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Why We Treat Transgender Kids

Dr. Linda Gromko graduated from University of Washington School of Medicine in 1984, and in 1989 established her own practice, Queen Anne Medical Associates, PLLC.

Now twenty-two years old, the practice employs two first-rate Nurse Practitioners. Dr. Gromko and the Nurse Practitioners serve a wide diversity of individuals, including Seattle’s transgenderedcommunity. While she has delivered hundreds and hundreds of babies over the years, Dr. Gromko stopped delivering babies in 2005. Her practice began featuring an active weight loss program, Queen Anne Medical Weight Loss, in 2010.

And while my University of Washington training as a family practice physician taught me nothing about the transgender community, my experience with hundreds and hundreds of patients had taught me volumes.

Sometime in early 2012, Gender Consultant Aidan Key paid me a visit. Aidan has coordinated Seattle’s Gender Odyssey Conference for over a decade – and has conducted support/information groups for kids and their families at Seattle’s Children’s Hospital for several years. More recently, he has founded an organization, Gender Diversity, to extend the reach of this important work.

Linda Gromko

“Would you consider being a resource for transgender kids?” Aidan asked. “For puberty blockers and later, cross-hormones?”

Aidan backed up the question with an invitation for a day trip to visit Dr. Dan Metzger, a pediatric endocrinologist in Vancouver, BC, along with another Seattle physician, naturopath Chris Bosted.

We sat in my clinic waiting room and I reflected about my practice. I’d worked with the adult transgender community for fifteen years: both MTFs and  FTMs. I’d referred people for various surgeries and followed them all postoperatively.

And while my University of Washington training as a family practice physician taught me nothing about the transgender community, my experience with hundreds and hundreds of patients had taught me volumes. As did my experience participating in months of open meetings at the Ingersoll Gender Center in the late 1990s. I’ve gone to conferences; I’ve joined WPATH.

“Our trans people are among our most satisfied clients,” I explained to Aidan. “It all seems so straightforward to me. Once a person’s gender is synchronous with one’s mind, everything else – career, education, relationships – everything – seems to get better.”

Aiden sat quietly.

“And we certainly see people who have been harmed by not being able to transition – or to transition later in their lives. We see patients having expensive surgeries to remove breasts that wouldn’t have developed if they’d had treatment as adolescents. Or vocal surgery or therapy that wouldn’t have been necessary had they received treatment earlier. Think of the thousands of dollars and painful hours people spend in facial electrolysis or laser. And I have a couple of MTF clients that are so tall, they worry they’ll never ‘pass,’ and they may be right.”

Aidan continued to listen as I continued to spell out the reasons why treating kids and teens is so very reasonable.

“And I have talked to a couple of people who physically tried to remove their own testicles. None of this had to happen, had these folks received appropriate treatment.”

We talked about the stories we’d both heard through the years.

Perhaps the most compelling reason to begin this care is that as transgender children reach puberty, the asynchrony can be so overwhelming – and the likelihood for meaningful assistance can be so limited – that the suicide risk for transgender kids is higher than among any other single group of kids.

This is simply intolerable – particularly when we do have the capacity to help.

Puberty blockers can be administered through injections given every four weeks, or via an implanted medication approximately the size of a matchstick placed in the superficial tissue of the inside of the upper arm. Insurance coverage will vary according to a person’s policy (though Microsoft, Google, and other companies have covered trans medicine for years).

The puberty blockers give a child and family more time to be sure about their gender identity prior to using cross hormones (i.e., estrogen for MTFs, testosterone for FTMs) that eventually have irreversible effects. The good thing about blockers is that they are completely reversible: puberty starts as soon as blockers are removed: either a progression to “genetically assigned puberty,” or the use of cross hormones to move on through gender transition.

Consistently, I’ve asked my adult patients what they would have done differently as we complete the bulk of the transition process, and the most consistent answer I hear is, “I would have done it years earlier.”

© Linda Gromko, MD

Dr. Gromko is a Board Certified Family Practice Physician and founder of Queen Anne Medical Associates, PLLC.

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