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Introduction: This study examined mental health, substance use, and sexual health across sexual attraction groups. Methods: 428 adolescents recruited from school-based health centers completed self-report measures. 72% were only opposite-sex attracted, 19% both-sex attracted, 3% same-sex attracted, 4% not sure. Results: Reported partners did not always align with reported attraction. Compared to opposite-sex attracted youth, 1) both-sex attracted youth had significantly higher rates of marijuana use (OR = 1.75, p =.04), depressive symptoms (OR = 2.62, p =.001) and inconsistent condom use (OR = 1.71, p =.05); 2) the “not sure” group had higher anxiety symptoms (OR = 4, p =.01). Conclusion: This study highlights the importance of considering sexual attraction in providing quality care to young people.

BACKGROUND/OBJECTIVE Studies have identified dermatologic conditions and relevant skin-related behaviors that distinctly or disproportionately impact sexual and gender minority (SGM) adults compared with their cisgender/heterosexual counterparts, but whether these observations apply to SGM adolescents remains unknown. We aimed to describe the nature and frequency of skin conditions in SGM youth relative to their cisgender/heterosexual peers and explore adolescents' attitudes toward their skin health and accessing dermatologic care. METHODS SGM and cisgender/heterosexual youth aged 13-21 years seen at Seattle Children's Hospital Adolescent Medicine and Gender clinics from June to December 2019 were invited to participate in this cross-sectional survey study, with subsequent statistical analysis. RESULTS One-hundred and eighteen subjects were included in the study. Sexual orientation did not affect how participants personally felt about and cared for their skin, though gender identity did influence this relationship. (P = .012) Both sexual and gender minority youth demonstrated a preference for a dermatologist who identified as SGM and would be more likely to actively seek care from these providers. (P

Transgender youth with autism spectrum disorder (ASD) may experience complex relationships with eating because of cognitive rigidity, including inflexible thoughts and behaviors around food and/or their body. Yet, there is no research that provides guidance to clinicians providing care for youth with the unique triad of gender dysphoria, ASD, and disordered eating. This case series discusses trends in presentation and management of three cases from a multidisciplinary gender care clinic. All three individuals endorsed rigid thoughts around food and/or body appearance, which affected nutritional intake; however, their presenting eating disorder behaviors, described etiology for disordered thoughts, diagnosis, and level of engagement in a multidisciplinary treatment model varied. Based on these cases we hypothesize several strategies including early engagement with ASD specialists, proactive screening and discussions around eating with all transgender youth with suspected/confirmed ASD, continued discussions throughout care, as disordered eating behaviors may change after the initiation of gender-affirming medications, dietician visits early in treatment regardless of endorsed thoughts and behaviors, tailored management to the unique needs of each individual and their eating thoughts/behaviors, and consistent multidisciplinary collaboration.

While some states in the USA have increased access to medical transition through mandating the services’ inclusion in their Medicaid expansion and tying in policy mandating transition-related care in private insurance plans, other states have chosen not to. Along with other factors, this uneven expansion has encouraged transgender adolescents to turn to crowdfunding to raise money for transition-related care. This ecological descriptive study compared trends in states with a Medicaid expansion that included access to medical transition for transgender adolescents to those that did not, through the lens of crowdfunding practices used to pay for a variety of transition-related healthcare costs. There was a proportionally higher number of transgender people conducting crowdfunding campaigns in states where Medicaid does not mandate access to a standard set of procedures for transgender people under 18 (unmandated state) than states where Medicaid does mandate access to a standard set of procedures for transgender people under 18 (mandated state). In the total sample of 98 cases, 60% (n = 59) were from unmandated states, while 40% (n = 39) were from mandated states. A surprising finding of this study was the prevalence of campaigns from mandated states. While access barriers previously discussed in the literature can account a great deal of the campaigns, an individual’s ability to work healthcare systems to their advantage, termed savvy in this paper, may account for the other cases. Transgender adolescents may need special outreach to educate them about their ability to use Medicaid to pay for transition, and guidance through overcoming access barriers to do so. Healthcare navigators skilled in the needs of transitioning adolescents are a worthy avenue for future policy development and funding.

