I am the proud mother of two young men, but I didn’t always know I had two sons. For 15 years, I believed I was raising a daughter. My younger child, who I now know is my son, is transgender. My husband and I supported his transition, at 15, from female to male.
I’ve been criticized and asked countless questions, such as, “How could a child possibly know who they are or what they want at that age?” and “What kind of parent would allow their child to make irreversible changes to their body with hormones and surgery?” and “What if it’s a phase? Why not wait until your child is 18 or 21 or older to make these changes and decisions?”
I get that. I had those questions, too. And many, many more.
If you asked me several years ago what it means to be transgender, I couldn’t have given a good answer. I had no concept of the struggles and pain he and our family would face. I’ve learned a lot over the years, and what I’ve learned has completely changed me.
My husband and I described our journey in a book, Allies & Angels: A Memoir of Our Family’s Transition. Healthcare providers and educators can obtain a free copy of the eBook at www.alliesandangels.com/free-books.
I’d like to share a little of what I’ve learned and what I wish our healthcare providers knew. But first, let me tell you about my son.
When he was growing up (and when we still thought he was our daughter) he was happy, healthy, and full of life. He was never a fan of dresses or dolls or stereotypical “girl things,” but that didn’t matter to us, and so it never presented a problem for him.
In 4th grade, the parents of some of his friends asked what we were doing as parents to raise a daughter with such high self-esteem that she wasn’t caught up in “girl drama” and didn’t care about wearing makeup, buying clothes, or fitting in with the popular girls. We often wondered the same thing but figured he was a “tomboy” and never dreamed he wasn’t caught up in “girl drama” because he wasn’t actually a girl!
Our son was a straight-A student, a social butterfly, and involved in Scouts, sports, student council, and countless clubs and activities. We were proud and grateful to have a happy, loving, and successful child.
But in adolescence, everything changed. My once-happy child began to slip away.
He was 11 or 12, at the onset of puberty, when depression, anxiety, and social isolation began. Each day became more of a struggle.
He was so uncomfortable with his changing body and tried to hide his new curves under baggy T-shirts and hoodies. By middle school, he no longer fit in. He didn’t look, dress, or carry himself like his peers expected of a girl, and he was relentlessly teased and bullied. Kids knocked him down in the hallways, laughed at him, called him “a freak” and “a loser” and told him he’d be better off dead.
I’ll never forget the night I found him covered in blood. My beautiful child attempted suicide when he was 13 years old. His struggle to understand, accept, and simply be who he is, nearly cost him his life.
Forty-one percent of transgender people attempt suicide (as compared to 1.6% of the general population). That number rises to 51% if the person is subjected to bullying or harassment, and to 61% if the person is a victim of physical assault.*
For my son and many other transgender youth, it’s not just about being bullied at school; it’s about not being able to conceive of a future where they can be accepted, safe, equal members of society.
Our son continued to withdraw, yet we still didn’t understand he was transgender. It would be two long years before any of us understood that. Two long years of therapy, countless prescription drugs to manage his depression and anxiety, and homebound instruction because going to school became too much. Two long years of not being able to articulate why he was so depressed. His best explanation was that no matter how hard he tried, he just didn’t fit in; he didn’t think like the girls or like the same things they liked. But we never thought that was because he actually wasn’t a girl. We didn’t know that was possible.
Unfortunately, neither did the doctors, therapists, and health professionals we consulted. Many didn’t know about gender identity and transgender youth, or they had some awareness but not enough experience to recognize the signs.
In fact, when my son’s therapist asked why he thought he didn’t fit in, my son said, “Sometimes I really think I’m a boy, not a girl.” His therapist, who didn’t know better, responded by saying, “Well, look at you. We know, of course, you are a girl, but it’s OK if you like boy things.”
