Gender diversity is being increasingly explored by young people of all ages. Gender exploration is a completely normal and expected part of development. Many parents wonder how to handle such behavior and when to recognize that it may be more than exploration. This article will review the differences between gender exploration and gender dysphoria and when it is a good time to discuss concerns with your child’s primary care provider.
Parents today are seeing children of all ages experiment with gender expression. When you walk into a school, it’s not uncommon to see students with hair in various colors, lengths, and styles, and clothing styles that are often perceived as androgynous. Today’s teens increasingly use pronouns that may or may not be associated with their assigned sex at birth.
Before we dive in, let’s review some commonly used terms:
- Assigned Sex at Birth: is typically the “It’s a …..” answer based on the presence of physical exam findings, either a penis or a vagina. (formerly known as biological sex)
- Gender Identity: is how a person FEELS on the inside and how they see themselves (identify). This can be the same as their assigned sex at birth (cisgender) or the opposite (transgender), or somewhere in between (nonbinary/agender/gender fluid). Like sexual orientation, this is not a choice.
- Gender Dysphoria/Gender Incongruence: is when one’s gender identity does not match their assigned sex at birth and causes the individual to experience significant distress around this. Often a diagnosis is made by a mental health professional.
- Gender Expression: is how one outwardly expresses themselves. Often this is in the form of hairstyles, clothing, name, and pronouns. Gender expression is a choice, and youth may choose not to express how they identify for fear of being targeted or excluded.
- Transition: The process of changing one’s gender expression to match their gender identity. This can be SOCIAL Transition, which includes all reversible actions such as hairstyles, clothing choice, accessories, names, and pronouns. MEDICAL transition is when either pubertal suppressors or hormone therapy is used to help in the physical transition, with some medications having permanent changes in the body.
Recent media reports discuss the rising incidence and prevalence of gender dysphoria in youth over the past several years, and parents are asking the question, WHY?
The answer is not so simple. Research looking into the cause of gender dysphoria has found that there are many factors, including genes, neurology, fetal environment, and nurturing patterns. I feel that gender dysphoria has been around since early ages, as it is documented in Egyptian hieroglyphics, Native American practices, and many other cultures throughout time. Recently, however, the concept of gender dysphoria has become more widely accepted. With this increasing acceptance in our society, youth feel increasingly comfortable accepting their gender identity and expressing it. This pattern has been compared to what happened with left-handedness. For many years, left-handed children we not allowed to use their dominant hand in schools. After this practice was abolished, the incidence of left-handedness skyrocketed for a period, and eventually leveled out. I predict this will be the same with gender dysphoria.
Parents may worry about social contagion. In general, youth will gravitate to people they feel most comfortable with, and if gender diversity is part of that group, that is where they will look for acceptance. It is common for LGBTQ people of all ages to find comfort, connection, validation, and safety in a community of like-minded people. This is especially pertinent for youth in settings where the greater population might not be supportive of LGBTQ identities, and youth are at increased risk for bullying and violence.
Children are aware of their gender identity as early as three years; however, they may not be able to verbalize or express it at that age. They play with toys and wear clothes they like best, not because they are associated with boys or girls. This can appear in various ways and is where exploration must not be confused with gender dysphoria. By age 4-5, kids are consistent, insistent, and persistent in their gender identity. The timeline between the two can be 2-3 years in early childhood. Unfortunately, many kids conform around age six as they learn social cues. Parents need to be aware of subtle signs that gender exploration has moved into gender dysphoria. Commonly, parents have described behavioral outbursts related to wearing clothes for a picture or a special event like a wedding that is markedly out of character for their child. Later on, gender dysphoria can present around puberty. During this time, the body is changing in a way that is not in line with the tween’s gender identity, and the youth may experience dysphoria as a result. Many kids I see report that they have always known about their gender incongruence but did not have the words to describe it until they learned about gender dysphoria from a friend, on the internet, or in the media.
Gender exploration is a very normal part of childhood development. Often children will explore different toys, clothes, and behaviors, no matter their age, to experience how it feels. This exploration should be accepted and encouraged. Many kids will be happy with just this stage of exploration and nothing more. It may gradually become more consistent, and the child may verbalize their feelings on gender. However, if a child does not feel that they can express their feelings, they may become withdrawn, depressed, and isolated. These are the signs that would warrant further evaluation. In addition, evaluation should be considered if your child is expressing significant anxiety about their pubertal changes or voicing their desire to transition, either socially or medically.
Your pediatrician is a good first step to gaining access to a mental health provider who is savvy in gender care. Typically, a mental health provider can help teens and their families explore issues related to the duration of dysphoria, the extent, and the goals and wishes of your child. Many mental health professionals are now experienced in gender health and can guide teens on how to address their feelings, work with families, and even aid with adjusting to the school environment.
The most important factor in children with gender dysphoria succeeding in life is having the love and support of their parents. If a child feels accepted and safe in their home and with family, they will have the confidence to attempt challenges in other aspects of life. This may be a scary step for parents, but it will result in a happier child.
Trevor Project: The Trevor Project | For Young LGBTQ Lives
Trans LifeLine: (Transgender Suicide Hotline) – (877) 565-8860
Books for Parents:
Book: Raising the Transgender Child by Michelle Angelo and Alisa Bowman; Becoming Nicole: Amy Ellis Nutt
Podcast for parents/guardians/caregivers of trans/gender diverse youth: Camp Wild Heart – A Podcast About Raising Transgender Kids And Nurturing An Affirming Family — Wild Heart Society
Parent/Caregiver group and Youth: Family and Youth Support Groups -TransActive Gender Project – Lewis & Clark (lclark.edu)
Randall Children’s Hospital Gender Care Center Website: Gender Care Center | Randall Children’s Hospital | Legacy Health
Karin Selva, MD, has been a pediatric endocrinologist for more than 20 years. She is the medical director of The Gender Care Center at Randall Children’s Hospital at Legacy Emanuel. Though she has worked in all aspects of pediatric endocrinology, helping transgender children and their families has been Dr. Selva’s focus since 2010. Her drive and passion to provide comprehensive care to this population has been recognized locally and nationally. Dr. Selva has lectured and been interviewed extensively in print, on radio and television about her progressive, evidence-based efforts in the field of transgender and gender diverse medicine for youth.