Gender identity and expression in youth

More and more children and adolescents are exploring their options for gender expression. This can include choosing their clothes, hairstyle, activities, and other aspects of appearance and behavior. As young people get older, their gender expression may shift over time along the gender spectrum. Allowing all young people to express themselves has been shown to be a healthy part of development. No child or adolescent should be shamed or punished for not conforming to gender stereotypes.

In the late 20th century, some young people began making a social transition at school with the support of their families, healthcare providers, and educators. A social transition may include using their preferred name and pronouns in addition to changes in appearance and behavior.

In some cases, these gender diverse children and adolescents also express their feelings about the gender identity they feel. Some children and adolescents have a gender identity different from their assigned gender.

The affirmative model of care is the consensus among medical professionals. According to a policy statement by the American Academy of Pediatrics, a professional organization of over 65,000 pediatricians:

In a gender-affirmative care model (GACM), pediatric providers offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. A strong, nonjudgmental partnership with youth and their families can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment.

American Academy of Pediatrics (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

In a GACM, the following messages are conveyed:

  • transgender identities and diverse gender expressions do not constitute a mental disorder;
  • variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities;
  • gender identity evolves as an interplay of biology, development, socialization, and culture; and
  • if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child.

This model allows all children to express themselves as they wish, leading to less stigma and shame.

For young people whose gender identity is complex or causing them distress, their parents or guardians may seek out healthcare professionals to help them explore these feelings. Mental health services are the most common medical option for distressed children and adolescents. Experienced therapists and counselors work with the child or teen to explore their feelings about gender and any related distress. In cases of distress, a harm reduction model may be used to reduce their distress.

Transgender youth

If the identity of the child or adolescent is consistent, insistent, and persistent, the parents may help with legal transition options such as a legal name change and changes to identity documents like passports or birth certificates.

Some children or teens whose gender identity and expression is consistent, insistent, and persistent will seek medical transition options from experts. This is usually via referral from a primary care provider or pediatrician. Some children and teenagers live near or travel to a city with a children’s hospital or pediatric unit that offers specialized gender-related healthcare from a team of experts in children’s health.

One available medical intervention is hormone blockers to prevent or stop puberty. These medications are reversible and have long been safely used on children and adolescents who experience early puberty. Hormone blockers can help reduce distress and allow the child or adolescent to spend more time exploring gender issues with their families, schools, and medical experts.

Some of these children and adolescents respond well to their social transitions and are deemed emotionally healthy and mature enough by their families and experts to make informed decisions about their own healthcare. In these cases, they may be prescribed hormones. The process and model of care are similar to providing HIV prevention drugs or birth control medications to adolescents who request them.

It remains unusual for minors to have transgender surgery. It is only allowed in cases where minors are legally emancipated or deemed to be mature minors by their families and experts. Some carefully screened trans boys have top surgery around 16, and some carefully screened trans girls have bottom surgery around 16. The majority do not make these decisions until they are adults.

For those seeking information and resources for themselves or someone they care about, please see this site’s special section on gender diverse and transgender youth.

References

Rider GN, McMorris BJ, Gower AL, Coleman E, Marla E.Eisenberg ME (2018). Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study. Pediatrics, Mar 2018, 141 (3) [e20171683]. https://doi.org/10.1542/peds.2017-1683

American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, & Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics142(4), [e20182162]. https://doi.org/10.1542/peds.2018-2162 (full text) (PDF)