The newly established Washington University Transgender Center at St. Louis Children’s Hospital provides care to children and adolescents who identify as a gender different from the sex they were assigned at birth. It is the only center of its kind in the region.
Growing up, Jacob Allmon was quiet and shy. “I could tell he wasn’t really a happy kid, and he struggled in school,” said Tracy Allmon, Jacob’s mother. “I saw genuine glimpses of his ‘true self’ when he was with his girlfriends, playing dolls and dress up.”
Jacob and his family didn’t know it at the time, but they were beginning to embark on a long journey that would bring them to St. Louis Children’s Hospital (SLCH), where Jacob would ultimately become Jessica.
“We are taking a multidisciplinary approach to the care we provide for these children and adolescents,” says Washington University physician Christopher Lewis, MD, pediatric endocrinologist at SLCH and Center director. “We are committed to providing a safe, supportive and welcoming environment in which transgender people may receive the education, medical assistance and mental-health counseling they need to make informed decisions that will impact their well-being throughout their lives.”
The center is a response to the growing number of transgender patients seen by Dr. Lewis and his SLCH colleagues. Dr. Lewis believes the reason for the increase in this patient population is twofold.
“There is greater cultural acceptance of people who have a gender identity different from what they were assigned at birth. That acceptance has made it more comfortable for them to disclose their identity to their family and friends and have a life as their affirmed gender,” he says.
The individualized care provided at the Transgender Center is based in part on the age and pubertal status at which children or adolescents are seen initially. Someone who has not yet received counseling may need a referral to a mental health provider, who can assess for the diagnosis of gender dysphoria and determine if any other issues exist, such as depression, low self-esteem, anxiety or substance abuse. In younger children, this assessment and an informational discussion with a pediatric endocrinologist may be all that needs to be done until the child enters puberty.
“Some parents may need help thinking through the right course of action going forward—for instance, timing for social transition,” says Sarah Garwood, MD, Washington University adolescent medicine physician at SLCH. “We can connect parents to community resources and support groups that can help them support their children.”
Adolescent medicine physicians specialize in the unique development needs of teens and also consult on patients referred for anxiety, depression, eating disorders, sexual and reproductive health care, and other concerns. Stigma and discrimination contribute to mental health diagnoses occurring at higher rates in transgender people.
For patients who have started puberty, pubertal blockers exist as an option to suppress undesired, irreversible secondary sexual characteristics such as deepening of the voice and facial hair for transgender females and breast development for transgender males. After meeting readiness and eligibility criteria, patients between the ages of 14 and 16 may begin taking cross-sex (gender-affirming) hormones that help make their physical body match their inner gender.
“Of course it is ideal if patients come to us prior to or in the early stages of puberty, but we can help older teenagers and young adults make the transition as well and in any way they want to,” says Dr. Lewis. “For some transgender people, adjustments in gender expression, such as preferred name and pronouns, makeup, hair, voice, clothing and/or behavior are enough. Some may want only hormonal therapy, while others want both hormonal and surgical interventions. Our goal is to help our patients make these decisions and then ensure they have the resources to carry them through, including referrals to legal services.”
In June, Drs. Lewis and Garwood met with local advocates and mental health providers to introduce the new transgender center and to elicit feedback. “Our plans for the center are to make it an important community resource that encompasses more than just a clinic setting. That will also include establishing a database in order to start developing research studies to advance how we approach care for transgender individuals,” says Dr. Lewis.
Now 18 years old, Jessica can finally be herself. Once a shy, quiet young boy who struggled in class, Jessica has blossomed into a lively, outgoing young woman who graduated high school on the honor roll. “I don’t know where we would be right now if it weren’t for Dr. Lewis,” said Tracy. “He changed Jessica’s life 100 percent.”
The Center accepts self-referrals or referrals from physicians and mental health providers. Patients are seen Tuesday afternoons at the St. Louis Children’s Hospital Specialty Care Center in west St. Louis County and Wednesday mornings at SLCH.
To refer a patient, call Children’s Direct at 800.678.HELP (4357). For additional information, listen to Drs. Lewis and Garwood’s podcast discussing services offered at the Center at StLouisChildrens.org/TransgenderPodcast.
Services Provided at the Washington University Transgender Center at St. Louis Children’s Hospital
Multidisciplinary medical and psychological consultations for transgender individuals and their families:
- Puberty blockers
- Cross-sex (gender-affirming) hormone therapy
- Speech therapy
- Surgical referrals
- Legal services referrals
- Support letters for gender marker and name change
- Connections to support groups and community resources