The complex medical and psychological needs of transgender and gender-diverse youth have prompted Children's Minnesota to launch a clinic to provide more timely treatment and information to children and their parents.

While almost 3 percent of Minnesota's high school students identify as gender diverse, this group of children often doesn't know where to turn when they first have questions, said Dr. Angela Kade Goepferd, medical director of the clinic, which started scheduling appointments Tuesday and will open to patients on April 22.

"What we really want to provide is a welcoming place to ask the questions they need to ask and to decide what interventions the children are going to need," she said.

The new clinic, adjacent to Children's flagship hospital in Minneapolis, will provide a variety of services, including initial consultations and therapy sessions to guide patients and make sure children are prepared for the treatment decisions they make, and hormone therapy to give patients bodies that conform to their identified genders.

The clinic will serve patients who are transgender, meaning they don't identify with their birth genders, and patients whose genders are diverse or haven't been identified. Goepferd said identity questions sometimes surface in preschool years, but often emerge in adolescence when children are nearing puberty.

Delays in addressing these questions can be problematic, and some children will have better treatment options if care is initiated before puberty. Medications that delay the onset of puberty or menstruation can give children time to sort through those options, but they can't be used after children have reached those developmental phases.

"Puberty is a permanent change ... that's congruent with their assigned sex at birth," Goepferd said. "In order to undo the effects of puberty, it often involves expensive medical and surgical procedures. So if we prevent those at the outset, we'll have better physical outcomes and often better psychological outcomes."

Chika Griswold said she didn't know where to go for advice a year and a half ago, after her 13-year-old slipped a long and thoughtful letter into her and her husband's bedroom one night. The letter said that the child, born female, did not identify at the time with either gender — which is often referred to as being nonbinary or gender diverse.

"You have all of these prior notions of the path that your child is going to take, and all of a sudden that path is not the way," she said.

The internet was a dubious source as the Griswolds tried to learn more and support their child. They fortunately received a referral from a family friend who knew that Goepferd had provided gender services for children for years. But Griswold said other families will benefit from a clinic that specializes in and promotes this service.

"The fact that I don't have to try and explain myself to these medical professionals — that they have this baseline understanding of my child — it's just so great," she said.

Children's joins a dozen hospital systems in the nation that operate gender clinics for youth and their families. Hennepin County Medical Center in Minneapolis also has operated a pediatric gender health clinic for several years.

Family Tree Clinic in St. Paul responded to requests from advocacy groups in 2015 by creating a hormone therapy program, mostly for transgender and gender identity patients. They now make up 28 percent of the sexual health clinic's practice.

Family Tree leaders said they welcomed the new Children's clinic, because they already see patients from seven states and take calls from across the nation.

"Children's actually ... putting their name on it — and hopefully showing other health systems that this is something pediatricians and pediatric clinics can do — is going to have a huge impact on people across the state and region," said Nathalie Crowley, patient resources director for Family Tree.

Goepferd said the family support provided by the clinic is critical, because children often show up for care having thought about gender issues for years, while parents are just grappling with them. And parents have to OK treatment decisions of their minor children, so she said it is important to get them to agree.

"We often, for sure at initial visits, find that teens and families are at different places," the doctor said.

Griswold said her child, now 15, identifies as a transgender male. The need for sympathetic doctors became clear during an awkward appointment with a dermatologist who was unaware of the issue and made Griswold's child uncomfortable when asking him to remove his shirt for a skin check.

Griswold's child has suffered from gender dysphoria, meaning anxiety over changes in his body caused by female puberty, such as breast growth, she said. "It's hard knowing that it hurts him so much, that his body causes him that much distress, so much pain. That's when you know this is no choice thing. This is real."

Griswold's child recently started injections of the hormone testosterone to make him go through male puberty and produce masculine changes to his voice, body shape and facial hair. He switched school districts for a fresh start so that he would be perceived as male by his peers.

"We want to help him in any way possible," his mother said, "but we've got a lot to learn."

Jeremy Olson • 612-673-7744