When Kids Say They're Trans E-Book

Stella O'Malley

• Herausgeber: Swift Press
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2023

Seitenzahl: 500

Beschreibung

'Essential reading for all parents and professionals supporting young people struggling with the issue of gender identity' Louise Perry Being the parent of a gender-questioning child is confusing. There is a lot of advice out there, but much of it goes against what many parents feel instinctively is the right approach. And the stakes are very high if you get it wrong. There have been many books written for parents who are facilitating a child's gender transition, but almost none for parents who decide that social or medical transition is not the best option for their child. Written by three professionals working in the field – Sasha Ayad, Lisa Marchiano and Stella O'Malley – When Kids Say They're Trans is explicitly a resource for parents who want their children to flourish, but do not believe that hasty medicalisation is the best way to ensure long-term health and well-being. Parents who have successfully helped their children navigate gender distress without resorting to surgery and hormones have done so by actively taking the reins, not waiting until they found the right therapist or doctor. When Kids Say They're Trans will tell you all you need to know, and will give you the confidence to trust your own instincts.

Leseprobe

Sasha Ayad, Lisa Marchiano and Stella O’Malley are therapists with extensive experience and refreshing perspectives on gender. In addition to consulting with thousands of families, they have worked together on several important initiatives. The three helped found GETA, an international association of therapists who aim to provide thoughtful treatments for legitimate mental health concerns, without pushing an ideological or political agenda. In addition, Stella is the founder of Genspect, an international alliance of professionals, trans people, detransitioners, parent groups and others who seek a healthy approach to sex and gender.

‘The authors have managed to provide an easily readable guide to gender identity aimed at parents and those who care for children and young people. They have found a way of speaking very plainly about this complex issue that maintains coherence without simplifying, and all the frequently raised questions and issues are dealt with in ways that will prove extremely helpful. In the sad history of this issue parents have often been marginalised from services providing “care” for children and young people, and this has been extremely damaging. This book redresses that. Apart from answering a real need of families and carers, it should also be read by all professionals dealing with children and young people, whether or not gender identity is their area of interest’

Dr David Bell, retired consultant psychiatrist and former governor of the Tavistock and Portman NHS Trust

‘A wise and empathic resource for parents struggling with intensely difficult parenting terrain, based on the authors’ extensive expertise as therapists for gender-dysphoric youth. A godsend for lonely and anguished parents trying to do the best for their trans-identified child’

Kathleen Stock, author of Material Girls

‘Parents of children who announce a transgender identity often find themselves in a world of confusion and contradiction. These brilliant, clear-eyed authors – all with extensive clinical experience – have written the emergency survival guide for families’

Abigail Shrier, author of Irreversible Damage: Teenage Girls and the Transgender Craze

‘This compassionate and evidence-based book is an essential counterbalance to the ubiquitous “trans child” narrative that has misled so many loving parents into unwittingly harming their gender-distressed children’

Helen Joyce, author of Trans

‘There is perhaps no subject today that is more complicated, fraught, and confusing than the sudden rise in gender dysphoria among young people. Parents encountering this issue for the first time will be hit with a tidal wave of conflicting opinions, theories, and “experts” that, however well meaning, are guided by an incoherent and potentially harmful ideology. The book could not have come soon enough. Its authors are leading figures in the effort to bring sense and rationality to the conversation. Moreover, they are experienced clinicians who understand that gender dysphoric youth deserve meaningful psychotherapeutic treatment, not blind approbation on the internet. For any parent embarking on the gender journey, When Kids Say They’re Trans should be the first stop along the way’

Meghan Daum, host of The Unspeakable Podcast and author of The Problem with Everything: My Journey Through the New Culture Wars

To every mother and father who loves their child and wonders what their gender distress is really about. And to parents who feel they’ve had nowhere to go with their worries. This book is for you.

Contents

Preface1 Is My Child Trans? 2 Social Contagion and Rapid Onset Gender Dysphoria (ROGD) 3 Sexuality 4 Parenting Alternatives to Affirmation 5 Social Transition 6 Medical Interventions 7 Dealing with Therapists, Schools, Universities and Other Professionals 8 Family Styles and Dynamics 9 Managing Conflict with Your Child 10 Self-Care for Parents 11 Alienation and Estrangement 12 Desistance 13 Detransition 14 How to Row Back After Affirmation 15 It’s Not Really About Gender Appendix 1: What Is Gender? Appendix 2: Social and Cultural Movements That Can Shape Gender-Related Distress Appendix 3: Gender Dysphoria: Diagnosis and Definitions Appendix 4: Approaches to Treatment Appendix 5: Child and Adolescent Development Appendix 6: Common Coexisting Conditions GlossaryResourcesReferencesAcknowledgements

The one thing parents can do for their children is live their lives as fully as they can, for this will open the children’s imagination, grant permission to them to have their own journey, and open the doors of possibility for them.

—James Hollis

Preface

This is a book for parents, and it is explicitly pro-parent. We are three psychotherapists, two of whom are mothers, who have each consulted with hundreds of parents over the course of our careers. Recently, parents have been getting a remarkably bad rap, especially when it comes to hot-button cultural issues such as gender. We recognise that there are some truly terrible parents in the world. It is difficult to be a therapist and not be aware of this fact, as many come into treatment to deal with childhood experiences that have left them traumatised or struggling. And yet the vast majority of mothers and fathers are good parents who love their children and sincerely want what is best for them. In general, parents or carers know their children better than anyone else – better than doctors, teachers, therapists or sports coaches. Parents also love their children more than anyone else. There is usually no one on the planet who is more invested in seeing their children thrive than them. When something goes wrong in children’s lives, it will be their parents who show up and do the potentially painful work of helping them put the pieces back together. When something goes well, no one is more thrilled, happy and proud than the parents. If you are a carer or an extended family member looking after a child, you will also feel highly invested in their well-being and want to guide them to make the right choices, especially if the child has a history of trauma.

