Transgender youth: A parents’ guide to helping their child transition
Since a very young age your son has played dress-up in his sister’s clothes. He always preferred playing with girls over boys and has repeatedly told you that he wants to be a girl. Lately, he’s begun insisting that he is a girl. What is going on? Your son may have gender dysphoria.
Gender dysphoria is broadly defined as a conflict between a person’s gender identity and their sex or anatomy assigned at birth.
“Gender dysphoria is emotional turmoil that transgender people feel,” says Dr. Laura Arrowsmith, DO, who runs a transgender clinic in Oklahoma City. “They’re living in a body that doesn’t match how they view themselves.”
Not every transgender person feels the dysphoria, says Dr. Arrowsmith, but younger children who are coming out as transgender face an uphill battle because their parents typically don’t understand what gender identity is.
“A lot of parents will say ‘Oh, it’s just a phase and he or she will grow out of it,’ ” says Dr. Arrowsmith. “And some kids do. We know some kids who initially come out as trans, then later will identify as gay or lesbian or none of the above.”
The research on transgender youth and adults shows much higher rates of homelessness, substance abuse, HIV infection, depression, anxiety, self-harm and thoughts of suicide than in the general population. Rejection by family and community are considered the main catalysts for these issues.
Family acceptance has been shown to play a key role in determining the mental health, substance abuse and sexual risk-taking of transgender adolescents and young adults. A 2010 study in the Journal of Child and Adolescent Psychiatric Nursing found that family acceptance of lesbian, gay, bisexual and transgender (LGBT) individuals in adolescence predicted “greater self-esteem, social support and general health status” in young adulthood. It also protected against depression, substance abuse and suicidal thoughts and behaviors.
A second study, published last year in the journal Pediatrics, provides evidence that socially transitioned children, or those who have adopted the name, hairstyle, clothing and pronoun associated with their affirmed, rather than birth gender, had similar levels of depression to non-transgender peers and had only marginally higher anxiety symptoms.
The research shows that children who are encouraged to be who they are and are loved unconditionally are significantly happier and healthier than those who do not have such support.
“Parents have a significant role in raising transgender kids,” says Dr. Arrowsmith. “Parents have a very tough time having to learn to accept this and give their kids unconditional love, but once they get on board—after stages of denial, rejection, condemnation and grief—they become advocates for them at school and with extended family. This is crucial to the child’s well-being.”
Social transition is also a completely reversible intervention that allows a child to get comfortable in his or her desired gender role and see if it’s the right fit.
Family acceptance has been shown to play a key role in determining the mental health, substance abuse and sexual risk-taking of transgender adolescents and young adults.
‘Persistence, insistence and consistence’
The clinical protocol for children indicates that when a child who has socially transitioned is “consistently” and “persistently insisting” that they are transgender, they may be placed on puberty-blocking medications.
These medications prevent the child from developing the secondary sex characteristics of their birth gender, such as breasts for females or facial hair for males. Stopping the onset of puberty is reversible and makes medical treatment simpler if the patient decides to fully transition. Adolescents typically stay on the puberty-blocking medications from one to three years, allowing them more time to mature and make sure the path they are on is the right one for them.
“We do know that if a child persists through puberty in identifying as the sex not assigned to them at birth, then it’s pretty certain that they are transgender,” says Dr. Arrowsmith.
Should they decide to change course and get off of the puberty-blocking medications, they will simply go through a delayed puberty of their birth gender.
If they decide to stay the course and continue transitioning, the next step would be hormone therapy. Females transitioning to males take testosterone while males transitioning to females take estrogen with an androgen inhibitor. Hormone therapy, unlike social transitioning and puberty suppression, is only partially reversible.
“If I’m treating a teenager who, for example, was born in a male body and is transitioning to female, I would make sure they know the consequences,” says Dr. Arrowsmith. “If they decide to stop the hormone therapy, they would not be able to reverse the growth of breast tissue without surgery and they would probably not be able to reproduce. Females who are transitioning to male would likely not be able to reverse masculinization of the face and enlargement of their clitoris.”
What parents can do
Parents first need to educate themselves on gender dysphoria, gender identity and the complexities of living transgender. “Then watch the child for eating disorders, self-harm, substance abuse and suicidal tendencies,” says Dr. Arrowsmith. “It is very important to find a mental health counselor who is familiar with transgender people and then to find support groups.”
Oftentimes, support groups are the turning point for families who are struggling with accepting their transgender children, says Dr. Arrowsmith. Once they meet other parents and see children who have transitioned, they become more comfortable.
One of the misconceptions over gender identity is that it is connected to sexual orientation, but the two concepts are separate and distinct.
“I wish people would understand that being transgender has nothing to do with sexual orientation,” says Dr. Arrowsmith, who transitioned from male to female as an adult. “Gender identity and sexual orientation are two completely separate things. This has nothing to do with whom I’m attracted to. This has to do with who I am, and it’s not a choice.”