Raising the Transgender Child

1

IDENTITY CRISIS

Seven Signs Your Child May Be Transgender

Popular magazines have conditioned us to reach for a quiz when we are curious as to how we measure up. For example, if you are wondering about the vibes you send to your romantic partner, you might take Cosmo’s “What Kind of Sexy Are You?” quiz. Or if you’re not sure whether your life is going in the right direction, there’s O magazine’s “Who Am I Meant to Be?” test.

In the healthcare profession, we also use checklists—albeit ones that are much more research driven—to help us arrive at a diagnosis or an insight. If, for example, we suspect you might be depressed, we might turn to the Beck Depression Inventory, a twenty-one-item list that measures your attitudes and symptoms of depression. If we want to know about your personality, we might ask you to take a Myers-Briggs test.

So it’s understandable that people assume there’s a test that can be used to determine whether a child is transgender. Unfortunately, there currently isn’t. We don’t yet have the research to say which characteristics define a child who is likely to identify as transgender. Also, the answer to the question, “Is my child transgender?” isn’t necessarily as simple as “yes” or “no.” We’re conditioned to think of gender as binary, either male or female. In reality, however, gender is more like a spectrum or a continuum. At one end of the spectrum, you’ll find people who identify as strictly male or female. Their internal sense of their gender matches their sex organs, and they present themselves to the world as that gender. At the other end are people who identify as transgender: their gender identity is the opposite of the gender they were assigned at birth. Between those ends, however, you’ll find a great deal of diversity. For example, someone born with ovaries and a uterus may identify as female, but prefer more stereotypically masculine hobbies and clothing. She might wear suits and kick back with a cigar and a glass of scotch—but she’s firm about being a “she.” She’s gender diverse, but not necessarily transgender. Yet another person born with feminine sex organs might identify and present himself as male, but not mind that his breasts and hourglass figure cause society to see him and relate to him as a female. Again, gender diverse but not necessarily transgender. Still another person might feel female some of the time and male at other times, fluidly moving back and forth among genders. These gender-diverse people fall in the middle of the gender spectrum and often identify as gender fluid. Others feel like one gender on the inside, but prefer to express themselves as a different gender on the outside. And some gender-questioning youth are not really sure—they’re still figuring out who they are.

As you can see, much like race, gender exists in many different shades. Children who don’t conform to gender norms today will not necessarily identify as transgender one day. One boy who enjoys ballet and likes to paint his nails may never identify as female, whereas another child assigned male at birth may enjoy the same interests and wonder, “Why does everyone keep telling me I’m a boy? I’m a girl! Why don’t they get it?”

All of this creates a challenge when creating a one-size-fits-all checklist. So, as you read the following signs, remember that they are only signs—not absolute proof of a child’s identity. No matter which signs you notice and which ones you don’t, line up support and seek out the assistance of a trained counselor with experience in helping gender-diverse people.

Sign #1: Your child presents in a way that is not congruent with the gender assigned at birth.

Though this is the sign that may have caused you to pick up this book, it’s probably the least predictive sign of all. That’s because, as we mentioned, gender falls along a continuum and one’s gender expression doesn’t always match up with one’s gender identity. Some rough-and-tumble boys love dolls, tea parties, and My Little Pony. So many boys love My Little Pony, in fact, that society even has an affirming nickname for them: bronies (a combination of “bro” and “pony”). Conversely, some girls prefer trucks and boxer shorts, but that doesn’t necessarily make them transgender. If you study the gender expression of 100 random people, we’re willing to bet that you’ll discover a wide diversity in gender expression. You’ll find women who work as plumbers and men who cry at romantic comedies, women who hate to sew and men who love to knit—the list goes on and on and on.

