Pediatric and Adolescent LGBT Health

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) youth face multiple challenges during their adolescence. This chapter addresses the developmental, psychosocial, medical, and mental health needs of LGBT youth and their families. This chapter explores literature on LGBT youth health disparities and introduces a framework for providing LGBT youth clinically and culturally competent care. Best practices and clinical resources for those caring for LGBT youth are reviewed in this chapter.

Appendices

Supplement 1: Resources

Useful Books for Youth, Counselors, and Family

Books

• Losing generations: adolescents in high-risk settings: panel on high-risk youth. Commission on Behavioral and Social Sciences and Education, National Research Council. 1993.

• Males M. Framing youth: 10 myths about the next generation. Common Courage Press. 1999.

Books for Children

• Heron, How would you feel if your dad was gay?—Examines the concerns of three children with gay parents.

• Newman, Heather has two mommies—Illustrates the loving and supportive family of 5-yearold Heather and her two lesbian mothers. So lovingly done, you’ll wonder what all the fuss was about in the NYC School Board.

• Willhoite, Daddy’s roommate—Illustrates many family situations with this non-traditional family.

• Willhoite, Families, a coloring book—Appreciating diverse (racial, generational, cultural, sexual) families, Ages 2–6.

Books for Adolescents Self Help

• Bass and Kaufman, Free your mind: The Book for Gay, Lesbian, and Bisexual Youth and Their Allies. Harper Perennial.

• Be yourself: Questions and answers for gay, lesbian and bisexual youth—Factual, no-nonsense, homo-positive 22-page pamphlet available from PFLAG.

• Due, Joining the tribe: Growing up Gay and Lesbian in the 90’s. Doubleday.

• Marcus, Is It a Choice? Answers to 300 of the Most Frequently Asked Questions about Gays and Lesbians. Harper Collins.

• McNaught, On being gay: Thoughts on family, faith, and love—Gay-positive essays on family, faith, and love, and what it means to be gay.

• Rench, Understanding sexual identity: A book for gay teens and their friends—Discusses coming out, healthy sexuality, homophobia, religious views, and resources.

Novels and Autobiographies

• Due, Joining the tribe: Growing up gay and lesbian in the 90’s—Interviews with several teens of varied backgrounds.

Books and Articles for Counselors

• Bergstrom and Cruz, Counseling lesbian and gay male youth: Their special lives/special needs. Increases counselors’ awareness of the issues.

• Berzon, Positively gay: New approaches to gay and lesbian life—Valuable anthology on living a fulfilling lesbian or gay life.

• Shiman, The prejudice book: Activities for the classroom—Although the book does not explicitly mention lesbians and gays, the discussion can certainly address these groups. Excellent vehicle for exploring prejudice, stereotypes, and discrimination.

Coming-Out and Parental Acceptance Handbooks

• Bernstein, Straight parents/gay children—Addresses parental fear and helps parents appreciate their child. Told through the vehicle of author accepting his lesbian daughter.

• Borhek, Coming out to parents: A two-way survival guide for lesbians and gay men and their parents—Good resource for lesbians and gay men, counselors, and parents. Chapter on religious issues.

• Borhek, My son Erik—Acceptance after initial difficulty relative to fundamentalist religious beliefs. Good for parents with religious issues.

• Fairchild and Hayward, Now that you know: What every parent should know about homosexuality. Harcourt Brace Jovanivich.

Reference and Office Books to Consider

• Mastoon, Adam. The Shared Heart-Portraits and Stories Celebrating Lesbian, Gay, and Bisexual young people. Harper Collins Press 1997

• Lathom, Bob. The invisible minority: GLBTQ Youth at Risk. Point Richmond Press 2000

• Owens, Robert. Queer Kids: The Challenges and promises for Lesbian, Gay and Bisexual Youth Harrington Park Press 1998. (State by State reference list of resources included.)

• Boykin, K. One More River to Cross: Black and Gay in America. New York: Anchor Books, 1996.

• Brown, L. S. Lesbian Identities: Concepts and Issues. In A. R. D’Augelli and C. J. Patterson (eds.), Lesbian, Gay and Bisexual Identities over the Lifespan. New York: Oxford University Press, 1995.