When children are small, parents are generally the best authority on their children. Parents have a sense of the child’s history, challenges and struggles. As children grow to independence, they will become the experts on themselves, but this takes time, and it is helpful to have scaffolding and guidance from someone who knows them well. When doctors, therapists, schools or other institutions intervene between a child and their parent, the result is usually not optimal, except in extreme (and thankfully unusual) conditions.

The first rule of this book, then, is that parents must trust their own instincts – that deep, inner knowing we often have about a situation. By ‘instincts’, we distinguish between impulsively reacting to an emotional trigger and taking into account the small, insistent voice that tells us what is right for us. Much of what is being promulgated about kids and gender invites parents to ignore or silence this instinctual knowing. We are told that our female-bodied child is a boy, and that we have never realised it before. We are asked to surrender our authority to others, including strangers on the internet who may be no older than our child. And we are ridiculed or demonised for not abandoning what we know about our child and about reality itself.

You are the world’s leading expert on your children, and you likely know more about them than anyone else. You certainly know more about your child than the three of us do! In the following pages, we’ve gathered advice and information based on the most current research, as well as our own experience with gender-questioning young people and their families. This may not all be a perfect fit for your family or your child. Take what feels right, but don’t let anything here supersede your instincts about what you or your child need.

The debate around the social and medical transitioning of children is evolving quickly. New research adds to our knowledge almost weekly. After spending several years working with gender-questioning young people and their families, talking to academics and researchers, and familiarising ourselves with all aspects of the debate, we believe that socially and medically transitioning a child is not advised, given the current knowledge about risks and benefits. As things stand, the medical transition of adolescents is, at best, experimental.

Medical transition damages the body. Taking cross-sex hormones comes with risks both known and unknown. If a natal (biological) female transitions in adolescence or young adulthood, she may be looking at taking testosterone for many decades. Transgender surgeries destroy healthy tissue and biological functioning. Whatever one thinks of cosmetic surgery, and we are certainly concerned about any such surgeries being performed on young people, transgender surgeries – sometimes referred to as ‘gender confirmation’ surgeries – tend to be more invasive and may render someone sterile or with impaired sexual function. Breast augmentation doesn’t usually have such damaging outcomes, although we would recommend extreme caution with regards to a young person undergoing that procedure, as we know adults can come to accept a physical feature that, to their teenage self, was an unacceptable flaw. Justifying invasive medical procedures that permanently harm the body requires proof that benefits outweigh harms. The claim that your child is the opposite sex from the one you know him to be and that he requires life-altering procedures to thrive is not supported by good evidence, much less the extraordinary evidence such a claim demands.

When science can’t give clear answers regarding children’s health, parental judgement becomes even more important. You deserve to be given all available information about possible treatments and afforded the respect to take your time and make the decision you believe to be right for your family and your child, without fearmongering, threats of dire consequences, or undue influence.

We recognise that some parents of gender dysphoric children and adolescents will decide that undertaking social and medical transition is the best option. This book might be helpful to you as you are considering your options and trying to decide which course to take. Fair warning: the evidence in this book will generally steer you away from transitioning your child. If you do decide to pursue your child’s transition, this book won’t be likely to help you much. There have been many books written for parents who are facilitating a child’s gender transition, but there are few if any books for parents who decide that social and/or medical transition is not the best option for their child. Many who have taken this approach have been vilified in the media and online. They have been told their children will become suicidal. There have been few places where they could find support.

This book aims to redress this balance. It is explicitly a resource for parents who want their children to flourish but who do not believe hasty medicalisation is the best way to ensure their health and well-being. It is a book for parents who would like to support their child’s exploration of identity but who do not believe it is advisable to concretise such exploration with irreversible drugs and surgeries. It is a guide for parents who affirm their child’s wonderful, unique personhood without believing ‘gender identity’ should be privileged over other aspects.

There are holiday clubs, summer schools, organisations, workbooks, Facebook pages and clinics for parents who want to affirm a child’s chosen gender. If you want the help of a professional to assist in socially or medically transitioning your child, you will have your pick. If, however, you would like to slow down a child’s rush to engage in life-altering medical procedures or to ensure a child has engaged in a thorough process first, you may find professional help in short supply. Every day, the three of us are contacted by desperate parents seeking therapists who will help a child to examine all potential outcomes of such a decision.

But helping your child to learn about themselves is not a job you can outsource to professionals. Parents who have successfully helped their children navigate gender distress without resorting to surgery and hormones have done so by authoritatively taking the reins, not waiting until they found the right therapist or doctor. You can do this. You are the person most invested in your child’s flourishing. You have the widest perspective on his or her future and past. Because there aren’t a lot of resources now, you will have to become your own expert. This book will help you do that.

In the chapters that follow, we’ll explore gender identity, also referred to as ‘gender’. How do we understand the increased interest in this subject in recent years, and how is this affecting children and young people? We’ll look at what is currently known about interventions for gender dysphoria (a discomfort with the sexed body) and offer advice on how to navigate these choices.

We’ll consider the impact that having a gender-questioning child has on a long-term partnership or on your relationship with your ex-partner, on siblings, on friendships, and on the extended family. We’ll explore best strategies for parenting and look at all the potential outcomes. Finally, we’ll offer suggestions for how to weather the storm. We’ve also included a resource list at the back of this book where you can learn how to find more information.

The three of us each have unique stories that brought us into this world of gender, and we have a lot of experience of working with parents. Since 2021 our organisation, Wider Lens Consulting, has offered in-person retreats for parents of trans-identifying children where we help them replenish their energy, bear witness to their experiences and offer them practical help with managing their child’s gender issues. Our work with parents has afforded us valuable insights into the experience of parenting a trans-identified child.

Stella is an Irish psychotherapist who had her own intense experience with gender as a child, and the resolution of her gender distress has made her curious about the wisdom of early intervention. She was the presenter of Channel 4’s documentary on the topic, Trans Kids: It’s Time to Talk (2018). In addition to facilitating a parent coaching site that provides practical help to parents who are navigating their child’s gender-related distress, Stella is the director of Genspect, an international organisation that offers a healthy approach to sex and gender.