Gender identity is not confined to how you express and present yourself; it’s also how you see yourself. So, though your child may strongly express as the opposite gender, treat this sign lightly, especially if none of the other signs apply. Give your child the space to explore gender. Instead of putting firm limits on what is and is not appropriate for your child’s gender, encourage your child to express their individuality. That’s what Karen and Brian, of northeastern Pennsylvania, did when they noticed that their two-year-old assigned-male child seemed to continually gravitate toward “girl” toys. If he was playing with a Thomas train set, he searched for the few girl engines, such as Rosie, Lady, and Emily. He chose to read books about Dora the Explorer, and never about Diego, and he wanted to dress up as Uniqua, the pink Backyardigan, for Halloween. “We didn’t know if it was a phase,” Karen said. “So we allowed our child to explore gender and experiment. We decided to give it until age five to see if anything changed.” As it turned out, by age five, their child was strongly identifying as female, so they transitioned their child to live as a girl.

Sign #2: Your child fantasizes about being a different gender.

During role-playing games, does your child consistently choose to be characters of the opposite gender? Does your daughter, for example, ask to be the dad when playing house? Does your son choose Wii avatars with ponytails and skirts? When telling stories about life as a grownup, does your child describe the life of someone of the opposite gender? For example, perhaps your son says, “When I grow up, I’m going to have a big family, and I’ll be the mom.” These are all signs that your child may identify as the gender that is opposite of the one your child was assigned at birth.

Sign #3: Your child is hypervigilant about privacy.

Transgender children can experience a great deal of discomfort about their genitals.

Some children engage in magical thinking: “If no one sees these private parts, we can pretend they are not there.” As a result, these children can experience intense anxiety in public bathrooms and changing areas as well as during visits to the doctor when they are expected to remove their clothing. Even at home, they often don’t want anyone, including their parents, to see them nude. Dr. Michele has counseled families whose young children kept locking them out of the bathroom.

For some children, the discomfort over their genitals can become dangerous. One parent caught her transgender daughter with scissors in the ready position to cut off her penis. Another mother asked her transgender girl why she kept pushing down her genitals. The girl said they were bothering her and she wanted them gone.

Youth who’ve gone through an unwanted puberty can become extremely socially anxious. Some spend time tightly binding their breasts in an attempt to present themselves with flat chests. Others become so socially anxious that they rarely come out of their rooms.

Sign #4: Your child smiles when people get confused over their assigned gender.

One mother told me that strangers continually mistook her child, assigned female at birth, for a boy. The mother cringed whenever strangers said, “What’s up, little man?” But then she noticed that her child smiled and visibly relaxed when strangers used male pronouns. The child quickly tensed up again when the mother corrected strangers and said, “Actually, she’s a girl.”

If your child is ever mistaken for the other gender, pay attention to your child’s reaction. Does your child seem to enjoy it? When you correct others, does your child wince? Has your child asked you to please not correct people when they refer to them as the other gender?

Those may be signs that your child is more comfortable when people relate to them as the gender opposite to the one assigned at birth.

Sign #5: Your child wants a do-over.

One mother of a six-year-old began to suspect her tomboy might actually be transgender one evening as she comforted her child after the loss of a family pet. Her daughter had asked, “What happens after we die?” and the mother had replied, “Some people believe nothing happens. Others believe we die and go to heaven. And some people believe in reincarnation, that when you die you are reborn as someone else.” The mother was stunned when her daughter said, “When I die, I’m coming back as a boy and my name is going to be Tyler.” This mother was also understandably concerned because her daughter now seemed to be looking forward to death.

I’ve counseled other children who have asked, “Why did God make a mistake when I was born?” and then followed up with, “Can I go back to heaven so God can fix me?” These are concerning questions. Not only are they a sign that your child might be transgender, but they are also signs that your child might be suicidal. Many of these children are too young to understand that they can’t simply take a trip to heaven, be fitted with new genitals, and be sent back to the same loving family. They don’t comprehend the certainty of death.

