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Factors such as religious background, sexual orientation, gender identity, family unit, and economic status all affect how children and adolescents grow by shaping their values, self-esteem, relationships, opportunities, and overall social and emotional development. Some may feel like they're struggling or feel left out because of who they are or because of their background. As a teacher it is my responsibility to make sure every students feels safe supported and included.

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Summary: 10-year-old transgender male with gender dysphoria desiring pubertal suppression and to start testosterone in the future.

Patient History: The patient is a 10-year, 10-month-old child assigned female at birth who identifies as male. He started showing interest in wearing boys clothing around first grade, and in the last two to three years has been saying that he "wants to be a boy." He now goes by his chosen name and uses he/him pronouns at school and at home, although his mom is still struggling with using these pronouns and name. He is out to his teachers and most of the kids at school, and most are supportive. The patient becomes very upset, aggressive and angry when people use the wrong name or pronoun. He has had some fights at school in these situations. Mom reports concern that the patient has been talking about hormones and surgery after doing some research on the Internet, and she worries about the permanency of these treatments. The patient started to have some pubertal changes, including breast development and pubic hair, three months ago, which has been distressing. He has not had any vaginal bleeding or discharge. The patient reports wanting a male body in the future and does not want to have breasts. He is very worried about menarche and wants to know what can be done to prevent his periods from starting.

The patient has a history of ADHD, currently treated with Concerta, Focalin and Intuniv, and also some aggressive behaviors in the past. He saw a therapist five years ago due to aggression, but has not seen a therapist regarding his gender dysphoria.

Patient Diagnosis: The patient has gender dysphoria, as his gender identity is incongruent with his sex assigned at birth, and this is causing him distress. Physical exam shows Tanner stage 2 breasts and pubic hair.

Labs/Imaging (if applicable): Laboratory evaluation showed early pubertal levels of luteinizing hormone (LH) 0.39 mIU/mL (>0.2 is consistent with puberty) and estradiol 16.3 pg/mL. A bone-age X-ray and DEXA scan were normal and consistent with chronological age. Vitamin D level was low with normal calcium.

Treatment and Discussion: Patients who are transgender have higher rates of suicide, self-harm, depression, anxiety, eating disorders, violence and bullying, family rejection and homelessness and risky sexual behaviors. Gender-affirmative care (oriented towards understanding a patient's gender experience), parental and family support of affirmed gender identity and medical interventions with puberty blockers or gender-affirming hormones can help improve many of these mental health comorbidities and health disparities.

This patient is in early puberty, confirmed clinically with Tanner stage 2 breasts and confirmed biochemically with LH and estradiol in the Tanner stage 2 range. Early puberty is the ideal time to start puberty blockers in kids with gender dysphoria to prevent any further feminizing changes from puberty, which would be permanent. If breast development is prevented with puberty blockers, this can avoid the need for chest reconstruction surgery in the future. Puberty blockers are reversible, and endogenous puberty will return if treatment is discontinued. Our recommendation is to use puberty blockers alone for a maximum of four years because of concern for negative effects on bone mineral density if continued for longer. DEXA scan, vitamin D and calcium levels are assessed at baseline and monitored throughout treatment. For patients who have started puberty blockers and choose to pursue gender-affirming hormones, these are typically started at age 13.5 to 14 years, with the goal of puberty occurring at a peer-congruent time. Some patients may choose not to pursue gender-affirming hormones, and puberty blockers can be discontinued and natal puberty will resume.

If the patient were older and in later stages of puberty (Tanner 4/5) and >2 years post-menarche, puberty blockers might not be the best option for the patient, as there would be little further development of breast tissue to prevent and the risk of side effects (hot flashes, mood swings) increases with blocking higher levels of endogenous hormones that occur in later puberty. For these patients, we discuss options for menstrual suppression while preparing to start testosterone. Any hormonal contraceptive option that one may choose for menstrual suppression in a cisgender (non-transgender) individual would also be an option for a transgender individual. Common medications used in our clinic for this purpose include continuous OCPs, norethindrone, Depo-Provera injections, and LARCs including Mirena IUD and Nexplanon. These may be continued for menstrual suppression while the patient is beginning testosterone and then discontinued once testosterone is at a therapeutic level to suppress menses, or it can be continued for contraceptive purposes.

Outcome: The patient and his mother had four appointments with our gender clinic psychologist. Mom began using the patient's chosen name, which decreased conflict between them. Patient and mom decided to move forward with puberty blockers, as mom realized how distressing a female puberty would be for the patient and she would like to stop this from happening and allow further time to explore gender with a mental health provider. The patient started Lupron 22.5 mg every 3 months, and puberty stalled based on clinical exam. He also had some regression in the breast buds that had developed. The patient is now engaged in weekly therapy and hopes to start testosterone when he turns 14 years old.

