An excerpt from About Your Black Transgender Child: Answers to MOST of Your Burning Questions.
“Mom, I would never have told my doctor because you were my doctor.”
—My trans young adult
Those words hit me hard!
My eldest offspring said them to me recently while we were having a conversation. I had shared my thoughts about the need for pediatricians and other physicians to create safer spaces at their offices in order to become better allies for their Q+ patients. To be clear, she wasn’t against my idea; she was simply stating how much more difficult it was for her because of the duality of my role in her life.
I think it is crucial for trans kids to share their feelings with their doctors, especially if they can’t confide in their parents or other significant adults in their lives. Well, as you can read from that quote, my kiddo wasn’t having it. She felt that while doctors do have some work to do, the responsibility should always come down to the kids’ parents.
As a pediatrician, I fully understand the important role that we play as parent extenders in the lives of transgender children, especially when the child is Black or a person of color. I am also aware of the long history of trauma from the medical community toward Black people and toward LGBTQ+ people, both of which your child is a member, and that compounds the situation.
Once upon a time, doctors had more autonomy to practice freely. Offering gender-affirming care had not become a practice regulated by the government. We could make decisions about our transgender patients and their welfare. Sadly, today, whole states in America are suing physicians and threatening to confiscate their licenses, preventing them from practicing or providing much-needed, life-saving gender-affirming care to children.
As your child’s parent, you have to fight!
To successfully fight back, you might have to move to a different state or possibly a different part of the world where gender-affirming care is legal. You will have to look for and find a compassionate pediatrician who will advocate for your child.
Your child will need referrals to a psychiatrist, a psychotherapist, an endocrinologist, a urologist, a general surgeon, an obstetrician/gynecologist, a voice therapist, and a licensed social worker, to name a few. Suffice it to say, they will also need good insurance if possible. These medical providers must be affirming. Meaning, they must own safe spaces that are nonjudgmental and inclusive, and their employees must do the same.
This will look like:
- A website that indicates inclusivity of the LGBTQ+ community
- Office staff that respects your child’s name and pronouns
- Inclusive entry forms that properly include all genders (or allow room for you to enter your child’s gender)
- Gender-neutral bathrooms or single-stall restrooms
- Displaying pride paraphernalia, etc., not only during the month of June
Your child’s pediatrician or doctor must also know and understand what questions to ask based on your child’s gender identity and body parts. This Glossary of Words, updated in March 2024 from Johns Hopkins University LGBTQ+ Life publication, only scratches the surface. Your child is the best source for the words they use to describe their body parts. Be respectful and ask them—don’t assume.
Whether your child is older and able to conduct their doctor’s visits on their own or still a minor and you have to accompany them to their doctors’ visits, the following list and discussion of nine focus areas for when you are at their doctor’s office should help:
Affirming environment
An affirming health care environment includes visible signs of inclusivity, such as pronoun pins, pride flags, gender-neutral bathrooms, and diverse artwork. These signals help LGBTQ+ patients feel safe and seen. Forms should allow for self-identification, including chosen names and gender identity. Additionally, waiting rooms should reflect diversity, featuring inclusive posters and materials that make all patients feel represented and valued.
Inclusive communication and respectful care
Health care providers should introduce themselves with their pronouns and ask for your child’s pronouns, ensuring they are addressed correctly and respectfully. It is essential that all staff members consistently use your child’s chosen name and pronouns, reinforcing their identity. Providers should respect your child’s autonomy by seeking permission before physical exams and allowing them to name body parts in ways that feel comfortable. Instead of fixating on gender identity, health care professionals should take a holistic approach, focusing on overall well-being, celebrating “queer joy,” and highlighting positive experiences.
Trauma-informed and confidential care
LGBTQ+ patients, particularly transgender and nonbinary youth, may have experienced discrimination or trauma in health care settings. It is crucial that providers are trained in trauma-informed care and demonstrate sensitivity to these experiences. Confidentiality is key—providers should always seek a child’s consent before sharing personal information. Additionally, health care professionals should allow patients to set the pace during physical exams and discussions, fostering trust and comfort, particularly for those with past traumatic experiences.
Advocacy, referrals, and resources
A supportive provider should be willing to refer patients to affirming mental health professionals, endocrinologists, and other specialists as needed. They should also connect families with LGBTQ+ organizations such as PFLAG, Gender and Sexuality Alliances (GSAs), or local health care centers that provide additional support. Furthermore, providers should have a strong understanding of health disparities affecting LGBTQ+ youth, particularly those with intersectional identities, and be proactive in advocating within the health care system to ensure equitable care.
Access to gender-affirming care
If a child seeks gender-affirming care, providers should have experience in or be willing to refer to specialists for services such as voice therapy, hormone therapy, and puberty blockers. They should also be knowledgeable about resources for gender-affirming medical supplies, such as binders and packers, ensuring that patients have access to safe and appropriate options.
Navigating insurance and medical records
Navigating health care systems can be challenging for transgender and nonbinary patients, particularly when dealing with insurance and medical records. An affirming provider should assist in managing insurance coverage for gender-affirming care and guide families in updating medical records to reflect a child’s chosen name and gender. Taking these steps helps prevent misgendering and ensures a smoother health care experience.
Cultural competency
A culturally competent provider recognizes that the LGBTQ+ experience is not monolithic and acknowledges the intersection of race, ethnicity, and religion in a patient’s identity. It is important to assess whether a provider understands the unique challenges faced by BIPOC LGBTQ+ patients and is committed to delivering care that is culturally relevant and affirming.
Building a long-term relationship
Health care should go beyond one-time visits—providers should demonstrate a genuine interest in fostering a long-term, supportive relationship with LGBTQ+ youth. Regular mental health check-ins are particularly important, especially for high-risk groups like Black trans youth, who may face additional societal and health care challenges.
Advocacy for trans rights
An affirming provider should be willing to support transgender youth in legal matters by writing letters for gender marker changes or other necessary documentation. They should also stay informed about policies affecting transgender health care, particularly in states with restrictive laws, to ensure they can provide guidance and support in navigating these challenges.
These focus areas cover more aspects of care, from navigating systems to ensuring that your child’s provider is truly committed to their long-term well-being. This way, you can feel even more equipped to advocate for your child’s needs while working with health care providers.
Uchenna Umeh is a pediatrician and the author of About Your Black Transgender Child: Answers to MOST of Your Burning Questions.
