Gender Identity: Is My Child Transgender?

Dr. Jill Jacobson, Pediatric Endocrinology

As many as one in 200 people in the United States are transgender, which simply put, means they have a deeply held feeling that their gender differs from what was assigned at birth.

There’s a misconception in society being a transgender person is connected to sexuality and sexual attractions, but that is not necessarily true. Most children explore the idea of being transgender at a young age even before puberty. Think of it this way; sexual orientation is about who you feel affection toward, while gender identity is about who you are.

When Do Children Know They’re Transgender?

Children as young as 18 months can feel gender dysphoric, and struggle with the way they feel and think of themselves because there is a discrepancy with the assigned gender. Although children this young don’t have a robust vocabulary and quite frankly, don’t even know what the words “boy” and “girl” mean at this age, they express their feelings in other ways. They’ll gravitate toward clothes they identify most with, whether it’s putting on high heel shoes or refusing to wear a dress. They’ll only play with toys associated with the opposite gender. Or when boys and girls are divided, they’ll go with the group they identify with most. By no means does this make your child transgender, but parents often tell me there were numerous signs at an early age, they just didn’t know it at the time.

Toddlers can also be very intuitive and may ask questions, such as why they’re in the wrong body or why they were given the wrong name.

Is Gender Identity in Children “Just a Phase”

A parent will often wonder if the child is going through a phase. Just because your son wants to play with Barbie dolls and your daughter wants to cut her hair short doesn’t mean they are transgender, and it’s not unusual for your child to talk about being opposite sex from time-to-time.

It’s when your child feels strongly about it and the feeling doesn’t go away. Transgender children are consistent (they clearly identifies with one particular gender, and don’t change their mind back and forth), insistent (they feel very strongly about their identity, and get upset when they’re told they’re not the gender they say they are), and persistent (how they identify themselves doesn’t change over time).

Stages of Transition

There are several stages of transition.

Social Transition

Gender expression is how you present yourself; name, gender, clothes etc. A social transition involves a change in gender expression. In some ways, it’s easier for children to socially transition when they’re younger. Kids look the same when they’re little, birthday parties are geared toward both genders, and sometimes elementary schools are easier to maneuver than high schools.

Puberty Blockers

After the first signs of puberty, a child can be prescribed puberty blockers which block puberty of the biological sex.

Hormone Replacement Therapy

Around the age of 16 years, children can receive hormone replacement therapy (estrogen or testosterone) to help them align with their gender identity. This is considered standard of care. There is some flexibility in the timing of initiation of hormone therapy.

Sex-Reassignment Surgery

Around the age of 18, a transgender person can consider sex-reassignment surgery. These are procedures that changes a person’s physical appearance and existing sexual characteristics to match the identified gender.

As society becomes more accepting, we’re seeing more-and-more patients who have no intention of undergoing surgery. Many are not as anxious and don’t feel a necessity to physically transition.

There’s no right or wrong way to transition, and people transitions at different paces. Some people prefer to do it earlier, whereas others wait until their older. There are also some who don't want to transition during the school year, but instead wait until summer or they go to another school.

Supporting your Transgender Child

It’s important that transgender children have the support of their families, schools and community to thrive. Just like anyone else, they want to be accepted for who they are.

If your child is transgender or exploring the possibility of being transgender, be supportive of their feelings. Allow them to express themselves in the ways that they want. It might involve allowing them to buy clothes of the desired gender. Be open-minded and let them know you’ll support them whether they’re a girl or a boy. Most importantly, (and this is advice to all parents whether you child is transgender or not) raise the child you have, not the one you expected.

Identify someone at school who will be your child’s ally, whether it’s the principal, teacher, counselor or coach. Some high schools also have LGBTQ (lesbian, gay, bisexual, transgender, questioning) safe zones, resources and clubs.

It’s important as a society that we reduce sham and stigma when it comes to transgender people. The more we talk about, the more we learn and the less judgmental we’ll be.

Learn more about Gender Pathway Services at Children's Mercy.