For several years, adolescent medicine specialists Renata Sanders and Errol Fields had been seeing a handful of teenage and young adult patients who questioned or felt disconnected from their gender identity. After last spring’s opening of the Johns Hopkins Center for Transgender Health, however, the physicians dedicated time in the adolescent medicine clinic once a month for these patients, and inquiries have jumped.

“I’m getting anywhere from three to seven referrals a week,” says Kathy Tomaszewski, adolescent nurse coordinator for the Emerge Gender & Sexuality Clinic for Children, Adolescents and Young Adults, which manages about 50 patients. At the clinic, patients as young as 6—most of whom come with parents or siblings—can find a safe space to discuss their concerns and health needs with Sanders, Fields and Tomaszewski. The multidisciplinary team includes social worker Tisha James and psychologist Kathryn Van Eck.

Depending on a patient’s stage of development and desires, Sanders and Fields can prescribe pubertal blocker medications or cross-hormone therapies, such as providing testosterone to a patient born female to deepen the voice and cause hair growth. The team also provides primary care services, family support and advice negotiating any special arrangements with schools or teachers. Gender affirming surgery for those 18 and older is available through the Center for Transgender Health’s plastic surgery associates.

“It’s been a very rewarding experience because families have been searching for resources and support, sometimes for a long period of time,” Tomaszewski says.

Many of these patients have not had supportive experiences in a health care setting, adds Fields. Even if other physicians have been open-minded, he says, they often “have no idea” how to help them because there is little training on how to work with transgender patients.

“I’ve had patients getting hormones for the first time who are in tears of joy because they are finally getting something that affirms who they are and experiencing some relief from their gender dysphoria,” says Fields.

Fields and Sanders see the clinic as part of a larger initiative they call SPACES—Supporting Pediatric Adolescent and young adult sexual and gender minorities through Advocacy, Clinical care, Education and training, and Scientific inquiry. In addition to conducting health disparities research on issues affecting lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) youth, they have conducted joint trainings for Johns Hopkins medical and nursing students—as well as frontline clinical staff—on how to work with these patients. Topics include counseling adolescents who are questioning their sexual orientation, encouraging parents to support their youth and identifying issues affecting the patient, such as depression or mental health needs, substance abuse or risky sexual behaviors. With clinic staff, they review using preferred names and pronouns, as well as other strategies to make transgender patients and their families feel welcome and comfortable in the clinic environment.

Adolescence is a critical time for development in terms of emotional, cognitive, neural, hormonal and physical changes, Sanders says, and those questioning their identity may feel isolated. “It’s really a vulnerable time for these youth,” she says. “You can’t just say they’re little adults, because you will miss key opportunities for intervention and support.”