Issues related to gender and gender identity can be sensitive subjects. Parents, as well as youth, may be hesitant to talk openly about gender identity and maybe even more hesitant to raise such topics with healthcare providers. When children or teens raise questions about their gender or tell a parent that they think they might be transgender, parents may respond a number of different ways, often feeling uncomfortable, possibly even trying to avoid the topic.
As uncomfortable as it may seem, we know that children and teens who are transgender or gender fluid, as well as those who are gay, lesbian, or bisexual are at much greater risk of:
- Engaging in unhealthy behaviors.
- Being bullied or victimized.
- Experiencing anxiety, depression, and others concerning emotional symptoms.
- Engaging in self-harm (including suicide).
For these and other reasons, addressing issues of gender is an important aspect of parenting. Gender identity develops differently in every child and gender differences can present at almost any age, sometimes in early childhood, sometimes much later. Often youth have been “thinking about” gender differences long before they openly share their thoughts and feelings. “Gender non-conforming,” “gender non-binary” and “transgender” are some of the terms used to describe individuals whose gender expression or gender identity do not conform to that typically associated with the gender they were assigned at birth.
Being transgender or gender non-conforming is not a disorder, but many youths who demonstrate a consistent and persistent pattern over time that they wish to be (or “are”) a gender other than that given at birth may experience very significant distress living with the body that they have. The Gender Understanding, IDentity and Expression (GUIDE) Program is dedicated to helping youth and families struggling with these issues regarding gender.
Why Choose Cleveland Clinic?
The Gender Understanding, IDentity and Expression (GUIDE) Program provides a wide range of support and intervention for youth (childhood through adolescent years) who are gender questioning, gender non-conforming, gender fluid, or transgender, or who are struggling with any other issues around gender. Sometimes they are trying to figure out gender identity, or how they want to express gender; sometimes they may just feel like their gender assigned at birth doesn’t fit quite right.
For patients transitioning into adult care, Cleveland Clinic’s Center for Lesbian, Gay, Bisexual and Transgender (LGBT) Care offers medical healthcare services at the Lakewood Family Health Center. Embedded in a primary care practice, the Center for LGBT Care provides care for all patients in a safe and welcoming environment. It includes providers who understand the health needs of LGBTQ+ patients, and access to specialists with expertise in LGBTQ+ care.
For transgender and non-binary patients patients, Cleveland Clinic's Transgender Medicine and Surgery Program offers routine medical care tailored specifically to patients’ needs, as well as transition-specific services including mental health support and therapy, gender-affirming hormone therapy and surveillance, and gender-affirming surgery.
GUIDE Team & Locations
GUIDE includes a group of healthcare providers from several disciplines, including mental health providers, pediatricians, and pediatric specialists, all who are experienced in the care of children and teens with gender “differences”. We understand some of the challenges that can exist in locating sensitive and respectful health care for these youth and strive to meet the needs of each unique child and situation. There is no one “right” approach!
Julia Cartaya, MD – Pediatric Endocrinology, Director, GUIDE Program
Veronica Issac, MD – Adolescent Medicine
Vanessa K. Jensen, PsyD, ABPP – Pediatric Psychology
Jason Lambrese, MD – Child and Adolescent Psychiatry
Hilary Mabel, JD – Bioethics
Ellen Rome, MD, MPH – Adolescent Medicine
Molly Wimbiscus, MD – Child and Adolescent Psychiatry
Cleveland Clinic Children’s provides a full array of healthcare services for LGBT youth and their families. All care is individualized, designed to meet the needs of each unique situation while at the same time complying with the standards and best practices for this population. Cleveland Clinic Children’s GUIDE program (Gender Understanding, IDentity, and Expression) includes a multidisciplinary team of healthcare providers with expertise in helping transgender youth and their families as they consider the range of options available to them.
Services available include:
- Pediatric providers with understanding of and sensitivity to the issues of LGBT youth
- Psychological and psychiatric services offered by LGBT affirming mental health providers (including specialized assessment related to referral for hormone consultation/treatment and other transgender services)
- Affirmative support and education for youth and families regarding LGBT issues and challenges
- Specialty care with pediatric endocrinology and adolescent medicine regarding use of medications in gender affirmation therapy
- Surgical services when appropriate
Specialized healthcare services can be an essential part of improving the overall health and well-being for transgender youth care.
Families of new patients should call us at 216.444.1917 to get the process started. You will be sent an informational packet with a questionnaire that will need to be filled out and returned to the GUIDE team. Once that information is received, your child will be set up with an appropriate provider.
PFLAG is a national organization with local chapters in Cleveland and Akron that works toward family and societal acceptance for LGBTQ people. We especially recommend the Welcoming Our Trans Families and Friends for families of transgender individuals
Human Rights Campaign
The Human Rights Campaign is a national civil rights organization that works to promote the equal rights of LGBTQ people. Supporting and Caring for our Gender Expansive Youth is a report designed to help adults find ways to communicate with and support all youth in their lives.
LGBT Community Center of Greater Cleveland
The LGBT Community Center of Greater Cleveland is a local nonprofit group that offers a space for group meeting and support groups for LGBT youth in the Cleveland area. TransFamily, see below hosts meetings there on the 2nd Saturday of every month.
Transgender support group in the Cleveland area, which holds regular support groups in Cleveland and Cleveland Heights. It also hosts online discussion groups for youth, parents, family and friends of transgender individuals.
TransOhio provides education, support and information regarding advocacy, name and gender marker changes as well as information regarding legal assistance for the above.
National Center for Transgender Equality
The National Center for Transgender Equality provides information regarding legal rights, name and gender marker changes, and advocacy opportunities for transgender people and their allies. Also has state specific information. In addition, they provide the annual US Transgender Survey results.
Gender Diversity increases the awareness and understanding of the wide range of gender variations in children, adolescents, and adults by providing family support, building community, increasing societal awareness, and improving the well-being for people of all gender identities and expressions.
Gender Spectrum provides community information and training on support for gender variant children and their families. Also of note is the Gender Spectrum Family Conference, an annual conference for people raising gender non-conforming, gender variant, and transgender children and adolescents.
TransYouth Family Allies
TYFA empowers children and families by partnering with educators, service providers and communities, to develop supportive environments in which gender may be expressed and respected. They have well trained advocates and provide resource assistance for families experiencing discrimination or other difficulties in schools or other environments.
The Trevor Project
The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people ages 13-24.
OutSupport was started by a group of mothers in Ohio who were looking for ways to support their LGBTQ children. Their goal is to promote the health and well-being of LGBTQ people and their families and friends with support, education and advocacy.
The World Professional Association for Transgender Health
WPATH is an international organization that focus on the professional development, science and ethics of transgender health. You can find the standards of care we use to treat transgender care here.
Nationally, GLSEN (pronounces “glisten”) works to ensure safe schools for ALL students, regardless of sexual orientation and gender identity. There are over 40 Chapters around the country, including one that focuses on the needs of northeast Ohio students and schools. The work that chapters do covers a variety of subjects and issues, from public policy to teacher training to supporting students and educators around the country
Equality Ohio advocates and educates to achieve fair treatment and equal opportunity for all Ohioans regardless of their sexual orientation or gender identity or expression.
Camp Lilac, a program of TransAction, provides an overnight camp with all of the usual camp activities within a safe and welcoming space where trans youth can be themselves within a positive, supportive, youth-focused environment. The annual camp is based in northeast Ohio.