Lisa is a US-based psychotherapist and Jungian analyst. Noticing parallels between gender exploration and other social phenomena, Lisa began investigating what might be contributing to the rising number of trans-identified teens. In her private practice, she has worked with dozens of parents of trans-identified young people and has also worked with clients who were detransitioning and regretting their medical gender interventions.

While working as a school counsellor, Sasha started her school’s first GSA (gay–straight alliance) to create a safe space for LGBT kids to discuss their evolving sense of identity and sexual orientation. She noted that, in some cases, gender dysphoria emerged after young people adopted a trans identity, rather than the other way around – especially following heavy social media and internet use. She began her private practice in 2016, which has been exclusively dedicated to gender identity concerns ever since. Sasha also runs a robust online membership group to help parents navigate their child’s identity exploration with discernment, wisdom, and compassion.

The three of us have counselled hundreds of families, dozens of gender-questioning young people, and numerous detransitioners. We offer a compassionate, evidence-based approach to parenting a gender-questioning child. This approach draws upon the most up-to-date research and also relies on age-old wisdom about what it means to be human.

A word about language: we don’t believe there is such a thing as a ‘trans child’. There is no evidence that children can be born in the wrong body, or that some children are born with an innate gender which is misaligned with their sex. We do know there are some children who suffer from gender dysphoria, and we recognise that medical interventions are offered in the belief that these will alleviate their distress. Nevertheless, it is not possible to change sex. Because we do not believe there is a separate category of people who are innately transgender, we use sex-based pronouns. We refer to children’s sex and not their gender identity, and we do not use terms such as ‘trans boy’, preferring the accurate term ‘trans-identified female’. We note that the term ‘trans children’ is not used in the Cass Review, the NHS’s commissioned report on gender services for children in the UK: ‘Some children and young people will remain fluid in their gender identity up to their early to mid twenties, so there is a limit as to how much certainty one can achieve in late teens.’1 Many young people identify as non-binary, gender-fluid or something else other than ‘transboy’ or ‘transgirl’. We use the word ‘trans’ to cover any and all gender identities.

Some people thrive after transitioning. We passionately believe trans-identified people deserve rights, protection, compassion and dignity. Nonetheless, we believe such a drastic intervention should only be considered by adults whose brains have reached emotional maturity. Furthermore, comorbidities (pre-existing mental health conditions) and any history of trauma should be taken into account when helping people discern whether medical transition will be right for them. Being human is an extraordinarily complicated affair, and we celebrate the myriad, creative adaptations people make to live as fully as they can. Like any intervention, however, transition may solve some problems and create new ones. Anyone considering such consequential procedures deserves a neutral space in which to consider all aspects of such a decision and access to solid information about possible risks and benefits.

Through our work, we have all become close to trans adults. Their wisdom informs our practice, and we are grateful for it. Many trans adults have joined with us in expressing alarm about the rapid medicalisation of children and young people. They have added their voices to the growing chorus of individuals from all walks of life and all parts of the political spectrum who champion children and young people in their wholeness and complexity rather than reducing them to a constricting, medicalised notion of gender. Their support has enriched our understanding of this issue, helping us to bring important insights to you.

This book celebrates parental love as a power that creates the foundation children need to move out into the world. Eventually, you must let your children find their own way and make their own mistakes, but as they grow to maturity, you are best suited to be their guides and support.

1

Is My Child Trans?

‘It came in like a rocket,’ said Jason, father of fourteen-year-old Clara. ‘One day she was a quirky kid, a little lonely, mad about anime, without any signs of gender issues, and the next day she was in tears, declaring that she was a boy, had always been a boy, and needed hormone treatment as soon as possible. It was the most bewildering moment of my life. If Clara really is trans we will support her all the way, but how can we know if this is truly who she is?’

These days, this is how it often happens: gender-related distress among teenagers arrives seemingly out of the blue, with few warning signs, and parents typically respond with a sense of shock and astonishment and an intense determination to seek out the best possible options for their child. The problem is that when a child comes out as trans, the emotional fallout can be considerable on everyone. In today’s heightened political atmosphere, gender issues have become so controversial that it can be very difficult for parents to ascertain the most suitable response.

The number of teens and young people medically transitioning has exploded across the Western world in the past decade. It is coming to light that clinicians have been providing these medical interventions without sufficient evidence that they are helpful or necessary.1 It appears that large numbers of young people, many of whom are gay, lesbian, bisexual, autistic or suffering from complex mental health issues, are being harmed. This is an unfolding medical scandal of unknown proportions. If you are reading this book, we assume your family has been caught up in this powerful cultural juggernaut.

What does trans mean?

As psychotherapists working with gender-related distress, we are frequently asked by parents whether we believe their child is ‘truly trans’. Hidden in this question is an implicit assumption that we subscribe to gender identity theory: the belief that some people have an unknowable, unfalsifiable, inner essence that makes them ‘trans’ and which may require the person to transition before they can be happy (see more on this in Appendix 1: What Is Gender?). We don’t view gender dysphoria in this way; instead, we have a developmental understanding of this phenomenon. There are a wide variety of reasons for a person to develop gender-related distress, and likewise there are many ways this distress can be alleviated. We see medical transition as a life strategy that comes with certain costs. The decision to medically transition is an attempt to adapt – whether it is the best strategy available is open to debate, and will differ from person to person.

Parents often find the terminology involved in gender issues confusing, and it can be valuable to learn the various terms so this doesn’t become an impediment to connecting with your child. While our ‘sex’ represents our natal bodies, our sense of ‘gender identity’ describes the range of characteristics pertaining to femininity and masculinity that a person might experience. To further complicate matters, the concept of gender identity also encompasses those who feel they operate outside the binary of feminine and masculine. Readers who would like to know more can refer to the Glossary at the back of the book. The six Appendices also clarify key concepts, co-occurring mental health conditions, and terminology.

