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More and more young people are identifying as gender diverse due to better information, greater acceptance, medical consensus, and less bullying in schools. A 2016 survey of Minnesota adolescents found that about 3% identified as transgender or gender nonconforming:
Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade (n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures.Rider (2018)
In other words, almost 1 in 30 young people surveyed identified as gender diverse. Gender diverse can mean many things, though.
According to a 2018 policy statement by the American Academy of Pediatrics, a professional organization of over 65,000 pediatricians, the affirmative model of care is the consensus among medical professionals.
I served on the Board of Directors of the nonprofit TransYouth Family Allies for many years, so I have helped many young people and their families. I often talk with healthcare professionals about gender identity and expression in children and adolescents. Below is a summary of the range of options for young people.
What does it all mean?
I created the chart below to help families and guardians understand issues around minors and gender.
Freedom of expression
Not all gender diverse young people make a gender transition. Many just want to express their gender creatively in ways that are not traditional for their assigned gender:
- Activities and interests
Experts now agree that affirming these young people and letting them be creative is a healthy part of development.
Experts recommend affirmative care
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.
Within this group of gender diverse minors, some do not identify with their assigned gender. For young people whose gender identity is complex or causing them distress, may also benefit from:
- Therapy (age 3 and up)
Working with a therapist who specializes in gender issues for children and adolescents can help them understand their feelings and have tools to be happier.
In addition to the kinds of expression above, some may make a social transition:
- New names and/or pronouns
- They may switch back and forth
After a social transition and with the approval of experts and family, some make legal changes on passport or birth certificate with or without medical care:
- Legal name change
- Legal gender change
Medical options are only for those who are:
- Persistent, consistent, & insistent and/or distressed
- Allowed by experts and family after steps above
- Reversible puberty blockers
- Offered to qualified youth age 8 and up after they have:
- Hormone blockers are reversible and have been safely prescribed for decades to children whose puberty starts before it should.
For those who adjust well to all the steps above, adolescents are sometimes approved later for hormones
- Offered to qualified youth around age 12 and up after they have:
- Some hormone effects are not reversible and have been safely prescribed for decades to mature minors who understand the risks, burdens, and benefits.
- Generally only offered to adults.
- In some cases, offered to mature minors around age 15 and up after they have:
- Surgery is not reversible and has been safely performed on mature minors who understand the risks, burdens, and benefits.
- Most do not have surgery until they are able to give legal consent.
Most young people do not have any surgery until they are legally adults. The media fixates on hormones and surgery, but those options are not available until experts and loved ones agree on a course of action based on each child’s unique needs.
Gender Spectrum (genderspectrum.org)
- The most comprehensive English-language site.
Healthy Children (healthychildren.org)
- From the American Academy of Pediatrics
- Gender-Diverse and Transgender Children
TransFamily Support Group (santaclaratransfamilysupport.net)
TransYouth Family Allies (imatyfa.org)
- Archived resource for parents of trans youth.
TransKids Purple Rainbow Foundation (transkidspurplerainbow.org)
- Advocacy group by parents of transgender children.
Children’s National Health System (childrensnational.org)
- Washington DC hospital whose goal is “to support and affirm young children with gender-variant behaviors so that they can grow and develop healthy self-esteem and positive social participation.”
- Gender Development Program
Lynn Conway (lynnconway.com)
Books and publications
- Trans Kids (2018) by Tey Meadow
- Gender Born Gender Made (2011) by Diane Ehrensaft
- Transgender Family Law: A Guide to Effective Advocacy (2012) by Jennifer L. Levi & Elizabeth E. Monnin-Browder
- The Transgender Child: A Handbook for Families and Professionals (2008) by Stephanie A. Brill, & Rachel Pepper
- The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens (2016) by Stephanie A. Brill, & Lisa Kenney
- Trans-Kin: A Guide for Family & Friends of Trans People (2012) by Eleanor Hubbard & Cameron T. Whitley
- Found in Transition: A Mother’s Evolution During Her Child’s Gender Change (2020) by Paria Hassouri
- Helping Your Transgender Teen: A Guide for Parents [Second Edition] (2018), Irwin Krieger
Historically significant works for parents
- Our Trans Children, Fourth Edition, Parents, Families and Friends of Lesbians and Gays, (PFLAG) pamphlet
- Trans Forming Families: Real Stories about Transgendered Loved Ones (1999) by Mary Boenke
- Mom, I Need To Be a Girl [Second Edition] (2007) by Just Evelyn
National Center for Transgender Equality (transequality.org)
- Going Public: Is Public Advocacy Right for You and Your Family? (PDF)
- This important document is a must-read for anyone considering discussing their family member’s gender identity and expression in a public forum.
Love What Matters (lovewhatmatters.com)
- Great podcast by parent of a trans child.
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. Pediatrics, 142(4), [e20182162]. https://doi.org/10.1542/peds.2018-2162 (full text) (PDF)
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