Skip to main content UVA Health logo of UVA Health
Healthy Balance

Transgender Youth: A Safe Space at UVA

Google “transgender teen suicide” and the results are shocking.Transgender Health Clinic meets at the Teen and Young Adult Health Center.

There are a lot of them.

According to one statistic, more than half of transgender youth will attempt suicide at least once by age 20. Adolescents already face a higher risk of suicide than other age groups: The teen years expose tender self-esteems to a barrage of hormones, social pressures, emotional changes and external stresses. Add to this gender dysphoria, social ridicule, and parental rejection, and we can see why transgender youth crack.

What can we do about this heartbreaking statistic?

Transgender youth need access to trusted mental health professionals, according to the Human Rights Campaign.

And a recent study from the Gender Management Clinic at Rady Children’s Hospital in San Diego showed treating the physical needs of dysphoric transgender youth results in their improved mental health.

Karen Barker of the Transgender Health Alliance of Central Virginia says, “Depression, self-harm and suicidal ideation are decreased when trans youth have access to comprehensive care that includes a path to transition for those who need it.”

Enter UVA.

Gender Definitions

Biological Sex: The physical gender identity assigned at birth

Gender Identity: Your inner concept of yourself as male, female, neither, or a blend – how you perceive yourself

Gender Expression: How you express your gender through outward appearance, behaviors

Transgender: A person whose gender identity does not correspond to their biological sex

Gender Dysphoria: A medical condition but not a mental illness, gender dysphoria describes the distress caused when your gender identity does not match your biological sex

Meeting the Needs of Transgender Youth

“They started coming to me because they had no place else to go.”

Nancy McLaren, MD, a pediatrician at the Teen and Young Adult Health Center, reports that about four years ago, she started to see a number of of transgender teens coming to her for help.

She was not prepared. But neither, it seemed, was anyone else. McLaren started to learn about their needs and knew she needed an endocrinologist to work with her, someone who could talk about puberty blockers or hormonal therapy with these patients. There wasn’t anyone here or in Richmond who could help, so she referred patients to Maryland and D.C.

But that’s when Christine Burt Solorzano, MD, a pediatric endocrinologist, stepped in. “She said, ‘Why don’t we learn about it here? Why should they have to go away from here to get this treatment?’ And she went to training, started seeing these patients in her clinic,” and one thing lead to another very quickly. She and McLaren started seeing these patients together.

They decided they wanted to develop a multidisciplinary clinic where transgender patients could be seen for comprehensive care in a place that felt safe and comfortable for them. Things happened quickly:

  • They set up the clinic in the Teen and Young Adult Health Center in the Battle Building and to offer it every three months.
  • The clinic expanded the age group it cares for to ages 11-26, so that the doctors could follow patients over a longer time, giving continuity to patients going through the transition process.
  • McLaren started collaborating with other providers in the community on transgender healthcare.
  • UVA hired David Repaske, MD, a pediatric endocrinologist who had run a transgender health clinic at Ohio State.

In March of 2015, the Transgender Health Clinic opened. The only transgender clinic in the area, it sees patients from all over Virginia and other states. And yes, they see a lot of patients.

inside the teen health center“I’m amazed about the numbers,” McLaren says. “It just surprises us that there’s as many people as there are. It’s much larger than we had any sense of.”

Barker was one of many locals grateful for the clinic’s opening. “Before the UVA Teen & Young Adult Health Center began offering transgender-specific care, families with gender dysphoric adolescents had to travel out of state for care. The Trans Health Clinic at UVA provides comprehensive care that is unique in Virginia, and the staff is affirming and respectful, which is vital to struggling dysphoric youth. The providers are also involved in educating colleagues and medical students on the need for transgender-inclusive care. Increased competence and comfort at the provider level will improve care for transgender people of all ages.”

And Linda McNeil, of the LGBTQ youth support group Rosmy, which meets at the Teen and Young Adult Health Clinic, says, “The obvious limitations of traveling out of state for comprehensive, ‘one-stop-shopping’ health care for most dysphoric transgender youth, even if they have supportive families — which is not always the case — are huge.”

A Safe Space

The clinic has an environment specifically developed to make patients feel comfortable and cared for.

“The staff are sensitive to pronouns and names,” McLaren says. ‘The front desk person, the nurses are always the same people. All are safe-space trained to be sensitive to transgender people’s needs, all the time. We have a real respect for patient concerns and issues.”

What is a “Safe Space”?

The use of the term “safe space” typically refers to a place where people feel comfortable and included, regardless of sexual orientation, gender identity, biological sex and other non-mainstream identities. A designated safe space implies that the staff, employees or other inhabitants have undergone an educational training, not just about the LGBTQ community, but about their own internal biases and prejudices.

The UVA LGBTQ Center offers these trainings on campus and beyond.

McLaren welcomes kids to come on their own and ask questions. But she also encourages parents to come and ask questions, too.

The clinic addresses overall health and mental and sexual health issues, all of which have nuances specific to the transgender experience. Services include:

  • Therapy for anxiety, depression and ongoing emotional issues
  • Referrals for evaluations for a diagnosis of gender dysphoria, which is the criteria for hormones or surgery
  • Surgery referrals (for gender reassignment)
  • Sex and contraceptive education
  • A community health educator who works with transgender patients to put resources together, such as how to change your name or get voice therapy

“We’re going beyond the medical part and helping the whole person,” McLaren says.