Assumptions that everyone has a gender identity and that gender is an innate quality are new and unevidenced theories that often ignore other factors that may be contributing to a person’s gender dysphoria. Some believe that once a child has a clinical diagnosis of gender dysphoria there is no other option but to medically transition, but this doesn’t follow. Studies show that most kids grow out of it: gender dysphoria is resolved naturally during puberty or early adulthood for roughly 80% of children.2 We have worked with many clients who have moved beyond gender dysphoria, and as mentioned earlier, one of us suffered from it in childhood. Some found therapy helped with an acceptance of their body and their place in the world. Others found that an absorbing interest in other aspects of life reduced and eventually eliminated their dysphoria: deeper friendships and loving relationships are often mentioned. Many people who have medically transitioned are happy they have done so, but others regret it and seek to reverse the process by detransitioning (see Glossary for definitions). Some people learn to live with their gender dysphoria, like millions of people with other conditions, and use different strategies to regulate their emotions so they can live a fulfilling life.

It is highly questionable that a person needs lifelong medication (which is what medical transitioning entails) to be their ‘true self’. Many trans-identified young people focus on concepts such as ‘my true self’ and ‘let me be who I really am’ and ‘I was born in the wrong body.’ But none of us have been ‘born in the wrong body’– we are born in and as our bodies; there are no alternatives. We die when our bodies die, and what happens after that is up for debate. There is no evidence to suggest we had other bodies to choose from.

Moreover, who is your true self? Is it the person you were at sixteen? Or thirty-five? There is little consensus. The English psychoanalyst Donald Winnicott used the term ‘true self’ to describe the authentic self: our ‘false self’ is created as a defensive facade, which can lead to the individual feeling dead and empty inside.3 Meanwhile, the American psychologist Carl Rogers focused on the ‘real self’ (that embodies the individual’s true qualities) and the ‘ideal self’ (the characteristics they aspire to have): the gap between our real and ideal selves is where our conflict lies. It is worthwhile for you and your children to know about these theories, as they offer rich opportunities to explore the nature of the self. You may be able to use these ideas to spark conversations with your child that can open up a deeper understanding. Plenty of gender-distressed individuals benefit from a psychological and philosophical analysis of human nature, the conscious and unconscious mind, and the options available to tackle any distress. No matter how intense the suffering, a thoughtful and compassionate exploration of who we are and who we want to be is often valuable.

So, is your child trans? If you mean does your child have an innate, untestable, inner quality that requires him or her to undergo social or medical transition to survive and thrive, the answer, we believe, is no. On the other hand, your child’s gender-related distress is likely real and acutely felt. Your child may well meet the criteria for a diagnosis of gender dysphoria. But what exactly does this mean?

What is gender dysphoria?

There is a difference between clinically diagnosed gender dysphoria and being trans. The word ‘trans’ is employed as an umbrella term to describe people whose gender identity is not the same as, or does not sit comfortably with, their biological sex. Being ‘trans’ is not a diagnosis, and anybody can identify as trans, whereas gender dysphoria is a diagnosable mental health condition. But nothing about this topic is simple, and different organisations take different positions. Essentially, in layperson’s terms, gender dysphoria is the distress related to being uncomfortable with one’s body and/or the associated stereotypical roles associated with one’s sex.

Gender dysphoria is not just one thing. Why a person develops gender dysphoria is the subject of a lot of debate. For example, the experience and presentation of gender dysphoria will look different in a middle-aged heterosexual natal male and an adolescent same-sex-attracted natal female, or between a small boy who loves to flounce in dresses and a teen girl with multiple mental health problems and a diagnosis of autism.

The condition will likely look different in different populations. We’ve included more information in the appendices about how gender dysphoria is conceptualised in different ways, as well as how our understanding of this condition has evolved in recent years. For now, it’s important to note that there are many theories related to ‘gender’ as a concept, and that the criteria used to diagnose gender dysphoria rely on outdated sexist stereotypes.

Some hold that all people have an innate sense of gender which may or may not be the same as their biological sex. This innate gender identity is said to be the origin of gender dysphoria, or a trans identification, when it doesn’t correspond with biological sex. However, there isn’t any robust evidence that all people are born with an innate gender identity. We believe gender dysphoria is the result of a complex interplay of biological, psychological and social factors, and its causes, manifestations and effects vary considerably from one sufferer to the next. People who hold this developmental understanding of gender dysphoria tend to view identity exploration as an important stage that unfolds during adolescence and needs to be tackled if the person is to become a fully functioning mature adult.

When Chloe suddenly identified as trans at fifteen, never before having shown any signs of gender-nonconformity, her parents were worried she had landed on the wrong solution. So they decided to slowly but surely speak about different aspects of their nationality, race, religion, sexual orientation, social class, thoughts, beliefs and experiences in a bid to show Chloe the significant impact these can have on identity. Chloe was mixed-race and had never before given much consideration to this part of her persona – and an online test that traced her DNA to India and Brazil widened her perspective on her sense of self and reduced the obsession and distress over gender.

Is my prepubertal child transgender?

Prior to the recent explosion in teens coming out as trans, gender dysphoria showed up most often in two groups – middle-aged natal males, and young, prepubertal children, especially natal boys. There has always been a small cohort of children – Stella was among this group – who strongly reject their biological sex when they are very young. As with other age groups, gender dysphoria in young children can be influenced by biological, social and psychological factors.

When a child has childhood-onset gender dysphoria, the whole street knows about it. This typically emerges between three and seven, when the child has come to realise that society has gendered expectations but before they have become overly self-conscious. Children this age often engage in magical thinking, and so it is relatively easy for them to believe they are the opposite sex. Their ability to take on the role of the opposite sex can be impressively insistent, consistent and persistent, and yet tends to rely upon outdated stereotypes. The strength of personality in many of these children can be a defining reason why some parents take it so seriously.

