Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories : Current Opinion in Pediatrics

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EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E Klig and Clifford W Bogue

Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories

Lillemoe, Jennaa,b; Holmstrom, Sara E.a,b; Sojar, Sakina H.a,b

Author Information
Current Opinion in Pediatrics 35(3):p 331-336, June 2023. | DOI: 10.1097/MOP.0000000000001239


Purpose of review 

Transgender and Gender Diverse (TGD) youth represent a growing subset of pediatric patients who are at increased risk for harmful health outcomes. Consideration of these risks during emergency encounters may decrease these undesired, sometimes fatal, adverse events.

Recent findings 

Gender affirmative care of TGD youth is considered a basic healthcare right as noted by several academic societies including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association [1–3] (Table 1

Table 1 - Summary of position statements for transgender youth.
Organization Date of Release Position Statements – Key Points
The American Academy of Pediatrics October 2018 • Support all children and adolescents, regardless of gender identity or expression, receiving care to promote optimal physical, mental, and social well being.
• Any discrimination based on gender identity or expression, real or perceived, is damaging to the socioemotional health of children, families, and society. [6]
The American Psychiatric Association July 2020 • Support access to affirming and supportive treatment for trans and gender diverse youth and their families, including appropriate mental health services, and when indicated puberty suppression and medical transition support.
• Oppose all legislative and other governmental attempts to limit access to these services for trans and gender diverse youth, or to sanction or criminalize the actions of physicians and other clinicians who provide them. [2]
Pediatric Endocrine Society December 2020 • Medical intervention for transgender youth and adults (including puberty suppression, hormone therapy and medically indicated surgery) is effective, relatively safe (when appropriately monitored) and has been established as the standard of care.
• Federal and private insurers should cover interventions as prescribed by a physician as well as appropriate medical screenings that are recommended for all body tissues that a person may have. [28]
Combined statement: AAFP, AAP, ACOG, ACP, AOA, APA April 2021 • Oppose any laws and regulations that discriminate against transgender and gender-diverse individuals or interfere in the confidential relationship between a patient and their physician.
• Strongly oppose to any legislation or regulation that would interfere with the provision of evidence-based patient care for any patient, affirming our commitment to patient safety…For gender-diverse individuals, including children and adolescents, this means access to gender-affirming care.
• Strongly oppose any effort to criminalize or penalize physicians for providing necessary care for their patients. [29]

). Withholding gender affirmative care can lead to undesired health outcomes including but not limited to an increased incidence of mood disorders, self-injurious behavior, suicidal ideation, sexually transmitted diseases, and delayed presentations of treatable illness. TGD youth often access acute care settings, yet many feel apprehensive due to prior negative experiences or fear of discrimination. Practitioners are also often unaware as to how to effectively provide this type of healthcare.


Acute care settings provide a unique and impactful environment to provide evidence-based, gender-affirming care that can make patients feel validated, mitigate future care avoidance, and minimize negative downstream health effects. In this review, we have consolidated high yield health considerations regarding TGD youth for acute care and emergency providers to deliver optimal care for this population.

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