Tuesday, October 26, 2021

How doctors treat transgender youth

Written by By: Katie Briese , CNN Staff

Brittney Lockey, 20, was born female but identifies as a male.

In 2016, she began using hormone replacement therapy and says the change not only led to physical signs like hair growth but also a positive change in mood and energy levels.

“(In my previous life) I suffered from mental illness,” Lockey says. “It reached a point where I had thoughts about wanting to kill myself — self-harm — so when I was on my period, I was telling everyone I had a bout of PMS, and (getting) hormone injections to turn it around again.”

Several years before she decided to seek hormone treatment, Lockey says her doctors did not see him as a healthy adult, as some transgender people may be expected to be at that point in their lives. Instead, she says they believed he was a child who suffered from hormonal imbalances. He says they believed he needed to be treated as if he were a child because of the way people dealt with him, which frustrated him greatly.

1 / 17 – Kaili Scott This year’s TIME 100 cover girl Kaili Scott sheds light on the life and spirit of the transgender community. Credit: Courtesy TIME/Jack Guez

Lockey was younger than most in his treatment. He says the primary reason his doctor didn’t anticipate he would turn out to be healthy enough to live as a transgender person was because he feared a bigger label: being called a “faggot” and being judged at work and school.

Now that they’ve made the initial treatment, Lockey says, his doctor is treating him as an adult and a new attitude has emerged that includes treating him as if he were a younger adult who may need help.

For some transgender people, Lockey says, the problem often starts with their prenatal care.

These days, there are plenty of treatments for transgender children like Lockey and they often begin years before their bodies have allowed them to make a definitive decision about what sex they are and the terms they prefer, which are called assigned at birth.

Healthy transgender youth are not diagnosed with severe health problems because of a lack of recognition of the difficulties they face, says Dr. Elliot Goldsmith, a psychiatrist and chair of the Pediatric Paediatric Gender Identity Clinic at the New York Psychiatric Institute.

Instead, a common diagnosis for transgender people in their late teens or twenties is mental health challenges. The good news is that just about any depressive episode that a person exhibits as a teenager does not necessarily mean they have gender dysphoria, he says.

By that point, however, there are various treatments doctors can prescribe to help the individual who believes they are transgender.

“There’s a significant gap between the psychosocial treatment that is available,” he says, referring to people who have identified as transgender as young children.

One of the biggest problems with pre-existing health problems such as obesity and diabetes is that “all of that is a barrier to anything you can do for your gender,” Goldsmith says.

“For transgender kids, especially kids that are not out, who face lots of social difficulties and stigmatization, eating disorders are a huge issue because they’re in a state of constant worry about how to provide enough food for themselves and their bodies,” he says.

1 / 12 Transgender activist Jasmine in ‘Ex Machina’ Credit: Warner Bros. Entertainment Inc.

Goldsmith says one type of screening for transgender people should include asking for photographs of the individual. He recommends taking skin questions because the family doctor can look at what the person is doing while in school and at their social activities.

Even though just about any picture of someone could be considered a snapshot, Goldsmith says taking photos at school, at work and at the doctor’s office is very useful because often a person’s first appearance when they come into the office does not mean the doctor is going to accept their new identity.

The way the doctor hears their voice also matters, he says.

“It’s important to give people just short sentences, very modest sentences, and just quote those sentences back to them as examples or better,” Goldsmith says.

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