For parents of teens, these types of self-harming statements and behaviors may be the first and only sign that something is amiss. Often these parents are blindsided by teens who—during or just after puberty—quickly transform from a happy, well-adjusted kid into an angry, anxious recluse. At first, the parents might blame it on puberty. Then they start to wonder if their child has a mental illness or personality disorder. It’s not uncommon for parents to take their teen from psychiatrist to psychiatrist, receiving one diagnosis and prescription after another. Finally, they learn their child is transgender. In many (but not all) cases, once they affirm their child’s true identity, the emotional problems fade.

Unfortunately, transgender youth attempt suicide at an astronomically high rate. If you suspect your child or teen is suicidal, seek immediate medical attention, ideally from someone experienced in gender issues.

Sign #6: Your child identifies as transgender, gender fluid, gender queer, gender expansive, or another gender-diverse label.

When your child tells you who they are, believe them. Younger children might express their gender in many different ways:

        Why do I have girl parts? I’m a boy.

        Why do I have boy parts? I’m a girl.

        Why can’t I be a boy?

        Why can’t I be a girl?

        I feel like I’m a boy.

        I feel like I’m a girl.

Older preteens and teens are often more blunt. Ruby remembers when her teenager pulled her aside and nervously said, “I can’t go on pretending anymore.” Ruby said, “Pretending about what?” Her child replied, “I don’t feel like a girl. I haven’t felt like a girl. I think I am transgender, and I would prefer to be a boy.”

When Sue asked her teenage child what was “wrong,” her teenager answered, “I am not in trouble, if that’s what you think . . .” There was a pause. The teen continued, “I am not gay, if that’s what you think . . .” Another pause, and then: “I am transgender.” Sue jumped up and hugged her child, saying, “Thank you for telling me. It’s okay! I want you to stop worrying right now. Everything will be okay. We’ll figure this out. I love you! We just want you to be safe and to be happy!” It wasn’t until the teen went to sleep that Sue Googled “transgender” because, as she said, “I had no idea what it was.” But, to Sue’s credit, she quickly got herself up to speed. “She’s intelligent, and I never doubted she knew who she was. I realized she must have been thinking about this for a long time, so I needed to help her get to a place where she would be happy.” Today, Sue’s daughter is a happy, healthy young adult who is in a loving relationship with another woman.

Here’s an important caveat: if your child hasn’t made such a statement, it doesn’t mean your child isn’t transgender or gender diverse. Not all children are mature or confident enough to voice strong statements about their gender identity without first being invited to talk about it.

Also, not all children understand the question, “How do you identify?” Instead, try asking, “Which would you say you are, a boy or a girl?” You may be surprised to hear a strong and confident answer. I’ve counseled children as young as three who are barely verbal but who will say, “I’m a boy” or “I’m a girl.”

Sign #7: Your child is happier after transition.

One of the best ways to get a sense of your child’s gender identity: invite your child to experiment with gender expression. If you’ve been resisting your son’s desire to grow out his hair and to go by the name Abby, stop resisting and start encouraging. Similarly, if your daughter has been begging for a buzz cut, allow it. Encourage friends and family to address your child with the name and pronouns your child prefers.

If you are like many of the parents I’ve counseled, the idea of doing this may feel scary. You may want to know, with 100 percent accuracy, that your child is transgender before transitioning socially. How will friends, other parents, and family react? Will your child be teased, bullied, and ostracized? Those are valid concerns, but you can work through them. If a full transition feels too daunting, you might try smaller, limited experiments. Maybe, for example, you first welcome your child to experiment with gender expression during a vacation to a place where no one knows your family.

As your child experiments with gender expression, notice if your child relaxes and seems happier. It may sound rudimentary, but noticeable happiness after transition is one of the best diagnostic tests we have to determine if a child is transgender.

In addition to the seven signs we’ve already mentioned, it’s also worth considering how persistent the signs have been. Have you noticed them only recently, or have they persisted for many months or even a few years? The longer the signs have persisted, the more likely your child is somewhere on the gender-diverse spectrum. That news may, at first, seem scary. So, we’d like to reassure you: Your child is an awesome human being, one whose life is full of possibility. When these children are championed, they go on to live amazing lives. You really do have what it takes to protect, nurture, and raise this beautifully diverse human being. The rest of this book will show you the way.

