Best Practices for Gender-Affirming Care for Pediatric Orthopaedic Patients

Abstract

Transgender and gender-expansive youth may experience barriers to healthcare due to stress and anxiety associated with accessing healthcare coupled with a lack of awareness by providers of best practices for treating this population. The pediatric orthopaedic community has an opportunity to improve relationships and outcomes for transgender patients by understanding the distinctive qualities of this population and how to best support these patients via the provision of gender-affirming care. By following best practices for gender-affirming care, pediatric orthopaedic providers are uniquely positioned to provide affirming, supportive care for transgender patients within their practices, which may ultimately impact patient outcomes and patient satisfaction. Gender-affirming care should begin the moment the patient enters the healthcare facility, continue through all perioperative and follow-up care, and should be practiced by all members of a multidisciplinary care team. Synergizing the expertise of psychologists, developmental and behavioral pediatricians, and orthopaedic surgeons, this article offers best practices at each step in the care pathway for providers to consider. An interview with a pediatric patient with gender considerations who has previously undergone orthopaedic surgery is included at the end of this article to provide additional insight from the patient perspective. Key Concepts•Transgender and gender-expansive youth may experience barriers to accessing orthopaedic care.•Orthopaedic providers should educate themselves on treatment considerations for this population in order to promote access to care in general and affirming care specifically.•Transgender and gender-expansive pediatric patients require specific education on pre- and post-surgical topics, such as foley catheter placement and removal, and chest binding, packing, or tucking.•Pediatric orthopaedic providers should be aware of how a patient's current or planned hormonal and/or surgical gender-affirming intervention(s) may intersect with their orthopaedic needs.

Figure 1

Gender documentation within the electronic medical record. A. Example of gender identity as it appears on the front page of a patient's electronic medical record. B. Example of a gender identity smart form that can be filled out for any patient to ensure the medical team is aware of gender identity, preferred pronouns, and gender-affirming treatments.

Figure 2

Gender affirming supports. A. Transtape used to mask the presence of breast tissue or genitalia. B. Chest binder used to mask the presence of breast tissue.

Figure 3

Example of “halter top” that some female patients are asked to don for clinical photos. Similarly, patients that are transgender males may feel uncomfortable with a request to remove their shirt without being provided a garment to cover up with, especially if they have developed secondary sex characteristics.