In more and more communities across the United States, transgender teens are comfortable coming out. That’s good news. But it’s also meant a learning curve—sometimes a steep one—for parents who are unfamiliar with transgender issues. And that’s most of us, as it’s estimated that less than one percent of the U.S. population (around 1.4 million people) identify as being transgender. We talked with experts about what it means to be a transgender teenager—and how adults can best support trans teens, especially during early adolescence.
Q: What does it mean to be transgender?
We are all born with a biological sex. During childhood, we also develop a gender identity, which is our sense of ourselves as male or female. For most of us, our biological sex matches our gender identity (that’s called being cisgender). But for some of us, it does not. A biological male may feel instead that he is female and vice versa. These individuals are transgender.
Gender dysphoria is the clinical term for what transgender individuals experience. Adolescents with gender dysphoria will express a strong desire to be a different gender and to be treated as such (not fleetingly, but for a significant period of time and likely for life); they are also often deeply distressed by the physical characteristics of their biological sex; and their distress may be so severe that it impairs day-to-day functioning.
Q: How is gender dysphoria treated in adolescence?
The goal is not to change the way an adolescent feels about his or her gender identity. Rather, it’s to relieve the suffering that can occur when a person feels like they’re in the wrong body. This can include taking steps to make a person’s outer appearance match up with his or her gender identity (called transitioning). Experts also recommend therapy, as transgender individuals are at significant risk for a number of mental health issues, including anxiety, self-harm behaviors, and depression. “The therapist should have training in adolescent development and, preferably, also in gender issues” explains Dr. Natalie Nokoff, a pediatric endocrinologist at the University of Colorado School of Medicine.
Q: Isn’t middle school and even high school early to make a decision like this?
Studies show that gender dysphoria in early childhood often does not persist into adolescence. But they also show that gender dysphoria that lasts through adolescence usually does persist into adulthood. Brushing off an adolescent’s feelings with “it’s just a phase” (or worse) is not only not helpful, it can increase the likelihood the adolescent will develop a mental health issue down the road. Instead, experts urge parents with adolescents experiencing gender dysphoria to make an appointment with their pediatrician.
Q: What does it mean to transition?
Adolescents with what experts describe as an “insistent, persistent, and consistent” transgender identity often elect to begin transitioning to the gender with which they identify. The first step is typically a “social transition.” This means they start to make changes that help them feel like their appearance—and social experience—lines up with their gender identity. They may dress differently, use a different name (and pronoun), or hang out with different friends.
Some adolescents may, if their parents consent, decide to take what are called puberty blockers. These drugs, called gonadotropin-releasing hormone analogs, pause pubertal development and prevent development of secondary sex characteristics (facial hair, breasts, etc.). Why do this? Because developing the secondary-sex characteristics of a gender with which an individual doesn’t identify can be deeply distressing. Puberty blockers can prevent that from occurring, giving the adolescent time to mature and be sure of his or her gender identity and what next steps to take. “These are generally pretty safe medications,” says Nokoff. “And they are totally reversible.”
It’s helpful for those of us on the outside of such decisions to understand that this is not a one-day-to-the-next process. Adolescents who are struggling with gender dysphoria—and their families—typically spend considerable time in counseling and working with their doctors before taking such steps.
The process of more permanently transitioning to a different gender starts with hormone treatments; guidelines by the Endocrine Society and World Professional Organization for Transgender Health recommend beginning at age 16, but some clinics may prescribe these medications at a younger age with parental consent and a letter of support from a therapist. Note that before the age of 18, a child must have parental approval to receive any medical treatment. In general, stresses Nokoff, there is no one-size, fits-all approach here. “Everybody is different and how one kid approaches it will be different than how another does.”
Q: How should I address my child’s transgender friends?
Many transgender teenagers will decide to use a different name, as well as a different pronoun (he, she, they, etc.). Adults should honor these decisions. “You could say, ‘Hey, I’m noticing you’re wearing some different clothes than you’ve worn before. I don’t want to make assumptions. Is there a preferred way you’d like me to refer to you?,’” recommends Joel Baum, senior director with the California-based not-for-profit Gender Spectrum. “That’s a way of asking respectfully.”
Q: How can I support a transgender teenager?
It’s tough to be a transgender teenager. You’re often harassed. You’re discriminated against. And you’re at a significantly increased risk for a slew of mental-health issues. In fact, a staggering 41 percent of transgender adults have attempted suicide. This is not an easy path to walk. But, stresses Baum, how parents and other adults respond to transgender teenagers can make all the difference. Teens need gender identity support. “The number one indicator for the health and well-being is parental support or lack thereof,” he stresses. “Without it, they are in deep trouble.”
Q: And other adults? What can they do?
Be sensitive and supportive of both the teenager and his or her parents. Avoid detailed questions; it’s not your business. Instead simple expressions of support—“How are you doing?”—are more than sufficient. But perhaps most helpful of all: take time to understand the issues, recommends Baum. “Think about your own experiences with gender,” he says. “Learn more. Become more informed.”