What should I do if I think my child is transgender?

When I was young there was no treatment of transgender or gender variant children available. My parents had noticed a problem – I did not get on with children of my own age so I was sent to a psychiatrist who discovered that I was 2 years ahead of my age mentally so I was put up a year in school for a while. Actually looking back it was not that I didn’t get on with children my own age – it was boys. I hated boys activities. I never played football or other sports; never got into fights; never hung out with groups of boys; I preferred quieter more artistic pursuits, girls comics and storybooks; and by the age of seven, I was secretly cross-dressing in my sisters and mothers clothes. I am glad they didn’t spot this because of one of the main treatments back then – ECT – Electro Convulsive Therapy, sadly still used as part of some reparative therapy practices.

On my Transgender Children Page there are a number of videos exploring the lives of Trans children and supportive parents who have had the courage to tell their stories. I use some of those videos in my Transgender Awareness Workshops because they help to highlight the social and family issues and clearly show that being transgender is not something that people just decide – it’s not a phase.

Seeing a child as early as two or three, adamantly insisting that they are really a boy when they have a girls body or really a girl when they have a boys body helps us all to understand that this is something we are born with. It’s not caused by the way we are brought up – it is not the parent’s fault.

But for a parent, coping with supporting a transgender child is not easy – and it’s a long emotionally challenging journey for both child and parents. To get a better understanding of the process, I strongly recommend you watch the video below. It’s a longitudinal study of a trans girl called Josie, revisiting her and her parents over a number of years as she progresses through early childhood exploring her feelings and the possible medical treatments. It’s not surprising that this video has had over 8 million views

Support from Parents and Family is Crucial

The documentary above highlights the huge range of challenges faced by gender variant children and their parents and families. But what should you do if you have a child who is uncomfortable with their gender? As was stressed in the video, not all children who express cross-gender behaviour are necessarily transgender, but not supporting and helping them with their confusion is likely to lead to mental health problems, often with devastating consequences.

Nearly 50% of gender variant children attempt suicide – we have no statistics on the levels of self-harm, but most trans people admit to attempting some form of self-harm Josie attempted to remove her penis and her mother Vanessa often expresses her fears for Josie’s survival if she does not get appropriate treatment and support. On December 28th 2014 Leelah Alcorn committed suicide and published a long suicide note on a social media site blaming her parents refusal to accept and support her as the reason. In her suicide note she said she wanted her death to make a difference and the story went viral prompting petitions to stop the unacceptable use of reparative therapy to “cure” trans people. Hopefully that will happen – but there is no doubt that the single most important change needing to happen is for parents of gender variant children to understand that it is their support more than anything that will make a difference. As we have seen with the work of the Jazz Jennings and her family, real lasting change comes from positive action, not as a response to a tragedy.

Support Options for Transgender or Gender Variant Children in the UK

Until 2012 treatment of Transgender Children in the UK was nothing short of barbaric. No treatment of any kind was offered until the child reached 18 by which time many physical changes have taken place that cannot be reversed. The pioneering work in treating children happened Holland as a result of the work of the Netherlands Institute for Brain Research. Dr Norman Spack a pediatric endocrinologist in the USA, who studied the work in Holland, began treating adolescent children in Boston including a number of British children and then in 2012 the policy was changed int he UK and now all children can access this support. It’s worth listening to Norman’s TED talk on the topic.

The first stage in the treatment of Transgender Gender children is the diagnosis of Gender Dysphoria – This is the official term in the DSM-5 (Diagnostic and Statistical Manual of Mental Health Version 5 – American Psychiatric Society). In order for a child to be diagnosed with Gender Dysphoria today, they must exhibit a strong and persistent cross-gender identification displaying six or more of the following for at least a 6-month duration:

repeatedly stated desire to be, or insistence that he or she is, the other sex

in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing

strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex

a strong rejection of typical toys/games typically played by one’s sex

intense desire to participate in the stereotypical games and pastimes of the other sex

strong preference for playmates of the other sex

a strong dislike of one’s sexual anatomy

a strong desire for the primary (e.g., penis, vagina) or secondary (e.g., menstruation) sex characteristics of the other gender

In the UK there is one Gender Identity Development Service for the treatment of transgender or gender variant children at the Tavistock and Portman NHS Foundation Trust. This service is located in London but has a branch service in Leeds and in Exeter. They are very supportive and happy to provide gender advice over the phone and via their web site. However you cannot self refer to the clinic. Any parent of a gender variant child should first speak to their GP. This will often result in a referral to the local Child and Adolescent Mental Health Services (CAHMS), the preferred referral route, although a GP or a school nurse can refer a child directly to either CAMHS or the Tavistock Clinic.

In addition to this there is an excellent voluntary support organisation called Mermaids run by parents of gender variant children and some transgender young people. I strongly recommend any parent with a gender variant child or any young person with gender issues contact Mermaids because they have real practical experience of the day to day challenges, can provide very valuable support and connect you with other parents and children facing the same issues. You can also download the following publications.

Where Do Mermaids Stand – Mermaids brochure, produced in collaboration with Action for Children

Guidance on Combating Transphobic Bullying in Schools produced by GIRES

Medical Care for Gender Variant Children and Young People produced by the DoH and GIRES