What to expect

Step 1: Call us

Parents or providers may call the Gender Health Program at 612-813-7950.

You will be asked to provide basic intake information to be placed on the waiting list.

Our clinic case coordinator will send you resources and referrals.

Our staff will call you when your child reaches the top of the waiting list and an appointment becomes available.

Step 2: Initial gender health mental health appointment

Our staff will reach out to you to schedule an intake with our team. The first intake appointment is with one of our mental health providers. The purpose of this appointment is to get to know your child and family, discuss mental health, understand your child’s gender identity and goals, and recommend supports and services. This appointment occurs 1-2 weeks before the initial medical appointment.

Initial mental health appointment includes:

• Either an in-person or virtual appointment with the patient and parent/legal guardian to gather information about gender identity, supports, goals, and mental health.
• For patients over age 10, we offer an opportunity to meet individually with the provider.
• Providing information about what to expect for the medical appointment and ongoing care with the Gender Health Program.
• Initial recommendations for mental health and gender supports, with the possibility of short-term therapy with a member of our mental health team.

Step 3: Initial gender health medical appointment

Meet with one of our gender health medical providers on our multidisciplinary team to get to know you and your goals and make a plan tailored to your journey. Education and resources will be provided at this visit.

Initial consultation includes:

• Discussing gender identity and medical history
• Possible physical exam (for puberty staging)
• For patients over age 10, we offer an opportunity to meet individually with the provider
• Education, resources and parent support
• Discussion of possible treatment options
• Planning next steps for care

Step 4: Continue care with our gender health team

Continue meeting with a gender health medical provider depending on your unique needs and goals.

Next steps, when age appropriate, could include beginning puberty blockers, menstrual suppression, and/or gender affirming hormones. It may also include referrals for voice-therapy or non-medication based interventions.

Our mental health team is able to provide short-term support and assessment. If you need longer-term therapy, we can provide referrals for gender-informed therapists outside of Children’s Minnesota.

Process for starting puberty blockers

1. Initial gender health consultation and discussion of options.
2. Child is physically ready to start treatment as determined by physical exam (puberty is Tanner stage 2) and family decides to pursue puberty
   suppression.
3. Meet with a gender health provider who prescribes puberty blockers to establish care and discuss fertility preservation.
4. Decide on which method of suppression preferred.
5. Lab studies and possible bone age X-ray.
6. Start prior authorization process for insurance coverage of treatment (can take 4–6 weeks).
7. Fertility preservation if desired.
8. Start puberty suppression.
9. Discussion near age 15/16 regarding next steps for puberty and consideration of gender-affirming hormones and/or stopping puberty suppression.

Process for starting gender-affirming hormones

1. Initial gender health intake with mental health and medical providers.
2. Letter of readiness and support from a mental health professional. Our mental health team can meet with patient and parent/legal guardian to assess readiness and provide a letter. Alternatively, if you already have a therapist outside of Children’s who has experience with gender identity and assessing readiness for hormone treatment you can request that they provide a letter. A member of our mental health team will coordinate care with your therapist.
3. Continue care with one of our gender health medical providers who will provide more in-depth information about hormone treatment and a timeline for starting.
4. Discussion of fertility preservation.
5. Lab testing and any needed follow-up to determine physical readiness for treatment.
6. Parent(s)/guardian(s) review and sign consents for treatment.
7. Prior authorization process with insurance company.
8. Appointment to learn hormone administration/shots and get prescription.
9. Ongoing care and monitoring with the gender health team.

Step 5: Begin gender-affirming medical treatments

Begin age-appropriate gender-affirming treatments when ready.

We will ensure that you have the skills and tools you need to administer certain treatments at home.

If pursuing gender-affirming hormones, a letter of support from our mental health team or a therapist outside of Children’s with experience in gender transition is required prior to starting hormones.

Step 6: Ongoing follow-up and support

You will continue to have follow-up appointments with our medical providers to monitor your treatment.

Our clinic case coordinator can provide resources along the way and connect you to our mental health team for assessment and short-term parent, individual, and family level support.

As you get older, we will help refer you to adult gender care and other appropriate services (such as surgical care).