Healthcare providers can expect to see young people who are questioning their gender. Other young people may be consistent, insistent, and persistent about their gender identity. These young people may want to make changes in their gender expression.
In 2018, the American Academy of Pediatrics released a policy statement called Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents (PDF). This document recommends the affirmative model of care.
Therapy is usually the first step in healthcare for this population. This is often via referral from a young person’s primary care physician or pediatrician.
Therapy may happen before or during a social transition.
Following therapy and a social transition, some young people may be approved for some aspects of legal or medical transition. These steps must be done with the involvement and approval of a minor’s parent or guardian, usually with the involvement of a specialist in pediatric healthcare for gender diverse youth.
In some cases, medical professionals have some flexibility in determining the best course of action for a minor patient. For instance, an emancipated minor or mature minor who is capable of giving informed consent may be deemed a good candidate for medical transition. Emancipated minors can be treated without parental knowledge or consent, and mature minors may in some instances be capable of making their own medical decisions without parental knowledge or consent.
In some cases, medical options may be the best course under a harm reduction model. If minors are engaging in self-harm or taking gender-related prescription medications without medical supervision, it may reduce harm to prescribe medications. While it is always best to make healthcare decisions with the knowledge and consent of parents or guardians, there may be rare cases where “do no harm” means a more flexible approach. It is similar to minors seeking information and medical options for matters related to reproductive health, such as contraception.
Rafferty J, AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4): e20182162 (PDF) https://doi.org/10.1542/peds.2018-2162
Gender Dysphoria Affirmative Working Group (gdaworkinggroup.com)