So Your Kid is Trans and You Have Questions

by Guest Post, posted in Health
Child hands rainbow paint
Photo credit Pixabay artist SharonMcCutcheon

So, your kid is trans, and you have some questions.

Or, maybe you just suspect your kid is trans, and you have some questions. 

Or, maybe your kid is displaying behaviors and traits that don’t seem to align with traditional ideas of their assigned sex. And you have some questions.  

Whatever the reason that brought you here, we can all agree that you have some questions. 

Fortunately, you’ve come to a place with answers.

Or, at least, some information, science and advice.

(Editor’s note: this article focuses on transgender children. This post may still offer insight to those whose loved ones are transitioning as adults, but we encourage readers with questions about adults in transition to review resources specifically for adults.)

There is a lot of misinformation on the internet and elsewhere regarding transgender children and adults, a lot of it biased by religious or political ideology. 

To avoid misinformation, it’s a good idea to seek out material from experts (scientific or medical experts working with trans individuals), transgender people telling their own stories, or resources like the ones linked at the bottom of this article that specialize in this topic. 

Now, before we dive in, let’s establish a common vocabulary. Here are some definitions:

  • Sex: A category (usually male or female) that people are grouped in depending on a combination of their internal and external genitalia, their chromosomes, their hormones, and their secondary sex characteristics (like breasts or facial hair). 
  • Gender Identity: An internal sense of your own identity, or the degree to which you feel masculine, feminine, neither, or both. 
  • Intersex: A term for those whose anatomy doesn’t match with the traditional definition of male or female. 
  • Transgender or trans: A nonspecific term for those whose gender identity is different from the sex they were assigned at birth.
  • Cisgender or cis: A term for those whose gender identity matches the sex they were assigned at birth.
  • Trans woman: An individual who was assigned male at birth but who identifies as a woman. 
  • Trans man: An individual who was assigned female at birth but who identifies as a man.
  • Gender expression: The way an individual presents themselves to the world (through things like clothing, makeup, hobbies, hairstyles or mannerisms) that are associated with a particular society’s idea of masculine or feminine. 
  • Gender non-conforming, fluid, non-binary, genderqueer, agender: Someone who does not always identify as the same gender, or any gender. These individuals may identify with many genders, no genders, or their gender identity may fluctuate.
  • Gender dysphoria: Distress or discomfort felt by some people whose gender identity does not match their assigned sex 

If any of these are not clear, or you’re wondering about a term that isn’t included here, you may find this article helpful.

Here’s an example of how this language is used: My name is Ada, I was assigned female at birth. I consider myself cis, as I also feel like a woman on the inside. In terms of my gender expression, most people would consider me feminine as I have a high-pitched voice, sometimes wear makeup, and generally wear clothes marketed to women. However, I am sometimes perceived as masculine due to my mannerisms (the way that I walk, talk, and sit), my short hair, and my refusal to wear bras. 

Many terms have come and gone throughout history to describe LGBTQ+ individuals, including trans people. While transexual was once favoured to describe those who undergo sex reassignment surgery, it has largely fallen out of use in the last decade and is considered rude. Where queer was once a derogatory term used to insult LGBTQ+ people, it has recently been reclaimed by LGBTQ+ activists, and is now embraced by many as a popular catch-all term for anyone who is non-cisgender or non-heterosexual. Language is always evolving, and is specific to a particular time and place. GLAAD recommends listening first to discern someone’s pronouns if you’re ever in doubt about what terms to use. “If you must ask which pronoun the person uses, start with your own,” they recommend in their online tips for allies of transgender people.   

Now that we’re speaking the same language, let’s talk science.

Science Supports Transgender kids’ Identities

There’s a common misconception that the field of biology opposes the existence of transgender individuals. Many anti-trans activists claim that studies supporting trans identities are flawed, ideologically motivated or otherwise unreliable, and that if you actually look into the science of sex and gender, they are non-fluid binaries, determined at birth.

That simply isn’t true. Biology is far too complex to be distilled into XX = woman and XY = man. There are many factors that we use to assign sex, such as chromosomes, hormones, gonads and secondary sex characteristics, that can combine into a multitude of variations of intersex. Although it’s difficult to get accurate statistics on the rates of intersex individuals (for reasons I discuss here), some figures suggest the prevalence is as high as 1.7%, which makes intersex indidivuals about as common as red haired people.

