Gender Care for Children and Adolescents

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 16 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 16 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 is on gender-affirming hormone therapy, we’ll refer them to an adult transgender specialist to continue treatment. If your teen wishes to pursue gender-affirming surgery after age 18, they will work with that provider as well as with their local psychologist or therapist. While Duke Health doesn’t perform gender-affirming surgery, we will make sure you and your child are well-prepared to begin their next phase of transition.