CHOP’s Gender and Sexuality Development Clinic helps youth be their happy, healthy, true selves.
When Shawn was born, his parents were told they had a new, healthy baby girl.
But as far back as Shawn can remember, he always felt different from other girls.
As a high school freshman, feeling pressure to fit in, Shawn tried to dress and act more like other girls. The experience left him angry and depressed.
“I felt like I wasn’t going to make it to see another year,” he says. “I’d be walking my dog and hope that a car would hit me.”
Sophomore year, Shawn decided to play drums in jazz band. The first time he wore the band uniform — a shirt and tie — something clicked.
“When I put on the uniform, I thought: ‘If I was a boy, how would I look in this outfit?’ And I realized that I had been doing that my whole life,” he recalls. “I was positive that I was a boy from that moment.”
When Shawn, pictured playing drums at home and hanging out with his dad, came out as transgender, he was met with unconditional love and support from his family, friends, school, community and CHOP’s Gender and Sexuality Development Clinic.
At first, awareness of his gender identity freaked him out. But after talking to a therapist for a few months, he got up the courage to tell his family. He wrote a note to his mom — “I see myself as a boy” — and braced for the worst. What he got instead were text messages from his parents expressing unconditional love.
In search of guidance on how to support Shawn, his parents discovered the Gender and Sexuality Development Clinic at Children’s Hospital of Philadelphia, one of only four pediatric programs of its kind in the country.
For most people, biological sex and gender identity and expression are aligned in the way society expects (called cisgender). However, for some, like Shawn, gender identity and/or expression is different from the sex on their birth certificates.
Transgender or gender-nonconforming individuals often experience rejection, isolation, discrimination and victimization from family members, peers, school officials and others. Getting support and acceptance can mean the difference between life and death. According to two recent studies out of Canada, transgender youth rejected by their parents were 13 times more likely to attempt suicide than those whose parents were supportive, while transgender youth who had support were 82 percent less likely to attempt suicide than those without.
The Gender and Sexuality Development Clinic is a safe and affirming space where children and their families can get medical and psychosocial support. Since its inception three years ago, the clinic has served more than 400 children, youth and their families from as far north as New York and as far south as Texas.
Children deserve to grow up to be happy, healthy and productive adults who can be their true gender selves, live without fear and disappointment, and feel their identity is not only supported, but celebrated. It’s an extreme privilege to be a part of this time in their lives.
Nadia Dowshen, MD, Co-director, Gender and Sexuality Development Clinic
When children come to the clinic, they first meet with Co-director Linda Hawkins, PhD, MSEd, LPC, and undergo a mental health/gender assessment. Regular follow-up appointments then allow the clinic team — which includes specialists in adolescent medicine, endocrinology, mental health and social work — to develop a comprehensive picture of a child’s gender identity over time and determine the most appropriate next steps in terms of medical support.
“With just a snapshot of a kid, we don’t know who they are going to grow up to be,” says clinic Co-director Nadia Dowshen, MD. “When we watch them over time, we start to get a better idea of whether they are just going through a period of gender exploration or are really committed to transitioning.”
Transitioning is the process of beginning to live as the gender with which a person identifies, rather than the sex assigned to them at birth. The clinic offers different levels of transitioning support depending on a child’s age and the trajectory of their gender identity. This can range from support through a child’s social transition — such as changing their name, adjusting to new pronouns, dressing the way they want, navigating which bathroom to use and getting support at school — to more permanent medical interventions like hormone therapy and referral for gender-affirming surgeries.
There’s not just one way to transition, so the clinic works closely with youth to see what is best for their specific gender journey, and then determine the healthiest options to support their goals. The clinic is currently working with centers across the nation to develop a patient registry to study different treatment approaches, develop best practices and get a better understanding of the long-term impact of certain interventions.
An Evolution of Support
When Hawkins and Dowshen began caring for gender-nonconforming youth, years before the clinic opened, patients were predominantly older adolescents who often were homeless and had no support from their families or communities. Today, while most of the clinic’s patients are still around age 15 or 16, their families are much more likely to be supportive, and it isn’t uncommon for the team to see children as young as age 5.
“It’s great to see so many families that are ready to love their kid no matter what,” says Dowshen. “When these kids are supported earlier, it can make a huge difference in their development and sense of identity, as well as their future health, wellness and happiness.”
Still, coming out as trans can be very isolating for kids and their families. To help, the clinic created monthly support groups for youth, as well as parents and siblings.
“Families have told us the single most effective support is talking to other parents — not coming to clinic, not reading a book,” says Hawkins. “Dads, especially, tell us the group is like medicine to them.”
A New Start for Shawn
With the help of his parents, the clinic, school administrators and his peers, Shawn successfully transitioned during his junior year.
“The clinic made everything easy for me,” he says. “I already had a lot of things going well, but it was nice to have someone confirm what I was feeling.”
Shawn is now a college freshman studying graphic design. He says though he’s still getting comfortable with himself, he is happy and excited for the future.
“Before I transitioned, it felt like I was getting pushed against a wall,” he says. “When I realized I was trans, the wall came down and everything was open. And I’ve just been feeling more and more happy with myself ever since.”