We believe gender-nonconforming children would feel much happier if they were allowed to wear whatever they pleased, and play with whatever took their fancy. We look forward to the day when a boy can dance around in a princess dress without being commented upon. Sadly, these days boys in fairy dresses and girls with short hair are often asked their pronouns by well-meaning adults who expect them to identify as a ‘trans kid’. It’s hard to be a gender-nonconforming child today, perhaps even harder than in previous generations. In a world where we are increasingly focused upon diagnoses, categories and frameworks, many find it difficult to remain ambivalent – the adults often seek to label a child as ‘trans’ or ‘gay’, but this might not suit a little boy who just wants to have a tea party wearing a princess crown. The world of make-believe can feel to children like a sacred space where they get the chance to expand their consciousness to the outer limits. Heavy-handed adults coming in with their grown-up perspectives can break the spell.

We believe it is inappropriate to ask children to state their pronouns or how they identify. As mentioned above, various studies have found that roughly 80% of these children outgrow their gender dysphoria by the time they are adults. Not only that, but a large majority of them end up being same-sex-attracted.4 Although puberty can be challenging, it can bring about a reckoning and a sexual awakening in the gender dysphoric individual, and this can lead them to a place of self-acceptance.

Some children, though, continue to feel profoundly self-conscious about their gender-nonconformity. Many experience mental pain because they are not the sex they want to be. If this is severe, parents might seek professional help. But given that the diagnosis of gender dysphoria relies upon regressive stereotypes (see Appendix 3), it might be more useful to bring gender-nonconforming role models into our children’s lives, rather than seeking professional help for what is often a societal problem. This way, they can learn there is no right way to be a boy or girl. Parents of young children could introduce their child to figures from history and literature – for example Joan of Arc, Grace O’Malley, George in The Famous Five, Jo Marsh in Little Women, Pippi Longstocking and David Walliams’ The Boy in the Dress all offer different ways to expand our understanding of gender roles. Some of these stories are over a hundred years old and yet feel more liberated than much of the content offered to girls today. On the other hand, the stark lack of representation of feminine boys in literature, notwithstanding more recent trends, suggests how deeply entrenched gendered expectations have been for young boys.

Parents can help by providing children with ways to answer adults who seek to impose categories on their identity. Answers to ‘What are your pronouns?’ can be sassy, such as ‘I don’t do pronouns, I’m still a kid,’ or more formal: ‘No thank you, I don’t feel the need to label myself.’ Whatever way the child prefers to handle this should be considered, but it is the parent’s role to ensure their child doesn’t become exhausted by constant questions about their identity, so a friendly word in the ear of adults before events such as summer camp can be valuable.

Parenting gender-nonconforming children in the age of trans kids

Lisa Selin Davis, author of Tomboy: The Surprising History and Future of Girls Who Dare to Be Different

My daughter was three when she first asked to wear a tie and a button-down shirt. This was not her father’s daily uniform – he went to work in frayed jeans and a T-shirt – nor mine. But somewhere she’d gotten the idea that this was how she wanted to dress, and we consented. My mother gave her a dapper hat. My stepmother gave her my little brother’s old blazer. She emerged as the nattiest dresser in preschool, one who mostly played with boys.

Then she asked for the same kind of short haircut that her male preschool friend had. To be honest, we were, by this point, a little confused, and even a little bit worried. Though I had been reared in the 1970s and 80s on the gender stereotype-busting record Free to Be You and Me, and myself wore short hair and unisex clothes as a kid in the golden era of the tomboy, there seemed to be no other girls like my daughter anywhere around us. I didn’t understand what was happening, or why she was so different, or what we were supposed to do.

Neither, I realised after many years of research into the science, psychology and history of gender-nonconformity, did anyone else. This was before the debut of Jazz Jennings, before the cultural battles over what to teach kids about gender in schools, or whether and how to medicate gender dysphoria, before children were asked to name their pronouns in school – or before schools hid pronoun changes from parents. Our doctor was fascinated, always asking our daughter if she felt like a girl or a boy. The parent coordinator at school asked if she wanted to change in the boys’ locker room. She was seven years old by then.

I did not know then that they were asking if my daughter wanted to socially transition; that wasn’t part of my vocabulary yet, not part of the cultural lexicon. Their offers struck my husband and I as kind, but also as strange. Why were they assuming that a short-haired kid who played baseball and wore sweatpants wanted to disavow her sex? We had several butch lesbians in our family. My daughter had models of female masculinity. She wasn’t unhappy or uncomfortable. But it was incredibly difficult to navigate a world that seemed to have absolutely no understanding of a girl who was more like a typical boy. No one had advice.

A decade has passed since then, and in that time so much has changed – including the word transgender, which has expanded to include young kids with no gender dysphoria but who don’t hew to the gender norms and stereotypes associated with their sex. Sometimes parents of these kids write to me. They tell me their daughter wants short hair and trucks and to wear boys’ clothes, or their son likes dresses and dolls and nail polish. They want to know what is happening, or why their kid is so different, or what they should do.

So here’s what I tell them – and what I wish people had told me ten years ago.

First, we have to insulate them against the messages that their sex will or should determine their interests. They will learn early and often by cultural osmosis that pink – and kindness, sensitivity, dolls – is for girls and blue – and sports, exuberance, anger – is for boys. We have to remind them they need not limit themselves in what they explore or cotton on to because of what kind of body they have. Clothes, toys, colours and nail polish have no sex. We don’t have to reinforce and play by our society’s rules about what’s for boys and what’s for girls.

We also have to accept and facilitate our kids’ nonconformity, allowing them to present as they please, and not shame them for their natural proclivities – while keeping them rooted in the reality of biological sex. It takes about eight years for kids to understand gender constancy, that their body is what makes them a boy or a girl, not what they like to wear or do or play with. Before that, they don’t always understand the difference between sex and sex stereotypes. If we keep talking about those differences, that will normalise their non-adherence to stereotypes. We can also make sure they have models of gender-nonconformity, of feminine boys and masculine girls, even though you might have to watch old Jodie Foster movies to locate them.

