Answers to questions families often have about caring for their youth who is transgender or gender-diverse

Some individuals' gender identities do not match their assigned birth gender; these identities are thought to develop from a combination of genetic, biological, hormonal, cultural, and environmental factors. Some terms used to identify this select group of individuals include transgender, gender-diverse, and gender non-binary.

People can realize that they are transgender at any age. While many transgender children consistently, persistently, and insistently express a gender identity that is different from their assigned sex, some transgender children may be afraid to share these feelings and may try to conform to the accepted standard for their assigned sex. Transgender children may adopt different pronouns, a new name, and clothing that matches their gender identity. However, these changes may not resolve their gender dysphoria, which may include symptoms of depression, anxiety, or anger, often related to the undesired physical traits of their biologic sex.

Additionally, someone may know they are transgender because they feel happier and more like their authentic self as the other gender.

For some transgender people, the difference between the gender they were assigned at birth and their personal sense of gender—their gender identity—can lead to serious emotional distress that affects their health and everyday lives if not addressed. Gender dysphoria is the medical diagnosis for someone who experiences this distress.

Diagnosis of gender dysphoria includes assessing for gender non-conforming identity, a detailed social history, and identifying symptoms of dysphoria. Individuals must show multiple characteristics for at least 6 months. Detailed criteria can be found in the Caring for Transgender & Gender-Diverse Youth diagnosis module.

Not all transgender people have gender dysphoria. On its own, being transgender is not considered a medical condition. Many transgender people do not experience serious anxiety or stress associated with the difference between their gender identity and their gender of birth, and so may not have gender dysphoria.

Gender dysphoria can often be relieved by expressing one’s gender in a way that the person is comfortable with. This may include informing others about their gender identity, dressing and grooming in a way that reflects who one knows they are, using a different name or pronoun, and, for some, taking medical steps to physically change their body (such as hormone therapy and surgery). Some people may also seek psychotherapy. The purpose of these steps is to promote gender roles and gender expression that are affirming to the individual. Often, making these changes helps the person to feel like their authentic self. All major medical organizations in the United States recognize that living according to one’s gender identity is an effective, safe and medically necessary treatment for many people who have gender dysphoria.

Each person will have different needs to become their authentic self. The goal of addressing gender dysphoria is to help the person with this process, as well as reducing or removing the distress caused by the dysphoria. Acceptance by family and a social network, as well as access to hormone therapy or surgery may reduce feelings of gender dysphoria.

Early identification and treatment of associated conditions, including mental health disorders, traumatic stress, substance use/abuse, HIV, and sexually transmitted infections may also be needed. It's important to remember that while being transgender is not in itself an illness, many transgender people need to deal with physical and mental health problems because of widespread discrimination and stigma. Youth who identify as transgender often have a mood disorder, anxiety disorder, or post-traumatic stress disorder. Psychosocial support, hormone therapy, gender-focused psychotherapy, and suicide prevention are helpful for youth and young adults.

The development of gender identity is not well understood and influenced by a variety of factors. Ongoing studies aim to better understand the roles of genetics and other factors in gender identity.

Families often struggle to understand and accept non-conforming gender identity but doing so may be the most important factor in a healthy outcome for the transgender or gender-diverse youth. Families can support treatment plans including psychological and medication treatments, provide emotional support, and assist with youth development into adulthood. Parents can ask their child how they want to be referred to (as a daughter, son, or using gender-neutral language), what pronouns they want to use, and how they would like to dress and groom. Seeing this as a way to grow with your child, get to know them better, and have a closer relationship can help children feel accepted and valued for who they are.