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Created on August 5, 2017. Last updated on March 6th, 2024 at 04:54 pm
Some children and adolescents identify as transgender or gender nonconforming. The term transgender is used as a broad umbrella term to describe people whose gender identity—their internal sense of being female, male, or some other gender—does not conform to their sex assigned at birth. The term gender nonconforming is similarly used to describe gender identities or gender expressions that do not fit in with societal expectations for the child’s sex assigned at birth. Being transgender or gender nonconforming is not a psychological disorder.
Gender dysphoria is a diagnosis that is included in the DSM-5. This diagnosis is used to describe the persistent, clinically-significant distress and impairment that some transgender or gender nonconforming youth may experience due to the incongruence between their gender identity/expression and their sex assigned at birth. Children and adolescents who experience gender dysphoria may be particularly distressed by certain parts of their body, typically primary or secondary sex characteristics.
Currently, there are no psychological interventions that have been shown to reduce gender dysphoria. Therapies that aim to change a child or adolescent’s gender identity are considered unethical. (For example, the Association for Behavioral and Cognitive Therapies (ABCT) issued a statement on June 6, 2022, which formally apologized for “behavior therapy’s contributions to the development and practice of sexual orientation and gender identity and expression change efforts.”)
However, transgender and gender nonconforming youth may benefit from seeing a therapist who can help them cope with stressful experiences that they may face. Transgender and gender nonconforming youth may encounter family rejection, stigma, discrimination, or even interpersonal violence due to their gender identity or expression. These negative experiences may lead to anxiety, depression, or suicidal thoughts and behaviors. It is very important that parents and families of transgender and gender nonconforming youth support and affirm their identity—for example, by using their preferred name and pronouns—as family acceptance is a strong protective factor against negative mental health outcomes.
The World Professional Association for Transgender Health has published standards of care (WPATH SOC version 7) that all physical and mental health care providers should use when treating transgender and gender nonconforming youth. The WPATH SOC-7 outlines several gender-affirmative interventions that can help reduce youth’s gender dysphoria. Children and adolescents may choose to socially transition to live in their affirmed gender by changing their name, the pronouns they use, or their appearance (e.g., clothing, hairstyle). Secondly, some young adolescents may decide with their parents and doctors to take medications to suppress their pubertal development. This reversible medical intervention halts the development of physical characteristics that may be distressing for transgender and gender nonconforming youth (e.g., facial hair, breasts, deepening voice). Lastly, older adolescents—typically around age 16—may be eligible for gender-affirmative hormone therapy. Hormone therapy involves taking either estrogen or testosterone, which leads to significant physical changes that help transgender and gender nonconforming youths’ body match their gender identity. Some of these physical changes are permanent, though others may revert if youth stop hormone therapy. Surgical interventions are generally not recommended until age 18, except under certain circumstances.
Citations
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., & Zucker, K. (2012). Standards of care for the health of transsexual, transgender and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165-232. https://doi.org/10.1080/15532739.2011.700873
Hembree, W.C., Cohen-Kettenis, P.T., Gooren, L., Hannema, S.E., Meyer, W.J., Murad, M.H., Rosenthal, S.M., Safer, J.D., Tangpricha, V., & T’Sjoen, G.G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869-3903. https://doi.org/10.1210/jc.2017-01658
American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864. https://doi.org/10.1037/a0039906
Edwards-Leeper, L, Leibowitz, S., & Sangganjanavanich, V. F. (2016). Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation and Gender Diversity, 3(2),165-172. https://doi.org/10.1037/sgd0000167
Online Resources
Supporting Caring for Transgender Children
Books
Helping Your Transgender Teen: A Guide for Parents
“Our Trans Loved Ones” by PFLAG helpful. It is available for free download here: https://www.pflag.org/ourtranslovedones
The Trevor Project is also a great crisis and suicide prevention resource for LGBTQ youth with an associated crisis hotline: 1-866-488-7386
Trans Lifeline also has crisis resources: https://www.translifeline.org/ US: 877-565-8860; Canada: 877-330-6366
The Transgender Child: A Handbook for Families and Professionals
The Gender Quest Workbook: A Guide for Teens & Young Adults Exploring Gender Identity
From the Family Acceptance Project, the following resource is very informative for parents. It takes the stance that parents of any background share the goal of wanting to love and protect their children and being supportive of LGBTQ youth is consistent with that message: Supportive Families, Healthy Children: Helping Families with Lesbian, Gay, Bisexual & Transgender Children
If religion is a barrier to acceptance for families, two other recommended books are Unfair: Christians and the LGBT Question by John Shore and Transforming: The Bible and the Lives of Transgender Christians” by Austin Hartke.