On the Science of Changing Sex

Advice to Parents of Transkids

Welcome

As an adoptive and foster parent myself, please allow me to express that you have my most sincere empathy.  Being a parent isn’t easy.  Raising children is both a privilege and and sacred trust.  You are entrusted with the well-being and responsibility to support another human being as they become an adult who will stand on their own.  Your job is helping them become the best person that they rightfully are, what ever that may be.

You are also charged with protecting your child.  Since much of the advice I give here may not be found anywhere else, you need to know it.  As a transgendered child and teen, I would have loved for my parents to have known this material.  This material is not theoretical.  Many of the issues I list below happened to me, my friends, and my charges.  In addition to my own personal experiences growing up, I was a foster mother to two girls, one a gender atypical girl, now lesbian, the other I officially adopted… and “unofficial” foster mother / god mother to several MTF transkids, when they were teens through young adult.  Presently, I’m serving as a Court Appointed Special Advocate (CASA) for transkids (both MTF and FtM) in fostercare.  So, my advice here is based on wisdom gained from real world experience.

I was an unhappy and lonely child, described by my mother as “prissy” and girlish, beginning as a toddler, put into therapy when I was ten, again when I was 15/16, and fortunately for me, was diagnosed as transsexual at the age of 17, at the then newly formed Stanford Gender Dysphoria Clinic, in early 1975.  I “came out” in high school around the same time and have lived happily as a girl/woman, wife, and mother since then.  You may learn more about me on my “about” page”.

I warmly welcome your correspondence.  I am NOT a medical professional.  I can NOT diagnose your child, especially not from email descriptions of your child’s behavior.  I can NOT offer reassurance that your child is or is not a transkid.  However, if you have questions or concerns that I haven’t addressed, or just need to talk to someone, whether you are a parent, grandparent, sibling, or a transkid, I can be reached at formertranskid@gmail.com

You have my most sincere wishes for your family’s happiness.

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RESEARCH OPPORTUNITY

Here is an opportunity for the parents of transkids to give feedback to a researcher looking into their experiences,

“Researchers at Case Western Reserve University are currently conducting an online study of the experiences of families of gender variant, transgender, or otherwise non-cisgender kids ages 10-17. The study involves completing questionnaires online about your experiences with the process of your child disclosing their gender identity to you and/or the process of your child’s transition, as well as questions regarding your emotions, attitudes, and preferences for potential psychotherapy interventions for families of gender variant children. Your child will also complete several brief questionnaires about their emotions and experiences with disclosing their gender identity. To participate, you must be the parent or primary caregiver of a child or teen ages 10-17 who identifies as gender variant, transgender, or otherwise non-cisgender and you yourself must be at least 18 years of age. You will have the option of including your contact information in order to receive a $10 gift card, although providing your contact information is not necessary to participate in the study. The information gathered from this study may help us to better understand the needs of families of gender variant children and ultimately help us to design therapies to help families better cope with the changes associated with their child’s transition.”

Please participate if you qualify, as we need as many voices and as broad range of experiences as possible:

http://psychology.case.edu/research/fear_lab/lgbtq_participation.html
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A word on words

The term “transgender” is unfortunately broad.  It refers to behavior and those people who exhibit them that does not fit our culturally defined typical behaviors for a given sex/gender.  It is so broad that it can encompass everything from the secretive, otherwise typical straight man, who cross-dresses for erotic pleasure to the profoundly gender atypical child who truly could fit the oft repeated trope of a “boy trapped in the body of a girl” or “girl trapped in the body of a boy”.   To address this overly broad definition, I use the term “transkid” in this much more narrow sense.

The term “gender dysphoric” means that one is distressed about their social and/or bodily sex/gender.  This distress must be extreme, not a mere, “Gee, I wish I were a boy, then I could be a fireman.”  Unhappiness with cultural gender role limits or expectations is cause for changing society, not one’s sex.

Intended Audience – Because not every “transgendered” individual is a transkid

This page is for parents, grandparents, older siblings, and teachers/caregivers of children, teenagers, or early 20somethings still living at home, or have recently gone off to school/college, who are both gender atypical and gender dysphoric.  That is to say, that they act like, and want to be, the opposite sex, to wit, transkids.   This may be a male child who has always been feminine, played dress-up and girl games with the neighbor girls, and dreams of being a wife and mother.  This may be a female child who has always been “one of the boys”, who likes rough and tumble play, hated wearing dresses, and who developed a crush or two on girls at school.  I’m assuming that your child or teenager is a classic transkid.  That is say, that they have always behaved like, wanted to be, and will grow up to transition to the opposite biological sex.

It is entirely possible that your gender atypical child or teen is not a transkid; Most gender atypical children will not be gender dysphoric, and not all gender dysphoric children will persist as such into their teen years.  Just wanting to do some activities that our culture considers to be stereotypical of the other gender does not automatically mean that that child is truly gender atypical, and certainly not gender dysphoric.  Many, perhaps most, “tomboys” and “sissies” do naturally grow out of it around seven to ten years old.  Most gender atypical children, especially “sissy boys” will grow up to be gay, not transsexual, accepting their gender of birth.  Tomboyish girls may grow up to be lesbian but most will be straight, given that perhaps a third of girls are labeled “tomboys” as children.  (Which means that they weren’t all that “atypical” to begin with…)  But if your child reaches their tween years (11+) and is still gender dysphoric, you may be assured that they will remain so.

Again, it is important to note that most children who are gender atypical and less than 10 years old will NOT be transkids, but most likely gay or lesbian instead.  To put this into numbers: 3% of adult men are exclusively gay and 1% of adult women are exclusively lesbian, most of them were somewhat gender atypical as young children, while only 0.001% of teenagers and adults are (former) transkids.  Thus, a gender atypical young child is a thousand times more likely to be gay or lesbian than transsexual.  The odds that a young child is transsexual goes up if that child is both extremely gender atypical and gender dysphoric of course, but it is still not certain.