The other thing we have to do is fortify our children to navigate a world that doesn’t understand them. Though many feel the current gender revolution makes room for gender-nonconforming kids, I’d argue it actually pathologises them. Telling a stereotypically boyish girl that she can be or is a boy doesn’t allow an ambiguous space for her to occupy. Telling a feminine boy that his mannerisms and tendencies make him a girl, or affirming his fantasy that he is one, tells him he’s doing boy wrong, that there’s no room for him in the category he naturally, biologically belongs to. I think this not only creates more shame, but can lead to very serious medical interventions.

Other than that, I don’t think there’s anything we have to do when our kids present as gender-nonconforming. Many parents want to know what their child’s gender-nonconformity signifies, if they have a child who is trans, or a child who will be gay later. They’re eager to slap a label on. I get it. I was very confused when my child acted so differently to all the other girls we knew, and so were all the professionals around us. But there is no way to forecast the future from a child’s gender atypicality. Gender-nonconformity in children is not predictive of any one outcome.

When we practise being comfortable with ambiguity, when we don’t immediately make meaning out of their gender, we leave room for exploration, for growing understanding, for shifts and changes, for a child to become a person. And then we can absorb the miracle of children like this: children so secure in themselves that they march against the grain, no matter how it unsettles the adults around them. All they needed to say was, ‘Congratulations on having a kid who is immune to stereotypes! Let’s check in down the line and see what happens.’

There’s research showing that the more a child rejects strict gender roles, the better they do academically and in other areas of life.5 Many women who were serious tomboys got better jobs later, because their comfort with men and masculinity allowed them to pursue male-dominated fields.6

Gender-nonconformity is a gift. If your child is this way, you don’t need to fix them. Let’s try to make room for them, and in the meantime, let’s make them resilient with our love and understanding. They are perfect just as they are.

Is my teen or young adult transgender?

Beginning around 2006, psychologists and researchers at gender clinics around the world started to notice an unusual pattern – more and more teens were beginning to complain of gender dysphoria and seeking out medical interventions to help them transition – and most of them were female.7 This was a significant change from previous decades, when most people with gender dysphoria were either young boys or middle-aged men. Nowadays, gender dysphoria among teens is common. Does this mean they are all trans? Once again, we note that ‘being trans’ suggests a belief in an innate gendered essence. There is no evidence base showing that teens who identify as trans have an essence which makes them inherently different from their peers and requires medical intervention. As with prepubertal children, the complex forces at work can shape a teen’s experience of mental suffering, and gender-related distress in teens can be influenced by biological, psychological and social factors.

Biological factors

Some people think gender dysphoria is a result of some sort of physical condition – for example an influx of hormones during pregnancy could theoretically lead the foetus to having had exposure to more testosterone (or oestrogen), which could eventually lead the individual to feel more or less feminine or masculine. Although some studies using brain imaging scans showed that the brains of transwomen were shifted towards their gender identity, these studies typically don’t factor in sexual orientation – gay men also have brains that are shifted towards being more female.8 Our brains are malleable – some women are masculine and some men are feminine – and if we could expand our understanding of how males and females ‘should’ act, then perhaps many people would feel more liberated to behave as they please.

We have noted in our work that polycystic ovary syndrome (PCOS), a condition which can cause irregular menstrual periods, excess hair growth, acne, infertility, weight gain and other issues, can contribute to a young person’s trans identification. Girls with PCOS may not ovulate and may have high levels of androgens, usually thought of as male hormones. Other medical conditions, such as the very rare differences of sexual development (DSDs), may play a role in some young people developing gender dysphoria. As with all things related to gender, there is little research and a lot of theory.

Disorders such as anorexia or body dysmorphic disorder (BDD) tend to be somewhat heritable, suggesting that there may be a genetic component to them. Both eating disorders and BDD appear to overlap with gender dysphoria, making it plausible that individuals may have a genetic predisposition to develop gender-related distress. BDD can sometimes masquerade as gender dysphoria. Body dysmorphia is a mental health condition where the individual spends an inordinate amount of time worrying about perceived or real flaws in their appearance.9 Anyone can develop this condition, but it is more common among teenagers and young adults. Many parents report how their teenage daughter has come to despise her breasts and seek to flatten them using a binder. Equally, teenage boys might become obsessed with their body hair and spend hours removing all trace of it. Many parents report that their child has identified as trans but appears to be experiencing BDD. You can help with this by reading about BDD, so you understand what might be going on for your child. We offer more information on conditions that are commonly linked with gender dysphoria in Appendix 6.

Psychological factors

Gender dysphoria can give expression to various kinds of psychological distress. These days, it often arises at the beginning of adolescence, which can be a difficult time for many. Childhood is usually filled with magic and make-believe. Then, somewhere around the age of twelve or thirteen, many teens are faced with the brick wall of reality. No longer are they in a world where the good guy always wins. High school is not the fun place promised in the movies – it can be joyless and often brutal. Many teenagers we work with can feel deeply disappointed by their adolescence, and it can tip them into an even deeper realisation that life can often be difficult, unfair and lonely. For many young people, there are no sleepovers filled with warm heart-to-hearts with their peers, no great romances. If your child is neurodiverse or has any additional challenges, the support can fall off a cliff at around this time – it’s suddenly deeply uncool to be receiving extra help, and many teens shun it. The schoolwork tends to go up a gear, and extracurricular activities typically become more focused and competitive during early adolescence.

Loneliness, anxiety, depression and other mental health concerns can emerge or worsen at this time, leaving a child susceptible to also developing gender dysphoria. Obsessive–compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), depression, anxiety, eating disorders and other conditions appear to make teens more vulnerable to developing gender dysphoria or understanding themselves as transgender. Gender-related distress may emerge as a result of trauma, and the young person may find gender dysphoria to be an effective unconscious defence against further vulnerability. For example, a girl who has been abused might want to become a boy to be able to fight off further aggression.

