As a pediatrician, I am concerned that children who are questioning not only sexuality, but basic identity (who am I, do I have purpose, do I matter), be able to have a conversation where they can voice being uncomfortable with same sex attraction or transgender feelings without a practitioner feeling as if their sole recourse is to affirm the discomfort as inevitable. These questions and struggles are common among adolescents and require restrained listening and support for the child without channeling and promoting decisions that the child may come to renounce.

I am particularly concerned about what I perceive in our media culture as a rush to affirm gender confusion and the medical interventions that can follow when the vast majority of children with gender confusion reconcile with there natural gender by the time they approach adulthood. Adult decisions about medical therapies and surgeries to alter sexual phenotypes are serious and permanent. I would rather see a medical system that shows excessive restraint in pursuing these modalities until the child is the adult who can appropriately own the consequences.

I want to be able to affirm my patient's humanity and worth above and beyond their questions of sexuality as the former well informs the latter. The converse is never true. Trying to base an identity on sexual attractions and preference is fraught with peril as the data for depression and suicide among those who identify as LBGTQ seems to demonstrate. 

With respect.