Deciding just how to raise a gender atypical, but not gender dysphoric, child is fairly clear, allow that child to experience and express themselves as they themselves see fit.  However it is unclear what to do if that child is also gender dysphoric, since not all such young kids will remain so… and demanding that a four year old “declare, once and for all, no going back” what their preferred social gender is to be is unreasonable.  But a child who is clearly in distress, who wants to be and is more comfortable as the other social gender, may and should be allowed to present as such.  On the other hand, a young gender atypical child who is quieter and less prone to complain, may be just as gender dysphoric but being compliant by nature, will not be inclined to throw tantrums to demand childhood transition; though such a child may be just as sad and lonely, and likely to become much more distressed and express greater gender dysphoria as  puberty looms. Such a child needs love and support, and outlets for their own gender expression needs just as much.  However, no child, nor anyone else, can make permanent determinations of social gender until the child is closer to ten to twelve years old, or even older.  Further, that child may need to “experiment” to find where they best fit in socially, before anything permanent is arranged.

Because most gender atypical children will not grow up to be transsexual, if your “sissy boy” is still eight years old or younger, in addition to reading the material here, I recommend reading Alice Dreger’s advice to parents of “Pink Boys”.

I also recommend parents of gender atypical children of both sexes read this brochure from the National Children’s’ Medical Center.

In a similar vein, if you have an otherwise gender typical teenaged boy or young adult (has acted ‘boyish’ since birth and is attracted to girls, or declares himself to be bisexual, pansexual, or asexual) who is cross-dressing in private, especially if focused on lingerie, this does not mean that he is or will become gender dysphoric… although he might.  Regardless, he is not a transkid.  He is autogynephilic, and will likely remain satisfied with such cross-dressing in private for erotic reasons, that is to say, he will remain a transvestite / cross-dresser; only very rarely will such a boy progress to become an adult transitioning transsexual.  He’s even more unlikely to wish to transition while still a teen, though it does happen.  If it does happen, you may be quite surprised, given that he was never girlish before.  He may even tell you that he hid his femininity from you, though you know that can’t be true.  (No one can monitor their behavior that well… especially not a four year old!)  What he means is, he hid his desire to be feminine/female from you, which is very likely true.  This child, while not a transkid, does need therapy and may still need to transition to living as a girl/woman, to relieve his unrelenting cognitive dissonance between his social identity as a boy and his internal erotic ideal as female.  Although the rest of this advice is for parents of transkids, not for autogynephilic boys; I do recommend that parents of autogynephilic transgendered boys educate themselves, and above all, love their sons… and not to punish, or attempt to restrict or change their child’s cross-dressing, as that will only induce shame for a sexuality that cannot be changed.  You may wish to start with my Frequently Asked Questions page.

There is a female equivalent, called autoandrophilia, that is extremely rare.  These will be girls who were typically girlish, perhaps with a tomboyish interest or two, who as they reach adolescence and adulthood, desire to live as gay or bisexual men.  Though these too are not transkids, they still need counseling and may need to transition as well.

If you are the parent (or sibling) of an adult (especially an older adult) just beginning  transition to living as woman, and this is a surprise to you since as a boy / young man “he” was never feminine, may even have been hyper-masculine (military / law enforcement / construction, etc.) and happily married to a woman, fathered children, etc., your new daughter is also autogynephilic… and deserves every kindness and understanding that you can find within yourself.  This decision did not come easily for her and you can’t change it.  I recommend that you find and join a PFLAG-TS support group.  You may wish to start with my Frequently Asked Questions page.

But, if your child was a feminine boy or a tomboyish girl, gender dysphoric…  and is now a gender atypical and dysphoric teenager or early 20somthing; This is NOT a “phase”.  Gender dysphoric teenagers and young adults very rarely grow out it.  Your child is a transkid.

If you are a transkid teenager looking for advice, please read my advice here.

Parental Angst

You may be asking yourself, “Why my child?” or “What did we do wrong?”

You did nothing wrong, and there is nothing you could have done, nor do now, to prevent or change your child’s nature.  While we don’t know exactly what causes a child to be gender atypical and dysphoric, we do know that it is in-born, biologically determined, before birth.  Nothing you could have said, or done, would have changed this outcome.  Nothing you do now will change the ultimate outcome, save that denial, emotional rejection, or abandonment will deeply harm your relationship with your child; while loving support will deepen it.  Such abandonment, of course, will also deeply harm your child’s emotional and lifelong socio-economic well-being.

It is common for parents, when they first learn from their child that they are gender dysphoric to be in denial.  They may have searched the web for ‘proof’ that their child is not “transgendered”.  Or they may focus on activities that their child did (often with parental encouragement or even insistence) that were not gender atypical.  They may say, “My child is just confused, this is just a phase, it will blow over.”

Denial will not serve.  You will win some battles, but lose the war.

Dr. Norman Fisk, early pioneer in transsexual research, who coined the term, “gender dysphoria”, offered this advice to the father of a 17 year old MTF transkid back in early ’75, telling him he should be supportive of that teen’s efforts to socially transition to living as a girl and get medical help, rather than continue his obstructionism, saying, “Denial will not serve.  You will win some battles, but lose the war.”  (That father, of course, was mine…)

You may be worried, even fearful, for your child’s future.  It is common for parents of transkids to worry that their child will have trouble with jobs and careers, that no one will hire them.  Another fear is that they will never have a loving spouse.  Or you may be sad that your child will never have children of their own.  I can tell you from having known literally dozens of adult transkids, that we do get jobs, have meaningful careers, find loving partners… and a few of us have been blazing trails in adoption and other alternative family planning options.  Nothing is guaranteed in life, but I can tell you that your child has every hope of having a very good and happy life.

As the parent of a gender atypical child, you likely have gotten comments from ignorant and insensitive people who have made ugly remarks about your child, and even of your parenting skills.  You may be embarrassed by your child at times.  You may wish that they would change and be “normal”.  But remember, your child didn’t “decide” to be gender atypical, s/he just is.

Still, you may also be feeling sad, a sense of loss for the child you hoped you would be raising.  This is expected and normal.  You may also find that there are times that you are angry, angry with the universe, with life, with your child…  With time, this too shall pass.

