Gender Care for Children and Adolescents

Gender Dysphoria, Transgender, Gender Fluid, Exploring Gender Identity

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When a child’s sense of who they are doesn’t match their physical sex characteristics, they need care and support from a team that understands gender dysphoria and what they’re going through and has the experience to help. Duke Children’s Child and Adolescent Gender Care team provides care to children and teens under age 18. Together with other Duke Health specialists and community providers, we focus on your child’s physical and emotional health and help them prepare for the life they envision.

Child and Adolescent Gender Care Process

Pre-Appointment Requirements

We make sure your child is working with a local psychologist or therapist before beginning treatment. We’ll work collaboratively with the therapist to ensure your child has plenty of support, both at Duke Children’s and in your community. 

Medical Assessment

During your child’s first visit, a pediatric endocrinologist will do a thorough physical exam and take a detailed health history. They’ll also do blood tests to check for health risks before moving forward with any medical treatment.

Psychosocial Evaluation

Also during your first visit, a social worker will talk with you and your child to assess your child’s mental and emotional health. We’ll learn about your child’s lifestyle, their needs and wishes, and their support system at home, at school, and with friends. We’ll screen for depression, eating disorders, high-risk behaviors, and other concerns.

Follow-Up Appointments

You and your child will return about one month after your first visit to review test results and discuss any medical risks and timing. The social worker will learn more about your child’s gender identity by interviewing both you and your child individually. You, your child, and your care team will discuss what’s right for your child and the next steps. If transition is right for your child, we’ll then help them prepare for and begin the process. 

Gender-Affirming Hormone Therapy

For children 18 and older, we provide gender-affirming hormone therapy, which brings about physical and emotional changes that better match their gender identity. We manage prescriptions and do lab tests to monitor your child’s health throughout therapy. Although the timing may differ for your child, most teens see the pediatric endocrinologist every three months for one-and-a-half to two years to manage the changing dose of hormones. During this time, your child must meet with their local therapist weekly to manage the emotional changes that happen during hormone therapy. 

Hormone Suppression to Delay Puberty

For children younger than 18 who are questioning their gender identity, we offer therapies to delay puberty. This gives them more time to explore their gender and relieves the stress of going through physical changes that don’t match their gender identity.

Adult Transgender Care and Gender-Affirming Surgery Referrals

If your teen wishes to pursue gender-affirming treatment after age 18, we can connect them with the right providers to pursue treatment. 

Why Choose Duke

A Team of Specialists
Your child’s care team will include a pediatric endocrinologist, pediatric urologist, adolescent medicine specialist, pediatric psychologist, and social worker. We work with specialists in gynecology, fertility, and family and community medicine to provide holistic, individualized care that considers all aspects of your child’s life.

We Follow WPATH Standards of Care
Members of our endocrinology team are part of the World Professional Association for Transgender Health (WPATH)

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Supportive Team for Your Child and Family
Our psychologists, social workers, spiritual care providers, and child life specialists offer your child and your family compassionate support, including referrals to local transgender teen support groups.

Gender Transition Support
We coordinate with specialists at Duke and in the community to address all aspects of gender transition, including voice specialists for vocal instruction, gender coaches to teach social nuances, and aestheticians to maintain a new look.

Assistance with Legal Issues 
If you need assistance with legal issues or a birth certificate or passport change, we work closely with Duke Law School to help you. 

LGBTQ+ Equality Leader

Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital, a campus of Duke University Hospital, are recognized as LGBTQ+ Healthcare Equality Leaders by the Human Rights Campaign Foundation. This recognition is evidence of our commitment to eliminate discrimination and promote equality and standing with the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) community in all aspects of care.