What is actually involved in a transgender transformation?

Your child or teen has decided to transition. What is the next step? Dr Brad McKay, GP and medical expert from Embarrassing Bodies Down Under talks through what to expect, and how you can help your child.

If your child or teen has decided to transition, it can not only be confronting, but also confusing. Here Dr Brad McKay provides his expert advice on the process and common questions that may arise.

Q: You hear stories of transitioning taking years. How does a child or teen transition and how long can it take?

1. Deciding to Transition:

“This can come as an epiphany or gradually over a long time,” explains Dr McKay. “Either way, you want to take time letting your decision sink in. Transitioning takes a lot of support and planning. Take the time to do it right, rather than rushing in.”

2. Social Transition:

This involves changing your appearance, clothing and makeup to suit your gender identity. "It’s not about fitting into social norms, but more about feeling comfortable with what you are wearing,” adds Dr McKay. “This can involve changing your name, changing the way people address you with pronouns (he/she/they), and even which bathroom you use,” he continues. Initially, however, “it involves careful planning between the trans child, their parents and the school.”

3. Medical Transition:

Seek out a GP, who can help you, Dr McKay advises. “You will need to see a psychiatrist to make sure that you can make this big decision, but you will also need support along your journey,” he explains. This will involve a referral to an endocrinologist in order to use puberty blockers, or before starting hormonal treatment.”

4. Surgery:

In Australia, you need to be over 18 years old to have any gender transition surgery. It’s also best to be on hormonal treatment for at least two years before embarking on surgical treatment, adds Dr McKay. “Remember that there isn’t ‘one magic operation’, but there are a series of operations necessary to transition,” he says. “Most operations are only noticed in the privacy of your bedroom, but they don’t usually make you feel any different about yourself as a person. Surgical options are just part of the overall treatment.”

Q: What are the physical (surgical) and medical (hormones) that a child/teen can undertake to transition?

The rise in oestrogen or testosterone production during puberty causes irreversible physical changes to the body. Fortunately for trans children, “puberty blockers” can be used to delay puberty and can give trans children more time to make sure that they are happy with their decision to transition. Putting a pause on puberty is associated with a good outcome and a low rate of regret. It can also allow puberty to be timed more appropriately, in alignment with peers.

Behavioural training can be provided at any age, to enable trans children to be more comfortable with how they present themselves to others.

Surgical procedures can only be performed in Australia once trans people are over 18 years of age, but it’s important to speak with your treating psychiatrist and endocrinologist to plan the timing of hormonal treatment and surgical procedures.

Remember that there is no 'end point' to gender transition. Hormones, behavioural training, speech pathology and surgery are only to be used as useful tools, to help trans people feel more comfortable in their skin.

Q: Under Australian law, what age are children legally allowed to start transitioning?

Children diagnosed with gender dysphoria can be given hormonal treatment to prevent puberty, giving them more time to think about their future transition goals. “When teenagers turn 16 years old, they can have hormonal treatment to stimulate physical changes that are characteristic of their affirmed gender. These changes are considered to be irreversible,” says Dr McKay. “Gender transition surgery is not carried out until a transgender teenager is over the age of 18 years.”

Q: What are three things you advise for parents if their children are actively requesting a full transition of gender?

1. Educate Yourself:

“Do everything in your power to educate yourself about transgender issues and gender transition. It’s important to understand your child’s point of view,” advises Dr McKay. “Read books, research online, speak to people who are already trans, but most importantly talk with your child. They have gone through a lot of emotional turmoil and anxiety to get to this point. Listen and understand them to the best of your ability.”

2. Seek Professional Help:

All doctors are not created equal, Dr McKay highlights, so finding a general practitioner, who has experience with trans patients and seeking the appropriate health services in your area is essential.

3. Be Patient:

“Transition is a process; it takes time.”

Q: How can families find the right health professionals to guide them through this time?

It’s important to have a GP who has knowledge and practice treating people who are trans, Dr McKay stresses. “If there isn’t one available in your area, the next best thing is to have a GP, who can listen, accept, learn and understand as you go through each step of the process.”

If your GP doesn’t know who the most appropriate psychiatrist or endocrinologist is in your area, then check out online resources or speak to people in online forums for their recommendations, he advises. “There are plenty of individuals who have gone through gender dysphoria before you, and they are usually happy to give guidance and support.”

Above all else, don’t continue to see anyone who is judgmental or not willing to listen to you or your child, Dr McKay points out. “If you continue to see a doctor who doesn’t understand the issues you are facing, this can do way more damage than good.”

Q: What type of emotions can parents expect to experience?

Parents will often feel confused or guilty when their child comes out as trans, Dr McKay admits, adding the ‘blame game’ is often common as they try and work out why their child is transgender. This is not doing anyone any good; he points out. “Remember, it’s not because you let your daughter play with trucks or because you bought your son a Barbie doll. Being transgender is part of the complexity and wonderfulness of being human - it just happens.”

Fear is also a common emotion parents experience as they worry about their children's safety, mental health and how they will be accepted by society. “Life is tougher for trans kids, but it’s better for them to live a life they are happy with, rather than live a life of misery being someone they don’t want to be,” he points out.

Q: What are the laws protecting transgender children and teens?

People who are trans are protected from discrimination by law. The Sex Discrimination Act makes it “unlawful to treat a person less favourably than another person in a similar situation because of the gender-related identity, appearance, mannerisms or other gender-related characteristics of the person”.

Q: How do these laws compare to overseas?

“Australia is one of only a few countries in the world that needs a court jurisdiction for trans children to receive medical treatment,” explains Dr McKay. “This causes significant stress and can cost up to $30,000 which is unaffordable for many families.” In 2014 there were discussions and a promise to facilitate faster and more fair court processes in Australia, but unfortunately (by 2015) this has not happened, he adds.

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