Educating yourself

It can be very confusing when first learning about transgender experiences.  Of course, I recommend reading my own pages here if you want to understand more of the science, but that isn’t, strictly speaking, necessary.  Instead, there are several excellent books about parenting transkid children and teenagers.  But be very, very cautious about reading about transgender and transsexuality in general, especially personal websites.  Most of it is about autogynephilic transgender identity and experience; most especially, don’t waste your time reading autobiographies of late transitioning (full adult) MTF transsexuals.  These will not apply to your child, and reading them will only cause confusion.

You will also learn about the so called “Standards of Care”, which unfortunately have, over the years, been instituted to guide health care providers in helping adult transitioning MTF transsexuals.  Although these SOC’s have gotten better in recent years, they in some ways are still inappropriate for transkids.

In the English speaking nations, MTF transsexuals who were transkids or “sissy boys” are a small minority among transsexual adults.  Most MTF transsexuals transitioned as adults, typically around age 35 to 40, but some as old as their 70’s.  But adult transitioning MTF transsexuals have a completely different biological etiology (original cause) and experience than transkids, being autogynephilic and gender typical , masculine – even hypermasculine as boys and young men.  Learning about them can be eye opening, but will not aid you in understanding your transgendered child.

Adult FtM transsexuals on the other hand were nearly all transkids or “tomboys”, though a small number weren’t.

It is unfortunate that the two separate conditions that give rise to MTF gender dysphoria have been conflated and confused.  You as the parent of a transkid, have been unwittingly thrust into a position where you must learn enough of both so that you may distinguish between the two, so that you may know what will be helpful to your child, and what won’t.

If, as you learn more about transgender experience and issues, you become aware of the differences between transkids and adult transitioning transsexuals, you may become profoundly aware that your child’s experiences are NOT those of adult MTF transsexuals.  You may then wish to become a true activist / advocate.  If so, you may wish to further your education here and by reading the scientific literature on the subject.  I sincerely hope you will speak up and educate other parents and health care workers of the differences and special needs of transkids.

Getting help and support for yourself

Take care of yourself.  Parenting is often challenging at the best of times.  But any parent of an atypical child, whether it be because they have health issues, disabilities, or emotional challenges will experience additional stress.  Be sure to cultivate a support network of friends and family.

You are not alone.  There are a number of organizations of parents of gender non-conforming children and teens, as well as individuals that support such parents.  Of them, I most heartily recommend PFLAG.

I am not personally conversant with most of the other organizations or programs that may also be valuable resources.  But I know that many good ones exist.

Be aware that there are older autogynephilic MTF transsexuals who also belong to these organizations and that many are in denial about their etiology and sexuality, often having edited their history to seem more like transkids.  Meeting them, you may become concerned that your child is similar.  Be assured that they do not represent your child’s future.  Also, be aware that parents and wives of autogynephilic MTF transsexuals may offer advice that makes no sense for your transkid.  At the present time, awareness and understanding of the special needs of transkids is deplorably absent.

A strong word of caution:  There are a few organizations out there which have officers and directors who have for personal reasons, shown themselves to be willing to use cyber-bullying,  intimidation, libel, slander, false allegations, and deliberate public outing of other autogynephilic transsexuals, transyouth, former (adult) transkids, and their supporters/families as a means of elevating and maintaining themselves in positions in these organizations and the transsexual community in general.  Most particularly, there are a number of such individuals who are themselves in denial about being autogynephilic, and lash out at those who are doing research or education on this phenomena.   They may cloak themselves with the mantle of being activists looking out for the greater good of the transsexual community.  But a person who is willing to hurt other transsexuals in the name of protecting them is not a true friend of the community.  A parent would be wise to review the leadership of such organizations and do a web search on their history and reputation, in order to protect their family.

Transkids are obviously different

Just as children come in all shapes and sizes, personalities and temperaments, children also show a range of gender expression.  To say that a given behavior is masculine or feminine is to say that males or females are more or less likely to behave in such a manner.  But no one individual is “purely” masculine or feminine.  However, if you know a transkid, you will also know that they are different.  Transkids are very obviously gender atypical, from the way they talk, move, sit, play, etc.

Transkids who were born male are like little girls, often interested in playing with other little girls, playing girl games, dressing up, into stories and images of princesses, perhaps interested in baby dolls or Barby dolls.  They walk like girls.  They have a distinctly feminine speech pattern, they sound like girls.  They typically hate playing boy games, avoid rough and tumble play, and may “throw like girls” when required to play ballgames.  As teens, they are interested in fashion, make-up, and handsome BOYS!  Many (but not all), love to be around babies and younger children, seeking out babysitting or other childcare activities.

Transkids who were born female are like little boys, often interested in playing with other little boys, playing boy games, into stories and images of masculine heroes (or villains), love loud, boisterous rough and tumble games.  They typically hate playing girl games, especially “house” or other make-believe games.  They may HATE having to dress up in feminine clothes.  As teens, they are interested in sports, athletics, fast cars or motorcycles, and pretty GIRLS!

Underneath the outward behavioral difference, which, while always present, there is an additional personal repugnance for one’s own sexed body, which if not directly observable, may be discerned by careful observation.  For example, a transkid may be very reluctant to discuss or allow others to observe their genitals, even parents or healthcare providers.  This reluctance is not simple modesty, but deep seated revulsion.  This repugnance only grows with the passing years, especially during puberty.

In a sense, if you ignore their original birth sex, they would have been very gender typical had they been seen as the opposite sex from the beginning.  However, if they are forced to conform to gender norms of their birth sex, they become withdrawn, sad, and prone to emotional outbursts.  They may have difficulty with school, unable to focus on tasks.

Special problems before transition

If your child is enrolled in a single sex school, classes, or youth groups, your child will be under greater scrutiny.  Gender atypical children are under far greater pressure to conform to gender norms in single sex settings, which may evidence itself from social isolation, verbal disapproval, to physical bullying.  They are also more stressed and uncomfortable in such situations, feeling out of place and lonely, a fish out of water.  Do not require your child to be in such environments.  They will not help your child to learn to “fit in better”… and will only increase your child’s awareness of their atypicality, in a negatively valued manner.

