareness of transgender issues is rising, as our culture has embraced TV series like Transparent and the KUOW-FM podcast How to Be a Girl. But it’s still hard to find adequate health care for transgender and gender nonconforming youths. “Each year, I saw more and more patients who had had to take a circuitous route to find care,” says Dr. David Breland, an adolescent medicine specialist at Seattle Children’s Hospital who helped created a new Gender Clinic (206.987.2028; seattlechildrens.org) at the hospital.
Research shows high rates of health issues and risk factors among transgender people: anxiety, depression, low self-esteem, substance abuse, and high rates of homelessness and HIV, sometimes contracted while selling their bodies to pay for gender transition hormones. Research also suggests that early identification and care may help transgender and gender nonconforming youths to have lower rates of depression and anxiety and a higher quality of life.
That’s why Breland helped to create the new clinic which opened last fall, and is one of only five in the nation. “I felt I needed to do something,” says Breland, the clinic’s director.
Staffed by doctors, nurses and medical assistants with training in adolescent medicine, hormones (endocrinology) and emotional health, the Gender Clinic provides care for patients from puberty to age 21. Patients younger than 18 are assessed for their readiness for treatment and require a diagnosis of gender dysphoria—a strong feeling that your body does not reflect your true gender—by mental health providers. The center offers mental health support, and may provide medicines that can temporarily pause puberty, which “buys families and patients time to think about what makes sense for them,” Breland says. For an adolescent who has been evaluated and feels ready to make the transition, the clinic can prescribe cross-sex hormones, such as estrogen or testosterone. The clinic does not provide gender-transition surgery.
Breland and other researchers conducted a 2015 study that may help physicians understand barriers to care for transgender youths. The researchers recruited 65 transgender youths (ages 14–22) and caregivers of transgender youths, and asked them to describe their experiences accessing gender-affirming health care. The study found big problems: few accessible pediatric providers trained in gender-affirming health care, a lack of consistently applied guidelines for diagnosis and treatment, and limited or delayed access to pubertal blockers and cross-sex hormones.
More than 150 families have contacted the clinic since the October opening, including patients who referred themselves and those who were referred by a mental health therapist or by their primary care doctor. Patients have also come from other states, including Alaska, Idaho and Montana. “The need is out there, for sure,” says Breland.