Transgender Children

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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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All individuals are valid and deserve to receive support from their families and communities, regardless of gender. If your child has come out as transgender or is questioning their gender identity, you may be wondering what your role as their parent should be during this process. One of the most important things to remember is that your child’s gender identity and exploration are their own. Providing support for your child is incredibly important, but it’s necessary to remember that this is their unique journey. Their journey may be different from what you had envisioned for your child.
J. Flowers Health Institute is here to guide you through the delicate process of adolescent evaluations and finding the health resources your transgender child needs. This article is an overview of transgender issues and explores how to support a transgender child.
What Does it Mean to be Transgender?
Transgender individuals identify as a gender other than the one they were assigned at birth. Identifying as transgender doesn’t always mean transitioning from one gender to the other. Your child’s gender identity (how they view their gender and why) can exist on a spectrum. Those whose gender is strictly male or female identify most likely as binary, meaning their gender is strictly on one end of the spectrum. Those who identity as the gender they were assigned at birth are cisgender.
Gender dysphoria is a valid struggle faced by many individuals who are transgender. The American Psychiatric Association defines it as “a conflict between a person's physical or assigned gender and the gender with which he/she/they identify… sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender.” If your child is experiencing gender dysphoria, you can take on a supportive role by finding helpful resources, such as a therapist who specializes in gender exploration.1
Just as people can experience gender dysphoria at any age, they can also realize they’re transgender at any age. Individuals who come out as transgender later in life are just as valid as those who realize their identity earlier. In the same way, if someone comes out in their teens or even younger, they should be embraced for who they are and accepted regardless of their age. Age does not validate or invalidate gender identity realization. Being transgender is not a phase and gender identity is not a choice. If your child has come out and you’re feeling confused or uncertain about your feelings, it is extremely important to know their journey is unique and it’s okay for them to be constantly evolving.
What are the Urgent Health Risks Facing Transgender Children?
Many transphobic people will ignorantly cite mental health struggles as a side effect of transgenderism. While people who are transgender have higher rates of mental illness, this is because of the way they are treated by society and not because of their gender identity. Transgenderism does not innately mean more struggles or pain than cisgender identity does.
Depression is one of the most common mental illnesses in the transgender community. Young people who are transgender are four times more likely to live with depression than their cisgender friends. Transgender youth are also more at risk to attempt suicide, as one in five struggle with this.2
Self-harm can result because of a variety of struggles, with 42% of transgender youth engaging at some point.3 This is can be correlated to gender dysphoria or trying to gain control over situations in which they feel unaccepted or unsafe.
Some young people who are transgender find themselves homeless, many of which have been rejected by unaccepting families. 58% of the gay and transgender youths who are homeless have been sexually assaulted. That number is heartbreaking and points to the need for parents to support their transgender children and become allies.4 Unfortunately, physical danger exists even if homelessness is not in the equation. One survey found that 9% of transgender people included had been physically assaulted within the past year.5
If you’re a parent who’s feeling scared about these statistics, it’s completely natural to worry for your child. However, it is not an excuse to invalidate their identity or force them to present as their gender assigned at birth. Mental health is just as important as physical health. Take time to talk with your child about ways that they can be safe in public.
How Can I Support My Transgender Child?
One of the most important parts of being an ally is confidentiality. If your child doesn’t want to publicly come out, that’s their choice. Nobody has the right to know anything your child doesn’t want them to.
It’s okay if you don’t know the correct terms or if you have questions. What’s not okay is intentional ignorance, shaming, or using unpreferred names/pronouns. It may take time to get used to calling your child by another name, but it’s important to show you’re making an effort. By using your child’s preferred name and pronouns, you’re showing them that you take their gender exploration seriously.
If your child has come out to others in the family, foster open, honest conversations to discuss feelings and answer questions. It’s okay to be honest, but there should never be guilt or shame attached. For instance, honesty is saying, “I’m having trouble remembering to use your correct name, but I’m going to keep trying.” Shame and guilt look like, “It would be so much easier for all of us if you would just use your old name.” You can be open with your feelings and emotions without placing them on your child. If you feel the need to discuss your child’s transgenderism further, it may be best to begin therapy or talk to a professional that will be able to listen.
This Material Explores Sensitive Topics
The following section discusses medical interventions for both younger children and young adults. These topics may upset the reader. Please feel free to skip to the next section if these topics make you uncomfortable. Talk to your family doctor or contact the medical team at J. Flowers Health to discuss all topics relating to gender identity.
What Do I Need to Know About Medical Interventions?
While some people who are transgender medically transition, others choose not to. Transgender identity without surgery or hormones is just as valid medical options. If your child is a minor, you will need to be involved in their medical decisions and you must stay updated and educate yourself about the many possibilities available.
Reversible Treatment for Younger Children
Puberty blockers “work by blocking the hormones – testosterone and estrogen – that lead to puberty-related changes in your body.”6 While your doctor can tell you about the specific effects this could have, it is a method that has had proven results and can greatly help gender dysphoria. Temporary puberty blockers are available, which are taken periodically to pause further changes. Once stopped, the body will produce the hormones which have been suppressed.
Partially Reversible Treatment for Older Teenagers or Young Adults
Estrogen and testosterone therapy are incredibly popular within the transgender community. Many may think that these therapies are a quick or all-inclusive option, but there is a lot of variety within them. For instance, some may choose to go on an incredibly low dose and may only experience one or two changes because of this. Even if your child chooses a higher dose, the effects will not be immediate and it may take months, or even years, to see the desired results.
Permanent Surgical Procedures for Young Adults
Transgender surgery modifies the body to add or remove the characteristics chosen by the individual and their surgeon. This can be one of the fastest ways to see results but can also require a thorough vetting process. If your child is experiencing extreme gender dysphoria, surgery could provide relief.
Some transgender surgeries or hormone therapies will require your child to undergo counseling before they begin. This can be incredibly beneficial for their overall wellbeing while providing the peace of mind that comes from knowing a mental health professional is involved.
How Can I be a Public Ally for My Child?
If you have friends and family that are transphobic, your child’s safety and wellbeing must come first. While you may not choose to completely cut off these people, be mindful of what information you share with them. While you have the choice to keep these people in your life, your child has the same choice. If they choose to remove them from their close circle, you must respect this and understand they are choosing to protect themselves.
Your child matters more than strangers, or even close friends. Protecting your child in all environments is your highest priority. If someone misgenders your child, it’s not rude to correct them. If your child prefers, you can politely and firmly tell them how your child prefers to be identified. It is important for all transgender children to see supportive parents do exist and there are adults who validate and care about their identities.
What are the Biggest Transgender Issues Talked About in Public?
Within the past few decades, transgender issues have become more prevalent and frequently discussed in political and athletic circles. Bathroom bans are laws that force transgender people to use the bathroom that aligns with the gender they were assigned at birth.7 There have been no reported cases of transgender individuals harming others in bathrooms matching their gender, and using bathrooms that don’t match their gender are very dangerous for your child. Transgender women forced to used male bathrooms have a higher risk of physical and sexual assault. Transgender males forced to use female bathrooms experience distressing confrontations.
Controversy has also arisen in sports, with some questioning if transgender athletes should compete as their identifying gender or their gender assigned at birth. Different organizations and groups have varying opinions about this issue. Transgender athletes should be allowed to compete in sports, so if an issue has arisen at
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