Many gender dysphoric children feel extremely uncomfortable wearing clothing that is especially iconic of their birth sex, especially if that clothing exposes or reveals their body.  For example, MTF transkids feel “exposed” if they are required to wear a boy’s bathing suit, exposing their upper body, as they feel that they are exposing what girls in our culture would never expose.  Similarly, FtM transkids feel humiliated at being required to wear feminine dresses and accessories, in exactly the same manner as would a typical boy who was forced to wear such clothing.  Clothing that is specifically designed for anatomic reasons (e.g. undergarments) may be a special source of shame and humiliation.

One of the most anxiety provoking situations for young gender atypical children or teens is using a public restroom, especially if there are other children or adults present.  They may avoid it as long as possible, giving rise to ‘accidents’, often just in sight of home.  Do not chastise your child for this.  (Consider, would you be comfortable going into the restroom of the other sex?  REALLY?)  Forcing the child to use a public restroom may induce lifelong “shy bladder” or “shy bowel” syndrome, not just temporary distress.  You may need to plan trips to avoid the need for public restroom visits.

Similarly, only amplified, the requirement for those in middle or high school to change and shower in a public locker room is extremely distressing.  Many transkids refuse to change or shower in such a situation.  Or, if they do, they go to great lengths to achieve what privacy they can.  This reticence is two fold: on one hand is being exposed to others who they experience as being the “opposite gender” to their own (never mind any biological sex similarities), the other is that of extreme repugnance and embarrassment over their own sexed body, which they feel to have been a “birth defect”, and not truly representative of their proper gender.  Refusal to change or shower in front of others will often result in official reprimand from gym instructors, who are unlikely to understand and/or sympathize with transyouth.

Sometimes, very little things may be the “final straw” for a youngster, causing upset greater than what the provocation would normally warrant.  For example, yet another long day spent in school, where the child is required to “line-up” by sex before entering the class, told to pair up by sex for classroom assignments, and they are required to take a role in a class skit or folk dance that is congruent with their assigned sex, but not their internal sense of self.  Finally, they do something good, and the teacher or other adult says, “Good boy” or “Good girl” as the case may be… Such a situation may cause deep upset and resentful outbursts, experiencing the complement as further pressure to conform to gender norms that are not natural to them, or even as deliberate veiled insults, leaving adults bewildered, with a belief that the child is deeply emotionally disturbed.  (Sound familiar?  How would you feel in the same situation, being who you are?)

Advocating for your child

TransSupportAs you step forward to help your child navigate the difficult job of growing up “different”, you will be second guessed by others, possibly by other family members, by insensitive neighbors and fellow church congregants, by ignorant school officials, and especially by hateful strangers.  You may be told that you shouldn’t “encourage” your child to be “that way”.  You may find that other parents refuse to allow your child to socialize with theirs.  You may also find others who will be dripping with false understanding and sympathy, saying how unfortunate you are to have “such a child”.  None of this is “fair”; but life is seldom “fair”.

Just as your child didn’t “choose” to be gender atypical.  You didn’t either.  You are neither a victim nor a villain.  You are simply a parent trying to be a good one.  Your child is neither a victim nor a villain.  S/he is simply a kid who is different than most, but still worthy of love and understanding, still worthy of being celebrated for being themselves, not just “tolerated”, or even just “accepted”, but truly celebrated, just as any other child.

Though you may not have chosen this role, you need to be an advocate for your child.  You must stand up, be counted, and face down those who would treat your child and family as lesser than other children and families.

By all means, be an advocate for your child… but don’t expose your child to the media.  Someday, your child may regret having his or her story in the press, and even worse, photos or video on YouTube, etc.  Most adults who were transkids prefer to live quiet, private lives.  Don’t preclude that as an option.

As discussed above, using public restrooms before transition may be very distressing for your child.  You may wish to discuss the issue at your child’s school to find suitable alternatives.  Before transition, excusing the child to visit the restroom during regular class time so as to be alone, or to visit the restroom at the nurses office are two possible solutions.  After transition, this should not be an issue, as long as the restroom has stalls with doors for privacy, since they will be using the restroom congruent with their preferred gender.

We can’t wrap our children in a protective cocoon, but chronic bullying is never “OK”.  You will want to speak up at your child’s school if bullying occurs.  Take a good look at your child’s teacher(s) and school administrators.  They too may be a source of subtle bullying, or of encouraging their other charges to be bullies by refusing to acknowledge or interfere with such behavior.  Don’t accept any excuses, “sticks’n’stones”, etc.  Bullying hurts, even if its only verbal.  Research has shown that chronic verbal bullying or social isolation causes life long negative health consequences, both physical and emotional.  Verbal bullying can and often does escalate to physical violence directed at gender atypical youth.

Don’t overlook your trans’ child’s siblings.  They too may be bullied or targeted for social ostracism because of their relationship to their gender atypical sibling.  Such siblings may even turn to bullying or ostracizing their own transkid sibling as a way of winning social approval.  Speak up!  Do something.  If this continues too long, it may permanently damage the sibling relationship, and even your relationship with your trans’ child, who will, rightly, look to you as being responsible.  Sometimes, siblings can be a great help in protecting a kid from bullying, usually an older brother of a feminine MTF transkid; but it isn’t really their job.  It’s yours.

Don’t let your child drop out of school to avoid bullying; Too many transkids drop out and never return.  If necessary, transfer your child to a new school.

Also, don’t let the fear of bullying stop you from helping your child transition or allowing other natural gender expression.  Bullying is usually far worse before transition, and decreases after, due to being more gender congruent.  Further, keeping a child from transitioning or insisting that they be less gender atypical because one fears that they will be bullied is a not so subtle form of “blaming the victim”, telling that child that they wouldn’t be bullied if they weren’t a transkid, that the bullying is their fault.  Remember, transkids did not choose to be such, and it is nearly impossible for a child to monitor one’s natural gendered mannerisms for more than a few minutes at a time.

