Twenty-one states have proposed new legislation that would criminalize or ban gender-affirmative medical care for transgender kids and gender-questioning youth, despite the evidence and support from organizations like the American Academy of Pediatrics for affirming medical treatments, including puberty blockers.
Below, Russell Toomey, PhD, answers our questions about caring for transgender and gender-questioning kids. Toomey is the chair of the Family Studies and Human Development program at the Norton School of Family and Consumer Sciences at the University of Arizona.
This post builds off of our previous post on this topic, So Your Kid Is Trans And You’ve Got Questions, which you should also read.
It’s easy to fall down a rabbit hole of misinformation. If your kid comes to you and says they’re transgender, nonbinary or gender-questioning, where can parents go for good information for caring for transgender kids?
RT: There are some really good resources out there:
- The American Academy of Pediatrics has some really great information in their statements around supporting transgender kids.
- The Human Rights Campaign has a whole group for parents who have transgender, non-binary and gender non-conforming children with science-based information.
- There’s also Gender Spectrum, which is a great resource that has a lot of science based information.
- For school-specific information, GLSEN is a national organization with a whole research arm. They have great information about what trans kids are experiencing in school, and the policies, procedures, and practices that schools can implement and that parents can advocate for in order to provide safer learning environments.
I had this sort of stereotypical idea of what a transgender kid says which led me to think that if your kid doesn’t say these things, they might just be going through a phase. Eventually I came across some great advice in Slate suggesting that worrying over whether or not this is a phase is kind of misguided. But I’m wondering if there are many different ways kids come to express that they are transgender?
Gender identity develops for all kids, not just trans kids, at around age two, and then through age three and four. During this time frame, kids are starting to be able to label, identify, and express their gender. But they may vary in their ability to share what’s happening on the inside.
There’s great variability in children, not only with gender, but with lots of different identities and experiences, and even regional contexts. Children are going to have access to differential language to be able to express their gender. I identify as transgender, and I didn’t come out until I was in college. I grew up in rural Appalachia and didn’t even hear the word gay for the first time until I was in high school when I was watching MTV and saw a gay person on the Real World.
Kids today have access to different types of language and different experiences. They may feel like, maybe I’m different, but they may not know what that difference is until they can access the language to express that experience.
Has the concept of gender fluidity changed how kids realize their gender identity?
Well, whether a child understands what gender they are is part of the standard developmental assessments that pediatricians give and, actually, we’re not seeing that change. For the bulk of kids, even transgender kids, they will assert what gender they are during the standard time frame.
Some pediatricians may say to them, you’re wrong, and then mislabel that expression as a developmental delay, but in fact they’re appropriately expressing their gender.
For parents of transgender kids, is there a best practice for when you should loop in your pediatrician?
I would say there’s no scientific evidence that would suggest a best practice for when to loop in various providers but, for any parent, if they need more resources and information, or if they feel like their child is struggling, then of course bring in a professional who may have better information or better knowledge about how to support that child and the whole family system.
Should parents of transgender kids be cautious about making an announcement on social media affirming our kid’s gender or is this a good way to show support?
There are two different types of questions there. The first is thinking about any kid’s digital footprint. That’s something that scientists are just now starting to research. What are the implications of that for child development? I don’t know that there are any solid answers or best practices just yet.
For transgender kids or kids expressing their gender, we know they want to be supported in the gender that they’re expressing. That is very clear from the science. The research from Kristina Olson’s lab has shown that children who are supported in their trans identities by their families have nearly the same mental health outcomes as cisgender youth.
After having a conversation with your transgender or gender-questioning kid, you might all decide together that posting online may be the best way to share that identity with a large group at once, rather than having to have individual conversations over and over and risk having people misgender or use the wrong name. While I would probably suggest having conversations with close family members and close friends before making those social media posts, those posts could end up being the best solution.
For other families that might be the worst solution because it could put them at risk for violence for harassment for a variety of different issues. Ultimately, I would say individualize that decision to a family’s comfort and their safety. Ask how will this impact my child? Is this the best decision for their safety and for their well being?
As a progressive, I figured my instincts in talking about gender would be spot-on but actually I’m screwing up left and right. As a parent, what can you do when you screw up?
Yeah, that’s a great question. If I put on my family scientist hat, what I can say is that all parents mess up, even parents who have PhDs in Family Science. Even transgender parents of trans children. And the best thing to do is to be authentic with your child and to address and to acknowledge that you made a mistake, and then talk about how to rectify and repair that mistake.
Even with two and three year olds, it’s best practice for parents to acknowledge their emotions and to acknowledge when they’ve made a mistake. That’s how children learn to manage their own emotions and to correct their behavior when they’ve done something wrong as well.
