Consulting in an affirmative way towards children and young people
Cross-gender play and other expressions of gender non-conformity in childhood are normal aspects of human development. However, parents may consult GPs when a child or young person is expressing unhappiness, distress, or anxiety around their gender identity.
If a child or young person is articulating their feelings around gender, it is important not be dismissive.
Be alert to the possibility that they may express gender-related distress in the form of challenging behaviours, truancy, attention deficiency, social anxiety, and through self-injury6 Some limit calories to slow or delay the onset of, or changes associated with, puberty, and present to the GP as being underweight.
As a rule of thumb, while a child or young person’s self-expression might well change over time, one way to avoid impacting well-being is to respect their identification and how they navigate the gendered world in the moment.7.
In this scenario, Jodie’s mum is already supporting her child with a partial change of social gender role, including a name and pronoun change, and some subtle shifts to the way she dresses to make her feel more comfortable. It is likely that the local school will be engaged in supporting this process, but levels of inclusivity and engagement can vary.
A formal change of medical record has not been requested, but it would be appropriate to suggest putting a note on the system so that Jodie can be called by her preferred name and not misgendered (using a form of address that does not reflect the gender with which a person identifies). It is courteous to use the name and pronoun requested, and not to pathologize this process by adding diagnostic read codes to the notes. Most certainly a change of social gender role does not need prior approval from a gender identity specialist.
Lastly, do not make gender identity the primary focus of the consultation if this is not why a patient comes to see you. Naturally it would be helpful to check to see if the family want help with signposting for support, but in this scenario, Jodie has an URTI and asthma exacerbation.
Practical Tip
GPs in Wales can refer patients over the age of 17.5 years directly to the Welsh Gender Service. Signpost to credible charities with experience in the field who can help support your patient and /or their family orientate themselves and navigate this terrain.
The National Trans Youth Network lists groups across the UK.
“Some appointments will be about referring me to a gender identity clinic, or about hormones. Others will be what anyone else comes for—tonsillitis, back pain. Please don’t bring up my trans status if it’s not relevant to the consultation.” I am your trans patient, BMJ 2017