Gender Management Service (GeMS) | Your Visit

GeMS offers consultations, assessments and care to children, teens and young adults. This process differs on the patient’s age.

For children 9 years old and younger: The GeMS-Youth (GeMS-Y) program offers consultations to gender-diverse youth and their families, a play therapy assessment with your child, discussion of specific and general gender issues in young children and assistance accessing resources in your community.

For children and teens ages 9 to 18: We offer an individualized and comprehensive psychological and medical assessment. Please note: We typically schedule the first five visits when you first call. This is meant to optimize continuity of care and is not intended to be a timeline to intervention. We require that the patient be in individual therapy, which we will help to facilitate if the child doesn’t yet have a therapist.

For young adults over age 18: The appointment process is typically shorter than our protocols for younger patients. While we don’t require you to have an individual therapist, we encourage it and can refer you to one.

Please note that mental health services provided in GeMS are for consultation and assessment purposes. Although our mental health staff provides these services and support for patients throughout care in GeMS, we are unable to provide either ongoing therapy or emergency services. We routinely provide referrals for GeMS patients and their families to community therapists for ongoing care and support. GeMS medical staff does not prescribe any psychiatric medication. If you or your child feel unsafe or in need of emergency services, please call 911 or go to the nearest emergency room for timely care.

Information about medical transition at GeMS

As part of our comprehensive gender program, we provide a variety of options for medical transition if desired by the patient. Every approach is individualized. Available treatments to reduce gender dysphoria are based on if, or how much, puberty has occurred. Some of the agents we prescribe are described in brief below. The links provided in our resource section give much more detailed information.

Puberty blockers. This is another name for a class of medications (GnRH agonists) that stop puberty from progressing. It is a commonly used approach by pediatric endocrinologists in cis-gendered children who develop abnormally early puberty, called central precocious puberty. It is important to know that this is a reversible therapy, so it is often prescribed to give children more time for exploration of gender without worry of developing a more adult-type body. We most commonly use this for children and adolescents who are in the earlier stages of puberty, but we may also prescribe this for older adolescents or young adults.

Testosterone. This is typically thought of as a “male” hormone, as it is made in high quantities in the testicles, although women also make smaller amounts of testosterone. This is the hormone that is primarily responsible for many of the differences observed between cis-men and cis-women, such as a deep voice, facial hair, broader shoulders and larger muscle mass.

Estrogen. This is typically thought of as the “female” hormone, mostly made in the ovaries. It is primarily responsible for body changes such as breast development, smoother and softer skin, and a stereotypical “hourglass” figure, which includes fat deposition in the hips and thighs.

Fertility. We strongly recommend that all of our patients discuss options for fertility preservation with their medical provider, prior to starting puberty blockers or gender-affirming hormones. Options for sperm or egg preservation will vary based on if, or how much, puberty has occurred. Our program can make appropriate referrals to urology (for birth-assigned males) or reproductive endocrinology (for birth-assigned females) to discuss options for fertility preservation.

Resources for patients and prospective patients

The following resources may help you plan for your visit.

Please note that neither Boston Children’s Hospital nor the Gender Management Service unreservedly endorses all of the information found at the external websites listed below. These links are provided as a resource.

Gender and GeMS information

Welcome Letter 
What is Gender
The Language of Gender
GeMS Resource List
MA Resource List for Parents of Trans Youth
Annotated Bibliography 
Navigating GeMS  
Mindfulness Skills Group 
Non-binary Gender Identification
Gender Unicorn
Gender Pronoun Guide

New patient self-reports

GeMS Family Self-Report Form
GeMS Self-Report for Young Adults Form 
Endocrine Questionnaire

Medical information

Safer Binding
Safer Tucking

Behavioral health

Therapist Finder Tips
Therapist Questionnaire
Guidelines for Completing Therapist Questionnaire
Name and Gender Marker Change 

Other

Suicide Awareness 
Preventing Suicide
Pediatric Endocrine Society

Upcoming events

GeMS-Y medical and mental health staff offer a focused presentation at night twice a year for parents of gender diverse youth between the ages of 3 and 11. Our medical staff will focus on puberty and how blockers work to suppress puberty. Mental health staff will address common developmental concerns that parents and gender diverse children may face. We will also review our clinic’s approach to treatment and standards of care. There will be time for general comments and questions.

If you are interested in attending the GeMS-Y Parents’ Night on March 20, 2019, please call our office at 617-355-4367.