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Doctors & Advice, Family Health

Yale Medicine Unveils Gender-Focused Program

BY CARRIE MACMILLAN February 2, 2017

"Transgender” has emerged as a topic in the national conversation.

Because of the “bathroom bill” in North Carolina, the Boy Scouts’ recent decision to accept transgender children, and Caitlyn Jenner’s public transition from male to female, the word “transgender” has emerged as a topic in the national conversation and in talks around dinner tables.

Yale Medicine is committed to providing affirming care to those who have questions about their gender—including identity, expression and sexual orientation—or who seek help making a physical transition.

Through the Yale Medicine Gender Program, medical and mental-health experts help children and their families navigate the options that are available for those questioning their gender or considering transitioning.

It’s important to note that Yale Medicine clinicians follow current medical protocols, which do not allow for either surgery or drug therapy for prepubescent children. Social transition is the only medically accepted form of gender-affirming care—and the only form of care they provide—for that age group.

Here are some commonly asked questions to help guide parents, children, and anyone who wants to know more:

What’s the most important thing I can do for my transgender or gender-questioning child?

Offer support and flexibility, says Christy Olezeski, director of the Yale Medicine Gender Program. Children are still sorting out who they are, but you can take an affirmative stance and tell them that you will love them, no matter what.

How do I know this isn’t just a phase?

It’s completely normal for children to explore their gender, including boys dressing up in their mother’s clothes. Time will tell if it’s more than typical child’s play. Pay close attention if your child is consistent, insistent ,and persistent about his or her gender identity and expression.

What services are available for a child with questions about gender?

At the Gender Program, a pediatric endocrinologist and a mental-health professional meet with a child and his or her parents at the very first appointment. They obtain a thorough medical history, answer questions, and discuss medical options, such as puberty blockers and cross-hormone therapy, if those are options the child is interested in.

What happens next?

Before any medical interventions are made, the child and parents — both together and separately — engage in an extensive readiness evaluation. This process takes six to eight hours and can be split up into sessions at the patient’s and family’s convenience.

Why is the mental-health component vital?

Among people in the transgender community, suicide attempts, substance abuse, depression, and anxiety are higher compared with the general population, Olezeski says. Helping kids now can prevent these issues and potentially save their lives.

What are puberty blockers?

Puberty blockers are medications that stop the body's natural production of estrogen or testosterone. These medications are available as either an intramuscular injection once every three months or as an implant that is effective for a year. Puberty blockers are typically administered around age 9 or 10.

What are cross-hormone therapies?

The goal of cross-hormone therapy, or administering estrogen or testosterone, is to change the balance of circulating hormones to be consistent with the individual’s gender identity. These medications are usually started between ages 14 and 16.

Are these medications safe for children?

Many, but not all, of the changes from the puberty-blocking medications can be reversed if a patient stops taking them. While data for cross-hormone therapy for adults shows them to be safe, there is little information evaluating their long-term effects for developing adolescents. The experts at the Gender Program thoroughly discuss all of these matters with patients and their families before starting any kind of therapy.

Where can parents get help for themselves?

The Yale Medicine Gender Program offers a support group for parents. It also keeps an active list of local and national organizations dedicated to helping children, adults, and families. Here are a few resources: Gender Spectrum, TransKids Purple Rainbow Foundation, New Haven Pride Center.

The Gender Program sees patients at the Pediatric Specialty Center at 1 Long Wharf in New Haven. For information, call 203-785-4081