• Butler, J. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1990.

• Butler, J. Bodies That Matter: On the Discursive Limits of Sex. New York: Routledge, 1993.

• Catallozzi M, Rudy B. Lesbian, gay, bisexual, transgendered, and questioning youth: The importance of a sensitive and confidential sexual history in identifying the risk and implementing treatment for sexually transmitted infections. Adolescent Medicine Clinics, Volume 15, Number 2—June 2004.

• Clare, E. Exile and Pride: Disability, Queerness, and Liberation. Boston: South End Press, 1999.

• Creed, B. Lesbian Bodies: Tribades, Tomboys, and Tarts. In E. Grosz and E. Probyn (eds.), Sexy Bodies: The Strange Carnalities of Feminism. New York: Routledge, 1995.

• D’Augelli, A. R. Identity Development and Sexual Orientation: Toward a Model of Lesbian, Gay, and Bisexual Development. In E. J. Trickett, R. J. Watts and D. Birman (eds.), Human Diversity: Perspectives on People in Context. San Francisco: Jossey-Bass, 1994.

• Diaz, R. Latino Gay Men and Psycho-Cultural Barriers to AIDS Prevention. In M. Levine, J. Gagnon and P. Nardi (eds.), In Changing Times: Gay Men and Lesbians Encounter HIVIAIDS. Chicago: University of Chicago Press, 1997.

• Fassinger, R. E. The Hidden Minority: Issues and Challenges in Working with Lesbian Women and Gay Men. Counseling Psychologist, 1991, 19(2),157–176.

• Feinberg, L. Transgender Warriors: Making History from Joan of Arc to Dennis Rodman. Boston: Beacon Press, 1996.

• Feinberg, L. Trans Liberation: Beyond Pink or Blue. Boston: Beacon Press, 1998.

• Fox, R. Bisexual Identities. In A. R. D’Augelli and C. J. Patterson (eds.), Lesbian, Gay, and Bisexual Identities over the Lifespan: Psychological Perspectives. New York: Oxford University Press, 1995.

• Halberstam, J. Female Masculinity. Durham: Duke University Press, 1998.

• Harry Benjamin International Gender Dysphoria Association. The HBIGDA Standards of Care for Gender Identity Disorders, Sixth Version. 2001.

• http://www.wpath.org/documents2/socv6.pdf

• Klein, F. The Need to View Sexual Orientation as Multivariable Dynamic Process: A Theoretical Perspective. In D.P. McWhirter, S. A. Sanders and J. M. Reinisch (eds.), Homosexuality/Heterosexuality: Concepts of Sexual Orientation. New York: Oxford University Press, 1990.

• Klein, F. The Bisexual Option. (2nd ed.) New York: Haworth Press, 1993.

• Raffo, S. Introduction. In S. Raffo (ed.), Queerly Classed. Boston: South End Press, 1997.

• Renn, K. A., and Bilodeau, B. Analysis of LGBT Identity Development Models and Implications for Practice. In R. Sanlo (ed.), Gender Identity and Sexual Orientation Research, Policy and Personal Perspectives. San Francisco: Jossey-Bass, 2005.

• Rhoads, R. A. Coming Out in College: The Struggle for a Queer Identity. Westport, Conn.: Bergin and Garvey, 1994.

• Savin-Williams R. The New Gay Teenager. Harvard University Press, Cambridge, MA, 2005.

• Wilchins, R. A. Read My Lips: Sexual Subversion and the End of Gender. New York: Firebrand Books, 1997.

• Wilchins, R. A. Queerer Bodies. In J. Nestle, C. Howell and R. A. Wilchins (eds.), Genderqueer: Voices from Beyond the Sexual Binary. Los Angeles: Alyson, 2002.

• Wilson, A. How We Find Ourselves: Identity Development in Two-Spirit People. Harvard Educational Review, 1996, 66(2), 303–317.

Videos

• It’s elementary: Talking about gay issues in school—Explores the teaching of tolerance in six different classrooms (available from Women’s Educational Media, San Francisco, 415-641-4632).

