"We think adolescents are not mature enough to understand their gender. There can be no bigger myth than this."

I recently had an opportunity to interact with Pediatricians who care for adolescents on the topic of Gender Affirming Care for Adolescents at the Asian Congress on Adolescent Health in Kolkata. Here are some key messages from this deliberation.

1. There is a difference between Sex, Gender, and Sexual orientation. Transgender People are not necessarily Intersex people or vice versa.

2. We don't know the exact reasons why some humans are transgender and some are cisgender.

3. Gender Identity starts to become known to the child as early as 3 years of age. Most adolescents know about their gender identity and are not confused. 

4. Puberty Blockers / Delayers / Suppressors can help the adolescent and their family buy time to take a decision regarding further gender-affirming procedures. It can also halt puberty which is dysphoric for most transgender adolescents. It can help make further gender affirmation by stopping secondary sexual characteristics or other functions like menses.

5. There is no law in India that prevents Endocrinologists or pediatricians from prescribing Puberty blockers to adolescents when care is sought by their parents or legal guardians. Gender-affirming procedures can be done on a child with parental consent and adolescent assent. Shared decision-making should be followed.

6. Research has shown that most adolescents with transgender identities continue to identify the same years later. Also, most people who start puberty blockers or cross-hormone therapy continue with their gender-affirming care later.

7. Regret of gender-affirming care and 'reversal' is overrated and hyped.

8. Conversion therapy is unscientific, illegal, and harmful. It's counted as professional misconduct and must not be done in any case even if requested by parents.

9. Transgender adolescents need affirming General Healthcare. Ensure that all clinical encounters are caring and inclusive of transgender and non-binary folks.

10. Lastly, Humanity is Diverse. We need to embrace this diversity in all its forms and not pathologize, criminalize or be afraid of things we do not understand.