2

IT’S NOT JUST A PHASE

Why Children Don’t Grow Out of Their Gender Identity

Just months after her transgender fifth grader had switched to using male pronouns and a male name, Alice received this email from her sister-in-law: “Current research shows that, of children who are gender variant at age 10, less than 20 percent are transgender as adults. As puberty and developmental changes occur in brain and body, over 80 percent will accept their gender.” The implication: Your child is going to grow out of this. You shouldn’t have let your child change pronouns. You should have just waited it out. Puberty will fix it.

Alice’s child had shown signs of being transgender as young as age two, and those signs had persisted over the years. After transitioning socially on the recommendation of a gender therapist, the transgender boy was noticeably happier and more confident. Still, after receiving this email, Alice doubted herself, wondering if she was doing the right thing. She worried: Is he going to be one of the 80 percent who grow out of this? Or one of the 20 percent who don’t? Am I doing what the most current research recommends? Or am I following the advice of people out on the fringe? Will we wrap our minds around the idea of having a son only for him to one day tell us he wants to go back to being our daughter?

The uneasy feeling clung to her. So, as a pediatric endocrinologist examined her child, the mother blurted out, “Am I doing the right thing? What if he grows out of this?”

“You are doing the right thing,” the doctor assured her. “Research tells us that these transgender kids have unique brains that cause them to think differently. Your child is not going through a phase. Your child really is wired differently.”

Alice was still unsure, so she consulted several more experts and met with parents of transgender children in a support group. She also watched her child, examining his every mannerism, comment, and behavior for signs of returning to his assigned gender, but finding none. Everything Alice read, heard, and saw pointed to an undeniable conclusion. Her child was transgender, and his behavior was not a phase. That’s when her uneasy feeling finally subsided.

Like Alice, many parents wonder if their child is going through a phase, as do their friends, neighbors, extended family members, and acquaintances, who counsel them not to give in to their child’s gender-nonconforming “whims.” Over and over again, these parents confront the 80 percent statistic. They’re told that most kids grow out of wanting to be the opposite gender—and that theirs will, too. This statistic is often mentioned as a way to console parents, but many people don’t realize how insulting and hurtful it is. It implies that there is something very wrong with the 20 percent of kids who don’t grow out of being transgender, and it equates gender diversity with immorality and abnormality. Rather than alleviating a parent’s emotional pain, this statistic only lengthens it, causing parents to cling to false hope and extending a painful period of mourning.

Perhaps the most important argument against this statistic, however, is this one: it’s not true. Though the statistic appears in many news stories, it’s based on several extremely flawed studies. There were three main problems with the research.

1. The studies included children who were not transgender.

Most or all of the 80 percent who were thought to “outgrow” being transgender were never transgender to begin with. “A larger percentage of gender diverse people are not trans,” says Kristina Olson, PhD, who is in the middle of an ambitious twenty-year study of hundreds of transgender youth enrolled in the University of Washington’s TransYouth Project. It’s common, for example, for young boys to enjoy dressing up as princesses, which doesn’t necessarily mean they are transgender. You don’t have to be a little girl to enjoy stereotypically feminine clothing and toys. Nor do you have to be a little boy to enjoy roughhousing, sports, and frogs. That’s because there’s a difference between someone’s gender identity (who they are) and someone’s gender expression (how they express who they are).

As children grow, some do indeed change their cross-gender expression, though their gender identity usually remains fixed. At age three, Jeremiah loved a pink tutu that belonged to his sister, happily spinning around the house while wearing it. Within three months, he lost interest, and the pink tutu eventually found its way into the yard sale pile. But this is not an example of a child “growing out of” being transgender; Jeremiah was never transgender. He was merely a child who enjoyed activities, clothing, and toys stereo-typically associated with femininity. Jeremiah always saw himself as a boy. He never once told his parents, “I’m a girl.” He didn’t grow out of his identity; he merely grew out of the pink tutu.

