The OHSU Transgender Health Program serves transgender and gender-nonconforming people of all ages. We take a family-centered approach to helping children, teens and parents/caregivers find the services they need.
This page explains:
- How the Transgender Health Program can help you
- What to expect
- Tips for parents
- Tips for teens
Learn more about OHSU’s health care services for gender-diverse young people on the Doernbecher Gender Services page.
The Transgender Health Program will help you and your child prepare for care at OHSU. We will contact you by phone after receiving your referral. Doernbecher Gender Clinic locations typically schedule your appointment between one and three months after receiving a referral.
Care outside the Portland area: OHSU offers care for transgender young people as often as once a month in seven cities in Oregon and southwest Washington. Call Doernbecher Pediatric Endocrinology at 503-494-3273 for locations and times.
Your provider: We offer training to medical and mental health providers to help improve access to transgender and gender-nonconforming care across the Northwest. The Transgender Health Program can provide more information.
For children and teens seeking treatment, THP staff start with an intake call to:
- Answer your questions, provide community resources and review OHSU services.
- Gather the patient’s gender experience and goals.
- Review options and expectations for treatment, including risks and benefits.
- Discuss insurance coverage.
- Help you find a mental health professional if you don’t have one.
- Assess the urgency of treatment.
- Make a recommendation to schedulers, who will contact you about an appointment.
Mental health therapy: We recommend that patients have an evaluation with a mental health professional before the first appointment. This avoids treatment delays because the evaluation is required for most therapies. We also recommend that children have access to mental health therapy during transition. We can connect you with a pediatric therapist at OHSU.
Mental health consent: In Oregon, teens can seek mental health care without parental consent starting at age 14, but we recommend that parents be involved.
Medical consent: The THP takes a patient- and family-centered approach to pediatric care. You can consent to medical care in Oregon starting at age 15. Before that, we want one or both parents to sign medical consent forms. Even when teens can consent on their own, we encourage support and involvement from parents.
Insurance information: We recommend that parents study their summary of benefits or contact their carrier to learn the extent of coverage. Learn more on our Insurance Information page.
Gender identity in children and teens
Gender awareness: Children usually develop some sense of their gender by age 2 to 4. It’s common — and normal — for young children to want to look, talk and act like someone of a different gender. For many, this doesn’t last beyond puberty.
Gender identity: Children are varying ages when they recognize that their gender identity is different from the one they were assigned at birth. Many are as young as 3 or 4. Others may not have this awareness until puberty or later.
Gender expression: There’s no typical way in which children express gender diversity. Some, seeking to please their family or fit in at school, may not express it at all.
Gender dysphoria: Gender dysphoria refers to the discomfort some young people feel about their gender identity not matching the gender they were assigned at birth. It often emerges or becomes apparent in kindergarten or first grade, when expectations to conform to gender roles increase. Children often become distressed about not being able to wear the clothes they wear at home, for example.
Gender dysphoria: Some teens become aware of their gender identity or choose to express it at puberty. The sex traits that develop in puberty — such as chest development, body hair or voice changes — can intensify or lead to gender dysphoria. Gender dysphoria in teens is highly likely to last into adulthood.
Emotional issues: Gender dysphoria can worsen emotional issues that often come with puberty, such as anxiety and depression. Teens with gender dysphoria are twice as likely to have suicidal thoughts as other teens, research shows.
Tips for parents
It can be hard for you to know whether gender-nonconforming behavior is a phase or a sign that your child is transgender or gender nonbinary. It may take time. If your child seems comfortable in a certain gender role, it may not be necessary to seek mental or physical treatment.
But if your child shows possible signs of gender dysphoria, treatment is recommended. Gender dysphoria can be hard to detect, especially if your child is suppressing feelings. Some things to look for that may be consistent over months or years:
- Insisting that their gender is different from their assigned gender.
- An intense dislike of their genitals.
- A strong desire to urinate differently (sitting or standing).
- Wanting to wear clothes, participate in activities or use a name typical of another gender.
- Difficulty functioning at school, at home or in social situations.
- Depression, anxiety or self-harming behavior.
Teens may feel extreme distress during puberty, even if they haven’t expressed gender-nonconformity before. Teens may be:
- Convinced their assigned gender doesn’t match their gender identity.
- Comfortable only in their gender identity role.
- Desperate to change their bodies.
- In the meantime, desperate to hide signs of their assigned gender.
Accepting and encouraging your child’s gender identity can ease gender dysphoria. A 2016 study found that transgender children who have support in expressing their gender identity socially have:
- The same rates of depression as other children.
- Only slightly higher rates of anxiety.
Ways to support your child include:
- Accepting your child’s identity.
- Talking to your child about what being transgender or gender nonbinary means. Being gender-diverse is different for everybody. If your child is transgender, that doesn’t necessarily mean your child wants to transition, wear certain clothes or use a different name.
- Using the name and pronouns your child wants, and insisting that others do, too.
- Not telling anyone your child is transgender or gender nonconforming without permission. Let your child decide who should know and when.
- Learning about gender identity, gender dysphoria and what issues your child may face at school, in social situations, sexually, in sports, in the workforce and more.
- Getting support for yourself from family members, mental health counselors and support groups.
Tips for gender-diverse teens
Support from your family
We recommend you involve your family in your care if at all possible. Having support at home and during your clinic visits can be important to your mental and physical health. It can also make getting insurance coverage easier.
Telling family and friends
It can be hard to tell people close to you that your gender identity is not what they think. Here are tips that may help:
- Be prepared: You may get lots of questions. Be ready to explain how you feel and why you’re sure. Gather information about what being transgender or gender nonbinary means, what transitioning may involve and the issues gender-diverse people face. Offer to guide people to resources where they can learn more.
- Pick a good time: Make sure the conversation won’t be rushed. Try to find a time when the people you’re telling won’t be tired or stressed.
- Get help: If you have an ally, consider bringing the person to support you. Or arrange to talk with your ally soon after your conversation. You also might find a support group in your area or online to help you before and after your talk.
- Be understanding: Don’t expect people to accept or reject your identity right away. It may take time. They may be confused and hurt, although don’t expect everyone to react negatively. Ask if you can talk about it again soon, especially if the conversation isn’t going well. You might ask your parents if they’ll go with you to talk with a doctor or mental health therapist.
Things to think about
- It’s up to you who knows. Tell your parents, family or friends whom they can share the news with and whom they can’t.
- Do you feel safe? Think about who might threaten you if they find out you’re transgender or gender nonbinary. Is a friend likely to spread it around school? If you have a job, will you be in danger of losing it if your manager knows?
- If you’re uncomfortable telling someone in person, consider using email. That may be better than keeping the person in the dark.
We encourage you to call or email the Transgender Health Program with questions. You can also find OHSU support services and information on our Resources page.