Too Young?

When I write about the plight of transgender kids, it is not unusual to encounter a comment or two from people who think it necessary to share their opinion that it is impossible for a child younger than 5 to know his gender.

It is also not unusual to encounter articles by people with little to no experience working with transgender kids expressing the same or similar opinion.

Examples: Debra Soh's Why Transgender Kids Should Wait to Transition and Andrea Peyser's Push for kids to choose gender identities too early could backfire.

Soh, in particular, identifies herself as having stretched gender boundaries as a child, but did not grow up to transition.

The thing is, "stretching gender boundaries" is not the measure of being transgender.

The erroneous assumption expressed in all this is that somehow caused by parents who re deciding their children's future for them...who want to have a child be transgender.

But people who have talked to the experts who work with the families of transgender and gender non-conforming children see something different.

The nay-sayers verbalize their discomfort with such as this: "Parents are transitioning their kids too early instead of just letting them be boys who like girls’ toys."

Even some of the researchers began with that attitude.

Basically what’s changed [for me] is that I’ve discovered that many, many of these families—including some of the families I know the best—went through that.

For these children, though, parental permissiveness around gender expression didn’t address the underlying issue: their gender identity.

They don’t feel that that represents who they are. They aren’t just a boy who likes dresses—they feel that they are, in fact, a girl.

--Kristina Olson, University of Washington's TransYouth Project

Olson’s landmark 2016 study out of the TransYouth Project—a first-of-its-kind longitudinal analysis of the mental health of transgender children aged 3 to 12 published in the journal Pediatrics—found that “socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group.” In fact, their average depression score was almost exactly in line with the national average.

In other words, although the research is still early, social transition may help transgender children avoid negative mental health outcomes.

And that seems to be what worries a lot of people: transgender people can grow up to be "normal."

The characterization that families are making this decision flippantly, or that it happens with no thought process going into it, isn’t the story we hear from families who have already made the decision.

Despite the recent alarmist calls about movements to persuade parents to socially transition their children to another gender and worry that doing so sets them up for a lifetime of hormone and surgical treatment, we know of no evidence suggesting that this is an issue.

--Lily Durwood, UW graduate student

Clinicians who work closely with transgender and gender non-conforming children, like therapists Jean Malpas and Benjamin Davis at the Ackerman Institute for the Family’s Gender and Family Project, say that the media often misses the nuance and diversity of gender expression and gender identity among children—and that no one’s rushing children through the process.

There are many children, Malpas says, who seem happy to adopt an expansive gender expression without socially transitioning—and it’s no surprise that some of these children would grow up to change that expression later in life. But there are also children who are “consistent, persistent, and insistent” that they are, in fact, another gender. And that’s when transition seems to help.

It is only when a child has been very clear for a long period of time in a way that’s consistent in different contexts with their parents, with other people in their families, and with providers when they’re working with professionals that we then support the family in making that decision of doing a social transition.

--Malpas

It is true, as researchers, clinicians, and medical professionals in this field generally agree—and as critics of social transition for transgender kids take pains to point out—that previous studies have shown that many children who display some symptoms of gender dysphoria will not persist to the age at which medical interventions would take place.

it’s hard to draw conclusions from figures about the percentage of children who do not persist in cross-gender identification because both the numerator and denominator are unknown.

To deny or delay transition—and later, medical treatment—to “consistent, persistent, and insistent” transgender children simply because there is a larger population of children who are gender non-conforming is to throw the baby out with the bathwater.

--Brynn Tannehill

And trying to convince transgender children that they’re not really transgender—as medical associations have been clear—is unethical.

Conversion therapy has also become illegal in many places.

Denying treatment can have dire consequences. The WPATH Standards of Care state that withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents because it can prolong gender dysphoria and increase psychiatric distress

--WPATH

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