As Texas’ governor attempts to criminalize medical treatments for transgender youth, experts say there are many ways to help adolescents who are questioning their gender.
Gov. Greg Abbott of Texas declared last month that medical treatments given to transgender adolescents, including puberty-suppressing drugs and hormones, could be considered child abuse under state law. Opponents of the move swiftly responded, including President Biden, who described the decision as “cynical and dangerous.” Investigations of alleged abuse sparked by the order were temporarily halted last week after a state court ruled that the policy was “unconstitutional.”
According to a 2019 C.D.C. study, 1.8 percent of U.S. teens identify as transgender, meaning that their gender identity does not match the gender they were assigned at birth. When researchers interviewed teens in Pittsburgh as part of a 2021 study, they found that nearly one in 10 did not identify as being exclusively male or female. These adolescents are becoming more vocal about their identities and experiences, as The Times found in a 2019 survey.
Children and teens who do not identify with their assigned gender can face higher rates of depression, suicide and self harm than other kids do. Research shows that they have better mental health outcomes when they have access to what doctors call gender affirming care, which can include mental health therapy and hormone treatments. There does exist some disagreement among doctors and advocates of gender affirming care over which adolescents could benefit most from certain treatments. Still, experts think these decisions should be made by doctors, patients and their parents — not by governors or state agencies.
We interviewed child health care providers who focus on gender to understand the best ways that parents and other adults can offer support to adolescents on the gender spectrum.
Get expert help if necessary
If you have a child who is questioning their gender, follow their cues, said Dr. Daniel Summers, a pediatrician in North Andover, Mass. “Some kids, they just want to dress in a different way,” he noted. Some want to do activities that aren’t typically associated with the gender they were assigned at birth, he added, and they are happy after they make these changes. In these cases, parents don’t need to do much other than to be supportive.
But if a child seems to be struggling with their body or in social settings, or wants a more significant life change, such as changing their pronouns or altering their body with hormones or surgery, consider finding additional support. One good option is a local gender clinic, which can offer gender-affirming care, Dr. Summers said. Gender-affirming care can involve various services, including therapy and primary care. Some kids who receive this care do not undergo any medical or surgical treatments, he said.
If no gender clinics are nearby, reach out to a local chapter of PFLAG, an organization that supports lesbian, gay, bisexual, transgender and queer (LGBTQ+) people, as there are chapters in every state. You could also use the “find a provider” tool through the World Professional Association for Transgender Health. One helpful online resource is Gender Spectrum, a nonprofit organization that works to create gender sensitive and inclusive environments for kids and teens.
Widen your gender vocabulary
When it comes to a person’s gender, “the language really matters,” said Laura Anderson, a child and family psychologist based in Hawaii who specializes in gender development. It’s important to try to understand and use the terms an individual asks you to use, she said.
“Nonbinary” is a broader category than transgender, in that a nonbinary person “may identify as feeling both male and female, or neither,” Dr. Anderson said. The term “genderqueer” can be used interchangeably with nonbinary, whereas “gender fluid” individuals have a gender identity that “is a bit more fluid, in that it can shift over time from one category to another,” she said.
It’s also important to try to use a person’s correct name and pronouns, Dr. Anderson said. When one’s gender identity does not match how they are treated by others, it can lead to psychological distress, she added. Research has shown that when transgender youth are not able to use their chosen names at home, school, work or with friends, they are more likely to experience symptoms of depression, consider suicide and attempt suicide.
Dr. Anderson acknowledged that it can be hard to use the terms correctly and consistently, since their meanings or connotations can shift, and new terms can arise over time. What’s key, she said, is that caregivers try to be open to the concepts and do their best to understand them as they evolve. If you mess up, acknowledge your mistake and apologize, and try to do better next time, Dr. Summers said.
“I think the specific language is less important than the clear sense of affirmation that you’re communicating with it,” he said. “What’s important to your child is that they can see that you’re doing your best, even if there are times when you’re still not getting it perfectly.”
Offer curiosity rather than judgment
If a child doesn’t bring up the issue of gender, don’t force it, Dr. Summers said. But if they do want to discuss it, respond not with judgment or immediate concern but with curiosity, he suggested. Parents and other adults in children’s lives should avoid saying “anything that’s going to make the kid feel shut down, or rejected or unsafe,” he said.
Dr. Anderson suggested first asking the child for more information. You could say: “When do you think you started wondering about this?” or “How should I learn about it?” she said. “Set the stage, no matter what direction it goes in, for staying connected and not creating a power struggle,” she said.
It’s also fine to ask for some time to think, Dr. Summers added. It’s “OK to say, ‘This is new information about you that I didn’t know before — I’m really glad you shared it with me, but would it be OK if I think about it a little bit, too?’” he said. Just be sure to come back to the conversation later, when you’re in a better mindset.
“The most important thing is that they know you love them no matter what,” said Dr. Jack Turban, a child and adolescent psychiatrist at the Stanford University School of Medicine who studies the mental health of transgender youth. “Support of a young person’s gender identity has been consistently linked to better mental health outcomes.”
Research all treatments
There are several options to weigh if your family decides to pursue medical treatment, Dr. Turban said. Puberty blockers are medications for teens that “put puberty on hold while an adolescent has more time to explore their gender identity and think about next steps,” he said.
Dr. Summers explained that the physical changes that accompany puberty can’t easily be undone, so puberty blockers can be helpful for kids who want a little more time to decide on their gender identity before being locked into it. If they are stopped, puberty continues, so in this sense they are “fully reversible,” he added.
More research is needed into how these drugs may impact brain development and fertility, and they can cause side effects including hot flashes, headaches and weight gain.
Older transgender teens can also take hormones, such as estrogen or testosterone, which “can help to align a young person’s body with their gender identity,” Dr. Turban said. Hormone therapy is not always reversible. If it is administered to transgender girls who have not gone through puberty, it can cause fertility loss. And some studies suggest that trans women who take hormones have an increased risk for side effects such as bone loss and blood clots, though research is mixed — women and teens who use hormonal birth control can also experience these side effects.
A new draft of guidelines released last year by the World Professional Association for Transgender Health recommends that adolescents receive psychological screening before qualifying for hormone treatments, though some clinicians disagree with that requirement.
Under current medical guidelines, genital surgeries are not typically offered to minors, although some teens have undergone chest surgeries to align their appearance with their gender identity, Dr. Turban said. “Surgery is obviously irreversible and a big decision,” he added. “Doctors work closely with parents, teens and their mental health providers when weighing the risks and benefits.”
It’s understandable for parents to feel overwhelmed or confused at first when their child says they do not identify with their assigned gender, Dr. Anderson said. “It’s an unsettling time for the whole family when kids are figuring this out,” she said.
The most important thing is for parents to communicate their love and support, Dr. Summers said — and it’s OK if you make some mistakes along the way. “Love your child and be honest with them and compassionate,” he said. “Tell them that you’re sorry that you may get things wrong, but you’re trying your best to get it right.”
