Sitting unassumingly on the exam table, Jay’s feet dangle above the floor and his hands are folded in his lap. He displays a warm smile when asked how he’s doing. His mother, Cynthia, looks at her son with an overt sense of pride and the type of love that needs no words to express its presence.
Jay is awaiting the arrival of the Gender Clinic care team and as his appointment draws near, he talks about what life is like as a 10th grader in the Seattle area and his hopes for his future. As his father and brother before him, Jay wants to go into the armed services. His particular branch of interest is the Air Force and he wants to go through officer training at West Point.
Assigned female at birth, Jay also talks about his desire to fully transition to the male gender that he has identified with since he was a baby and the challenges that it presents, especially at his young age.
Cynthia, a cancer survivor herself, knows all about taking on challenges. Her experience as a patient taught her about the medical system.
“I know how important it is to be your own advocate,” she said. “I am so proud of Jay for his bravery in being his own advocate and taking control of his own medical decisions.”
Finding a medical home where the experts listen
As Jay decided to start his transition, Cynthia says it was important they found the right medical home.
“When we first talked about things, we decided that we weren’t going to go just anywhere,” Cynthia said. “We were going to the best.”
Their search led them to Dr. David Breland and his team at Seattle Children’s Gender Clinic, which is one of only a few clinics in the country that offers this type of care to adolescents.
When asked how his experience has been, Jay replies, “They’ve been great. They listen.”
Jay’s personalized course of treatment is what has resonated with him and his mother. The clinic has taken the time to see him as an individual and create a care pathway that is tailored to his needs.
The Gender Clinic team ensures this personalized approach by meeting every Tuesday morning before the first patient arrives. They have a round table discussion about the unique needs of the patients they will be seeing that day. Every aspect of the clinic is represented and each young adult that will be seen is reviewed and their unique situations are considered. Aside from discussing considerations around any medical conditions, Breland and the team also talk about how to make the patients and their parents comfortable by focusing on their shared goals.
A different kind of integrated care
When it comes to meeting the needs of adolescents who are transitioning genders, there are a lot of factors involved and one of the most important elements is the coordination of care. The clinic’s secret weapon in coordinating successful treatment is Lara Hayden, Gender Clinic program manager and care navigator.
Hayden is a social worker with over a decade of experience and a particular focus on the LGBTQ community. She has spent her personal life counseling friends and family, and when she saw the posting for the position with the newly formed Gender Clinic, she knew it was where she should be.
“It was like all my previous jobs and passions came together and had a baby, and I knew this was the perfect fit for me,” Hayden said.
Donning a pair of white, heart-shaped glasses and ruby red lipstick, Hayden breaks down the silos of care that can be confusing to patients and families. She is their first contact when they reach out to the clinic. Each family has a comprehensive phone consultation, including a mental health component, with Hayden before their first appointment is scheduled. She has conducted initial screening interviews with over 280 families since the opening of the clinic last year.
“The initial call to the clinic is 30 to 60 minutes and we just have a conversation about the potential patient, their goals, what we can offer and how the process works,” Hayden said.
Hayden is accustomed to encountering the tough questions that come from adolescents and parents who often are approaching the clinic at what feels like a vulnerable time in their lives.
“I make one thing clear right away,” she said. “I tell them you are not alone. You are not the only one experiencing this.”
Hayden says that in itself is a huge relief to patients and families. During the phone screening, she answers sensitive questions that parents are often afraid to ask in front of their children. Nothing is out of bounds and there is no topic that cannot be discussed. She is hyper sensitive to the fact that parents are going through this along with their children.
“I let them know that this is a brave new world for parents,” she said. “This stuff is not in parenting books.”
Preparing patients for success
To help relieve the anxiety associated with the treatment, Hayden makes it her goal to ensure that the patient is set on a course to find their happiest, healthiest self. Her main focus is a single question: “How can we affirm gender while maintaining their health?”
Gender identity treatment is complex as many patients have other issues that have manifested as a part of gender confusion. Some of the more common conditions associated with gender confusion are eating disorders and being on the autism spectrum.
The Gender Clinic is tasked with unraveling the associated conditions and treating the whole patient, which includes the coordination of everything from endocrinology to mental health services. This coordinated care is intentionally built into everything the clinic does and Hayden is the conduit who makes the necessary connections.
For patients like Jay, that translates to the best possible care, all in one place. It includes all the necessary medical treatment in addition to suggestions for things like support groups and information about available community resources. The goal of the clinic is to help families find their own level of comfort with what can be a confusing period in both the child and parent’s lives.
Hayden and her team understand the importance of building an individual care plan for each patient.
“We know that every family is different and at a different place in their journey,” she said. “We never forget that their physical and mental health are intertwined. We’re all starting to understand that gender is a spectrum and not just black and white, so we need to treat each patient in a way that suits their particular needs.”
Her advice to parents who have children with gender questions is straightforward.
“Let your kids know you love them and get them the support they need,” she said. “Talking about these issues can be a hard and scary conversation, but both the child and the parent are better off when the parents ask questions and they move forward together.”
Jay and his mother agree with that sentiment and are pleased they have found experts to help guide them as they move forward.
“It’s worth it for us to come here because we know they’re the best,” she said. “They are here with us every step of the way and that support is invaluable.”
Jay simply smiles and nods, ready to face his future and attain his goals.