Leaders of the Duke Child and Adolescent Gender Care Clinic, which celebrated its seventh anniversary in July, have identified a large number of patients reporting anxiety caused by COVID-related isolation.

Pediatric endocrinologists and gender care specialists says school closings made it difficult for young patients and their families to find gender-focused clinical care. Some clinics reduced hours as a response to COVID, limited options for individuals and families seeking care.

Being away from friends and classmates in school settings can exacerbate mental health challenges for some patients, specialists say. The clinical team, which encourages candid communication in a safe, comfortable setting, has counseled more young patients who report feelings of isolation as a result of COVID.

A recent expansion to a new clinic has now shortened appointment wait times, Duke specialists say.  In addition to pediatric endocrinologist, the multidisciplinary team includes a child and family clinical psychologist, a pediatric urologist, a clinical psychologist who specializes in eating disorders, and a social worker who plays a key role in working with families during the initial appointment.

Distinctive services offered:

• Access to the Duke Voice Clinic for vocal training.
• Counseling from nutritionists to help with eating disorders.
• Physical therapy to help children as they prepare for physical changes following surgery. Some patients, for example, want to add muscle and improve strength.
• Access to a gynecological team to help with menstrual management or family planning.
• Psychological counselling.
• Identification of and help with access to community partners who can help with transitions.
• Dermatological services to help patients treat acne or eliminate unwanted hair.
• Plastic surgery.

Gender care is not recognized as reproductive health care in North Carolina; young people under 18 can legally access reproductive health care without parental permission. As a result of this classification, specialists say they cannot reach all individuals who need care. Families with children under age 18 usually approach their pediatricians, who commonly refer many patients to the Duke clinic.

To improve patient education about gender issues, the clinic hosts an evening Zoom session each month. Many parents become more aware of gender issues after engaging with the clinic, which brings expertise from 20 years of research to help guide patients and families.