Gender is likewise complex, fluid, and influenced by the society you live in.  

As trans and non-binary author and activist Kate Bornstein wrote in their 2010 book, Gender Outlaws: The Next Generation, “the word gender has scores of meaning built into it. It’s an amalgamation of bodies, identities, and life experiences, subconscious urges, sensations, and behaviors, some of which develop organically, and others which are shaped by language and culture. Instead of saying that gender is any one single thing, let’s start describing it as a holistic experience.”

If you’re interested in going deeper into the science supporting trans identities, you can read about how genetics, neurobiology and endocrinology all back up the experiences of trans individuals. Florence Ashley discusses this in their piece about why the Ontario Progressive Conservative Party is wrong to insist that gender identity theory is “unscientific ‘liberal ideology.’” Or you can read an article I wrote answering the question, “Is sex a binary?” (spoiler: it’s not.)

The point is that there is a remarkable body of scientific literature surrounding transgender people. While identifying as transgender is not a mental illness, one aspect or symptom that some trans people experience, gender dysphoria, is characterized in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as “the distress a person feels due to their birth-assigned sex and gender not matching their gender identity.” 

This definition replaces the outdated diagnosis of “gender identity disorder.” Treating a mismatch in one’s gender identity and assigned sex as a pathological condition, as the DSM did from 1980-2013, led to practitioners attempting to “cure” trans people of their identity (something that not only didn’t work but actually caused a lot of harm).

The hope is that this depathologization of being trans, that unfortunately came more than four decades after the DSM removed homosexuality from its lists of mental illnesses, will help practitioners focus on gender dysphoria as a symptom to be treated rather than a diagnosis in of itself. Sort of like how nausea is a symptom, not a diagnosis.

Will my trans kid “grow out of it”?

Thanks to over a century of research about the psychology and physiology of trans individuals, we know that the age at which a child expresses that their gender doesn’t match their sex matters quite a lot. The older a person is, especially once they’ve reached the age of puberty and beyond, the more likely they are to continue identifying as transgender.

child in colorful hammock outdoors
Let your kid be your kid.
Photo credit Pixabay artist ddimitrova.

While pre-pubescent children often explore and experiment with their gender expression without it necessarily meaning that they are transgender, post-pubescent children most often do not. 

This is part of the reason that most doctors do not recommend physical methods of altering a child’s body so that it better matches their gender identity until after puberty, typically not until after the age of 16. The exceptions to this rule are hormone blockers (also commonly known as puberty blockers), which can be given to pause the development of the secondary sex characteristics that come with puberty. These medications are safe, effective and allow a child more time to come to a conclusion about their desire to transition or not. If they decide not to, the effects of these medications can be reversed simply by discontinuing them.

The fact that some kids who explore gender expression turn out to be cisgender should not be used to discount the realities of kids who identify as trans— exploring one’s gender expression as a child can be normal, but persistent gender dysphoria should be discussed with a respectful medical professional. 

Even if a child’s gender identity eventually matches their assigned-at-birth sex, their experiences in the meantime are real, valid, and can affect them greatly into adulthood. 

Is being trans bad for my kid?

Simply put, no. But not supporting their identity is harmful.

Trans and gender-nonconforming individuals of any age are at a heightened risk for self-injury, suicidal feelings, depression, anxiety and suicide. But research tells us that the mental health of trans individuals tends to improve when they socially transition (begin living as the gender they identify with rather than the sex they were assigned), and that the mental health of transgender individuals who are supported in their identities is essentially the same as their non trans peers.

The American Academy of Pediatrics, as well as many other organizations, support the principle of “Gender Affirmative Care” for transgender kids. This method is predicated on supporting and understanding a child’s gender experience, and stands in sharp contrast to conversion therapies that attempt to pray for, shame or punish a child into identifying as cisgender. Conversion therapy has been outlawed in several countries and was recently deemed “immoral” by the Canadian government.  One study surveyed 27,715 transgender participants, 19.6% of whom had been exposed to gender identity conversion efforts, and found that those exposed to conversion efforts were more likely to have attempted suicide during their lifetime, especially if the exposure occured before the age of 10. 

