Gone are the days of a pink cradle and a blue cradle, a pink or a blue wardrobe. Once the baby reveal party. has happened ,  politically correct and woke parents/  women  sit back in the well thought out  gender neutral space they have created and with curiosity wonder what gender their child will decide is their choice: male, female, transgender, gender,  non binary, agender +++

And when your child begins to claim to feel he/she/they are in the wrong body, do not pull out your hair, thump your chest and wonder where you went wrong. Just know that  gender identity evolves as an interplay of biology, development, socialization, and culture; In other words it is   a construct of multiple intersections, not just influence from you  as parents.

Although politically and legally many Western countries endorse the right of people to be gender diverse and even punish any form of  gender dsicrimination , gender diversity remains a very challenging situation for parents ,  families , educators and religious leaders to manage.

As we begin this important discussion , it’s vital to get your  understanding and language correct. It is your first step into your child’s world.

Gender identity :A person’s innermost concept of self as male, female, a blend of both or neither. One’s gender identity can be the same or different from their sex assigned at birth.

Gender expression: The external presentation of one’s gender, as expressed through one’s name, clothing, behaviour, hairstyle or voice, and which may or may not conform to socially defined behaviours and characteristics typically associated with being either masculine or feminine.

Gender diverse: A term to describe people who do not conform to their society or culture’s expectations for males and females. Being transgender is one way of being gender diverse, but not all gender diverse people are transgender.

Assigned male at birth: A person who was thought to be male when born and initially raised as a boy.

Assigned female at birth: A person who was thought to be female when born and initially raised as a girl.

Trans or transgender: A term for someone whose gender identity is not congruent with their sex assigned at birth.

Cisgender: A term for someone whose gender identity aligns with their sex assigned at birth.

Trans boy/male/man: A term to describe someone who was assigned female at birth who identifies as a boy/male/man

Trans girl/female/woman: A term to describe someone who was assigned male at birth who identifies as a girl/female/woman.

Non-binary:  A term to describe someone who does not identify exclusively as male or female.

Agender: A term to describe someone who does not identify with any gender.

Gender dysphoria: A term that describes the distress experienced by a person due to incongruence between their gender identity and their sex assigned at birth.

Social transition:The process by which a person changes their gender expression to better match their gender identity.

Medical transition: The process by which a person changes their physical sex characteristics via hormonal intervention and/or surgery to more closely align with their gender identity.

It is a big ask of you as a parent to imagine that the child you birthed is a different gender. It is going to feel traumatic and challenging and has been known to tear parents and families apart. It is also well known that having you, a parent , on his/her/they side can be a matter of life or death to a Transgender Gender Diverse child.

Consider a case currently happening in the courts of Texas where it is being decided whether or not a 7 year old boy,  James Younger should be raised as  a girl or his biological sex.  His father wants no intervention, merely a “watch and wait” approach. This is a now outdated approach, signifying a binary model and placing the child at harm as he/she/they are denied much needed psychological  support.

His mother has begun ” social affirmation ” intervention , allowing her son to take on the role of a girl. This has caused a rupture inter marriage – and of course added trauma to their child.

Experts are arguing in court as  there is some  evidence to prove that the majority of young children who self identify as gender diverse “desist” at adolescence . They claim their biological sex.  The minority “persist” to become transgender adolescents. This has been hotly denied  as this  research has been deemed methodologically flawed. And harmful to the child.

Importantly this is disputed by  the American Association of Pediatrics(AAP)

Its complicated, right ? Who to believe?!

Science not scandal, not gender politics but science holds the truth for us.

The American Association of Pediatrics  put out their policy statement in 2018, saying that when your pre pubertal child, say your 3 year old daughter, begins to take on stereotypical male roles, and is insistent on being called by her male name, wearing male clothing and engaging in typical male play,  do not follow “watchful waiting.” This places him at risk for gender dysphoria.

Gender  dysphoria is the distress that arises from incongruence between a person’s gender identity and their sex assigned at birth. High rates of depression, anxiety, eating disorders, substance use, self-harm and suicide afflict gender diverse children. They are at increased risk of harm because of discrimination, social exclusion, bullying, physical assault and even homicide. Once a child begins to socially transition , this gender dysphoria disappears. Voila!