You may also need to look at your own home life.  Too often, transkids come from homes where even loving parents or other close relatives unwittingly create a hostile home life for their transgendered child.  Often one or more relatives will attempt to “toughen up” an MTF transkid, “be a man!”; or they may push an FtM transkid to “be more feminine” around company by insisting that child wear that special dress that grandma bought for them.  Sometimes family will attempt to “manage” a child’s gender atypicality by setting time schedules and places when&where it is “ok” to be atypical, but insist on gender typical behavior and attire at other times&places, as though a child can control their gender expression at will.  It is common for relatives or neighbors to go overboard in trying to “correct” a child’s gender atypicality by giving gifts that are overly stereotypical of a child’s natal sex (e.g. a football helmet to a child that would rather take ballet, or a barby doll or make-up to a child who would rather play football).  You can trust that the child will get the hint that they aren’t acceptable as they are, and will feel very bad because they know that they should express gratitude for the gift, but feel only shame and resentment instead.  A relative  or neighbor may verbally tease, chastise, or even bully a transkid over their gender atypical appearance, mannerisms, or interests in an attempt to change them (e.g. a father grabs his MTF child’s growing long hair, yanking the head back angrily, and yells “What’s next?! Are you going to wear barrettes in your hair now?!”).  That relative may feel that this will help your child “fit in better”.  Trust me, it won’t!  These subtle and not so subtle messages to your transkid will only cause them to experience shame and true low self-esteem.

Similarly, there have been  historically accepted, but totally erroneous beliefs, among a minority of child development “experts” and psychotherapists, that an overly strong emotional bond between the child and their opposite sex parent, or allowing gender atypical children participation in, expressing interest in, or even just being exposed to, gender atypical activities or hobbies leads to gender dysphoria and/or homosexuality.  This has led to an emotionally abusive therapy by some child therapists, encouraging opposite sex parents to reduce their involvement in the child, while encouraging the same sex parent to become more involved, especially in stereotypical gender typical activities, to punish gender atypical behavior and reward gender typical behavior, as a means of precluding a young child from becoming a transsexual or gay adult.   Following or allowing such a course will more likely lead to resentful withdrawal and long term damage to the parent/child relationships.  Both parents should endeavor to love, bond with, and accept their children as they are.

(I can attest from personal experience, that nothing could be further from the truth.  I was and remain very close to my father, while my mother was and remains cold and distant; and both consistently disapproved of my gender atypicality, encouraging my gender neutral hobbies and regularly attempting to encourage, one may say requiring, stereotypically gender typical ones, which were universally rebuffed by me, from an early age.)

Another, less recognized, form of hostile home environment occurs after a transkid teen comes out as such, when one or both parents are in denial of their child’s deep and growing discomfort about the physical changes occurring during puberty and adolescence.  For a transkid, these changes, though welcomed in normal children, are experienced as deeply disturbing.  They (we) see them as being like a serious mistake of nature, making them feel ugly and freakish.  Parents in denial, whose own memories of their own teen years do not include such concerns, may dismiss, often in angry terms, their child’s distress.  This distress is not just temporary.  The changes that puberty brings are permanent and will cause problems for transkids when they later transition, entailing greater medical procedures to reverse (electrolysis for beards, mastectomy for breasts, etc.) and problems with appearance that appears “funny”, broad shoulders / narrow hips on a woman (MTF), narrow shoulders / broad hips on a man (FtM).

To understand the nature of their distress consider that for an MTF transkid, that she finds the growth of a beard as would a typical teenaged girl, with horror at becoming a circus freak, a bearded lady.  Instead of looking forward to her body softening into woman’s soft curves, her bones and muscles become daily more alien, more ugly.  Her lovely high voice suddenly turns harsh and alien.  The onset of nocturnal emissions (“wet-dreams”) become an especially humiliating reminder of one’s wrong embodiment.

For an FtM transkid, his budding breasts would be just as embarrassing as they would for a self-conscious teenaged boy, something to be ashamed of and hidden.  Instead of looking forward to growing taller and stronger, to a deeper, more resonant voice, and a maturing young man’s beard, his body gets soft and rounded.  The onset of menses (“periods”) become an especially humiliating reminder of one’s wrong embodiment.

To these transkids, their anguished appeals for medical help is denied by parents who view their child’s plight as a silly “phase” that they will soon grow out of… or worse, that they know that their child is distressed, but feel a deep anger and hatred toward transgendered people in general, and vow that they will do everything in their power to keep their child from becoming “one of those people”.  As I quoted above, Dr. Fisk’s 1975 advice regarding such a course still holds, “You will win a few battles, but lose the war.”

More often than loving parents would care to believe, there are also parents who become emotionally and even physically abusive toward their transkid child or teen.  From research, and as personally corroborated from personal discussions with numerous transkids, about one out of three transkids are obliged to leave their home as teenagers due to unaccepting or abusive parents.

You must step in and advocate for your child, with schools, with neighbors, even with your spouse or other relatives.  If you don’t, it will only lower your child’s expectation that they can count on you to be understanding and supportive.

Conversing with your transkid

Nearly every parent of a transkid has known for a long time that their child was “different”.  That child has known it too.  But often, far too often, neither has spoken much about it.  If this is you and your child, the time to break the ice will be sometime when you are alone with him/her, at some quiet time, when you both have many hours to devote to the topic.  Since your child will have been getting negative messages from society in general about their behavior, you should START the conversation with saying something complementary about their behavior that you know the child is proud of themselves.  Further, you should tell them that you love and admire them, for being who they are, ALL of who they are.  Without this reassurance, your child will be defensive and unable to be open and honest.  If at all possible, affirm some aspect of your child’s personality and character that is gender atypical, so that they will know that talking about being a transkid will be an acceptable topic.  If, as the topic becomes open, you should feel some angst, reservation, or fear, acknowledge it openly as your own problem, NOT your child’s.  Trust me, they already know it exists.  But it helps a great deal to ‘lay one’s cards on the table’.

If your child is a transkid, at some point, there will likely be a tearful confession of unhappiness and a sincere plea for your help. Remember, not every gender atypical child is a transkid.  Most are simply gay or lesbian.  A few may be straight.  Only your child can make a determination as to which they are.  But, it’s your job as a parent to love them either way.

