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Care and support for transgender youth and gender issues

By Bernadette Gillis October 25, 2016

Adrian Chamberlin, 17, considers himself one of the lucky ones. Unlike many transgender teens, he has the support of his family and friends. While the Raleigh teen experienced depression, he’s happier now than he has been in a long time since coming out to his family last year.

“I needed to tell my family because I was keeping this whole chunk of my life apart from them,” he said. “I felt like I was lying to them. I finally came out to them, and it was such a good response. It’s been great being able to be open about who I am.”

Being open about his identity was a big step for Adrian, who was born a girl. But that was only the beginning. Finding his way in the world as a transgender male will be a long process that requires education, guidance, and support, not only for him but also for his parents and sister.

He found all that and more at the Duke Center for Child and Adolescent Gender Care. The clinic, which opened in 2015, serves children who are transgender and those born with conditions affecting internal and external sex organ development, called differences in sex development (DSD). The first of its kind in North Carolina and only one of a few located in the Southeast, it is staffed by providers from an array of disciplines at Duke, including endocrinology, social work, urology, pediatric surgery, child and adolescent medicine, psychiatry, psychology and pastoral care. Their goal is to work together to provide evidence-based, patient- and family-centered care. The clinic is open one full day and one half day each month. Patients come from North Carolina, South Carolina, Virginia, Georgia, and Florida. The clinic served 127 patients during its first year, and administrators anticipate nearly doubling that number next year.

Transgender counseling and treatment

For the clinic’s transgender patients, treatment focuses on gender dysphoria, a condition that occurs when a person’s internal sense of gender does not match their physical sex and gender assigned at birth. Those with the condition often describe feeling as though they were born in the wrong body and become increasingly uncomfortable with their bodies as they approach puberty.

All transgender patients receive counseling, most often in their own hometowns. Duke’s gender care team works closely with the children’s therapists and other providers.

Many are being treated “because they have significant depression and anxiety from the mismatch between their gender identity and their assigned sex or their physical appearance,” said clinic director Dr. Deanna Adkins, MD, a pediatric endocrinologist. “That depression and anxiety causes them to be at significant risk for suicide. Adrian knows firsthand the struggles of gender dysphoria. Even though his experience coming out was a positive one, he hasn’t been immune to all of the challenges that come with being transgender. He credited the gender clinic at Duke with helping him to understand the available options for transitioning and helping to improve his overall quality of life.

“They helped me to make plans on how to adjust my life and help me to physically transi­tion,” Adrian said. “Otherwise I probably wouldn’t have been able to do it.”

In addition to counseling, treatment includes hormone therapy for transgender patients 16 and older, and hormone blockers, which delays puberty, for people under 16. Blocking puberty until age 16 plays a major role in helping the children transition successfully, said Adkins. It keeps body dysphoria at bay and decreases the chances of depression, anxiety, and suicide until they are old enough to transition physically. It may also mean they will need fewer surgeries as adults.

“In the past, people have tried to treat the depression and anxiety with traditional depression and anxiety medications, and they still do,” Adkins said. “But the problem doesn’t go away. Only the symptoms of depression and anxiety ameliorate a little bit. They never ameliorate completely until the biological part is addressed.”

Once the bio­logical concerns are addressed, Adkins said outcomes are overwhelmingly positive. She pointed to a few studies which show that 75 percent to 80 percent of patients treated hormonally experienced complete amelioration of their symptoms, and they were able to stop taking anxiety and depression medications whether they underwent surgery or not.

More than 40 percent of young transgender people have contemplated suicide.

Care coordinated by specialists

As with all of the clinic’s transgender patients and their families, initial treatment at the gender care clinic begins with consultations with Adkins and the clinic’s social worker, Kristen Russell, CSW.

During the consultations, Adkins and Russell assess where the child is with his or her transition. They get a baseline for how they’re coping with anxiety and body image issues, and check hormone levels. They also spend time talking with parents.

Although Nancy and Dave Chamberlin supported their son’s transition, they had a lot of concerns and uncertainties. Initially, they were reluctant to attend the consultations. However, in the end, they found the talks—particularly their time with Russell— to be informative and helpful.

“For me transitioning meant surgery, and I wasn’t anywhere near wanting him to have surgery,” Nancy said. “But once we got there that was not what it was about. It was about hormone shots. While there are a couple of permanent changes, he could stop hormone shots at any time.”

Dave said the consultations “made me a lot more comfortable, helped me come to grips with things.” He added, “I had kind of put my head in the sand—not ignoring Adrian’s desire to be male but just not really trying to understand it better. They provided the perfect environment for me to sort things out. It helps to have one place to go where you have your social needs and physiological needs all rolled into one.”

Adrian is currently getting testosterone shots, which he will have to do for the rest of his life. As for next steps, he knows his transition will involve surgery, but he has yet to decide exactly when that will happen. For now, he is happy to have a team of caring professionals to help support and guide him.

“It made me feel great to know that people are on my side who just want to help me. I haven’t had bad experiences with doctors, but a lot of them just don’t understand what being transgender entails.”