Trans Teen 18

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The New Girl in School: Transgender Surgery at 18
It was not easy. For days afterward, she had dry heaves. She lost weight from her already frail frame. She did not seem empowered; she seemed regressed. “I just want to hold Emma,” she said in her darkened room at the bed and breakfast in New Hope, Pa., run by the doctor who performed the surgery in a hospital nearby. Emma is her black and white cat, at home outside Syracuse, N.Y., 200 miles away. Her childlike reaction was, perhaps, not surprising. Kat, whose side-parted hair was dyed fire engine red, is just 18, and about to graduate from high school. It is a transgender moment. President Obama was hailed just for saying the word “transgender” in his State of the Union speech this year, in a list of people who should not be discriminated against. They are characters in popular TV shows. Bruce Jenner’s transition from male sex symbol to a comely female named Caitlyn has elevated him back to his public profile as a gold-medal decathlete at the 1976 Summer Olympics.
In a cozy cottage decorated with butterflies to symbolize transformation, Katherine Boone was recovering in April from the operation that had changed her, in the most intimate part of her body, from a biological male into a female.
It was not easy. She retched for days afterward. She could hardly eat. She did not seem empowered; she seemed regressed.
“I just want to hold Emma,” she said in her darkened room at the bed-and-breakfast in New Hope, Pa., run by the doctor who performed the operation in a hospital nearby. Emma is her black and white cat, at her home outside Syracuse in central New York State, 250 miles away.
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It is important to make distinctions between instances where “kids are being kids” and when they’re asserting things about themselves that are critical to their identity and development -- as is the case with gender identity and expression.
Children are not born knowing what it means to be a boy or a girl; they learn it from their parents, older children and others around them. This learning process begins early. As soon as a doctor or other healthcare provider declares – based on observing the newborn’s external sex organs – “it’s a boy” or “it’s a girl,” the world around a child begins to teach these lessons. Whether it’s the sorting of blue clothes and pink clothes, “boys’ toys” and “girls’ toys” or telling young girls they’re “pretty” and boys they’re “strong.” It continues into puberty and adulthood as social expectations of masculine and feminine expression and behavior often become more rigid. But gender does not simply exist in those binary terms; gender is more of a spectrum, with all individuals expressing and identifying with varying degrees of both masculinity and femininity. Transgender people identify along this spectrum, but also identify as a gender that is different than the one they were assigned at birth.
Gender identity and expression are central to the way we see ourselves and engage in the world around us. This is certainly true of transgender and gender-expansive children and teens, for whom family support is absolutely critical.
In fact, an increasing body of social science research reflects that gender-affirming behavior on the part of parents and other adults (teachers, grandparents, etc.) greatly improves mental health and well-being. The opposite is true---transgender children are more likely to experience anxiety, depression, and at greater risk of substance abuse and homelessness when their immediate caregivers are rejecting or hostile.

It is important to know--and quite alarming, that research finds that transgender youth are at greatest risk of suicide (compared to their non-transgender peers) as a result of rejection, bullying, and other victimization.
In other words, for some transgender youth, family support can be the difference between life and death. Parents and caregivers can find resources, peer support, and professional guidance to help along the journey, and to insure that your child can not just survive, but thrive.
At some point, nearly all children will engage in behavior associated with different genders – girls will play with trucks, boys will play with dolls, girls will hate wearing dresses and boys will insist on wearing them – and gender nonconforming behavior does not necessarily mean that a child is transgender. That said, sometimes these behaviors can clue us in to what a child may be feeling about their gender – with some children identifying as another gender than the one they were assigned by the time they are toddlers.
The general rule for determining whether a child is transgender or non-binary (rather than gender nonconforming or gender variant) is if the child is consistent, insistent, and persistent about their transgender identity. In other words, if your 4-year-old son wants to wear a dress or says he wants to be a girl once or twice, he probably is not transgender; but if your child who was assigned male at birth repeatedly insists over the course of several months--or years, that she is a girl, then she is probably transgender. Children who are gender non-binary---in other words, they do not feel that they are a boy or a girl, but perhaps a bit of both, or neither, may not have the words at a very young age to capture that feeling, but over time it may become more clear to them, and ultimately to you, that they are non-binary, versus a trans girl or a trans boy.
Naturally, there are endless variations in the ways that children express themselves, so the best option if you think your child might be transgender is to consult a gender therapist. You can find our map of gender clinics here.
Gender identity and sexual orientation are two different things. Being transgender is about an individual’s gender identity--whether they feel male, female, a little of both, or neither. Being gay, lesbian or bisexual is about an individual’s sexual orientation, which is our sexual or romantic attraction to people of the same gender, different genders, both or neither. While many children who go on to identify as lesbian, gay or bisexual express gender-expansive behaviors, whether they are transgender is about identity rather than attraction. Everyone possesses both a gender identity and a sexual orientation; in other words, a transgender person can also identify as gay, lesbian or bisexual.
Gender dysphoria is the diagnosis typically given to a person whose assigned birth gender is not the same as the one with which they identify. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the term – which recently replaced Gender Identity Disorder – “is intended to better characterize the experiences of affected children, adolescents, and adults.” To be clear, transgender identity is not a mental illness. The “disconnect” transgender people often experience is a persistent and authentic disconnect between the sex assigned to them at birth and their internal sense of who they are. This disconnect is referred to by medical professionals as “gender dysphoria” because it can cause undue pain and distress in the lives of transgender people. The diagnosis of gender dysphoria is often the gateway to having insurance coverage for gender-affirming care and to allowing trans people to live as their most authentic selves.
Sure, most children and teens go through “phases” – like only wearing all black, dying their hair, being obsessed with a certain band or asking to go by a nickname – but being transgender or non-binary is not a phase---it is a journey, and trying to dismiss it can be harmful during a time when your child most needs support and validation.
Trying to change your child’s gender identity – either by denial, punishment, reparative therapy or any other tactic – is not only ineffective; it is dangerous and can do permanent damage to your child’s mental health. So-called “reparative” or “conversion” therapies, which are typically faith-based, have been uniformly condemned as psychologically harmful by the American Psychological Association, the American Medical Association, the American Psychiatric Association, and numerous similar professional organizations.
The most recent survey of high school students by the Centers for Disease Control finds that roughly 3% of adolescents and teens identify as transgender or non-binary.
While many transgender people say that they knew they were transgender as soon as they knew what “boys” and “girls” were--as young as age 3, for many others, the journey to living openly as their affirmed gender is longer one. For some, understanding their gender identity---whether transgender or non-binary, is a more complex process that lasts into their teens or adulthood. Stigma, lack of knowledge and fear of rejection by family and peers often keep transgender people from coming out as children or teens. Sometimes a transgender person will come out as gay, lesbian, or bisexual before recognizing their gender identity or coming out as their true gender. No matter when your child comes out, knowing they have your support is critically important.
Gender Spectrum has adapted Family Acceptance Project research for parents and family members of transgender children.
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