Transgender Youth & Health Care: A Guide for Reporters

For an introduction to transgender people more broadly, click here.

According to the Center for Disease Control & Prevention, one in 50 teenagers in the United States identifies as transgender. Also according to the CDC, these youth are among the most vulnerable members of the next generation: They are four times as likely as their peers to have been physically attacked at school. They face three times the risk for sexual assault, twice the risk of cyberbullying, and five times the risk of experiencing a suicide attempt.

By any measure, transgender youth are experiencing a public health crisis in this country. The victimization and vulnerability of these children means clear, accurate, and thorough reporting on their health care is vital. The support and care of transgender youth is not a political or cultural story — it is a public health story.

Transition-Related Care 101

Cornell University: What does the scholarly research say about the effect of gender transition on transgender well-being?

A persistent discomfort with one's gender expression and identity is called gender dysphoria.

According to the American Psychological Association:

Gender dysphoria involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender.

People with gender dysphoria may often experience significant distress and/or problems functioning associated with this conflict between the way they feel and think of themselves (referred to as experienced or expressed gender) and their physical or assigned gender.

The support and health care of transgender people differs vastly depending on that person’s age.

A transgender adult may pursue mental health care, counseling, hormonal therapy, and transition-related surgery. These interventions are widely-recognized throughout the medical mainstream as safe and effective, including by the American Medical Association, the American Psychological Association, and the American Psychiatric Association.

Transgender teens who have shown a persistent and consistent discomfort with their gender identity may likewise seek counseling and hormonal treatments, including puberty blockers which allow families and providers more time to consider the right course of action before the development of permanent secondary sexual characteristics. Such treatments are supported by the American Academy of Pediatrics, the American Academy of Adolescent and Pediatric Psychiatry, and The Endocrine Society (a governing body that sets standards for hormonal health care including hormone therapies and puberty blockers).

Prepubescent children who express a consistent need to explore and express their gender, however, are never receiving permanent health care. For elementary school-aged children, transition-related support means allowing the child to explore who they are and how they want to express themselves through clothing, hair, toys, playtime, and the name and pronouns used to address them at home and at school.

Often referred to as “social transitioning,” the American Academy of Pediatrics describes these steps as:

“A reversible intervention in which children and adolescents express partially or completely in their asserted gender identity by adapting hairstyle, clothing, pronouns, name, etc. Children who identify as transgender and socially affirm and are supported in their asserted gender show no increase in depression and only minimal (clinically insignificant) increases in anxiety compared with age-matched averages.”

Such basic steps have a monumental impact on the well-being of the child. In a 2018 University of Texas study:

Researchers interviewed transgender youths ages 15 to 21 and asked whether young people could use their chosen name at school, home, work and with friends. Compared with peers who could not use their chosen name in any context, young people who could use their name in all four areas experienced 71 percent fewer symptoms of severe depression, a 34 percent decrease in reported thoughts of suicide and a 65 percent decrease in suicidal attempts.

Transition-related health care is not controversial in the medical field. Among experts on the topic, these are basic, well-established facts.

Proper background on this issue is crucial for any reporter and their readers. But even more crucial is speaking with the right people about this landscape and perspectives.

Where to Begin Your Reporting

Perhaps you are profiling the family of a transgender child. Or maybe a new clinic has opened in your area providing care to transgender youth. Or maybe a lawmaker or political figure has raised the issue in a speech, tweet, or proposed legislation. How should you introduce this topic to your readers?

Step 1: Talk to medical providers

While advocates and lawmakers across the country are working to support the needs of transgender youth, it is crucial to provide your readers with impartial, nonpartisan viewpoints on this issue. Call doctors, clinics, medical societies, and other public health professionals who specialize in transition-related health care.

The Human Rights Campaign has a useful directory of medical providers across the country that work with transgender youth.

If you cannot reach a doctor before your deadline, the above statements from leading medical bodies are a good entry point for you and your readers. Cite them clearly and fully.

Step 2: Talk to families

Many families of transgender youth are open and willing to share their experiences with reporters to help educate the public and advocate for the rights of their children.

PFLAG — the nation’s oldest LGBTQ support program — has over 400 chapters across the country supporting the caregivers of queer youth including trans youth. Here is a directory of PFLAG chapters you should consider calling.

The Human Rights Campaign operates an advisory board of caregivers of transgender youth from across the country. They would likewise be a useful resource for finding families to talk to, profile, or provide a personal perspective in your article.

Treat the personal information of transgender minors with utmost caution. A story focusing on their transition may include personal information about their lives, their identity, and their medical care that, once included in your article, will live forever online. Consider offering to use a pseudonym for children and/or their families even if the parent does not proactively ask you to do so.

