Supporting Kids Questioning Gender Identity
May 18, 2019 Cedars-Sinai Staff
Gender dysphoria—the distress that can result when a person's gender does not align with the sex they were assigned at birth—is associated with feelings of anxiety, depression, and hopelessness. It typically starts early in childhood and lasts throughout adulthood.
"You want to give a nonjudgmental and nurturing environment in which kids can say what they're feeling."Dr. Maurice Garcia, director of the Transgender Surgery and Health Program, says 85% of his patients first experience gender dysphoria between the ages of 5 and 7.
"What this means is the negative effects of being transgender are experienced almost as long as people can remember being alive," says Dr. Garcia.
"A lot of people who are getting gender dysphoria treatment now as adults could have used treatment much earlier in life."
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Many parents may not feel properly equipped to help their child deal with questioning their gender.
If you're looking for ways to help your child who may be dealing with gender dysphoria, keep these things in mind:
Hold the judgment
When your child chooses to open up and talk about how they're feeling, make sure to validate their feelings and avoid framing their situation as a problem.
"You want to give a nonjudgmental and nurturing environment in which kids can say what they're feeling and where their identity is going," says Dr. Garcia.
Think before you speak
Words are extremely powerful, so be sure to use neutral language and avoid words like "real" when referencing gender.
It is also helpful to educate yourself on basic language, including terms like cisgender (those whose gender and personal identity correspond with their sex organs at birth) and transgender (those whose gender and personal identity do not correspond with their sex organs at birth), to teach your child how to use that language to express themselves.
Find them a qualified professional to talk to, whether it's a counselor, a doctor who specializes in gender identity issues, or a group program for kids in a similar situation.
"That's why I started a clinic to create a place for kids to explore their feelings," says Dr. Garcia.
"Stress and anxiety levels go down with understanding they're not alone and there are options."
Bridge to care
Dr. Garcia's Pediatric and Adolescent Transgender Care Bridge Clinic aims to make the journey between childhood and adulthood smoother for transgender patients.
His idea for the clinic was to provide a haven not only to educate the kids and their families when the time comes to learn about different options, but also to provide a place they can go to when they age out of the pediatric healthcare system.
"That way, they're less likely to fall through the cracks and just spin out because they're not connected to the community," says Dr. Garcia.
In the clinic, Dr. Garcia talks with kids from 9 to 18 about ways to help them through their transition and what they can expect if they pursue surgical options.
"Their stress and anxiety levels go down with understanding they're not alone and there are options," he says. "Even if they're not going to pursue surgery tomorrow."
In Discoveries : Transformational: Maurice Garcia, MD
Fear of the unknown
One thing that Dr. Garcia is hoping to achieve with his work is to clear up some of the confusion and misconceptions that surround transgender people.
For a lot of young kids, growing up and exploring their gender identity means being estranged from their families, friends, and social circles due to a lack of understanding.
"Being supportive is something kids will be grateful for," says Dr. Garcia. "And it's one of those things they'll never forget for the rest of their lives."
Not everyone will go on to have transgender surgery, but for many people with gender dysphoria, surgery is the light at the end of the tunnel of a hard journey.
For many adolescents, age 17—before leaving home for college—may be the best time for them to pursue genital surgery options to align their bodies with their gender.
Decisions about readiness for surgery and timing are decided on a patient-by-patient basis and always in the context of interdisciplinary care that includes the patient's family, says Dr. Garcia.
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A common misconception is that transgender surgery is a cosmetic procedure. "What we do is simply align the body to better reflect the person's identity. That's not cosmetic—that's fundamental stuff," he says.
Transgender surgery can be profoundly transformative for people, the sense of relief and peace that it gives those who get it is powerful.
"The morning after surgery, a patient once said, 'I can’t describe it but this way: It's like all my life I've lived with this really horrible white noise in my head, and now it's gone,'" says Dr. Garcia.