LGBTQ Pride Month is not just for adults.
Nearly 2 million youth, ages 13 to 17, identify as lesbian, gay, bisexual, and/or transgender. These children and young people are vibrant, diverse, and deserving of full acceptance and joy. But due to social stigma, homophobia, transphobia, and other forms of discrimination, they face many serious health inequities.
Young people who identify as lesbian, gay, bisexual, or who are unsure of their sexual identity are more likely than heterosexual peers to have considered suicide, been forced to have sex, experienced bullying, used drugs, and felt depressed. Compared to cisgender students, transgender students are more likely to report being victims of violence, substance use, suicide risk, and more. These young people may also face family rejection, housing and employment discrimination, and a lack of resources. A 2017 study found that youth who identify as LGBTQ+ had a 120% higher risk for homelessness.
Homophobia and transphobia, like racism, are deeply embedded into our society’s systems and, tragically, also show up in healthcare. It is vital that pediatricians are intentionally inclusive of children and young people who identify as LGBTQ+, educated about issues that impact them and their unique health needs, and that they listen to and learn from them. This is especially true for providers working with youth of color and others who are impacted by discrimination in multiple ways.
Often, pediatricians may be the first or only person a young transgender person feels comfortable speaking to about their gender identity. Of our partner providers across the country, 39% have specific services for LGBTQ+ youth. One of these providers, Dr. Vinny Chulani, leads Phoenix Children’s Adolescent Medicine Program and runs its LGBTQ+ service programs. Dr. Chulani is intentional about listening to patients and their families, and creating an environment where they can express themselves. Gender-diverse children, as young as 4 and 5, are among his patients.
As awareness expands and more language develops to describe sexual orientations and gender identities, more children and young people may begin using these terms and concepts to describe themselves and their experiences. Increased consciousness around using a person’s correct pronouns is one way that we see this happen now. The impact of this cannot be minimized. The Trevor Project found that “transgender or nonbinary youth who reported having their pronouns respected by all or most people in their lives attempted suicide at half the rate of those who did not have their pronouns respected.” This is a stark illustration of how life-saving the appropriate support can be.
“When you take a look at the literature on LGBTQ+ populations, it’s always framed in hardship, rejection, difficulties, disparities, and bad outcomes. I think it’s important for us to recognize that while risks and challenges exist, there’s also resilience,” said Dr. Chulani. “There are tremendous examples of LGBTQ+ people who have achieved and succeeded, and are doing well … [We should] not approach them from a sense of deficit but … trust that given internal and external supports, they can be successful, and they can thrive.”
In addition to affirming healthcare, addressing systemic homophobia and transphobia in policies, laws, and systems is essential in eliminating the immense health inequities facing LGBTQ+ youth. Sadly, children are being placed at the forefront of this fight today.
Many pediatricians agree, like Dr. Maureen Connolly, a specialist in transgender care from our partner program in Detroit. Like other providers in our network, Dr. Connolly’s advocacy goes beyond direct patient care: She’s a “provider-advocate” who champions healthcare legislation. At a recent hearing in Michigan’s state legislature about a restrictive anti-transgender sports bill, Dr. Connolly said that it “will have a direct negative impact on the health and well-being of transgender young people, and will only add to the marginalization that they may be experiencing at school.”
Like Dr. Chulani, Dr. Connolly listens to her patients and uses her influence as a trusted medical provider to advocate for a world where they can live with safety, health, and dignity. This needs to be the norm in pediatrics and healthcare in general. The LGBTQ+ community has shifted the consciousness of this country, but they should not have to fight alone.
