Having a child, teenager or young friend come out as transgender or considering transitioning is a huge time in their lives. They need support, guidance and love.
Here is an educational guide from Dr Brad McKay to help parents and siblings throughout the process.
Choosing to come out as transgender is a significant step,” points out Dr. Brad McKay, GP and a member of the Embarrassing Bodies Down Under medical team. Choosing to transition permanently to a different gender is another huge step, he adds. “Offer support, understanding and compassion to anyone questioning their gender identity. Don't assume anything and if you are not sure, ask.”
Q: What does ‘transgender’ mean in youth that may be different from adults?
‘Transgender’ is when a person feels their gender identity is different from their biological sex, explains Dr. McKay. “Some children can be adamant from a young age that they feel born into the wrong-gendered body, or adults can experience a sudden epiphany or a gentle dawning of realisation. Being transgendered can be complicated, and everyone has a different story.”
There are challenges at any age for people coming out as transgender, notes Brad, “but it can be especially difficult for kids.”
“It takes incredible courage telling friends or family that you feel your actual gender is different from the one you’ve been born into. Children often experience confusion, embarrassment, distress and anxiety as they work out their gender identity. They are often fearful of not being understood, or worried that others may make fun of a serious situation.”
Transgendered children are particularly vulnerable as they depend on their parents or guardians for support and access to health care and professional support, adds Brad. “Emotional and financial support from the family can even be a matter of life and death. Research shows that 50 per cent of adolescents not receiving appropriate treatment will harm themselves and 30 per cent will attempt suicide.”
Q: What are some emotions that children and teenagers could be feeling if they experience ‘gender dysphoria’?
Trans children and adolescents can feel very confused about their gender identity and uncomfortable in their body, explains Dr. McKay. “It is difficult for children to comprehend that they’ve been born a girl when they feel that they should’ve been born a boy. Sometimes these feelings are adamant, but they may not be able to find the right words to express themselves.”
Stress, anxiety, frustration, anger, depression, embarrassment and shame are common feelings. People can feel hatred toward their body, and this can lead to self-harm or even suicide, he adds. “Emotions can become more intense as puberty approaches, and they notice physical changes, not in alignment with their gender identity.”
Q: Is there a certain age these can arise?
As soon as some kids learn to talk, they’ll be telling their family that they feel uncomfortable with their physical body while other children may have a more gradual realisation, as they get older. “Everyone has their path in life, and there are no set rules,” highlights Dr. McKay.
Q: Can children ‘grow out of’ these feelings?
Everyone’s journey is different and expecting people to ‘grow out of it’ is unhelpful, cautions Dr. McKay. Some trans children and teens feel extremely uncomfortable in their body and are highly motivated to transition to an alternate gender as soon as possible, and others will come to a more gradual and meandering understanding of their gender identity, explains Dr. McKay.
They may decide to present themselves as different genders at different events, or they may go through multiple phases of expressing their gender at various times, he adds. “Whatever course life takes, it’s important to provide understanding and support every step of the way, encouraging them to present themselves to others in the way that makes them feel most comfortable.”
Q: How can parents determine if confusion over gender is simply puberty?
Pubertal changes that occur in cisgendered children (children comfortable with their anatomical gender) are usually eagerly anticipated and help them to develop more firmly their gender identity, as they become young adults.
“However, puberty is a significant time of distress for transgender children as they start to notice unwanted physical changes,” Dr. McKay notes. “Transgender children who identify as a male can feel distressed when they begin to develop breasts or have periods. Transgender children who identify as female may be distressed when they start to grow facial hair or notice their voice deepening. If changes during puberty cause significant and persistent anxiety, stress or depression, then this could be consistent with gender dysphoria and it would be important to seek an opinion from a health professional.”
Q: How can an adult or friend know the difference between the two?
“The only way of knowing what a young teenager is going through is to ask them, Dr. McKay highlights. “If they feel comfortable telling you, great, but if they don’t feel like telling you, don’t push them,” he urges. “Make sure to leave the conversation open so they know they can talk to you if, or when, they feel like talking.”
Q: If a parent or friend is concerned about a transgender child, what are three important things they can do initially?
1. Talk to them about what they are going through and offer to help.
2. Educate yourself and help them to find appropriate sources of information. "There are many health services for trans children and adolescents around Australia. Transcend is an excellent place to start,” advises Dr. McKay.
3. Book an appointment to see a GP with experience treating trans patients. "If your usual GP doesn’t seem to be the right person, you can always go to the closest Sexual Health Clinic.”
Q: What support is out there for parents of transgender children and teens?
There is a growing number of support groups and online forums that can provide appropriate information for parents, says Dr. McKay. "There wasn’t much available information about 10 years ago, but now there are many parents and trans people who have already gone through the more difficult parts of their journey and are happy to provide a helping hand when needed.”
Q: What conversations should parents have with schools and sporting groups/family friends do you think?
Before parents talk to schools or sporting groups, it’s important to talk with their child first, says Dr. McKay. "Disclosing to others about your child’s gender identity, without first getting permission from your child, could do more harm than good. If your child is happy for you to contact their school, it is often most helpful to organise a meeting with a trusted teacher,” he says.
“Gender transition is a process, and you need a good plan. Talking with the school or sporting group about how to approach your child’s gender transition may sound daunting, but will often go more smoothly than expected,” advises Dr. McKay. “Which uniform will your child wear, what name will they go by, which toilets will they use, which sports teams will they play in, when is this change going to take place - these are all important questions to work out beforehand in order to minimise unexpected problems.”
Q: What difference do you think positive role models are having on children and teens transitioning?
This is a very pivotal point, notes Dr. McKay. “The increased media attention toward positive transgender role models makes it much easier for children and teens to come out as trans and gives them the opportunity to speak up, rather than suffer in silence,” he says. “However gender dysphoria is still poorly understood, and trans people continue to experience discrimination and poor mental health outcomes. There is much room for improvement.”
Q: As a GP, what is the most important message you can share with parents and friends of transitioning children or teens?
“Gender identity isn’t black and white," says Dr. McKay, explaining that some people don’t feel entirely male or female, and others don’t identify 100 per cent as either gender. “Others feel more comfortable being ‘gender-fluid,' choosing to identify as either male or female as they wish,” he continues. “It’s important not to push your thoughts onto transgender children or teenagers.”