Purpose News stories about transgender and gender nonconforming (TGNC) people have become more common in recent years and TGNC youth may be disparately affected by this information compared with their cisgender peers. The aim of this study was to understand how TGNC youth react to news stories about TGNC and other gender and sexual minority (GSM) identifying persons. Methods As part of a larger study, 23 TGNC youth were recruited from the Seattle Children's Gender Clinic to participate in a semistructured interview. Interviews were audio recorded, transcribed, and thematically analyzed. Results Participating youth ranged in age from 13 to 19 years (mean = 16.9 years). Of the 23 participants, 43% identified as having a transfeminine gender identity, 39% transmasculine, and 17% nonbinary/gender fluid. Four main themes were identified: (1) news coverage of current political climate affects gender transition; (2) negative news coverage of GSM people contributes to concerns about mental well-being and safety; (3) geographical location affects perception of news; and (4) positive news coverage of TGNC people increases visibility and hope. Conclusions Exposure to negative news about GSM people may contribute to increased levels of stress among TGNC youth. With increased visibility, participants described frustration associated with inaccurate portrayals of the TGNC community in the news; however, with increased visibility, there is also a growing sense of shared community and opportunity for acceptance of TGNC people. Given the scope of responses to negative and positive news on GSM people, TGNC youth may benefit from increased support to promote resilience when interpreting the news.

Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor doctrine and state intervention for neglect. Our discussion approaches this parent–child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors’ decision-making authority in certain medical situations.

Sexual and gender minority (SGM) persons, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) individuals, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Unfortunately, our understanding of these needs as they relate to dermatology is still nascent, particularly with respect to children and adolescents. This two-part review will discuss the dermatologic care of SGM youth, with Part 1 providing practical advice for dermatologists seeking to provide more culturally mindful and accessible care for SGM children and adolescents. A more comprehensive understanding of the psychosocial and physical needs of SGM youth will allow dermatologists to more actively and compassionately care for this health disparity population.

Sexual and gender minority (SGM) individuals, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) persons, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Part 2 of this two-part review will address unique concerns regarding acne, tanning behavior, sexually transmitted infections, and other health disparities among SGM adolescents. A more comprehensive understanding of the dermatologic needs of SGM youth will better allow pediatric dermatologists to actively and compassionately care for this health disparity population.

Purpose Practicing and resident pediatricians report inadequate skill in caring for adolescents, despite adolescents comprising roughly one-quarter of most general and subspecialty practices. This study examined the effectiveness of participation in an adolescent medicine rotation at improving pediatric residents’ self-perceived skills and confidence across nine key adolescent health domains. We also evaluated the impact of didactic instruction during the rotation. Methods Resident and recent-graduate participants (n = 34) completed milestone-based self-assessment of their skill and confidence caring for adolescent patients in nine key adolescent health-related domains. This study employed a post-test then retrospective pretest, an educational study design used to minimize response-shift bias whereby participants rate their skill and confidence at the end of the intervention (post-test), and then reflect back to retrospectively rate their preintervention skill (retrospective pretest). Additionally, differences in gains between those who did and did not participate in didactic instruction were evaluated. Didactic instruction was delivered during the adolescent medicine rotation utilizing a flipped-classroom model; participants received standardized preparatory materials and participated in active-learning workshops. Results Participants demonstrated a significant (p ≤ .0001) increase in self-perceived skill levels for all assessed domains after the rotation as compared to before the rotation, whether or not they received didactic instruction. Participation in didactic instruction did not yield significant (p ≤ .05) additional benefit for any of the assessed domains. Conclusions Participation in an adolescent medicine rotation is of value to pediatric resident trainees and leads to increased self-assessed skill and confidence in caring for youth.

Purpose: To assess youth and parent/caregiver satisfaction with care at a pediatric multidisciplinary gender clinic. Methods: Transgender/gender nonconforming youth (n=33) and their parent/caregiver (n=29) completed self-report questionnaires and individual interviews (n=20) about experiences and satisfaction with care. Results: Quantitatively, participants reported being extremely satisfied with care experiences (parents 97%; youth 94%). Qualitatively, main themes included (1) affirmation due to use of preferred name/pronouns, (2) access barriers due to scheduling and readiness assessments, and (3) positive interactions with Care Navigator. Conclusion: Youth and parents/caregivers are highly satisfied with multidisciplinary, coordinated health care for transgender/gender nonconforming youth; however, some challenges remain.

