*Queue Lady Gaga’s, “Born This Way”, pull up a YouTube video of fireworks on an iPhone, and commence a dance party* - this was the setting of the clinical exam room when a 15-year-old teenager heard he’d be receiving his first dose of testosterone that day. The day he started hormone replacement therapy (HRT) seemed to be the happiest day of his life, and as a clinician involved in his care, I’m not going to lie, it was probably one of my happiest days in medicine, too.* An authentic life, happiness, health, a future—these are the things that are promised to children when they’re allowed to be who they are, when they’re loved, cherished, and even celebrated by family and friends for being themselves and for loving who they love. Unfortunately, not every child is given this same privilege and is not guaranteed support and unconditional love by those meant to love them most.

Recently, The National Survey on LGBTQ Youth Mental Health 2020 released some staggering insights into the challenges that these youth face daily. Forty percent of LGBTQIA respondents seriously considered attempting suicide, with more than 50% of that population being made up of transgender and nonbinary youth(1). Rates of anxiety, depression, and self-harm are disproportionately higher in LGBTQIA youth compared to their heterosexual, cisgender counterparts. In 2021 alone, more anti-trans bills (specifically anti-trans youth) have been introduced than any other year in history.

Over 40% of LGBTQIA youth reported being unable to receive care due to needing parental permission and fear of asking for it. The ability to afford care was reported to be the strongest barrier, as well as youth having concerns related to the LGBTQIA competence of providers(1).

Providers must take the necessary steps to expand their knowledge on LGBTQIA healthcare.

When seeing a pediatric patient for their annual Well Child Checks, we must ask our youth not only if they’re eating and sleeping well, or if they’ve been sick recently, but also ask them who they are, how they feel, and if there is anything we can do to support them. We must provide them with a safe space to be exactly who they are and to have an ally in who they can disclose this information to. We must ask every patient with a judgment-free, open-minded perspective, as sometimes, the child or teenager who needs it most, won’t be asked in any other setting than during this one clinical visit. No patient should ever fear seeing a provider who they feel lacks the competence to affirm their identity while receiving care, or who they fear will refuse them care altogether.

Lower rates of accessibility to appropriate care, combined with higher rates of unique health considerations and mental health concerns, reflect just how impactful discrimination and oppression is of this marginalized community — which is especially amplified at an intersectional level (i.e. when an individual’s identity is comprised of being both a person of color and transgender.)

We must do better, and we can.

We know that with parental support, and unconditional love, youth thrive. When LGBTQIA youth perceive that they are supported, the rates of mental health challenges, substance abuse, sexual risk, and suicidality are significantly lower(2). As parents, as providers, and as society, we can change these statistics, and we can change the lives of so many children and adolescents—if only we could be kinder, more open-minded, and more supportive.

Having the privilege to be a queer provider at Brave Care, where kids are seen for who they are, pronouns are asked at every check-in, and our metaphorical Pride flags are waved high—not just during Pride, but always—has brought me more joy and comfort than I could ever express. Being a queer adult in 2021 often has me reflecting on the quote, “be who you needed when you were younger,” and when deciding to go into medicine, I vowed to do just that—to value each patient and their individual identities, to refuse to impose strictly heteronormative views on children and their families, and to contribute in any way possible to the well-being of each patient I have the honor of treating.

Every child is special, unique, and worthy of being loved. During Pride—and every day—we should celebrate what makes every single one of us who we are.

*While Brave Care strives to provide care in an affirming environment, we do not offer hormone replacement therapy at this time as part of our services. We do however, refer to local gender clinics (like OHSU’s Transgender Health Program) and can provide support.*

References:

1. The Trevor Project. (2020). 2020 National Survey on LGBTQ Youth Mental Health. New York, New York: The Trevor Project.
2. Newcomb, M. E., LaSala, M. C., Bouris, A., Mustanski, B., Prado, G., Schrager, S. M., & Huebner, D. M. (2019). The Influence of Families on LGBTQ Youth Health: A Call to Action for Innovation in Research and Intervention Development. LGBT health, 6(4), 139–145. https://doi.org/10.1089/lgbt.2018.0157