Children who don’t follow cultural gender norms often face a hostile world as they struggle to be who they are.
Parents of transgender or gender nonconforming children struggle, too. They may be in denial, confused or dismayed and unsure how to respond.
Health experts say support at home is crucial for young people who identify as transgender or otherwise defy gender stereotypes in manner and appearance.
“It’s the most important thing you can do for your child. The big risks for kids who identify as transgender are depression and suicide. Rejection at home puts them at high risk for these and other problems.”
Dr. Sondike said gender preference is not a choice and not a result of upbringing, but a product of brain biology.
“If it’s a choice, why would anyone choose to subject themselves to bullying, to disappointing their families, to discrimination?” he said. “Who would choose to go through what some of these individuals go through to reach their potential?
“It’s biological and innate. It’s imprinted on the brain somehow, but we’re not sure how yet. It’s not something you can choose and not something you can change.”
Dr. Sondike and his team in the Division of Adolescent Medicine encourage their patients to talk about gender identity issues, as well as sexuality, so that teens receive needed health services. Research has shown that kids who identify as lesbian, bisexual, gay and transgender (LBGT) are at higher risk for depression, as Dr. Sondike noted, and also sexually transmitted diseases, substance abuse and homelessness.
Support at home can prevent some of these negative outcomes, Dr. Sondike said. It’s natural for parents to have many questions, so Dr. Sondike addressed a number of them:
Facts and myths
- Tomboy girls or effeminate boys aren’t necessarily transgender.
- A girl or boy who identifies as a person of the opposite gender, or who embraces certain characteristics of the other gender, is not certain to be transgender.
- A transgender person may become sexually attracted to either sex. Sexual orientation develops in young people separately, and later than gender identity.
- Some children may start identifying with the opposite gender as early as toddlerhood. Many transgender adults say they began seeing themselves as a person of the opposite sex at a very young age. Others first experience those feelings in adolescence.
- Some children persistently identify as a person of the opposite sex, into adolescence and beyond. But children sometimes fall elsewhere on the spectrum. Some feel they are both genders, or neither. Some will adopt traits associated with the opposite gender – hair and clothing styles, for example – but not feel they are that gender.
“Sometimes gender nonconforming feelings and behaviors are fleeting, sometimes they are not,” said Dr. Sondike. “If it’s persistent for years, then they are probably transgender. Persistence is a good clue.”
What to do/medical options
- Dr Sondike said it’s important to let kids express themselves. In other words, don’t force your boyish girl to wear dresses.
- If by the teen years or possibly earlier, a child want to use gender nonconforming names and pronouns, parents should respect their wishes.
“You can turn a sullen and depressed kid into a happy kid when you allow them to be who they are and allow them to express themselves the way they want,” Dr. Sondike said.
- Puberty blockers delay development of sex characteristics for transgender children coming to terms with gender identity. The drugs are safe and the effects reversible, and they give young people who wish to delay the onset of puberty time to understand and form their gender identity.
“It buys time,” Dr. Sondike said. “You’re not going to do any harm, even if it turns out their feelings of wanting to be the opposite gender do not persist. But you do a lot good if those feelings do persist.”
Hormone replacement therapy is another option for teens, generally 16 or older, who are certain they are transgender and wish to change secondary sex characteristics.