Some questions you might consider asking:

When did you first notice symptoms of gender dysphoria in your child?

Were you at all hesitant to let your child explore their identity?

What difference has accepting your child made in their well-being and demeanor?

What misconceptions do other families have about your child?

How supportive is your child’s school environment?

Step 3: Check your language

Transgender is a term for people whose gender identity, expression or behavior is different from those typically associated with their assigned gender at birth. Transgender is an adjective, not a noun, thus “transgender people” is appropriate but “transgenders” or “transgendered” are often viewed as disrespectful.

• Assigned Gender at Birth: The gender as reported by caregivers and/or medical providers upon the birth of a child typically based on physical anatomy.
• Transgender Man: A term for a person assigned female at birth who currently identifies as a man.
• Transgender Woman: A term for a person assigned male at birth who currently identifies as a woman.
• Non-Binary: People whose gender is not male or female use many different terms to describe themselves, with non-binary being one of the most common. Other terms include genderqueer, agender, bigender, and more. None of these terms mean exactly the same thing — but all speak to an experience of gender that is not simply male or female.
• Gender Identity: An individual’s internal sense of being male, female, or something else. Since gender identity is internal, one’s gender identity is not necessarily visible to others.
• Transition: The time when a person begins living as the gender with which they identify rather than the gender they were assigned at birth, which often includes changing one’s first name and dressing and grooming differently. Transitioning may or may not also include medical and legal aspects, including taking hormones, having surgery, or changing identity documents (e.g. driver’s license, Social Security record) to reflect one’s gender identity. Medical and legal steps are often difficult for people to afford.

Use the names and pronouns given by a transgender person. This includes when referring to a transgender person in the past before they came out or began their transition.

As The New York Times Style Book has recommended since 2005:

“Cite a person’s transgender status only when its pertinence is clear to the reader. Unless a former name is newsworthy or pertinent, use the name and pronouns (he, his, she, her, hers) preferred by the transgender person. If no preference is known, use the pronouns consistent with the way the subject lives publicly.”

Since 2017, the Associated Press Stylebook has likewise provided guidelines on the use of the singular “they” for transgender individuals who request it:

In stories about people who identify as neither male nor female or ask not to be referred to as he/she/him/her: Use the person’s name in place of a pronoun, or otherwise reword the sentence, whenever possible. If they/them/their use is essential, explain in the text that the person prefers a gender-neutral pronoun. Be sure that the phrasing does not imply more than one person.

Step 4: Proceed with caution

Misinforming your readers about any form of health care carries grave risks — and this includes transition-related health care.

According to the American Public Health Association:

The field of public health is increasingly challenged by the confluence of misinformation on social media and declining levels of trust in traditional sources of health information. Most Americans are now getting at least some of their news from social media and sharing information with others on these platforms. Meanwhile, the public’s trust in traditional sources of information — like mass media, government agencies, and the medical system — is either deteriorating or at best staying at relatively low levels.

Vaccines, cancer treatments, infectious diseases, reproductive health care, mental health, suicide, and transition-related health care are all the focus of confusion, misinformation, and misrepresentation online.

In the summer of 2019, a network of partisan media outlets manipulated public data to spread a myth that puberty blockers commonly prescribed to transgender youth had mysteriously killed thousands.

Over the course of 2018 and 2019, a mother in Texas became the focus of death threats and harassment when she was falsely accused by these same sites of “forcing” her child to be transgender and subjecting them to chemical castration.

While reporting by established media outlets can help dispel such myths, it can also help amplify them or make them the topic of public debate. Avoid sources and viewpoints which attempt to contradict medical findings. Amplifying their message poses a serious public health risk.

As transgender people, our rights, and our health care increasingly become the focus of lawmakers and legislators, it is more important than ever for an accurate representation of us in the news media. Only one in four adults in the US report knowing someone who is transgender, leaving the public dependent upon you and your work when forming views about this marginalized and oft-misunderstood group.

Never forget that a transgender person is a kind of person. We are not a political movement, partisan talking point, or emblem of the culture wars. We face widespread poverty, prejudice, and violence throughout our lives. It is critical that reporters, editors, and journalists reject attempts to draw political lines around our existence, our rights, or our health care.

We do not need you to be activists; we just need you to be right. In a quest for impartiality or fairness, many reporters and editors may feel the need to seek “alternative viewpoints” or “the other side” of these issues. But the other side of the truth is a lie. We need you to be committed to the truth above all other pressures. Do your job like our lives depend on it because our lives do depend on it.

If you have any questions or are seeking other resources, please contact me at gillianbranstetter [at] gmail.com.