Life is hard for transgender kids. Rates of depression, anxiety, and suicide tower over the lives of transgender kids at dramatically higher rates than their cisgender peers. One obvious and troubling reason for this is sexual violence. Some 30 percent of trans high schoolers report being the victim of sexual violence within the past year, three times the rate of cisgender peers. But the trouble also continues at home. Many adults don’t understand or accept them. Some think it’s just a phase. Others think trans kids are a threat to cisgender kids, or those who identify with the gender they were assigned at birth. Still, others want to support transgender kids and teens, but they don’t know how.
The first step to addressing these tragic statistics at home is to listen, says Russ Toomey, a professor and the program chair of family studies and human development at the University of Arizona. Parents should believe what their child says about their own gender identity, though they should keep track of how persistently and consistently they identify as that gender. The second step? Get support. There are many resources available that provide guidance on how to support trans kids.
But first, the basics. Toomey, a leading researcher on trans youth who is trans himself, talked to us about trying to be the best possible parent to your own trans kid and parsing the facts from political rhetoric.
When do kids begin to understand their own relationship to gender?
All kids, regardless of their gender identity, start to understand their own gender typically by the age of 18 to 24 months — that’s their awareness that I’m a boy, I’m a girl, I’m something totally not within that gender binary I’m seeing in the world around me. Usually, they can label that and start to share that between 18 to 24 months and up to 30 months.
Do transgender kids have the same strength in their sense of gender as kids who are cisgender?
Yes! We know this from Kristina Olson’s work, which has been transformative. It’s really the first of its kind to compare transgender children to their cisgender peers in a beautifully conducted, rigorous study of trans kids. We see very similar patterns of gender identity development, recognition, and sharing — and the strength of gender identity — between trans kids and cis kids. They’re very similar with the ages at which they identify with their gender and share it with others. Trans kids push back against being treated as the wrong gender in different ways to different people, the same as adults do in terms of whether they’re going to push back when somebody says, ‘No, you’re not a boy. You’re a girl.’ We will see trans kids strongly identifying with the gender that they say that they are. It’s just whether adults in their environment believe them or not.
If a child is gender non-conforming, such as a “boy” who likes to wear dresses, does that mean they’re transgender?
No. That means they may be exploring gender and playing with gender. What we know about trans kids is that they may be engaging in those types of non-conforming behaviors, but they are also typically at that time saying, ‘Hey, I am a girl,’ or ‘Hey, I’m a boy,’ or ‘I don’t really feel like a boy or girl.’ They’re going to be verbalizing that. It will be persistent and consistent across time.
Why are some children transgender and others not?
I don’t think we really know the answer to that question. There’s no clear evidence that points to any parenting behavior or experience that would cause a person to be transgender. But what the research does say is pretty clear: Sex is not even a binary. Our whole notion that there are only boys and girls, and only cisgender boys and girls, is flawed from the very beginning. For example, there are so many different variations of sex chromosomes other than the two that we’re typically presented with.
What should parents do if their child is saying that they’re not a boy or not a girl?
The first thing is to support what you hear your kid saying. Across anything in child development, kids need their parents and their caregivers to believe them and listen to them. The next thing is for parents to seek out support. I can speak to this as a parent myself. We are socialized to understand what is expected of kids from the cisgender-dominant world that we live in, so parents often don’t have the language to be able to be supportive of their kids. Many communities now have a ‘parents of transgender kids support group,’ particularly in larger communities. If you’re in a more rural spot, you can go online to find support from other parents who have transgender kids or kids who are exploring their gender. You can find supportive mental health professionals in most areas now to help guide you through the process.
What should a parent do if their child hasn’t said they don’t feel like a boy or a girl, but they suspect their kid is transgender?
The research is not strong there yet. From general parenting advice, we know that parents should provide the context that is supportive of whatever emerges from their kids. Don’t push the kid, but provide that openness for that child to be able to explore their gender, removing any barriers that might exist for that child related to gender. Provide opportunities for the child to pick whatever toys they want to play with, or to dress however they want to dress, or to choose their hairstyle. Hairstyles are a big issue that we see come up over and over again in interviews with trans adults. They say it was always a fight with their parents around hairstyle, and whether it was girl enough or boy enough.
What does transitioning look like for young trans kids?
Pre-adolescence, it’s typically what we refer to as a social transition. That would involve perhaps changing one’s name to better align with their gender identity and asking people to use different pronouns. That’s really it for kids. It really revolves around how people reflect back that gender to the child and going with what the child is asking at the time.
Do many children who socially transition change their mind and decide they’re not actually transgender?
The research on that is minimal, but we do not see too many kids who go through a transition and say, ‘Oops, I was wrong.’ There are some figures out there saying 80% of kids who are gender non-conforming grow up to not be transgender. Those studies, unfortunately, were not of kids who were saying, ‘I am a girl’ or ‘I am a boy’ or ‘I’m non-binary’ (in more kid-friendly terms). Those were studies of kids whose parents took them to treatment because they were worried about the gender non-conformity. Those studies that we often see quoted are based on a very skewed sample of kids who were gender non-conforming and whose parents took them to therapy because they wanted to change something about that gender nonconformity. Often those kids are referred to as ‘potentially trans kids,’ but most of them likely never even identified as transgender.
How do older trans kids transition?
Once kids get closer to puberty, we have medication that can delay the onset of puberty or suppress puberty. What that gives the child is time to not go through a physical transition or transformation (through puberty) that may further exacerbate any kind of gender dysphoria that they may be feeling. Puberty tends to exacerbate anxiety, depression, and other mental health symptoms in trans kids who don’t have access to puberty suppressors. And we know from studies now that kids who get puberty suppressors and who identify as transgender look very similar in terms of mental health outcomes to their cisgender peers. We see these as really promising treatments.
Once a kid gets to a point where puberty transformation is in order to fit in with their age group, then we do see some cross-sex hormones being used. I like to refer to them as gender-affirming hormones. Using hormones typically doesn’t happen in the U.S. until mid or late adolescence. Surgery is typically not provided here until very late adolescence for transmasculine adolescents, and that’s typically only chest surgery. That would not be conducted by a doctor unless it was very clear that the child is transgender and that identity isn’t really fluctuating or changing.
Are there downsides to puberty blockers?
From the literature, we really haven’t seen any. One of the potential limitations is around fertility, and there’s ongoing research on this. Puberty suppressors could potentially lessen the opportunity or totally remove the opportunity for trans kids to have biological children. There are procedures to either remove sperm or eggs to preserve them for later use, but that’s only accessible to those who are very wealthy, who can afford those types of procedures.
Developmentally, we know very little about how stable is it if you ask eight- or nine-year-olds if they want kids someday. So, there’s a tradeoff: Puberty suppression has drastic mental health implications in terms of reducing suicidality and reducing depression and anxiety. Do you not use that because of a potential life choice around biological parenting that would come decades later? There’s that trade off of immediate mental health support versus the possibility that one day a person will potentially regret that decision because they want to have kids.
I like to point to the journal Pediatrics. In October 2018, they made a policy statement about the lives of transgender children. And there’s a quote in there: “More robust and current research suggests that, rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family.” How we talk about trans kids, particularly in the media, is that we often focus on these life experiences that are decades down the road. We really need to focus on how do we support these kids today, and how do we help them thrive in a world that doesn’t value their existence?