My gender-diverse child is still exploring their gender identity, but really distressed about puberty. What can we do?
- During puberty, hormone “blockers” can be used to delay physical development. This is reversable and gives an individual more time to explore their gender identity. Available data show that delaying puberty in transgender children generally leads to improved psychological functioning in adolescence and young adulthood. For those who were assigned female at birth, periods may be particularly distressing. Periods can be reduced or blocked with “blockers” or with certain contraceptive agents.
What treatments are available for children who identify as transgender? What does the process include?
- As gender-diverse individuals express their underlying gender identity, they engage in a gender affirmation process (sometimes referred to as “gender transition”). This process involves reflection, acceptance, and, for some, intervention. There is no prescribed path, sequence or endpoint, but the process may include any of the following components:
- Social Affirmation:This is a reversible intervention in which children and adolescents express their asserted gender identity by adapting hairstyle, clothing, pronouns, name, etc.
- Legal Affirmation:When elements of a social affirmation, such as name and gender marker, become official on legal documents (birth certificates, passports, school documents, etc.). The steps to doing this vary from state to state, and often specific documentation from the child’s health providers is required.
- Medical Affirmation:This is the process of using hormones to allow adolescents who have started puberty to develop characteristics of the opposite gender. Some changes are partially reversible if hormones are stopped, but others are not.
- Surgical Affirmation: Surgical approaches are used most often in adults, but occasionally on a case-by-case basis in older adolescents, to also modify certain characteristics, such as hair distribution, chest, or genitalia. These changes are not reversible..
The decision of whether and when to initiate gender-affirmative treatments is personal and involves careful consideration of the risks, benefits and other factors unique to each patient and family. The gender affirmation process is best when facilitated through collaboration between the patient, their family, their primary care provider, a mental health provider (preferably with expertise in caring for transgender and gender diverse youth), social supports, and a pediatric endocrinologist or adolescent medicine gender specialist, if available.
If my child says they are “gender fluid” does that just mean they are confused?
No. For some people gender identity can be fluid, shifting between more masculine, feminine, in between or something else, in different contexts or at different times. This may also be part of a person’s personal journey or exploration of gender.
Can my child become transgender because of their friends or things they see online? What if there were no earlier signs?
Being transgender is not contagious. Some children and teens may not have confronted or feel they have to suppress gender-diverse traits until they find nonjudgmental and affirming peers or online communities. If this is discovered by parents, or the child discloses such suppressed feelings, it may seem sudden and unexpected.
About Dr. Rafferty:
Last Updated 9/17/2018
Source American Academy of Pediatrics (Copyright © 2018)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
