Introduction

Standards of Care/Existing System Overview

As you look for a provider for gender affirming healthcare, an understanding of the system is key. Gender affirming healthcare generally falls under two common approaches: the World Professional Association of Transgender Health (WPATH) Standards of Care, and the “Informed Consent Model” of gender affirming care. To read more about the differences between these two approaches to providing care and decide which may be best for you, read our standards of care overview.

Gender Dysphoria

Gender Dysphoria is a feeling of discomfort and/or distress that sometimes occurs in people whose gender identity isn’t that of the sex assigned to them at birth, or their sex-related physical traits. A diagnosis of gender dysphoria—found in the DSM V, a manual published by the American Psychiatric Association—was created to help people with gender dysphoria gain access to necessary care and treatment. Gender dysphoria can be minor, but can also affect wide parts of life, including school, work, and other daily activities. 

For more information about gender dysphoria, go here.

Hormones/Blockers

Puberty Blockers

Puberty blockers prescribed to children and teens can help treat dysphoria and allow children and their caregivers time to make a decision regarding puberty. However, puberty blockers cannot be used indefinitely. 

Puberty blockers work by blocking the hormones (testosterone and estrogen) that lead to puberty-related body changes. There are several kinds of puberty blockers, including:

• Histrelin acetate
• Leuprolide acetate
• Anti-androgens (lower testosterone levels)

For more in-depth information about puberty blockers, go here, here, or here.

Gender Affirming Hormone Therapy

Many trans people who choose to medically transition will pursue gender-affirming hormone therapy to help their bodies and appearance align with their gender identity. Some pediatric patients will do this as well, in consultation with their providers and in accordance to the WPATH standards of care. Gender Affirming Hormone Therapy (GAHT) comes in roughly three broad types, with room for nuance.The types are: Feminizing hormone therapy, Masculizing hormone therapy, and microdosing either of those types.

Pursuing gender affirming hormone therapy for pediatric patients is nearly always done in accordance to the WPATH standards of care, rather than the informed consent model.

Puberty blocker versus Gender Affirming Hormone Therapy (GAHT)

In brief, puberty blockers will block changes from puberty that do not match a child or teen’s gender identity. Gender Affirming Hormone Therapy on the other hand, will have them go through puberty for the gender they identify with.

Surgeries

Some healthcare providers will perform gender affirming surgeries on teens 15 years old and up. However, getting gender affirming surgery as a minor depends on both the provider and the type of surgery needed. For questions regarding health insurance coverage for gender affirming surgeries, make sure to check with your insurance provider as coverage varies wildly and may require extensive documentation.

• Follow WPATH guidelines “to surgically treat people who are stable in their gender identity and have documentation of persistent gender dysphoria”
• Top surgery: some providers will perform surgeries on teens 15 years old and up.
• Feminizing surgeries (bottom): some providers will perform on minors on a case by case basis.
• Insurance coverage:
  • Check coverage details for your insurance policy
  • May require the following:
    • Be at least 18 years old
    • Have a gender dysphoria diagnosis, and
    • To have letters of support from qualified health and mental health professionals

The closest provider for pediatric gender affirming surgery is Boston Children’s Hospital.

Maine Pediatric legal rights

Maine doesn’t have any specific laws about pediatric gender affirmative care specifically. Both of the larger pediatric gender care clinics in the state follow the WPATH guidelines.

Pediatric Gender Clinics

Maine has a few clinics that accept pediatric patients for gender care. They are linked below, along with resources in Boston.

• Gender Clinic MaineHealth 
• Gender Clinic Northern Light
• BCH GEMS clinic  (Boston)

Non-Medical Gender Affirmative Actions

Some common actions that a trans person might take to affirm their gender identity should be done so while exercising awareness about their potential risks. In-depth discussion of how to do these safely is linked below.

• Tucking (ways people conceal a penis and testes) Safety​​ 
• Binding (flattening one’s breast tissue in order to create a traditionally male-appearing chest) Safety

Teens and Sexuality

For information about LGTBQ Sexual Health, please see our Sexual Health page.

Myths:

Myths about gender transition cause real harm to trans youth and adults. They have been used to justify legal challenges to pediatric transgender healthcare. To help address this misinformation,  Bustle compiled a list of the most common myths and debunked them.