Implamening Cri and nitions Climate Changes to mprove Heth Care z, {or ineviduals Who five LGBT, Gender Nonconforming, or Born with DSO ‘AAMC Serge Gender Dysphoria in an Adolescent Piratratcon a kalroMie ao Jaime s.9 14-year-old adolescent who was born with anatomy consistent with the male sex whom you have been eating sines be wasa Young child. You ask one of the his vital signs daring a well child visvisit She reads your chart Information and learns that, a a eld, Jl “always liked ‘gluing and fel ike all inside, but did nor think that ic was possible to do anything because “all people witha penis must bea hoy." He wasa rather happy and smart child, formed peer relationships easly, payed with boys and git equally and flexibly adapted to whatever aetvity was available. “Two years apo (around the age of 12) ata routine visi, Jaime's mother asked if you could provide 2 referzal fora erapist She fet that aime started 1o become sadder fr “no apparent reason” ond {he grades in schoo! startedto slip. You sent them to 2 colleague who works wll with depressed auolescets. Several months lar, she therapist communicated to you, sounding alarmed that Jaime mentioned in a sessin tha be thought he ws having crushes on other boys and questioned the counselor whether he might he gay. The therapists comment 1o you: I don't realy specialize in these ses” The therapit also asked if you had performed an HIV text anid STI sereening. despite Joime's denial ofan sexual relations with oxhers. Shortly zhereafter, your staf received a cal rom Jaime’ school indicating that he had made a Suicidal statement after an incident of bullying: “just don’ know if want to continue living anymore” You len that the therapist shared with the parents that “Jaime thinks he might be 194” latr stating that as okay to break conidentility “because a safety issue was at hand” “The parents repeatedly asked Jaime if he ight be “going threugh a phase” fr several months: however inthe year sine hey have bork come to be more supportive snd to accep hs sight be gay. Your clinical asistant goes othe waiting room and looks fr a cen mate but cannot identify one. Aer calling the name “Jaime.” an androgynou appearing adolescent stands up wearing makeup, tong pink hair, and ighttving jeans. The assistant acts surpeise, and nervously states, “Ob, ! was expeeting a young man inskad”eicing stares from other patients During your encounter, ine nots that his depression hasgoten worse and discloses tha since he always felts differen fom other boys, he conclude that he was simply gay. “But this {sdifecrt about who tam, not who {an stiracted Lo. fm old enough to eal thst now!” 0 ‘Asacaton of amerika ei Colege, 208{ot ingsia who we LORY, Gender Noncontorming. eran ath 830 fee Jaime asks you,“ fm a git onthe inside and have crushes on boys, but still havea penis, does that make mie gay or straight?” He asks you to use female promouns--someting that close Fiend have already been doing—and lets you Know he (she) prefers tobe called Martin, the name of charscier (om a movi he (she) likes, On physical exam, Jaime (Martine) is at Tanner Stage 1 anal becomes earful when you examine his (hen genital area. Jaime (Martine says that he (she) ic afraid of getting taller and developing alt of body hate and ther proclaims 1 jst wish didnt have wo foe this way.” You ate unsure how to respond. You ate also asked to “Leepthisaseerer from Jaime (Marines) parents Marine k's yout many questions about blocking puberty” and “hormones” and svhether or not it wil be posse wo stat them without her paren’ consent.Implementing Curada and iutonal mate Orange to improve sth Cae Zz ‘ov lnaiuate Who hee GR, Gone Mnornaiming, m1 Ren sith PED. ‘AAMC rerio Gender Nonconformity in a Prepubertal Child Author. Scott Leibowitz, M.D. Jonny isa 7-yearold child who was bora with anatomy consistent with the male sex. Ever since he could tak and express an ineeest in activites, his parenis real im pecerring hobbies that were stercolypically minine, For example, from a young age he prefered playing with dlls an {aking dresses from bis two older ster” closets to wear, Ave tured five Yrs ol, he woul ony play with female peers and theew tantrurns every ime his parents rid getting him o play soccer ‘outside with the other boys. At that age, there were several instances witen he seemed sad ané when asked why, he would answer, “I wish could be agit” ort just ike the name Julia rnc better.” This lod to some disagreements between his mother and father ver the best way to adleess his behaviors His methee would wonder wheter he might gro up to be transgender si she storied buying him dlls an dress, which made him very happy. His lather, onthe ether hand, would wry binging Jenny wo baseball games and would make satements to him sich as, “Boys don't wear dreses” Nov a7, Jonny insists on wearing his halong. has only female rit, ‘and continues wo wear deescs in the eomnort af his wa home. Despite the fact that he wears stereotypical “boy clathes” at school he il ges bullied by the boys andi often excluded from play with the girs Jonny's mother brings him in for 2 well-child visit with you, hs peiarician. Alshough his mother reports thal Jonny hay not made a taemtent that he wishes vo bea gil in some time, he pers hhappy and comfortabe wearing his favorite purple dress and happy playing withthe dlls in the waiting room. As the mothe and chil ae called back tothe examination room, one ofthe nerses Inadverterily refers o Jonny as she" when telling Jonny's mother how adorable Jonny Is. Bulg the appoiniment, the mother shares several of her concerns with you and asks the following questions: 4+ “What is going tohappen to Jonny?* + Tse transgender or pay? ‘+ “Tsthe simply a boy wo Likes ie thingy >* 1 “How ean thes sappoet him?= we cin ot meando calles 20%(Cena R Ske an Eanes toncentoming orton Baouc ‘When you ask Jonny about his rind in schoo, he quickly changes the subject to his favorite movie, Cinderela, and talks about his crush on the Prince. On physical exam, Jonny has Tonner 1 male genitals with no apparent abnormalities and displays ao discomafon during the exam. Atthe ‘end ofthe appointment, his moter asks If you could provide a noe 1 excuse Jonny fron gy “He relly dows ike gym and tends tobe teased for not boing asathleticasthe otter boys” In response to this discussion, Jonny says. 1 know t'm a boy. bt sometimes just sh L was agi ‘beens I eally Like doing ge things." The mother says In froncof im, “1 keep telling him that its ok fhe wants tobe agi, Ive sen pleny of docurtentaries on TV abou boys who become sis? [Atthat point, you politely intereupt and ask to meet with the mother alone—palling her into a Separate ronme—where sh begins to ery and says that she and her husband at ate at odds over how to best support Jonny, She notes that hee husband “thinks thisisall a phase” She recalls that hee own brother was stereotypically feminine 3s chil, “but he gees upto be gay and ot transgender 50 Fm just realy really confosed.” You oller counseling on how to best suppor Jonny by educating her on the lack of slic data regarding the preditablty of uajecories of gender nonconforming childeen and help her derstand how to advocate fo Jonny inthe schoo! siting Snd elsewhere You ao encourage er i support Jonny’sstengits and wo minimize bet use of Language that eveates shame or presumes future outcomes, and you assess whether a referral (0a lbchavioralncolth provider (ov is afieming and familiar with onder ove) is necessary.