By: Jason Rafferty MD, MPH, EdM, FAAP
Parenting a gender-diverse child can leave some parents with a lot of questions and concerns for their child's wellbeing. Research suggests that
gender is something we are born with; it can't be changed by any interventions. So, rather than predicting or preventing who a child may become, it is better to value them for who they are now, even at a young age. This approach fosters secure attachment and resilience.
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The American Academy of Pediatrics
recommends parents make their home a place where their child feels safe and loved unconditionally for who they are. Here are frequently asked questions from parents about topics related to gender identity.
Will my child grow up to be transgender?
- By preschool, kids start to recognize gender differences, both physically and socially. They also start to develop feelings, thoughts, and fantasy play that allows them to explore their gender. It is important to recognize that cross-gender preferences and play is a normal part of this exploration process, regardless of their future gender identity. However, research suggests that children who assert a gender-diverse identity know their gender as clearly and consistently as other kids do and benefit from the same level of support, love, and social acceptance.
It used to be the case that for children, gender-diverse assertions were seen as "possibly true" and not acknowledged until they were considered old enough to know for sure. This does not serve the child, because it increases discomfort without offering critical support and understanding. The best approach for parents is to love and appreciate their child as they are in the moment.
What caused my child to identify with a different gender?
- While we do not understand why some children identify as gender-diverse or transgender, research suggests that gender identity involves biology, development, socialization and culture. There is no evidence that parenting is responsible for a child having a gender identity that is not in line with his or her gender assigned at birth. Childhood trauma does not cause a child to become gender-diverse, transgender, or impact their sexual orientation. Variations in gender identity and expression are normal aspects of human diversity.
If a mental health issue exists, it most often stems from other factors, such as bullying, discrimination, and other negative experiences. Being seen as "different" is not easy, especially in childhood, and may contribute to teasing or bullying. If this is happening, speak with the child's teacher and the school to
create a plan to prevent bullying. The most important thing to remember is to support, love, and accept your child as he or she is.
My gender-diverse child is still exploring their gender identity, but really distressed about puberty. What can we do?
- During puberty, hormone "blockers" can be used to delay physical development. This is reversable and gives an individual more time to explore their gender identity. Available data show that delaying puberty in transgender children generally leads to improved psychological functioning in adolescence and young adulthood. For those who were assigned female at birth, periods may be particularly distressing. Periods can be reduced or blocked with "blockers" or with certain contraceptive agents.
What treatments are available for children who identify as transgender? What does the process include?
- As gender-diverse individuals express their underlying gender identity, they engage in a gender affirmation process (sometimes referred to as "gender transition"). This process involves reflection, acceptance, and, for some, intervention. There is no prescribed path, sequence or endpoint, but the process may include any of the following components:
Social affirmation: This is a reversible intervention in which children and adolescents express their asserted gender identity by adapting hairstyle, clothing, pronouns, name, etc.
Legal affirmation: When elements of a social affirmation, such as name and gender marker, become official on legal documents (birth certificates, passports, school documents, etc.). The steps to doing this vary from state to state, and often specific documentation from the child's health providers is required.
Medical affirmation: This is the process of using hormones to allow adolescents who have started puberty to develop characteristics of the opposite gender. Some changes are partially reversible if hormones are stopped, but others are not.
Surgical affirmation: Surgical approaches are used most often in adults, but occasionally on a case-by-case basis in older adolescents, to also modify certain characteristics, such as hair distribution, chest, or genitalia. These changes are not reversible.
The decision of whether and when to initiate gender-affirmative treatments is personal and involves careful consideration of the risks, benefits and other factors unique to each patient and family. The gender affirmation process is best when facilitated through collaboration between the patient, their family, their primary care provider, a mental health provider (preferably with expertise in caring for transgender and gender diverse youth), social supports, and a pediatric endocrinologist or adolescent medicine gender specialist, if available.
Ask your pediatrician if a telehealth visit by phone or video call is an option. Your child may feel more comfortable talking to their doctor from home. For teens, the telehealth visit should take place in as private of a place as possible so they can have a one-on-one conversation with the doctor. You can make a plan with the doctor about talking before or after they talk to your teen privately. If it’s a video call, and your child or teen would prefer to have the camera off, they can ask their doctor if that is okay. Telehealth visits can also be used for follow-up visits to check on your child’s progress.
If my child says they are "gender fluid" does that just mean they are confused?
- No. For some people gender identity can be fluid, shifting between more masculine, feminine, in between or something else, in different contexts or at different times. This may also be part of a person's personal journey or exploration of gender.
Can my child become transgender because of their friends or things they see online? What if there were no earlier signs?
- Being transgender is not contagious. Some children and teens may not have confronted or feel they have to suppress gender-diverse traits until they find nonjudgmental and affirming peers or online communities. If this is discovered by parents, or the child discloses such suppressed feelings, it may seem sudden and unexpected.
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About Dr. Rafferty:
Jason Rafferty, MD, MPH, EdM, FAAP, is a "Triple Board" residency graduate who is pediatrician and child psychiatrist at Thundermist Health Centers, a Patient-Centered Medical Home in Rhode Island. He specializes in adolescent substance use disorders and gender and sexual development, and also practices in related specialty clinics at Hasbro Children's Hospital and Emma Pendleton Bradley Hospital. Dr. Rafferty is an advocate in his local community and on a national level through work with the American Academy of Pediatrics on issues including the emotional health of young men, access to care for LGBTQ youth, and prevention of childhood homelessness.