Transgender kids are a reliable source of controversy. They are also human beings.
Over the past two years, articles and opinion pieces published in The Wall Street Journal, Wired, Pacific Standard, New York magazine, and more have questioned the provision of health care and parental support to transgender children—especially the reversible and non-medical practice of social transition, or allowing a child to live and dress as a gender different from the one they were assigned at birth.
With headlines like “Why Transgender Kids Should Wait to Transition” and “Push for Children to Choose Gender Identities Early Could Backfire,” these articles paint a picture of a world in which children are being rushed through transition at a young age.
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But if you ignore the often-superficial media controversy around this issue—and talk to experts who are actually working with the families of transgender and gender non-conforming children—a more boring truth begins to emerge: Helping children transition is nowhere near as ill-advised and irreversible as you may have been warned. In fact, it can be life-saving.
Kristina Olson, an associate professor of psychology at the University of Washington and director of the TransYouth Project at UW’s Social Cognitive Development Lab, told The Daily Beast that she used to place more stock in the belief—spread by some alarmist commentators—that “parents are transitioning their kids too early instead of just letting them be boys who like girls’ toys.”
Then Olson researched the families of children who have socially transitioned and her views shifted.
“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,” she said, referring to the fact that many parents of transgender children did indeed allow their child to adopt behaviors and preferences that defied gendered expectations without allowing them to transition socially.
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,” Olson explained. “They aren’t just a boy who likes dresses—they feel that they are, in fact, a girl.”
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.
That stands in stark contrast to previous studies of un-transitioned children diagnosed with Gender Identity Disorder—a now out-of-date term for gender dysphoria—which found alarmingly “high rates of psychopathology,” like depression and anxiety.
In other words, although the research is still early, social transition may help transgender children avoid negative mental health outcomes.
Indeed, when then-president of the American Academy of Pediatrics Dr. Benard Dreyer read the Pediatrics study, he wrote in a letter to the medical association, “There appears to be no harm—and possible benefit—from such parent-supported early social transitions.”
Much of the controversy around gender transition for children stems from a misunderstanding of how that process works.
The first and earliest step, social transition, is completely reversible: Changes to names, pronouns, and dress can all be undone. The second step, taking hormone blockers to suppress the changes of puberty, is also “fully reversible,” according to the World Professional Association of Transgender Health’s oft-consulted Standards of Care—and it is only undertaken at the onset of puberty.
Only beyond that point can these children can undergo cross-sex hormone treatment—and even then, the effects of that treatment are “partially reversible,” per WPATH. Irreversible interventions like surgeries don’t even enter the picture until the “age of majority.”
That leaves plenty of time along the way for children, families, and mental health professionals to make decisions together—especially at the early and fully reversible stage of social transition.
“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,” Lily Durwood, a UW graduate student and co-author on Olson’s study, told The Daily Beast.
Last year, Olson and Durwood wrote a piece together for Slate criticizing the recent media hand-wringing over social transition for transgender kids, which is often fueled by speculation and personal anecdotes.
“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,” they wrote.
One journalist whom the researchers specifically addressed, Debra Soh, has written for The Wall Street Journal and the Pacific Standard about her own experience of being a “gender atypical little girl” who grew up to be more content with her birth-assigned gender—the implication being that an early social transition might place children like her on the track to unnecessary medical treatment.
But 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 told The Daily Beast.
Davis said he understands that outside observers with limited experience in the field might be concerned that clinicians are “shuttling [children] through transition very quickly.”
“In reality, that’s not at all what’s happening,” he stated definitively.
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.
But that’s a large pool of children to draw from and lumping all of them together, Davis says, is an example of “compressing the folks who are very binary-identified” and the “gender explorers” into a single category.
As Brynn Tannehill wrote for The Huffington Post, 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, Tannehill argued, to throw the baby out with the bathwater.
And trying to convince transgender children that they’re not really transgender—as medical associations have been clear—is unethical.
WPATH, for example, acknowledges that social transition in childhood is “a controversial issue” in need of future research but the association is adamant that any treatment “aimed at trying to change a person’s identity and expression to become more congruent with sex assigned at birth”—also known as reparative, or conversion therapy—is both unsuccessful and “no longer considered ethical” (PDF).
(With regard to social transition, the WPATH Standards of Care state that “[m]ental health professionals can help families to make decisions regarding the timing and process of any gender role changes for their young children” and that parents should make it clear to their children that social transition is reversible.)
With this careful approach, the risk of giving children unnecessary medical treatment appears to be very low. The Endocrine Society’s 2009 guidelines in this area recommend that hormone specialists help “transsexual adolescents” by “suppressing puberty… until age 16 years old, after which cross-sex hormones may be given.”
One 2011 study in the Journal of Sexual Medicine followed 70 adolescents who reached the fully reversible stage of taking puberty-suppressing medication. Their findings: “No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.”
But denying that 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” (PDF).
There is no doubt that everyone working in this field wants more information. WPATH’s Standards of Care note that “research with children who completed early social transitions would greatly inform future clinical recommendations.”
And Olson and Durwood, who say that their research on precisely this cohort of children has produced good results, want even more information about long-term outcomes and the role of parental support, provided they can secure funding for this research.
But sounding the alarm bells at this point helps no one—especially transgender kids.
“Our results suggest that kids who are socially transitioning have quite normal, good mental health and they have typical gender development that seems to match pretty well with their peers,” said Olson. “And we haven’t seen any results that are worrying or alarming at the average, or mean, level.”
