Youth issues

More and more children and teens are exploring their options for gender expression. 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 teen should be shamed 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 parents, healthcare providers, and educators. A social transition may include using their preferred name and choosing their clothes, hairstyle, and other aspects of appearance and behavior.

In some cases, these gender expansive children and teens also express their feelings about their gender identity. Some children and teens have a gender identity different from their assigned gender.

The affirmative model of care is the consensus among medical professionals. This model allows all children to express themselves as they wish, leading to less stigma and shame.

In cases where a child or teen has distress about their gender identity, the parents may seek out healthcare professionals to help them explore these feelings. Mental health services are the most common medical option for distressed children and teens. Clinicians 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.

If the identity of the child or teen is consistent, insistent, and persistent, the parents may help with legal transition options such as a legal name change.

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 teens 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 teens who experience precocious puberty. Hormone blockers can help reduce distress and allow the child or teen to spend more time exploring gender issues with their families, schools, and medical experts.

Some of these children and teens 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 expansive and transgender youth.


Postoperative psychological functioning of adolescent transsexuals
Archives of Sexual Behavior, June 2002 v31 i3 p255(7).

Postoperative psychological functioning of adolescent transsexuals: a Rorschach study. (Statistical Data Included)
Yolanda L.S. Smith, Leo Cohen and Peggy T. Cohen-Kettenis