When Children Have Transgender Questions
Parents don't have to deal with a child's gender questions on their own. There are local medical professionals, families and support groups that can help guide them.
As a child in Medford, NJ, Elliot Clement often felt uncomfortable.
Assigned female at birth, his favorite moments were taking on “boy” roles when he and his friends played make believe. Now 23 years old, Elliot is transgender, having transitioned socially and medically into a male. He started the process four years ago and today says he’s a happy, healthy, first-year graduate student studying library science.
“Now I feel so much more comfortable in my everyday life,” says Elliot, who lives in New York City. “It doesn’t feel like this big, sweeping change. Just normal, like this is the way it’s supposed to be.”
He and his mom, Beth, are now advocates for transgender youth, telling their story to help other families navigate unfamiliar territory.
The percentage of individuals who are transgender is not clear, but the most common statistic is that three in every 1,000 individuals are transgender, says Dr. Rachel Levine, Pennsylvania’s Secretary of Health, who is a pediatrician and one of the country’s highest-ranking transgender public officials. “This number has not changed significantly over the last number of years.”
As a child, Elliot didn’t realize that girls and boys felt differently. He recalls just feeling uncomfortable, that something didn’t fit right. He did traditional “girl” activities — ballet lessons, wearing bikinis at the beach — all in an effort to try to fit into what he thought a girl was supposed to be.
It wasn’t until he learned the word transgender, around age 12, that he was able to understand his feelings. “I remember thinking it would be so much nicer to be a boy and I wished I was, but I thought that’s just how I was born,” he recalls. “I thought it was something everybody felt.”
At 14, Elliot first approached his mom about his feelings. She took him to the doctor, but she chalked it up to puberty and the changes his body was going through. So he backtracked. “When I found out that was something people would frown upon, I just tried to forget about it and deal with what I had,” he says, worried about the stress it was causing his family.
Transitioning to male
Then Elliot went away to college. “When I was 19, I made the decision to transition both socially and medically, because I’d reached the point where continuing the way things were wasn’t an option for me anymore,” recalls Elliot, who began hormone injections and had chest reconstruction. “Even though I was trying to push those feelings away, they would cycle back up and it got harder and harder to live in the world as something I didn’t think was right.”
At first, his transition was tough on his mom. “I was very selfish about how this was going to impact me versus the struggle that my child had been going through,” admits Beth Clement, who now serves as VP of PFLAG of Collingswood, NJ, a support group for parents, the LGBTQ community and supporters. “I cried a lot and mourned the loss of my daughter because it felt like a real loss to me. Now, I think it was more mourning the loss of the future I had planned for that child. He’s still the same person, he’s happier and his anxiety is gone. But, it was a hard process for our family.”
When Beth began reading about suicide rates — approximately 40 percent of transgender adults reported having attempted suicide, according to the 2015 U.S. Transgender Survey — “that got my head on straight,” she admits.
There aren’t reliable statistics on how many young kids question their gender, says Charles Zimbrick-Rogers, adolescent medicine physician at the Children’s Hospital of Philadelphia.
Gender identity starts to emerge in children around the ages of 3 to 5. “That’s also when some kids start identifying that they don’t fit into those categories,” he says.
For example, in preschool, when kids are asked to line up in a row of boys and girls, a questioning child might stand in the middle, unsure of where to go, Zimbrick-Rogers says. Even at that young age, he urges parents not to panic. “They have the same need for love and support as every other kid out there,” he says. “Don’t try to push the child in any direction because they’ve got time to sort this out.”
Parents don’t have to deal with gender questioning on their own — it can be helpful to speak with a pediatrician or psychologist. However, in early childhood there is often no need for an in-depth medical evaluation. Many children, especially early on in childhood, express things that could indicate a child might be transgender or gender non-binary. However, many of these children settle into their gender assigned at birth, he says.
It can be difficult for a parent to distinguish between curiosity and a need for gender change. Figuring this out is “very individualized to each child,” Zimbrick-Rogers says. Some children know they are a different gender from their earliest possible memory, while for others, it’s not so clear-cut. Parents need to create an environment where they listen and support their child, and trust that over time their children will show them who they are.
If a child’s questioning continues into puberty, parents can begin to discuss medical treatments that can provide more time to consider options.
“As the child reaches puberty, there are medical interventions that can put a pause on further pubertal development,” says Zimbrick-Rogers. “That gives a child and a family more time for processing, and prevents some of the physical changes of puberty, including hair growth, body changes and menses.”
Those treatments are easily reversible, and if stopped, puberty resumes at a normal pace, adds Levine. The current method of treatment is to use puberty blockers at the first sign of puberty, while the individual works with their therapist and doctor.
Between 14 and 16 years old, if everyone is on board, then it is often recommended to begin cross-gender hormone treatments to start the transition.
“Previous protocols delayed treatment until an individual was 18 years old, but this would often cause psychological and developmental issues for individuals who went through a puberty not consistent with their gender identity,” Levine says. “This can often lead to depression and anxiety, among other mental health issues.”
Take the example of a child assigned female at birth who has never waivered on being transgender from a very young age. The family has allowed the child to live as a boy in his clothing, haircut, and using his preferred name in school. That child can go on a puberty-blocking agent.
“Several years down the line, when the time is right, cross-gender hormones may be started to allow his body to start going through male puberty,” says Zimbrick-Rogers. “Once that process has gone on, at some point the young person may decide to have surgeries, which most often happen after the person turns 18. It is important to remember, however, that not every transgender individual undergoes surgeries.”
While puberty blockers are completely reversible and cross-gender hormones partly reversible, surgeries, for the most part, cannot be undone, Zimbrick-Rogers says.
Studies, however, show that it is rare that a transgender person changes their mind after a gender transition. In one large study from Europe, less than 1 percent regretted the decision, “not because they were convinced they were not transgender, but because it had cost them family and social relationships,” Zimbrick-Rogers says. “They wished they had not done it because their families rejected them. That is profoundly sad.”
Advice for parents
There has certainly been an increased awareness of gender identity issues. “Young people aren’t necessarily following the traditional male/female binary system,” says Levine. “Many teens are re-evaluating gender identity issues. These people may self-identify as queer, gender-queer, gender non-conforming, or gender-fluid.”
One of the primary factors to influence whether someone seeks treatment is access to care, Levine says, noting that outside of Philadelphia, Hershey and Pittsburgh, there are many areas of the state where this care is not provided. (In Delaware, there is a Gender Wellness Program at Nemours/ Alfred I. duPont Hospital for Children in Wilmington.)
Elliot urges kids who might be questioning their gender to find someone they can talk to about it. “They can help you sort that feeling out,” he says. “Don’t be afraid to try different things, like wearing different clothes to see what feels right. You don’t have to know everything – you can take time to see what feels the best.”
He wishes someone had told him about being transgender when he was younger. “I would have been able to put a name to the feelings and understood them earlier,” he says.
Zimbrick-Rogers says parental concerns about suicide are understandable, but a supportive family has been shown to mitigate that risk. “A recent study showed that in young people who came out to their parents early in childhood, and their family wrapped around them with love and support, those risks were almost completely eliminated,” he says. “They went back to being normal kids.”
This is why parents should become their child’s biggest advocate, ally, and accomplice, he says, so that all spaces their child inhabits, including school, religious, community and home, are safe places for exploring their identity.
“By doing that, children won’t feel they have to hide part of themselves,” he says.
Terri Akman is a contributor to MetroKids.