• Pride and prejudice: The life and times of gay and lesbian youth—Focuses on a Toronto weekly youth group showing the significance of this service for teens (available at 416-924-21 00).

• Safe schools: Making schools safe for gay and lesbian students (available from Donna Brathwaite, Safe Schools Program, Massachusetts Department of Education, 617-388-3300, ext. 409. Plan to send blank tape).

• Teaching respect—Produced by the Gay, Lesbian, and Straight Teachers Network. This video explains why educators should be concerned about homophobia and abuse in school (available at 212-727-0135).

• Both My Moms’ Names Are Judy is a provocative 10-min video that shows elementary school children who have gay or lesbian parents talking about their experiences at school. The video is available from Lesbian & Gay Parents Association, 519 Castro St., Box 52, San Francisco, CA 94114-2577, Phone: 415-522-8773, e-mail: LGPASF@aol.com (10 min, $25 individual/$50 institution).

• Gay Youth. This powerful video is extremely effective in showing why sexual orientation education is important. A variety of young people are interviewed, and the effect of family support is revealed. The results range from suicide to having a same-sex date for the senior prom. I have used this video for faculty at all grade levels as well as for high school students. Audiences always gave it high marks on the evaluation form (40 min, $59.95).

• Out of the Past traces the emergence of gay men and lesbians in American history through the eyes of a young woman coming to terms with herself. This film by Jeff Dupre won the Sundance Film Festival Audience Award for Best Documentary as well as a Bronze Apple from National Educational Media Foundation in 1998 (65 min, $25 individual/$99 institution).

• The Trevor Project: www.trevorproject.org

• It Gets Better: www.itgetsbetter.org

• PRCH: Adolescent Reproductive and Sexual Health Education Project

  http://prh.org/teen-reproductive-health/arshep-explained/

  www.prch.org email: info@prch.org, phone: 646-366-1890

  Physicians for Reproductive Choice and Health

  55 West 39th St, suite 1001, New York, NY, 10018-3889

  Fax 646-366-1890

National Organizations

• Coalition for Lesbian and Gay Student Groups (214) 621-6705

• Gay, Lesbian, Straight Education network: http://www.glsen.org

• National Coalition for LGBT Youth: http://www.outproud.org

• Sexuality information for Teens, by Teens: http://www.sxect.org

• The UCSF Center for AIDS Prevention Studies: http://hivinsite.ucsd.edu

• An AIDS and HIV information resource: http://thebody.com

• National AIDS Advocacy Organization: http://aidsaction.org/

• Information on AIDS and HIV in Spanish: http://www.ctv.ed/USERS/fpardo/home.html

• The HIV/AIDS Treatment Information Service (ATIS): http://hivatis.org

• The American Academy of Child and Adolescent Psychiatry—Facts for Families: http://www.aacap.org/publications/factsfam/index.htm (AIDS #30 GL Adol #63)

• National Gay and Lesbian Hotline: 1-800-SOSGAYS

• National Runaway Switchboard and Adolescent Suicide Hotline: 1-800-621-4000

• National Youth Advocacy Coalition (NYAC): http://www.nyacyouth.org

• The Trevor Project: http://www.trevorproject.org 866-4-U-TREVOR

• Transfamily: http://transfamily.org

• Transkids Purple Rainbow: http://www.transkidspurplerainbow.org

• Family Acceptance Project: http://familyproject.sfsu.org

• It Gets Better: http://www.itgetsbetter.org

• National Federation of Parents, Family and Friends of Lesbians and Gays (PFLAG): http://www.community.pflag.org

• Youth Resource: http://www.amplifyyourvoice.org/youthresource

Medical Professional Organizations

• GLMA: Health Professionals Advancing LGBT Equality: http://www.glma.org

• AMA LGBT Advisory Committee: https://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page

• The World Professional Association for Transgender Health, Inc (WPATH): http://wpath.org

• Adolescent Reproductive and Sexual Health Education Project: http://www.prh.org/ARSHEP

