ents from moving down the extremely risky road of “conversion therapy,” which can cause children profound distress by seeking to dissuade them from their engrained transgender identity. The prospect of puberty can provoke extreme anxiety and depression in transgender youth. On the threshold of womanhood, transgender girls who identify as boys face unwanted physical changes. Similarly, transgender boys who identify as girls know they will soon develop male characteristics that contradict their gender identification. Consequently, compared to their non-transgender peers, transgender youth have an elevated incidence of suicide attempts and selfharm. Their well-being is additionally at risk because they may try to avoid doctors’ appointments, sensing that they may be uncomfortable or unwelcome. Prior to puberty, care for the transgender child is limited to individual and family counseling, since there are no physical changes to suppress. “You can’t stop what hasn’t started,” says Dr. Marshall. When he meets his patients, a first step is to make sure they are clear in their gender identification. Only when that has been confirmed can affirmation treatment be initiated. If this is the path the patient and family select, medications are administered at the start of puberty to block the emergence of male- or female-related body changes. Based on the current guidelines, hormonal affirmation treatment begins at about 16 years of age: estrogen for MtF transitioning and testosterone for FtM. The goal of treatment is not only to give the patient the physical characteristics that match with her or his gender identity, but also to reduce the anxiety the child may have lived with up to that time. To emphasize the positive aspects of the process, Dr. Marshall and his colleagues refer to hormonal affirmation as “treatment,” not “therapy.” D Delivering Optimal Care to Transgender Youth r. Marshall has been working with Gloria Bachmann, MMS ’72, MD, professor and interim chair, Department of Obstetrics, Gynecology, and Repro- “ It is my hope that maintaining the well-being of transgender patients will soon be as familiar and accepted in the medical community as prescribing insulin for patients with diabetes,” says Gloria Bachmann, MMS ’72, MD, professor and interim chair, Department of Obstetrics, Gynecology, and Reproductive Sciences. ductive Sciences (OB/GYN), to establish the groundwork for a collaborative program that also includes RWJBarnabas Health. Several additional collaborations with other Rutgers University schools and departments are emerging or already exist. Under the supervision of Dr. Bachmann and Dr. Marshall, medical students and attending physicians in OB/GYN developed two videos, one MtF and one FtM, that explain the effects of hormonal affirmation treatment to young transgender patients and their families. Over the summer, two medical students devoted their research time to projects that involved moving transgender medicine to the next level. “Many physicians have not been fully trained in how to care for transgender individuals, but most want to learn,” says Dr. Bachmann. “It is my hope that maintaining the well-being of transgender patients will soon be as familiar and accepted in the medical community as prescribing insulin for patients with diabetes.” “A program offering patients comprehensive, multidisciplinary care in an academic setting has a definite place in the mission of the medical school,” says Patricia Whitley-Williams, MD, professor and chair, Department of Pediatrics. “Professionalism—described in its twopart definition as respect, compassion, and integrity, and sensitivity to diverse patient populations—is one of our six core competencies required for graduation,” she adds. “Our goal is to move the health care of transgender individuals away from the perspective that they are atypical to one that speaks of the harmony they have achieved with their gender identity by embarking on their affirmation journey,” says Dr. Bachmann. “Only in this way will all transgender individuals be able to embrace the physical and mental wellness they achieve by living as their selfidentified gender. We are proud that we, as their health care team, can assist them in realizing this personal wellness.” M Robert Wood Johnson I MEDICINE 19