You may wish to share my Advice to Transkid Teens.

If a transkid seems to be angry, resentful, or disrespectful after he or she confides that she is transgendered, as I often am told by anguished parents, it is usually because their family or other important people in their lives, have not given the emotional reassurances that they have been heard, respected, and are still loved.  One of the single most important signals that transkids use to determine this is consistent use of their new name and pronouns.  For example, using the child’s preferred name and gender in their known presence, but their old name and gender pronouns when that child is believed to be out of earshot, will very quickly be discovered by that child… as “walls have ears”.  This signals to the child that that individual is only paying lip service, and is in actuality, very actively antipathetic to that child.  Refusing to use their preferred name is even more powerful evidence of antipathy.

Creating a plan for social transition

There is no “right way” to transition.  There is no “right age” to transition.  Each child and family situation is different.  While a therapist may be able to help, there are very, very few who are experts at this.  But you are THE expert of your family.  That having been said, it is generally recognized that those who transition early in their teen years are happier and better adjusted, than those who are required to wait until they are in their late teens or early 20’s.

Although there have been articles in the media about camps for transgender children, which in general are a good thing, as they allow lonely kids to socialize with others like themselves, don’t be fooled into thinking that they are a substitute for full time transition for your child.  (As I told my own father when he offered to pay for “vacations” when I was a teenager, if I agreed to live a boy / man the rest of the time, “I am NOT a part-time woman!”)

However, your child will need to experiment with temporary “transitions”, expeditions if you will, in which they interact with peers and adults who do not know that they are transkids, BEFORE, any permanent social transition is attempted.  This is so that your child truly will understand if this is the right direction… and if it is even possible for them to pass as non-transkid in the new social gender.  The goal of transition is to improve one’s chances in life.  If they can’t ever pass, they will need to find another accommodation to their situation.

This potential ‘other accommodation’ may or may not be a happy one, as the alternative is to live as a very gender atypical gay or lesbian teenager and adult.  Contrary to popular portrayals, gender atypical individuals are not very well accepted in the gay male community, which values the “straight looking / straight acting” ideal.  The general population is even less accepting of such gender atypical adults.  Further, the mismatch between expectations for social behavior for each gender and the natural gendered behavior of gender atypical transkids grow with each year older they get.

If you honestly do not believe that your child can or should socially transition in your household, because of other family or community issues, consider other options such as other family members who can and would take your child in, e.g., brothers or sisters, your parents, etc.  If those are not available or willing, consider foster parenting through networks of other parents of transkids, or even adult (former) transkids themselves.  Given that transkids’ options for parenting are limited, this may be an ideal option.  Your child will become a valued member of an extended family and you will remain in close contact with your child.  (Note, I have been a legal foster parent in two states and can easily be re-licensed.  If I could do it, so could they.)

Transition for transkids is usually a happy and magical time,  her/his dreams of many years are coming true.  You will need to monitor it to keep the situation in hand.   But it can also be stressful.  “Will grandma still love me?”  “Will I have friends?”  “Can I still play soccer?”  You may also discover that your child will seem to “regress” emotionally, need to be like a toddler, checking back in very often for emotional reassurance and safety.  This is quite common and expected.  If you and the rest of the family are receptive to this process, it will deepen your relationships.

You and other family members may feel awkward for a while, using a new name and gender.  It will get better as you see your child blossom in his or her new social identity.

There are many logistical issues that will need to be addressed: school, medical help, therapy (if needed, most transkids don’t), informing other relatives and close family friends, etc.  You may consider moving to a new neighborhood and school, if financially practical, to allow your child to be “stealth”.  (Being “stealth”, keeping one’s post-transition transgender status private, is a very common goal of transkids as they mature.  After all, if “everyone knows”… they haven’t really socially transitioned, just dressed differently.)   At the very least, transferring to a new school at some practical distance should be considered.

Your other children need to be considered in creating your trans’ child’s transition plan.  They may need to talk to somebody about their feelings, which can range from anger to fear.  Be that somebody.  Their lives will also be effected by any relocation or school transfer.  They may also be effected by bedroom assignment changes that may be needed.  There may also be some confusion and uncertainty over what their sibling’s transition means for their own sense of self and expectation of stability in others.  They too may mourn the loss of the “brother” or “sister” they thought they had.  Listening will go a long ways to alleviate their concerns.

Be aware that transsexuality and homosexuality does “run in families”.  Its not unheard of to have two or even three children in one family.  Dealing with one child may bring another child to the point of being willing to talk about their own issues.

At the doctor’s office

It almost goes without saying, but you will want to find a sympathetic physician; far too many transkids have had unpleasant experiences with unsympathetic ones!

First order of business; Have your child vaccinated against Human Papilloma Virus (HPV)!  All children, both boys and girls should be vaccinated against all of the common viral threats, but MTF transkids are especially vulnerable to HPV because of their sexuality.  It is important that MTF transkids be vaccinated against HPV before they become sexually active as teenagers to avoid the risk of HPV induced anal cancer.  Even after sex reassignment surgery, these kids are at increased risk of genital cancer caused by HPV due to the nature of the post-operative tissue exposed.  (This is not theoretical for me… I too had genital cancer, which required surgery to remove.)  On the flipside, the risk of cervical cancer in FtM transkids is likely lower than for gender typical girls… but HPV also causes oral and urogenital cancers.  Vaccinate.

You may feel it would be best to find an expert but, in reality, this isn’t necessary.  Any good general practitioner, gynecologist, or internal medicine specialist will be up to the task of monitoring your child’s hormone replacement therapy (HRT).  Be aware that many physicians are overly cautious about HRT for transkids, often delaying beginning treatment unnecessarily, or prescribing an ineffectively low dose, fearing iatrogenic harm.  Be assured, that if your child has reached the age of 12 or so, and insists on beginning HRT, he or she is ready and very unlikely to regret this decision.  Don’t be talked into delaying HRT; Consider that not being on HRT is the same thing as being on HRT, but in the opposite direction!  Some of the undesired changes from delaying HRT are permanent and should be avoided at all costs.  If your child is ambivalent or uncertain, delaying puberty is a possibility, but don’t let the doctors dictate this.

