About five years ago, Dr. Alejandro Diaz, a pediatric endocrinologist at Nicklaus Children’s Hospital, started getting patients referred to him due to gender dysphoria, or the feeling that a person’s identity is different from their biological sex.
At the time, the only pediatric endocrinologists counseling on this issue were in Broward, Diaz said.
“I spoke to the hospital to create consent forms,” Diaz said. “Then I started taking care of these children and teenagers.”
Providing supportive services to children and teens struggling with gender identity can be invaluable in ensuring a smooth transition and potentially lower their risk of suicide, said Dr. Chris Salgado, section chief of UHealth’s LGBTQ Center for Wellness, Gender and Sexual Health.
According to a report from the Center for Excellence for Transgender Health, 41 percent of transgender people who responded to its survey attempted suicide. Following treatment and therapy, that rate drops to 3 percent, the report found.
“The most important thing is to avoid suicide,” Diaz said.
Before transitioning, Victorino Marti, a 19-year-old whom Diaz has treated, was bullied. At school, his head was constantly shoved into lockers, and boys would slam stacks of textbooks against his head, he said.
“After transitioning, I’m no longer suicidal,” Marti said. “I see myself the way I’m supposed to look.”
As pediatricians become more aware of transgender issues and gender programs at hospitals are starting up, doctors are seeing younger children as patients.
“I have kids who are 4, 5, 6 years old coming in,” Diaz said. “Pediatricians know I’m doing this program and they send them here.”
Salgado sees the same trend at UHealth — the University of Miami Health System. The Gender Center at Nicklaus mainly focuses on top surgeries and chest reconstruction (although surgeons performed one bottom surgery on a transgender female), so they refer many bottom surgeries to UHealth. Patients usually can get top surgery around age 16 and bottom surgery at 18 at UHealth.
“Before, 10 percent of our patients were children under the age of 16,” Salgado said. “Now we see about 30 percent under 16.”
Youth-friendly programs are extremely important for transgender children, said Landon Woolston, MSW, the homeless youth programs and services manager at Pridelines, which works with Miami’s LGBTQ community.
“Medical transitions at younger ages can prevent trans children from developing secondary sex characteristics that may cause additional dysphoria,” he said.
Not all patients get surgery, Salgado said. To receive surgery, a patient must have a letter from a mental health professional saying they are eligible to transition.
The road to surgery is a long one. The process begins with the patient seeing a mental health specialist, who will meet with the child and family over the course of several months. Trans women might also see a voice therapist.
A nurse practitioner will begin monitoring the patient’s hormones, and children receive puberty blockers to begin the transition. Only after these steps have been completed can a person see a surgeon to modify their body to align with their gender identity.
Support is key
Diaz’s job is to provide parents with information about support groups, psychologists and therapists. After educating the family, the patient usually returns after beginning puberty to receive blockers.
“He has a list of people for everything because when you transition you will get acne and start gaining and losing weight,’’ said Marti. “You need psychiatrists and hormone therapists.”
Diaz’s main goal is to ensure the child is happy and comfortable, and to “look physically well and compatible with their gender identity.”
Diaz urges parents to connect with support groups. Among those he recommends: the YES Institute in South Miami, which has information about surgeons, psychologists and other resources.
Additionally, he suggests contacting Pridelines, which offers various support groups, including some for gender non-conforming youth. Other organizations include PFLAG and SunServe Youth.
Salgado says that a crucial aspect of a gender-variant child’s happiness is the support of the parents. Parents often don’t realize how much their child is suffering, and professionals can help them understand that and get through this together.
“Every seven times an adult is misgendered, there is a suicide attempt,” Salgado said.
If the parent understands the issues and is sensitive to — and accepts — the child as he or she is going through this, then the chance of suicide is greatly reduced, experts say.
“Far too often trans youth are told that they are confused about their gender, while this is something that cisgender children don’t face,” Woodston said. “Just as cisgender children know who they are at very young ages, often it’s the same for trans kids.”
▪ Appointments for the Gender Program at Nicklaus Children’s Hospital can be made at www.nicklauschildrens.org or by calling 305-666-6511.
▪ Beyond the Binary, a weekly psycho-social support group for trans and non-binary young adults ages 14-24, meets at Pridelines, 6360 NE Fourth Ct., from 6-8 p.m. every Tuesday.