Open dialogue and nurturing help parents support transgender children

In February, Texas Governor Greg Abbott declared that medical treatments given to transgender teens, including drugs and puberty-blocking hormones, could be considered child abuse under state law. Opponents of the measure reacted promptly, including President Joe Biden, who called the decision “cynical and dangerous”. Investigations into alleged abuse, stemming from the governor’s order, were temporarily suspended after a state court ruled that the policy was unconstitutional.

According to a 2019 study by the CDC (Centers for Disease Control and Prevention), 1.8% of teenagers in the US identify as transgender, meaning their gender identity does not match the gender they were assigned at birth.

When researchers interviewed teenagers in Pittsburgh for a 2021 study, they found that nearly one in ten did not identify as exclusively male or female. These teens have been speaking out more openly about their identities and experiences, the New York Times found in a 2019 poll.

Children and adolescents who do not identify with their assigned gender may have higher rates of depression, suicide and self-harm than the rest. Research indicates that they do better in their mental health when they have access to what doctors call gender-affirming care, which can include mental health therapy and hormone treatments. There are disagreements between physicians and proponents of gender-affirming care as to which adolescents may benefit most from certain treatments. Even so, experts believe that these decisions should be made by doctors, patients and their parents – not by governors or government agencies.

We interviewed health professionals who serve children and adolescents and are gender-focused to understand how parents and other adults can support adolescents on the transgender spectrum.

If necessary, seek expert help.

If you have a child who is questioning their gender, follow their lead, recommended pediatrician Daniel Summeres of North Andover, Massachusetts. “Some teenagers just want to dress differently,” he points out. Some want to engage in activities that are not usually linked to the gender assigned to them at birth, and are content to do so afterward. In such cases, parents don’t need to do much other than support their children.

But if a child seems to be having a hard time dealing with their body or coping with social environments, or if they want a more significant transformation like changing the pronouns they’re treated by or modifying their body with hormones or surgery, consider seeking additional support. A good option is a gender clinic, says Summers, which can offer gender-affirming care. This may involve a variety of services, including therapy and general practice. According to him, some adolescents who receive this assistance do not undergo any medical or surgical treatment.​

Expand your gender vocabulary

“Language is very important” when it comes to a person’s gender, says Laura Anderson, a child and family psychologist based in Hawaii who specializes in gender development. According to her, it is important to try to understand and use the terms that the individual asks you to use.

“Non-binary” is a broader category than transgender, in that a non-binary person “may identify as male and female, or neither,” Anderson says. The term “genderqueer” can be used interchangeably with non-binary. The so-called “gender fluid” individuals, on the other hand, have a gender identity that is “a little more flexible, insofar as, over time, they can move from one category to another”, says the psychologist.

It’s also important to try to use the person’s correct name and pronouns, says Anderson. When a person’s gender identity does not match how they are treated by others, it can lead to psychological distress. Research has shown that when transgender youth cannot use the names they have chosen for themselves at home, school, work or with friends, they are more likely to experience symptoms of depression, consider and attempt suicide.

Instead of judging, show curiosity

If your teen doesn’t bring up the gender issue, don’t force it, advises Summers. But if he wants to talk about it, he doesn’t react with judgment or immediate concern, but rather with curiosity, he suggests. Parents and other adults in a teen’s life should avoid saying “anything that makes a teen feel rejected, insecure, or that they’re trying to shut their voices up,” he says.

Anderson suggests that you start by asking your child for more information. Ask “when did you start thinking about this?” or “How do I find out more about this topic?” she recommends. “Create conditions to continue communicating with your child and not set up a power struggle with him, whichever way the conversation goes.”

For Summers, it’s also okay to ask for some time to think. “It’s okay to say ‘this is new information about you that I didn’t know about. I’m glad you shared it with me, but I want to think about it a little bit, okay?” says the pediatrician. But be sure to bring it up again at a later time when you are calmer.

“The most important thing is for your child to know that you love him, no matter what,” says Jack Turban, a child and adolescent psychologist at Stanford University School of Medicine and a student of the mental health of transgender youth. “Supporting an adolescent’s gender identity has been consistently linked to better mental health outcomes.”

Search all treatments

If your family opts for medical treatment, there are several options to consider, Turban said. Puberty blockers are teen drugs “that put puberty on hold to give the teen more time to explore their gender identity and reflect on next steps,” he said.

Summers explained that the physical changes that come with puberty aren’t undone easily, so puberty blockers can be useful for teens who want a little more time to decide their gender identity before they get stuck. If the person stops taking the blockers, puberty continues; therefore, in that sense, said the doctor, they are fully reversible.

More research is needed on how these drugs might impact brain development and fertility. And they can have side effects, including hot flashes, headaches, and weight gain.

Older transgender teens can also take hormones, such as estrogen or testosterone, which “can help align a young person’s body with their gender identity,” says Turban. Hormone therapy is not always reversible. If given to transgender girls who haven’t gone through puberty, it can cause loss of fertility. And some studies suggest that trans women who take hormones are at an increased risk of side effects such as bone loss and blood clots, although research is inconclusive — women and teens who use hormonal birth control can also experience these side effects.

A new draft guidelines released last year by the World Professional Association for Transgender Health (WPATH) recommends that teens undergo psychological screening before accessing hormone treatments. But some doctors disagree with this requirement.