Helping trans, non-binary and gender diverse kids thrive

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Misunderstanding and stigma about being gender diverse or transgender remains one of the biggest challenges facing children and their families. It can prevent them from receiving the help, understanding and support they need as they grapple with complex issues of gender identity. And it can mean they don’t always feel confident and safe in their own body as they find their place in the world.

Gender incongruence, having a gender that differs from that presumed at birth based on sex, is a variation in humanity that has always existed in every continent of the world. Australia is the home of the oldest living civilization on Earth and some Aboriginal languages that continue today feature multiple words to describe genders reflecting the reality of multiple genders having existed for millenia, for example, ‘yimpininni’ in Tiwi, ‘kwarte kwarte’ in Arrente, ‘kungka kungka’ in Pitjantjatjara.

Having worked as a specialist supporting children and young people who do not conform to society’s expectations for boys and girls for many years, I have seen first-hand the mental and physical harm, that stigma and misinformation about gender incongruence can cause. This can come from the young people’s personal views about gender, as well as those of their family, friends, school, place of worship and wider community.

Fortunately, I have seen a positive change in attitudes which has resulted in improved support for children and adolescents who may have questions about their gender. There are now specialist children’s gender services established in all mainland states of Australia. However, trans youth still report difficulties accessing health services with 40% saying they have experienced healthcare providers who did not understand or respect their identity. So, we still have a way to go before a young person can openly share their concerns without fear of discrimination, judgement, or ridicule.

Many children and teenagers are gender expansive which means the way they express gender (for example, through clothing, haircuts, first name) may or may not conform to society’s expectations or they may reject the whole notion of gender and seek to break down stereotypes. Other young people are transgender, which is when someone’s gender identity (internal sense of being male, female, non-binary or another descriptor) doesn’t align with the gender assigned to them at birth. Neither are pathological or psychiatric conditions, but both may require specialist support if the child or young person is distressed or experiencing what is called gender dysphoria.

We don’t have clear answers as to why some children or adolescents are gender diverse or trans, though believe it is likely a complex interplay of factors.

Part of the role of child and adolescent gender services is to increase understanding of the reasons why children and adolescents experience gender diversity, provide support to optimise health outcomes and provide a thoughtful and thorough assessment to those seeking medical interventions.

So, what is gender dysphoria?

The children and young people I see describe and experience varying levels of distress associated with a deep internal, sense that the gender typical to their body does not fit with the gender they identify with. Young people also talk about ‘social dysphoria’, or their distress related to negative reactions of others, such as invalidating misgendering experiences, bullying and discrimination. Gender dysphoria can range from manageable to debilitating, causing problems with family, friends, school performance, as well as depression, anxiety, self-harm and, in the worst cases, suicide.

Being trans is not ‘just a trend or a phase’. For those who experience gender dysphoria, it is a serious and persistent distress, psychiatrically distinguishable from other mental health concerns that often exacerbates risk.

Let’s not forget that growing up is complicated, and young people experience a wide array of internal and social pressures that may lead to questioning gender. Furthermore, gender diversity is distinct from gender expansive expression or diversity in sexuality, described by terms like gay, lesbian, bisexual, or pansexual.

There are also children who strongly identify with another gender from a very young age or those that begin experiencing distress in early puberty as they became intensely aware of the development of secondary sexual characteristics.

For example, parents will say that from a very early age their child never behaved as a stereotypical boy or wore boy’s clothing, that they wanted to be called a girl’s name and insisted on being referred to with she/her pronouns. In older adolescents, some have never had the opportunity to express these feelings as a child.

Children and young people who socially transition (adopt names, hairstyles and clothing that align with their identified gender) can experience external sources of distress such as rejection by friends or family, bullying, transphobia, messages of shame from public figures that contribute to depressive or anxiety symptoms, self-harm or suicidal ideation. Parents and siblings are the most important people in buffering the impacts of these stressors and much of the work of gender services involves supporting parents to understand their child, providing evidence-based information and explaining the options available to optimise their child’s life-long wellbeing.

Many parents have reported that the mental anguish and distress their children experiences quickly reduces after they transition, provided that the child has support from their family, school and other social networks.

Some children say to me that they enjoy playing with toys, or wearing clothes, commonly associated with another gender. Other young people tell me that they deeply wish that they had been born a different gender, but have no desire to access medical transition options, confident in their identity and even expressing gender euphoria. Other adolescents say they do want to transition but won’t do so because of current social circumstances (for example, they may be in the final year of high school or fearful of rejection from loved ones). Whatever the presenting issues may be, the child or adolescent, and their family, should have the opportunity to receive a comprehensive assessment and work closely with their treating clinician on an appropriate management plan.

The right support at the right time can save lives

The health risks associated with inadequate care and support for gender-diverse children are well documented. Furthermore, the lack of understanding and acceptance of gender-expansive people in our society leads to transphobia and individuals are at an increased risk of harm because of discrimination, social exclusion, bullying, physical assault and even homicide.

Gender-diverse children and adolescents also have increased rates of mental health issues if not treated early and in accordance with internationally recognised treatment guidelines. Trans youth have a 20 times increased risk of suicide compared with same aged peers in Australia and 7 times higher rate of self-harm. Some adolescents report that they resort to self-treatment with hormones (sometimes purchased online on black markets), which has potentially serious medical consequences.

Research tells us that that with the right support these kids can grow up to be trans adults with the same or better health, social and educational outcomes as same-aged peers. Gender affirming specialist care is associated with decreases in psychological distress and improvement in quality of life for trans youth.

While gender diverse children and young people are thankfully seeking help, the referrals are exponentially greater than a decade ago. European gender clinics that have been providing care for 40 years tell us today’s gender clinic youth have no greater rates of mental health distress nor are they less likely to be transgender than the smaller numbers that sought help a decade ago. The good news is that more of these kids are reaching out for support and that specialist gender services are now established.

Some families are concerned about children and young people changing their minds later in life, regretting either a social transition or medical gender affirming treatments. Retransition, or changing gender identity after socially or medically transitioning, does occur in small numbers and the exact gender trajectory of any child can never be predicted. Internationally, a recent study found that just 0.03% of young children who began puberty blockers retransitioned to the gender presumed at birth and 2.5% of early social transitioners retransitioned socially to their gender presumed at birth. While the vast majority of trans adolescents do not retransition, counselling and support is important for those that do experience a shift in gender identity. In adults the figures vary but it remains low and external pressures associated with difficulties in society being trans are often cited as key factors.

Ultimately, every child is unique and deserves access to specialist, developmentally informed, comprehensive assessment and timely, appropriate treatment when indicated. With 1-2% of adolescents potentially identifying as trans or gender diverse it’s important that our schools, health services and broader community learn more about what helps these kids thrive and the challenges they face.

Most importantly, these young people deserve respect and to be listened to and understood. It is only when this happens that they can get the support that will enable them to live a full and meaningful life as is everyone’s right.

More information

Queensland Children’s Gender Service

Open Doors Youth Service


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