It took two more years before my son learned what it means to be transgender and came to understand that he actually was a boy. Two long, heart-breaking years, desperately seeking answers. And when we finally had some answers – the formal diagnosis, an understanding of what it means, and new healthcare providers with the knowledge and experience to help us – it didn’t get better overnight.
For many years, I was dedicated to supporting my son’s transition so he’d be seen and accepted as the young man he knew himself to be. It was a long and difficult process. There was bullying and rejection and discrimination along the way. We moved to another city, changed schools multiple times, and had to educate countless people – including doctors, educators, and court officials. Access to transition-related care is a medical necessity according to every major professional health organization, yet we had to challenge and fight our insurance company to pay for my son’s care.
But many would say we succeeded. My son is now 20 years old and happy and healthy. He’s a successful college student researching a cure for cancer, he’s in a great relationship and engaged to be married, and he is living his life fully as the young man I now know he has always been.
In this article, you won’t find any photographs of my son. The feedback I receive at speaking engagements is that audiences want to see more photos of my son before, during, and after his transition. And that actually led to my decision not to include any photos with this article. Because although I understand the curiosity of most audiences, it isn’t clinically relevant.
Instead of looking at photos of my son, I’d like you to imagine that it’s your child, or your best friend, or your brother or sister, or someone you care deeply about.
How my son looks, whether he can “pass” or you “can tell” he was assigned female at birth isn’t clinically relevant. A person’s presentation should never impact the quality of care they receive or the experience they have in a healthcare setting.
Unfortunately, a national survey found that 19% of transgender people report being refused medical care due to their gender identity or expression.* And 28% postponed medical care due to the discrimination they faced.* Twenty-eight percent report being subjected to harassment in medical settings.* Nearly 40% of medical students surveyed said they were uncomfortable caring for transgender patients. (Safer JD & Pearce EN, Endocrine Practice, 2013)
Those statistics upset me, but I understand not knowing. I understand taking gender for granted and making assumptions based on one’s own experiences and identity. My husband and I didn’t know. Despite our advanced degrees and access to resources, we were ignorant. My son struggled and suffered for years because we didn’t recognize the signs, advocate for him sooner, and seek out providers experienced with transgender youth. But as Maya Angelou said, “When you know better, you do better.” I hope I can inspire readers to know better and do better.
These days we see, hear, and read more than ever about transgender people, yet much tends to be ill-informed, negative, and misleading. Society has a long way to go. Most of us still don’t talk about or learn about gender. Many conflate gender with sex or sexual orientation.
Medical students have the option of learning about transgender healthcare, but it’s not a required component in most medical school curricula. This would explain why a national survey found that 50% of transgender Americans have to teach their medical providers about transgender identities and transgender healthcare.*
Let me help change that by defining some basic terms I’ve been using and then address some misconceptions that I (and many other parents and providers) have had.
Gender identity refers to a person’s internal sense of being male, female, or something else. Gender expression refers to the way a person presents themselves and communicates their gender identity, through clothing, behavior, hairstyles, mannerisms, voice, etc. Transgender (or trans) is an umbrella term for people whose gender identity, gender expression, or behavior doesn’t conform to that typically associated with the sex they were assigned at birth.
The first misconception I’d like to address is that my son was “born a girl” and he “wanted to become a boy.” He was always a boy. We just thought he was a girl because he was born with a vagina. I’ve learned that gender is hardwired in the brain, and not assured by simply observing a newborn’s genitals.
Gender identity is innate; it is not a choice or decision. There are over 150 studies, papers, dissertations, and other peer-reviewed sources that have found biological origins of gender identity and gendered behavior. Most of them found that endocrine disruptions during pregnancy affected both. This concept isn’t new; studies from 1973 on have found this.
Furthermore, according to a Boston University School of Medicine study, gender identity is hardwired in the brain and not simply a matter of psychology, (Aruna Saraswat, Jamie Weinand, & Joshua Safer, Evidence Supporting the Biologic Nature of Gender Identity. Endocrine Practice, 2015)
And so, my son was always a boy, and transition for him meant aligning his body with who he always was inside.
