Letter from the President: Pediatricians should not be transgender children’s first bully

As I sat at the AAP Districts II and VIII joint meeting in late June listening to two families talk about their experiences with their young transgender children, I felt privileged to witness such love and acceptance — and such normal, happy children who just happened not to fit their “assigned” or birth gender. I was proud to be an AAP member and a pediatrician, just as I was proud in April, when the North Carolina Chapter and national AAP called for repeal of North Carolina’s so-called “bathroom bill,” a law that denies transgender students access to gender-segregated spaces such as restrooms and locker rooms in schools.

I’ve learned so much from these children and their families. First, gender dysphoria can start very early. Both children experienced strong opinions about their gender at the age of 4 or 5. Second, there is a continuum in gender dysphoria. Both children had natal male genders. Yet one child changed her name to reflect a female gender and insisted she was a girl, while the other child wanted to be addressed with male pronouns in spite of a preference to dress like a girl and choose play and roles traditionally engaged in by girls.

Both families stressed how important it is for home to be a safe and accepting space for the transgender child. When those children walk through the door of their homes at the end of a school day, they should be able to be themselves without any judgment. As one of the fathers passionately said, “I won’t be my child’s first bully!”

The pediatrician’s office, and the entire health care setting, should be a safe, accepting place as well. I was sad to receive an email from one of the parents telling of another family’s encounters with the health care system when they bring their 5-year-old transgender daughter in for care for her serious chronic disease. The doctors refuse to treat her as a girl until she is older, and some have even called child protective services claiming the mother is harming her child for allowing her to live as a girl.

This is done even though a study by Olson and colleagues, published in Pediatrics in March, showed socially transitioned transgender children who are supported in their gender identity have improved mental health outcomes (Olson KR, Pediatrics. 2016;137:e20153223, http://bit.ly/29jaKIK). There appears to be no harm — and possible benefit — from such parent-supported early social transitions.

The parents asked the AAP to get the word out to our members about our support for transgender children and their families. I will paraphrase the statement made by one of the fathers and suggest we pledge that as physicians, especially pediatricians, we not be our patients’ first bully.

It’s been 44 years since the release of “Free to Be …You and Me” by Marlo Thomas and Friends. When it was first published, my daughter was 5 years old, and I must have listened to every lyric in the book enough times to memorize them all. My beloved wife, Constance, made sure we had every version of the text (book, record album and video). After all, the point was to empower girls to believe they could do anything, empower boys to think outside the narrow constraints of male stereotypes and empower all children to be unique individuals. It had a major impact on my daughter who quotes it to this day.

Now I’m a grandfather with two granddaughters, so I’ve been listening to the lyrics once more. This time, however, I’ve been thinking especially of transgender children and how the words so resonate with their world.

I will end this column by speaking directly to transgender children and youth with a quote from the book: I would like “to remind you that you’re the hero of your own life adventure and that you can write your story any way that you dream it can be.” You are free to be whomever you want to be!

Please see related story "Transgender youths may struggle to find gender-affirming care."