Children who are transgender typically know at a young age that their physical appearance doesn’t match their gender identity. It may be a while before they can do anything about it, though. They’re not eligible for surgery until they’re 18, and generally can’t get hormonal therapy under the age of 16, and then only with parental permission.
A new clinic at the Johns Hopkins Children Center is providing patients and their families with crucial information and support services.
At the Emerge Gender and Sexuality Clinic for Children, Adolescents and Young Adults, pediatric social worker Tisha James takes her cues from the patients.
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She supports transgender boys in binding their breasts, and transgender girls in putting on makeup and finding cute shoes. She guides some of her patients through the process of retiring their old names and introducing themselves to classmates with their new names and genders.
With parents, she discusses how to advocate for their children at school, shares information about how to change their names and gender identifications on documents, and helps them find resources like therapists close to where they live. “The bottom line is we are supporting their needs,” says James, who added Emerge patients to her existing Johns Hopkins pediatric caseload when the clinic opened in August 2017.
Emerge is part of a recent expansion of services at Johns Hopkins for patients who are transgender or don’t identify as either male or female. The Center for Transgender Health opened earlier the same year.
Adolescent medicine specialists Renata A. Sanders and Errol L. Fields were already treating transgender adolescents and young adults as part of their practices when they launched Emerge as a clinic specifically to care for transgender youth and those who don’t identify as either male or female. “It serves patients as old as 25 and as young as 6,” says Sanders.
Nationwide, very few pediatric gender clinics exist, and even fewer provide the in-depth multidisciplinary care offered by Emerge, they say.
The Emerge team includes adolescent medicine specialists, psychologists, social workers and nurses. Sanders and Fields provide various kinds of hormone therapy, including hormones that block puberty, when indicated. Pediatric endocrinologists are available to review complex cases and provide referrals for more specialized hormone therapy if necessary.
Emerge works with child and adolescent psychiatry for patients with comorbid mental health concerns — important because transgender youth have higher rates of suicide, depression and anxiety than the general adolescent population.
“Supporting transgender and gender nonbinary youth with counseling to help them thrive through this process is our ultimate goal,” says adolescent clinical psychologist Kathryn Van Eck. “I am honored to be a part of a team doing just that.”
The numbers attest to the pent-up demand. In its first year, Emerge had 116 referrals, provided care to 85 patients and referred 11 patients who are 18 years and older for surgery at the Johns Hopkins Center for Transgender Health, says Kathy Tomaszewski, nurse coordinator for the clinic.
“We have found that patients have been incredibly happy to find us,” says Fields. “For many, they have been on a long search to find a health care space where they will be affirmed and their gender health needs will be met.”
Often, says Sanders, the whole family needs counseling. “A child’s transition creates a transition for parents, too, regarding how they think of their child,” she says. “Transgender identity may be new to them and they may have a lot of questions. Parents are also looking for someone to address their concerns and reassure them that their child or adolescent will succeed.”
“I hear from patients who feel trapped, forced to be something they are not,” says Emerge’s clinical psychologist Tiffany Washington. “The clinic is a safe haven for them to ask questions, to have someone understand, to start a transition, and for patients to feel free to be themselves.”