References:
Seattle Children's Gender Clinic Website: https://www.seattlechildrens.org/clinics/gender-clinic/
Endocrine Society Guidelines: Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. https://academic.oup.com/jcem/article/102/11/3869/4157558

UCSF Center of Excellence for Transgender Health: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at www.transhealth.ucsf.edu/guidelines

AAP Policy Statement: Rafferty J, AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics. 2018;142(4):e20182162. https://pediatrics.aappublications.org/content/142/4/e20182162

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Case Study on Transgender Youth: Juanita Hodax, MD, and Catherine Sume

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7.3.19 | Patients who are transgender have higher rates of suicide, self-harm, depression, anxiety, eating disorders, violence and bullying, family rejection and homelessness and risky sexual behaviors.

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Implicit biases are automatic judgments we make about people without thinking like assuming that a woman isn't good at math or that a young black man is dangerous even if it isn't meant that way. These hidden biases can affect the way we act towards each other without us noticing. It is imperative that we are aware of them so we can treat people the way they deserve to be treated.

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Framework for Developing Cultural Competence 

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Framework for Developing Cultural Competence 

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A framework for developing cultural competence should include valuing diversity, doing regular self-assessments, managing differences, being willing to learn about other cultures, and adapting to the needs of the community because these efforts help teachers understand and respect all students, build better relationships, and create a safe and welcoming environment where all can succeed.

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Cultural competence is the ability to understand, respect and work well with people from different backgrounds. For example, a teacher who is culturally competent might celebrate different holidays in class or learn about their students traditions. Being culturally competent helps create a welcoming environment where everyone feels accepted and valued.

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The Importance of Cultural Competence in Helping Others

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Anthropology document from Grand Canyon University, 2 pages, Alexis Rahne Assignment 2 Basic Interviewing and Helping Skills February 21, 2019 1 Cultural Competence Cultural awareness and compentence are key compenants of being a successful helper because it allows you to be knowledgable and conscious to the situat

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Implicit bias refers to attitudes that affect our understanding, actions, and decisions in an unconscious manner. These attitudes can be either positive

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My implicit biases could make me unintentionally treat students differently. I might expect more from certain students while expecting less from others because how they talk or act. This could hurt the student's chances to do their best. In order for me to be a better teacher I need to notice my biases and treat all my students fairly and with respect.

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Addressing implicit bias in the classroom

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Teacher's Bias: Assumes boys are better at taking the lead in group projects

Decision because of that bias: Teacher give boys more leadership roles and less encouragement to the girls

Result: The girls may lose confidence, and the boys may become more confident which perpetuates the existing stereotype

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Cultural awareness means being sensitive to the differences and similarities between two cultures when communicating or interacting with members of other cultural groups. Cultural sensitivity involves inculcating values, attitudes, and knowledge that display openness and respect for different cultures, religions, languages, manner of dress, and communication styles.

Although language plays a significant role in developing cultural awareness, being fluent in a foreign language doesn't mean that you're culturally aware, as there are nuances and a wide range of contextual meanings for words that native speakers use, which you can't learn from books alone.

Culture is a broad term that refers to the social behaviour, customs, and beliefs of a particular group or society, which develop over time.

Cultural awareness is often used interchangeably with other terms, such as 'cultural safety' and 'cultural competence.' The following definitions will help you understand the meaning of each term. Practical knowledge of these terms will facilitate effective, appropriate, and safe communication with people of different cultures.
If you are interested in our Indigenous Cultural Awareness Training, you can learn more at this link.
A Detailed Definition Of Cultural Awareness

Cultural awareness involves raising people's understanding of the influence our culture has on how we do things , including how we communicate, what foods we eat, or even how we go about our work. Being culturally aware means understanding diversity why cultural diversity is important and recognising that not every person will do things in the same manner as we do. Being mindful of this allows us to be more respectful of the way others operate based on their cultural backgrounds. While you may not be intimately familiar with other cultures, if you at least understand your own culture and how it affects you, you can take the first step in developing a sense of cultural awareness when it comes to interacting with people who may have a different background than yourself.

Cultural awareness helps you understand yourself better, your weaknesses, your psychology, and how to become a better person. It also helps with cognitive flexibility, problem-solving, decision - making, and improved communication skills.

In the professional world, many people, including medical staff, diplomats, teachers, and business professionals, find that being culturally aware has a positive influence on their ability to perform their duties.

Essentially, any person with some form of cultural understanding will benefit because cultural awareness is all about helping people get along without misunderstandings, confusion, or poor decisions getting in the way. So, why is cultural awareness important? If you're interested to learn more about why cultural awareness is so important, we go in - depth on the topic in the article linked above.

Understanding Cultural Safety

Cultural safety refers to an environment that is safe for all people. An environment where there's no denial of or challenge to their identity or to who they are. It is a space that embraces the differences between people and allows for a shared experience of respect, acknowledgement, and understanding. A culturally safe environment allows people from different cultures to come together to work with dignity.