* Abbreviation: GDY — : gender-diverse youth In many studies on gender-diverse youth (GDY), those whose gender identity and sex assigned at birth do not fully align, researchers cite the 2017 Youth Risk Behavior Survey finding that 1.8% of US high school students identify as “transgender.”1 This was the first nationally representative prevalence estimate of GDY and was higher than previous estimates. However, the question assessing gender identity (“Do you identify as transgender?”) likely underrepresents the prevalence of GDY because many do not identify with the word “transgender.” As an alternative, researchers recommend a 2-step question: (1) What was your sex assigned at birth? (2) Which of the following best describes your gender identity?2,3 Much of the research involving GDY has been conducted in clinical settings, in which there is a predominance of white and masculine-identified youth.4–7 GDY … Address correspondence to Kacie M. Kidd, MD, West Virginia University School of Medicine, Department of Pediatrics, 1 Medical Center Drive, Morgantown, WV 26506. E-mail: kkidd3{at}hsc.wvu.edu

Transgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care.To investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality.This prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021.Time since enrollment and receipt of PBs or GAHs.Mental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome.Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51).This study found that gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.

Purpose Gender-affirming treatment for transgender and nonbinary adolescents has been shown to decrease anxiety, depression, and suicidality, but treatments have medical consequences. Specifically, hormone replacement and pubertal blocking may impact patients' fertility and childbearing capabilities. We interviewed gender diverse adolescents regarding their thoughts on family and fertility. Methods We completed semistructured interviews with 23 gender diverse adolescents recruited from the Seattle Children's Gender Clinic. Interviewees included transfeminine, transmasculine, and nonbinary youth. Interviews were recorded, transcribed, and analyzed using Braun and Clarke's theory of thematic analysis, a flexible framework for qualitative analysis. Results Gender diverse adolescents have myriad views on fertility, but four main themes were identified: (1) an interest in future family, including ideas regarding adoption and biological children; (2) barriers to fertility, including cost and procedure-related dysphoria; (3) factors unique to the developmental stage of adolescents, including the age discordance of making fertility decisions as a teenager and parental influence on decision-making; and (4) suggestions for clinicians approaching fertility counseling with adolescents considering hormone therapy. Conclusions Many gender diverse youth asserted an interest in building families, although the process of fertility preservation remains fraught. Relative to other studies, our participants were hopeful, imaginative, and interested in having children. Participants wanted to receive specific counseling on fertility, to receive help navigating the logistics of fertility preservation, and to be listened to when their hopes for children (or no children) were stated. Further research is needed to create care paradigms that address fertility of transgender youth in an affirming, developmentally appropriate manner.

Transgender and gender-diverse youth deserve proper sex education, but current educational and clinical structures largely ignore their developmental experiences. As a result, many of these teens go online to seek crucial information. Designers and researchers alike can benefit from an understanding of the design needs of gender-diverse youth for sex education online resources. We recruited 19 gender-diverse youth, ages 15 to 21, to participate in a mix of in-person and online design methods. This research makes three contributions; 1) identification of preferences for where gender-diverse teens prefer to get certain kinds of sexual health information, 2) design considerations for an online resource, 3a) a new method for eliciting preferences, the Four Corners Exercise, and 3b) a new method for combining the Asynchronous Remote Community (ARC) method with in-person sessions. Through this research, we provide key considerations in developing an online sex education resource for gender-diverse youth.

Purpose To determine how the seven Maternal and Child Health Bureau funded Leadership and Education in Adolescent Health (LEAH) programs currently obtain information on gender identity from their patients. Methods A computerized survey was sent to all LEAH site directors with questions to identify if and how programs documented youth's gender identity and barriers to implementation. Results With response rate of 100%, seven LEAH programs reported a total of 43 primary care and specialty clinics. For clinics with Electronic Health Records, 67% of clinics had a standardized gender identity question. Barriers to implementing a standardized question included concerns about confidentiality, lack of trained providers, low numbers of transgender patients, and no validated gender identity question. Conclusions Incorporation of inquiry of gender identity is possible in numerous clinical settings that serve adolescents. Future research is needed to determine how this information affects conversations with providers and necessary referrals to treatment.

Care of transgender and gender diverse youth is complex and requires a multidisciplinary approach. Many transgender patients and providers feel the limited availability of affirming, knowledgeable professionals is a barrier to obtaining care. Such care can be provided through a clinic with providers from different disciplines who are trained in the unique care of transgender youth. In this paper, we discuss the care guidelines for transgender youth and the unresolved challenges that need to be addressed during the development of a transgender clinic. We describe our experience at Seattle Children's Hospital in the development of a multidisciplinary Gender Clinic which incorporates the expertise of social work, mental health professionals, pediatric endocrinology, adolescent medicine, and bioethics. Other institutions may build from our experience, with the ultimate goal of further decreasing health disparities for young transgender patients.