You may have read that using puberty blockers has become the standard of care for young transkid teens.  However, you should be aware that the reason for this is NOT medical, but political.  These docs are afraid to begin actual HRT for two reasons, one is reasonable, the other is not.  The first reason is the fear of iatrogenic harm… that is, that if they use HRT to begin a teen’s physical “sex change” and that child changes their mind, that they will have accidentally done great harm instead of good.  The second, unstated reason, is that our society is still uncomfortable with minors making such changes, period.  What you should know about puberty blocking is that NOT ONE TEEN who has been put on puberty blockers EVER decided against HRT later.  In other words, if puberty blocking (delaying) is supposed to allow time for those teens to “change their minds”, it has yet to happen, ever.  Thus, while delaying is better than allowing a natural puberty to occur, the evidence is that such delay is unnecessary, just delaying the inevitable.   And it is, in my opinion, just plain cruel, as it keeps a transkid teen in limbo, in between looking like a boy and a girl, at a time when one should be developing along side one’s peers, making one’s social acceptance more difficult.  Further, some desired changes that occur earlier in adolescence, will not happen if HRT is delayed on puberty blockers, leaving a transkid with a “funny” appearance.

Consider that the “standard of care” for children with certain Disorders of Sex Development, such as hypogonadism, is to start HRT as soon as their peers enter puberty, in order to improve self-esteem and social acceptance.  If this protocol is good for one population, why is it not good for another?

For MTF transkids, I strongly recommend using “bio-identical” HRT of estradiol and micronized progesterone in combination with an androgen blocker, beginning around age 12.  If there are signs of early masculinizing puberty before that age, consider an androgen blocker in combination with low dose estradiol.  Avoid estinyl-estradiol, Premarin, Prempro, or anything with synthetic progestins such as medroxyprogesterone; These products are less effective and possibly carcinogenic and neurotoxic.  Given that your child will be on a higher dose than natal women typically are…  and for her entire life, it’s important not to be taking anything but the best available, especially given that they may actually cost less.  It is best to maintain a constant dosage, that is to say, that it is not only not necessary, but actually counter productive, to “cycle” HRT.  Monthly cycling of HRT is sometimes practiced in the mistaken belief that it mimics female menstrual cycles.  If started young enough, facial hair growth is avoided.  If she has had some growth, but is still not fully developed, HRT may reverse some of the growth.  A physician can also prescribe eflornithine topical cream (Vaniqa) which combined with HRT may control the facial hair.  Otherwise, electrolysis and/or laser treatments may be needed.

For FtM transkids, although not typically known, due to lack of research into the special needs of FtM transkids, consider delaying puberty until age 14 with puberty blockers, possibly in combination with low dose testosterone, then adding Human Growth Hormone to the traditional testosterone treatment from age 14 to 22, so as to allow him to reach average male height and build.  Boys typically start their growth spurt later and continue to grow taller in their later teen years.  The delayed puberty and then added growth hormone will help duplicate this process.  If facial and body hair is lacking and desired, consider using minoxidil, available over the counter as Rogaine, topically on the face and limited body areas to accelerate hair growth.  (Caution:  minoxidil can lower blood pressure, which should be monitored.)

Finding a therapist

Most transkids don’t need psychotherapy.  But, our present “Standards Of Care” for transgendered persons, designed for autogynephilic MTF adults, requires that a psychologist or psychiatrist diagnose an individual as being transgendered, and not psychotic, before HRT may be prescribed.  (Truth be told, “Gender Dysphoria Disorder” is, and always has been, a self-diagnoses, as only the individual can really know.)  Additionally, one is required to have a “letter” or two from such authorities before a surgeon will perform sex related procedures (i.e. Sex Reassignment Surgery {SRS}, mammoplasty, etc.).

As a parent, you want to do the right thing.  You may not hear this advice anywhere else, but this is extremely important:  If your child is a transkid and not an autogynephilic teenaged boy, your child will be far better served if the therapist understands the specific needs of transkids.  That means that the therapist must also understand and acknowledge that there are two different and distinct biological / psychological etiologies for transgender people, that transkids are not the same as late transitioning adults.  I strongly recommend interviewing prospective therapists to determine their views on this matter.  If he or she is not knowledgeable of, or objects to, this understanding… look elsewhere.

Under no circumstances should you allow your child to be counseled by a gender therapist who believes that all transsexuals have the same underlying condition.  The reason that this is ill advised is that gender therapists who hold this view will be seeing a more numerous population of adult transitioning MTF transsexuals who are autogynephilic.  The therapist will naturally apply what  helps this population to your child, with very confusing, potentially distressing and counter productive results.

In a similar vein, don’t allow a therapist to encourage your child to read autobiographies of adult transitioning transsexuals.

The single most damaging thing that could happen in a therapeutic setting would be to include your transkid in a support group for older adult transitioning transsexuals.  Simply put, their etiology, experiences, motivations, and especially sexuality, are at complete odds with transkids’ experiences and needs.  Asking youngsters to expose their innermost feelings to others is best done with those like themselves.

Similarly, do not allow your transkid child to socialize with older transitioning transsexuals.  Instead, help your child to find and maintain friendships with other transkids of similar age.  If you have an adult (former) transkid in your social circle, that adult may or may not be a good role model, depending on their own circumstances and history… but if you do find a responsible, mature, and successful adult who transitioned as a teenager who can show by example that your child has a good future, by all means, allow that relationship to flourish.

After transition

As a child grows through adolescence into adulthood, he or she feels their way through the world of sexuality and romance, with many a heartache and sometimes missteps.  What is true for non-transgendered children goes double for transkids.  They will need your emotional support and guidance.  If you let them, they will open up and you will find a stronger bond with them than ever before.  However, there are issues that you as a non-(former)-transkid will not truly understand.  But you must try.

