It's a troubling fact: Anti-transgender parents can damage their children — potentially for life. A lot of research shows that if parents or families reject, mistreat, or otherwise mishandle a child due to the child's gender identity, they can significantly increase the risks of the child acting out, developing mental health issues, and attempting suicide. So how can a parent make sure that they get this right?
I reached out to Diane Ehrensaft, a developmental psychologist who works closely with trans kids and author of the insightful The Gender Creative Child, to get answers to some of the questions parents might have.
In short, Ehrensaft put forward a very consistent theme: Parents should pay very close attention to persistent cues from their children, take those cues seriously, and not try to forcefully alter the direction a child seems to be going in. So if a child is consistently showing signs that their gender identity or expression does not match the gender that was assigned to them at birth, parents should take that seriously, and let the child live based on their clearly and persistently expressed identity. And to the extent a parent can get this wrong, it's by acting too rigidly and trying to force a child into acting like someone they're simply not.
What follows is my conversation with Ehrensaft, edited for length and clarity.
How to tell if a child is transgender: pay attention, and take the cues seriously — without policing gender
German Lopez: How can parents realize if their child is transgender?
Diane Ehrensaft: Like other parts of parenting, keep your eyes open and listen. Kids will send out pretty strong smoke signals that they're working out something about gender. The parents may not be able to know that the child is transgender right away.
Unfortunately, we don't have a blood test, which everybody wishes we did to be crystal clear. We can only get a cross-section of a child and where that child is at the moment.
Here's what we look for:
If a child says something like the statement, "you have it wrong; I'm not the gender you think I am" or "why did God get it wrong?" or "can I go back in your tummy and come out with the right parts?" you want to pay attention to those signals.
If a child is insistent, consistent, and persistent on that message or related messages, we want to pay attention to it. So it's not just one point in time, but over many points in time. It keeps coming back to the same thing.
"If a child says something like … 'Can I go back in your tummy and come out with the right parts?' you want to pay attention to those signals"
If a child, particularly a young child, is really excited about their body parts, and says "Can I grow one?" or "Can I cut this one off?" there's often a signal of a real unhappiness with the body that you have and that marks you as a boy or a girl in the culture.
Lots of kids these days like to play with toys that were labeled for the other gender. That's not uncommon. We know Target took down gender-segregated toys. We know something's going on in the culture. So there's a lot of kids — boys who want to play with dolls, girls who want to play with trucks, etc.
The child who's transgender often will go beyond play to what I call "serious business." They're not just, for example, wanting to try out their sister's princess dress and pretend to be a princess for a day. They do that, too. But they may — as someone who's [designated as] a boy who says, "I'm a girl" — go and steal their sister's full clothes, regular girl clothes, so they can dress to tell people, "Hey, this is who I am. I'm not a fairy princess. But I'm a girl who wants to go to school dressed like this." So you look for play as "serious business."
It's not fool-proof, but those are good signs.
There are things parents should do if they realize a child is transgender. But mostly, they should be accepting.
GL: Let's say some parents think their child is trans. What should they do then?
DE: In terms of the mental health field, I will quote Dickens: It's the best of times, it's the worst of times.
If they can find a well-trained, gender-affirmative professional to help them think about it, that's a good way to go, because it's hard to do this on your own. Some people do it with support groups. Some people do it by connecting with other people online. Some people just have it within their own bones to be able to read the tea leaves and know what to do about it.
But given the journey ahead, if you can find someone like a pediatrician that you go to from time to time for check-ups, but who's a mental health professional, sensitive to gender issues, [and] who can just be part of your team to think about it and offer their expertise, that's a good step.
"If they can find a well-trained, gender-affirmative professional to help them think about it, that's a good way to go"
What a parent can do is to watch out for being a police officer of gender. That harms kids, and it gives them bad messages. So if you say, "You can't do that, because boys aren't allowed to," that's a real pain on your child, and that can have some damaging effects.
If you say something a little different — "You know, honey, where we live people don't understand this, so we might do this just at home, but until we help the people out there to understand it, we might just leave it at home" — it's still a bit of a mixed message, but it says to the child that "the problem is not with you, the problem is the town we live in, so we're going to create safe spaces for you." The hope there is the child doesn't take it in as "I'm weird" but that this world has a lot of learning to do.
But the first thing you want to do, like with any other sense of identity, is instill pride in the child, rather than shame.
GL: I imagine that a lot of parents are unfortunately not going to have access to very good mental health professionals for all sorts of reasons — geography, insurance, or whatnot. So what are some of the common tips and guidance you would give to those parents, who think their kids are trans?
DE: The first thing — and this is the motto you can put on your wall — is around children's gender, it's not for us to say, but for them to tell, and to give them the opportunity to say what's going on with them. And listen.
The second is that all of us, as parents and people walking down the street, have what I call gender ghosts and gender angels.