Neurodivergent kids can find gender a welcome explanation for their experiences of difference. While intense fixation, fantasy and rigidity are developmentally normal for most adolescents, they are even more pronounced for children with autism spectrum traits, from childhood through adolescence. Your autistic daughter may have very concrete ideas about being perceived as male, despite your attempts to inform her about biological reality. Your son may have constructed an elaborate fantasy of how happy he will be when he is ‘seen as a woman’, while in practice his poor hygiene and masculine appearance couldn’t make him any less feminine-looking. Why the disconnect? Autistic teens have greater difficulty not only in reading the perspective of others, but in imagining how his or her own perspective may change in the future. They also tend to fixate obsessively on their passions, and if gender transition has captured your teen’s attention, you may find it extremely difficult to broaden his or her interests.

Young people may find that a trans identity offers a sense of belonging or an acceptable explanation for experiences of difference of all kinds. It appears that gifted kids are adopting trans identities at disproportionately higher rates. In her 2018 paper that first described rapid onset gender dysphoria, Lisa Littman found that almost half of the young people described in the sample had been formally identified as academically gifted.10 This could be in part because these kids are deep thinkers, but being very smart can lead one to feel out of step with one’s peers, and so gifted kids can struggle socially. Identifying as trans may offer a comforting and much-needed tribe of other quirky, misfit kids that is also socially valorised in many schools.

A trans identity can do other heavy psychological lifting as well, giving voice to unconscious conflicts with parents and providing a way to separate from them psychologically. During adolescence, individuating from parents is a key task as we begin to sort out who we are and how we are different from our families. Some kids recruit a trans identity to help them with this task.

Social factors

The extraordinary rise in the number of teens identifying as trans in the last decade has not happened in a cultural vacuum. A perfect storm of social phenomena has occurred, a confluence of apparently random events: the arrival of social media (YouTube and Reddit came into being in 2005, Twitter in 2006, Tumblr in 2007, Instagram in 2010, Discord in 2015 and TikTok in 2016); a rise in the popularity of identity politics and a corresponding surge in social justice activism; ‘diagnosis creep’ (widening definitions of disease so that more people are diagnosed) and the tendency to self-diagnose via the internet. This confluence of events has resulted in an unexpected consequence: thousands of young people across the world have suddenly and intensely come to believe they need to medically transition into a different person. In Appendix 2, we have included some more information on social and cultural movements that influence many young people.

The conflation of sexual orientation with gender identity

Same-sex-attracted adolescents may experience gender dysphoria as they come to terms with their sexual orientation. Many detransitioners have stated that they experienced shame and discomfort as they grew into an awareness of their sexual orientation, and that this is part of what fuelled their desire to transition. Internalised homophobia seems to be a significant contributor to the growth of teens identifying as trans.11 We have included a fuller discussion of this important subject in Chapter 3.

Raising a gender-nonconforming child in the twenty-first century

Not all gender-questioning kids are gender-nonconforming. Many trans-identifying teens have no significant history of early gender variance or distress. However, some kids who identify as trans have struggled to fit themselves to society’s gendered norms. For these kids, navigating distress can be especially complicated. Despite the emphasis on gender identity, sexual orientation, inclusivity, diversity, Pride marches and flag-waving, it seems to be more difficult to be a gender-nonconforming child today than it has been for decades. Although, as mentioned earlier in this chapter, current research suggests that the vast majority of children with childhood gender dysphoria outgrow the condition by early adulthood, these studies were mostly carried out prior to the conception of social transition and/or the widespread use of puberty blockers. This generation is the first to be offered the option of social transition in the early years and medical intervention at puberty, and nobody knows the long-term outcomes. Puberty blockers are experimental and have never been tested for large-scale use on children with gender dysphoria. Little is known about the long-term side effects, such as whether or how much hormone blockers can affect the development of the teenage brain or children’s bones.12

While books, films and other media can be helpful to introduce gender-nonconforming figures, introducing real-life role models is also very important. Becoming familiar with cultures whose perspectives on gender are different – for example the fa‘afafine in Samoa or the muxe in Mexico – can further broaden your child’s perspective. Learning about places where a third gender has been introduced apparently as a way to cope with homosexuality in patriarchal societies could lead to thought-provoking conversations between parents and children. The general idea would be to bring about a deeper awareness of how society can have an impact on our behaviour.

Although many gender-nonconforming children in previous generations felt lonely and isolated, these kids today seem to be more confused and anxious. Gender-nonconforming young people often report feeling a sense of relief that they finally have a clear path before them when they identify as trans, and in many schools and colleges announcing a trans identity can elevate a child’s social status. Teenagers have always had a greater sense of invincibility, one which is often responsible for impulsive decisions and poor risk assessments. The older we get, the more risk-averse we tend to become. It is the role of teenagers to push against boundaries, but it is the role of parents to maintain boundaries in their children’s lives.

Treatments for gender-related distress

As we have seen, whether we are discussing young children or teens, it is unlikely that their gender-related distress can be attributed to a single, simple explanation. Instead, a complex interplay of factors goes into shaping each person’s experience. Gender-related distress manifests a little differently for each person who develops it. An individualised method of treating such distress therefore makes the most sense. Unfortunately, in the last decade or so, a single one-size-fits-all approach to treating it has taken hold.

The affirmative approach to treating children and youth with gender dysphoria was developed in the first part of the century and has since become widespread. It rests on the assumption that children who announce a trans identity have an innate gender identity which is at odds with their biological sex. From this premise comes the conclusion that the most compassionate and effective way to respond is to affirm this child’s stated gender and offer support for them to socially and/or medically transition. If people had an innate, unchangeable gendered essence that could be at odds with their biology, early medical transition would likely make sense. However, as we have seen, there is no evidence that this is the case.