Talk Lines/Hotlines/Crisis Lines

AIDS Foundation Hotline (English and Spanish)	(800) for AIDS
GLBT Peer Youth Hotline	(800) 399-PEER
Gay, Lesbian, and Bisexual Youth Line	(800) 347-TEEN
Gay Men’s Health Crisis (GMHC)—HIV/AIDS	(212) 807-6655
LYRIC Gay Youth Talk Line and Info Line	(800) 246-PRIDE
Lesbian AIDS Project HIV/AIDS info and referral	(212) 337-3532
National Center for Lesbian Rights	(800) 528-6257
National HIV/AIDS Hotline	(800) 342-AIDS
National Lesbian and Gay Crisis Line	(800) 221-7044
National Native American AIDS Prevention Center	(800) 283-AIDS
National Runaway Hotline	(800) 843-5200
National Suicide and Runaway Switchboard	(800) 621-4000
National Suicide Hotline	(800) 882-3386
Out Youth Hotline	(800) 96-YOUTH
Parents and Friends of Lesbians and Gays	(415) 921-8850
	(202) 638-4200
Project Inform Hotline—HIV/AIDS Information	(800) 822-7422

Supplement 2: Transgender

Medical

• Bilodeau, Brent. Genderism: Transgender Students, Binary Systems and Higher Education. Saarbriicken, Germany: VDM Verlag Dr. Muller Aktiengesellshaft, 2009.

• Bockting, Walter, and Eric Avery. Transgender Health And HIV Prevention: Needs Assessment Studies from Transgender Communities Across the United States. Binghamton, NY: The Haworth Medical Press, 2005

• Bockting, Walter, and Joshua Goldberg (eds). Guidelines for Transgender Care. Binghamton, NY: The Haworth Press, 2007.

• Coleman, Edmond J., Walter 0. Bockting, and Sheila Kirk. Transgender And HIV: Risks, Prevention, and Care. Binghamton, NY: Haworth Press, 2001.

• Denny, Dallas, ed. Current Concepts in Transgender Identity. Garland Reference Library of Social Science, 1998.

• Drescher, Jack, and Ubaldo Leli, eds. Transgender Subjectivities: A Clinician’s Guide (Journal of Gay & Lesbian Psychotherapy Monographic Separates). Binghamton, NY: Haworth Medical Press, 2004.

• Ellis, Alan L., Melissa White, and Kevin Schaub. The Harvey Milk Institute Guide to Lesbian, Gay, Bisexual, Transgender, and Queer Internet Research (Haworth Gay & Lesbian Studies). Harrington Park Press, impt of Haworth Press, Binghamton, NY, 2002

• Ettner, Randi, Stan Monstrey, and Even Eyler. Principles of Transgender Medicine and Surgery (Human Sexuality). Binghamton, NY: Haworth Press, 2007.

• Gottlieb, Andrew. Interventions With Families of Gay, Lesbian, Bisexual, And Transgender People: From the Inside Out. Binghamton, NY: Haworth Press, 2006.

• Harcourt III, John P. Current Issues in Lesbian, Gay, Bisexual, And Transgender Health. Binghamton, NY: Harrington Press (impt of Haworth Press), 2006.

• Hines, Sally. TransForming Gender: Transgender Practices of Identity, Intimacy and Care. Bristol, UK: Policy Press, Univ of Bristol, 2007.

• Kirk, Sheila. Hormones for the Female to Male. Available from www.ifge.com.

• Lev, Arlene. Transgender Emergence: Therapeutic Guidelines for Working With Gender Variant People and Their Families (Haworth Marriage and the Family). The Haworth Clinical Practice Press, impt of Haworth Press, Binghamton, NY, 2004.

• MacGillivray, Ian K. Gay-straight Alliances: A Handbook for Students, Educators, and Parents (Haworth Series on GLBT Youth &Adolescence). Binghamton, NY: Harrington Park Press, 2007

• Makadon, Harvey J., et al. Fenway Guide to Lesbian, Gay, Bisexual & Transgender Health. American College of Physicians, 2008.