I found like my kid actually kind of lit up when I was like, okay so here’s what I learned, and here’s the thought process I was going through at the time and why I was mistaken.
In the mid 2000s, a researcher named Dr. Caitlin Ryan studied family acceptance and rejection related to sexual orientation, and one of the common themes that came up is that parents are not malicious, even those who kick out their children from their homes.
- It’s usually not that they hate their children but that they’re acting on the best information that they have. The problem is that information isn’t science-based.
If we can get to that place of giving them better information, we can really help parents learn how to change behaviors to better support their children. Along the way, sometimes we need to remind parents that we all mess up, and it doesn’t mean you don’t love your child.
What about when kids or family members are not supportive. How can we as parents know when to step in and when to empower our kids to handle it on their own if that’s what they want to do?
That question really gets at the idea of autonomy. There’s not much research, but I just wrote about autonomy-granting as a piece that we need to really start studying with trans youth. What we’re seeing right now is parents showing up at these state legislatures and advocating, putting themselves on the line by testifying in front of these state bodies. But parents can’t always be there. So I think it’s critical to help trans youth find ways to be social and network with other trans youth. In these spaces, they can learn a lot from their peers about how to handle those situations, and how to correct behaviors that are harmful.
The research from the Family Acceptance Project has really shaped how I view intervention.
- It’s not about changing a person’s attitudes or beliefs, because attitudes and beliefs are very difficult to change. The question is how do you change behavior?
- If a child is being misgendered, how can we teach them to say, that’s not my name. I need you to use my name. Or, that really hurts when you call me that. Can you call me by this name? Or, please use these pronouns.
For younger kids, parents are going to have to do more of that direct intervention but, for older kids, I think it really is more like, how can you network? How can you find support for them in trans communities with other trans youth so that they can gain that pure experience and pure knowledge.
- Creating those opportunities and connections, whether it’s online, in-person or at a local youth group or youth community center, we know those connections are critically important, especially for teenagers.
If you’re in one of those states that has proposed or pending anti-trans legislation, is there anything parents should be doing in those states to make sure their kids are not getting denied the right care? There’s an activism component but also a care component, though I know this is going to depend on the state.
it’s going to be state specific, because things like mental health counseling, even medical health provision licenses do not always cross state boundaries. So you have to look at the laws in your state, and whether you can get medical care from an out-of-state provider if you need to, whether that’s mental health or physical health. You can also reach out to some of the national organizations that we’ve discussed because they’re starting to create networks and lists of places where kids in, say, Arkansas, can go to find medical care.
- There are providers in various states who are willing to provide care to trans and gender-questioning kids out of state, but sometimes it depends on the regulations of their medical license.
- What’s even more important is finding care in your community through support groups for trans kids.
Parents also need a very specific kind of support that the child doesn’t always need to be there for. I used to help run a camp here locally in Tucson and we would always be very careful to make sure that we had separate parent and caregiver spaces where the kids wouldn’t have to witness their mom or caregiver crying. Because in the suicidality research that I and others have done, we found that feeling like you’re a burden to others is a key predictor of suicidality among trans populations.
- We never want a situation where trans youth are perceiving that they’re a burden.
- We want to make sure that there are multiple layers of support for both families and for the child and adolescent.
That multi-generational trans support can be hard to find because it’s limited across the country, particularly in rural areas, but having spaces where trans youth can be with trans adults to actually see that they have a future is so important. Often trans representation in the media is not necessarily a positive representation, so if we can try to structure and scaffold those positive representations in our communities, it gives trans youth the ability to see trans adults living healthy, productive lives, I think that’s critical, especially now.
It’s interesting, sometimes we parents complain so much about social media but for my kid, TikTok has mostly been a very positive thing.
There are great YouTube channels as well. Jordan Forrest Miller, a graduate student researcher at Georgia State University, has done some research on how YouTube can be used in positive ways to build that connection for trans youth who are just starting out on their journey.
Further reading and resources:
American Academy of Pediatrics Statement, Ensuring Comprehensive Care and Support for Trangender and Gender-Diverse Children Adolescents
Family Acceptance Project: Research-backed guides for developing and maintaining healthy family relationships with LGBT children.
Gender Odyssey: A conference focused on meeting the needs and interests of trans and gender diverse children and their families.
HealthyChildren.Org: Information for parents of LGBTQ+ teens.
Gender Spectrum, creating gender inclusive spaces for children and teens
Safe Schools Coalition, helping schools become safe places for everyone regardless of gender, gender identity or sexual orientation
The Trevor Project: A national organization that provides crisis intervention ad suicide prevention to LGBTQ youth under the age of 25.
Young Trans Children Know Who They Are The Atlantic