Affirmation is a relatively new approach, without a lot of solid evidence to back it. Gender dysphoria in children was not treated according to the affirmative approach in the past; clinicians usually recommended ‘watchful waiting’, that is, monitoring a child’s gender issues without intervening. We explore this approach further in Appendix 4. The affirmative approach doesn’t accord well with treatments for any other mental health issue – therapists don’t usually simply agree with a patient’s self-diagnosis and green-light whatever treatments the patient wishes. According to the affirmative approach, not only therapists are meant to affirm; everyone in the child’s life is meant to validate and even celebrate the child’s perception that she is a boy. This includes teachers, friends, family – and parents.

Some affirmative clinicians take their time and assess a young person thoroughly. They may take several sessions and consider factors such as social influence and comorbid conditions in their assessment. In our experience, though, these more careful clinicians are in the minority. In any case, the paradigm of the affirmative model is that some kids are ‘truly trans’. We believe this is the wrong framework. We all tell ourselves stories to help us make sense of our distress. Sometimes these stories allow us to find constructive or neutral responses to our distress, and sometimes they lead us to choose destructive ways of coping with it. We believe it is better to address the causes of the distress rather than its symptoms.

A growing body of research has not yet identified the most effective treatments for gender-related distress. Though many studies tout the efficacy of social and medical transition for children and young people with gender dysphoria, lots of these have significant methodological limitations that make it difficult to place much confidence in their conclusions. Social transition appears to set kids on a path to medical intervention, and medical intervention can have significant health consequences. Anecdotally, we often see the mental health of young people who have transitioned getting worse instead of better.

Conventional psychotherapy, on the other hand, has an established history of assisting people in finding lasting solutions to handling their distress. Since the three of us are psychotherapists, it is probably not surprising that we favour therapy as a first-line treatment for gender-related distress. Psychotherapy is an exploratory process that facilitates deeper self-understanding, and the gender-affirmative approach, with its narrow-minded focus upon gender, can deprive individuals of sufficient psychological care. Clinicians who advocate gender-affirming treatment sometimes equate psychotherapeutic approaches with conversion practices. On the other hand, others argue that gender-affirmative therapy is a form of conversion therapy, as an individual who is experiencing internalised homophobia could seek to ‘trans away the gay’; a butch lesbian might end up medically transitioning to become a boy who is attracted to girls. This accusation is rooted in the fact that a disproportionate number of gender dysphoric children are same-sex-attracted.13 We have met enough adolescents with internalised homophobia to know that this is a real issue and must not be discounted.

We have more information about treatment approaches to gender dysphoria in Appendix 4, and we encourage you to familiarise yourself with this material. You need to be aware that many therapists are providing treatment according to the affirmative model, which could foreclose exploration and lead a young person to a medicalised pathway without careful assessment and time for open-ended questioning. If this is the only option available to you, you may be more effective at helping your child through this experience yourself rather than going to a therapist.

So, is your child trans? As you probably realise by now, we don’t think that’s the right question. Your child may be experiencing utterly real, painful distress. He or she needs your love, support and understanding. But how we conceptualise psychological suffering varies dramatically depending on the lens we bring to the situation. How we understand someone’s distress often determines how we respond to it, and responding with medical intervention carries significant risks. We prefer to look at a child’s gender distress through a psychological lens that considers the whole person. Through compassionate connection, loving engagement and a holistic, depth-oriented understanding, we believe that parents can support their children’s healthy growth and development.

2

Social Contagion and Rapid Onset Gender Dysphoria (ROGD)

During lockdown, thirteen-year-old Becky was allowed free access to her devices – there was little else to do and so she immersed herself in the digital world. Puberty had brought difficult changes, and Becky started to hate her body. Online meanderings led her to take a quiz touted as ‘simple and accurate’ to find out if she was trans. After answering questions such as ‘Do you feel comfortable in your own body?’ and ‘What is your first memory of learning about gender?’, the results declared ‘Congratulations, you’re trans!’ This made Becky feel both thrilled and scared. Finally there was an answer to all her inner turmoil. Naturally risk-averse, she felt worried and intimidated by the road before her, but the knowledge that she was ‘truly trans’ gave her confidence and courage.

Becky continued to read about LGBTQ+ issues and came to believe that she only needed to transition to feel comfortable in her own body. Internet sources suggested that her parents wouldn’t be happy about this and so she began a secret, online life which offered a community of other distressed people who seemed to be feeling just as she did. Most parents wish to only do what is best for their beloved kids, and had Becky confided in her parents she would probably have received a good deal of love and support. But by the time kids like Becky come out as trans to their parents, they have often been led to believe two things: that they have an innate gender identity within them, and that their parents could well be resistant. Parents, on the other hand, are generally blindsided by this unexpected swerve into gender issues and race frantically to catch up with their child while desperately trying to figure out whether their child could be trans.

Often parents have assimilated gender identity theory without thinking about it much, and so they assume ‘being trans’ is an innate condition affecting a small number of people. They tend to believe this is unlikely to be their child, as the announcement feels bizarre and incongruous. Their children perceive this as transphobia. To complicate matters further, parents often believe their child has been unduly shaped by online influences; their child often reacts with bitter fury, as if this somehow degrades the purity of their trans self.

Social contagion is a concept that social scientists have observed and discussed for over a hundred years. It refers to the spread of ideas, behaviours, emotions and beliefs among networks. Our modern idiom, ‘going viral’, recognises the potential for the contagion-like spread of ideas. As humans, we have an innate susceptibility to being influenced by those to whom we are connected. Research on social media shows that interpersonal influence can spread happiness, divorce, weight gain, smoking, bulimia, political engagement, cooperation, climate change action, suicidality, depression, and any other number of ‘conditions’.1 Social scientists have recently become concerned about the potential for mental health concerns to spread via social media, particularly among young people. It appears plausible that online networks could help disseminate symptoms and an accompanying belief system about these symptoms that would result in an internet-mediated mass sociogenic illness. ‘Mass sociogenic illness’ refers to the spread of disease-like symptoms where no infectious agent exists.