Pediatricians group recommends 'affirmative care' for transgender youth

The American Academy of Pediatrics published a policy statement Monday recommending children be “free to develop and explore their gender.”
by Tim Fitzsimons /

For the first time, the American Academy of Pediatrics published a policy statement that calls for gender-affirming health care for all transgender and gender-diverse (TGD) youth. The policy, which was posted online Monday and will be published in the next issue of the journal “Pediatrics,” is aimed at pediatricians who “are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.”

Noting that the field is “rapidly changing,” the AAP said in a statement that its new policy aims to address the disproportionate health risks faced by trans youth, like “high rates of depression, anxiety, eating disorders, substance use, self-harm and suicide.”

The main thrust of the proposal is what the AAP calls a “gender-affirmative care model,” or GACM, in which “providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.”

The GACM undergirds “a strong, nonjudgmental partnership with youth and their families can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment.”

In an interview with NBC News, the lead author of the policy guidance paper, Dr. Jason Rafferty, said “the biggest thing right now is the lack of education around this issue.” He said the policy guidance aims to ease the process for transgender and gender-diverse children and their parents as they attempt to navigate the pediatric challenges posed by the transgender experience.

“At this point, there seems to be a threshold of research out there really supporting an affirmative approach and supporting the need that kids have for a nurturing, loving environment in which to self-discover and develop, that it was enough that they AAP could make an official position on this topic,” Rafferty said.

The policy statement, Rafferty added, is for parents as much as it is for kids and providers, “in terms of approaching a provider, approaching a situation, knowing what to expect from your provider — knowing what sort of practice the evidence supports.”

The policy statement also recommends messaging that expresses transgender identities are normal and not causally related to mental health disorders; it notes that “stigma” often is a root cause for trans youth with mental health disorders.

But it is not a major policy change, Rafferty stressed. What the policy statement does is bring the AAP’s policies more up-to-date with current best practices.

“That rapid evolution is very intimidating for anybody in science and anybody in medicine, and so just being able to stay on top of that gives the provider a sense of confidence and understanding that they actually can play an important role even if they're not the one providing the treatments,” Rafferty said. “Those initial steps of supporting someone through coming out, and through disclosure, and woking with their family — it can really be lifesaving."

Ellen Kahn, director of the Children, Youth and Families Program at the Human Rights Campaign Foundation, a nonprofit LGBTQ advocacy group, applauded the AAP’s policy statement.

“Pediatricians have a critical role to play in both providing care to patients and in advocating for protections that support the mental and physical health of the public,” Kahn said in a statement shared with NBC News. “Today's statement by the AAP continues their long record of supporting the health of all youth."

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