Stanford Children's Health has begun to offer medical and other services to transgender children and adolescents, with an eye toward opening within the next year a more comprehensive multidisciplinary clinic to support what health providers say is a growing population.
Stanford begun offering hormonal treatments to transgender children and adolescents for the first time about six months ago, filling a void in the Peninsula. Families in the area seeking this care typically go to the Child and Adolescent Gender Center at University of California, San Francisco (UCSF), which offers comprehensive medical and psychological care, as well as advocacy and legal support, to transgender and gender non-conforming youth and adolescents.
Families who previously approached Stanford for care would typically be referred to the UCSF center, said Tandy Aye, a Stanford pediatric endocrinologist who started treating transgender children and adolescents about six months ago. She said she saw an "increasing need" and felt compelled to support local families.
Aye is currently seeing nine patients and receives several referrals per month. One family drove from as far away as six and a half hours because they couldn't access the services they needed where they live; another lives as close as Palo Alto, Aye said. Her patients are as young as 4 1/2 years old and as old as 15 years old.
"We're assessing the need, but it seems like the need is there and growing," Aye said.
In addition to providing medical services, Aye is also working with mental health providers and social workers to guide and advise families throughout their personal processes, which vary greatly from family to family and also, depending on the age of the child.
A younger child who has yet to enter puberty might be a candidate for puberty blockers, a set of medications that are prescribed by an endocrinologist to suppress or inhibit the production of sex hormones.
A teenager who has already gone through puberty, however, might opt for cross-sex hormone treatment, which can induce the physical and psychological characteristics of the sex that matches the patient's gender identity.
Patients must be evaluated by a mental health professional before receiving these treatments.
Though controversial, recognizing a child's gender dysphoria early before puberty and opting for puberty blockers can change the course of his or her transition drastically. The treatment is fully reversible, but can give "young people time to achieve greater self-awareness of their gender identification," according to the UCSF center's website.
"People are noticing, also, that if these children get the treatment they need even from an earlier age and not wait so long, the depression and suicide and other comorbidities ... are improved," Aye said. "Kids are happier."
Teenagers with persistent gender dysphoria experience a high rate of psychiatric comorbidities, including depression, suicidal ideation and attempted suicide, according to UCSF.
Transitioning during puberty can also mean "less corrective surgery down the road," Aye said.
A patient of any age might be in the process of deciding whether or not to socially transition at school, a decision that Aye and other professionals also work to support.
"That's all, to me, part of the treatment," she said.
This approach is a preview of what's to come at Stanford within the next year: a multidisciplinary clinic that would bring all of the subspecialties transgender children and adolescents need to access pediatric endocrinology, adolescent medicine, psychiatry, psychology, social work, OBGYN and urology under one roof. This increases access for both patients and their providers, who can then more easily collaborate with each other, Aye said.
Stanford Children's Health plans to open this clinic somewhere in Santa Clara County in the next eight to 12 months.
Aye, along with Stanford child and adolescent psychiatrist David Hong, is also in the midst of a pilot study that will follow both children with and without gender dysphoria for two to three years as they go through puberty.
The study aims to examine the physiological effects of puberty blockers and cross-sex hormones, an area Aye said has not been studied before in the United States. They are currently accepting study participants.