Elementary Exploration

It might surprise people to learn that the clinic offers services for youth ages 4-9.

At younger ages, McLaren says, children may question their gender or appear to be cross-dressing. A girl might say, “I want to dress like a boy,” have boy behaviors or interests, play with other gender toys, but maybe not labeling themselves as the other gender. “But because in elementary school puberty hasn’t developed, we don’t call this gender dysphoria. In younger kids, it doesn’t always persist into adulthood.”

But often it does. Children can start identifying as the other gender as soon as their awareness of gender begins. Even for relatively supportive parents, this intense insistence on the part of young children can prove challenging to conventional ideas about gender and sex.

Which is why, when children are this young, McLaren really sees the family as a whole. “What we try to do with younger ones is support the parents to allow their child to explore their identity, instead of feeling like they have to nip it in the bud. Not being supportive makes it more difficult for the child, who begins to feel like their parents don’t like or care about them.” This can be especially difficult if kids experience bullying at school.

And McLaren is quick to underscore that a younger child’s gender ambiguities or choices can easily shift as they mature: “It doesn’t mean they’ll always be one way or the other.”

McNeil views the approach of dealing with the whole family as a positive in all directions. “The staff at our clinic offers their support not only to the patients, but to the entire family. This goes a long way towards everyone’s health; all of society’s included.”

Is Your Child Transgender?

The rule of thumb in answering that question is to see “if the child is consistent, insistent, and persistent about their transgender identity. In other words, if your 4-year-old son wants to wear a dress or says he wants to be a girl once or twice, he probably is not transgender; but if your child who was assigned male at birth repeatedly insists over the course of several months that she is a girl, then she is probably transgender.”

Source: Human Rights Campaign

The Problem of Puberty

When puberty looms, some of these kids start to feel distressed, and this can result in depression, anxiety, stress, impairing their lives at school. Kids may have suicidal thoughts, abuse substances. The thought of growing up can, in this situation, feel scary and threatening, not exciting.

At this point, when puberty starts, the Trans Health Clinic can discuss the options of a puberty blocker.

“Juvenile suppression hormones are totally reversible,” McLaren explains. “Hormone therapy delays the growth of secondary sex characteristics, like body hair and breasts. It lessens erections and stops periods, giving the child time to figure out who they are. Surgery is not an option until age 18, so pubertal blockers decrease the things causing the child’s distress.” The effects can be life-saving.

McNeil has seen evidence of this first hand. “The vast majority of Rosmy Charlottesville’s transgender and non-binary youth are served by the UVA Clinic, to varying degrees. They all repeatedly express how it has literally saved their lives! I have seen close to 10 youth go from barely speaking when they first attended Monday group (some still using their birth-assigned gender pronoun) to blossoming into compassionate and knowledgeable peer supporters, leaders and educators.”

lgbtq resources Worried Parents

Parents, of course, worry.

“They ask the same common questions: Is this really real? Is it just a phase? What if they change their mind? Will they regret this? Will they be able to ‘go back’? Parents are afraid of agreeing to it or supporting their child.”

McLaren and her staff address these concerns with compassion. “I explain that we’re really careful, we know what we’re doing and we’re not going to do this if the child is not ready.”

And the effects of puberty blockers are totally reversible. As soon as the therapy stops, puberty ensues, and the child can develop normally. If the child instead chooses to transition, avoiding puberty development prevents some of the costs and risks of gender reassignment surgery.

Educate Yourself

Whether a parent, teacher, provider or friend, learning about the issues can help you make a difference in someone’s life. Get the basics on transgender identity.

Transgender Education & Resources

Despite the recent headlines about celebrities like Caitlyn Jenner or the popularity of Laverne Cox on “Orange is the New Black,” parents can still find themselves feeling isolated and lacking support, even as they try to support their child.

Which is why much of the work McLaren does with patients involves education and connecting families with local resources. “When they first come in, we sit down, we’ll talk to both child and parents. I talk to the child by themselves, to see where they are, what they think is going on. The parents come in by themselves, and that’s a gate-opener. Parents will say they don’t understand what’s going on, and I’ll connect them with PFLAG or Rosmy,” local support groups servicing the LGBTQ community.

McNeil is grateful for “the symbiotic relationship between the clinic and Rosmy. The fact that both programs happen in the same space is certainly a boon; but the clinic staff’s dedication to our program goes way way beyond the extra mile.”

The clinic also works to educate colleagues and medical students on the need for transgender-inclusive care. “Increased competence and comfort at the provider level will improve care for transgender people of all ages,” Barker says.

Visit the Transgender Clinic

Call to schedule a visit at the transgender clinic.

McLaren makes herself available and works to help families find resources because, “You can’t have kids feeling like this. It’s very real to me. Their emotions and feelings are very real. They’ve got to have some place to come, and we’ve got to find care for them. We’re trying to make it more visible that we are supportive, and this is a safe space to come.” The goal is to have them develop and grow into healthy adults who feel happy in their own skin.

Reply & View Comments Search Submit

Subscribe for Updates

Get stories & health tips every week