Position paper
Promoting Health Equality and Nondiscrimination for Transgender and Gender-Diverse Youth

https://doi.org/10.1016/j.jadohealth.2020.03.016Get rights and content

Abstract

Adolescent and young adult health-care providers often care for transgender and gender-diverse (TGD) youth—youth whose gender identity is incongruent with the gender assigned to them at birth. This patient population faces health challenges distinct from their cisgender peers (i.e., youth whose gender identity aligns with their assigned gender at birth), which include the health impacts from gender dysphoria and from societal stigma and discrimination. SAHM encourages adolescent and young adult health-care providers to receive training in providing culturally effective, evidence-based care for TGD youth; calls for more research on gender-affirming health care; and advocates for policies that protect the rights of TGD youth and minimize barriers to attaining healthcare. Consistent with other medical organizations, the Society for Adolescent Health and Medicine promotes the call for gender affirmation as a mainstay of treatment and is opposed to the notion that diversity in gender is pathological.

Section snippets

Positions of the Society for Adolescent Health and Medicine

The Society for Adolescent Health and Medicine (SAHM) supports the following positions:

  • Providers of health care to adolescents and young adults need to ensure patient-centered, culturally effective practices when treating transgender and gender-diverse (TGD) youth (evidence and consensus).

  • SAHM recognizes that variation in gender identity and expression is normal, recognizes that incongruence between gender identity and genotypic/phenotypic sex is one of many developmental trajectories that

Statement of the Problem

Many providers for adolescents and young adults have reported an increased number of TGD youth seeking care [1]. However, many providers also lack the knowledge required to address the needs of this unique patient population. Therefore, there is an unmet need for providers to learn the skills necessary to care for TGD youth.

The American Psychological Association defines gender identity as a person's “deeply-felt, inherent sense of being a boy, a man, or male; a girl, a woman, or female; or an

Methods

The authors conducted a literature review on peer-reviewed publications and policy papers from national and international organizations obtained from databases including PubMed, PyschINFO, and SCOPUS using key terms such as “transgender,”“gender identity,” and “gender-affirming care.” We reviewed all articles relating to pediatric and adolescent transgender health, employing a perspective of adolescent health, public health, policy, and advocacy. The evidence presented by consensus is based on

Training in the care for TGD youth

Most health professional training curricula lack content about transgender health, resulting in limited provider comfort and knowledge in this area [3]. Multidisciplinary guidelines exist that can provide foundational and continuing educational training for providers [[4], [5], [6], [7]]. This position paper does not recommend a specific guideline for adolescent and young adult health-care providers.

Culturally effective care for TGD youth

Although guidelines describe minimal cultural competency standards for working with TGD youth,

Summary

Health-care providers must acknowledge that TGD youth have unique health-care needs compared to their cisgender peers. Nascent research and collective clinical experience strongly suggest that gender affirmation is the best approach for working with TGD youth. However, because anti-transgender stigma and discrimination are major drivers for adverse health outcomes among TGD youth, health-care providers must also advocate for medical institutional and governmental policies that promote equitable

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