For Pediatric Clinicians: A Guide to Supporting Transgender and Gender Diverse Patients and Their Families

Dear Colleagues,

I write as both a pediatrician and the parent of a transgender child. I have sat on both sides of the exam room — caring for patients and advocating for my own child’s well-being. That dual perspective brings clarity to this moment and to what is at stake.

Dame Cicely Saunders, who helped establish the field of palliative care, once said: “Suffering is only intolerable when nobody cares.” In my work as a pediatric palliative care physician, I journey with children and families through difficult circumstances we cannot fix. Our work is about walking alongside them so they are not alone, minimizing suffering where we can, and ensuring people feel seen, heard, believed and valued, even when the weight they carry remains.

That lens feels essential now.

Across the country, access to gender-affirming care for minors is being destabilized — not by evidence or evolving standards, but by external pressures outside the practice of medicine. This conflicts with what we teach and value: that care should be evidence-based, equitable, and grounded in our patients’ best interests. Continuing to offer mental health support while withholding medical care ignores our understanding that health is not divisible. It is an unsettling and disorienting time to be a provider — and it does not feel good to fall short of the holistic care we aim to provide.

I feel this tension not only as a clinician, but as a parent. I am navigating a healthcare landscape for my child that feels increasingly narrow and uncertain. Seeking care for my child feels vulnerable, unfamiliar, and othering — frankly, scary. I am traveling across state lines to unfamiliar systems and providers who do not know him. I want his doctor — not just a doctor. I want him cared for in spaces grounded in familiarity, trust, consistency, and dignity — spaces where he feels safe naming his hopes, fears, pain, and what matters most to him.

Palliative care teaches that when we cannot make things better, we are still responsible for how we show up.

There is power in sitting with people in suffering, affirming their humanity, and ensuring they are not alone. There is also power in advocacy — in refusing to accept as inevitable what others have come to accept and continuing to work for change.

This is the work in front of us now.

We may not be able to offer the full scope of care our patients need and deserve right now. But we are still responsible for the spaces we create and the care we provide within them. We can listen carefully, speak respectfully, document thoughtfully, and advocate where we are able. We can create clinical environments grounded in safety, dignity, and trust. We can minimize harm, even when we cannot eliminate it.

Our patients are already carrying enough. Our responsibility, especially now, is not to add to that weight, and to ensure they know we care. This guide is intended to help clinicians do exactly that. 

Anne Marsh, MD
Associate Professor of Pediatrics
Division of Pediatric Hematology, Oncology, Transplant and Cellular Therapy
University of Wisconsin School of Medicine and Public Health*

* Opinions expressed are solely my own and do not express the views or opinions of my employer.