Conforming Healthcare for Nonconforming Youth – Creating a Safe Space for Trans, LGBTQ Individuals

Access to Care for Transgender, LBGTQ Individuals Mission HealthDiversity enhances the intellectual, emotional, economic, moral and spiritual life of a community. Lucky us! With 83 percent more lesbian, gay, bisexual, transgendered and queer (LGBTQ) residents than an average American city, the Asheville area is vibrant and thrives on diversity.

But diversity isn’t always understood and its acceptance can be outweighed by social stigma, discrimination and denial of civil and human rights. Communities across the nation, including right here at home, despite our saturated area of diversity, deeply feel the impact of unacceptance when there are gaps in health and healthcare for those among the LGBTQ community.

In 2018, we posted “Pride Month – What Can We Do As a Community? [1]” which breaks down health inequity by the numbers, causes of disparities in healthcare and how communities play a role in its state of equity or inequity. Since then, a term you may have heard more about within the LGBTQ initialism is “transgender,” which is when a person whose sense of personal identity and gender does not correspond with their birth sex.

Coming off the heels of Pride Month, we remained curious about the evolution and growing need of healthcare in our community for those who identify as LGBTQ. We talked with physician and advocate, Lori Wagner, MD, Pediatric Endocrinologist at Mission Children’s Hospital, who shed light on the mental and physical hurdles that transgender and nonconforming youth face, and how individuals and community can help replace those hurdles with acceptance and support.

What are the biggest hurdles the transgender community is facing in relation to mental and physical healthcare?

Dr. Wagner: While I believe that the healthcare community is working on educating themselves about appropriate care for trans individuals, there is still a lot of room for learning. Many providers lack comfort in addressing people by their preferred name and/or pronoun. They are often not aware of care guidelines for trans individuals, both children and adults. As such, even if the provider is willing to appropriately care for every person, they may lack the knowledge to do so appropriately.

We are working to educate our team members both in the inpatient and outpatient settings on the appropriate use of names and pronouns, and of the importance of treating the patient in front of you as you would treat any other patient. I strongly urge people to read and have at least a basic understanding of World Professional Association for Transgender Health (WPATH) guidelines [2].

Likewise, we want patients and their families to feel that their healthcare needs are important, whether those needs are trans specific, such as gender affirming hormone therapy or not, such as a flu vaccine.

According to the Trevor Project, “LGB youth who come from highly rejecting families are 8.4 times as likely to have attempted suicide as LGB peers who reported no or low levels of family rejection.” What can be done to help alleviate this disparity among LGBTQ suicides?

Dr. Wagner: ACCEPTANCE! This is the key for families. These kids may not be able to control their every environment, such as school, community groups, etc. But they should feel safe, supported and accepted at home from those who love them most. This seems to be the key factor in the mental health of the kids that I see – the acceptance and support in their home environment.

Should parents address the existence of different sexual orientations with their children? How and when?

Dr. Wagner: I believe the key to raising children with healthy self-acceptance is both in modeling self-acceptance and acceptance of others. If you show a caring side for all people, including yourself as well as others who are not like you, with different backgrounds, orientations, ethnicities and understandings of the world, kids will feel included in that acceptance. That way, if there comes a time, when they question their gender identity or sexual orientation, they will know they are safe and will be nurtured through any questions that arise.

Finally, it is critical that parents keep an open mind when kids talk about issues and questions of orientation and identity. A cold shoulder or unkind word in that moment could shut the door on future conversations for years to come.

What advice do you have for allies, friends or family who would like to advocate for LGBTQ issues?

Dr. Wagner: I recommend that you start in your own community. Reach out to friends and neighbors and include everyone in local events and gatherings. I also recommend that people advocate in their school system for equal treatment of all kids by both staff and fellow students, including a child’s right to use the bathroom that they are most comfortable using as well as working to stamp out bullying behavior when it arises.

Lastly, recognize that the people around you are mostly good people trying to do the best they can on a daily basis just like you are. Lean on the things you have in common, and you will soon find yourself celebrating the differences as well.


Lori Wagner, MD, is a Pediatric Endocrinology at Mission Children’s Hospital and a 2019 recipient of the Spirit of Dr. Martin Luther King, Jr. Award. Through her work, Lori has improved care and outcomes for this often vulnerable population to create gender-affirming environments that ensure access to medical services and connect our youth with community resources. She has also helped create educational resources for staff and community members to gain a better understanding about gender identity. Learn more about Dr. Wagner [3].
Learn more about pediatric services and care with Mission Children’s Hospital at missionchildrens.org [4].

Mission Health is committed to diversity, inclusion and health equity by fostering a culture that values differences and similarities. Our standard of practice is to exist as a fair, equitable, healthy and inclusive organization that aligns with and supports our patients, our workforce and the communities that we serve. Learn more at missionhealth.org/diversity [5].