A common, but misguided, behavior of family, relatives, and neighbors, of transkids who have transitioned is to attempt to “protect” their child.  For example, their recently socially transitioned child will go to the bathroom appropriate for their new social gender, while a parent to sibling “stands guard” outside the stall or bathroom door.  This behavior only brings unnecessary attention, leading strangers to wonder just why such a guard is needed.  Or a parent may restrict their child’s social circle to only those friend who “know”, or attempt to inform or educate their friend’s parents, in effect “outing” their child, defeating the purpose of transition.  You must refrain from these policies.  Your child must, MUST, be treated and regarded as actually being a member of his/her new social gender/sex.

As parents, we would wish that our teenagers not explore their sexuality too intimately.  But, being realistic, this exploration is going to happen.  However, for transkids, this is especially fraught with danger.  If your nontransgendered child were dating, you would be worried about unplanned pregnancy.  This is of course, unlikely for transkids, both MTF and FtM, for their own, rather obvious reasons, given that transkids are universally attracted to the opposite gender (of identity).  However, there are special dangers, especially for MTF transkids, of being seriously physically harmed, even murdered, by boyfriends who discover their date’s pre-operative status accidentally.  Be sure to meet and vet any and all of your teen’s dates.  Let them know that your child is loved and protected.  Further, discuss this danger with your teen.  Devise strategies for safety: staying in public, double dating, carry a cellphone, having and sticking to a pre-approved itinerary, having appropriate chaperones at parties, no drugs or alcohol, etc.

This may be a good time to also have a discussion about ‘safe sex’ practices.  For MTF transkids, buy and supply condoms to them.  It is far better to be safe than sorry.  {Special note:  These condoms are for your child’s boyfriend’s use, size accordingly.}

At some point, your teen will want to share their medical history with a romantic partner.  This is a personal decision that can only be made by him or her.  This is where a budding romance can end rather suddenly and dramatically, with attendant heartache, and possibly with a public outing at school, church, or work.  (This is why I personally mostly avoided dating any man I knew in the same profession or firm.)

If your child is already “out” at school or church, this may not be an issue.  But another issue may arise.  That of other people not approving of your teen’s gender presentation, and especially of their sexual orientation.  Other adults may interfere with your child’s romantic life.  (e.g. the parents of a romantic partner may forbid or pressure their child to discontinue the relationship.)  You may or may not be in a position to advocate for your child in this situation, but you must always be ready to listen with a sympathetic heart to your child in this matter.

Consider becoming a foster parent or CASA

As hard as it may be to imagine, some parents of transkids do not love and support their child, finding their gender atypicality and sexual orientation to be deeply embarrassing or religiously offensive.  Research shows that around one third of MTF transkids are disowned by, or run away from, their disapproving families as teenagers.  These teens often turn to “survival sex” or commercial prostitution to support themselves.  FtM transkids also lose the support of their families, ending up on the street.  All of these kids are at very high risk of transphobic violence and substance abuse.  These kids are very difficult to place in foster care, as typical foster parents are ill equipped to support a transkid in transition.  Group homes can be even worse, as this exposes transkids to yet more bullying, as they typically place transkids in the “wrong” gender group in most parts of the country.  If you have room in your home and your heart, please consider taking in a transkid, either formally from your local child protective services or informally from the street if they have already reached the age of majority.

Also consider becoming a Court Appointed Special Advocate for foster youth.  There is always a shortage of volunteers, but especially those who know the special needs of transkids.

(I’ve had two official foster children, one of whom I legally adopted.  I’ve also had a number of unofficial (over 18 years of age) ‘foster’ transkids over the years, some of whom have lived with me for a time.  Being such a foster-mom is a very rewarding experience.  I’m currently a CASA, a similarly rewarding experience.)

In the hospital

One day, you may accompany your child to the hospital for sex reassignment or other surgery.  While the “official” line is that transkids must wait until they are 18 before SRS or other related surgeries, I know for a fact that that is not true.  A number of teens have had SRS before 18.  But this fact is understandably not publicized by the surgeons or their patients.  You should begin to plan for medical expenses as soon as you know learn that your child is a transkid.  Review your healthcare insurance options as not all carriers cover SRS and other procedures.

Insist that your child have either a room to themselves, or with another transkid of the same social gender and sexual orientation.  Under no circumstance allow your MTF child to share a room with an adult MTF transitioner.  The hospital administration usually has no real clue about the realities of transsexuality and transsexuals, and think that we are all the same.  No one would think of asking a young lady to share a hospital room with an older straight man… but that is in effect what is happening in hospitals on a regular basis.  Autogynephilic MTF transsexuals are sexually attracted to women, and often, even especially, to young MTF transkids.  Further, a fair number of autogynephilic individuals sexualize the very act, the process of changing sex, both in themselves and in others.  Due to a lifetime of socialization as men, and only limited experience in their new gender role, these individuals often do not recognize appropriate boundaries.  Do not allow your child to be so exposed when they are at their most physically and emotionally vulnerable point in their young lives!

(I myself had a very upsetting incident when I had SRS at age 23.  Recently, I accompanied a transkid to that very same hospital, who had a similar experience, 28 years after my own. )

Someday…

Someday, your child will be an adult, a “former transkid”.  Life does not stop.  Heartache does not stop.  Your child will hopefully find a loving husband or wife (as the case may be).  They will want children, as transkids make excellent parents.  For FtM transmen who are married to young women, the choices for bearing children are rather straight forward.  They may choose to use a sperm donor, either a stranger (through a sperm bank), or a close male relative of the same generation (brother or cousin), to allow their wives to bear children.  For MTF transsexuals, the choices are much harder.  To date, we have not yet found a way for MTF transsexuals to bear their own children.  So, as many couples in similar situations, they may choose adoption or surrogacy.  Fortunately, our society has become much more understanding and accepting of transsexual women adopting children (it wasn’t always so… I believe that I am the very first transsexual to have been a foster/adoptive parent through Child Protective Services in the United States, in two states no less).  But some countries and even U.S. states, are not yet so enlightened.  It may be necessary for your child and her husband to move to a more enlightened locale.  Surrogacy may or may not be too expensive, given your child’s future finances, but is legally an easier option.

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