• Mallon, Gerald P. Social Work Practice with Transgender and Gender Variant Youth. New York: Routledge, 2009.

• Meezan, William, and James I. Martin, eds. Research Methods With Gay, Lesbian, Bisexual, and Transgender Populations (Journal of Gay & Lesbian Social Services, 3/4)

• Nunter, Nan D., Courtney G. Joslin, and Sharon M. McGowan. The Rights of Lesbians, Gay Men, Bisexuals, and Transgender People (American Civil Liberties Union Handbook). Southern Illinois UP, ACLU, 2004

• Meyer, Ilan H., and Mary E. Northridge, eds. The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations. New York: Columbia UP, 2006.

• O’Keefe, Tracie, and Katrina Fox, eds. Finding the Real Me: True Tales of Sex and Gender Diversity. San Francisco: Jossey Bass, 2003.

• Sanlo, Ronni L., ed. Working with Lesbian, Gay, Bisexual, and Transgender College Students: A Handbook for Faculty and Administrators (The Greenwood Educators’ Reference Collection). Westport, CT: Greenwood Press, 1998.

• Sears, James T. Gay, Lesbian, And Transgender Issues In Education: Programs, Policies, And Practice (Haworth Series in GLBT Community and Youth Studies). Binghamton, NY: Harrington Park Press, 2005.

• Valentine, David. Imagining Transgender: An Ethnography of a Category. Durham, NC: Duke University, 2007.

• Whittle, Stephen, and Susan Stryker. The Transgender Reader. Binghamton, NY: Haworth Park Press, 2005; New York: Routledge, 2006.

• Winters, Kelley. Gender Madness in American Psychiatry: Essays from the Struggle for Dignity. ISBN l-4392-2388-2, GID Reform Advocates

Medical Journals

• Gagne, Patricia, Richard Tewksbury and Deanna McGaughey, Coming out and Crossing over: Identity Formation and Proclamation in a Transgender Community. Gender and Society, Vol. 11, No.4 (Aug., 1997), pp. 478–508. http://www.jstor.org/stable/190483

• P Lee, C Houk—The Diagnosis and Care of Transsexual Children and Adolescents: A Pediatric Endocrinologists’ Perspective. J Ped Endocrin Metab, 2006, vol. 19 (no. 2)

• Rosenberg, Miriam, M.D., Ph.D. Recognizing Gay, Lesbian, and Transgender Teens in a Child and Adolescent Psychiatry Practice. J Am Acad Child Adolesc Psychiatry. 2003 Dec; 42(12): 1522–3.

• Stoller, R.J. (1979). Fathers of Transsexual Children. J. Amer. Psychoanal. Assn., 27:837–866.

General Adult and Professionals

• Beam, Cris. Transparent: Love, Family, and Living the T with Transgender Teenagers. Orlando, FL: Harcourt Brace, 2007.

• Boenke, Mary, ed. TransForming Families: Real Stories about Transgendered Loved Ones, 3rd ed. New York: PFLAG, 2003.

• Boyd, Helen. She’s Not the Man I Married: My Life with a Transgender Husband. Emeryville, CA: Seal Press, 2007.

• Brill, Stephanie A. and Rachel Pepper. The Transgender Child: A Handbook for Families and Professionals. San Francisco: Cleis Press, 2008.

• Brown, Mildred, and Chloe Rounsley. True Selves: Understanding Transsexualism: For Families, Friends, Coworkers and Helping Professionals. San Francisco: Jossey-Bass, 2003.

• Cascio, J., Catherine Brown, and Beatrice Gordon. Dragonfly Stories: Stories Celebrating the LGBTQ Community, (vol. 1). Kearney, MI: Rainbow Legends, LLC, 2007. Published in the Journal of GLBT Family Studies, Volume 4, Issue 4 September 2008, pages 543–545.

• Feinberg, Leslie. Trans Liberation: Beyond Pink or Blue. Boston: Beacon Press, 1998. Gold, Mitchell, with Mindy Drucker. Crisis: Growing Up Gay in America. Greenleaf Book Club Press, 2008.

• Green, Jamison. Becoming a Visible Man. Nashville: Vanderbilt UP, 2004.

