Health Care for Transgender and Nonbinary Teens

Most people are told they are a boy or a girl (male or female) based on the genitals they were born with. This is the sex you are assigned at birth. For some people, that male or female label may not feel right.

Someone assigned female at birth may feel that they are really a male, and someone assigned male at birth may feel that they are really a female. People who feel this way are called transgender.

Others may feel that they belong to neither gender or to both genders. People who feel this way are sometimes called gender nonbinary, gender fluid, or genderqueer. Some other terms may include androgynous, agender, gender neutral, and gender nonconforming.

Everyone has a gender expression. People often express their gender through their choice of clothing and style of hair or makeup. Some people who are transgender or nonbinary decide to change how they dress or wear their hair. Some choose to change their name and pronouns (he, she, they, etc.).

Some people choose to take medications or have surgery so that their bodies more closely match their gender identity. Others do not do any of these things. There is no "right" way to be a transgender or nonbinary person.

There are websites and hotlines where you can go if you need information. These websites can also help you teach your parents, family, and friends about what being transgender or nonbinary means. Some of these websites allow you to talk to others anonymously. See the Resources section for details.

It may be helpful to talk with your parents, a teacher, counselor, doctor, or other health care professional. It's a good idea to ask about what can be kept private before you talk with an adult.

There are doctors and other health care professionals who can help you

• figure out the best way to talk with your friends and family about your gender identity

• find information and resources near where you live

• give documents to your school that support your gender identity

• get routine health care (including vaccines, screenings, and birth control)

• find gender-affirming care (health care that supports your gender identity, such as medications that can stop your periods or help with a gender transition)

See the Resources section for help finding a trans-friendly doctor or other health care professional in your area.

A gender transition is a process you can go through to express your gender. There are many ways people can transition, including

• changing how they dress or act

• changing their name and pronouns (she, he, they, etc.)

• taking medication (including puberty blockers and hormone treatment)

• having surgery

You can think about doing some, all, or none of these options. If you are interested in a medical transition, talk with your doctor. They may ask you to see an obstetrician–gynecologist (ob-gyn) or other health care professional. Health care professionals can help you transition safely.

Laws in some states may limit your doctor's ability to talk with you about transitioning or offer you this care. If you can't talk with your doctor, there are online resources that can help you find care. Read the Resources section below.

Remember, taking treatments from anyone without a medical license can be dangerous.

In most places in the United States, you will need permission from your parent or guardian to do a hormonal or surgical transition before you are 18. You may also need to talk with a mental health professional and get a letter of support before starting treatment. This may involve multiple counseling sessions.

Puberty blockers (also called suppressors) are medications that delay the changes that come with sexual maturity. These medications can stop menstrual periods and the growth of breasts, or stop the deepening of the voice and the growth of facial hair. Most effects of puberty blockers are reversible and temporary. The effects only last as long as you are taking the blockers.

Puberty blockers are given as an implant or as a shot. You may need to wait until you have started the early stages of puberty before taking puberty blockers. The early stages of puberty include budding breasts, growing testicles, and light pubic hair.

Hormone treatment is medication that helps you look or sound more masculine or feminine. This may also be called cross-sex hormone therapy or gender-affirming hormone therapy. Depending on the treatment, these medications can help you develop sex characteristics, such as

• deepening your voice

• growing facial hair

• developing breasts

• changing your body shape

Most of these changes cannot be reversed.

Depending on the hormone, treatment comes in several forms, including as a shot, pill, patch, gel, cream, or implant. You may need to wait until you are 16 to begin hormone treatment, but you may be able to take puberty blockers in the meantime.

No, hormone treatment is not a replacement for birth control. If you have female sex organs and you have sex with a person with male sex organs, you can still get pregnant. All teens who are sexually active and want to prevent pregnancy need to use birth control. Read Birth Control to learn about birth control options.

Puberty blockers may help your emotional and social development. They may help you feel more comfortable in your body. Hormone treatment is shown to help transgender people with depression and boost self-esteem. Puberty blockers prevent changes in your body that you are not comfortable with. They may also prevent the need for future surgery, such as removal of the breasts ("top surgery").

Puberty blockers may

• slow your physical growth and affect your height

• decrease your bone density (making your bones more likely to break in the future)

Hormone treatment may increase your risk of

• blood clotting problems

• high blood pressure

• mood changes

• liver inflammation (hepatitis)

Surgery may be an option for you. This depends on many factors, including the laws where you live. Talk with a trusted health care professional if you are interested in surgery. 

