Abstract
Adolescent and young adult (AYA) transgender health care and research have expanded
rapidly in the United States and abroad, but the effects of gender-affirming social,
hormonal, or surgical care on overall health remain unclear. Gender diverse identities,
also termed nonbinary, have often been neglected in favor of (male/female) binary
identities, even in the context of transgender health care and research. No high quality
studies have assessed how gender-affirming medical care impact health inequities in
transgender and gender diverse (TG/GD) adults, much less in AYAs, despite the fact
that that TG/GD adults have higher than average morbidity and mortality across a host
of health concerns, from human immunodeficiency virus infection to thromboembolism,
and that reported depression with suicidal ideation is >10 times higher in TG/GD adults
than in the general population.
TG/GD youth have related but different needs from TG/GD adults. TG/GD AYA are embedded
in family and schools, where stigma may be difficult to escape; mental health during
adolescence has areas of increased risk as well as resilience; and the effects of
early hormonal and surgical interventions on long-term health are insufficiently studied.
Because of this, an inclusive and proactive approach to addressing the needs of TG/GD
AYA by pediatric clinicians, researchers, and educators is particularly crucial.
This article focuses on what is known and unknown about clinical practice, research,
and education related to TG/GD health. We highlight the role of gender affirmation
by clinicians as they care and advocate for TG/GD AYAs; the potential challenges of
hormonal treatment for peripubertal youth; and short- and long-term effects on physical
and reproductive health of medical or surgical interventions. We also discuss how
social context influences knowledge gaps and the health-relevant risks faced by TG/GD
AYA. The challenges are formidable, but opportunities await: high priority research
questions to explore, educational gaps to be filled, and advocacy that needs the voices
of pediatricians to promote policies to facilitate positive health outcomes for TG/GD
AYA.
Keywords
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Article info
Publication history
Published online: September 23, 2020
Accepted:
September 21,
2020
Received:
January 14,
2019
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2020 by Academic Pediatric Association
