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Emergency Care for Transgender and Gender-Diverse Children and Adolescents (Ethics CME)
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Emergency Care for Transgender and Gender-Diverse Children and Adolescents (Ethics CME) -
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Publication Date: September 2020 (Volume 17, Number 09)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 9/01/2023.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Ethics CME credits, subject to your state and institutional approval.

Authors

Hannah Janeway, MD
International and Domestic Health Equity and Leadership Fellow, Department of Emergency Medicine, UCLA, Los Angeles, CA
Clinton J. Coil, MD, MPH, FACEP
Associate Health Sciences Clinical Professor, David Geffen School of Medicine at UCLA; Co-Medical Director for Transgender Health, Los Angeles County Department of Health Services, Los Angeles, CA; Chief Quality Officer, Harbor-UCLA Medical Center, Torrance, CA

Peer Reviewers

Daisy Chin, MD
Lead Physician, Transgender Health, Pediatric Endocrinology and Diabetes, Goryeb Children’s Hospital, Atlantic Health, Morristown, NJ
Adrian D. Daul, MD, MPH, FACEP
Faculty Emergency Physician, Cooley Dickinson Hospital, Northampton, MA

Abstract

Transgender and gender-diverse (TGD) youth may present to the emergency department with a range of medical problems and health concerns. Some of these may be directly related to their gender identity, but the vast majority are not. While gender diversity is not considered a mental illness, TGD youth are at increased risk for suicide, anxiety, depression, and other psychological conditions, as well as family rejection, homelessness, food insecurity, and poverty. Lack of knowledge and cultural competency among emergency clinicians can create a barrier to effective care. This issue will review relevant terminology, epidemiology, and clinical best practices. It will help emergency clinicians understand common gender-affirming practices and recognize possible complications.

Excerpt From This Issue

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?

The nurse in triage comes to tell you that a 15-year-old male was brought in by EMS. The patient has a deformed right wrist after falling at school. When you walk into the room, you encounter an individual with long hair, who is wearing mascara and lipstick and is dressed in a skirt and blouse. The registration clerk is explaining to the patient that their driver’s license says “male” and the legal name is “Evan,” and that the gender and name listed in the EMR have to correspond. The nurse then says, “Evan, why do you want to be a woman? You’re such a handsome young man!” The patient asks, “Can you please just take care of my arm?” The patient tells you that they tripped and fell onto an outstretched arm and are experiencing subsequent pain. They have no other pain or injuries. On examination, you encounter an anxious but well-appearing teenager. There is soft-tissue swelling over the wrist, which appears deformed. It is neurovascularly intact. What questions should you ask, and how should you ask them? Are there any systems changes you can advocate for at your hospital?

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