What’s Your Diagnosis? Emergency Care for Transgender and Gender-Diverse Children and Adolescents
August 21, 2020
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on High-Flow Nasal Cannula and Noninvasive Ventilation in Pediatric Emergency Medicine right.
Case Presentation: Emergency Care for Transgender and Gender-Diverse Children and Adolescents
You pick up the chart of a 12-year-old female with a chief complaint of ?behavioral issue.? According to her parents, they have noticed the child increasingly dressing in baggier clothing and that the child had changed their pronoun to ?he? on Facebook. They have overheard the child?s friends calling them ?Alex,? when their given name is Andrea. The child also has become what they describe as ?increasingly moody.? They are concerned about these changes and wonder if they are related to the new friends the patient is hanging out with at school. How should you initiate a conversation with the patient? What advice should you give to the parents? What are the next steps and referrals you can make from the ED?
You introduced yourself to the 12-year-old patient by saying, ?I?m Doctor Turner, what is your name?? The patient said, ?Andrea.? You said, ?My pronouns are she and her, what pronouns do you use?? The patient said, ?she and her.? Even though the patient did not disclose her gender identity initially, you signaled to the patient that you were a safe and open person with whom to discuss these issues. When you spoke to the patient privately, they revealed they have felt more comfortable with a male gender identity for a year and have been starting to experiment with their gender expression. They were not sure if they wanted to use a different name or pronouns. You honored this and used Andrea and female pronouns. She was afraid to disclose this to her parents but she agreed to disclose it to her mom, with you in the room
You urged both the patient and her mother to review the section of the PFLAG website (www.pflag. org) on transgender youth. You told them that PFLAG is an organization that provides support to LGBTQ+ people, their families, and allies. You also referred them to the local LGBTQ+ center?s programs for transgender youth and parents. You recommended that they discuss these concerns with their primary care doctor, and recommended assessment by a mental health professional. You clarified that being transgender is not a mental illness, but a social worker, psychologist, or family therapist could help explore gender identity and assist families.