• Heman, Joanne. Transgender Explained For Those Who Are Not. Bloomington, IN, AuthorHouse, 2009.

• Howard, Kim, and Steven Drukman. Out & About Campus: Personal Accounts by Lesbian, Gay, Bisexual & Transgender College Students. Los Angeles: Alyson Publications, 2000.

• Huegel, Kelly. GLBTQ: The Survival Guide for Queer and Questioning Teens. Minneapolis, MN: Free Spirit, 2003.

• Israel, Gianna E., Donald E. Tarver and Diane Shaffer. Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts. Philadelphia: Temple UP, 1997.

• Jennings, Kevin, and Pat Shapiro. Always My Child: A Parent’s Guide to Understanding Your Gay, Lesbian, Bisexual, Transgendered or Questioning Son or Daughter. New York: Fireside, 2003.

• “Just Evelyn.” Mom, I Need to be a Girl. Imperial Beach, CA: Walter Trook Publishing, 1998. [276 Date St. Imperial Beach, CA 91932]

• Kane-Kanedemaios, J. Ari, and Vern L. Bullough, eds. Crossing Sexual Boundaries: Transgender Journeys, Uncharted Paths. New York: Prometheus, 2006.

• Kerry, Stephen. Are You a Boy or a Girl? Intersex and Genders: Contesting the Uncontested: A Comparative Analysis between the Status of Intersex in Australia and the United States of America. Saarbriicken, Germany: VDM Verlag, 2008

• Kotnla, Dean. The Phallus Palace: Female to Male Transsexuals. Los Angeles, Alyson Press, 2002.

• Lundschien, Randy P. Queering Creole Spiritual Traditions: Lesbian, Gay, Bisexual, and Transgender Participation in African Inspired Traditions in the Americas. Binghamton, NY: Haworth Press, 2004.

• Matzner, Andrew. 0 Au No Keia: Voices From Hawai’i’s Mahu and Transgender Communities. 2001 (out of print)

• O’Keefe, Tracie, and Katrina Fox. Trans People in Love. New York: Routledge, 2008. Rose, Lannie. How To Change Your Sex: A Lighthearted Look at the Hardest Thing You’ll Ever Do. Lulu Press, 2004.

• Rudacille, Deborah. The Riddle of Gender: Science, Activism, and Transgender Rights. New York: Pantheon Books, 2005.

• Stryker, Susan. Transgender History (Seal Studies). Berkeley: Seal Press, 2008

Books for Children

• Dyer, Wayne, Kristina Tracy, and Melanie Siegel. Incredible You: 10 Ways to Let your Greatness Shine Through. Carlsbad, CA: May Mouse, 2005.

• Ewert, Marcus, and Rex Ray. 10,000 Dresses. New York: Seven Stories Press, 2008.

• Jimenez, Karleen Pendelton. Are You a Boy or a Girl? Toronto, Canada: Green Dragon Press, 2000.

• Kates, Bobbi. We’re Different, We’re the Same. New York: Random House, 1992.

• Parr, Todd. It’s OK to be Dif.forent. Little, Brown, 2001.

• Perel, Ronnie. Fluffy the Bunny. Available at www.IFGE.org

• Wanzer, C. Kevin. Choose To Love: A Poem About Life, Love & Choices. Bloomington, IN: AuthorHouse, 2006.

Books for Children (Spanish)

• Dyer, Wayne. Eres increible!: 10 formas de permitir que tu GRANDEZA brille a traves de ti, Carlsbad, CA: May House, 2006.

Books for Teens

• Anders, Charlie. Choir Boy. [available on Amazon.com]

• St. James, James. Freak Show. New York: Penguin, 2007.

• Saint Clair, C.C. Morgan in the Mirror. ISBN-10: 0980334438 ISBN-13: 978-0980334432. POD.

• Bomstein, Kate. Hello Cruel World: 1OJ Alternatives to Suicide for Teens, Freaks and Outlaws. Kindle Edition, 2006.