In the 2020  ICD 11 (International Classification of Diseases )  classification system notably Gender Incongruence of Childhood has been moved out the Mental Disorders chapter and placed in the new chapter of “Conditions Related to Sexual Health” . Its called “depathologizing ” A victory !

And it is for this very reason that the American Association of Pediatrics as well as World Professional  Association of Transgender Health (WPATH)  assert a more active intervention of “Social transition ” and “Affirmation” rather than “watch and wait”.

Research substantiates that children who are prepubertal and assert an identity of TGD (transgender gender diverse)  know their gender as clearly and as consistently as their developmentally equivalent peers who identify as cisgender and benefit from the same level of social acceptance.

So here is what  you as a respectful, responsible, albeit terrified parent, take along with you when you take your child  to your health care provider:

Protocol for gender affirming interventions. These  incorporate World Professional Association of Transgender Health  (WPATH)  and Endocrine Society recommendations and include ≥1 of the following elements:

  1. Social Affirmation: This is a reversible intervention in which children and adolescents express partially or completely in their asserted gender identity by adapting hairstyle, clothing, pronouns, name, etc.

  2. Legal Affirmation: Elements of a social affirmation, such as a name and gender marker, become official on legal documents, such as birth certificates, passports, identification cards, school documents, etc.

  3. Medical Affirmation: This is the process of using cross-sex hormones to allow adolescents who have initiated puberty to develop secondary sex characteristics of the opposite biological sex. Some changes are partially reversible if hormones are stopped, but others become irreversible once they are fully developed

  4. Surgical Affirmation: Surgical approaches may be used to feminize or masculinize features, such as hair distribution, chest, or genitalia, and may include removal of internal organs, such as ovaries or the uterus (affecting fertility). These changes are irreversible.

Now parents, you need so much support as you and your families support your child. Here’s a guideline for you.

General principles for supporting transgender and gender diverse children and adolescents(before the onset of puberty)

  1. Your child needs professional support , so get him/her/they to a health care provider who is well versed in transgender health
  2. Use  of respectful and affirming language : pronouns. This means using your child’s  preferred name and pronouns . This is vital to affirming and respectful care.
  3. Psychological support: Non judgmental , safe and supportive environment.Research has shown that gender diverse children have a higher incidence of  autism spectrum disorder, depression and anxiety.  Add in trauma, family dysfunction  or learning difficulties .  They need psychological support.
  4. Family support is imperative. This is associated with better mental health outcomes.
  5. Social transition :  allow your child to outwardly express him/her/themselves in a gender role that is consistent with stated  gender identity. This may include changing your child’s  preferred name and pronouns, hairstyle, or wearing clothing that is stereotypically associated with the gender he/she/they  identifies . Allow your child to take the lead and do it in their own way. Allowing this social transition brings rates of depression , anxiety and self worth into norms with  cisgendered peers.

General principles for supporting transgender and gender diverse adolescents(after onset of puberty) 

  1. Psychological support :Many adolescents experience difficulties such as family rejection, bullying, discrimination and occasionally physical assaults after disclosing their gender identity concerns to others.
  2. In adolescents with insistent, persistent and consistent gender diverse expression, a supportive family, affirming educational environment and absence of coexisting psychological concerns is ideal. It is  buffer against mental illness.

    3. Fertility counselling and preservation procedures. Discuss this with your endocrinologist.

    4. Puberty suppression (stage 1 treatment).Thsi is recommended for adolescent who experiences distress with the onset or progression of pubertal development. Supression of strong or testosterone responsible for induction of secondary sexual characteristics, like breasts, voice changes ,  facial growth, penis growth, menstruation . It is reversible. Discuss this with your endocrinologist.

    5.Gender-affirming hormone treatment using oestrogen and testosterone (stage 2 treatment). Estrogen or testosterone used to feminize or masculine person . Some of these effects are reversible, others not. Ensure that your child is not buying hormones online and self medicating.

    Surgical interventions for TGD adolescents.

    Chest reconstruction, and genital surgery performed before the age of 18 years remains relatively uncommon internationally. Sexual function and reproductive potential plus risks fo surgery mean this is delayed for as long as possible.

    So parents, look your TGD child in the eye and promise to love and to cherish , irrespective of his/her/they gender. it could be life saving for your child.

    For more information about TGD children, contact me.