Frequently Asked Questions from Patients and Families

Experts from the Transgender Clinic at Cincinnati Children's answer frequently asked questions from parents.

Many children have gender “atypical” behavior. The amount of this behavior varies. Some individuals also experience their sense of being male or female as different from their gender at birth. Some children experience significant distress about not being able to live and act the way that they feel. For many children who experience these feelings before puberty, it is a phase.

If the child is insistent, consistent and persistent, we initially discuss living in this gender outside of the house. When a child who is insistent, consistent and persistent begins puberty, we discuss delaying puberty.

We work with patients and families to determine if the transgender identity is “real.” Sometimes it can take a while. We offer support to patients and families the whole time.

Puberty blockers are a medicine that delays the start of puberty. They can prevent the development of secondary sexual characteristics, such as voice changes, facial hair development and breast development. Puberty blockers can help relieve distress and prevent changes that are difficult to reverse. They can also buy time to be sure transgender identity is “real.”

The Transgender Clinic follows the guidelines established by experts. To start puberty blockers, a child needs to have started puberty but not gone too far. The team determines the appropriate timing based in part on a physical examination and blood work. We discuss the risks and benefits of treatment and ask families to sign a consent form. Patients, their families and the treatment team all need to agree that this is the appropriate next step. We generally require that our patients have seen a therapist prior to starting treatment. These medications are almost completely reversible.

Gender affirming hormones are used to change an individual’s body to be more consistent with gender identity. For example, individuals who were born female but identity as male may take testosterone to promote growth of facial hair, increase muscle mass, and stop periods.

The Transgender Clinic follows national and international professional guidelines. To start gender affirming hormones, a young person needs to have gone through puberty, or have been on puberty blockers for several years. They need a letter from their therapist and baseline blood work. The team will help determine the appropriate type and timing of treatment based in part on physical examination and blood work.

We discuss the risks and benefits of treatment. One risk is infertility. We will discuss options to preserve fertility prior to starting treatment.

If the patient is under 18 years old, the patient signs an assent form and the family signs a consent form to start. If the patient is 18 or older, the patient signs the consent form to start.

Patients, their families and the treatment team all need to agree that this is the appropriate next step. The effects of these medications are only partially reversible.

Every insurance plan is different. Cincinnati Children’s Financial Counseling Department can help patients and their families figure out the answers to these questions. Call 513-636-0201.

It is important to remember that for insurance to cover our services, the patient’s legal name in the Cincinnati Children’s system needs to match the name on the insurance card. If the patient’s legal name has changed, it should be updated in our records.

The Transgender Clinic has resources to help families with this issue. Families often talk about this issue in our support group and in our private Facebook group. This may look different for each family, and there is no right or wrong way. Helpful resources are from the Human Rights Campaign (HRC) and the Family Acceptance Project:

We will see your child on a regular basis to assess how things are going. We will talk to your child and you to determine the best plan for each individual child.
Some resources that talk about this important question include:

  • Gender Spectrum – Gender support and communication plans for families to complete and share with their school

We constantly reassess your child’s needs and goals and work together to provide the appropriate treatment at the appropriate time. Although uncommon, some patients decide to stop treatment. They make this decision for various reasons. Some of the treatments are reversible, and others are partially reversible.

Our goal is to make sure the patient and their families or guardians are supported and have access to accurate information and expert opinion throughout their journey.

We will see your child on a regular basis to assess how things are going. We will talk to your child and you to determine the best plan for each individual child, depending on the needs and goals of the patient and their families.

Common Concerns that Families Express

Experts from Cincinnati Children's discuss common concerns from families about transgender treatment.

Cincinnati Children’s Transgender Clinic is dedicated to meeting families where they are. We know that patients and their families have diverse values and beliefs.

We work with patients and their families to make sure the patient has the correct diagnosis, to educate them, and to provide them with the support and resources that they need.

Cincinnati Children’s has a protocol that was developed using International Transgender Treatment Guidelines and input from other experts and our treatment team, including our ethicist. The treatment plan for each patient and their families or guardians is individualized and based on patient and family preferences and needs.

To begin medical treatment, transgender youth need to be insistent, consistent and persistent in their gender identity. We work with patients and families to determine if patients meet appropriate diagnostic criteria before beginning puberty blockers or gender affirming hormone therapy treatment. Sometimes it can take a while to determine if this is the correct diagnosis. We offer support to patients and their families during this process.

“Gender dysphoria” includes many factors. Gender dysphoria means someone is uncomfortable with their gender at birth. We know that genetics plays a part in gender identity. We also know that there are some physical differences in transgender individuals. In research studies, transgender people have areas of the brain that are different sizes than cisgender people. “Cisgender” means that a person thinks their gender identity matches their gender at birth.

In the Transgender Clinic at Cincinnati Children’s we do a complete history and physical exam, and the child is seen by both a physician or nurse practitioner, and a social worker. We make referrals to specialists if any other concerns are found.

Documentary Video Clip: Gender Revolution: A Journey with Katie Couric

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