• Sardella, Rebecca. My Brother Beth (out of print)

• Bomstein, Kate. My Gender Workbook: How to Become a Real Man, a Real Woman, the Real You, or Something Else Entirely. New York: Routledge, 1998.

• Peters, Julie Anne. Luna. New York: Little Brown, 2006. Wittlinger, Ellen. Parrotfish. New York: Simon & Schuster, 2007.

References for Gender Dysphoria

• Brown, M.L., and Rounsley, A.C. (1996). True Selves: Understanding Transsexualism for Families, Friends, Coworkers, and Helping Professionals. San Francisco, CA: Jossey-Bass.

• Brill, S.A. & Pepper, R. (2008). The Transgendered Child: A Handbook for Families and Professionals. San Francisco, CA: Cleis Press Inc.

• Cohen- Kettenis, P.T. and Pfafflin, F. (2003). Transgenderism and intersexuality in childhood and adolescents: Making choices. Thousand Oaks, Sage Publications.

• Cohen-Kettenis, P.T., Delemarre-van de Waal, H.A., and Gooren, L.J. The treatment of transsexual adolescents: Changing insights. Journal of Sexual Medicine, 2008, 5, 8, 1892–1897.

• Delemarre-van de Waal, H.A. and Cohen-Kettenis, P.T. Clinical management of gender identity disorder in adolescents; A protocol on psychological and pediatric endocrinology aspects. European Journal of Endocrinology, 2006, Nov 155, Suppl 1: 131–137.

• Drummond, K.D., Bradley, S.J., Peterson-Badali, M., and Zucker, K.J. A follow-up study of girls with gender identity disorder. Developmental Psychology, 2008, 44, 34–45.

• Hembree, W., Cohen-Kettenis, P.T., Delemarre-van de Waal, H., Gooren, L.J., Meyer III, W. Spack, N., et al. Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 2009, 94, 3132–3154.

• Spack NP. Transgenderism, Lahey Clinic Medical Ethics, 2005, 12(3). Fall issue.

• Speigal, A. (May 2008). “All Things Considered:” An Interview with Dr. Norman P. Spack on Pubertal Suppression in Transgender Adolescents. National Public Radio “Driveway Moments” 2009 Series;

  http://www.npr.org/templates/story/story.php/?storyId=90247842 (part 1)

  http://www.npr.org/templeates/story/storyId=90273278 (part 2)

• Wren, B. (2000). Early physical intervention for young people with atypical gender identity development. Clinical Child Psychology and Psychiatry, 5, 220–231.

• Zucker, K.J. “I’m half-boy, half-girl”: Play psychotherapy and parent counseling for gender identity disorder. In R.L. Spitzer, M.B. First, J.B. W. Williams, and M. Gibbons (Eds.), DSM-IV-TR’ casebook, Volume 2. Experts tell how they treated their own patients. Washington, DC: American Psychiatric Publishing, 2006, pp. 321–334

• Zucker, K.J. On the “natural history” of gender identity disorder in children [Editorial]. Journal of the American Academy of Child and Adolescent Psychiatry, 2008, 47, 1361–1363

• Zucker, K.J. Children with gender identity disorders: Is there a best practice? [Enfants avec troubles de l’identite sexuee: y-a-t-il une pratique la meilleure?] Neuropsychiatric de l’Enfance et de l’Adolescence, 2008, 56, 358–364.

• Zucker, K.J. The DSM diagnostic criteria for gender identity disorder in children. Archives of Sexual Behavior, 2010, 39, 477–498.

Supplement 3: Making Your Health Care Setting Safer for LGBTQ Youth

• (A) Conduct training for staff around homophobia, cultural competency, confidentiality and privacy for GLBTQ Youth.

• (B) Use broad inclusive language for human sexual behavior and relationships that is gender neutral.

• (C) Insure understanding of consent, confidentiality and legal/policies that govern your practice.

• (D) Address anti-gay behavior and language in clear and consistent manner and according to same rules that apply to other groups/cultures.

• (E) Designate a resource person (and/or provider) who is knowledgeable in existing resources and community contacts/programs.