Another misconception: Transgender children are mentally ill or being transgender goes hand in hand with having mental health issues. The American Psychiatric Association (APA) does not consider transgender people to be disordered and clearly states that being transgender is not an illness. In fact, the APA says the exact opposite: “Gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.” (Gender Dysphoria, APA, 2013) According to the National Alliance on Mental Illness (NAMI), it is the fear of coming out and being discriminated against that can lead to depression, post-traumatic stress disorder, thoughts of suicide, and substance abuse.
The overwhelming majority of studies show that discrimination, rejection, and isolation are the cause of high suicide rates in the trans community.
Another misconception is that children can’t possibly know who they are and parents should not allow children to transition. All children (not just transgender youth) start understanding gender identity around age 2 years. (Carol Lynn Martin & Diane N. Ruble, Patterns of Gender Development, Annual Review of Psychology, 2013)
My son didn’t say, “I am a boy,” until adolescence, but he always felt something was different that he couldn’t articulate. Some children, however, are insistent, persistent, and consistent in voicing who they are as young as 2 and 3 years, saying, “No, Mommy, I’m not a girl. I’m a boy,” or vice versa.
In a population where nearly one-half experience suicidal ideation, the risk of nonintervention is quite high. (Ilana Sherer, Social Transition: Supporting Our Youngest Transgender Children, Pediatrics, 2016)
Accepting a child’s identity is the healthiest thing parents and their healthcare providers can do for them. A new study published in the journal Pediatrics found that out trans kids with supportive families have no more anxiety or depression than kids who don’t identify as transgender. (Olson et al., Mental Health of Transgender Children Who Are Supported in Their Identities, Pediatrics, 2016) One recent study found that children whose parents reject their identities are 13 times more likely to attempt suicide. (Travers et al., Impacts of Strong Parental Support for Trans Youth, 2012) Another showed that having a family that accepts a child’s gender identity reduces the suicide attempt rate by 82%. (Bauer et al., BMC Public Health, 2015) Negative outcomes for trans youth are strongly linked with rejection of their gender identity.
I urge all healthcare providers and behavioral health professionals not only to learn about transgender identities but also how to offer more inclusive and culturally competent care to their transgender and gender nonconforming patients.
This is not just about providing transition-related care, such as prescribing hormones or performing gender affirming surgeries. No matter what type of practice you have, you will have transgender patients. Transgender people are people, just like everyone reading this. They will need to see general practitioners, oncologists, cardiologists, urologists, dermatologists, gynecologists, orthopedic surgeons, and the list goes on.
You may think we’re talking about a small number of people, so why direct your limited time to learning about transgender identities and care? In the journal Endocrine Practice, researchers said that as many as one in 100 people could be living with some form of gender dysphoria. The lead researcher said, “This paper represents the first comprehensive review of the scientific evidence that gender identity is a biological phenomenon. As such, it provides one of the most convincing arguments to date for all medical providers to gain the transgender medicine skills necessary to provide good care for these individuals.” (Aruna Saraswat, Jamie Weinand, & Joshua Safer, Evidence Supporting the Biologic Nature of Gender Identity. Endocrine Practice, 2015)
Consider this: You may not treat many transgender patients, but I assure you, you can make a life-changing and even lifesaving difference for all those patients—and for their families, as well. Healthcare providers are looked up to and seen as an authority. The best chances and lowest-risk factors for transgender youth are when they have supportive parents. One of the most powerful influences of parents are experienced healthcare professionals. You can help someone like me save their child’s life.
My hope is that something I’ve written will move, inspire, and motivate you to do just that.
Terri Cook is co-author of Allies & Angels: A Memoir of Our Family’s Transition and can be reached by email at firstname.lastname@example.org, and on the web at: www.alliesandangels.com/about.
* (Grant et al., Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, 2011).