Yes, you need to keep seeing an ob-gyn or other health care professional to continue taking hormones. Health care professionals can also help make sure you stay healthy, physically and emotionally, throughout your life.

Both transgender men and transgender women may need to see an ob-gyn. Make sure to see an ob-gyn if you

• have female sex organs (like a uterus or a vagina)

• are taking feminizing hormones (like estrogen)

All people who are sexually active are at risk of getting a sexually transmitted infection (STI). If you have a uterus and ovaries and are sexually active, you can also get pregnant. Read Birth Control for a list of birth control options.

Condoms give the best protection against STIs, but they are not the best protection against pregnancy. It's best to use condoms and another method of birth control, such as an intrauterine device (IUD) or a birth control implant, to protect against both pregnancy and STIs.

Some kinds of hormone treatments may make it harder for you to have a baby in the future. Some kinds of surgery may make it impossible. Talk about this with your doctor before you have treatment. If you think you may want to have a baby in the future, there are ways to help preserve your fertility.

These are common problems that can be treated. Options may include birth control pills, a birth control shot, or an IUD. Talk with your ob-gyn or other health care professional about your options.

Many parents, communities, and schools support teens who are transgender or nonbinary. Teens who do not feel supported by adults are more likely to be depressed. Some teens cope with these thoughts and feelings in harmful ways. They may try to hurt themselves. They may turn to drugs and alcohol. Some skip school or drop out. Some run away from home.

Transgender and nonbinary teens may also have a higher risk of being in relationships with partners who act violently or threaten them. Read more about healthy relationships.

Help and support are out there if you need it. If you are feeling depressed or if you just want to talk to someone, think about talking with a teacher, counselor, or doctor. The Resources and Hotlines sections below also have places you can go to for help.

Resources

Centerlink
954-765-6024
www.lgbtcenters.org
Directory of community centers for LGBT people.

Trans Health Project: Trans Health Care Providers
https://transhealthproject.org/resources/trans-health-care-providers/
List of websites to help find a trans-friendly health care professional.

Transgender Care Listings
www.transcaresite.org
Directory of trans-friendly health care professionals.

Trans Youth Equality Foundation
www.transyouthequality.org
Resources for transgender teens and young adults.

Campus Pride
www.campuspride.org
Resources for LGBTQ college students.

PFLAG
202-467-8180
www.pflag.org
Network of communities for LGBTQ people, parents, and friends.

Gender Spectrum
510-788-4412
www.genderspectrum.org
Organization that supports gender-expansive children, teens, and their families.

Hotlines

Trevor Lifeline
Toll-free: 866-4-U-TREVOR (866-488-7386)
Hours: 7 days a week, 24 hours a day
www.thetrevorproject.org
Confidential suicide and crisis counseling for LGBTQ teens and young adults. Text and instant messaging options are available on the website.

Trans Lifeline
Toll-free: 877-565-8860
Hours: 7 am–1 am PST / 9 am–3 am CST / 10 am–4 am EST
www.translifeline.org
Peer support hotline that is run by and for trans people.

LGBT National Youth Talkline
800-246-PRIDE (800-246-7743)
Hours: Monday–Friday 1 pm–9 pm PST / 4 pm–12 am EST, Saturday 9 am–2 pm PST / 12 pm–5 pm EST
[email protected]
www.glbthotline.org/youth-talkline.html
Peer support and resources for LGBTQ teens and young adults.

Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm. The implant releases a hormone to prevent pregnancy.

Depression: Feelings of sadness for periods of at least 2 weeks.

Estrogen: A female hormone produced in the ovaries.

Gender Expression: The ways a person communicates their gender to others. This can include the clothes and hair styles they wear, the pronouns they use, and their body language.

Gender Identity: A person’s sense of being male, female, or something else. This identity may or may not match the sex assigned at birth.

Gender Nonconforming: A term used to describe a person who does not follow other people’s ideas about how they should act according to gender roles. Also called gender fluid, gender expansive, or genderqueer, among other terms.

Genitals: The sexual or reproductive organs.

Hormones: Substances made in the body that control the function of cells or organs.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Menstrual Period: The monthly shedding of blood and tissue from the uterus.

Nonbinary: A term used to describe a person whose gender identity is neither male nor female.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Puberty: The stage of life when the reproductive organs start to function and other sex features develop. For women, this is the time when menstrual periods start and the breasts develop.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact.

Transgender: A person whose gender identity is different from the sex they were assigned at birth.

Transgender Men: A term used to describe people who were assigned female at birth but have a male gender identity.

Transgender Women: A term used to describe people who were assigned male at birth but have a female gender identity.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.