Medical and Mental Health Considerations

Regardless of their assigned gender at birth, some children have lived in accordance with their gender identity since a very young age, living in a way that feels the most natural to them. The onset of puberty, and all its accompanying physical changes, can bring panic and anxiety to parents and child alike.

Parents of pre-pubertal transgender children are aware of this oncoming physical betrayal. They are fearful of the potential depression their child may experience, and the consequences of this depression. Rightfully so, many parents are worried their child may experience suicidal feelings if forced to experience the pubertal changes not in alignment with their identity. Simultaneously, parents are often in the dark about the consequences of acting to delay puberty or to offer cross hormones.

Medical intervention can be a more difficult decision when your pre-teen or teen suddenly announces they are transgender. This news is almost always shocking and difficult to integrate. We want to protect our children and have them make healthy decisions, yet the changes your child may request can be dramatically life-changing and permanent.

In the midst of puberty, a teen can understandably feel a strong sense of urgency as a result of physical changes. There can be intense pressure to make potentially permanent decisions without enough time or adequate understanding. As a parent, the goal is to support your child, yet still have time to make thoughtful, informed decisions. Navigating this terrain without alienating our children can be very difficult even in the best of circumstances.

Facilitating physical changes (known as “transitioning”) for transgender children brings new questions surrounding ethics, religion, fertility, and nature. As a parent learns more, some fears may be allayed while new fears are inspired. Parents may grieve for the dreams they’ve had for their child, and may not yet have discovered new ones to take their place. Yet, for these children, the ability to have their bodies develop in ways that feel natural to them can be one of the most affirming things in their lives. The importance of family support during this transition cannot be underestimated.

Parents who are just discovering their teen’s cross-gender identity may be more than a little confused regarding appropriate medical options for their child. Your teen, on the other hand, may know exactly what they want to do. Take time to let your child know that you support them. Keep the lines of communication open and explore options together. Discussing what you learn together can work to make the whole family better informed as well as allow for ample adjustment time. However, keep in mind that a parent and their child may have very different ideas of an appropriate timetable. Your child may feel rejected by you if these critical life decisions are delayed indefinitely.

Do We Need a Gender Therapist?

During this time, it may be important to provide your child with the support of a therapist who can help them navigate the various challenges and experiences they are having. It is also not uncommon for families to experience internal conflict and contention. Therapists can play a key role in helping families to make the complicated decisions related to their child.  The question of whether a family or child needs a therapist needs to be examined from several perspectives.

Once you have determined that you will seek a therapist’s support, you must then identify a professional who will be most appropriate for the needs of your child and family. By no means are all therapists well versed in issues of gender, particularly as they relate to children and youth. As you seek the services of professional, ask them what their experience is with working with transgender or gender nonconforming youth.

Gender Spectrum is part of the Child and Adolescent Gender Center (CAGC), which is a network of professionals across California committed to affirmative care and support of gender diverse youth.  If you need referrals for medical, mental health, legal or educational support, contact us at (510) 567-3977 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it and we will connect you to CAGC professionals who can help you find appropriate referrals.

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