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What a Pediatrician Learned from a 9-Year-Old Transgender Child

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The number of transgender people in America has doubled in the last decade, but that doesn't mean the medical profession has caught up. Transgender patients are often unable to find quality health care. Research shows they may face stigma and discrimination, and that they can't find medical interventions like hormone therapy and/or sex reassignment surgery.

Ximena Lopez is a pediatric endocrinologist at Children’s Health in Dallas, Texas, one of the few in the country who specialize in care for transgender youth. Recently she shared the story of her steep learning curve at the TEDMED conference in Palm Springs.

I caught up with her afterward. The following interview, in Lopez's words, has been edited for length and clarity:

Parents Desperate for Help

I was not prepared when my first transgender child walked into my clinic. I didn’t get any training in medical school, my residency or my sub-specialty training to care for transgender children. And there were people in my clinic who questioned whether I should take the appointment. I decided to see whether I could help, but I didn't think I'd actually provide care.


During the first appointment, the most striking thing was how desperate the parents were for help. They told me they had called 100 doctors and nobody wanted to provide treatment to stop Tyler's puberty. Then they said, 'We don't care if you experiment with our child. We will do anything for his mental health.'

They used a phrase that really stayed with me, 'We prefer to have a living son than a dead daughter.'

I knew I had to help.

Very Little Expertise Available

I went to the mental health team in my hospital for their expertise and they said, 'We have no experience whatsoever. The only time we've seen transgender patients is when they're trying to commit suicide and admitted to the psychiatric unit.'

Fortunately, I eventually found a specialist in Boston and a local psychiatrist to help me navigate suppressing Tyler's puberty.

Puberty suppression is a reversible step. It buys time to explore gender identity. So even if the child changed his or her mind later on, we could stop the puberty suppression and puberty will just restart.

It's Not a Choice

Gender dysphoria is the conflict that exists when a person's physical or assigned gender is different than how they feel or identify. It's very clear that it's not a choice.  That's what I've learned from my patients. Parents have been dealing with this for a long time. They've had years of denial -- mourning the child that they're losing, and then accepting the child they have.

When parents are not supportive the risk of suicide attempt can be as high as 60 percent. And when parents are very supportive it can be as low as 4 percent. The difference is just incredible, so parental support is more than critical.

Society should see transgender people as just normal people. I think we as humans tend to be afraid of what's different and what's new.

Biological Basis for Transgender Identity

There's very little known. There's no genetic explanation. We do know that 40 to 60 percent of identical twins are transgender. For example, if one identical twin is transgender, the odds of the other twin being transgender is 40 to 60 percent. That means there probably is a genetic link because that's a high prevalence. But it's not 100 percent. We don't know anything about the specific gene or genes.

The other thing is there is a new brain imaging study that is called a functional MRI (fMRI) that show subtle differences in movement in the brain between regular males and females. Researchers looked at transgender people before they received any hormone therapy or any treatment that could affect brain function or morphology, and transgender people have differences that put them more aligned with the gender they identify with. In other words, their brains are actually acting more like the brain that they identify with rather than their biological gender.

Have you been able to find appropriate health care for your needs as a transgender person? Why or why not? Tell us your story; your responses will be kept confidential and will never be shared without your permission.


Editor's Note: We will post Ximena Lopez's TEDMED talk here as soon as it is available.

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