The gender ghosts are all of the messages that we got in the way we live — such as our religious beliefs — that tell us that there's something wrong if a child is either gender nonconforming or transgender, or that makes you feel uncomfortable or weird about it. You can't sweep the gender ghost under the rug, because they're there. So you have to take them out and take a look at them. And if you're parents, you always should be questioning yourselves: "Are any of these beliefs harming my child?"
Most parents love their children and believe that they're supporting their children. But what they offer may not sometimes be good for the child. And that's where gender ghosts come in: You may feel like you're supporting your child by saying "don't be ridiculous, boys don't wear dresses" [by] showing them how to be a boy in the culture, but at the same time you're giving them a very negative message about who they are.
"If you're parents, you always should be questioning yourselves: 'Are any of these beliefs harming my child?'"
This, quite frankly, is why we such high levels of anxiety, depression, social withdrawal, acting out at school — this kind of common misery among gender nonconforming kids who are getting messages like that. Those are our gender ghosts speaking.
So we want to bring them out to the light of day and put them at war with what I call our gender angels. Those are the parts of us — and I think they're either there or can be harvested and fertilized — which open up our eyes to gender expansiveness, to the notion of gender diversity, to the notion that not following the rules does not mean you're sick or have a disease or that it's pathological, but that it's creative. That's why I call it the gender-creative child in the book. And it's just who these children are.
So we accept who these children are. I do believe that when we have people around gender ghosts and gender angels, we have a cognitive dissonance moment. The gender ghosts are telling you, "This is wrong," "This goes against the principles of my faith," etc. On the other side of that comes, "But I love my child very much. And I can either change those beliefs or hurt my child." So what I see over and over again among the parents I know is love conquers all — that sadly there are certain families where it does not happen, but happily there are families where their child profoundly changes them, and brings out the gender angels and poofs away their gender ghosts.
The next thing is that no matter where you are, you can find other parents. Fortunately, we have the internet. And there are now so many organizations that have chatrooms or places where parents can set up a [email] listserv with each other. And it has been a wonderful change for parents to not feel isolated in their experiences. And in the United States, there are now conferences all over the country where people can meet other parents, meet professionals, have the children meet each other — and even doing that once a year can make a tremendous difference.
Children can realize that they're transgender at a very young age. Or they might not — and still be transgender.
GL: When should you expect a child to be more comfortable and confident in their identity, so you know it's perhaps a sure thing?
DE: Since you need to know that they're persistent and consistent over time, obviously you need time. It can't be one point in time. This is the most complicated thing about parenting a gender-creative child.
It could pop up at any time. There's no one boilerplate. There are a subgroup of kids where you most likely know by the time they're in preschool. And they will so define early on, and they won't switch. So you could know in the first year of life if you have your eyes open. You might need more time to really get it in focus. But I'm having a number of parents who are now coming to talk to me about their three 3-year-olds, where they already got it [that] they have a transgender 3-year-old.
Now, everybody gets a little nervous about that. "How could a 3-year-old know their gender?" But for kids who are not transgender, we should expect them to know their gender by age 3. In our culture, we expect most kids to know if they line up in the boys' line or the girls' line. But we don't give the same latitude to transgender children. And because I don't think many of us understand that gender doesn't belong between their legs, but between their ears — it's their mind and their brain. So even among the littlest ones, their minds are already made up.
"In our culture, we expect most kids to know if they line up in the boys' line or the girls' line. But we don't give the same latitude to transgender children."
But there are other kids for which it may not show up until they hit puberty. Often puberty is a point in which the body starts to change [and] all of a sudden it rises up, whatever was lying quietly and dormant, and they'll go, "Whoa, wait a second, this feels so wrong, and I'm miserable."
Now, a lot of kids are miserable through puberty. We know that. Any one of us could probably tell a tale.
But this is a different kind of misery. So if you're not transgender, if you imagine that you woke up one morning and your nose was turning into an elephant trunk, and you are going to have to live that way for the rest of your life, that's how it feels. Unless you would like to have an elephant trunk, but let's assume you wouldn't.
Kids are often traumatized, and that's a moment where they may say for the first time, "Well, you know what? I'm not a boy. I'm a girl. And I'm freaked out." And parents will often at that point be really confused, because they'll say, "But they weren't that way when they were toddlers. I never saw an inkling of this." And that doesn't mean it's not true.
Gender is a lifelong process. And it's not necessarily fixed at a time, although for many of us we're stable by age 5. That's the challenge for parents: It could show up at any point, and you'll have to start from that point on. Is it really persistent and consistent? Is it stable? Is it really a solution to something else, or not about gender at all? Tricky questions.
While parents should be willing to help their kids live their identities, they need to look for consistency
GL: I'm sure a lot of parents would worry, especially with a 3-year-old, that they would start treating the child differently — like letting the child transition — and it might turn out that the child was just gender nonconforming or going through what some people would call a phase. How do you balance out that concern?
