Recognizing and Raising a Transgender Child

Transgender people make up a small percent of the population; estimates range from .6% to 3%. One reason this group is so difficult to track is due to an historic lack of support—and often outright contempt—for transgender people has made many afraid to be “out”.

In the U.S., acceptance and understanding are just beginning to gain a foothold in mainstream culture, so even parents who are supportive of their child will have a difficult time finding help and services. Below is some guidance and resources for the ages and stages of transgender children.

Early childhood

Young children are naturally fluid in their interests, play and expression; they have not yet internalized cultural expectations and pressures around gender. Little boys may play with dolls or try on their mother’s jewelry, and little girls may enjoy playing in the dirt with trucks—and none of these behaviors necessarily predict anything about their gender or sexual identity.

“The key words are consistent, insistent, and persistent,” says Danielle Weitzer, DO. “If over months, they are adopting the dress and affectations of the opposite gender, and telling their parents they are the opposite gender, parents should take them at their word.”

Most transgender people feel that they were born in the wrong body, a phenomenon known as gender dysphoria. As a result, burgeoning trans children will often reject clothing, toys and behaviors typically associated with their birth-assigned gender. One way for parents to show their support is to think of games or activities that allow the child to express themselves.

Dr. Weitzer says the best response from parents is unconditional love and acceptance. She acknowledges that parents may feel uncomfortable, embarrassed or worried but emphasizes that the child should always feel loved and supported. She adds that less than 30 percent of children with gender dysphoria continue to develop into transgender adults.

However, the more insistent the child is over a prolonged period of time, the higher the likelihood there is of gender dysphoria being a true expression of gender. Therefore it is important for parents to consider this before making any definitive conclusions.

“The parent-child bond is the foundation for a person’s sense of security and self-confidence and self-esteem,” says Dr. Weitzer. “Even if this is a phase the child grows out of, he will likely always remember how his parents reacted and whether he felt safe to explore and express his identity.”

Not feeling accepted by family is the driving cause of disproportionately high rates of depression, substance abuse, homelessness and suicide within the trans community, adds Dr. Weitzer. She points out that there will be plenty of judgment and hostility from the outside world, making a safe home life all the more essential.

Early adolescence

As a child gets older, navigating the world as a transgender person becomes more challenging. Societal pressures toward gender conformity are pronounced, and often enforced through bullying.

This is also a stage when trans children may become more certain of who they are and more likely to “come out.” This may mean living out her gender identity publicly, which can include dressing to the gender identity, changing their name and using the appropriate restroom. It is during this sensitive period of time that transgender individuals are at the greatest risk of discrimination.

“The most important step is to understand what the child wants,” says Dr. Weitzer. “This involves helping the individual feel comfortable in their home and school environments so that there is a blanket of security, which is essential to identity development.”

Assuming the child wants to publicly live out their gender identity, communication with the school is critical. Having open, honest conversations with the child’s teacher and principal can help the faculty prepare for your child’s social transition.

Ideally the school will provide a unified front in helping the child return as her authentic self. This includes setting a tone for acceptance and support, and making it clear that bullying will not be tolerated.

If the school does not provide a safe environment, it may be best to transfer to a more accepting school. However, if transferring is not an option, there may be legal protections for transgender students that parents can invoke.

Puberty and beyond

As puberty sets in, the child and parents will have to decide whether to pursue gender-confirming medical interventions. The first line of treatment is puberty suppression, which blocks hormones and the development of sex traits. Puberty suppression buys time for the adolescent to explore his identity and, should he decide to someday fully transition, the treatment prevents the body from developing sex characteristics that are difficult or impossible to reverse.

Puberty suppression is a fully reversible intervention. However, there are still criteria the child must meet before being approved. These include:

• A long-lasting and intense experience of gender dysphoria;
• Gender dysphoria that was onset or worsened by puberty;
• Social, psychological and physical stability to ensure treatment adherence;
• Informed consent by the adolescent and their parents

After a couple years of puberty suppression, transgender teens wishing to continue toward transition may begin feminizing/masculinizing hormone therapy. This treatment is only partially reversible and should be taken with full parental support.  However, some states allow teens to access hormone therapy without parental consent.

Once an adolescent is a legal adult, they can pursue gender-confirmation surgery. Given that this step is irreversible, it is required that the patient first live in their gender identity continuously for at least a year. This step is also known as “the real life test.”

Dr. Weitzer recommends the World Professional Association for Transgender Health (WPATH) Standards of Care guidebook for comprehensive details on this process.

Benefits of therapy

Even in the best scenarios, transgender children will encounter bullying, discrimination and loss of friends. Family members may well also experience negative reactions from coworkers, neighbors and extended family. In addition, parents and siblings are likely to feel a sense of loss when the boy or girl they’ve known for years says they are someone else entirely.

“Every parent has expectations and hopes for their child: a long life, a good career, a spouse or partner and possibly children,” says Dr. Weitzer. “But it’s important for parents to consider: what does my child want for her life? And how can I be supportive, even if that’s not what I imagined for them.”

Working through these experiences and feelings with a family therapist—individually and as a group—can be very helpful. When looking for a qualified psychologist or psychiatrist, Dr. Weitzer recommends looking for a qualified therapist through the Gay and Lesbian Medical Association’s provider directory or WPATH’s transgender-specific directory.

“So much of the transgender experience turns our assumptions and expectations on their head. It can be very disorienting for everyone involved,” says Dr. Weitzer. “Having a guide who can help the family prepare for the journey ahead and process their feelings along the way is indispensable.”