However, the concepts of cultural safety and cultural awareness, while related, differ significantly. Being culturally aware refers to the initial point of creating a better understanding of other people's perspectives so that you're culturally mindful.

Cultural safety encompasses the actions that nurture, respect, and acknowledge the unique cultural identity of another individual to safely meet their needs, expectations, and rights. This involves working from the point of view of the other person, not only from your own.

Embracing Cultural Competence

Cultural competence is the understanding that a person's perspective is shaped by complex personal experiences and their cultural background. It also involves the awareness of your own cultural assumptions when communicating in cross-cultural contexts.

Intercultural competence is comprised of four key components, (knowledge, attitude, awareness, and interpersonal skills). There are also three capabilities, (conflict management, relationship building, and intercultural teamwork), and two supporting skills, (emotional intelligence and critical reflection) that apply across different domains, such as professional, private, and academic, when it comes to cultural competence.

Being culturally aware is the starting point to ultimately reach such levels of competence, where you can fluidly interact with people from different backgrounds and cultures without an issue.

How Do You Become More Culturally Aware Through Training ?

Cross-cultural communication can be prone to misunderstandings on both ends. But that issue can be avoided by considering other people's cultures when interacting and working with them.

While we may prefer not to admit to doing so, most of us have had the experience of forming stereotypes about someone based on our own set of beliefs or preconceived ideas, rather than actually experiencing the person for who they truly are. Uncovering those stereotypes and recognising any explicit or unconscious bias is the key to becoming more culturally aware.

Being culturally aware develops your interpersonal skills, making you more sensitive to other people's emotions. It allows you to improve your interactions and communication with others. Getting to know your colleagues and finding common ground is essential to do this. This process of developing cultural awareness is even more critical today, in the age of digital communication channels, where we often don't interact with others in a face - to - face manner.

Final Thoughts on Cultural Sensitivity and Awareness

Today, communicating and interacting with global communities has become a part of our daily lives, making cultural awareness a valuable skill that can help you advance both your professional and personal relationships.

By comprehending the differences, as well as the similarities in beliefs, ethics, attitudes, and values of people and developing our own sense of cultural awareness, we can create a culturally safe environment where every individual can feel like they belong.

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What is Cultural Awareness? The Importance of Becoming Culturally Sensitive and Aware | Evolve Communities Pty Ltd

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Cultural awareness means being sensitive to the differences and similarities between two cultures when communicating or interacting.

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Teacher's Bias: A teacher assumes a student from a low-income background struggle

more academically.

Decision because of that bias: The teacher might give them less challenging work thinking they can't handle difficult tasks.

Result: The student therefore isn't challenged which then causes them to under preform as a result

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Impact of Implicit Bias on Teacher Perceptions

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Impact of Implicit Bias on Teacher Perceptions

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Implicit bias can affect teacher's perceptions by leading them to have lower expectations or misinterpret behaviors and family involvement based on unconscious stereotypes which can affect students academic performance, relationships, and opportunities.

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Joan J. Martínez Postdoctoral Scholar, Haas School of Business, University of California, Berkeley

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Gender stereotypes in the classroom affect gender inequality later in life

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Stereotyped assessments by teachers exacerbate gender disparities in educational outcomes for high school students in Peru. New evidence shows that these negative impacts persist years later in labour market gender gaps.

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Cultural awareness, sometimes referred to as cultural sensitivity, is defined by the NCCC (National Center for Cultural Competence) as being cognizant, observant, and conscious of the similarities and differences among and between cultural groups.

Becoming more culturally aware is a continual process and it can help to have curiosity, an open mind, a willingness to ask questions, a desire to learn about the differences that exist between cultures, and an openness to becoming conscious of one's own culturally shaped values, beliefs, perceptions, and biases.

The Value of Cultural Awareness

Read on to learn more about cultural awareness, including the impacts it can have, how to become more culturally aware, how to approach conversations about cultural awareness, and how to address cultural awareness in intercultural relationships.

The Importance of Cultural Awareness

Cultural awareness involves learning about cultures that are different from your own. But it's also about being respectful about these differences, says Natalie Page Ed.D., chief diversity officer at Saint Xavier University in Chicago. "It's about being sensitive to the similarities and differences that can exist between different cultures and using this sensitivity to effectively communicate without prejudice and racism," she explains.

5 Reasons Why Cultural Awareness Is Important

How to Be More Culturally Aware

Knowing about the importance of being more culturally aware is one thing, but actually taking steps to do so is something else.

Here are a few tips for how to go about becoming more culturally aware.

Understand That It's a Process

"Becoming culturally aware is a process that is fluid, birthed out of a desire to learn more about other cultures," says Dr. Page.