DE: By not going too fast. You raise a very important point: that, indeed, you don't want to jump to a conclusion by one point in time.
Now, I know that in developmental psychology, we have phases, [and] kids go through phases. So the common response from a pediatrician when a parent says, "My little girl doesn't ever want to wear a dress," is that she's just going through a phase. That's a possibility, but it's quite unlikely.
So what we want to do is give it some time to see whether this isn't a flash in the pan. But don't give it too much time, because then you have a miserable child.
"What we want to do is give it some time to see whether this isn't a flash in the pan. But don't give it too much time, because then you have a miserable child."
We do have some parents, particularly with all of the coverage of transgender children, who are too hot to try. They come with their false gender angels, claiming, "We are progressive. We will support our child. We believe in transgender children. And so we'll allow our child to transition from boy to girl." And then you meet the child and they're like, "Whoa, no, no, I'm just saying I want to try this out."
Here's what we have to help us with that: what I call the ex-post-facto test. And it's a pretty good one. It's not universally accurate. But if you got it right and you listen to the child, and you heard what they have to say, and what you heard is that they're not the child you think they are, and if you let them live full time in the gender they say they are, they get happier — not only a little bit happier, but it's also a remarkable transformation. So the ex-post-facto test says, "I got it right. I have a much happier, healthier child now that I finally listened and let them be who they are."
If they're not happy, and their misery goes up, you go, "Oh, maybe we should go look at that." It doesn't necessarily mean that they're not transgender. It may mean that they're going to a school that treats them terribly everyday, so there are things that are hurting them in the world. So you want to pay attention to what's going there.
But you look for a happiness quotient. I see it as a professional. But I also hear it from parents who say, "Wow, I wish we listened earlier. I didn't realize. But I now have a different view."
To the extent trans people suffer disproportionately from mental health issues, it's due to discrimination
GL: For a lot of people, there's a lot of confusion in what the medical and scientific fields say about this. For example, I've seen some members of Congress cite gender dysphoria and the fact it's listed in the Diagnostic and Statistical Manual of Mental Disorders as proof — and these are their words, not mine — that trans people are mentally ill and disordered. But based on what you're saying and what other medical professionals and trans people have told me, to the extent some trans people have severe dysphoria — and not all trans people do — it should be treated by letting them transition without discrimination, not try to change their identity. Is that right?
DE: Yes. Absolutely.
I would start by saying that there are some of us who are still fighting to get any mention of gender out of the DSM for the exact reasons you just said: It pathologizes children around something that is not pathological.
There are parallels to homosexuality. We got it out of the book, and now we have marriage equality years later, which I think is relevant to recognizing one's diversity rather than pathology around sexual identity.
So a lot of people need an education.
"We want to help them get their gender in order — to help them live in their true gender self, their gender identity"
Even with the [gender dysphoria] diagnosis, that just means that someone is having an upset until they get their gender in order. And we want to help them get their gender in order — to help them live in their true gender self, their gender identity. And that should be the goal for any child and adults as well.
If there's any pathology, it lies in the culture, not in the child.
The only difficulty for some is they do get upset about how their body is showing up. That's not just around the culture out there — although when the culture says penis equals boy and vagina equals girl, and no one with a penis can be a girl, that seriously upsets people. But still, there might be an upset about your body.
So I think the one thing we do see that is inside the child who has a brain that's saying I have XX chromosomes but I'm a boy is that they have body mismatch sometimes, and it makes them unhappy, no matter how accepting everybody is.
But if there's any misery, it's probably because people aren't being allowed to live their lives based on who they are.
It's not just a social construct or biological. Gender identity is influenced by all sorts of variables.
GL: With some people, particularly those skeptical of everything that we're discussing, one source of confusion I've seen is that, on one hand, experts are telling them that gender is a social construct, but, on the other hand, experts are saying that gender identity is something inherent in kids that they might realize as young as 3, 4, or 5 years old. There's just a lot of confusion about those two concepts. So how do you explain it to people?
DE: Here's how I explain the whole notion of gender: It's not completely unrelated to culture, nor is it only a social construct. That's why I use the concept of a gender web — that every person's gender is spinning together nature, nurture, and culture. So we have to look at all three components, but there is a strong internal — and we can put it in nature, we can put it in nurture.
But gender is not just shaped by the outside, because otherwise we could spin these transgender kids into being cisgender [not trans]. And we can't; that would just make them go underground. So there is a constitutional, biological component that reasons people's gender, but it's not the only stream coming in.
So we have to consider all three: nature, nurture, and culture.
GL: So on the one hand you do have these roles that people expect of certain genders, and those are the social constructs. But on the other hand people inherently identify in certain ways, based on how they think of themselves, their bodies, and all of that. And all of these factors come together to influence somebody's gender identity.
DE: Exactly. And I would say to this day, for why it is, it's still a mystery. We know a lot and we're learning a lot more about the "what is it?" but not so much the "why" of it.