When Alex was three years old, he knew that he didn’t fit the body he’d been born with. Alex and his mother eloquently describe their journey with gender dysphoria and ultimately his gender transition in Season 3 of Inside Pediatrics.
My colleague Dr. Jill Jacobson and I founded the Gender Pathways Services Clinic (GPS) in 2014 because a growing number of gender-variant, gender-questioning, and transgender children, like Alex, were being seen in separate Children’s Mercy clinics. We realized these children and teens required a multidisciplinary clinic of their own, designed to provide gender-affirming health care and address their unique medical, social, and psychological needs.
Providing family-centered services for an at-risk population
Children like Alex face a host of challenges that can make them highly vulnerable to poor health outcomes. Transgender children are at increased risk for depression, suicide, homelessness, and victimization. Children and adolescents, especially those who are harassed because of their gender non-conforming behavior, and those who are victimized or homeless, may experience many adverse health outcomes, including higher rates of suicide, substance abuse, school dropout, involvement in sex work, and HIV infection.
Our clinic is one of a few programs of its kind in the Midwest, offering interdisciplinary services provided by social work, psychology, endocrinology, adolescent medicine, hearing and speech, and even chaplaincy. We provide multi-faceted, step-by-step care that is tailored for each child’s behavioral, environmental, and physical needs.
An important part of this care can include providing pubertal suppression and gender-affirming hormone medications for children with gender dysphoria. Of the 400+ patients we see annually, at least 40 percent are appropriate for pubertal suppression medicine. These medicines help children “buy time” so they can explore and consolidate their gender identity with their mental health professional and family without the fear or distress associated with physiological maturation. This allows patients like Alex to “pass” and live in society as their chosen gender. Patients who have family support and who undergo medical transition show improved quality of life, well-being, and decreased suicidal ideation.
Unfortunately, puberty blocking medicines are extremely costly. The least expensive, a generic, costs $3,400 from our in-house pharmacy. Then there is the added cost of implantation and removal for a total cost of $5,734 per patient. For some families, this is simply too great, especially when insurance won’t cover the cost.
Without treatment, transgender children and adolescents may resort to using much less desirable methods to stop their bodies from developing. For instance, transgender children may engage in self-mutilation or resort to restricting their food intake to retard physical development and stop their monthly periods.
Fortunately, a 2017 applicant defined grant from Health Forward Foundation helped us create our first GPS Family Support Fund to increase access to treatment for children diagnosed with gender dysphoria. The fund helps pay the cost of medicine for families with limited financial resources and also helps pay for the cost of inserting and removing the medical implant for pubertal suppression.
The stakes are high and if we wait until children reach adulthood before helping them, it may be too late. Alex says it best in the docu-series: “So many people in my community die before they are adults … You have to treat them as children, because, if you don’t, they may not be alive tomorrow.”
How you can help
Children’s Mercy is a nonprofit organization that in 2018 offered more than $140 million in community benefit services and uncompensated care to people in Kansas City and around the region. We are able to do so thanks to donations from the surrounding community. If you’d like to support Children’s Mercy and programs and services like those offered through the Gender Pathways Services Clinic, please visit GiveMercyKC.org.
Dr. Moser is also an associate professor of pediatrics a the University of Missouri-Kansas City School of Medicine.