MDNews - Central Pennsylvania

Penn State Health Children's Hospital: A Holistic Approach to Gender Health BY CARI WADE GERVIN THE GENDER HE AlTH ClINIC AT PENN STATE HE AlTH CHIlDREN'S HOSPITAl PROVIDES CARE TO CHIlDREN AND yOUNG ADUlTS QUESTIONING THEIR GENDER IDENTIT y. A S CULTUR AL AWARENE SS and acceptance of transgender and non-binary people has increased in recent decades, a greater number of young people have sought medical care related to questioning or affirming their gender. But until the Gender Health Clinic at Penn State Health Children's Hospital opened in the fall of 2019, children in central Pennsylvania had to travel to Pittsburgh or Philadelphia for treatment. "Central Pennsylvania has not historically had a lot of providers who are familiar with gender identity or providing gender- affirming services," says Amy K. Keisling, ACSW, LCSW, BCD, coordinator of the Gender Health Clinic. "Trans and gender- diverse youth really need a tremendous amount of support because they are a very vulnerable population. If you have an issue with identity and you're not getting an affirming response from the people around you, it can really increase anxiety and depression. When you provide affirming care, you can reduce that significantly." A TEAM APPROACH The Gender Health Clinic has an adolescent medicine physician, a psychiatrist and two endocrinologists, in addition to Keisling's counseling services. All are established experts in LGBTQ, gender identity and sexual health issues for children and young adults. " We also have relationships with dermatolog y, and we're trying to establish relationships with other departments, too," says Keisling, who is also a World Professional Association of Transgender Health Certified Provider and has specialized in gender identity counseling for more than 20 years. The team works together to determine plans of care, which vary greatly depending on the age and mental health of the patient. "With really young children, we're not doing any medical or surgical interventions," says R. Claire Roden, MD, FAAP, director of Adolescent Gender and Sexual Health Services at Penn State Health Children's Hospital and assistant professor of pediatrics in the Division of Adolescent Health at Penn State College of Medicine. "The only intervention that is recommended in a prepubertal person is therapy and maybe a haircut. That's it." Children who are on the verge of puberty may be prescribed puberty blockers, a reversible way to pause puberty, as they consider whether they want to try gender-affirmation hormone therapy later in adolescence. Some patients may simply take menstruation suppression. Others, depending on their readiness for and interest in treatment, will choose to start hormone therapy. "It depends on the level of sophistication of that child's under- standing of their own identity, the level of distress they're having, the length of time that they've been addressing the issue," Keisling says. "We work with families to determine the best timing." Because gender-affirming surgeries are not provided in the Gender Health Clinic, clinicians will refer patients as appropriate to surgeons who specialize in the procedure they seek. "I don't know what that patient is going to need to alleviate dysphoria surrounding their body," Dr. Roden says. "We try to remain agnostic as to what's the 'right' way, and instead just want to know what is the best way for this individual." FOCUSED ON RURAL PATIENTS (AND PROVIDERS) One thing that sets the Gender Health Clinic apart is its focus on rural patients, a focus which has only expanded over the past year. "Because of COVID-19, we made a substantial move to tele- medicine," Dr. Roden says. "That opened up our availability to all these patients who live hours and hours away from us." To meet these patients' needs, the clinic has been trying to look for ways to provide access to care in remote settings. "Instead of coming to see me in person, for instance, I can counsel a patient about testosterone [remotely]," Dr. Roden illustrates. "We're looking into finding providers in different parts of the state who are comfortable teaching patients how to do their own testosterone injections." The team is open to answering questions and providing education on transgender health to rural providers via a phone call or a presentation. They also have a nonjudgmental approach to referrals from physicians who aren't comfortable treating transgender youth. "Whether they feel like they don't have the time to, or they don't have the resources to, or they're worried that the staff are not going to be supportive, or they simply don't want to provide this type of care, we don't mind," Dr. Roden says. "Send the patients to us." It is not necessary for physicians to diagnose a child with gender dysphoria before referring patients to the Gender Health Clinic. In fact, they prefer physicians don't diagnose the child, both for insurance and therapeutic reasons. "We can make that determination," Keisling says. "They can just say, 'This is a kid who's questioning.'" n Find out more about the Gender Health Clinic at Penn State Health Children's Hospital by visiting pennstatehealth.org/childrens/ services-treatments/gender-health-program or calling 717-531-2073. M D N E W S . C O M /// M D N E W S C E N T R A l P E N N S y lVA N I A ■ 2 0 21 1 5

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