Mary Bridge pediatric transgender program: Supporting transgender youth since 2012
For young people who identify as transgender, or who suspect they might be, it can be difficult to find proper support and treatment. In Washington state, for example, less than a handful of programs and clinics exist that offer comprehensive care for transgender youth.
The Pediatric Transgender Program at Mary Bridge Children's Hospital is one of these programs. Begun in 2012, it offers coordinated, compassionate care that focuses on respect for patients and their families and follows clinical practice guidelines for transgender care approved by the Endocrine Society and the World Professional Association for Transgender Health (WPATH).
Run through the Mary Bridge Endocrine Clinic, the multidisciplinary program uses a team approach in caring for transgender youth and their families. Staff members include four pediatric endocrinologists, a clinical medical social worker, two psychologists and two members of the MultiCare Complex Care Team, who act as liaisons and advocates for patients and their families.
The program is based in Tacoma, but patients can also be seen at locations in Olympia, Puyallup, Covington, and Silverdale. Patients have come from as far away as Sedro Woolley and Eastern Washington for treatment.
Coordinated care over time
The program generally treats about 30-40 patients, offering services that include hormone suppression therapy, cross-hormone therapy, counseling, social advocacy and support throughout the transition process. The clinic sees patients as young as 8 and as old as 18, after which point they are referred to adult care.
"For younger patients, initial visits are just about providing information and connecting them with counseling. Not every child who we see is going to end up identifying as transgender, but it's a good opportunity to talk with parents about the gender spectrum and how to communicate with the child," says Barbara Thompson, MD, pediatric endocrinologist and medical director of the Pediatric Transgender Program.
If the child does end up identifying as transgender, starting the transition process before puberty generally leads to better outcomes, she says.
Many older patients come to the clinic ready to begin hormone suppression or cross-hormone therapy. Before proceeding, they participate in a readiness evaluation performed by team psychologists and meet with a staff social worker who works closely with them and their families throughout the process.
Transgender kids more at risk
What does it mean to be transgender? The term refers to people whose biological gender doesn't match their innate sense of being male or female. Many transgender people say that they were assigned a gender at birth that doesn't match how they feel inside. Transgender people might identify as male or female, or feel that neither label fits them.
In order to express their chosen gender, transgender people might transition from their birth gender by changing their names or style of dress, or by undergoing medical intervention in the form of hormone therapy and/or surgery.
Some people might not know they're transgender until they're older, but others know early on, feeling from a young age that they don't belong in the body they were born into.
Transgender youth are more at risk for mental illness, including depression, anxiety, suicidal thoughts and attempts, and self-harm than their non-transgender peers, according to a 2015 study published in the Journal of Adolescent Health.
"When our patients come in, a lot of them have some level of depression and anxiety, but as their needs get met, that often begins to lessen," says Jesica Lester, LICSW, a clinical medical social worker in the Pediatric Transgender Program.
A positive environment
By the time patients get to the clinic to talk to a doctor about medical intervention, they're relieved and "over the moon" excited, Lester says.
"Everyone who comes in is so happy to be heard in a non-judgmental place where the doctor knows what needs to happen medically to get from point A to point B. It's a positive environment because of that," she says.
Patients at the clinic generally experience an improved mood and better quality of life, Lester says.
"As kids go through treatment, self esteem increases, body image improves, isolation lessens, and peer interactions improve. Even just for them to know that it's possible to transition helps decrease their anxiety.
"My favorite part of my job is being a support person for these kids who have struggled for so long, and being a strong advocate to make sure their rights and needs are being addressed in the community. It's really exciting to see the happiness on their faces when they're finally somewhere they feel heard and accepted," she says.