A few years ago, Dr. Nina Jain recognized a need.
A pediatric endocrinologist at UNC Children’s Hospital, she was starting to see patients with gender dysphoria and other concerns regarding gender identity coming in and asking for care.
“As an endocrinologist, I had never been trained in gender-affirming care,” Jain said. “But I was starting to see that patient need and recognized that there weren’t a lot of providers able to meet those needs.”
Jain had the background to understand the medicine behind the needed care and the willingness to do something about it. She consulted her colleagues at Duke Health and attended a training conference sponsored by Harvard University and Fenway Health. And, as luck would have it, Dr. Martha Perry came to Carolina just in time to help move things along.
Perry completed adolescent medicine training at Boston Children’s Hospital and a fellowship at the University of California, San Francisco — one of the first centers for gender-affirming care — before joining UNC Children’s as a general pediatrician and adolescent specialist. Shortly after her arrival, she and Jain helped start the Pediatric and Adolescent Clinic for Gender Wellness at UNC Children’s.
The clinic is approaching its fourth anniversary this October. Since its launch in 2017, Jain and Perry — and a multidisciplinary team that includes specialists from pediatric endocrinology, social work, pediatric psychology and psychiatry — have provided gender-affirming care to more than 250 patients in the pediatric and young adult population.
A collaborative effort
The team provides several resources for patients and families:
- Pediatric endocrinologists provide expertise about puberty suppression for children in early puberty, as well as gender-affirming hormone therapy for management of gender dysphoria in older adolescents;
- pediatric psychologists and psychiatrists provide integrated and coordinated, high-quality gender-informed care for transgender and gender nonconforming individuals and their families;
- and social workers work collaboratively with patients, their families and the medical team, offering education, support and navigation through the process of gender-affirming treatment.
The clinic is “probably the only collaborative effort of its kind in North Carolina,” said Perry. “There are definitely specialists operating individually throughout the state, but our center is more far-reaching and comprehensive as far as trying to meet all the needs in one place with one team, so patients don’t have to bounce around to get all their needs met.”
In addition to the support from a wide range of specialists, the UNC School of Medicine recognizes that trainees across the system need experience in providing gender-affirming care.
“I have loved seeing the interest from different departments across campus that want to make sure they are gender-affirming,” said Perry. “It’s important to be willing and able to train our future health care providers in all realms.”
Jain said she would also love to see more continued education for providers.
“This is not a niche population,” stressed Jain. “This is our youth, our young adults. All health care providers need to be comfortable providing care to all patients.”
Even with their success and reinforcement from their colleagues, Jain and Perry encounter challenges — some systemic and others specific to their operational needs.
For example, patients face financial barriers.
“Many health insurance plans don’t meet the needs of all our patients, and that is super stressful,” Perry noted.
Patients don’t always have the support they need.
“All too often, patients don’t have the support of their parents or communities, and many have had not-great experiences with their physicians and therapy,” said Jain. “We know kids who are transgender are more likely to attempt and complete suicide, and family support helps reduce that risk tremendously. We work hard to encourage families to be as supportive as possible, even if they don’t completely agree, but our patients really suffer.”
“When we know we can help our patients, but we can’t get the funding or the family and community support, that’s hard,” added Perry.
The Clinic for Gender Wellness provides behavioral therapy and psychiatric services, “but I feel like often we have overwhelmed that particular group,” explained Jain.
“Having a full-time therapist fully embedded in the program would be amazing, but it can be hard to create new positions within a university health care system. With funding, we could temporarily subsidize the position while demonstrating the need for a new position.”
When asked to dream big, Jain said she would really love to have a more cohesive clinical space.
“While Martha and I share patients, we don’t have a clinic together in the same location. Having the opportunity to co-locate with all of our collaborators would make things easier for our patients.”
Perry would like to be better equipped to offer more family-centered care and connect patients and families with the resources they need — particularly as they think about logistical things.
“Whether it’s name changes or coordinating with schools, I want to find ways to help parents, children and teens navigate to make sure their community-based needs are met,” she explained. “Having more space would help us provide opportunities for parents to talk to each other, to families in the same situation who can relate.”
The ultimate reward
While there are certainly challenges, Jain and Perry both acknowledged the rewarding aspects and the necessity of their work.
“It’s been a wonderful experience,” said Jain. “I’ve learned so much from my patients. It’s definitely been a learning curve, but the more I’ve learned and the more I’ve done, I’ve recognized that gender-affirming care is, more simply, just patient care.”
“For me,” added Perry, “I enjoy seeing young adolescents become young adults. I get to watch them grow and become their own person. Part of adolescence is forming your identity, and gender identity is a part of that — recognizing and achieving that is a true gift. I feel lucky that I love what I do, and that gender-affirming care is a part of my practice.”
Learn more about the Pediatric and Adolescent Clinic for Gender Wellness at uncchildrens.org.