Lesbian, gay, bisexual and transgendered youth
While doing outreach on the Bridge Over Troubled Waters medical van on a freezing January night, I met a timid looking 14-year-old girl whose cheeks were bright red from the cold. She told me she’d arrived in Boston by bus from her home in a small town in Maine and had no place to go, having been asked to leave her home the night before because she was a lesbian. When we reached out to her family, they told us they didn’t have a daughter anymore.
That was in 1983. But this type of situation continues to play out in our city and across the country on a regular basis. Youth are thrown out of their homes for various reasons, but the largest population is one that either "comes out" to their parents or is found out to be gay, lesbian bisexual or transgender (GLBT). Not all youth who identify as GLBT are thrown out of their homes, but many struggle with their feelings of difference and marginalization. And research shows a clear link between young GLBT youth who experience family rejection and negative health outcomes, including substance use and abuse, sexual risk-taking, depression and suicide.
This is what motivated me early in my career at Children’s Hospital Boston to work with at-risk youth, including gay or lesbian teens and those questioning their sexual identity. My role has evolved significantly in my almost 30 years at Children’s, and I see patients from all backgrounds who come in for primary and urgent care. When youth have questions about their sexuality, I reassure them that homosexuality is not an illness or disorder, but a form of normal sexual expression. When they are ready to come out, I connect them with resources. If parents wonder how they "failed," I educate and refer them to Parents and Friend of Lesbians and Gays. Often, I help GLBT teens who suffer from internalized homophobia, which can lead to feelings of self-loathing and decreased self-esteem. As a gay man who grew up in the 1970s in the suburbs of Boston, I remember what it was like dealing with feeling different and being told—even by family members—that gay and lesbian people are freaks. I saw how people treated young men who acted effeminate in high school and I did my best to avoid being labeled. Like many closeted youth, I lived a life of secrecy, never revealing my true feelings of same-sex attraction. The risks of rejection and ostracism were way too
After leaving the suburbs for college, I was slowly able to be more honest with myself and others. I remember coming out to a friend at an Elton John concert and the reaction was, "Big deal, you’re still who you always were." It was then that I realized that who you are as a sexual being is just one aspect of who you are as a person. Of course, others don’t always see it that way, and I’ve had friends who have rejected me because of who I am. But I’ve found that this simple idea is educational for many who fear and have bias toward GLBT people. Once someone learns about all that a person has to offer in addition to his sexuality, the less there is to fear.
Although attitudes have improved somewhat over the years, there still remains a lot of fear and anger. I’ve lectured extensively around the country to professionals, parents, teens and religious groups and have heard similar messages of prejudice. Some stereotypes persist—we are all pedophiles, we recruit children into a gay lifestyle and we’re destroying the fabric of our society. Many people still think that you choose to be homosexual and they question the need to come out. Often, I’ll hear, "But why do they have talk about it?" People still think that gay men and lesbians look and act differently than straight people. If you pay attention to the media, read the paper or go online, you see this on a daily basis. This is what our youth see, hear and internalize.
Slowly, our country is learning to accept GLBT people. There are now high school gay-straight alliances, youth support groups and organizations for parents. And, of course, Massachusetts was the first state to legalize marriage between partners of the same sex. My husband and I were one of the first couples to be issued a marriage license—at 3:45 a.m. on May 14, 2004—at Cambridge City Hall. I’ve been fortunate to work at Children’s, which is committed to serving GLBT youth. We’re a national leader in training adolescent providers to understand the issues of GLBT youth. We help develop a street outreach program and we’ve been instrumental in getting condom machines in homeless shelters and in downtown churches. Children’s was recently recognized by the Boston Alliance of Gay, Lesbian Youth for its work with local youth.
As a clinician, I want to promote a healthful lifestyle. This includes educating people about wearing seatbelts, eating well, exercising and being happy as the sexual people they are. One of my favorite quotes is from the famous psychologist Erick Erickson. "Some day, maybe, there will exist a well-informed, well-considered and yet fervent public conviction that the most deadly of all possible sins is the mutilation of a child’s spirit." This commitment to protect children is what I continue to strive for every day.
-Maurice Melchiono, RN, MS, CFNP
Dear Dr. Spack,
I appreciate that you are addressing issues of transgender children and want to share my perspective as an adult transgender woman. I had struggled with shame, deep depression and thoughts of suicide for most of my life because of my gender conflict — which I have been aware of since my earliest thoughts.
It was only much later that I was able to resolve this debilitating issue. I followed the standards of care and have fully transitioned from male to female. Today, I am free from that tension which would indeed have driven me to end my life; I could not live otherwise. Even if I had I lived in shame and fear and with a deep unhappiness, my condition was to the point where I had no quality of life, no joy in life.
It would have been so much better to have had the resources like the ones you are making available for young people and their parents. I believe it would have saved me so much pain and distress. I know there are those who are critical of your efforts to help young transgender people. People like us, and especially the young ones who struggle through childhood and puberty with such hurt, really need that care.