Matthew Oransky, PhD, Director, Psychology Training Program, Mount Sinai Adolescent Health Center, Assistant Professor of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai

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Growing up transgender without strong parental support can be difficult, even life-threatening. Compared with their peers, transgender youth suffer higher rates of depression, suicide, substance abuse and homelessness. Keep in mind that being transgender is not something parents can cause, or change. But parents can play a major role in keeping their transgender children healthy and safe. And the newest research shows that family acceptance significantly protects them against such risks into adulthood.

The Transgender Experience

Most transgender people are diagnosed with “gender dysphoria,” the distress that comes from the mismatch between their true gender and their sex assigned at birth. The amount of distress varies a lot from person to person and can also vary over the course of a person’s lifetime. However, we do know that transitioning can make this stress go away.

Embracing a child’s true gender identity involves helping them transition both socially and medically. Each transgender person’s journey is unique and can pose different issues at different ages.

Social Transition

Social transition may include changing one’s mode of dress and hairstyle, choosing a new name, and using the correct pronouns. These social changes are reversible and might be all a child needs to thrive.

A recent study found that on average, transgender youth recognized their gender incongruity when they were eight years old. And if parents ignore these concerns, they risk their kids feeling isolated or rejected, which can lead to a cascade of more serious problems. Here are some ways to show support:

· Seek professional advice if your child is showing signs of distress, to guide your family through this complicated process. An occasional check-in may suffice, or the provider may recommend returning when the child reaches a certain age.

· When young children, around age five, are gender-nonconforming, just let them be who they are. Allow them to dress and act as they prefer so they feel validated and supported.

· Don’t force labels or interpretations on your child. For instance, don’t tell a child she is just a “tomboy” or ask them if they are transgender. Let them define themselves.

· Help your child find a supportive community of other gender-nonconforming kids.

· If your child wants to make a transition in how they dress and are addressed, help them decide where they want to take this step—just with family and friends or also at school, religious institutions, and community programs.

· Work with these people and organizations to ensure they use the correct name and pronouns, allow your child to dress accordingly, and, in general, treat them appropriately for their gender identity.

· Balance validating your child with keeping him or her safe. In some communities, a young person or the whole family could be ridiculed or rejected. Contact the elementary school principal, high school guidance counselor, dean, or a supportive teacher to get a read on the school culture, and to determine how the school will react and what they can do to support your child’s transition.

· Be aware of local policies. The New York City Department of Education, for example, allows transgender students to use the pronouns they identify with, and their preferred bathroom. Sometimes, legal help may be needed to confront schools or other systems that are not respecting a child’s gender.

· By middle school, kids are sorting themselves by gender, and there is more to handle socially. Stay aware of any bullying that needs to be addressed.

· Understand that, at times, the child may experience a parent’s attempt to protect them as a sign of rejection. Worried about the child’s physical safety, you might ask, “Are you sure you want to wear that dress to your after-school program?” But the child may experience this comment as, “I don’t approve.”

· Around age 14, dating and sexuality become factors. Be aware this is something your child may be negotiating.

· When the family is ready, supporting a child’s social transition might include helping them legally change their name, an act that is often ceremonial and meaningful for a young transgender person.

Medical Transition

Puberty. Watch for the onset of puberty starting around age 10. When a child’s body changes in the wrong way, it can be unpleasant, even traumatic. One female-to-male transgender boy described getting their period as like “nature punching me in the face every month.” Even a little breast growth in a transgender 12-year-old boy may spark intense feelings of dysphoria. As clinicians, we often see intense distress, anxiety, depression, and even suicide attempts associated with the onset of puberty.

Puberty Blockers. Parents should consider hormone-blocking agents to prevent typical puberty or stop its progression as soon as possible. This will allow the child to later go through puberty only once—in the correct gender. Cross-gender hormone therapy usually isn’t employed until a few years later, but puberty blockers can be started between ages 10 and 12.

Puberty blockers can buy time while deciding on cross-gender hormone therapy. They have no permanent effect, so they can be stopped at any point if the child decides not to transition, and anatomical puberty will then occur.

Halting regular puberty also eases the transition if transgender youth later go on cross-gender hormones. For example, someone going through natural male puberty before starting cross-gender hormones will acquire many male characteristics, like an Adam’s apple, body hair, and wide shoulders, which cannot easily be reversed later.

Cross-Gender Hormones. It is standard to start kids on cross-gender hormones at age 16, though some experts initiate therapy as early as 14, and others advocate starting even younger. The idea is to keep the child’s development in pace with their peers.

Have a medical provider who is well versed in caring for transgender children lined up in advance to start cross-gender hormone therapy when your family decides the time is right. Your nearest LGBT center can provide a list of transgender-friendly providers.

Surgery. The child may or may not decide to pursue surgery. The important thing is to support children and young adults in making their own decisions. Most kids wait until age 18 to 21 to start procedures. Support at that stage may involve helping them figure out what kind of surgery they want and looking into insurance coverage. A surgeon can be found through a local LGBT center or online, where there is plenty of information about different surgeons, including reviews and which age groups they work with.

Support Yourself

Understand that living with gender dysphoria can be harder than living as a transgender person. When children explain how gender dysphoria feels, parents see the pain they are suffering and may become more accepting. That said, if you are struggling with understanding and accepting your child’s transgender journey:

· Don’t make them explain it repeatedly, or look for evidence that falsifies their story. They can sense your disapproval and conflict.

· Educate yourself about gender dysphoria by seeking out LGBT groups, talking with other families dealing with similar issues, or consulting online resources, like the Human Rights Campaign or the Trans Youth Equality Foundation.

· Seek help from someone other than your child, like a caregiver support group or mental health professional.

Parental support for transgender youth is paramount, and a lack of support can have devastating consequences. Listen to your kids—they know what feels right and true to them.