Yet another variation: Some children fluidly move among genders, feeling more “boy” some days and more “girl” other days. Or they may not identify as either gender. It’s easy to make the mistake of assuming that these children are “changing their minds” or “outgrowing” their gender identity. What’s really happening, however, is that their identity is fluid, neither exclusively male nor female, but rather a mixture of both. We refer to such children as gender fluid, gender expansive, or gender queer.

Finally, many gender-diverse children—arguably the majority of them—become more insistent and persistent in their cross-gender expression and identity as they age. They feel strongly that they are boys, despite having been born with ovaries and a uterus, or that they are girls, despite having been born with a penis and testes. In Dr. Michele’s many years of clinical experience working with these kids, she has found that when children consistently identify in this way for more than a year, it’s highly unlikely that they will outgrow their gender identity, and many other clinicians around the country have found the same.

When all of these children get lumped together into one research category, it can seem as if 80 percent of them outgrow their gender identity. Yet, many of the children in past studies never identified as a different gender than what they were assigned at birth. When asked if they were boys or girls, the feminine boys answered, “Boy.” But because they expressed themselves in stereotypically feminine ways, they were brought to a gender clinic by concerned parents and tracked over time, along with the truly transgender children. In reality, most of the kids who were included in the “80 percent” were never transgender in the first place.

In Kristina Olson’s study—which is still ongoing—children are sorted into the transgender category only if they identify as a gender different than the one they were assigned at birth. She’s also following a separate group of non-transgender, gender-diverse children (who may be gender queer or fluid), as well as a group of cisgender kids, and the results—to appear in the next several years—may, once and for all, lay the 80 percent myth to rest.

2. They documented people who stopped coming to their clinics as no longer transgender.

Just because the children stopped coming to the clinic doesn’t mean they are no longer transgender. They might have switched doctors, moved, or, worse, committed suicide. Also, it’s common for transgender people to express their true gender, face an abundance of ridicule and harassment, and then repress it. “At age three, four, or five, an assigned male might show a proclivity for stereotypically girl clothes and toys and might love playing dress up at preschool. Such a kid gets many messages not to do this. So what happens? That child’s identity gets suppressed,” says Johanna Olson-Kennedy, MD, an adolescent medicine physician who specializes in the care of gender-diverse children at Children’s Hospital in Los Angeles. “The shame grows as the kid grows. Adolescence begins and if the kid makes it through puberty, the struggles become unbearable during adulthood.”

Transgender people often cycle through many expressions and repressions before ultimately living authentically. As transgender woman Tina Madison White wrote in her memoir Between Shadow and Sun, “We spend decades pursuing every explanation and remedy we can think of . . . But eventually, we see our time running short and our list of alternative explanations running out. Exhausted and demoralized, we look at last at the one door we had never opened. Open it. Or die never having lived.”¹ Consider Caitlyn Jenner and the many other public personalities who transitioned late in life. Had they been a part of a study during their adolescence, the researchers would have said they’d outgrown their transgender phase. In reality, however, they’d only learned to conform and hide who they really were.

3. The study samples were extremely small.

When a study includes fewer than 100 study participants—as all of these studies did—spurious correlations tend to pop up. And this seems to be the case with these “80 percent grow out of it” statistics because, if you survey endocrinologists and gender therapists, you’ll quickly learn that “desisting” (the term used to describe children who “grow out of” their gender identity) is extremely rare, especially after children have socially transitioned and lived as their identified gender for at least a year. Many will say that they don’t have a single documented case. Others might offer one or two out of hundreds of children who have been under their care. “In my clinic, we have not seen any of our patients change their mind about their affirmed gender identity,” wrote Norman Spack, MD, the first U.S. endocrinologist to begin treating transgender children in 1985.²