Role of Development on Youth Decision-Making and Recovery From Gender-Affirming Surgery

Objective: With greater numbers of transgender and gender-diverse youth seeking gender-affirming medical care at pediatric health centers (Chen, Fuqua, & Eugster, 2016), it is important for pediatric psychologists to be informed about the needs of this population and the care they may be seeking. Pediatric psychologists are well suited to this role, not only with their history in the development of gender health programs but in the breadth and depth of their overall training (Cousino, Davis, Ng, & Stancin, 2014; Edwards-Leeper & Spack, 2012; Palermo et al., 2014). Method: This article uses a case study of a 15-year-old transmasculine patient seeking gender-affirming chest surgery to discuss the impact of development on his perception of his surgical result and his immediate emotional adjustment postoperatively. Results: Stage of cognitive development; the presence and stability of co-occurring behavioral health concerns; and awareness and understanding of the risks, benefits, and expected outcomes of the discussed procedure were factors identified as important to evaluate when supporting youth pursuing gender-affirming medical care. Conclusions: The goal of this publication is to offer providers factors to consider when working with transgender and gender-diverse youth seeking gender-affirming medical interventions to optimize medical and emotional outcomes. Of particular importance is educating youth in detail about the recovery process and evaluating for the expectation of idealized results. This case study also highlights the value of an interdisciplinary team, with a behavioral health provider, for optimal patient care. Implications for Impact Statement This case highlights the importance of understanding the development of adolescent decision-making, consideration of youths' ability to engage in future-oriented thinking about their expectations of gender-affirming surgical care, and robust support for youth with prior behavioral health histories.