Unquestionably, the best thing you can do for your trans child is to support them. This means validating their experiences, seeking out specialized healthcare providers for them, educating yourself and providing resources. It also may mean shielding them from people in your lives that are unwilling to support them. 

Ask your child what they need and how you can help. They are the experts on their lives, and they’ll know best what support they want and need. If they seem unsure, questions you can ask include: 

  • What pronouns would you like me to use for you?
  • What name would you like to be called by?
  • What sorts of clothes would you like to wear?
  • What sorts of toys would you like to play with?
  • Would you like me to refer to you as my son, daughter, child, or something else?
  • Would you like me to tell people about this, or keep it just between you and me?

Whatever they decide, respect their choices. It may be difficult for you to understand how your child is feeling if you’ve never struggled with your own gender identity. But you don’t need to understand what your child is going through in order to support and love them.

“Finding a way to say, honestly, ‘This is a lot for me to take in, but I know we can get through this together. I love you no matter what’ might be enough to start,” states Families in Transition, a resource guide by Central Toronto Youth Services.

Even if you can’t understand, or don’t agree, remember that, while they may be your child, they are individuals first. Like adults, children have a right to bodily autonomy (outside of situations in which medical intervention is necessary for safety, like with vaccines). 

But what about all these surgeries and hormones on trans kids I keep hearing about?

If your child does decide to socially transition, that is, begin presenting themselves as a different gender to some (or all) people in some (or all) situations, they may also wish to undergo physical gender-affirming interventions. Not every trans person does, however, and choosing not to does not invalidate their trans identity. Both surgical and hormonal interventions have been practiced since 1918 for the purpose of altering a body to match its owner’s gender identity, so your kid has the benefit over 100 years of developments and improvements. 

Typically, these interventions will involve hormonal treatments (like blocking estrogen production and/or administering androgens to replace it), surgical methods (augmenting or diminishing the breasts, altering the face or neck, removing testicles, ovaries or uteri, vaginoplasty or phalloplasty) or vocal training (to raise or lower their voice). 

Anti-trans voices have complained about doctors performing surgery on young children, but most doctors will not start hormonal treatments until a child is 16 years old, and surgery until they are 18. 

If your trans child is interested in physically transitioning, talk to an expert. They will be able to explain the options available to your child and can evaluate when to undertake them. They can discuss the potential outcomes, risks and benefits. If you’re unsure how to contact an expert in this field, try this database.

Doctors and other medical experts have been working for decades to develop, improve, and minimize the risk associated with gender-affirming procedures for transgender children. They will never be risk free, because no medical procedure, however routine, is risk free. Not undergoing gender-affirming procedures comes with risks as well, including the deterioration of your child’s mental health. Opting out of surgery is a choice just as much as opting in is one too.

Dr. Daniel Summers, a pediatrician based in Maine, told me via a Twitter DM that he consistently gives parents the same advice: “let your kid be your kid.” What might that look like? 

  • Don’t assume your child’s gender expression is a form of rebellion or defiance.
  • Don’t prevent your child from expressing their gender in public or at family activities to avoid making others uncomfortable.
  • Don’t try to shame or punish the gender expression out of your child.
  • Don’t block your child’s access to gender-diverse friends, activities or resources.
  • Don’t blame your child for experiencing discrimination.
  • Don’t belittle or ridicule your child’s gender expression or allow others in your family to do so.
  • Do ask your child when, and in what situations, they would like to be “out.”
  • Do make sure to call them by their preferred name (avoid deadnaming).
  • Do share age appropriate resources with your child, and with other adults in their life.
  • Do support your child’s friends who may be experiencing gender confusion as well.
  • Do let your child gravitate towards whatever clothes, toys and activities they want.
  • Do seek out the support of other parents of trans kids.

In short, as Summers advises: “Be open to letting them play and express themselves however they choose and love them the same regardless.”

Additional Resources 

Acknowledgements:  The SciMoms thank Cheryl Chu, Haiden King, Tris Mamone, Galen Suh, Alex Thomas, Rine Vieth and a few others for reviewing and offering input for this piece.

This guest post is by Ada McVean, a science writer and masters student living in Montreal, Quebec, Canada. She recently finished her Bachelor of Science, with a double major in bio-organic chemistry, and gender, sexuality, feminist and social justice studies at McGill University. She especially enjoys writing about veterinary pseudoscience, menstruation and biases in science.