Emergency Care for Transgender and Gender-Diverse Children and Adolescents (Ethics CME)

Points & Pearls Excerpt

• Lack of knowledge and cultural competency regarding care for transgender and gender-diverse (TGD) youth can create barriers to effective care and negatively affect the quality of care patients receive.
• TGD refers to any person whose internal sense of gender is not aligned with their sex assigned at birth. Some TGD individuals begin to express these feelings as early as toddlerhood.
• Gender exploration or dysphoria may evolve over time.
• A good approach is to introduce yourself and your pronouns, and ask the patient their name and their pronouns. “You/your” and “your child/your child’s” are neutral terms. If you use an incorrect name or pronoun, apologize and move on.
• Patients may have their own way of referring to themselves and all efforts should be made to use the patient’s chosen words. If the name on their medical record is different than the name the patient tells you and the name on record must be used, offer an explanation for why it is necessary, as this can sometimes be a negative experience for the patient.

Most Important References

• * Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people. Accessed August 15, 2020. (Guidelines)
• Lech CA. EMRA Transgender Care Guide. Irving: Emergency Medicine Residents’ Association. 2018. (Book)
• * Mahfouda S, Moore JK, Siafarikas A, et al. Gender-affirming hormones and surgery in transgender children and adolescents. Lancet Diabetes Endocrinol. 2019;7(6):484-498. (Review)