Take Jessie, assigned male at birth, who is 4-years-old and has persistently and consistently identified as a girl since the time she was old enough to talk. Jessie’s parents need to find a pediatrician who will work with them to support their child. Or consider Aubrey, a 12-year-old transgender girl who is interested in hormone treatment, but has no endocrinologist. Where do she and her mom start?

Beyond transition itself, there are many moments where children and parents come into contact with a doctor and need to navigate their identities. Imagine 8-year-old Jake’s visit to the dentist’s office. Assigned female at birth, Jake has already transitioned socially. But his legal name is still “Jennifer.” Will your new dentist’s office be respectful of Jake’s name? Will they call out “Jennifer” in the waiting room? Will the hygienist look only to the patient records and refer to Jake using the wrong gender throughout his cleaning?

Healthcare settings can be stressful enough for children and parents. When a child is worried about being embarrassed or even harassed by unknowing or unfriendly medical professionals and staff, that stress is only compounded. While every situation will differ, we have worked with transgender youth and their parents, as well as allied doctors, to detail some ways to help make interactions with medical providers as friendly and respectful as possible.

Educate Yourself and Others:

• Unfortunately, parents of transgender children often find themselves in the position of having to educate other people – including medical professionals – about transgender-related care. Making sure you understand and are able to explain fundamental issues like the difference between sex and gender or the basics and implications of a gender dysphoria ¹ diagnosis will help make these conversations go more smoothly for everyone involved.

• If your child’s medical provider has never worked with transgender children before, many of the resources listed below can be easily printed and sent to the office ahead of time or taken with you. Encourage medical professionals to take steps toward being more inclusive in their materials and language, like changing intake forms to allow for gender fluidity, preferred gender pronouns, and preferred names.

Talking to medical providers about your child’s transition:

• Often the easiest way to notify other healthcare professionals about your child’s transition is by having the gender therapist send letters to them, explaining gender dysphoria and how they should respond to that diagnosis. Keeping in mind that doctors are often very busy, these letters should be concise and easily scanned in a minute or two.

• Before the appointment (and not in front of your child), ask to speak with the office manager. Discuss the importance of using preferred names and pronouns, and request that doctors and their staff address your child using these terms. Also ask the office manager to ensure that your child’s preferred name and pronouns are used on all official documentation. If they say they do not have a place in their electronic records system to put this information, let them know some doctors will insert an alert flag on the file so that the information comes up each time your child’s record is pulled.

• Before every appointment, confirm that when you register at the front desk, they’ll use the right name and pronouns.

• Talk to medical staff ahead of time about gender marker discrepancies on documents like insurance policies.

• If your child suffers from extreme dysphoria, explain that in advance to any medical staff who may have to perform a physical exam.

Preparing your child for the doctor’s office:

• Know your rights. Many states provide non-discrimination protections for transgender people applicable to medical providers. Other states prohibit insurance providers from denying transgender-related care. Section 1557 of the Affordable Care Act prohibits discrimination based on sex by any provider who receives federal funds. If your child is denied care because of gender identity, you can file a complaint with the Health and Human Services Office of Civil Rights.

• Always be honest and prepare your child. While most people find doctor visits awkward and uncomfortable, medical exams and procedures can be triggers for transgender children. Knowing that you’re aware that it can be uncomfortable and you’ll be there to support them can make a world of difference. Offer to hold your child’s hand during exams, no matter how old they are. That small extra show of comfort can be the difference between a good and a bad appointment.

• Tell your child that someone might misgender them, and that it isn’t your child’s fault. You might also work with your child to develop their own language for responding to people who misgender them, which is a great way to help them gain confidence about their identity.

• Assure your child that you will stand up for them and correct people who use the wrong name or pronouns.

• Talk to your child’s gender therapist about ways to make these situations easier for your child.

• Explain that you love your child and support their gender identity and transition -- but that not everybody will. Some people may be rude, make jokes or say something harmful. Be sure your child knows that regardless of what one person might say, you will always support them and there is nothing wrong with them.

Prepare for an emergency:

• Many kids find themselves in the emergency room or an urgent care center with injuries from playing sports, gymnastics or rough housing with siblings. It’s good to know what hospitals are nearby and how they treat their patients. Check out the HRC Foundation’s Healthcare Equality Index at www.hrc.org/hei to find hospitals in your area with patient non-discrimination policies that include gender identity.

• Keep a letter from your gender therapist about your child’s gender dysphoria diagnosis in your car, in your wallet or purse, or with your child’s belongings so that it can be handed to emergency room staff.

• Even if a hospital doesn’t have gender identity listed in their non-discrimination policies, most hospitals are required as part of their accreditation to prohibit discrimination based on gender identity. If you encounter any discrimination, you should follow the hospital’s grievance process. In addition, you may file a complaint directly with The Joint Commission.

All children deserve to feel safe and have their identities affirmed, particularly in healthcare settings where many already feel vulnerable. The more of these conversations we have with doctors, teachers, coaches, service providers and others who work with gender-expansive youth, the more welcoming and inclusive spaces we can create for all people.

_{1 Transgender identity is not a mental illness that can be cured with treatment. Rather, transgender people often experience a persistent and authentic disconnect between the sex assigned to them at birth and their internal sense of who they are. This disconnect is referred to by medical professionals as “gender dysphoria” because it can cause undue pain and distress in the lives of transgender people.}

Resources for you and your child’s doctor:

Gender Spectrum’s Medical Resources

TransYouth Family Allies

HRC: Supporting and Caring for Our Gender-Expansive Youth

WPATH Standards of Care