<p><strong>OBJECTIVES: </strong>Transmasculine individuals, those assigned female sex at birth but who identify as masculine, have high rates of suicidal behavior and often suffer from chest dysphoria (discomfort and distress from unwanted breast development). Growing numbers of transmasculine youth are pursuing definitive treatment with masculinizing chest surgery (MCS), and adult studies reveal marked benefits of MCS, although little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of MCS. In this study, we aimed to explore youth experiences of chest dysphoria and the impact of MCS.</p>

<p><strong>METHODS: </strong>Transmasculine youth aged 13 to 21 were recruited from a pediatric hospital-based gender clinic. Participants completed a semistructured qualitative interview exploring the experience of chest dysphoria and thoughts about or experiences with MCS. Interview transcripts were coded by 3 investigators employing modified grounded theory, with the median interrater reliability at κ = 0.92.</p>

<p><strong>RESULTS: </strong>Subjects ( = 30) were a mean age of 17.5 years, and 47% had undergone MCS. Youth reported that chest dysphoria triggered strong negative emotions and suicidal ideation, caused a myriad of functional limitations, and was inadequately relieved by testosterone therapy alone. All post-MCS youth reported near or total resolution of chest dysphoria, lack of regret, and improved quality of life and functioning.</p>

<p><strong>CONCLUSIONS: </strong>We observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning. Additional research is needed to develop patient-reported outcome measures to assess the impact of chest dysphoria and MCS.</p>

<p>Many sexual minority youth are at higher risk for poor health outcomes because of stigma, shame, and discrimination they may face because of their identity. Professional guidelines, including the American Academy of Pediatrics' Bright Futures, encourage discussion of sexual attraction and behavior in adolescent health supervision visits so that clinicians can support healthy adolescent sexual development, assure that the health needs of youth of all sexual identities are met, and facilitate family acceptance and support of youth when needed. Although these discussions have been recommended as best practice for many years, we know that pediatricians generally spend little time addressing sexual health. In one study of audio-recorded pediatric well visits, one-third spent no time discussing sexuality or sexual health, and the average amount of time spent was only 36&nbsp;seconds. To address this gap between recommendations and practice, some pediatric providers are incorporating questions about sexuality into electronic or other previsit screening tools. In this issue of the <em>Journal of Adolescent Health</em>, Parmar et&nbsp;al. are the first to report findings from a large-scale implementation of a standardized assessment of sexual attraction at adolescent health supervision visits.</p>

<p>Sexual and reproductive health are an integral part of all youths' health and wellbeing, including youth who are transgender and gender-expansive. This article will discuss general approaches to the sexual and reproductive health care of transgender and gender-expansive youth, and review the topics of contraception and menstrual suppression, fertility preservation and family building, and the prevention and treatment of sexually transmitted infections and HIV in this population. Although transgender youth on testosterone therapy often become amenorrheic, ovulation and pregnancy can still occur, and thus all youth on testosterone therapy should be counseled on the potential for pregnancy and have access to effective contraception. Many forms of hormonal contraceptives are both safe and efficacious when used by youth on testosterone therapy. Hormonal contraceptives may also be used to provide menstrual suppression for those experiencing dysphoria from unwanted uterine bleeding. All transgender youth should receive counseling on fertility preservation and reproductive options prior to starting pubertal blockers and/or gender-affirming hormones, therapies that have varying effects on long-term fertility potential. Several different methods of fertility preservation exist, however there are numerous barriers to transgender youth receiving fertility preservation services, and rates of utilization of these services is low. Transgender individuals suffer from a disproportionate burden of HIV compared to their peers-thought to result from stigma, marginalization, and lack of access to appropriate care. All providers caring for youth should be informed about HIV pre-exposure prophylaxis (PrEP) and HIV post-exposure prophylaxis (PEP), which may help to prevent HIV acquisition.</p>