• (F) Books, magazines, posters, hotline numbers, handouts and brochures specific or inclusive of LGBTQ should be available. These should be visible and accessible (perhaps in a private manner.)

• (G) Connect with LGBTQ and/or allies to assist with family navigation, and/or with health promotion and prevention programs.

• (H) Be prepared to help children, youth and families, as well as other family members, and refer them to services they may need.

• (I) Items like rainbow stickers, upside down pink triangle located in exam rooms or at front desk can be a subtle way to communicate the LGBT friendly practice.

Supplement 4: Adolescent Anticipatory Guidance for Sexuality

Early Adolescence: 11–14 Years

Abstinence for those who have not had sex, and as an option to those who are sexually experiences, is the best protection from pregnancy, STIs and the emotional distress of disrupted relationships. Knowing how to protect oneself and one’s partner is critical for those sexually active. Delaying sexual debut, is beneficial for children.

Sample Questions

• Parent: How do you plan to help your child deal with pressures to have sex? How does your culture help you do this?

• Youth: Have you had sex? Was it wanted or unwanted? Have you ever been force or pressured to do something sexual that you haven’t wanted to do? How many partners have you had in past year? Were your partners male or female or have you had both male and female partners? Were your partners young, older or your age? Did you use a condom and other contraception?

Anticipatory Guidance

For parent:

• Encourage abstinence or a return to abstinence

• Help your child make a plan to resist pressures. Be there when support is needed

• Support safe activities

• If uncomfortable talking about these topics, learn more from reliable sources

• Talk about relationships and sex when issues arise on television, at school or with friends. Be open, nonjudgmental, but honest about your views

For youth:

• Abstaining from sexual intercourse, including oral sex, is the safest way to prevent pregnancy and STIs

• Figure out ways to make sure you can carry through on your decisions. Plan how to avoid risky places and relationships

• If you are sexually active, protect yourself and your partners from STIs and pregnancy

Middle Adolescence: 15–17 Years

Sexuality and relationships are an important issue in middle adolescence. Parents and adolescents need accurate information and support to help them communicate with each other.

Sample Questions

• For youth: Have you talked with your parents about crushes you’ve had, about dating and relationships, and about sex? Are you attracted to males, females or both, or are you undecided? Do you have any questions or concerns about who your gender identity or who you are attracted to? Have you had sex?

• For parent: Do you monitor or supervise your adolescent’s activities and friends? Do you enjoy talking with your adolescent and her friends? Have you established house rules about curfews, parties, dating and friends? How do you plan to help your adolescent deal with pressures to have sex? Does he have any special relationships or someone he dates steadily?

Anticipatory Guidance

Youth:

• It’s important for you to have accurate information about sexuality, your physical development, and your sexual feelings. Please ask me if you have any questions.

Parent:

• Communicate frequently and share expectations clearly.

• Help your adolescent make a plan to resist pressures to have sex.

• Be there for her when she needs support or assistance.

Late Adolescence: 18–21 Years

For the young adult, the issue of sexuality is central. Some young adults still may have questions or concerns about their sexual orientation, gender identity, or sexual maturity. For some the decision to have and intimate relationship and become sexually active may be relevant. For thoughts about emotional intensity of a romantic relationships, or protection from STIs and pregnancy may be uppermost in their minds.

Sample Questions

• For young adult: What are your values about dating and relationships? Are you attracted to males, females, or both? Do you have any questions or concerns about your gender identity (as a male or female)? Have you had sex? What are your plans and values about relationships, sex, and future family or marriage? have you talked with your parents/family about stable relationships or marriage?

• For parent: Your teen in now a young adult. Are you comfortable with her development?

Anticipatory Guidance

• Sexuality is an important part of your normal development as a young adult.

• If you have any question s or concerns about sexuality, or your development, I hope you will consider me one of the people with whom you can discuss these issues.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright futures: Guidelines for Health Supervision of Infants, Children and Adolescents, Third addition. Elk Grove Village, IL: American Academy of Pediatrics.

Access for free at:

• http://brightfutures.aap.org/

• http://brightfutures.aap.org/3rd_edition_guidelines_and_pocket_guide.html