What trans kids need from health care professionals
I can clearly remember the taste of my fear the moment I learnt that my 13 year old transgender daughter, Liv, was in a ‘demographic’ which had the highest suicide rate in the world.
The shocking statistics for the mental health of trans youth
In 2020, researchers at the Telethon Kids Institute in Perth published the largest Australian study of the mental health of trans and gender diverse young people* (859 participants). They found that trans young people reported very high levels of mental distress, including:
- Self-harming 79.7%
- Suicidal thoughts 82.4%
- Attempting suicide 48.1%
- Depression 74.6%
- Anxiety 72.2%
These figures are 3-4 times higher than those for non-trans teens.
Why is the mental health of trans youth so poor?
Trans and gender diverse youth reported the following negative experiences when talking to the Telethon researchers:
- peer rejection (89.0%)
- bullying (74.0%)
- discrimination (68.9%)
So, trans kids obviously need mental health support from health care professionals to help them cope with their trans related mental health struggles. In addition, however, in order to medically transition**, they are completely dependent on medical clinicians to facilitate this process.
So, trans kids REALLY need health care professionals
For trans kids to medically transition they need a referral from a GP to see a psychiatrist/paediatrician/clinical psychologist for an assessment and diagnosis of Gender Dysphoria*** which they then take to an endocrinologist for a further assessment and potential prescription of hormone medication****. Later, if surgery is necessary, then trans teens need to engage extensively with psychiatrists and surgeons.
So, contrary to popular opinion, it is very difficult for trans kids to get access to gender affirming medication and treatment. This is partly because it is nearly impossible to find health care professionals who are gender-sensitive, educated about trans health and mental health and willing to do this work. And those few who are, often end up having to ‘close their books’ because of the overwhelming demand for their services.
For non-binary young people, the path ahead is quite different. For these youngsters who do not identify as exclusively male or female, who feel like they are a mix of genders, or like they have no gender at all, their experience can be that they are a minority within a minority. This is the subject of a whole other piece of writing.
Our bad experiences of mental health care with health professionals
The day after I found out that my son was actually my daughter (she told her twin brother who then told me), I took her to see her psychiatrist, a woman whom Liv had been seeing for depression and anxiety for more than a year (retrospectively I realise that Liv’s depression and anxiety had kicked in when she had first begun to suspect that she may be trans). When Liv told this psychiatrist that she was transgender, this woman said to her and to me that Liv was ‘probably gay rather than trans’ and that Liv was ‘attaching a feeling of being different because of her Asperger’s to the concept and identity of being trans’. She then added that if Liv ‘really was trans, she would have known when she was much younger’.
Liv left this appointment utterly devastated at not having been heard, not having her traumatic ‘coming out’ taken seriously. It was only months later that I found out just how wrong this psychiatrist was – that in fact 50-60 % of young people first identify as trans when puberty begins.
This psychiatrist referred us on to a child psychiatrist who specialised in working with trans children but this next psychiatrist misgendered Liv several times in our first consultation, referring to her as ‘he’ and ‘him’ when talking to me about Liv – while Liv was in the room. So, unsurprisingly, that relationship didn’t last either.
But, our experiences of health professionals have been mostly positive
Despite some very negative experiences, we have encountered many supportive and respectful health care professionals who have:
- Asked for and used Liv’s (new) name and pronouns
- Followed Liv’s lead on where she wanted to go with her transition (some kids want to go slowly with this journey, others don’t)
- Framed their thinking and responses to Liv’s negative experiences as a reflection of society’s struggle with trans people rather than as some ‘fault line’ in her.
- Been educated about trans matters – and if they weren’t, then by the second visit they had quickly ‘upskilled’.
- Worked closely with the other health care professionals Liv needed.
- Checked in with other family members, recognising that a trans child is a massive transformation in the family.
- Made sure that all their practice records reflected Liv’s preferred name and gender, so these were used by the reception staff and others in the practice.
When I asked Liv who her favourite health professionals have been in her transitioning journey, she referenced the following people:
- GPs Gerald and Simone whom, she said, didn’t care that she was trans but who just treated her the same as any other girl they saw in their rooms, and not as special, or different or ‘wrong’ because she was trans.
- GP Michelle who was very educated about trans health, took her seriously, and who administered her oestrogen implants.
- Psychologist, Ben, who doesn’t ‘get stuck’ on her being trans but sees being trans as just one part of her identity.
Liv is now 17 years old, doing well in Year 11, engaged with a lovely group of nerdy friends, largely preoccupied with learning Japanese and coding computer games. This positive outcome was not inevitable for Liv as a trans teen but having a supportive family and school, and excellent treatment from many health care professionals made it possible for her to thrive.
* Trans and gender diverse (TGD) people have a gender that is incongruent with their sex assigned at birth. Between 1.2% and 2.7% of adolescents are estimated to identify as TGD.
** Transitioning is the process of changing the way you look and how people see and treat you so that you become the gender you feel on the inside. Transitioning is an individual journey and happens differently for trans people. It can include social transitioning (e.g., coming out to friends and family, asking people to use the pronouns and name that match your gender identity, and dressing and grooming to match your gender identity), legal transitioning (changing legal documents to match your gender identity and new name e.g., birth certificate, passport, Medicare card, bank card etc), and medical transitioning (hormone therapy and surgery).
*** Gender dysphoria: A concept designated in the DSM-5 as clinically significant distress or impairment related to a strong desire to be of another gender, which may include desire to change primary and/or secondary sex characteristics. Not all transgender or gender diverse people experience dysphoria.
**** Hormone medication: This refers to either ‘puberty blockers’, the meds that ‘press pause on puberty’ allowing youngsters to work through their gender identity without all the secondary sexual characteristics developing that can cause them extensive Gender Dysphoria, or when they are older, many trans teens need gender affirming hormones such as oestrogen or testosterone.
A few potentially useful articles and websites:
'I'm still the same person inside': Olivia's journey coming out as a transgender teen by Caitlin Fitzsimmons in the SMH 17 Jan 2021 Newspaper article: Olivia's journey as a trans teen
Penelope Strauss, Angus Cook, Sam Winter, Vanessa Watson, Dani Wright Toussaint, and Ashleigh Lin. Mental Health Issues and Complex Experiences of Abuse Among Trans and Gender Diverse Young People: Findings from Trans Pathways LGBT Health. Apr 2020.128-36. http://doi.org/10.1089/lgbt.2019.0232
Strauss, P., Cook, A., Winter, S., Watson, V., Wright Toussaint, D., & Lin, A. (2020). Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: Findings from Trans Pathways. Psychological Medicine, 50(5), 808-817. https://pubmed.ncbi.nlm.nih.gov/31280740/
A blueprint for improving the health and well-being of the trans and gender diverse community in NSW https://www.acon.org.au/wp-content/uploads/2019/04/ACON-TGD-Health-Blueprint-Booklet.pdf
Monash Health: Affirmative Care for Trans, Gender Diverse and Non-Binary People: Best Practices for Health Care Staff https://monashhealth.org/wp-content/uploads/2019/06/Trans-Affirmative-Practices-for-Health-Staff.pdf
The Australian Professional Association for Trans Health (AusPATH):, Australia’s peak body for professionals involved in the health, rights and well-being of trans, gender diverse and non-binary people https://auspath.org/
Transhub: for health professionals who are seeking to strengthen the clinical care they deliver to trans patients and clients https://www.transhub.org.au/clinicians