She says it can be helpful to study the model laid out by Dr. Ibram Kendi, the author of How To Be An Antiracist. Dr. Kendi says that there are basically three paths to growing cultural awareness:

"The first is moving from the fear zone, where you are afraid and would rather stay in your own culture comfort zone," Dr. Page describes.

Next is moving into the learning zone, where you strive to learn about different cultures, how people acquire their cultures, and culture's important role in personal identities, practices, and mental and physical health of individuals and communities. The learning zone can also include becoming more aware of your own culturally shaped values, beliefs, and biases and how they impact the way you see yourself and others.

"The last phase is the growth zone, where you grow in racial advocacy and allyship," says Dr. Page.

Ask Questions

Dr. White says that asking questions is a vital part of becoming more culturally aware. You can start by asking yourself some important questions, such as: "How is my culture affecting how I interact with and perceive others?" Dr. White suggests.

Educate Yourself and Do the Work

There's no way around it: if you want to become more culturally aware, you need to take action and educate yourself.

"Don't lean on assumptions," says Dr. White. "Actually research cultures different from yours." This can help you become more aware of how culture affects every aspect of your life and the lives of others. In addition to research, educating yourself often involves seeking and participating in meaningful interactions with people of differing cultural backgrounds. "Expand your network to include people from different cultures into your circle," Dr. White recommends.

Study the Cultural Competence Continuum Model

The Cultural Competence Continuum Model is an assessment tool that helps us understand where people are on their journey to becoming more culturally competent.

Different people fall into various categories along the continuum. Categories include cultural destructiveness, cultural incapacity, cultural blindness, cultural pre-competence, cultural competence, and cultural proficiency.

Studying this model can help us become more aware of the process of moving toward more cultural sensitivity, and become more patient with ourselves and others as we move through the process.

Acknowledge Your Own Bias

We all have our own biases when it comes to cultural awareness, because we all begin by looking at the world and at others through our own cultural lens.

It is important to acknowledge this as it can help us see how our cultural biases may prevent us from being as culturally sensitive as we wish to be.

What If I Say the Wrong Thing?

Often, people don't want to address topics having to do with culture or race because they are afraid they will say the wrong thing or make a mistake while talking to someone.

"If you make a mistake, simply apologize and let the person that you may have offended know that you are learning and be open to any suggestions they may have," she recommends. Sometimes it even makes sense to apologize in advance, if you are saying something you are unsure of. You can say, "I may have this wrong, so I apologize beforehand but..." Dr. Page suggests. "The key is to be sincere in your conversations and always open to learning from others," she says.

Making mistakes is a necessary part of the learning process and it is important to approach these topics and conversations with shared respect, compassion, and grace.

Cultural Awareness and Sensitivity in Intercultural/Interracial Relationships

If you are in a relationship with someone who is of a different race or culture than you, it's important to have open, honest discussions about this. "If a person is going to grow in interracial and intercultural relationships, you have to step out of your cultural comfort zone and seek an understanding about other cultures," says Dr. Page.

Questions to Ask Someone to Learn About Their Culture

Having a genuine discussion with someone about your differences can feel awkward, and it can be helpful to kick-start the conversation with a few open-ended questions. Dr. White shared some helpful questions:

Can you tell me about your culture?

Tell me a little something about how you were raised?

What role does religion play in your life?

Here are some additional questions that could be asked with respect and consent, to another (and also to yourself!):

What holidays and celebrations are important in your culture?

What customs and etiquette are important in your culture?

What is your favorite food in your culture?

Is religion an important part of life in your culture? If so, what religion do people practice most often and why do you think that is?

How do you express your cultural identity?

What stereotypes or misconceptions do people from your culture often face and what do you wish more people knew?

Is there anything about your culture that you find challenging?

How has your culture changed over time?

How do you think your culture has influenced your personal values and beliefs?

What is the importance of family in your culture?

Can I Ask Someone to Help Me Learn About Their Culture?

One of the important ways to develop culture awareness is to educate yourself about other cultures. Learning directly from people of different cultures is a fantastic way to get authentic information. But it's important to engage in conversations with others about their cultures in respectful, appropriate manners.

Finally, make sure to take it upon yourself to do some of the work. "Once you learn of someone's culture you wish to cultivate a relationship with, do your homework to learn as much as you can," Dr. White says. Don't simply rely on others to educate you-this may be seen as insensitive, Dr. White says.

Pitfalls of Not Developing Cultural Awareness

The main pitfalls of not developing cultural awareness is that we don't expand our understanding of other cultures, we don't deepen our relationship with people who are different than we are, and that we risk continuing to have a narrow view of the world around us.

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How Cultural Awareness Can Improve Your Relationships

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Cultural awareness is the understanding of other people's cultural identities and values and how their culture informs their life.

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A new study finds evidence that teachers’ implicit bias may lead to unequal student outcomes.